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Repair a bad kidney or make a new one to order

Searching for ways to delay the need for a transplant and trying to build kidneys to order.

Kidney disease

The Netherlands has some 60,000 kidney patients. The kidneys of more than a quarter of these patients work so poorly that they depend on dialysis or a transplant. But kidney dialysis is only a partial replacement for the kidney’s most important function: purifying the blood. About 70% of these patients dependent on kidney dialysis die within five years. For this reason a large proportion of these patients are on a waiting list for a kidney from a donor. The chances of survival with a donor kidney are much greater. However, the number of available donor kidneys is small, and with an increase in the number of kidney patients the waiting period is only getting longer.

Repairing kidneys with stromal cells

The mesenchymale stromal cells (MSCs), which are so promising for treating Graft-versus-Host disease, are also being investigated for treating patients with kidney diseases. Their immune-suppressing property is currently being tested on patients undergoing a kidney transplant. In this way the researchers hope to figure out whether the chance of a transplanted kidney being rejected can be reduced. Patients undergoing a kidney transplant need to take a lot of medicines to suppress their immune system. These medicines often have serious side effects. A kidney transplant in combination with MSCs would provide a way to reduce the quantity of medications and thus also reduce the associated side effects.

In addition to the aforementioned MSCs, Ton Rabelink’s group is also working on organ-specific MSCs. These are MSCs extracted from the kidney. Within the EU-sponsored STELLAR project, researchers are studying whether these kidney MSCs are better equipped to regenerate a sick kidney. One would be able to make the sick kidney a bit better, so to speak, allowing the need for dialysis to be postponed or even making dialysis unnecessary.

A new kidney made to order

In close collaboration with a group in Australia, Ton Rabelink’s research group is investigating whether it is possible to produce custom-made kidneys. To do this they use pig kidneys from which all the cells are removed. This process results in a kidney consisting of nothing more than its ‘skeleton’. This kidney skeleton is then covered with cells from the patient. All the individual components needed to construct a kidney are already available, but cobbling a kidney together is a very complicated process. The cells used to cover the skeleton have to undergo a complicated procedure to get the stem cell to grow into various kidney-specific cells. Furthermore, the right cells need to be produced in sufficient quantities and then be correctly positioned in the skeleton. Much more research is still needed before the first made-to-order kidney can be transplanted. But when we do reach that point, it will be a medical breakthrough: a solution for the kidney donor shortage.

For more information on this research, see the STELLAR-website.

A pig kidney from which all the celss are removed (photo: Ton Rabelink).

For more information on this research, see the STELLAR-website.

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