Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver

Abstract

Increasing severity of cirrhosis causes derangement of the hematopoietic niche and loss of HSCs, contributing to the hematological and immunological dysfunctions and reduced potential for regeneration; restoring BM functions could provide new therapeutic options in cirrhosis. (Hepatology 2016;64:1273-1288).

Early cirrhosis and a preserved bone marrow niche favour regenerative response to growth factors in decompensated cirrhosis

“…This suggests that a healthy cellular BM is a pre‐requisite for effective stem cell mobilization therapy and BM paralysis in advanced liver disease might be responsible for their non‐response to growth factor therapy. Advanced cirrhosis is known to have deleterious effect on BM HSCs and may be responsible for ineffective mobilizable HSC pool from the BM.…”

Autologous bone marrow-derived cell transplantation in decompensated alcoholic liver disease: what is the impact on liver histology and gene expression patterns?

“…The severe inflammatory condition present in AH could also alter this phenomenon. A reduced potential of regeneration for bone marrow stem cells from patients with cirrhosis was also recently described and correlated with the severity of the liver disease assessed by prognostic factors [24]. Another hypothesis is that the bone marrow stimulus in our study (5-day GCSF stimulation followed by one single injection of stem cells in the hepatic artery) was not sufficient to enhance regeneration.…”

Radiotherapy for one rectal cancer patient with cirrhosis and moderate to severe thrombocytopenia: a case report

“…At present, splenic platelet sequestration is considered to be the major cause of thrombocytopenia in cirrhotic patients,4–6 while immunological processes, chronic HCV infection, and a decrease in hematopoietic growth factors can also contribute to it 7. Studies have also shown that bone marrow function is suppressed in advanced cirrhosis and the potential for regeneration declines, and this contributes significantly to hematological abnormalities in patients 8. Thrombocytopenia is considered a major risk factor for bleeding events; however, in recent years, some researchers have argued that a “rebalance” would be established in patients with chronic liver disease9 as coagulation inhibiting factors decrease concomitantly when clotting factors decline 10.…”

“…But in the case of the patient described in this study, platelet count declined much more sharply than generally observed and failed to improve after platelet transfusion and supportive treatment. While input platelets are likely to have been destroyed in the spleen, decreased bone marrow compensatory function due to long-term cirrhosis and thrombocytopenia must also be considered as this may lead to deficient hematopoiesis and poorer tolerance of radiotherapy 8. Therefore, for patients with liver cirrhosis and thrombocytopenia, bone marrow function may also be defective in addition to hypersplenism.…”