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Abstract: PO2101

Adjunctive Mesenchymal Stem Infusion Boosts Recovery of GFR After Renal Revascularization for Atherosclerotic Renovascular Disease

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Abumoawad, Abdelrhman, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Saad, Ahmed, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Ferguson, Christopher M., Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Eirin, Alfonso, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Herrmann, Sandra, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Hickson, LaTonya J., Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Bendel, Emily, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
  • Lerman, Lilach O., Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Textor, Stephen C., Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
Background

Atherosclerotic renovascular disease (ARVD) reduces renal blood flow RBF, GFR and accelerates poststenotic kidney (STK) tissue injury. Renal revascularization alone often fails to restore GFR in ARVD. Whether adjunctive infusion of autologous mesenchymal stem cells (MSC) can modify reparative processes during restoration of RBF is unknown.

Methods

We measured RBF (MDCT), GFR (iothalamate clearance), systolic blood pressure (SBP), in 16 human subjects with ARVD, before and 3 mo after MSC delivery and stent PTRA. MSC were administered at 3 dose levels (1, 2.5 and 5.0x10^5 MSC/kg, n=7,5,4 patients each) into STK, after stent PTRA. A cohort with ARVD n=17 matched for age, SBP and GFR studied under identical protocol treated with stent PTRA alone served as controls.

Results

SBP decreased in MSC + PTRA and PTRA alone groups 145±20 to 135±19, P=0.022, and 147±20 to 137±16 mmHg, p= 0.02. RBF increased in both MSC + PTRA and PTRA alone treated groups following the three-month hiatus 233±121,to 291±178 ml/min, p=0.015 and 315±260,to376±304 ml/min, p=0.017. By contrast, GFR increased In the MSC + PTRA group 64±29 to73±34 ml/min p=0.017 whereas GFR did not change in the PTRA group 63.7±30.7 to 65.0±28.6, p =0.35. The increases in RBF and GFR were higher in the group treated with the highest MSC dose Fig1.

Conclusion

These data reinforce the dissociation between restoring RBF and recovery of GFR in ARVD. Adjunctive therapy with autologous MSC was associated with a dose-related increase in GFR after restoring blood flow, consistent with the ability of MSC to repair microvascular injury. Further clinical trials to characterize the durability and extent of these reparative pathways are warranted.

Funding

  • NIDDK Support