The impact of recipient age on the effects of umbilical cord mesenchymal stem cells on HBV-related acute-on-chronic liver failure and liver cirrhosis

Abstract

Background The results of a previous study verified that umbilical cord mesenchymal stem cells (UCMSCs) have good therapeutic effects for the treatment of HBV-related acute-on-chronic liver failure (ACLF) and liver cirrhosis (LC). Nevertheless, it is still unknown whether the effects of UCMSCs are affected by recipient age. Methods Patients treated with UCMSCs who met the criteria of HBV-related ACLF and liver cirrhosis were identified in this retrospective observational study. Patients were divided into subgroups according to the World Health Organization (WHO) age criteria (< 45 vs. ≥ 45 years). Group A included young ACLF patients (< 45 y), and group B included older ACLF patients (≥ 45 y). Young LC patients (< 45 y) were assigned to group C, and group D included older LC patients (≥ 45 y). Patients’ clinical characteristics, demographics, biochemical factors, and model for end-stage liver disease (MELD) scores were compared for 24 weeks. Results Sixty-four ACLF patients and 59 LC patients were enrolled in this study. Compared with patients in groups B and C, patients in group A did not show significant superiority in terms of the levels of ALT, AST, TBIL, AFP, and PTA and MELD scores. However, the median decrease and cumulative decrease in the TBIL and ALT levels of patients in group C were larger than those of patients in group D after four weeks of UCMSC transfusions. For older patients (≥ 45 y), the cumulative decrease and the median decrease in the TBIL of ACLF patients were significantly greater than those of LC patients after UCMSC treatment. However, the median decrease in ALT levels of ACLF patients was significantly greater than that of LC patients during UCMSC treatment, and the cumulative decrease in ALT levels of ACLF patients was significantly greater than that of LC patients at all time points. Conclusion The therapeutic effects of UCMSCs for HBV-related acute-on-chronic liver failure and liver cirrhosis varied partly by patient age. Assessing patient age is necessary prior to UCMSC clinical use.

Relationship Between Platelets and the Clinical Efficacy of Umbilical Cord Mesenchymal Stem Cells for HBV-Related Acute-on-Chronic Liver Failure and Liver Cirrhosis: A Preliminary Clinical Study

“…A brief diagnostic description was conducted as previously described. 3 We selected ACLF type A for inclusion in our study. Patients with LC who met the Chinese guidelines for the management of liver cirrhosis (abbreviated version) 10 were included in this study.…”

“…As described in our previous study, 2 , 3 all patients received standard clinical treatments before, during, and after UCMSC infusion. Data from all patients were collected from baseline to 24 weeks after therapy.…”

“…The details of the isolation, culture, and characterization of UCMSCs and the quality control were described in our previous study. 3 Patients received UCMSC transfusions once per week after recruitment. As detailed in our previous research, 2 UCMSCs suspended in 100 mL of normal saline solution were infused intravenously through a forearm vein at each treatment time.…”

“…ACLF patients have faster declines in serum total bilirubin than patients with LC. We attribute this differential efficacy to patient-related factors, such as the age of the patient, 3 their levels of platelets, and their liver size.…”

Mesenchymal stem cells-based therapy in liver diseases

“…However, research found that adipose-derived MSCs were insensitive to HBV [ 544 ] and may be a more suitable source for HBV-related liver diseases. In addition, recent studies have shown that the efficacy of MSCs in the treatment of HBV-associated acute chronic liver failure and cirrhosis varies depending on the age of the patient [ 559 ]. In summary, prior to the clinical use of MSCs, assessment of patient's age and further study of the long-term effects of MSCs therapy in HBV-infected patients from different sources are necessary to determine the safety and efficacy of their therapeutic use.…”