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  • Accute/Chronic Liver Disease

    Liver Cirrhosis is any condition that causes liver inflammation or tissue damage and affects liver function.

    Overview of Liver Disease


    Liver cirrhosis is any condition that causes liver inflammation or tissue damage and affects liver function. The liver is a vital organ located in the upper right-hand side of the abdomen. It is as large as a football, weighs 2-3 pounds, and performs numerous functions for the body: converting nutrients derived from food into essential blood components, storing vitamins and minerals, regulating bloods clotting, producing proteins and enzymes, maintaining hormone balances, and metabolizing and detoxifying substances that would otherwise be harmful to the body. The liver makes factors that help the human immune system fight infection, removes bacteria from the blood, and makes bile, which is essential for digestion.

    What is liver Cirrhosis?


    Liver cirrhosis is categorized both by the cause and the effect it has on the liver. Causes may include infection, injury, exposure to drugs or toxic compounds, an autoimmune process, or a genetic defect that leads to the deposition and build-up of damaging substances such as iron or copper. Effects may include inflammation, scarring, obstructions, clotting abnormalities, and liver failure.

    Formal treatments of liver Cirrhosis?


    Although liver has a very good regenerative capacity but in chronic liver disease, this begins to fail, and then fibrosis, and eventually cirrhosis develops, called end stage liver disease (ESLD). Chronic liver disease is the fifth leading cause of death after cancer, cardiovascular disease, stroke, and respiratory disease.

    At present liver transplantation is the only therapeutic option for patients with acute and chronic ESLDs and liver based metabolic defects. Liver transplantation, however, has the disadvantage of requiring lifelong immunosuppressant, with 10–15% of patients dying whilst on the waiting list due to the shortage of donated organs.

    Hepatocyte Cells transplantation has been suggested as an alternative to liver transplantation, especially for hepatic disorders but the widespread application of hepatocyte transplantation, however, is also limited by organ availability, by problems with viability of isolated hepatocytes after cryopreservation, and by the potential formation of hepatocyte aggregates after transplantation because hepatocyte cell has the problems of insufficient cell survival and engraftment.

    Don't worry. We are here to help you to recover soon.

    Introduction:


    A lot of clinical trials have shown that Stem cell therapy is successful in liver cirrhosis treatment like acute liver failure or end stage liver disease (ESLDs). So the concept is that stem cell has the potential to differentiate into hepatocyte cells after transplantation in liver cirrhosis and show improvement for all the evaluations in liver cirrhosis disease.

    Reference

    Patient group

    Number (𝑛)

    Site injection

    BM cells

    Outcome

    Am Esch et. al.

    Patients with liver cancer, no cirrhosis

    Study: 3
    Control: 3

    Portal vein

    Autologous,
    bone marrow,
    CD133+

    2.5-fold increase in left lobe in study group on CT volumetry

    Gordon et al.

    Hepatitis B or C
    Alcoholic cirrhosis and 
    primary sclerosing cholangitis

    5

    Portal vein 3
    Hepatic artery 2

    Autologous
    peripheral blood,
    post-G-CSF CD34+

    Improvement in albumin or bilirubin in 3/5 patients

    Terai et al.

    Hepatitis B or C
    Cirrhosis

    9

    Peripheral vein

    Autologous,
    iliac crest,
    unsorted BM

    Improve in the Child-Pugh Score and albumin

    Yannaki et al.

    Alcoholic cirrhosis

    2

    Peripheral vein

    Autologous
    Peripheral blood,
    post-G-CSF CD34+

    Improvement in the Child-Pugh and MELD Score

    Furst et al.

    Patients with liver cancer, no cirrhosis

    Study: 6
    Control: 7

    Portal vein

    Autologous,
    bone marrow,
    CD133+

    Increase in daily liver growth

    Lyra et al.

    Alcoholic, hepatitis C, cholestatic and cryptogenic cirrhosis

    10

    Hepatic artery

    Autologous,
    Iliac crest,
    unsorted BM

    Improvement in Child’s Pugh score, bilirubin, and albumin

    Gasbarrini et al.

    Drug-induced acute liver failure

    1

    Portal vein

    Autologous
    Peripheral blood,
    post-G-CSF CD34+

    Improvement in clotting (PT), AST, and ALT

    Yan et al.

     

    Hepatitis B cirrhosis

     

    2

     

    Hepatic artery

     

    Autologous peripheral blood monocytes post-G-CSF

     

    Improve in albumin, Bilirubin, AST, ALT, and the Child-Pugh Score

    Mohamadnejad et al.

    Decompensated cirrhosis

    4

    Peripheral vein

    Autologous bone marrow mesenchymal stem cells

    MELD Score improvement in 2 patients

    Pai et al.

    Alcoholic liver cirrhosis

    9

    Hepatic artery

    Autologous, post-G-CSF, CD34+cells expanded in vitro

    Significant improvement in bilirubin and liver enzymes

    Khan et al.

    Hepatitis B or C

    4

    Hepatic artery

    Autologous, post-G-CSF, CD34+cells

    Improvement in liver function

    Kharaziha et al.

    Hepatitis B or C Alcoholic cirrhosis and Cryptogenic

    8

    Peripheral or portal vein

    Autologous bone marrow mesenchymal stem cells

    Significant improvement in MELD Score

    Lyra et al.

    Hepatitis B or C 
    Alcoholic and
    cryptogenic cirrhosis

    Study: 15
    Control: 15

    Hepatic artery

    Autologous mononuclear-enriched bone marrow cells

    Improvement in liver function


    Stem Cell Transplantation:


    For obtaining a high local stem cell concentration at the injured site, we use a new route of transplantation by combining three ways:-

    1. Intra portal vein
    2. Hepatic artery
    3. via Intrvenously

    So by using the combining methods, Stem cells reaches at the necessary target to fulfill their niche and promote the endogenous repair with better results in acute and chronic stages also.
    Stem Cell therapy offers the potential benefits when transplanted into liver disease.

    1. Stem cell can differentiate or regenerate into hepatocyte cells so recover the damaged hepatocytes cells in the liver cirrhosis.
    2. Stem cell transplant also provide new vascularization so it provides good environment for the renewal, differentiation of stem cells into hepatocytes.
    3. Stem cell provides immune-regulatory properties by secreting anti-inflammatory cytokines so stop inflammation and slow down or stop further deterioration of hepatocytes cells.

    Liver disease is any condition that causes liver inflammation or tissue damage and affects liver function.

    Scientific Papers


    1. Salama et al. 2010 (Cell Transplant). Autologous hematopoietic stem cell transplantation in 48 patients with end-stage chronic liver diseases.

    2. Khan et al. 2008 (Transplant Proc). Safety and efficacy of autologous bone marrow stem cell transplantation through hepatic artery for the treatment of chronic liver failure: a preliminary study.
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