Uso do fator estimulador de colônias de granulócitos (G-CSF) na mobilização de células-tronco da medula óssea em pacientes com cirrose hepática

Abstract

Liver cirrhosis is an advanced stage and, so far, irreversible of damage to the liver. The definitive treatment is liver transplantation, but the increasing number of patients on the waiting list for a liver transplant and the low number of donated organs indicate the need for development of alternative therapies to increase survival rate of patients awaiting a transplant or even eliminate the need for transplantation. Thus, studies in animal models and clinical trials have been performed and suggest that treatment with bone marrow progenitor cells in chronic diseases in organs such as heart and liver is promising to regenerate the damaged organ. A possible alternative to cell therapy is the mobilization of precursor cells from bone marrow by using the cell hormone granulocyte colony-stimulating factor (G-CSF), which mobilizes progenitor cells from bone marrow to peripheral blood, through which these cells can reach the damaged organ. The present study is a phase I clinical trial using G-CSF (filgrastim) in patients with chronic liver disease in an advanced stage waiting for liver transplantation, designed to evaluate the safety and feasibility of the therapy in these patients. Five selected patients received four cycles of G-CSF, corresponding to two daily doses of G-CSF for five days, and were followed for four months. The patients were monitored by physical examination, laboratory tests and abdominal ultrasonography during the administration of G-CSF and with physical examination and laboratory tests during the follow-up. There were no significant adverse effects of the use of GCSF, except for bone and muscles pain related to product administration. However, there were no significant changes in their Child-Pugh or MELD scores, neither bilirubin and albumin levels. We conclude that the treatment regimen in repeated cycles of G-CSF (filgrastim) is safe and feasible in patients with chronic liver cirrhosis, with adverse effects of low intensity and easy handling, although our results do not indicate an improvement in the severity of the disease by the criteria for Child-Pugh and MELD these patients with this treatment.