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Regenerative Therapien in der Nephrologie

Reparatur oder Neubau?

Regenerative therapy in nephrology

Repair or construction?

  • Schwerpunkt: Niereninsuffizienz
  • Published:
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Zusammenfassung

Tierexperimentelle Untersuchungen sowie Analysen humanen Nierengewebes weisen darauf hin, dass die Regeneration von untergegangenen Tubuluszellen durch benachbarte, überlebende Tubuluszellen erfolgt. Die Tubuszellen der geschädigten Niere haben eine hohe Regenerationsfähigkeit und können je nach Ausmaß der edithalen Schädigung vollständig wiederhergestellt werden. Entdifferenzierung, Migration, Proliferation und Redifferenzierung werden durch lokale Wachstumsfaktoren reguliert. Auch renale Stammzellen können an diesem Prozess beteiligt sein. Für eine Nierenregeneration sind mesenchymale Stammzellen von entscheidender Bedeutung. Falls in der adulten Niere noch vorhanden, könnten sie das Ausgangsmaterial für Reparatur und Regeneration nach Verletzung darstellen. Die genaue Lokalisation und Rolle der bisher in der Niere nachgewiesenen residenten mesenchymalen Stammzellen ist weiterhin unklar. Neue Oberflächenmarker und eine bessere Charakterisierung der möglicherweise zahlreichen am Regenerationsprozess beteiligten Zellpopulationen sind nötig, um deren komplexe Interaktionen aufzuklären. Unklar ist, ob auch mesenchymale Stammzellen aus dem Knochenmark oder anderen Organen beteiligt sind. Neben der strukturellen Regeneration kommt den Stammzellen auch eine Rolle bei der funktionellen Erholung nach akutem Nierenversagen zu. Wegen ihrer funktionellen und räumliche Komplexität ist der artifizielle Neubau einer menschlichen Niere schwierig. Durch zusätzliche Verwendung von Zellen in Dialysegeräten lassen sich aber evtl. die Qualität der Filtration verbessern und auch andere Nierenfunktionen ersetzen. Erste Ergebnisse zum Einsatz dieser neuen Technik in klinischen Phase-I/II-Studien an Patienten mit akutem Nierenversagen sind erfolgversprechend. Trotz der Zunahme unseres Verständnisses der Stammzellbiologie und des Reparaturprozesses in der Niere ist die Stammzelltherapie zurzeit noch ein experimenteller Ansatz, und zusätzliche Untersuchungen müssen durchgeführt werden, bevor die Stammzelltherapie in der Nephrologie in die Klinik eingeführt werden kann.

Abstract

Animal experiments and analyses of human renal tissues show that regeneration of degraded renal tubules is caused by adjacent surviving tubules. Differentiation, migration, proliferation and redifferentiation are regulated by local growth factors. Renal stem cells can also participate in this process. Mesenchymal stem cells play a pivotal role in renal regeneration and if these are still present in the adult kidney, they could be the source material for repair and regeneration following injury. The exact location and role of resident mesenchymal stem cells which have been demonstrated in the kidneys is still unclear. New surface markers and a better characterisation of the many cell populations possibly participating in the regeneration process are necessary in order to clarify their complex interaction. It is also unclear whether mesenchymal stem cells from bone marrow or other organs are also involved. In addition to structural regeneration, the stem cells also play a role in the functional recovery following acute renal failure. Artificial regeneration of human kidneys is difficult due to their functional and spatial complexity. By the additional use of cells in dialysis machines it may be possible to improve the quality of filtration and also replace other renal functions. Initial results using this new technique in clinical phase I/II studies on patients with acute renal failure are promising.

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  1. Klinik für Nieren- und Hochdruckkrankheiten, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    H. Haller

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  1. H. Haller
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Correspondence to H. Haller.

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Haller, H. Regenerative Therapien in der Nephrologie. Internist 48, 813–818 (2007). https://doi.org/10.1007/s00108-007-1910-1

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  • DOI: https://doi.org/10.1007/s00108-007-1910-1

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