Waking a sleeping giant

▸ Spahr L, Lambert JF, Rubbia-Brandt L, et al. Granuloctye-colony stimulating factor induces proliferation of hepatic probenitors in alcoholic steatohepatitis: a randomized trial. Hepatology 2008;48:221–9.

Recent recognition that bone-marrow-derived circulating pluripotent cells could participate in the regeneration of hepatocytes has generated great excitement among clinicians and scientists. With an intention to translate this knowledge into a potential treatment in liver failure, Spahr and colleagues studied the short-term effects of granulocyte colony stimulating factor (G-CSF) on CD34+ stem cell mobilisation and liver cell proliferation in patients with alcoholic steatohepatitis, a condition with a poor short-term prognosis.

Twenty-four patients (mean age 54 years) with alcoholic cirrhosis (Child–Pugh score 10 (7–12)) and biopsy-proven steatohepatitis (Maddrey score 36 (21–60)) were randomised to standard treatment (prednisolone 40 mg daily in severe steatohepatitis) plus 5 days of G-CSF (10 μg/kg/day, n  =  13) or standard treatment alone (n  =  11). Serial measurement of CD34+ cells, cytokines (including hepatocyte growth factor) and (13) C-aminopyrine breath tests were performed. Proliferating hepatic progenitor cells (HPC; double immunostaining (Ki67/cytokeratin 7)) and histology were assessed on baseline and day 7 biopsies.

G-CSF treatment was well tolerated. At day 7, CD34+ cells (+747% vs -6%, p<0.003) and HGF (+212% vs -7%, p<0.03) increased in those …