Depletion of podocytes, common to glomerular diseases in general, plays a role in the pathogenesis of glomerulosclerosis. Whether podocyte injury in adulthood can be repaired has not been established. Here, we demonstrate that in the adult human kidney, CD133ϩCD24ϩ cells consist of a hierarchical population of progenitors that are arranged in a precise sequence within Bowman's capsule and exhibit heterogeneous potential for differentiation and regeneration. Cells localized to the urinary pole that expressed CD133 and CD24, but not podocyte markers (CD133ϩCD24ϩPDXϪ cells), could regenerate both tubular cells and podocytes. In contrast, cells localized between the urinary pole and vascular pole that expressed both progenitor and podocytes markers (CD133ϩCD24ϩPDXϩ) could regenerate only podocytes. Finally, cells localized to the vascular pole did not exhibit progenitor markers, but displayed phenotypic features of differentiated podocytes (CD133ϪCD24ϪPDXϩ cells). Injection of CD133ϩCD24ϩPDXϪ cells, but not CD133ϩCD24ϩPDXϩ or CD133-CD24Ϫ cells, into mice with adriamycin-induced nephropathy reduced proteinuria and improved chronic glomerular damage, suggesting that CD133ϩCD24ϩPDXϪ cells could potentially treat glomerular disorders characterized by podocyte injury, proteinuria, and progressive glomerulosclerosis. Glomerular diseases account for 90% of ESRD at a cost of $20 billion/yr in the United States. 1 The traditional glomerular disease classification encompasses a bewildering array of descriptive pathologic entities and their clinical counterparts. However, converging evidence suggests that podocyte depletion, secondary to toxic, genetic, immune, infectious, oxidant, metabolic, hemodynamic, and other mechanisms, is a common determining factor that can result in a broad spectrum of clinical syndromes. As long as the podocyte loss is limited, restitution or repair is possible. By contrast, 20 to 40% podocyte loss results in a scarring response, until at greater than 60% podocyte loss glomeruli become globally sclerotic and nonfiltering. These stages of podocyte depletion are accompanied by corresponding degrees of proteinuria and, as an increasing proportion of glomeruli become involved, by measurable reduction in the clearance function of the kidney. [1][2][3] To what extent podocytes can be replaced at all during adult life, and if so, how and at what rate, is still unclear. Indeed, mature podocytes have limited capacity to divide in situ and display all phenotypic and functional features of highly spe-
