Human umbilical cord blood-derived mononuclear cell transplantation for umbilical hernia and hepatic hydrothorax in primary biliary cirrhosis

Ying-Mei Tang, Yun Zhang, Li-Ying You, Wei-Min Bao, Hong-Wei Wang, Jin-Hui Yang, Xiang Hu

Department of General Surgery, Yunnan Provincial 1st People’s Hospital, Kunming, China.
Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical College, Yunnan Research Center for Liver Diseases, Kunming, China.
Shenzhen Beike Cell Engineering Research Institute, Shenzhen, China.

DOI: 10.4236/scd.2012.22005                

Abstract

Cell therapy was proposed as a potential treatment intervention for liver cirrhosis recently due to the fact that the therapeutic protocol for primary biliary cirrhosis (PBC)-associated refractory umbilical hernia and hepatic hydrothorax is not well defined currently. We report herein the case of a 58-year-old woman who received routine treatments for PBC, which developed into an incarcerated hernia and uncontrolled hydrothorax. This subject’s condition was significantly improved and maintained stable condition after receiving human umbilical cord blood-derived mononuclear cell (CBMC) transplantation. Consequently, this new strategy may be a potential treatment option for the refractory umbilical hernia and hydrothorax caused by PBC. However, sufficient data from large-scale controlled and double-blinded clinical trials are needed to further confirm the treatment efficacy and longterm safety before this cell transplantation can be used as a regular therapy for liver cirrhosis.

Keywords

Primary Biliary Cirrhosis (PBC); Umbilical Hernia; Hepatic Hydrothorax; Human Umbilical Cord Blood-Derived Mononuclear Cell (CBMC) transplantation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Poupon, R. (2010) Primary biliary cirrhosis: A 2010 update. Journal of Hepatology, 52, 745-758. doi:10.1016/j.jhep.2009.11.027
[2]	Hohenester, S., Oude-Elferink, R. P. and Beuers, U. (2009) Primary biliary cirrhosis. Seminars in Immunopathology, 31, 283-307. doi:10.1007/s00281-009-0164-5
[3]	Kaplan, M.M. and Gershwin, M.E. (2005) Primary biliary cirrhosis. The New England Journal of Medicine, 353, 1261-1273. doi:10.1056/NEJMra043898
[4]	Zhao, D.C., Lei, J.X., Chen, R., Yu, W.H., Zhang, X.M., Li, S.N. and Xiang, P. (2005) Bone marrow-derived mesenchymal stem cells protect against experimental liver ?brosis in rats. World Journal of Gastroenterology, 11, 3431-3440.
[5]	Terai, S. and Sakaida, I. (2011) Autologous bone marrow cell infusion therapy for liver cirrhosis patients. Journal of Hepato-Biliary-Pancreatic Sciences, 18, 23-25. doi:10.1007/s00534-010-0305-1
[6]	Yang, W.Z., Zhang, Y., Wu, F., Min, W.P., Minev, B., Zhang, M., Luo, X.L., Ramos, F., Ichim, T.E., Riordan, N.H. and Hu, X. (2010) Safety evaluation of allogeneic umbilical cord blood mononuclear cell therapy for degenerative conditions. Journal of Translational Medicine, 8, 75. doi:10.1186/1479-5876-8-75
[7]	Eker, H.H., van Ramshorst, G.H., de Goede, B., Tilanus, H.W., Metselaar, H.J., de Man, R.A., Lange, J.F. and Kazemier, G. (2011) A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites. Surgery, 150, 542-546. doi:10.1016/j.surg.2011.02.026
[8]	Lemmer, J.H., Strodel, W.E., Knol, J.A. and Eckhauser, F.E. (1983) Management of spontaneous umbilical hernia disruption in the cirrhotic patient. Annals of Surgery, 198, 30-34. doi:10.1097/00000658-198307000-00006
[9]	Garrison, R.N., Cryer, H.M., Howard, D.A. and Polk, H.C. Jr. (1984) Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Annals of Surgery, 199, 648-655. doi:10.1097/00000658-198406000-00003
[10]	Belghiti, J. and Durand, F. (1997) Abdominal wall hernias in the setting of cirrhosis. Seminars in Liver Disease, 17, 219-226. doi:10.1055/s-2007-1007199
[11]	Gordon, F.D., Anastopoulos, H.T. and Crenshaw, W. (1997) The successful treatment of symptomatic, refracttory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology, 25, 1366-1369. doi:10.1002/hep.510250611
[12]	Park, S.Z., Shrager, J.B. and Allen, M.S. (1997) Treatment of refractory, nonmalignant thydrothorax with a pleurovenous shunt. The Annals of Thoracic Surgery, 63, 1777-1779. doi:10.1016/S0003-4975(97)00131-8
[13]	Russo, F.P., Alison, M.R., Bigger, B.W., Amofah, E., Florou, A., Amin, F., Bou-Gharios, G., Jeffery, R., Iredale, J.P. and Forbes, S.J. (2006) The bone marrow functionally contributes to liver fibrosis. Gastroenterology, 130, 1807-1821. doi:10.1053/j.gastro.2006.01.036
[14]	Oyagi, S., Hirose, M., Kojima, M., Okuyama, M., Kawase, M., Nakamura, T., Ohgushi, H. and Yagi, K. (2006) Therapeutic effect of transplanting HGF-treated bone marrow mesenchymal cells into CCl4-injured rats. Journal of Hepatology, 44, 742-748. doi:10.1016/j.jhep.2005.10.026
[15]	Amer, M.E., El-Sayed, S.Z., El-Kheir, W.A., Gabr, H., Gomaa, A.A., El-Noomani, N. and Hegazy, M. (2011) Clinical and laboratory evaluation of patients with endstage liver cell failure injected with bone marrow-derived hepatocyte-like cells. European Journal of Gastroenterology & Hepatology, 23, 936-941. doi:10.1097/MEG.0b013e3283488b00
[16]	Peng, L., Xie, D.Y., Lin, B.L., Liu, J., Zhu, H.P., Xie, C., Zheng, Y.B. and Gao, Z.L. (2011) Autologous bone marrow mesenchymal stem cell transplantation in liver failure patients caused by hepatitis B: Short-term and longterm outcomes. Hepatology, 54, 820-828. doi:10.1002/hep.24434
[17]	Kim, J.K., Park, Y.N., Kim, J.S., Park, M.S., Paik, Y.H., Seok, J.Y., Chung, Y.E., Kim, H.O., Kim, K.S., Ahn, S.H., Kim, Y., Kim. M.J., Lee, K.S., Chon, C.Y., Kim, S.J., Terai, S., Sakaida, I. and Han, K.H. (2010) Autologous bone marrow infusion activates the progenitor cell compartment in patients with advanced liver cirrhosis. Cell Transplantation, 19, 1237-1246. doi:10.3727/096368910X506863
[18]	Broxmeyer, H.E., Douglas, G.W., Hangoc, G., Cooper, S., Bard, J., English, D., Arny, M., Thomas, L. and Boyse, E.A. (1989) Human umbilical cord blood as a potential source of transplantable hematopoietic stem/progenitor cells. Proceedings of the National Academy of Sciences, 86, 3828-3832. doi:10.1073/pnas.86.10.3828
[19]	Schoemans, H., Theunissen, K., Maertens, J., Boogaerts, M., Verfaillie, C. and Wagner, J. (2006) Adult umbilical cord blood transplantation: A comprehensive review. Bone Marrow Transplantation, 38, 83-93. doi:10.1038/sj.bmt.1705403
[20]	Stanevsky, A., Goldstein, G. and Nagler, A. (2009) Umbilical cord blood transplantation: Pros, cons and beyond. Blood Reviews, 23, 199-204. doi:10.1016/j.blre.2009.02.001
[21]	Yang, W.Z., Zhang, Y., Wu, F., Zhang, M., Cho, S.C., Li, C.Z., Li, S.H., Shu, G.J., Sheng, Y.X., Zhao, N., Tang, Y., Jiang, S., Jiang, S., Gandjian, M., Ichim, T.E. and Hu, X. (2011) Human umbilical cord blood-derived mononuclear cell transplantation: Case series of 30 subjects with hereditary ataxia. Journal of Translational Medicine, 9, 65. doi:10.1186/1479-5876-9-65
[22]	Teramoto, K., Asahina, K., Kumashiro, Y., Kakinuma, S., Chinzei, R., Shimizu-Saito, K., Tanaka, Y., Teraoka, H. and Arii, S. (2005) Hepatocyte differentiation from embryonic stem cells and umbilical cord blood cells. Journal of Hepato-Biliary-Pancreatic Surgery, 12, 196-202. doi:10.1007/s00534-005-0980-5
[23]	Zhang, F.T., Fang, J.Z., Yu, J., Wan, H.J., Ye, J., Long, X., Yin, M.J. and Huang, C.Q. (2006) Conversion of mononuclear cells from human umbilical cord blood into heaptocyte-like cells. Academic Journal of Second Military Medical University, in Chinese, 21, 358-364.
[24]	Fujino, H., Hiramatsu, H., Tsuchiya, A., Niwa, A., Noma, H., Shiota, M., Umeda, K., Yoshimoto, M., Ito, M., Heike, T. and Nakahata, T. (2007) Human cord blood CD34+ cells develop into hepatocytes in the livers of NOD/SCID/γcnull mice through cell fusion. The FASEB Journal, 21, 3499-3510. doi:10.1096/fj.06-6109com
[25]	Lee, O.K., Kuo, T.K., Chen, W.M., Lee, K.D., Hsieh, S.L. and Chen, T.H. (2004) Isolation of multipotent mesenchymal stem cells from umbilical cord blood. Blood, 103, 1669-1675. doi:10.1182/blood-2003-05-1670
[26]	Hong, S.H., Gang, E.J., Jeong, J.A., Ahn, C., Hwang, S.H., Yang, I.H., Park, H.K., Han, H. and Kim, H. (2005) In vitro differentiation of human umbilical cord bloodderived mesenchymal stem cells into hepatocyte-like cells. Biochemical and Biophysical Research Communications, 330, 1153-1161. doi:10.1016/j.bbrc.2005.03.086
[27]	Moon, Y.J., Yoon, H.H., Lee, M.W., Jang, I.K., Lee, D.H., Lee, J.H., Lee, S.K., Lee, K.H., Kim, Y.J. and Eom, Y.W. (2009) Multipotent progenitor cells derived from human umbilical cord blood can differentiate into hepatocytelike cells in a liver injury rat model. Transplantation Proceedings, 41, 4357-4360. doi:10.1016/j.transproceed.2009.08.053
[28]	Sun, Y., Xiao, D., Zhang, R.S., Cui, G.H., Wang, X.H. and Chen, X.G. (2007) Formation of human hepatocyte-like cells with different cellular phenotypes by human umbilical cord blood-derived cells in the human-rat chimeras. Biochemical and Biophysical Research Communications, 357, 1160-1165. doi:10.1016/j.bbrc.2007.04.087
[29]	Kakinuma, S., Tanaka, Y., Chinzei, R., Watanabe, M., Shimizu-Saito, K., Hara, Y., Teramoto, K., Arii, S., Sato, C., Takase, K., Yasumizu, T. and Teraoka, H. (2003) Human umbilical cord blood as a source of transplantable hepatic progenitor cells. Stem Cells, 21, 217-227. doi:10.1634/stemcells.21-2-217
[30]	Nonome, K., Li, X.K., Takahara, T., Kitazawa, Y., Funeshima, N., Yata, Y., Xue, F., Kanayama, M., Shinno, E., Kuwae, C., Saito, S., Watanabe, A. and Sugiyama, T. (2005) Human umbilical cord blood-derived cells differentiate into hepatocyte-like cells in the Fas-mediated liver injury model. American Journal of Physiology Gastrointestinal and Liver Physiology, 289, 1091-1099. doi:10.1152/ajpgi.00049.2005
[31]	Bassiouny, A.R., Zaky, A.Z., Abdulmalek, S.A., Kandeel, K.M., Ismail, A. and Moftah, M. (2011) Modulation of AP-endonuclease1 levels associated with hepatic cirrhosis in rat model treated with human umbilical cord blood mononuclear stem cells. International Journal of Clinical and Experimental Pathology, 4, 692-707.
[32]	Jung, K.H., Shin, H.P., Lee, S., Lim, Y.J., Hwang, S.H., Han, H., Park, H.K., Chung, J.H. and Yim, S.V. (2009) Effect of human umbilical cord blood-derived mesenchymal stem cells in a cirrhotic rat model. Liver International, 29, 898-909. doi:10.1111/j.1478-3231.2009.02031.x
[33]	Shi, L.L., Liu, F.P. and Wang, D.W. (2011) Transplantation of human umbilical cord blood mesenchymal stem cells improves survival rates in a rat model of acute hepatic necrosis. American Journal of the Medical Sciences, 342, 212-217. doi:10.1097/MAJ.0b013e3182112b90
[34]	Jung, K.H., Uhm, Y.K., Lim, Y.J. and Yim, S.V. (2011) Human umbilical cord blood-derived mesenchymal stem cells improve glucose homeostasis in rats with liver cirrhosis. International Journal of Oncology, 39, 137-143. doi:10.3892/ijo.2011.1016
[35]	Zhang, F.T., Wan, H.J., Li, M.H., Ye, J., Yin, M.J., Huang, C.Q. and Yu, J. (2011) Transplantation of microencapsulated umbilical-cord-blood-derived hepatic-like cells for treatment of hepatic failure. World Journal of Gastroenterology, 17, 938-945.doi:10.3748/wjg.v17.i7.938