Autologous Bone Marrow-Derived Stem Cell Transplantation In Patients With Child C Liver Cirrhosis Comparative Study

Background: Adult stem cell therapy could help patients with child C liver cirrhosis . Aim and methods: to evaluate the effect of autologous transplantation of BM-derived mononuclear cells subjected to ex vivo hepatocyte differentiation and BM-derived undifferentiated mesenchymal stem cells in cirrhotic patients, and assessing the safety and efficacy of transplantation of these cells via direct intrasplenic injection. 30 patients with Child C cirrhosis were enrolled , They were divided into three groups. Group 1: 10 patients who received bone marrow derived mononuclear cells after ex vivo hepatocyte differentiation. Group 2: 10 patients; who received bone marrow derived undifferentiated mesenchymal stem cells. Group 3: 10 patients who were maintained on their ordinary liver supportive treatment . Bone marrow aspiration was done from the posterior superior iliac spine. After MNCs separation, induction of hepatocyte differentiation by co-cultures with hepatocyte growth factor and basic fibroblast growth factor were done and demonstration of alpha fetoprotein and albumin gene expression were used as markers of hepatocyte differentiation, the cells were then injected to group 1 patients in a dose of 5×106/ml suspended in 5 ml sterile saline via intrasplenic route under ultrasonic guidance. Isolation of mesenchymal stem cells was done followed by primary culture and subculture of the isolated cells. Flow cytometry was used to identify MSCs by surface expression of CD44, CD73, and CD34. Group 2 were injected with undifferentiated mesenchymal stem cells in a dose of 5×106/ml suspended in 5 ml sterile saline via intrasplenic route . Control group remained on their medical liver supportive measures. Monthly liver function were done for 6 months follow up . Results: there was a statistically significant improvement in the hepatic synthetic function and possible reduction in mortality in patients received stem cell therapy compared to control group. Statistical comparisons between the two transplanted groups did not merit any significant difference. Conclusion: Transplantation of either BM- derived mononuclear cells after ex vivo hepatocyte differentiation or BMderived undifferentiated mesenchymal cells can be used as a potential treatment for liver cirrhosis. Also intrasplenic route of cells injection is both safe and feasible