It's Time for New Insights Into Renovascular Hypertension at the Cellular Level

Objective: Ischemic nephropathy underlying atherosclerotic renal artery stenosis (ARAS) gradually induces a decrease in tissue perfusion, ultimately resulting in pronounced tissue hypoxia and inflammatory kidney injury. Administration of mesenchymal stem cells (MSC) has emerged in preclinical studies as a potential choice to repair the renal microcirculation, attenuate inflammatory injury, and restore kidney function. Recent data in humans suggest that the infusion of autologous MSC can be safely performed in subjects with ARAS, leading to increased tissue oxygenation when the MSC are infused into a single renal artery. Design and method: Design and Method:In this open-label, single center, study perspective, will be enrolled adult patients with significant ARAS estimated by renal artery Doppler ultrasound velocity acceleration (average peak systolic velocity >300 cm/s) and magnetic resonance/computed tomography angiography with evident atherosclerotic stenosis (>60% lumen occlusion), and hypertension (systolic hypertension >155 mmHg and/or the use of at least two BP drugs) and/or with declining kidney function. The intervention group (n=5) will received a single infusion of MSC (2.5 × 105 cells/kg) plus standardized medical treatment; the medical treatment only group (n=5) included subjects matched for age, kidney function, and stenosis severity. We will measured cortical and medullary volumes, perfusion, and RBF using multidetector computed tomography. Tissue oxygenation will be assessed by blood oxygen level–dependent MRI and GFR by iothalamate clearance. We plan to determine the levels of the following laboratory parameters: vascular endothelial growth factor,inflammatory cytokines,Monocyte chemoattractant protein-1 and TGF at the baseline, three and six months after MSC infusion. The determination of NGALwill provide valuable insights into the safety of MSC infusion for the patient. Results: Study perspective Conclusions: Conclusion: We hypothesize that this study perspective will provide evidence regarding the safety of intra-arterial infusion of autologous MSCs in patients with ARAS. MSC infusion without revascularization of the main renal artery is associated with increased renal tissue oxygenation and cortical blood flow as well.