Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7444
Peer-review started: August 21, 2020
First decision: October 18, 2020
Revised: October 31, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: December 21, 2020
Although multiple drugs are accessible for recovering liver function in patients, none are considered efficient. Liver transplantation is the mainstay therapy for end-stage liver fibrosis. However, the worldwide shortage of healthy liver donors, organ rejection, complex surgery, and high costs are prompting researchers to develop novel approaches to deal with the overwhelming liver fibrosis cases. Mesenchymal stem cell (MSC) therapy is an emerging alternative method for treating patients with liver fibrosis. However, many aspects of this therapy remain unclear, such as the efficiency compared to conventional treatment, the ideal MSC sources, and the most effective way to use it. Because bone marrow (BM) is the largest source for MSCs, this paper used a systematic review approach to study the therapeutic efficiency of MSCs against liver fibrosis and related factors. We systematically searched multiple published articles to identify studies involving liver fibrosis and BM-MSC-based therapy. Analyzing the selected studies showed that compared with conventional treatment BM-MSC therapy may be more efficient for liver fibrosis in some cases. In contrast, the cotreatment presented a more efficient way. Nevertheless, BM-MSCs are lacking as a therapy for liver fibrosis; thus, this paper also reviews factors that affect BM-MSC efficiency, such as the implementation routes and strategies employed to enhance the potential in alleviating liver fibrosis. Ultimately, our review summarizes the recent advances in the BM-MSC therapy for liver fibrosis. It is grounded in recent developments underlying the efficiency of BM-MSCs as therapy, focusing on the preclinical in vivo experiments, and comparing to other treatments or sources and the strategies used to enhance its potential while mentioning the research gaps.
Core Tip: Bone marrow (BM)- mesenchymal stem cells (MSCs) are a promising therapy for liver fibrosis. However, several aspects, such as efficiency, of this treatment are vague. This review summarizes the recent advances and effectiveness of BM-MSC therapy, its mechanisms, and related factors by focusing on preclinical in vivo experiments. While BM-MSCs appear to be effective in some cases, cotreatment appears to be a better option. Studies on strategies, implementation routes, and cotreatments are helping to strengthen the efficiency. While the potential of this therapy continues to advance, research is still needed to achieve full potential.