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Review
. 2014 Jan;23(1):25-31.
doi: 10.1097/01.mnh.0000437332.31418.e0.

Kidney injury, stem cells and regeneration

Benjamin D Humphreys  1
Affiliations
Review

Kidney injury, stem cells and regeneration

Benjamin D Humphreys. Curr Opin Nephrol Hypertens. 2014 Jan.

Abstract

Purpose of review: The review summarizes the most recent advances in stem cell and regenerative approaches to treat kidney injury, and highlights areas of active controversy. Over the past year, a number of findings have been reported that have brought this field much closer to clinical translation.

Recent findings: Recent progress in regenerative nephrology includes the directed differentiation of embryonic stem cells to kidney fates, understanding the proliferative capacity of tubules after injury, the use of mesenchymal stem cells for kidney disease and tissue engineering approaches to renal replacement. Controversies persist, however, including whether adult epithelial stem cells exist at all, the best therapeutic strategy for the treatment of kidney injury and how to use mesenchymal stem cells optimally for the prevention of acute kidney injury.

Summary: Although recent progress in kidney regeneration is very encouraging, current controversies must be resolved before clinical breakthroughs can occur.

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Figures

Figure 1
Figure 1. Dueling Models for Epithelial Repair after Injury
(a) In the stem/progenitor model, scattered progenitors located adjacent to differentiated proximal tubule epithelium. After injury, these cells preferentially survive and selectively proliferate. Their progeny differentiate into proximal tubule epithelial cells. The progenitors express CD24, CD133, Kim-1 and Vimentin, among other markers. (b) In the self-duplication model, any fully differentiated cell that survives the injury has an equivalent capacity to dedifferentiate and proliferate. The progeny the re-differentiate into proximal tubule epithelium. In this case, CD24, CD133, Kim-1 and Vimentin are not markers of a separate stem cell compartment, but are injury markers expressed by a dedifferentiated epithelial cell. Thus new epithelia derive from their fully differentiated neighbors in a process of self-duplication.
Figure 2
Figure 2. Models to Combine Stem Cells and Kidney Engineering
(a) ES or iPS cells are differentiated into kidney progenitors. Alternatively, somatic cells may be directly reprogrammed into progenitors. These cells are then combined either with a decellularized kidney scaffold, or alternatively with a synthetic cartridge, to differentiate into functional kidney cell types. The goal with both types of engineered kidney is to transplant into humans with kidney failure.
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