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      Endoscopic ultrasound-guided intraportal injection of autologous bone marrow in patients with decompensated liver cirrhosis: A case series

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          Abstract

          BACKGROUND

          Recently, stem cell therapy has been extensively studied as a promising treatment for decompensated liver cirrhosis (DLC). Technological advances in endoscopic ultrasonography (EUS) have facilitated EUS-guided portal vein (PV) access, through which stem cells can be precisely infused.

          AIM

          To investigate the feasibility and safety of fresh autologous bone marrow injection into the PV under EUS guidance in patients with DLC.

          METHODS

          Five patients with DLC were enrolled in this study after they provided written informed consent. EUS-guided intraportal bone marrow injection with a 22G FNA needle was performed using a transgastric, transhepatic approach. Several parameters were assessed before and after the procedure for a follow-up period of 12 mo.

          RESULTS

          Four males and one female with a mean age of 51 years old participated in this study. All patients had hepatitis B virus-related DLC. EUS-guided intraportal bone marrow injection was performed in all patients successfully without any complications such as hemorrhage. The clinical outcomes of the patients revealed improvements in clinical symptoms, serum albumin, ascites, and Child-Pugh scores throughout the 12-mo follow-up.

          CONCLUSION

          The use of EUS-guided fine needle injection for intraportal delivery of bone marrow was feasible and safe and appeared effective in patients with DLC. This treatment may thus be a safe, effective, non-radioactive, and minimally invasive treatment for DLC.

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          Most cited references22

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          Burden of liver diseases in the world

          Sumeet K Asrani, Harshad Devarbhavi, John Eaton … (2019)
          Liver disease accounts for approximately 2 million deaths per year worldwide, 1 million due to complications of cirrhosis and 1million due to viral hepatitis and hepatocellular carcinoma. Cirrhosis is currently the 11th most common cause of death globally and liver cancer is the 16th leading cause of death; combined, they account for 3.5% of all deaths worldwide. Cirrhosis is within the top 20 causes of disability-adjusted life years and years of life lost, accounting for 1.6% and 2.1% of the worldwide burden. About 2 billion people consume alcohol worldwide and upwards of 75 million are diagnosed with alcohol-use disorders and are at risk of alcohol-associated liver disease. Approximately 2 billion adults are obese or overweight and over 400 million have diabetes; both of which are risk factors for non-alcoholic fatty liver disease and hepatocellular carcinoma. The global prevalence of viral hepatitis remains high, while drug-induced liver injury continues to increase as a major cause of acute hepatitis. Liver transplantation is the second most common solid organ transplantation, yet less than 10% of global transplantation needs are met at current rates. Though these numbers are sobering, they highlight an important opportunity to improve public health given that most causes of liver diseases are preventable.
          Article 0 comments Cited 1026 times – based on 0 reviews     Review now
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            Accumulated chromosomal instability in murine bone marrow mesenchymal stem cells leads to malignant transformation.

            Byoung-Do Seo, John Nash, Masako Miura … (2006)
            Despite recent emerging evidence suggesting that cancer stem cells subsist in a variety of tumors, it is not yet fully elucidated whether postnatal stem cells are directly involved in tumorigenesis. We used murine bone marrow-derived mesenchymal stem cells (BMMSCs) as a model to test a hypothesis that tumorigenesis may originate from spontaneous mutation of stem cells. In this study, we demonstrated that murine BMMSCs, after numerous passages, obtained unlimited population doublings and proceeded to a malignant transformation state, resulting in fibrosarcoma formation in vivo. Transformed BMMSCs colonized to multiple organs when delivered systemically through the tail vein. Fibrosarcoma cells formed by transformed BMMSCs contained cancer progenitors, which were capable of generating colony clusters in vitro and fibrosarcoma in vivo by the second administration. The mechanism by which BMMSCs transformed to malignant cells was associated with accumulated chromosomal abnormalities, gradual elevation in telomerase activity, and increased c-myc expression. Moreover, BMMSCs and their transformed counterpart, fibrosarcoma-forming cells, demonstrated different sensitivity to anti-cancer drugs. BMMSCs/fibrosarcoma transformation system may provide an ideal system to elucidate the mechanism of how stem cells become cancer cells and to screen anti-sarcoma drugs.
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              Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients.

              G D'Amico, L Pasta, A. Morabito … (2014)
              Morphological, haemodynamic and clinical stages of cirrhosis have been proposed, although no definite staging system is yet accepted for clinical practice.
              Article 0 comments Cited 146 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Shao-Peng Zheng
                Ao-Jian Deng
                Jing-Jing Zhou
                Ling-Zhi Yuan
                Xiao Shi
                Fen Wang
                Journal
                Journal ID (nlm-ta): World J Gastrointest Surg
                Journal ID (publisher-id): WJGS
                Title: World Journal of Gastrointestinal Surgery
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 1948-9366
                Publication date (Print): 27 April 2023
                Publication date (Electronic): 27 April 2023
                Volume: 15
                Issue: 4
                Pages: 655-663
                Affiliations
                Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
                Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Central South University, Changsha 410000, Hunan Province, China
                Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
                Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Central South University, Changsha 410000, Hunan Province, China
                Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
                Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
                Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Central South University, Changsha 410000, Hunan Province, China
                Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
                Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
                Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Central South University, Changsha 410000, Hunan Province, China. wfen-judy@ 123456csu.edu.cn
                Author notes

                Author contributions: Wan F designed the research; Zheng SP, Zhou JJ, Yuan LZ, Shi X, and Wan F performed the research; Zheng SP analyzed the data; Zheng SP and Deng AJ wrote the paper.

                Supported by the National Natural Science Foundation of China, No. 82270594; National Natural Science Foundation for Youths of China, No. 882002614 and No. 82103151; Hunan Provincial Natural Science Foundation of China, No. 2020JJ4853; Scientific Research Project of Hunan Provincial Health Commission, No. 202103032097; Outstanding Youth Foundation of Hunan Province, No. 2022JJ20092; Hunan Provincial Natural Science Foundation of China for Youths, No. 2021JJ40935 and No. 2020JJ5609; and Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hospital of Central South University , No. YX202103.

                Corresponding author: Fen Wang, MD, PhD, Doctor, Professor, Department of Gastroenterology, Third Xiangya Hospital of Central South University, No. 138 Tongzi Road, Changsha 410013, Hunan Province, China. wfen-judy@ 123456csu.edu.cn

                Article
                Other ID: jWJGS.v15.i4.pg655
                DOI: 10.4240/wjgs.v15.i4.655
                PMC ID: 10190720
                SO-VID: 7db93cf7-3574-47e0-a223-5fb779b808cc
                Copyright © ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

                History
                Date received : 17 October 2022
                Date revision received : 31 January 2023
                Date accepted : 21 March 2023
                Categories
                Subject: Clinical Trials Study

                Keywords: endoscopic ultrasonography,fine needle injection,portal vein,decompensated liver cirrhosis,bone marrow
                Data availability:
                Keywords: endoscopic ultrasonography, fine needle injection, portal vein, decompensated liver cirrhosis, bone marrow

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