barcelona . spain - European Association for the Study of the Liver

BARCELONA . SPAIN
156 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 157
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
Table 3 : Controlled clinical studies of autologous BM- derived cells transplantation in chronic liver
disease
Abbreviations: BM: bone marrow; ALD: alcoholic liver disease; ASH: alcoholic steatohepatitis; G-CSF:
granulocyte colony-stimulating factor; RCT: randomized controlled trial
Author (yr) Patients (n) Clinical setting Protocol Route Outcome
Lyra
(2010)
Peng (2011) 53
Spahr (2011) 28
15 Cirrhosis on LT list
Decompensated
chronic Hep B
Decompensated
alcoholic liver
disease
No G-CSF
BMA+
No G-CSF
BMA+
3.4 x 10 8 MNC
G-CSF +
BMA+
0.47 x 10 8 MNC/k
HA
HA
HA
Transient
improvement in
bilirubin
Transient
improvement in MELD
score
No benefit
Abbreviation: BMA: bone marrow aspiration; MNC: mononuclear cells; HA: hepatic artery; PV: portal vein
CONCLUSIONS AND PERSPECTIVES
BM stem cell therapy offers the potential for a novel approach to liver regeneration. Based on available
data, the contribution of BM-derived stem cells to liver repair seems marginal, and the mechanisms are
incompletely understood. RCTs in patients with decompensated liver disease suggest that autologous BMC
transplantation is safe and may transiently improve clinical and biological parameters. The aetiology of liver
disease may account for differences in the response to stem cell therapy, as patients with decompensated
ALD don’t derive any benefits in terms of liver function compared to standard of care treatment. Future
studies should better characterize the efficiency of G-CSF and BM stem cell therapy in the regeneration/
repair mechanisms of the injured alcoholic liver, and explore the fate and potential of transplanted cells.
Figure: evolution of the MELD score in patients with decompensated ALD (n=58) (ref 21)
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