Combination of Autologous MSC and HSC Infusion in Patients With Decompensated Cirrhosis
Status:
Completed
Trial end date:
2020-09-01
Target enrollment:
Participant gender:
Summary
Though the results of autologous CD34+ cell infusion and MSC in independent studies have
shown promise, yet they are yet to reach the desired long term outcome. The possible
postulation for this is possibly because when using autologous CD34+ cell infusion, the
inflammatory milieu of the liver may not be conducive for sustained effects of the mobilized
CD 34+ cells. MSC have immunomodulatory effect (ref) and may improve the liver environment
making it more beneficial for the CD34+ cells to function and survive. In addition, MSC has
ben shown to produce hepatocyte growth factor which is protective against liver injury and
beneficial for liver regeneration (shown in above tables). However, it remains to be
understood how MSCs promote liver stem stem cells to differentiate into hepatocytes or expand
the residual hepatocyte population. MSC can also directly inhibit the activation of hepatic
stellate cells, the main source of extracellular matrix via MSC derived IL 10 and TNF-αand
may also induce hepatic stellate cell apoptosis. Current lacunae in cell based therapy is
based on the poor consensus and understanding on the best type of cells to be used, the ideal
number of cells, the most appropriate route of administration and the need for repeat dosing
. The concept that combination of autologous hematopoietic and mesenchymal stem cells
infusion may be more beneficial than infusing any one of them alone has been discussed in
many scientific forums but there are no study till date to either see the safety as well as
the efficacy of this proof of concept .
With this above background data, we propose a study design which will be a safety study for
combination use of autologous CD34+ and MSC