Acute renal failure: growth factors, cell therapy, and gene therapy.

The rapid understanding of the cellular and molecular basis of organ function and disease will be translated during the next several decades into new therapeutic approaches to a wide range of clinical disorders, including acute renal failure (ARF). The development of the biotechnology for recombinant genetic engineering has led to the prospect of using purified protein products for therapy. In this regard, the repair of ischemic and toxic ARF is critically dependent on a redundant, interactive cytokine network of growth factors to return kidney function to near normal baseline function. Recombinant growth factors are being tested both experimentally and clinically to accelerate the repair of kidney tissue in this disorder. A newer strategy in biotechnology is the development of cell therapy derivatives. Cell therapy is based on the ability to expand specific cells in tissue culture to perform differentiated tasks and to introduce these cells into the patient either in extracorporeal circuits or as implants as drug delivery vehicles of a single protein or to provide physiological functions. Cell therapy devices are being developed to replace components of renal function that are lost during ARF and chronic renal failure and are not replaced with current hemodialysis or hemofiltration. These new approaches may result in therapeutic modalities that diminish the degree of renal failure and the time needed to recover renal function in acute tubular necrosis. This article examines the future prospects of these developing therapies in the treatment of ARF.