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In Vitro Differentiation of Mouse Granulocyte-macrophage-colony-stimulating Factor GM-CSF-producing T Helper THGM Cells
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Outcomes after multiple courses of granulocyte colony-stimulating factor and growth hormone in decompensated

Nipun Verma1, Amritjyot Kaur2, Ratiram Sharma3

  • 1Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Hepatology (Baltimore, Md.)
|December 27, 2017
PubMed

Insights

Granulocyte-colony stimulating factor (G-CSF) improved survival and disease severity in decompensated cirrhosis patients. Growth hormone (GH) did not offer additional benefits, but G-CSF therapy was well tolerated.

Area of Science:

  • Hepatology
  • Stem Cell Mobilization
  • Clinical Trials

Background:

  • Decompensated cirrhosis (DC) has high mortality, with liver transplantation (LT) limited by donor organ availability.
  • High waitlist mortality underscores the need for effective therapies to improve outcomes for DC patients awaiting LT.
  • Investigating novel therapeutic approaches is crucial for managing DC and reducing mortality.

Purpose of the Study:

  • To evaluate the impact of granulocyte-colony stimulating factor (G-CSF) with or without growth hormone (GH) on transplant-free survival (TFS) in DC patients.
  • To assess secondary outcomes including hematopoietic stem cell mobilization, clinical scores, liver stiffness, nutrition, infection episodes, and quality of life (QOL).
  • To determine if GH provides additional benefits when combined with G-CSF therapy in DC patients.

Main Methods:

  • A randomized controlled trial involving 65 DC patients assigned to standard medical therapy (SMT) plus G-CSF/GH, SMT plus G-CSF, or SMT alone.
  • Primary outcome measured was 12-month TFS.
  • Secondary outcomes included CD34+ cell mobilization, clinical scores, liver stiffness, nutritional status, infection rates, and QOL at 12 months.

Main Results:

  • Both G-CSF with or without GH significantly improved 12-month TFS compared to SMT alone (P = 0.001).
  • G-CSF therapy led to increased CD34+ cell mobilization at day 6 (P < 0.001).
  • Significant improvements were observed in clinical scores, nutrition, ascites control, liver stiffness, infection episodes, and QOL in G-CSF treated groups at 12 months (P < 0.05).

Conclusions:

  • Multiple courses of G-CSF effectively improved TFS, mobilized stem cells, and enhanced various clinical parameters in DC patients.
  • G-CSF therapy also reduced infections and the need for LT, demonstrating its therapeutic potential.
  • Growth hormone (GH) did not confer additional benefits when used alongside G-CSF in this patient population.

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