Acute Kidney Injury Successfully Treated with Autologous Granulocyte Colony-Stimulating Factor-mobilized Peripheral Blood CD34-Positive Cell Transplantation: A first-in-Human Report

Abstract

A 36-year-old man with severe acute kidney injury (AKI) was admitted to Shonan Kamakura General Hospital in Japan. He was diagnosed with refractory hypertension based on a severely elevated blood pressure of 224/116 mmHg and retinal, cardiac, and brain damage revealed by electrocardiogram, fundoscopy, and magnetic resonance imaging, respectively. Although hemodialysis was withdrawn following strict blood pressure control by an angiotensin receptor blocker, severe kidney insufficiency persisted. Therefore, we performed an autologous granulocyte colonystimulating factor-mobilized peripheral blood CD34-positive cell transplantation.Collected CD34-positive cells were directly infused to both renal arteries. The patient's general condition was unremarkable after intervention, and the serum creatinine level gradually improved to 2.96 mg/dL 23 weeks after cell therapy. Although transient fever and thrombocytosis were observed after intervention, no major adverse events were observed. This patient is the first case in a phase I/II clinical trial of autologous granulocyte colony-stimulating factor-mobilized peripheral blood CD34-positive cell transplantation for severe AKI with a CD34-positive cell doseescalating protocol (trial number jRCTb030190231).

Repetitive administration of cultured human CD34+ cells improve adenine-induced kidney injury in mice

“…CD34+ cells have been used in regenerative therapy for several organ damages, including critical limb ischemia[ 27 , 28 ], myocardial ischemia[ 29 ], stroke[ 30 ], and acute kidney injury[ 31 ]. CD34+ cells possess two important properties that are considered necessary for regenerative therapy: Enhanced angiogenic and anti-inflammatory potential[ 10 , 11 ].…”

CD34 positive cells as endothelial progenitor cells in biology and medicine

“…Furthermore, according to Lee et al , G-CSF-mobilized CD34 + transplantation into the right renal artery is 100% safe and maintains the renal function in a stationary state, suggesting that CD34 + transplantation could mitigate the collapse of renal homeostasis in CKD subjects ( Lee et al, 2017 ). Besides, in phase I/II study, Suzuki and colleagues reported that direct injection of G-CSF-mobilized CD34 + cells to both renal arteries of a 36 years old AKI patient significantly improved the serum creatinine level, GFR, angiogenic-related cytokines, and consequently kidney function 23 weeks after cell therapy without major adverse events ( Suzuki et al, 2021 ). Therefore, CD34 + cell transplantation could apply renoprotective effects by improved angiogenesis and anti-inflammation capability and could be considered a new therapeutic tool for kidney disorders.…”