title: A pilot study of autologous CD34-depleted bone marrow mononuclear cell transplantation via the hepatic artery in five patients with liver failure.
abstract: OBJECTIVE
  Many rodent experiments and human studies on stem cell therapy have shown promising therapeutic approaches to liver diseases. We investigated the clinical outcomes of five patients with liver failure of various causes who received autologous CD34-depleted bone marrow-derived mononuclear cell (BM-MNC) transplantation, including mesenchymal stromal cells, through the hepatic artery.
  
  
  METHODS
  CD34-depleted BM-MNCs were obtained from five patients waiting for liver transplantation by bone marrow aspiration and using the CliniMACS CD34 Reagent System (Miltenyi Biotech, Bergisch Gladbach, Germany), and autologous hepatic artery infusion was performed. The causes of hepatic decompensation were hepatitis B virus (HBV), hepatitis C virus (HCV), propylthiouracil-induced toxic hepatitis and Wilson disease.
  
  
  RESULTS
  Serum albumin levels improved 1 week after transplantation from 2.8 g/dL, 2.4 g/dL, 2.7 g/dL and 1.9 g/dL to 3.3 g/dL, 3.1 g/dL, 2.8 g/dL and 2.6 g/dL. Transient liver elastography data showed some change from 65 kPa, 33 kPa, 34.8 kPa and undetectable to 46.4 kPa, 19.8 kPa, 29.1 kPa and 67.8 kPa at 4 weeks after transplantation in a patient with Wilson disease, a patient with HCV, and two patients with HBV. Ascites decreased in two patients. One of the patients with HBV underwent liver transplantation 4 months after the infusion, and the hepatic progenitor markers (cytokeratin [CD]-7, CD-8, CD-9, CD-18, CD-19, c-Kit and epithelial cell adhesion molecule [EpCAM]) were highly expressed in the explanted liver.
  
  
  CONCLUSIONS
  Serum albumin levels, liver stiffness, liver volume, subjective healthiness and quality of life improved in the study patients. Although these findings were observed in a small population, the results may suggest a promising future for autologous CD34-depleted BM-MNC transplantation as a bridge to liver transplantation in patients with liver failure.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Chung-Hwa
authors.initials: CH
authors.lastname: Park
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Hee Yeon
authors.initials: HY
authors.lastname: Kim
authors.forename: Ja Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jung
authors.forename: Ho Jong
authors.initials: HJ
authors.lastname: Chun
authors.forename: Myeong Jun
authors.initials: MJ
authors.lastname: Song
authors.forename: Sung-Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Seok Goo
authors.initials: SG
authors.lastname: Cho
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: Nam Ik
authors.initials: NI
authors.lastname: Han
authors.forename: Young Sok
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006499:Hepatic Artery / Q000166:cytology / Q000601:surgery; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000637:transplantation*; D008103:Liver Cirrhosis / Q000473:pathology / Q000628:therapy*; D017093:Liver Failure / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D008875:Middle Aged; D010865:Pilot Projects; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: autologous transplantation; liver cirrhosis; liver failure; mesenchymal stromal cell