A new study regarding use of stem cell treatment for liver cirrhosis which will involve 46 patients and cost around SGD2.6 million started in Singapore.
It will offer hope to numerous patients in Singapore who are fighting end-stage liver cirrhosis and waiting for a liver transplant, which is currently the only cure. The four-year study is led by National University Hospital and comprises a multi-centre team from several restructured hospitals. It is funded by the National Medical Research Council.
In the study, there will be 46 patients aged between 40 and 70 years old who are at the terminal stage of chronic liver disease, over three years. During the clinical trial, patients will be divided into a therapeutic group and a control group.
All patients will receive an injection to stimulate their bone marrow cells as part of the supportive treatment for their liver cirrhosis. However, only patients in the study group will have the stem cells from the bone marrow extracted and deposited directly into their liver for more targeted repair.
Using one’s own stem cells will avoid the problem of cell rejection.
The liver tissue will be examined three months later, and an investigation to compare pre- and post-transplant results will be conducted after a year.
Since invasive surgery is not required for stem-cell therapy, the fatality risk is significantly lowered for the patient. However, other risks such as severe bleeding and infections still remain, given the patients’ weakened conditions.
Liver failure is one of the top 20 causes of death in Singapore, but many patients are not suitable for a transplant due to factors such as age and surgical fitness.
Dr Dan Yock Young, principal investigator of the clinical trial and senior consultant at NUH’s division of gastroenterology and hepatology, said, “Out of every five patients doctors see with end-stage liver disease, only one qualifies for a liver transplant.”
Speaking about liver transplants, he said, “ It is curative, but it is a complex procedure, and many patients are not suitable for it. For these patients, treatment is limited, but morbidity and mortality rates are high — as high as 50 per cent in one year — and this is probably worse than many other terminal illnesses we talk about today.”
However, there is hope from stem cell therapy, as animal studies conducted over the last five years have shown that stem cells can reconstruct the micro-environment of a normal liver.
He explained, “Like how branches are of critical importance in supporting the leaves and fruits of a tree, the endothelial (stem) cells contribute to supporting a nutritious environment for the hepatocyte (liver) cells.”
However, there is word of caution. While similar stem-cell studies have been conducted in other centres in Asia, there has been “no definitive evidence” of the benefits of the treatment for liver patients.