Mesenchymal Stromal Cells for Acute Renal Injury

Summary Stem cell–based therapy has emerged as an innovative intervention to enhance the limited capacity of the kidney to regenerate following acute ischemic or toxic injury. Acute kidney injury (AKI) is a potentially devastating disorder with extremely serious outcomes in developing and developed countries. Different pharmacological therapies to improve renal function and survival of patients with AKI have been tested with disappointing results. Mesenchymal stem/stromal cells (MSCs), among adult stem cells, have been described as a powerful tool due to their unique biological properties, including renotropisms, antiinflammatory and immunomodulatory properties coupled with proregenerative capacity. In this chapter, we attempt to provide an overview of the biological processes underlying the renoprotective effects of MSCs in experimental AKI, primarily focusing on the paracrine effect MSCs have on renal cells and on their capacity to shuttle genetic information, via extravesicles, to target cells. New strategies to enhance their capacity to migrate, to engraft the damaged renal tissue, and to locally produce growth factors and cytokines, will be also analyzed.