Autologous bone marrow derived mesenchymal stromal cell therapy in combination with everolimus to preserve renal structure and function in renal transplant recipients

Journal of Translational Medicine

Johan W de Fijter¹  Ton J Rabelink²  Wim E Fibbe³  Frans HJ Claas³  Cees van Kooten¹  Jan Lindeman⁴  Volkert AL Huurman⁴  Dave L Roelen³  Sebastian Heidt³  Helene Roelofs³  Geertje J Dreyer¹  Jonna R Bank¹  Marlies EJ Reinders¹ 

[1] Department of Nephrology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, the Netherlands;Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, the Netherlands;Department of Immuno-haematology and blood transfusion, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, the Netherlands;Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, the Netherlands

关键词: Repair;    Immune modulation;    Fibrosis;    Renal transplantation;    Mesenchymal stromal cells;   

Others  :  1146739
DOI  :  10.1186/s12967-014-0331-x

 received in 2014-10-14, accepted in 2014-11-13,  发布年份 2014

【 摘 要 】

Background

Kidney transplantation has improved survival and quality of life for patients with end-stage renal disease. Despite excellent short-term results due to better and more potent immunosuppressive drugs, long-term survival of transplanted kidneys has not improved accordingly in the last decades. Consequently there is a strong interest in immunosuppressive regimens that maintain efficacy for the prevention of rejection, whilst preserving renal structure and function. In this respect the infusion of mesenchymal stromal cells (MSCs) may be an interesting immune suppressive strategy. MSCs have immune suppressive properties and actively contribute to tissue repair. In experimental animal studies the combination of mammalian target of rapamycin (mTOR) inhibitor and MSCs was shown to attenuate allo immune responses and to promote allograft tolerance. The current study will test the hypothesis that MSC treatment, in combination with the mTOR inhibitor everolimus, facilitates tacrolimus withdrawal, reduces fibrosis and decreases the incidence of opportunistic infections compared to standard tacrolimus dose.

Methods/design

70 renal allograft recipients, 18–75 years old, will be included in this Phase II, open label, randomized, non-blinded, prospective, single centre clinical study. Patients in the MSC treated group will receive two doses of autologous bone marrow derived MSCs IV (target 1,5x10⁶, Range 1-2x10⁶ million MSCs per/kg body weight), 7 days apart, 6 and 7 weeks transplantation in combination with everolimus and prednisolone. At the time of the second MSC infusion tacrolimus will be reduced to 50% and completely withdrawn 1 week later. Patients in the control group will receive everolimus, prednisolone and standard dose tacrolimus. The primary end point is to compare fibrosis by quantitative Sirius Red scoring of MSC treated and untreated groups at 6 months compared to 4 weeks post-transplant. Secondary end points include: composite end point efficacy failure (Biopsy Proven Acute Rejection, graft loss or death); renal function and proteinuria; opportunistic infections; immune monitoring and “subclinical” cardiovascular disease groups by assessing echocardiography in the different treatment groups.

Discussion

This study will provide information whether MSCs in combination with everolimus can be used for tacrolimus withdrawal, and whether this strategy leads to preservation of renal structure and function in renal recipients.

Trial registration

NCT02057965 webcite.

【 授权许可】

   
2014 Reinders et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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