Imaging in Stem Cell Transplant and Cell-based Therapy

60

significant research into other therapeutic options, which can alter the course of
disease, are being performed and multiple clinical trials have been reported.
Stem cell therapy and their mode of action have been studied in the management
of cirrhosis (Table 4.6, Fig. 4.5). In addition to their ability to differentiate into
functional hepatocyte like cells, mesenchymal stem cells play a major role by
secreting several trophic factors. Some of these trophic factors modulate the activity
of hepatic stellate cells that are important cells that promote fibrosis in the liver.
Thus, trophic factors derived from mesenchymal stem cells act by inhibiting the
proliferation of stellate cells and promoting their apoptosis. Several routes of admin-
istration of stem cells including administration through peripheral veins, portal vein
and hepatic artery have been described [ 31 ].
Meta analysis of several clinical trials have proven that treatment with bone mar-
row derived mesenchymal stem cells showed improvement in several parameters of
liver function such as serum albumin, prothrombin concentration, total bilirubin and
MELD (Model for end stage liver disease) score [ 32 ].

4.4.2 Inflammatory Bowel Disease

Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis,
is a complex immune mediated chronic gastro intestinal inflammatory disease that
occurs in genetically predisposed individuals as a result of interaction between

Table 4.6 Mechanism of action of stem cells in the liver

Differentiation into hepatocyte like cells

Secretion of trophic factors (which regulate hepatic stellate cell activity and inhibit fibrosis as

well as promote regeneration of damaged liver)

Immune modulation

Cirrhotic liver Injection of stem

cells

Functional hepatocytes

and inhibition of stellate

cells

Fig. 4.5 Role of stem cells in cirrhosis

R. Ram et al.