{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:29:51Z","timestamp":1790616591045,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T00:00:00Z","timestamp":1533859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001407","name":"Department of Biotechnology , Ministry of Science and Technology","doi-asserted-by":"publisher","award":["BT\/PR8251\/MED\/31\/281\/2013"],"award-info":[{"award-number":["BT\/PR8251\/MED\/31\/281\/2013"]}],"id":[{"id":"10.13039\/501100001407","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000732","name":"UK-India Education and Research Initiative","doi-asserted-by":"publisher","award":["IND\/CONT\/E\/12\u201013\/793"],"award-info":[{"award-number":["IND\/CONT\/E\/12\u201013\/793"]}],"id":[{"id":"10.13039\/501100000732","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,1]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Exogenous growth factor\u2010mobilized bone marrow (BM<\/jats:styled-content>) stem cells have shown a differential response in the management of decompensated cirrhosis (DC<\/jats:styled-content>). This study was designed to evaluate potential clinical benefit of adding Erythropoietin (EPO<\/jats:styled-content>) in granulocyte\u2010colony stimulating factor (G\u2010CSF<\/jats:styled-content>)\u2010mobilized stem cell therapy, possible mechanisms of regeneration and predictive factors of regenerative response.<\/jats:p><\/jats:sec>Methods<\/jats:title>Sixty consecutive DC<\/jats:styled-content> patients received either G\u2010CSF<\/jats:styled-content> with EPO<\/jats:styled-content> (Group A; n\u00a0=\u00a030) or G\u2010CSF<\/jats:styled-content> and placebo (Group B; n\u00a0=\u00a030) for 2\u00a0months and were carefully followed up for 1\u00a0year. Baseline and post\u2010treatment liver biopsy, BM<\/jats:styled-content> biopsy and BM<\/jats:styled-content> aspirate were analysed for fibro\u2010inflammatory and regenerative response and BM<\/jats:styled-content> hematopoietic reservoir.<\/jats:p><\/jats:sec>Results<\/jats:title>Addition of EPO<\/jats:styled-content> to G\u2010CSF<\/jats:styled-content> showed a significant improvement in Child\u2010Pugh score (P<\/jats:italic>\u00a0=\u00a00.03) and MELD<\/jats:styled-content> score (P<\/jats:italic>\u00a0=\u00a00.003) as compared to G\u2010CSF<\/jats:styled-content> alone, with reduction in mortality (16.6% vs 36.7%, P<\/jats:italic>\u00a0=\u00a00.09). The combination arm also demonstrated a decreased incidence of acute kidney injury (P<\/jats:italic>\u00a0<\u00a00.001), encephalopathy (P<\/jats:italic>\u00a0=\u00a00.005) and refilling of ascites (P<\/jats:italic>\u00a0=\u00a00.03). Compared to monotherapy, it increased CD<\/jats:styled-content>163+ macrophages (P<\/jats:italic>\u00a0=\u00a00.013), Ki67+ index (P<\/jats:italic>\u00a0<\u00a00.001) with decrease in \u03b1\u2010SMA<\/jats:styled-content> levels (P<\/jats:italic>\u00a0<\u00a00.001) in liver tissue. The response was better with grade 1 and 2 than with grade 3 ascites; Child B cirrhosis and MELD<\/jats:styled-content>\u00a0<\u00a016. Non\u2010responders had lower hematopoietic stem cells (HSC<\/jats:styled-content>s) at baseline. On multivariate analysis, the liver disease severity (MELD<\/jats:styled-content>\u00a0<\u00a016) and a relatively preserved BM<\/jats:styled-content> (BM<\/jats:styled-content>\u2010HSC<\/jats:styled-content>s\u00a0>\u00a00.4) predicted therapeutic response (AUROC<\/jats:styled-content>\u00a0=\u00a00.82).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Early DC (MELD<\/jats:styled-content>\u00a0<\u00a016) patients with mild\u2010moderate ascites and those with a healthy cellular baseline BM<\/jats:styled-content> respond better to growth factor therapy. Addition of EPO<\/jats:styled-content> to G\u2010CSF<\/jats:styled-content> provides better regenerative response than G\u2010CSF<\/jats:styled-content> monotherapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13923","type":"journal-article","created":{"date-parts":[[2018,7,2]],"date-time":"2018-07-02T06:48:54Z","timestamp":1530514134000},"page":"115-126","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Early cirrhosis and a preserved bone marrow niche favour regenerative response to growth factors in decompensated cirrhosis"],"prefix":"10.1111","volume":"39","author":[{"given":"Lovkesh","family":"Anand","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chhagan","family":"Bihari","sequence":"additional","affiliation":[{"name":"Department of Pathology Institute of Liver and 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