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Calciphylaxis: ongoing challenges and treatment opportunities with mesenchymal stem cells
Daoxu Wu1,2,3 , Shijiu Lu1,2 , Jiaying Hu1,2 , Ming Zeng2 , Jingjing Wu2 , Cui Li1,2,4 , Xingfang Tang1,2,5 , Tian Lu6,7 , Yi Zhu6,7 , Jiayin Liu8,* , Lianju Qin8,* , Ningning Wang1,2,9,*
1Division of Nephrology, Department of Geriatrics, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
2Department of Nephrology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
3Department of Nephrology, Yantai Yuhuangding Hospital, Yantai 264000, China
4Department of Nephrology, Nanjing Pukou People’s Hospital, Nanjing 211800, China
5The Affiliated Lianyungang Municipal Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang 222042, China
6School of Medicine, Westlake University, Hangzhou 310024, China
7Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, China
8State Key Laboratory of Reproductive Medicine and Offspring Health, Center of Clinical Reproductive Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210036, China
9Jiangsu Provincial Key Laboratory of Biological Therapy for Organ Failure, Nanjing Medical University, Nanjing 211166, China
*Correspondence to:Ningning Wang , Email:wangnn@njmu.edu.cn Lianju Qin , Email:ljqin@njmu.edu.cn Jiayin Liu , Email:jyliu_nj@126.com
J Mol Cell Biol, Volume 17, Issue 2, February 2025, mjaf009,  https://doi.org/10.1093/jmcb/mjaf009
Keyword: calciphylaxis, calcific uremic arteriolopathy, orphan disease, microvascular calcification, microthrombus, infection, mesenchymal stem cells, biomarkers

Calciphylaxis is a rare, progressive disorder characterized by subcutaneous adipose and dermal microvascular calcifications, microthrombi, and endothelial damage. It mainly affects patients with chronic kidney disease (CKD), which is also known as calcific uremic arteriolopathy. Skin biopsy is the gold standard for diagnosis, but it is an invasive procedure. Calciphylaxis frequently results in ischemic and nonhealing ulcerations with a high mortality rate. A multidisciplinary targeted approach is the primary treatment method. Vascular calcification, which is a common complication in patients with CKD, cannot completely explain the rapid progression of calciphylaxis. This article reviews the advances in the epidemiological characteristics, risk factors, and diagnosis, including non-uremic calciphylaxis and visceral calciphylaxis, pathogenesis, associated animal models, and treatment of calciphylaxis. The scarcity of animal models that mimic the clinical presentation of calciphylaxis hampers the understanding of its pathogenesis. The acute effects on progressive vascular injury, including the induction of severe ischemia and inflammatory responses, have been emphasized. Actively listening to the voices of patients and their families and building a multidimensional research system with artificial intelligence technologies based on the specific molecular makeup of calciphylaxis patients will help tailor regenerative treatment strategies. Mesenchymal stem cells (MSCs) may represent a novel therapy for calciphylaxis because of their regenerative effects, inhibition of vascular calcification, anti-infection and immunomodulation properties, and improvement of hypercoagulability. Safe, effective, accessible, and economical MSC strategies guided by biomarkers deserve consideration for the treatment of this devastating disease.