Autologous bone marrow mononuclear cell infusion for liver cirrhosis after the Kasai operation in children with biliary atresia

Nguyen, Thanh Liem; Nguyen, Hoang Phuong; Ngo, Duy Minh; Ha, Thu Hien Thi; Mai, Kieu Anh; Bui, Thu Hang; Nguyen, Phan Van; Pham, Lan Huong; Hoang, Duc Minh; Cao, Anh Dao Thi

Abstract

Aim: To evaluate the safety and early outcomes of autologous bone marrow mononuclear cell (BMMNC) infusion for liver cirrhosis due to biliary atresia (BA) after Kasai operation.

Methods: An open-label clinical trial was performed from January 2017 to December 2019. Nineteen children with liver cirrhosis due to BA after Kasai operation were included. Bone marrow was harvested through anterior iliac crest puncture under general anesthesia. Mononuclear cells (MNCs) were isolated by Ficoll gradient centrifugation and then infused into the hepatic artery. The same procedure was repeated 6 months later. Serum bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and prothrombin time were monitored at baseline, 3 months, 6 months, and 12 months after the first transplantation. Esophagoscopies and liver biopsies were performed in patients whose parents provided consent. Mixed-effect analysis was used to evaluate the changes in Pediatric End-Stage Liver Disease (PELD) scores.

Results: The average MNC and CD34+ cell counts per kg body weight were 50.1 ± 58.5 × 106/kg and 3.5 ± 2.8 × 106 for the first transplantation and 57.1 ± 42.0 × 106/kg and 3.7 ± 2.7 × 106 for the second transplantation. No severe adverse events associated with the cell therapy were observed in the patients. One patient died 5 months after the first infusion at a provincial hospital due to the rupture of esophageal varices, while 18 patients survived. Liver function was maintained or improved after infusion, as assessed by biochemical tests. The severity of the disease reduced markedly, with a significant reduction in PELD scores.

Conclusion: Autologous BMMNC administration for liver cirrhosis due to BA is safe and may maintain or improve liver function.


Trial registration: ClinicalTrials.gov identifier: NCT03468699. Name of the registry: Vinmec Research Institute of Stem Cell and Gene Technology.

https://clinicaltrials.gov/ct2/show/NCT03468699?cond=biliary+atresia&cntry=VN&draw=2&rank=2. Registered on March 16, 2018. The trial results will also be published according to the CONSORT statement at conferences and reported in peer-reviewed journals.

Citation

Nguyen, T. L., Nguyen, H. P., Ngo, D. M., Ha, T. H. T., Mai, K. A., Bui, T. H., Nguyen, P. V., Pham, L. H., Hoang, D. M., & Cao, A. D. T. (2022). Autologous bone marrow mononuclear cell infusion for liver cirrhosis after the Kasai operation in children with biliary atresia. Stem Cell Research and Therapy, 13(1), 1-11. https://doi.org/10.1186/s13287-022-02762-x

• Journal Article Type: Article
• Acceptance Date: Sep 8, 2021
• Online Publication Date: Mar 14, 2022
• Publication Date: 2022-12
• Deposit Date: Oct 19, 2024
• Publicly Available Date: Oct 23, 2024
• Journal: Stem Cell Research & Therapy
• Print ISSN: 1757-6512
• Electronic ISSN: 1757-6512
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 1
• Article Number: 108
• Pages: 1-11
• DOI: https://doi.org/10.1186/s13287-022-02762-x
• Keywords: Biliary atresia, Kasai operation, Bone marrow mononuclear cell infusion
• Public URL: https://nottingham-repository.worktribe.com/output/40563082
• Publisher URL: https://stemcellres.biomedcentral.com/articles/10.1186/s13287-022-02762-x
• Additional Information: Received: 8 September 2021; Accepted: 1 February 2022; First Online: 14 March 2022; : ; : The study protocol was reviewed and approved by the Institutional Review Board of Vinmec International Hospital on January 15, 2017. The reference number for the ethics approval is 150117/2017/QD-VMEC. The committee evaluated the ethical aspects of the study in accordance with the World Medical Association’s Declaration of Helsinki. The study was explained in detail to the parents of the participants.; : This manuscript does not include personal information of participants. Therefore, written inform consent for publication is not applicable. We confirm that informed consent to receive the cell therapy/interventions containing explanation of benefits and risks was obtained from parent of all patients. Autologous BMMNC infusion for children with BA was approved by the Ministry of Health (Approval number: 612/QD-BYT). Participants in this study did pay for treatment fee.; : The authors have declared that no competing interests exist.