Primary Biliary Cirrhosis
Conditions
Keywords
Primary Biliary Cirrhosis, Mesenchymal Stem Cells, Serum alkaline phosphatase, Serum Bilirubin
Brief summary
Primary biliary cirrhosis (PBC) is a slowly progressive disease that causes substantial loss of intrahepatic bile ducts, ultimately resulting in cholestasis, advanced fibrosis, cirrhosis, liver failure and even hepatocellular carcinoma. Histologically, the disease is characterized by chronic portal inflammation with infiltration, destruction and loss of the epithelial cells in the small-sized and medium-sized bile ducts. Currently, Ursodeoxycholic acid (UDCA) in a dose of 13-15mg/kg/day is recommended as therapeutic drugs for PBC by AASLD and is approved for this indication by the U.S. Food and Drug Administration (FDA). Treatment with UDCA may delay disease progression and prolong survival free of liver transplantation. However, one out of three patients does not adequately respond to UDCA therapy and many need additional medical therapy or liver transplantation, or both. UC-MSC has been application for the treatment of several severe autoimmune diseases, such as immune thrombocytopenia, systemic lupus erythematosus, and therapy-resistant rheumatoid arthritis. In this study, the safety and efficacy of UC-MSC transplantation for PBC patients will be evaluated.
Detailed description
Primary biliary cirrhosis (PBC) is a slowly progressive cholestatic disease associated with the development of cirrhosis and liver failure that may justify liver transplantation. Ursodeoxycholic acid (UDCA) is currently the only drug approved specifically for the treatment of PBC. However, one out of three patients does not adequately respond to UDCA therapy and many need additional medical therapy or liver transplantation, or both. The potential for stem cells to differentiate into biliary epithelial cells was recently confirmed. In particular, bone marrow-derived mesenchymal stem cell (BM-MSC) transplantation has been applicated in the clinic for treat several human disease such as GVHD, cardiac injury and brain injury, and displayed good tolerance and efficiency. Recently, umbilical cord-derived MSCs (UC-MSC) has also been used to treat severe autoimmune diseases, such as therapy-resistant rheumatoid arthritis and multiple sclerosis. The purpose of this study is to learn whether and how UC-MSC can improve the disease condition in patients with primary biliary cirrhosis. This study will also look at how well UC-MSC is tolerated and its safety in PBC patients Participants in the study will be randomly assigned to one of two treatment arms: Arm A: Participants will receive 12 weeks of UC-MSC treatment plus UDCA. Arm B: Participants will receive 12 weeks of placebo plus UDCA. UC-MSC will be prepared according to standard procedures and is collected in plastic bags containing anticoagulant. UC-MSCs are given via i.v. under sonography monitoring. After cell therapy, patients are followed up at week 4,8,12,24,36 and 48. The evaluation of some clinical parameters such as the level of serum alkaline phosphatase (ALP), alanine aminotransferase(ALT) aspartate aminotransferase (AST) and total bilirubin (TB), prothrombin time(PT), albumin(ALB), prealbumin(PA), are detected at these time points. Mayo risk score, portal hypertension, Liver histology, MELD score and clinical symptoms were also observed simultaneously.
Interventions
Received conventional treatment and taken i.v., once per 4 week, at a dose of 1\*10E6 UC-MSC/kg body weight for 12 weeks.
Received conventional treatment and taken i.v., once per 4 week, at 50 ml saline for 12 weeks
Sponsors
Beijing 302 Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Written informed consent 2. Primary Biliary Cirrhosis (according to the criteria defined by AASLD practice guidelines , Hepatology, 2009;50:291-308 ) 3. Negative pregnancy test (female patients in fertile age)
Exclusion criteria
1. Hepatocellular carcinoma or other Malignancies 2. Pregnant or lactating women 3. Viral Hepatitis ( HAB, HBV, HCV, et al ) 4. Vital organs failure (Cardiac, Renal or Respiratory, et al) 5. Sepsis 6. Active thrombosis in the portal or hepatic veins
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Serum alkaline phosphatase (ALP) | 0, 4, 8,12, 24, 36,48 weeks after treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Serum Bilirubin | At base line and at week 4,8,12,24,36 and 48 | — |
| Serum AST | At base line and at week 4,8,12,24,36 and 48 | — |
| Mayo risk score | At base line and at week 4,8,12,24,36 and 48 | — |
| Histological changes in liver biopsies | baseline and 48 weeks | — |
| MELD score | At base line and at week 4,8,12,24,36 and 48 | — |
| Number of participants with improvement of clinical symptoms | At base line and at week 4,8,12,24,36 and 48 | clinical symptoms including fatigue (Fatigue Impact Score, FIS) and pruritus ( Visual Analog Scale ,VAS) |
| Number of patients with Portal Hypertension after 12 weeks treatment | At base line and at week 12,24,36 and 48 | — |
Countries
China
Contacts
Primary ContactFu-Sheng Wang, professor
Backup ContactZheng Zhang, Doctor
Outcome results
None listed