Stem cells for Liver Disease:
The number of lives lost due to liver disease across the world is around 2 million every year. Of these, 1 million is accounted for by viral hepatitis and hepatocellular carcinoma while the remaining 1 million is due to complications associated with cirrhosis. 3.5% of all deaths globally are accounted for by liver cancer and cirrhosis that are the 16th and 11th causes of death, respectively. Additionally, the incidence of viral hepatitis and so is the prevalence of drug-induced liver injury. To add fuel to the fire, alcohol is consumed by 2 billion people globally facing the risk of alcohol-associated liver disease and the tendency to be obese or suffer from diabetes puts one at the risk of non-alcoholic fatty liver disease and hepatocellular carcinoma. It is thus not surprising that the second most common solid organ transplantation is that of the liver. However, a major challenge here is donor shortage: not even 10% of global transplantation needs are being addressed now (Asrani et al, 2019).
Stem cells with their multiple advantages enter the scenario: early work in 2006 showed that the administration of autologous bone marrow stem cells from the ilium of nine liver cirrhosis patients was associated with no adverse effects. Additionally, the use of stem cells for cirrhosis was suggested given that the stem cell treatment resulted in improved levels of serum albumin levels and total protein, as well as, the Child-Pugh scores (a system to assess mortality in patients with cirrhosis) (Terai et al, 2006).
A multicenter, randomized, open-label, phase 2 trial published in 2016 by Suk and team described the potential of bone marrow-derived mesenchymal stem cell therapy for liver cirrhosis. The administration of autologous MSCs (5 × 107 BM-MSCs; hepatic arterial injections) in patients resulted in lowered fibrosis, as measured by a decrease in collagen by 25% (one-time MSC treatment) and 37% (two-times MSC treatment). Further, an improvement was also noted in Child-Pugh scores 12 months after the cell injection showing the ability of MSCs to address fibrosis and improve liver functions.
The burden of liver disease looms over the world threatening world health: the field of stem cells emerges as the light at the end of the tunnel in terms of safety and efficacy to help patients live a life of dignity: a basic right!
Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151-171. DOI:10.1016/j.jhep.2018.09.014
Tsuchiya, A., Takeuchi, S., Watanabe, T. et al. Mesenchymal stem cell therapies for liver cirrhosis: MSCs as “conducting cells” for improvement of liver fibrosis and regeneration. Inflamm Regener 39, 18 (2019). https://inflammregen.biomedcentral.com/articles/10.1186/s41232-019-0107-z
Terai S, Ishikawa T, Omori K, et al. Improved liver function in patients with liver cirrhosis after autologous bone marrow cell infusion therapy. Stem Cells. 2006;24:2292–8.
Suk KT, Yoon JH, Kim MY, et al. Transplantation with autologous bone marrow-derived mesenchymal stem cells for alcoholic cirrhosis: Phase 2 trial. Hepatology. 2016;64(6):2185-2197. DOI:10.1002/hep.28693