First experience in usage of lipoaspirate-derived mesenchymal stromal cells in combined treatment of the patients with liver cirrhosis
Liver cirrhosis (LC) is a serious problem with respect to drug therapy. Certain promises are associated with development of stem cell-based technologies, in particular, mesenchymal stromal cells (MSCs). Over recent years, a significant interest was drawn to the usage of MSCs isolated from adipose tissue, which have a number of advantages over bone marrow MSCs. The aim of this study was to evaluate safety and tolerability of transplantation of autologous MSCs derived from adipose tissue (lipoaspirate) when treating the patients with LC of different origin. The study group consisted of 12 patients (4 men and 8 women), aged 33 to 67 years. In six patients, development of LC was due to viral hepatitis; in other subjects it was caused by non-viral factors, including toxic effects (n = 3), primary biliary cirrhosis (n = 2) and cryptogenic cirrhosis (n = 1). The LC severity assessed by the Child-Pugh scale corresponded to class A (6 cases) or class B (6 patients). The MELD scores varied from 8 to 11. All patients were injected once with autologous MSCs (a mean of 12.94 × 106, 11.3 to 16.0 × 106) obtained by culturing the lipoaspirate cells for 14 days. Lipoaspiration and injection of MSCs were not accompanied by development of side effects, or serious adverse events. Analysis of clinical efficacy, carried out 6-12 months after therapy, made it possible to distinguish two subgroups: responders to the therapy (subgroup 1, n = 6) and non-responders (subgroup 2, n = 6). In subgroup 1, the MELD score was found to be decreased in 4 cases, and did not change in 2 patients. In contrast, the MELD score increased in the patients from subgroup 2. Both subgroups did not differ in etiology and severity of LC, or concomitant pathology (COVID-19). Positive dynamics in subgroup 1 was revealed for the signs of hepatocellular insufficiency (n = 1), cytolysis (n = 2) and cholestasis (n = 1). In two patients with MELD score stabilization, the scores reached the reference values. After MSC therapy, the majority of patients (8/12) underwent a new coronavirus infection, and the COVID incidence rate was similar in groups with or without response to MSC therapy (4 patients in each group). The results of the study suggest the safety of using MSCs isolated from the adipose tissue of patients with liver cirrhosis, and the perspectives of such approach in order to stabilize or improve liver function.