Mechanisms and clinical advances in the in vivo regeneration of renal tissue: a narrative review

Sun, Fuzheng1; Cui, Yun1; Zhi, Wenqiang1; Chen, Zhenwei2; Li, Yafeng2,*

1Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi Province, China

2Department of Nephrology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China

*Correspondence to: Yafeng Li, dr.yafengli@gmail.com.

Abstract

Chronic kidney disease and acute kidney injury are significant global health issues that impact the well-being and quality of life of millions of people. Currently, kidney transplantation and dialysis are the primary treatments for renal failure, but these methods have many limitations, such as donor shortage, immune rejection, and chronic complications, and there is a pressing need to develop new treatment strategies to enhance patient outcomes. Recently, in vivo renal regeneration, as an emerging therapeutic approach, has gradually gained widespread attention by virtue of its potential to restore function by promoting the kidney’s own repair mechanism. We used databases such as PubMed, Web of Science, China National Knowledge Infrastructure and Google Scholar. Keywords include in vivo renal regeneration, kidney regeneration, renal repair, mesenchymal stem cells, adult renal stem/progenitor cells, induced pluripotent stem cells, hydrogels, decellularized scaffolds, extracellular vesicles, growth factors, gene editing, three-dimensional bioprinting, acute kidney injury, and chronic kidney disease. By combining the keywords through Boolean logic (AND, OR, NOT) and setting filters such as year of publication and type of study (original study, review article, and clinical trial), 222 relevant papers were initially screened. This paper reviews the renewability of renal regeneration and related cell-derived approaches, including mesenchymal stem cells and renal stem/progenitor cells, as well as materialological approaches, such as hydrogels and decellularized scaffolds. In addition, this paper explores the use of extracellular vesicles and growth factors in renal regeneration and their mechanisms. In vivo regeneration has strong potential for renal repair and regeneration and is expected to provide more efficient and safer therapeutic options for patients with acute and chronic kidney disease.

体内肾组织再生的机制和临床研究进展：叙述性综述

摘要

慢性肾脏病和急性肾损伤是全球性的重大健康问题，影响着数百万人的福祉和生活质量。目前，肾移植和透析是治疗肾功能衰竭的主要方法，但这些方法存在供体短缺、免疫排斥、慢性并发症等诸多局限性，迫切需要开发新的治疗策略来改善患者的预后。近来，体内肾脏再生作为一种新兴的治疗方法，凭借其通过促进肾脏自身修复机制恢复功能的潜力，逐渐受到广泛关注。文章通过检索 PubMed、Web of Science、CNKI和谷歌学术数据库。以关键词“体内肾脏再生、肾脏再生、肾脏修复、间充质干细胞、成体肾脏干/祖细胞、诱导多能干细胞、水凝胶、脱细胞支架、细胞外囊泡、生长因子、基因编辑、三维（3D）生物打印、急性肾损伤和慢性肾病”对文章进行筛选。文章总结了体内肾脏再生的最新研究进展，重点关注基于细胞的方法（如间充质干细胞、成体肾脏干细胞/祖细胞[ARPCs]和诱导多能干细胞[IPSCs]）、基于材料科学的方法（如水凝胶和脱细胞支架[dECM支架]）以及非细胞方法（细胞外囊泡[EVs]和生长因子）。文章还阐述了这些方法的机制和潜在的临床应用，并强调了基因编辑和三维生物打印等新兴技术在优化肾脏修复策略中的关键作用，旨在为体内肾脏再生提供理论依据并探索其未来前景。