SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/10  
 
  2016 Oct;64(4):1273-88  
  doi: 10.1002/hep.28754  
 
  Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver  
 
  Bihari C, Anand L, Rooge S, Kumar D, Saxena P, Shubham S, Sukriti, Trehanpati N, Kumar G, Pamecha V, Sharma S, Rastogi A, Kumar A, Sarin SK  
  http://onlinelibrary.wiley.com/doi/10.1002/hep.28754/abstract  
 
 

Bone marrow (BM) is a reservoir for immune and hematopoietic cells and critical for tissue repair and regeneration. All of these functions are severely altered in cirrhosis. We investigated the cellular and functional state of BM in cirrhosis patients. We studied the histological, cellular, and molecular changes in BM of cirrhosis patients (n = 168) and controls (n = 44). Hematopoietic stem cells (HSCs) and associated niche cells, mesenchymal stem cells, Schwann cells, neural fibers, and endothelial cells were evaluated by immunohistochemistry. Cytokines and growth factors were analyzed in peripheral blood and BM plasma. Cirrhotic BM showed an inverse correlation between cluster of differentiation 34+HSCs and Model of End-Stage Liver Disease (ρ = -0.582, P < 0.001) and Child's scores (P < 0.038). BMs of cirrhosis patients with higher Model of End-Stage Liver Disease (>15) showed significantly decreased HSCs, mesenchymal stem cells, Schwann cells, and neural fibers; increased interleukin-1β (P = 0.004), tumor necrosis factor-α (P = 0.040), and interferon-γ (P = 0.03); and decreased oncostatin M (P = 0.04), stem cell factor (P = 0.05), and stromal cell-derived factor 1 (P = 0.03) compared to those with lower Model of End-Stage Liver Disease scores (≤15). The cluster of differentiation 34+ cell population was a predictor for the development of sepsis (P < 0.001), and per unit loss increased the probability of sepsis by 16%. Cirrhosis patients with fewer HSCs had lower hemoglobin (P = 0.05) and platelet counts (P = 0.05) and showed early graft dysfunction.

CONCLUSIONS:
Increasing severity of cirrhosis causes derangement of the hematopoietic niche and loss of HSCs, contributing to the hematological and immunological dysfunctions and reduced potential for regeneration; restoring BM functions could provide new therapeutic options in cirrhosis. (Hepatology 2016;64:1273-1288).

 
Question posée
 
Existe-t-il une altération du status médullaire osseux cellulaire et fonctionnel chez les patients cirrhotiques ?
 
Question posée
 
Oui que ce soit les cellules souches CD34+ ou les autres cellules de la moëlle osseuse associée à une corrélation avec la gravité de la cirrhose (seuil du MELD à 35) et au risque d’infection.
 
Commentaires

Des marqueurs périphériques reflets des marqueurs médullaires pour évaluer la gravité et permettre des traitements plus ciblés des cirrhoses sévères en attente de transplantations sont encore nécessaires

 
www.snfge.org