Excessive rates of INF- production by NK cells have correlated with progression to lethal endotoxin shock in mice [46]
Excessive rates of INF- production by NK cells have correlated with progression to lethal endotoxin shock in mice [46]. Further support for an immunomodulatory role of renal tubule cells has been suggested in the Phase I/II clinical trial of HBGF-3 the RAD containing human renal tubule cells [35]. demonstrates metabolic activity with systemic effects and improvement of survival in patients with AKI and multiorgan failure. It also appears to influence systemic leukocyte activation and the balance of inflammatory cytokines, Aloperine suggesting that cell therapy by use of the RAD may improve morbidity and mortality by altering the proinflammatory state of patients with renal failure. In addition to providing cellular metabolic function, technologies directed toward disrupting systemic inflammatory response may well enhance the clinical outcome of critically ill patients in the future. Innovative approaches to intensive renal care such as the RAD may break the mold of current institutional dialysis therapies and provide numerous opportunities to develop lifesaving technologies. Keywords:Acute kidney injury, systemic inflammatory response syndrome, bioartificial kidney, cell therapy, renal replacement therapy == INTRODUCTION == Acute kidney injury (AKI), also called acute renal failure (ARF), affects 57% of hospitalized patients and up to 30% of patients in intensive care units (ICUs). The development of AKI in a hospitalized patient results in a 5- to 8-fold higher risk of death [1,2]. Improved treatment regimens in patients with AKI in the ICU have not shared the same quantum leaps of progress that have been seen in other illnesses, such as myocardial infarction, despite an improved understanding of the pathophysiology of AKI and techniques for renal replacement therapy [1,2]. Currently, the main treatment modalities for AKI are the dialysis therapies based on diffusion, convection, or absorption. Although these therapies are undoubtedly life-sustaining in patients with renal failure, morbidity and mortality rates are still unacceptably high because dialysis replaces only the filtration function of the kidney, not the lost homeostatic, regulatory, metabolic, and endocrine functions of the defected tubular elements of the kidney [3]. Novel therapeutic approaches must Aloperine be formulated to replace fully all functions of the kidney and change the dismal prognosis for patients with AKI. The present review will focus on the use of renal cell therapy in the treatment of AKI as an extension to the current renal substitution processes of dialysis. == KIDNEY AS A FILTRATIVE, ENDOCRINE, METABOLIC, AND IMMUNOREGULATORY ORGAN == The kidney plays a critical role in maintaining body water and electrolyte homeostasis through excretory and regulatory functions of glomerulus and tubule. Current dialysis therapies, including hemodialysis (HD), hemofiltration, and peritoneal dialysis (PD), replace these functions by removing waste products and excess electrolytes from blood using artificial or natural semipermeable membranes. In this regard, the kidney is unique in that it is the first organ for which long-termex vivosubstitutive therapy has been available and lifesaving. The kidney, however, has many other roles. It is regarded as an important endocrine organ, responsible for the secretion of hormones that are critical in maintaining hemodynamics (renin, angiotension II, prostaglandins, nitric oxide, endothelin, and bradykinin), red blood cell production (erythropoietin), and bone metabolism (1,25-(OH)2-vitD3or calcitriol) [4]. It synthesizes glutathione and free-radical scavenging enzymes and provides gluconeogenic and ammoniagenic capabilities [5,6]. Catabolism of low-molecular-weight proteins, including peptide Aloperine hormones, cytokines, and growth factors, is also accomplished by the kidney [7]. The kidney Aloperine also has an immunoregulatory function, which has been less recognized. The mammalian renal proximal tubule cells are immunologically active. They are antigen-presenting cells [8] that have co-stimulatory molecules [9] that synthesize and process a variety of inflammatory cytokines [9,10]. The roles of the renal tubule cells in glutathione metabolism [5], regulation of vitamin D, and production and catabolism of multiple cytokines [4] are critical to immunoregulation to maintain tissue integrity and host defense under stress conditions [11]. A growing body of evidence indicates that inflammation plays a major role in the pathophysiology of AKI, so that this disorder is, to some extent, an inflammatory disease [12]. == AKI AS SYSTEMIC INFLAMMATORY RESPONSE SYNDROME == The.
