<i>Rilparencel</i> (Renal Autologous Cell Therapy-REACT<sup>®</sup>) for Chronic Kidney Disease and Type 1 and Type 2 Diabetes: Phase 2 Trial Design Evaluating Bilateral Kidney Dosing and Redosing Triggers

<b><i>Introduction:</i></b> Autologous cell-based therapies (CBT) to treat chronic kidney disease (CKD) with diabetes are novel and can potentially preserve renal function and decelerate disease progression. CBT dosing schedules are in early development and may benefit from individual bilateral organ dosing and kidney-dependent function to improve efficacy and durability. The objective of this open-label, phase 2 randomized controlled trial (RCT) is to evaluate participants’ responses to <i>rilparencel</i> (Renal Autologous Cell Therapy-REACT^®) following bilateral percutaneous kidney injections into the kidney cortex with a prescribed dosing schedule versus redosing based on biomarker triggers. <b><i>Methods:</i></b> Eligible participants with type 1 or 2 diabetes and CKD, eGFR 20–50 mL/min/1.73 m², urine albumin-to-creatinine ratio (UACR) 30–5,000 mg/g, hemoglobin &gt;10 g/dL, and glycosylated hemoglobin &lt;10% were enrolled. After a percutaneous kidney biopsy and bioprocessing ex vivo expansion of selected renal cells, participants were randomized 1:1 into two cohorts determined by the dosing scheme. Cohort 1 receives 2 cell injections, one in each kidney 3 months apart, and cohort 2 receives one injection and the second dose only if there is a sustained eGFR decline of ≥20 mL/min/1.73 m² and/or UACR increase of ≥30% and ≥30 mg/g, confirmed by re-testing. <b><i>Conclusion:</i></b> The trial is fully enrolled with fifty-three participants. Cell injections and follow-up clinical visits are ongoing. This multicenter phase 2 RCT is designed to investigate the efficacy and safety of <i>rilparencel</i> with bilateral kidney dosing and compare two injection schedules with the potential of preserving or improving kidney function and delaying kidney disease progression among patients with stages 3a–4 CKD with diabetes.