Clinical outcome of hepatocyte transplantation in four pediatric patients with inherited metabolic diseases.

Autors de IIS La Fe

• 

  Carmen Ribes Koninckx

  Autor

• Eugenia Pareja Ibars

  Autor

• Maria Angeles Calzado Agrasot

  Autor

• Ana Bonora Centelles

  Autor

• Juan José Vila Carbó

  Autor

• Esther Donat Aliaga

  Autor

• José Mir Pallardo

  Autor

• María José Gómez-Lechón Moliner

  Autor

• José Vicente Castell Ripoll

  Autor

Autors aliens a IIS La Fe

• Miquel BP

Grups d'Investigació

• Enfermedad celíaca e Inmunopatología digestiva

  

  Leader

  Carmen Ribes Koninckx

• Hepatología experimental y Trasplante hepático

  Investigador Principal

  Laia Tolosa Pardo

• Unidad Mixta de Investigación en Hepatología Experimental

  

  Investigador Principal

  Ramiro Jover Atienza

Abstract

Hepatocyte transplantation (HT) has become an effective therapy for patients with metabolic inborn errors. We report the clinical outcome of four children with metabolic inborn errors that underwent HT, describing the cell infusion protocol and the metabolic outcome of transplanted patients. Cryopreserved hepatocytes were used as this allows scheduling of treatments. Functional competence (viability, cell attachment, major cytochrome P450 and UDP-glucuronosyltransferase 1A1 activities, and urea synthesis) and microbiological safety of cell batches were assessed prior to clinical use. Four pediatric patients with liver metabolic diseases [ornithine transcarbamylase (OTC) deficiency, Crigler-Najjar (CNI) syndrome, glycogen storage disease Ia (GSD-Ia), and tyrosinemia type I (TYR-I)] underwent HT. Indication for HT was based on severity of disease, deterioration of quality of life, and benefits for the patients, with the ultimate goal to improve their clinical status whenever liver transplantation (LT) was not indicated or to bridge LT. Cells were infused into the portal vein while monitoring portal flow. The protocol included antibiotic prophylaxis and immunosuppressant therapy. After HT, analytical data on the disease were obtained. The OTC-deficient patient showed a sustained decrease in plasma ammonia levels and increased urea production after HT. Further cell infusions could not be administered given a fatal nosocomial fungus sepsis 2 weeks after the last HT. The CNI and GSD-Ia patients improved their clinical status after HT. They displayed reduced serum bilirubin levels (by ca. 50%) and absence of hypoglycaemic episodes, respectively. In both cases, the HT contributed to stabilize their clinical status as LT was not indicated. In the infant with TYR-I, HT stabilized temporarily the biochemical parameters, resulting in the amelioration of his clinical status while diagnosis of the disease was unequivocally confirmed by full gene sequencing. In this patient, HT served as a bridge therapy to LT.