One of the saddest cases I ever treated was a two year old baby brought to the clinic on a late Friday afternoon, with a history of throwing up for two days.

Not usually a problem, since gastroenteritis is a common problem with kids, and usually easily treated with oral pedialyte or other fluids.

But when I checked the kid, it was not only mildly dehydrated but it was jaundiced. And so we admitted the child, started IV fluids, and checked the bilirubin. On admitting the child, we called the local pediatrician– the only one in our county, and he agreed with the treatment, and didn’t think transfer was needed.

But then after we put a needle into a vein to give the child fluids, we noted the tiny wound bled more than expected, and when the bilirubin came back it was 30.

To make a long story short, the child was quickly transferred 200 miles to the University, where his condition deteriorated, and a liver transplant was needed. But there was no children’s liver available, but the father had a tissue match, so the child was transferred again to a different University that was doing partial transplants from a living adult relative. Alas, the day before the transplant, the child had a massive stroke, which is a complication of liver failure was not clotting, and two days later he died.

Losing a child is always a tragedy, and losing a child to viral hepatitis, which is usually mild in children, is especially heartbreaking. But losing an adult from liver disease is alas not rare, and often transplant is not an option because of lack of organs, coexisting disease,  and also the high reoccurance of the same disease in the new liver.
Most people dying of liver disease are after chronic hepatitis of one sort or another: from one of the various viral infections, or from toxins, the most common of which is alcohol.

But one feels especially helpless when the need is for a transplant from an infection, especially since usually if you can keep the person alive, the liver is able to regenerate itself.

So the latest newspaper headline in the UK Telegraph is a little bit misleading:

Stem cell therapy ‘could cut liver transplants

A quick glance suggests that using embryonic stem cells would regrow your liver. But it isn’t. It is about using the patient’s own bone marrow stem cells to increase the patients’ immune system to stop the virus from killing the liver cells. This would let the person live longer, and allow the remaining liver cells to regenerate, or if the liver is too far gone to repair the damage, to live long enough for a transplant.

The idea is not new, but scientists have found a way to get enough cells to make it work…so far in rats. from the article:

the MGH research team used mesenchymal stem cells (MSCs) – cells from the bone marrow that develop into tissues supporting blood cell development in the marrow cavity. Previous research has shown that MSCs are able to inhibit several immune system activities. A supply of MSCs can be extracted from a patient’s own marrow and expanded to levels that could be therapeutically useful….

Although simply transplanting MSCs was not effective, two methods of delivering molecules secreted by the cells lessened inflammation within the liver and halted cell death….

A patient presenting with liver failure could first be treated with an intravenous injection of an ‘off-the-shelf’ drug containing MSC-produced factors in an effort to halt cell damage and allow the organ to regenerate. If that is not effective, an MSC-based support device could be used as a bridge to transplantation or even as a long-term treatment.”.

And the article says that stopping the inflammation of liver cells could lengthen the lives of those with chronic liver problems.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket and she writes medical essays at Hey Doc Xanga Blog. 

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