Decompensated cirrhosis has a high overall mortality rate. There is a large unmet need for safe and alternative therapeutic potions. This clinical trial is to inspect the efficiency and safety of mesenchymal stem cells (MSCs) therapy for decompensated cirrhosis.
Decompensated cirrhosis has a high overall mortality rate. Liver transplantation is still the most effective treatment for decompensated cirrhosis. However, the shortage of matched liver sources, high costs, and rejection after liver transplantation restrict the development of liver transplantation. Mesenchymal stem cells (MSC) are a kind of pluripotent stem cells belonging to mesoderm, which mainly exist in connective tissue and organ interstitium. At present, MSC can be isolated and prepared from bone marrow, fat, synovium, bone, muscle, lung, liver, pancreas and amniotic fluid and umbilical cord blood . Due to its wide range of sources and self-proliferation and differentiation ability, MSCs have therapeutic potential for many diseases, including acute and chronic liver diseases. In recent years, our team has carried out a series of clinical trials using umbilical cord-derived MSCs to treat patients with end-stage liver disease, decompensated cirrhosis, primary biliary cholangitis, and status after liver transplantation and found that MSCs therapy can significantly improve patient liver function, reduce post-transplantation rejection, reduce complications, improve quality of life, and improve survival. Other investigators have also found in clinical trials with MSCs from different sources that treatment with MSCs can improve MELD scores or liver function levels to varying degrees. However, some studies have found no significant difference between the treatment group and the control group, and MSCs may differentiate into hepatic stellate cells and have the risk of promoting liver fibrosis, it is believed that MSCs do not favor the improvement of liver function in these studies. Therefore, the therapeutic effects of MSCs need to be further validated by larger multicenter randomized controlled clinical trials. The investigators will do a prospective, double-blind, multicentre, randomised trial to assess treatment with three intravenous doses of MSCs compared with placebo. 240 decompensated cirrhosis patients will be recruited in China.120 patients will receive i.v. transfusion 3 times of MSCs (6.0×10E7 cells per time) and the standard of care as the treated group. In addition, the 120 patients will receive placebo and standard of care as control group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
240
3 does of UC-MSCs(6.0×10E7cells per time) intravenously at week 0, week 4, week 8.
3 does of placebo intravenously at week 0, week 4, week 8.
The First Hospital of Lanzhou University
Lanzhou, Gansu, China
NOT_YET_RECRUITINGHainan hospital of Chinese PLA General Hospital
Sanya, Hainan, China
NOT_YET_RECRUITINGRenmin Hospital of Wuhan University
Wuhan, Hubei, China
NOT_YET_RECRUITINGChange in Model for End-Stage Liver Disease (MELD) score from baseline to 24th week
The Model for End-stage Liver Disease (MELD) is a scoring system that evaluates the liver function reserve and prognosis of patients with chronic liver disease by creatinine, international normalized ratio (INR), and bilirubin-conjugated cirrhosis etiology. The MELD score is calculated by the formula: R = 9.6 × ln (creatinine mg/dl) + 3.8 × ln (bilirubin mg/dl) + 11.2 × ln (INR) + 6.4 × etiology, and the results are taken as integers. ( 0 for cholestatic and alcoholic cirrhosis and 1 for other causes of cirrhosis such as viruses).
Time frame: at 24th week
Change in MELD score from baseline to 48 weeks
Time frame: up to 48 weeks
Incidence of each complication associated with decompensated cirrhosis
Time frame: up to 48 weeks
liver transplant-free survival
Time frame: up to 48 weeks
Incidence of liver failure
Time frame: up to 48 weeks
plasma albumin (ALB)
Time frame: up to 48 weeks
total bilirubin (TBIL)
Time frame: up to 48 weeks
serum cholinesterase (CHE)
Time frame: up to 48 weeks
prothrombin activity (PA)
Time frame: up to 48 weeks
Child-Turcotte-Pugh (CTP) score
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Shanghai Changzheng Hospital
Shanghai, Shanghai Municipality, China
NOT_YET_RECRUITINGBeijing 302 Hospital
Beijing, China
RECRUITINGChild-Turcotte-Pugh (CTP) score is a scoring system that evaluates the liver function.
Time frame: up to 48 weeks
EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D)
Time frame: up to 48 weeks
ChronicLiver Disease Questionnaire (CLDQ)
Time frame: up to 48 weeks
Incidence of liver cancer
Time frame: up to 48 weeks
Incidence of Treatment-Emergent Adverse Events and Serious Adverse Events
Time frame: up to 48weeks