A selective cytopheretic inhibitory device to treat the immunological dysregulation of acute and chronic renal failure.
BACKGROUND
The poor outcomes in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD) on chronic dialysis are due to immune dysregulation associated with these disorders. Evolving evidence suggests that the kidney, and specifically renal epithelial cells, plays an important role in the immunological response of leukocytes under disease states.


METHODS
In this regard, the development of two therapeutic approaches utilizing renal epithelial cells and 'smart' immunomodulatory membranes has been tested in preclinical animal models and clinical trials.


RESULTS
These two approaches have been demonstrated in phase II human trials to improve the survival of intensive care unit patients with AKI and multiorgan failure. The use of a 'smart' immunomodulatory membrane is also being evaluated in a small exploratory clinical trial to assess its effects on immunoregulation in ESRD patients requiring chronic hemodialysis.


CONCLUSIONS
The use of renal progenitor/stem cell therapy and/or cytopheretic membranes may result in effective treatments to alter the dysregulated immunological state of acute or chronic renal failure and improve the outcomes of these diseases.
Humes
H David
HD
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Mich., USA. dhumes@med.umich.edu
Sobota
Joseph T
JT
Ding
Feng
F
Song
Joon Ho
JH
D058186:Acute Kidney Injury / Q000150:complications / Q000276:immunology* / Q000628:therapy; D000925:Anticoagulants / Q000008:administration & dosage; D000938:Antigen-Presenting Cells / Q000276:immunology / Q000473:pathology; D050197:Atherosclerosis / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D019343:Citric Acid / Q000008:administration & dosage; D016207:Cytokines / Q000378:metabolism; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000276:immunology* / Q000628:therapy; D007687:Kidney Tubules, Proximal / Q000276:immunology / Q000473:pathology; D047589:Leukocyte Reduction Procedures / Q000295:instrumentation*; D007962:Leukocytes / Q000276:immunology; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*
D000925:Anticoagulants; D016207:Cytokines; D019343:Citric Acid; D006493:Heparin