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Granulocyte-colony stimulating factor + erythropoietin is a combination biologic therapy investigated for the treatment of decompensated cirrhosis. The combination typically consists of filgrastim (a recombinant G-CSF) and either recombinant human erythropoietin or its long-acting analogue, darbopoetin alfa. Filgrastim acts as an agonist at the granulocyte colony-stimulating factor receptor (CSF3R), mobilizing hematopoietic stem cells from the bone marrow to the liver to promote tissue repair and regeneration. Erythropoietin acts on the erythropoietin receptor (EPOR), which is expressed in the liver and has been shown to stimulate hepatic regeneration and reduce apoptosis in preclinical and clinical models. This therapeutic approach was developed and evaluated by the Institute of Liver and Biliary Sciences (ILBS) in India, demonstrating significant improvements in survival and liver function scores (MELD and Child-Turcotte-Pugh) in patients with advanced cirrhosis.
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