Mechanisms, efficacy, and future perspectives of cellular-based therapies for liver fibrosis/cirrhosis: focusing on mesenchymal stromal cells.

Several human studies show positive signals, while research methods and sample sizes continue to develop.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Liver fibrosis/cirrhosis, characterized by excessive deposition of extracellular matrix (ECM) and formation of fibrous scars, arises from chronic liver injury and poses a significant global health burden. Although liver transplantation remains the sole curative option, its application is limited by donor scarcity, immune rejection risks, and high costs. Cellular therapies, particularly those based on mesenchymal stromal cells (MSCs), have emerged as a promising alternative. This review comprehensively examines the therapeutic mechanisms and clinical efficacy of diverse cell therapies for liver cirrhosis, with a focus on MSC-based approaches. MSCs demonstrate multifaceted advantages, including immunomodulatory properties, anti-fibrotic effects (via hepatic stellate cell inhibition and ECM remodeling), promotion of hepatocyte regeneration, and mitigation of oxidative stress. Their low immunogenicity facilitates allogeneic transplantation, while their availability from multiple sources (e.g., bone marrow, umbilical cord, adipose tissue) supports scalable clinical application. We analyze 95 registered clinical trials (73 MSC-focused), highlighting consistent safety profiles but variable efficacy, influenced by factors such as cell source, preparation protocols, administration route, and patient heterogeneity. Key challenges include standardizing MSC production (donor selection, cul

Evidence level

Several human studies show positive signals, while research methods and sample sizes continue to develop.

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