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Infusion of autologous bone marrow mononuclear cells leads to transient reduction in proteinuria in treatment refractory patients with Idiopathic membranous nephropathy.

Sengupta U, Kumar V, Yadav AK, Marwaha N, Kohli HS, Sakhuja V, Jha V - BMC Nephrol (2013)

Bottom Line: At 6 months, only 2 patients had >50% reduction.No infusion related side effects were noted.This effect, however, is transient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. vjha@pginephro.org.

ABSTRACT

Background: The current treatment options for idiopathic membranous nephropathy (IMN) carry significant toxicity. In this prospective, observational pilot study, we used single time infusion of bone marrow derived autologous mononuclear cells (MNCs) in adult patients with treatment refractory IMN.

Methods: Twelve patients of biopsy proven IMN who had failed a cyclical 6-month regimen of steroid and cyclophosphamide were enrolled in the study. Bone-marrow was harvested from the iliac crest and underwent processing to isolate MNCs. Cells were counted and subjected to viability testing before being infused through a peripheral vein on the same day. After the infusion, subjects were followed up monthly for the next six months. Supportive treatment including angiotensin antagonists and statins was continued throughout the study period.

Result: The proteinuria, serum albumin and creatinine values at entry were 2.97 ± 0.6 gm/1.73 m2/d, 2.27 ± 1.1 gm/l and 0.9 ± 0.8 mg/dl respectively. There was a reduction in proteinuria (p < 0.0001), and increase in serum albumin (p = 0.001) at 1 month, with 64% of the subjects showing >50% reduction in proteinuria. However, the response was ill sustained. At 6 months, only 2 patients had >50% reduction. Serum creatinine remained stable throughout the study period. No infusion related side effects were noted.

Conclusion: Autologous mononuclear cell infusion leads to transitory reduction in proteinuria and improvement in serum albumin in treatment refractory IMN. This effect, however, is transient. Whether this can be overcome by repeated infusion of cultured mesenchymal cells needs to be investigated.

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Baseline and follow-up values of serum creatinine.
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Figure 4: Baseline and follow-up values of serum creatinine.

Mentions: All subjects showed a reduction in proteinuria ranging from 8-85% (Figure 1). The value decreased to 1.0 ± 0.61 g/day (p < 0.0001) at one month and 1.33 ± 0.7 g/day (p = 0.001) at 2 months. None of the subjects underwent complete remission. The proteinuria came back to 1.8 ± 1 g/day At 3 months and 2.15 ± 1.1 g/day at 6 months (p > 0.05). About 64% of the subjects showed more than 50% decrease in proteinuria in the first month, which decreased to 9% in the fifth month of follow-up (Figure 2). This was associated with improvement in serum albumin to the tune of 6-70% at 1 month (2.27 ± 0.57 d/dl vs 2.9 ± 0.8 g/dl, p = 0.001, Figure 3). However, the response was ill sustained, the proteinuria again increased and the serum albumin declined in majority of the cases. There was no effect of this therapy on serum creatinine (Figure 4).


Infusion of autologous bone marrow mononuclear cells leads to transient reduction in proteinuria in treatment refractory patients with Idiopathic membranous nephropathy.

Sengupta U, Kumar V, Yadav AK, Marwaha N, Kohli HS, Sakhuja V, Jha V - BMC Nephrol (2013)

Baseline and follow-up values of serum creatinine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219434&req=5

Figure 4: Baseline and follow-up values of serum creatinine.
Mentions: All subjects showed a reduction in proteinuria ranging from 8-85% (Figure 1). The value decreased to 1.0 ± 0.61 g/day (p < 0.0001) at one month and 1.33 ± 0.7 g/day (p = 0.001) at 2 months. None of the subjects underwent complete remission. The proteinuria came back to 1.8 ± 1 g/day At 3 months and 2.15 ± 1.1 g/day at 6 months (p > 0.05). About 64% of the subjects showed more than 50% decrease in proteinuria in the first month, which decreased to 9% in the fifth month of follow-up (Figure 2). This was associated with improvement in serum albumin to the tune of 6-70% at 1 month (2.27 ± 0.57 d/dl vs 2.9 ± 0.8 g/dl, p = 0.001, Figure 3). However, the response was ill sustained, the proteinuria again increased and the serum albumin declined in majority of the cases. There was no effect of this therapy on serum creatinine (Figure 4).

Bottom Line: At 6 months, only 2 patients had >50% reduction.No infusion related side effects were noted.This effect, however, is transient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. vjha@pginephro.org.

ABSTRACT

Background: The current treatment options for idiopathic membranous nephropathy (IMN) carry significant toxicity. In this prospective, observational pilot study, we used single time infusion of bone marrow derived autologous mononuclear cells (MNCs) in adult patients with treatment refractory IMN.

Methods: Twelve patients of biopsy proven IMN who had failed a cyclical 6-month regimen of steroid and cyclophosphamide were enrolled in the study. Bone-marrow was harvested from the iliac crest and underwent processing to isolate MNCs. Cells were counted and subjected to viability testing before being infused through a peripheral vein on the same day. After the infusion, subjects were followed up monthly for the next six months. Supportive treatment including angiotensin antagonists and statins was continued throughout the study period.

Result: The proteinuria, serum albumin and creatinine values at entry were 2.97 ± 0.6 gm/1.73 m2/d, 2.27 ± 1.1 gm/l and 0.9 ± 0.8 mg/dl respectively. There was a reduction in proteinuria (p < 0.0001), and increase in serum albumin (p = 0.001) at 1 month, with 64% of the subjects showing >50% reduction in proteinuria. However, the response was ill sustained. At 6 months, only 2 patients had >50% reduction. Serum creatinine remained stable throughout the study period. No infusion related side effects were noted.

Conclusion: Autologous mononuclear cell infusion leads to transitory reduction in proteinuria and improvement in serum albumin in treatment refractory IMN. This effect, however, is transient. Whether this can be overcome by repeated infusion of cultured mesenchymal cells needs to be investigated.

Show MeSH
Related in: MedlinePlus