La terapia combinata di cellule mesenchimali stromali e aceinibitori riduce la fibrosi renale in un modello animale di ostruzione ureterale unilaterale

Mesenchymal stromal cells (MSC) are multipotent cells with immunomodulant and anti-inflammatory effect. Several studies have shown MSC beneficial effect in acute kidney injury but are not yet known MSC effects in chronic kidney disease. Unilateral ureteral obstruction (UUO) is a model of renal interstitial fibrosis, the final common pathway for progressive renal diseases where the activation of vasoactive molecules, inflammatory and profibrotic cytokines plays a pathogenetic role in the development of cell apoptosis and tubular atrophy. Renin-angiotensin system (RAS) plays a pivotal role in renal fibrosis and agents that target angiotensin II, principal mediator of RAS, are the most effective therapy to reduce progression of chronic kidney disease. Its known that angiotensin-converting enzyme inhibitors (ACEi) induce a compensatory increase in plasma renin levels because of the disruption of the negative feedback of its production. However renin (R) promotes renal injury not only by stimulating angiotensin II (ANG II) generation, but also up-regulating pro-fibrotic genes through renin/prorenin receptor activation. The aim of the study was to investigate whether MSC infusion attenuate renal injury in a rat model of UUO and to compare the protective effects of ACEi and MSC in UUO. We studied 5 groups of rats. A: rats sham operated. B: rats UUO received saline solution on day 0 (vehicle control). C: rats UUO received MSC 3X106 on day 0 via tail vein. D: rats UUO received lisinopril from d 1 to 21. E: rats UUO received MSC on d 0, and lisinopril from d 1 to 21. Rats were sacrified on d 7 and 21. Our results show that MSC in UUO rat model prevent renin increase, reduce angiotensin II generation and in combination therapy with ACEi suppress further angiotensin II block, thereby lead to a synergy in ameliorating renal fibrosis.