Could treatment with neohepatocytes benefit patients with decompensated chronic liver disease?

Abstract

In the current edition of this journal, Li and colleagues report that the re-infusion of a monocyte-enriched suspension of autologous peripheral blood mononuclear cells via the hepatic vein into two patients with HBV-related cirrhosis was associated with a 12- to 18-month improvement in the clinical condition of both individuals [1]. Any interpretation of these case studies as evidence for a beneficial clinical effect of the cell infusion is complicated by the fact that both patients also received treatment with hepatocyte growth factor, which may have had an independent therapeutic effect [2–4]. Nevertheless, while Li’s results provide no mechanistic insight into the therapeutic benefit attributed to this monocyte infusion, the clinical findings are of considerable interest because they broadly agree with results from experiments using monocyte-derived cells undertaken in this laboratory and elsewhere [5,6]. We await the outcome of any further studies of this therapeutic approach that may be undertaken at the Xijing Hospital with enthusiasm. Several potential mechanisms might account for any therapeutic effect of infusing monocyte-derived cells into the portal circulation of patients with decompensated liver disease. It is possible that monocyte-derived cells could directly complement lost hepatic functions, perhaps by acquiring metabolic capabilities usually only associated with hepatocytes, or by directly contributing to the liver parenchyma, either by a process of transdifferentiation [5–13] or by fusion with hepatocytes [13,14]. Alternatively, it may be