SVF
Level B· Emerging Clinical EvidenceRandomized Controlled Trial

Periadventitial delivery of mesenchymal stem cells improves vascular remodeling and maturation in arteriovenous fistulas.

Kilari S., DeMartino RR., Nyberg SL., Dean PG., Colglazier JJ., Takahashi E.

Randomized Controlled Trial on Chronic Kidney Disease, Chronic Inflammation, Autoimmune Research, published in Sci Transl Med (2025) — summary generated from the PubMed abstract.

This page is generated from the PubMed record. The Thai description is an automated summary of bibliographic fields and the abstract, not a full translation, and is not medical advice.

Study type
Randomized Controlled Trial
Journal
Sci Transl Med (2025)
Country
United States
Reported sample size
—
PMID
40864685
DOI
10.1126/scitranslmed.adp7723

Abstract (original English)

Worldwide, more than 4 million patients with end-stage kidney disease require hemodialysis through an arteriovenous fistula (AVF). AVFs fail because of venous neointimal hyperplasia (VNH) resulting in venous stenosis formation. A phase 1 randomized trial in patients undergoing upper extremity AVF placement was performed to evaluate the safety and efficacy of autologous adipose-derived mesenchymal stem cells (MSCs) in improving AVF function. The mechanism of action by which MSCs exert their beneficial effects was investigated using AVFs created in mice and pigs treated with allogenic MSCs and xenotransplant using patient MSCs in CD1- Foxn1nu mice. At a median follow-up of 42 months, patients with MSC-treated AVFs had reduced time to maturation with an increase in the vein diameter compared with controls. AVFs treated with allogenic MSCs in mice and pigs had an increase in M2- and M1-like macrophages with a decrease in VNH. Transcriptomic analysis of AVFs treated with allogenic MSCs in mouse and MSC xenotransplants of patients with successful AVFs showed decreased peroxisome proliferator-activated receptor gamma ( Ppar γ) and leptin receptor ( Lepr ) and increased latent transforming growth factor-beta-binding protein 2 ( Ltbp2 ). PPARγ was reduced in CD68 (+) cells from successful AVFs and allogenic MSC-treated mouse AVFs. Venous stenosis and VNH formation were mitigated in AVFs

What this study does not prove

  • • This study does not prove SVF is an approved treatment or a replacement for standard care.

Evidence level

Several human studies exist, but sample sizes, methodology, or follow-up remain limited, so conclusions are not firm.

How we grade evidence
AnimalsFemaleHumansMaleMiceMiddle AgedArteriovenous FistulaMacrophagesMesenchymal Stem Cell TransplantationMesenchymal Stem Cells
Systemic / IVChronic Kidney DiseaseChronic InflammationAutoimmune Research
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