Animal studies have shown that mesenchymal stromal cell (MSC) infusions improve 
acute kidney injury (AKI) outcomes when administered early after 
ischemic/reperfusion injury or within 24 hours after cisplatin administration. 
These findings have spurred several human clinical trials to prevent AKI. 
However, no specific therapy effectively treats clinically obvious AKI or 
rescues renal function once advanced injury is established. We investigated if 
noninvasive image-guided pulsed focused ultrasound (pFUS) could alter the kidney 
microenvironment to enhance homing of subsequently infused MSC. To examine the 
efficacy of pFUS-enhanced cell homing in disease, we targeted pFUS to kidneys to 
enhance MSC homing after cisplatin-induced AKI. We found that pFUS enhanced MSC 
homing at 1 day post-cisplatin, prior to renal functional deficits, and that 
enhanced homing improved outcomes of renal function, tubular cell death, and 
regeneration at 5 days post-cisplatin compared to MSC alone. We then 
investigated whether pFUS+MSC therapy could rescue established AKI. MSC alone at 
3 days post-cisplatin, after renal functional deficits were obvious, 
significantly improved 7-day survival of animals. Survival was further improved 
by pFUS and MSC. pFUS prior to MSC injections increased IL-10 production by MSC 
that homed to kidneys and generated an anti-inflammatory immune cell profile in 
treated kidneys. This study shows pFUS is a neoadjuvant approach to improve MSC 
homing to diseased organs. pFUS with MSC better prevents AKI than MSC alone and 
allows rescue therapy in established AKI, which currently has no meaningful 
therapeutic options.