Stenting and cell technologies in the treatment of atherosclerotic renovascular hypertension Part 2. Effectiveness and safety of postnatal

Abstract

Aim. To assess effectiveness and safety of stem cell auto-transplantation (SCT) into renal and vertebral arteries among patients with renovascular hypertension (RVH) lasting over 10 years.Material and methods. Seventy-eight patients were randomized into main (MG, n=26) and placebo groups (PG, n=52). Primary end-point was systolic blood pressure (SBP) level. Secondary end-points included: restenosis incidence; glomerular filtration rate (GFR); effective renal plasma flow (ERPF); creatinine level and microalbuminuria (MAU); quality of life (QoL); renal biopsy and immuno-hystochemical assay data; renal vessel calcification; cerebral metabolism level.Results. Restenosis at 12 months was observed in 17% of both MG and CG patients; repeated revascularization was needed in 8%. Stenting resulted in average BP decrease from 181/107 to 142/93 mm Hg; after 6 weeks, no patient achieved target BP levels. After SCT into both renal arteries, BP normalization was achieved in 61% of MG participants. Only 23% of regenerated renal tissue originated from transplanted SC (trans-differentiation), the rest originated from local tissues (de-differentiation). After 50-55 weeks, in 37-39% of the patients Stage I AH was observed. At 6-8 weeks after SCT into both vertebral arteries, cerebral metabolism increased, and BP normalized, reducing from 138/90 to 119/69 mm Hg.Conclusion. SCT plays an important role in renal artery thrombosis prevention and RVH control. Renal and vertebral artery SCT solves the problems of nephron destruction and renal tissue fibrosis, atherosclerosis treatment and harmful cerebral influences. Remaining problems include target organ damage and genetic defects.

Keywords

• ишемическая болезнь почек, стволовые клетки, стентирование