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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 Progress of degree of ascites in group III (control group). b Progress of the degree of ascites in group I (single infusion). c Progress of degree of ascites in group II (repeated infusion)
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Fig8: a Progress of degree of ascites in group III (control group). b Progress of the degree of ascites in group I (single infusion). c Progress of degree of ascites in group II (repeated infusion)

Mentions: At the end of the study, 66.7 % of the patients in G-II showed improvement in their ascites compared with 36.7 % in G-I (P = 0.001) (Table 7 and Fig. 8). Changes in the grade of ascites were confirmed by measuring the abdominal girth and the body weight of the patients as well as by repeated ultrasonography during the follow-up. Ascites was categorized as: (1) mild if localized in the pelvis and/or hepatorenal angle only, (2) moderate if it reaches the mid-abdomen or (3) massive if more than this. On the other hand, there was a significant reduction in the tapping of ascites in G-II patients after 9 and 12 months; respectively compared with 15 % in G-I and 32 % in the control group (P = 0.58).Table 7


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 Progress of degree of ascites in group III (control group). b Progress of the degree of ascites in group I (single infusion). c Progress of degree of ascites in group II (repeated infusion)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig8: a Progress of degree of ascites in group III (control group). b Progress of the degree of ascites in group I (single infusion). c Progress of degree of ascites in group II (repeated infusion)
Mentions: At the end of the study, 66.7 % of the patients in G-II showed improvement in their ascites compared with 36.7 % in G-I (P = 0.001) (Table 7 and Fig. 8). Changes in the grade of ascites were confirmed by measuring the abdominal girth and the body weight of the patients as well as by repeated ultrasonography during the follow-up. Ascites was categorized as: (1) mild if localized in the pelvis and/or hepatorenal angle only, (2) moderate if it reaches the mid-abdomen or (3) massive if more than this. On the other hand, there was a significant reduction in the tapping of ascites in G-II patients after 9 and 12 months; respectively compared with 15 % in G-I and 32 % in the control group (P = 0.58).Table 7

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