Adipose Tissue- Derived Mesenchymal Stem Cells in Peritoneal Dialysis Patients

Peritoneal dialysis (PD) is one of useful modalities whenever apatient reaches end stage renal diseases (ESRD). Worldwide PDpenetration rate is ۱۱% while in Iran is ۴.۱%. This modality isassociated with some complications. Around ۳۰-۵۰ % of all patientswho are on PD for ۶ years, experience ultra-filtration fail ure (UFF). UFF is associated with peritoneal membrane thickness,inflammation and fibrosis which has no specific treatment.Moreover, UFF may ends in Encapsulation peritoneal sclerosis(EPS) with high mortality rate. In a retrospective study, weshowed that longer time being on PD, younger age, and higherUFF duration are risk factors for peritoneal sclerosis.Following promising results of mesenchymal stem cell (MSC)transplantation in PD models in recent decade, this method istaken into consideration in clinical trials. Experiments reportedthat MSC in PD models attenuated submesothelial thickness,inflammation, angiogenesis and fibrosis as well as improvedultra-filtration volume, glucose uptake, glucose mass transferand solute transport. Taken together we hypothesized that MSCcould induces anti-fibrosis, immunomodulation and anti-apoptosiseffects in these settings. Therefore, we designed the first inhuman clinical trial of MSC in PD.In this open label, non-randomized, phase I clinical trial, weinfused autologous adipose derived MSC in ۹ eligible patientsand followed them for ۶ months. Ten patients were regarded ascontrol group. The primary endpoint was safety and the secondaryendpoint was changes in membrane function.۱۴ Minor adverse events (AE) were recorded in MSC groupwhich were subsided by itself or by supportive therapy. No seriousadverse events or adverse events related to cell infusionwere recorded. There was a significant reduction in Dialysateto-plasma ratio (D/P) of creatinine in MSC group (۰.۷۷ to ۰.۷۳P=۰.۰۲).In summary, this trial showed safety, feasibility and tolerabilityof autologous MSC in UFF patients which could be a foundationfor efficacy assessment by a RCT.

کلیدواژه ها:

Peritoneal Dialysis ، Peritoneal Fibrosis ، Ultrafiltration Failure ، Adipose Tissue Mesenchymal Stem/Stromal Cell