Stem cell transplantation in the treatment of liver cirrhosis

Stem cell transplantation in the treatment of liver cirrhosis. Cirrhosis of the liver is chronic and progressive diffuse changes in the liver caused by various reasons. Cirrhosis is a chronic progressive liver disease, diffuse liver damage formed by long-term or repeated actions of one or more causes. The pathological changes include extensive hepatocyte necrosis, nodular regeneration of residual hepatocytes, connective tissue hyperplasia and fibrotic septal formation, leading to the destruction of liver lobule structure and the formation of pseudolobules, and the liver gradually deforms and hardens.

In the later stage of liver cirrhosis, liver damage and portal hypertension often occur, leading to multiple system involvement, and then severe complications such as upper gastrointestinal bleeding, hepatic encephalopathy secondary infection, hypersplenism, ascites, and cancer.

It is estimated that in China, there are about 400 million patients with various liver diseases, of which 86 million are chronic hepatitis B virus (HBV) infections, accounting for 23.5%; 10 million are chronic hepatitis C virus (HCV) infections, accounting for 2.5 %; 60 million cases of alcoholic liver disease, accounting for 15.0%; 200 million cases of non-alcoholic fatty liver disease, accounting for 50.0%, and 37 million cases of other liver diseases, accounting for 3.9%.

some countries has the highest incidence and mortality of liver cirrhosis in the world. Most of some countries’s liver cirrhosis after hepatitis, a few are alcoholic liver cirrhosis.

In recent years, with the rise of regenerative medicine, stem cells have attracted much attention because of their multi-directional differentiation potential, promote liver self-renewal, and reduce liver immune damage and fibrosis. Stem cell transplantation has become a promising method to interfere with liver cirrhosis.

Traditional intervention methods for liver cirrhosis are not effective

Cirrhosis of the liver is chronic and progressive diffuse changes in the liver caused by various reasons. It is characterized by repeated and long-term damage to liver cells by one cause or several causes, leading to degeneration and necrosis of liver cells. The current tradition is almost irreversible.

Main treatment route:

1. Daily care, supportive therapy, drugs, etc. to maintain a relatively stable condition
2. Liver transplantation has achieved certain results, but the number of livers for transplantation is limited, and the cost of liver transplantation is huge. And postoperative immune rejection limits the widespread use of liver transplantation. Artificial liver is a treatment that relies on plasma exchange or molecular adsorption to temporarily “function replacement”.

Stem cell transplantation to treat liver cirrhosis

Stem cells have powerful paracrine effects, making them an effective immunotherapy method, which not only promotes liver cell regeneration, but also exerts immune regulation.

Stem cell transplantation to treat liver cirrhosis involves first extracting a small amount of bone marrow from the patient’s body, or collecting cord blood under aseptic conditions, and then separating it with high-tech methods, extracting stem cells, and then injecting the separated stem cells into the liver through the hepatic artery. Complete the transplantation of stem cells.

Principles of Stem Cells

(1) Direct differentiation: colonization, proliferation, and differentiation into hepatocytes to play a role under the influence of liver injury microenvironment;

(2) Paracrine pathway: Mesenchymal stem cells can secrete different levels of cytokines and interact with each other in the environment of liver injury, exhibit anti-inflammatory effects, and may activate liver stem cells in the liver to promote liver cell regeneration;

(3) Cell fusion: Mesenchymal stem cells may directly fuse with liver cells to initiate cell proliferation;

(4) Mesenchymal stem cells degrade the extracellular matrix through high expression of matrix metalloproteinases, directly degrade the extracellular matrix deposited in the liver, and reduce liver fibrosis;

(5) Mesenchymal stem cells can not only differentiate into hepatocytes, but also have the function of immune regulation in the body, reducing liver inflammation and damage.

Research progress of stem cell transplantation in treatment of liver cirrhosis

In 2019, the domestic scientific research team used meta-analysis to evaluate the clinical efficacy of mesenchymal stem cell transplantation for decompensated liver cirrhosis. A total of 394 patients with liver cirrhosis were statistically analyzed in eight clinical trials. After 3 months of treatment with mesenchymal stem cells, the end-stage liver disease score and serum alanine aminotransferase indexes were significantly improved. MSCs transplantation treatment can effectively improve the liver function of patients with decompensated cirrhosis and reduce the mortality rate.

The follow-up results showed that most patients who received stem cell transplant intervention had clinical symptoms of ascites. Abdominal distension, lower extremity edema reduced, appetite and physical strength were significantly improved; liver function was also significantly improved before intervention.

Summary

Research results show that mesenchymal stem cell transplantation intervention can repair liver damage, improve liver function, is safe and feasible, has no adverse risks, and can effectively improve the quality of life and liver function indicators.

As early as 2000, Japanese scholar Alison et al. confirmed that stem cells can differentiate into hepatocytes and transplant stem cells into the damaged liver. Stem cells may differentiate into hepatocytes under the regulation of liver microenvironment to repair and rebuild liver structure. Structure, thereby improving liver function.

(source:internet, reference only)

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