4.5 Article

Infusion of autologous bone marrow derived mononuclear stem cells potentially reduces urinary markers in diabetic nephropathy

期刊

JOURNAL OF NEPHROLOGY
卷 32, 期 1, 页码 65-73

出版社

SPRINGER HEIDELBERG
DOI: 10.1007/s40620-018-0548-5

关键词

Type-1 diabetes mellitus; nephropathy; Autologous bone-marrow derived stem cells; Microalbuminuria; Urinary neutrophil gelatinase-associated lipocalin

资金

  1. Ministry of Healthcare of Republic of Kazakhstan [N 0104 RK 00133, C03.01, 0.0634]

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BackgroundDiabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Previous studies demonstrated safety and efficacy of autologous bone marrow-derived mononuclear cells (ABM-MNCs) in induced type-1 diabetes mellitus (T1DM) rats. However, the effect of ABM-MNCs on urinary markers of DN in humans is not well studied. We evaluated the therapeutic effect of ABM-MNCs on the urinary markers microalbuminuria (MAU), urinary type-IV collagen and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in T1DM patients with and without nephropathy. Methods This prospective open-label pilot study included 15 patients with T1DM, who had completed 2 visits within 6 months. Patients were divided into two groups according to the presence (DN, n=7) and absence of nephropathy (T1DM, n=8). ABM-MNCs were injected at each visit as per study protocol. Routine laboratory data, diabetes tests (fasting serum C-peptide and insulin, glycated hemoglobin, fasting and postprandial glucose), 24-h MAU and urinary type-IV collagen were measured at each visit. uNGAL levels were studied before and after 3days of ABM-MNCs infusion at each visit. Results Mean age of patients was 29.210.4 years, 33% were male, and 27% of the overall group had hypertension. MAU was significantly reduced in the overall group (-26.0%, p=0.037), including in DN (-83.2%, p=0.021). A short-term significant reduction of uNGAL levels was observed 3days after ABM-MNCs administration during the both the 1st visit (median 13.4 vs. 9.5ng/ml, p=0.027) and 2nd visit (median 8.8 vs. 6.4ng/ml, p=0.042) in both groups. However this reduction did not remain significant at the 6-month follow-up. Urinary type-IV collagen did not respond significantly to ABM-MNCs infusion. Conclusion Infusion of autologous bone marrow-derived mononuclear cells significantly reduced levels of MAU in DN patients. Further studies with larger sample size are needed to confirm these observations.

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