title: Infusion of autologous bone marrow mononuclear cells through hepatic artery results in a short-term improvement of liver function in patients with chronic liver disease: a pilot randomized controlled study.
abstract: OBJECTIVE
  This randomized controlled study evaluated the effect of autologous infusion of bone marrow cells (BMC) in patients with hepatic cirrhosis.
  
  
  METHODS
  Thirty patients on the liver transplant waiting list were randomly assigned to receive BMC therapy or no treatment. They were followed up for 1 year. The study was nonblinded. Autologous mononuclear-enriched BMC were infused into the hepatic artery; liver function scores/tests were chosen as endpoints to assess efficacy. Statistical analysis calculated mean relative changes (RC) from baseline and fitted a random-effects model.
  
  
  RESULTS
  Mean age, baseline model for end-stage liver disease, and Child-Pugh score were similar in both groups. Child-Pugh score improved in the first 90 days in the cell therapy group compared with controls (P = 0.017, BMC group RC = -8%, controls RC = +5%). The model for end-stage liver disease score remained stable in the treated patients (RC -2 to +6%), whereas it increased during follow-up in the control group (RC +6 to +18%). Albumin levels improved in the treatment arm, whereas they remained stable among controls in the first 90 days (P = 0.034; BMC group RC = +16%, control group RC = +2%). Bilirubin levels increased among controls, whereas they decreased in the therapy arm during the first 60 days; INR RC differences between groups reached up to 10%. The changes observed did not persist beyond 90 days.
  
  
  CONCLUSIONS
  Transplantation of autologous BMC into the hepatic artery improved liver function in patients with advanced cirrhosis in the first 90 days. However, larger studies are necessary to define the role of BMC therapy in cirrhotic patients. Repeated autologous BMC infusions or combination therapy with granulocyte-colony-stimulating factor might improve or sustain the treatment response.
authors: Hospital Sao Rafael and c-HUPES/Federal Univeristy of Bahia, Medicine-Gastro-Hepatology Service, Graz, Austria. aclyra@atarde.com.br
authors: Andre Castro
authors: AC
authors: Lyra
authors: Milena Botelho Pereira
authors: MB
authors: Soares
authors: Luiz Flavio Maia
authors: LF
authors: da Silva
authors: Eduardo Lorens
authors: EL
authors: Braga
authors: Sheilla A
authors: SA
authors: Oliveira
authors: Marcos Fraga
authors: MF
authors: Fortes
authors: Andre Goyanna Pinheiro
authors: AG
authors: Silva
authors: Daniele
authors: D
authors: Brustolim
authors: Bernd
authors: B
authors: Genser
authors: Ricardo Ribeiro
authors: RR
authors: Dos Santos
authors: Luiz Guilherme Costa
authors: LG
authors: Lyra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D016026:Bone Marrow Transplantation / Q000379:methods*; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D012709:Serum Albumin / Q000378:metabolism; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D001663:Bilirubin