NEWS FOR CKD PATIENTS FROM THE SECRETARY OF HHS

Regardless of what Americans think of our current administration and the Secretary of Health and Human Services, this article below was given last month, actually six weeks ago to the NKF and yet I've not heard one word about this from the HU Administrators. Since they have been silent I thought it was time to let everyone here know about the comments made. Personally, I would like to see these move along faster but at least it's moving.

hhs.gov/about/leadership/se...

[SN23]

Thanks so much for sharing Mr. Kidney. So good to see this...The Kidney Project had posted this on their FB page last month. Pray they win the kidney x award:

“At the end of last month, The Kidney Project team submitted 4 project concepts to the Redesign Dialysis Prize Competition sponsored by KidneyX. We proposed concepts to advance both the hemofilter and bioreactor components of the bioartificial kidney. Winners will be announced in April, so fingers crossed!

What is KidneyX?

The Kidney Innovation Accelerator or KidneyX is a public-private partnership between the US Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN) to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases. KidneyX seeks to improve the lives of people currently affected by kidney diseases.

Learn more by clicking hhs.gov/about/news/2018/09/..., and here kidneyx.org/.”

[orangecity41 NKF Ambassador]

Here is link from AAKP web site that is related to this information.

aakp.org/press-release/resp...

[Bet117 NKF Ambassador in reply to orangecity41]

Thanks to both of you!

[lowraind]

I think many of us can look at the prevention piece and hope for an improvement in the attitude of so many in the medical community that there is nothing we can do to improve our kidney function. That one action alone would prevent so much further action down the road.

[Dragondog]

Anyone know anything about the NIH’s Kidney Precision Medicine Project... are they looking for volunteers?

[SaraEads]

Thank you for posting this.

[RhenDutchess123]

Thank you so much for this info Mr Kidney.....I have often wondered why the Treatment (and I say that midly) has not changed much in decades...While Our Medical Technology in other areas has advanced in leaps and bounds....but not how we prevent and treat Kidney Disease and End Stage Kidney Failure....I have been following the Kidney Project for a few years and they are close to developing a Transplantable Artificial Kidney, but strugle for funding. Lobbyists for Kidney Dialysis are powerful and they dont want to lose their lucritive profits from it....Hearing that now that portions of our federal government is tuned in and listening is so very encouraging.......

[Hidden in reply to RhenDutchess123]

Just a bit of reality here for you. I wanted to keep politics out of this. The current head of the Executive Branch has no clue as to what is going on with this issue. The only reason this is now news is because the Secretary of HHS has a father for who had CKD and went into ESRD. If he hadn't had that exerience with his parent this would probably not have gotten the attention is now is getting.

You have every right to feel what you want about politics, but in this forum with such a diverse community, I think it's better if we refrain from any political commentary. Of course that's just my opinion.

[RhenDutchess123]

i understand...i didnt mean to be political....i would consider any administration that listens or tunes an ear to the under funded Kidney Research great....but thankyou for the reminder ans i adjusted my post accordingly..

[steve680]

I was disappointed that there wasn't any mention of stem cell research for kidney disease... unfortunately they seem to still have a "dialysis or transplant" mentality. It was good to see however that at least they see and acknowledge that for-profit dialysis corporations like DaVita are part of the problem, i.e. they have incentives to keep you in that dialysis chair. A quick phone call to any major university like Harvard or Stanford who's doing stem cell research would have revealed at least two things:

1) They're a lot closer than people may think in terms of having stem cell treatments for people with kidney disease.

2) The main reason progress with stem cell research for kidney disease has not been as fast as it could have been is due to the lack of funding. Hard to understand considering that the US government currently spends 133 billion a year on what everyone agree is an undesirable "outcome".

[Hidden in reply to steve680]

Stem cell research will only go towards a possible help for those who have a genetic form of CKD. Those folks, and the majority of folks with CKD who develop it due to hypertension and/or diabetes won't be helped by any stem cell research. In the articles I've read regarding this the vast majority of people with CKD do not have a genetic form of CKD. DaVita and Fresenius are the leaders in their specific area but rest assured, if another avenue does come along to help those with kidney disease, you'll find both companies at or near the top.

[steve680 in reply to Hidden]

That's not true at all; you are severely misinformed!

[Hidden in reply to steve680]

You may be right. Why don't you post the articles that state your point clearly and let me read them? If my information is incorrect I'm willing to admit it.

[Hidden in reply to Hidden]

Meant to post this at the end of my last comment. This is what I've read and we are a long way from this happening.

What do we know? ▼

Our kidneys help establish the correct balance of salts and minerals in our blood. They also filter out toxins and generate several important hormones. Nephrons are the key working components of the kidney.

Kidney diseases are caused by damage to nephrons, which can be sudden and short lived (acute kidney disease) or slow and progressive (chronic kidney disease).

Chronic kidney disease can lead to kidney failure, which is fatal unless treated by blood dialysis or a kidney transplant.

Researchers are studying how stem cells might help kidneys to repair damaged nephrons and restore kidney function.

What are researchers investigating? ▼

Scientists are studying how the kidney can regenerate itself and what types of kidney cells are involved in this process.

It is still not clear which type of cells are involved in kidney regeneration. There are several groups of cells around nephrons that have ‘stem cell like’ characteristics. One type is called Renal Progenitor Cells (RPC), Another group has features similar to mesenchymal stem cells (MSCs), cells typically found in bone marrow.

Scientists are also using induced pluripotent stem cells (iPSCs) to produce 3D nephron-like structures that are being used to study how kidneys form in embryos as well as develop and test new drugs and therapies. Eventually it may be possible to use these cells to create new nephrons in damaged kidneys.

What are the challenges? ▼

Studying kidney development, kidney disease and the natural repair process is very difficult because of the complex structures and large diversity of cells in a kidney.

Kidney diseases can be caused by damage to different types of cells in the kidney. Stem cell treatments will only be effective if they consider which cells are damaged and must be replaced.

Cell treatments that promote natural repair pathways could happen sooner than cell replacement therapies, but researchers still need a better understanding of how the natural repair processes works before treatments can be developed.

Significant progress has been made to advance stem cell products as potential therapies for kidney diseases: various kinds of stem cells can restore renal function in preclinical models of acute and chronic kidney injury. Nonetheless this literature contains contradictory results, and for this reason, we focus this review on reasons for apparent discrepancies in the literature, because they contribute to difficulty in translating renal regenerative therapies. Differences in methodologies used to derive and culture stem cells, even those from the same source, in addition to the lack of standardized renal disease animal models (both acute and chronic), are important considerations underlying contradictory results in the literature. We propose that harmonized rigorous protocols for characterization, handling, and delivery of stem cells in vivo could significantly advance the field, and present details of some suggested approaches to foster translation in the field of renal regeneration. Our goal is to encourage coordination of methodologies (standardization) and long‐lasting collaborations to improve protocols and models to lead to reproducible, interpretable, high‐quality preclinical data. This approach will certainly increase our chance to 1 day offer stem cell therapeutic options for patients with all‐too‐common renal diseases. Stem Cells Translational Medicine 2019;8:82–92

We highlight a variety of stem cell approaches in preclinical development for acute kidney injury (AKI) and chronic kidney disease (CKD). Our goal is to provide examples of seemingly contradictory results and evaluate differences and similarities between studies. From this analysis, we provide our opinion for the most promising paths forward for the use of stem cells in renal regeneration and to speed translation of these cells. The activation of endogenous renal cells for kidney regeneration, embryonic and pluripotent stem cells for the generation of renal organoids, and kidney‐on‐a‐chip technologies are not included in this analysis, and readers are referred to relevant interesting reviews 8, 9. Similarly, pluripotent stem cells used to create nephron organoids 10 and more complex kidney organoids 11, 12 are not discussed. We also do not address the myriad engineered adjuncts to stem cell therapies, or genetically manipulated stem cells or renal tissue engineering.

A number of studies examined resident populations of mesenchymal stromal cells (MSC) from glomeruli and renal interstitium. When compared with nonrenal MSC, the resident population has a more nephrogenic gene expression profile, suggesting propensity to transdifferentiate or differentiate into renal cells under appropriate cues. Indeed, they can differentiate not only into renal epithelial cells but also into erythropoietin‐producing fibroblasts and juxtaglomerular cells containing renin granules 18. Nestin+ renal MSC mediate rescue of AKI in mice, reducing serum creatinine and blood urea nitrogen (BUN) levels, and host apoptotic events. Paracrine protective effects of this population include vascular endothelial growth factor (VEGF) signaling, essential in maintaining the glomerular basement membrane 19. These kidney‐derived cells are unlikely to be developed for autologous use as the population is exhausted over the course of progression of CKD.

Although not an exhaustive list of stem cell‐based approaches to preclinical kidney disease, the aforementioned studies highlight diversity in the source, the characterization, the application, and the mechanism of action of stem cells; the diversity of species studied and disease models. Table 1 is a summary of types of stem cells used, route of delivery, and disease models and species for experimental renal disease therapies.

[steve680 in reply to Hidden]

OK, fair enough. There are many places (universities) doing stem cell research right now regarding kidney disease. One such place is the Harvard Stem Cell Institute who have short and long range goals and are specifically focused on getting people off dialysis. They are also focused on repairing kidney damage that is a result of diabetes. Researchers there have said that the biggest impediment to getting workable treatments and solutions faster is the lack of funding. Anyhow, the following article is from their web site:

hsci.harvard.edu/kidney-dis...

The Harvard Stem Cell Institute is developing new therapies to repair kidney damage, reducing the need for dialysis and transplantation.

Diabetes is a corrosive illness. The imbalance of blood sugar causes small changes in the body that slowly lead to blurry vision, skin rashes, and damaged nerves. In serious cases, diabetes wears away the path of blood to the kidneys, causing eventual organ failure. In fact, half of all kidney failures in the United States are caused by diabetes. For the majority of patients who end up on the waiting list for a kidney transplant, a diagnosis of kidney failure means a choice between dialysis and certain death.

Dialysis costs both time and money. Most patients must drive to a dialysis center three times per week to be hooked up to a machine for four hours per session. The annual costs for this treatment are about $80,000 per patient and rising. The total amount of private and public funds spent on the procedure will soon reach $50 billion per year. A single kidney transplant is equivalent in cost to about two-and-a-half years of dialysis, but it usually takes three years to find an available donor match.

Our Vision

The Harvard Stem Cell Institute (HSCI) Kidney Group has short, medium, and long-term strategies to develop new therapies for diabetes-related kidney damage (diabetic nephropathy). This multi-pronged approach aims to capitalize on promising translational achievements in the near future, while pursing potential drugs and the ultimate goal of creating an entirely artificial kidney using stem cells.

Short-Term Plan

Mesenchymal stem cells are the body’s natural defense against kidney damage. Found in the bone marrow, these stem cells protect the kidneys from injury and accelerate healing. Harvard Stem Cell Institute scientists have identified protein candidates secreted from mesenchymal stem cells that may be administered independently to aid in kidney repair. In another approach, mesenchymal stem cells are being incorporated into miniature dialysis machines that expose the patient’s blood to these cells, allowing pro-repair proteins to be delivered directly to the kidneys.

Medium-Term Plan

Having identified the kidney cell types that are most susceptible to injury during diabetes, the HSCI Kidney Group now plans to target them with new drugs. In order to screen for potential drug targets, researchers must first identify genes that change in diabetic kidney cells, and then identify compounds that slow or stop the destructive gene expression. A drug for disease-related kidney damage has the potential to eliminate the need for dialysis.

Long-Term Plan

The project with the greatest potential impact on diabetes patients is HSCI’s large, multi-disciplinary effort to create an artificial kidney using stem cells and nanotechnology.

The functional unit of the kidney is a nephron – a long tube that filters blood at one end and then turns that filtrate into urine. HSCI scientists plan to isolate kidney stem cells, mix them with soluble gels, and mold them into the architecture of a nephron. Scientists have already successfully created an artificial rat kidney that produces urine once transplanted into the animal, making artificial organ transplantation a highly possible reality for humans.

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[JimVanHorn in reply to steve680]

Science had been working on the artificial kidney since 1978. I wish them luck with this project.