title: A bio-artificial renal epithelial cell system conveys survival advantage in a porcine model of septic shock.
abstract: Renal cell therapy using the hollow fiber based renal assist device (RAD) improved survival time in an animal model of septic shock (SS) through the amelioration of cardiac and vascular dysfunction. Safety and ability of the RAD to improve clinical outcomes was demonstrated in a Phase II clinical trial, in which patients had high prevalence of sepsis. Even with these promising results, clinical delivery of cell therapy is hampered by manufacturing hurdles, including cell sourcing, large-scale device manufacture, storage and delivery. To address these limitations, the bioartificial renal epithelial cell system (BRECS) was developed. The BRECS contains human renal tubule epithelial cells derived from adult progenitor cells using enhanced propagation techniques. Cells were seeded onto trabeculated disks of niobium-coated carbon, held within cryopreservable, perfusable, injection-moulded polycarbonate housing. The study objective was to evaluate the BRECS in a porcine model of SS to establish conservation of efficacy after necessary cell sourcing and design modifications; a pre-clinical requirement to move back into clinical trials. SS was incited by peritoneal injection of E. coli simultaneous to insertion of BRECS (n=10) or control (n=15), into the ultrafiltrate biofeedback component of an extracorporeal circuit. Comparable to RAD, prolonged survival of the BRECS cohort was conveyed through stabilization of cardiac output and vascular leak. In conclusion, the demonstration of conserved efficacy with BRECS therapy in a porcine SS model represents a crucial step toward returning renal cell therapy to the clinical setting, initially targeting ICU patients with acute kidney injury requiring continuous renal replacement therapy. Copyright © 2014 John Wiley & Sons, Ltd.
authors.affiliation: Innovative BioTherapies Inc., Ann Arbor, MI, USA.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Westover
authors.affiliation: Innovative BioTherapies Inc., Ann Arbor, MI, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Buffington
authors.affiliation: Innovative BioTherapies Inc., Ann Arbor, MI, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Johnston
authors.affiliation: Innovative BioTherapies Inc., Ann Arbor, MI, USA.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Smith
authors.affiliation: Innovative BioTherapies Inc., Ann Arbor, MI, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pino
authors.affiliation: Innovative BioTherapies Inc., Ann Arbor, MI, USA.|Department of Internal Medicine-Nephrology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: H David
authors.initials: HD
authors.lastname: Humes
mesh_terms: D000818:Animals; D001187:Artificial Organs / Q000382:microbiology*; D001794:Blood Pressure; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D004847:Epithelial Cells / Q000473:pathology*; D004926:Escherichia coli / Q000502:physiology; D006400:Hematocrit; D006439:Hemodynamics; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D007677:Kidney Function Tests; D012772:Shock, Septic / Q000097:blood / Q000473:pathology* / Q000503:physiopathology; D016019:Survival Analysis; D034421:Sus scrofa
chemical_list: D016207:Cytokines
keywords: acute kidney injury; artificial kidney; capillary leak syndrome; immunotherapy; septic shock; systemic inflammatory response syndrome; tissue therapy