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The impact of repeated autologous infusion of haematopoietic stem cells in patients with liver insufficiency.

Zekri AR, Salama H, Medhat E, Musa S, Abdel-Haleem H, Ahmed OS, Khedr HA, Lotfy MM, Zachariah KS, Bahnassy AA - Stem Cell Res Ther (2015)

Bottom Line: By the end of the study, 36.7 % of the patients in G-I and 66.7 % in G-II showed improvement in the degree of ascites compared to the control group (G-III).We also reported an improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score.Safety of the procedure was evidenced by the low incidence of complications encountered.

View Article: PubMed Central - PubMed

Affiliation: Molecular Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Kasr Al-Aini st., Fom El-Khaleeg, Cairo, 11976, Egypt. ncizekri@yahoo.com.

ABSTRACT

Introduction: The worldwide shortage of donor livers has prompted the search for alternative cell therapies. Previous data from our laboratory proved a supportive role for stem cell therapy in the treatment of end-stage liver disease patients. Therefore; this study was conducted to assess the clinical and biochemical effects of repeated stem cell infusion.

Methods: Ninety patients with liver cirrhosis were randomized to receive either one session treatment (G-I) or two sessions 4 months apart (G-II) of autologous haematopoietic stem cells (HSCs) transplantation and a control group (G-III) who received regular liver treatment. G-CSF was administered to transplanted patients before infusion; HSCs were isolated from 400 cc bone marrow (BM) aspirate. CD34+/CD133+ cells were purified: 50 % of the cells were infused locally in the portal vein on the same day and the other 50 % were differentiated to MSC and infused systemically in a peripheral vein (one session treatment G-I). In G-II, the same process was repeated after 4 months from the first treatment (two session's treatment G-II). Liver function was monitored for 12 months after stem cell therapy (SCT).

Results: Statistically significant improvement was reported in the transplanted patients (G-1) as regards the mean serum albumin, bilirubin and INR levels which started to improve after 2 weeks of treatment and continued to improve till the 6(th) month in the single infusion group. The two sessions infused group (G-II) showed sustained response which continued throughout the all follow-up period (12 month). By the end of the study, 36.7 % of the patients in G-I and 66.7 % in G-II showed improvement in the degree of ascites compared to the control group (G-III). We also reported an improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score. Safety of the procedure was evidenced by the low incidence of complications encountered.

Conclusion: In patients with end-stage liver disease, the repeated infusion with combined routes portal and peripheral veins has a beneficial effect on liver functions with minimal adverse events and more lasting clinical efficacy after repeated HSCs infusion.

No MeSH data available.


Related in: MedlinePlus

a Child–Pugh score in group III patients (control group). b Child–Pugh score in group I patients (single infusion). c Child–Pugh score in group II patients (repeated infusion)
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Fig6: a Child–Pugh score in group III patients (control group). b Child–Pugh score in group I patients (single infusion). c Child–Pugh score in group II patients (repeated infusion)

Mentions: At the end of the study, 12 patients (40 %) showed improvement in their Child–Pugh grade compared with the baseline (P = 0.05) (Table 5 and Fig. 6). Similarly, there was an improvement in the MELD score of the double-infused group (17.23 ± 1.33) rather than both the control and the single-infused groups at the beginning of the study compared with that at 12 months in the double-infused group (13.96 ± 1.59) compared with the single-infused group (14.96 ± 2.39) and the control group (16.32 ± 3.70) (P = 0.0001) (Table 6 and Fig. 7).Table 5


The impact of repeated autologous infusion of haematopoietic stem cells in patients with liver insufficiency.

Zekri AR, Salama H, Medhat E, Musa S, Abdel-Haleem H, Ahmed OS, Khedr HA, Lotfy MM, Zachariah KS, Bahnassy AA - Stem Cell Res Ther (2015)

a Child–Pugh score in group III patients (control group). b Child–Pugh score in group I patients (single infusion). c Child–Pugh score in group II patients (repeated infusion)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4482193&req=5

Fig6: a Child–Pugh score in group III patients (control group). b Child–Pugh score in group I patients (single infusion). c Child–Pugh score in group II patients (repeated infusion)
Mentions: At the end of the study, 12 patients (40 %) showed improvement in their Child–Pugh grade compared with the baseline (P = 0.05) (Table 5 and Fig. 6). Similarly, there was an improvement in the MELD score of the double-infused group (17.23 ± 1.33) rather than both the control and the single-infused groups at the beginning of the study compared with that at 12 months in the double-infused group (13.96 ± 1.59) compared with the single-infused group (14.96 ± 2.39) and the control group (16.32 ± 3.70) (P = 0.0001) (Table 6 and Fig. 7).Table 5

Bottom Line: By the end of the study, 36.7 % of the patients in G-I and 66.7 % in G-II showed improvement in the degree of ascites compared to the control group (G-III).We also reported an improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score.Safety of the procedure was evidenced by the low incidence of complications encountered.

View Article: PubMed Central - PubMed

Affiliation: Molecular Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Kasr Al-Aini st., Fom El-Khaleeg, Cairo, 11976, Egypt. ncizekri@yahoo.com.

ABSTRACT

Introduction: The worldwide shortage of donor livers has prompted the search for alternative cell therapies. Previous data from our laboratory proved a supportive role for stem cell therapy in the treatment of end-stage liver disease patients. Therefore; this study was conducted to assess the clinical and biochemical effects of repeated stem cell infusion.

Methods: Ninety patients with liver cirrhosis were randomized to receive either one session treatment (G-I) or two sessions 4 months apart (G-II) of autologous haematopoietic stem cells (HSCs) transplantation and a control group (G-III) who received regular liver treatment. G-CSF was administered to transplanted patients before infusion; HSCs were isolated from 400 cc bone marrow (BM) aspirate. CD34+/CD133+ cells were purified: 50 % of the cells were infused locally in the portal vein on the same day and the other 50 % were differentiated to MSC and infused systemically in a peripheral vein (one session treatment G-I). In G-II, the same process was repeated after 4 months from the first treatment (two session's treatment G-II). Liver function was monitored for 12 months after stem cell therapy (SCT).

Results: Statistically significant improvement was reported in the transplanted patients (G-1) as regards the mean serum albumin, bilirubin and INR levels which started to improve after 2 weeks of treatment and continued to improve till the 6(th) month in the single infusion group. The two sessions infused group (G-II) showed sustained response which continued throughout the all follow-up period (12 month). By the end of the study, 36.7 % of the patients in G-I and 66.7 % in G-II showed improvement in the degree of ascites compared to the control group (G-III). We also reported an improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score. Safety of the procedure was evidenced by the low incidence of complications encountered.

Conclusion: In patients with end-stage liver disease, the repeated infusion with combined routes portal and peripheral veins has a beneficial effect on liver functions with minimal adverse events and more lasting clinical efficacy after repeated HSCs infusion.

No MeSH data available.


Related in: MedlinePlus