Developmental Approaches to Kidney Regeneration

The growing gap between the number of patients on kidney transplant waiting lists and the number of organs available for transplantation creates a pressing need to find alternative treatments for kidney diseases. Recent methodological advances in developmental biology and stem cell research create intriguing possibilities for generating kidney tissues that are suitable for transplantation. Some exploit known developmental programs in order to either grow whole donor kidneys within living recipients or engineer transplantable kidney tissue in vitro starting with embryonic kidney cells. In particular, these approaches include (1) transplanting whole embryonic kidneys or fragments to pursue organogenesis in vivo and develop functional kidneys; (2) cultivating metanephric cells in three-dimensional culture systems that allow them to self-organize into 3D kidney structures; and finally (3) using blastocyst complementation that makes it possible to grow donor kidneys from pluripotent stem cells injected into animals lacking normal renal developmental capacity. This chapter provides an overview of these approaches, highlights methodological advances reported in recent years, and discusses their limitations.