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Wakil A, Niazi M, Lunsford KE, Pyrsopoulos N. Future Approaches and Therapeutic Modalities for Acute-on-Chronic Liver Failure. Clin Liver Dis 2023; 27:777-790. [PMID: 37380297 DOI: 10.1016/j.cld.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Acute-on-chronic liver failure (ACLF) results from an acute decompensation of cirrhosis due to exogenous insult. The condition is characterized by a severe systemic inflammatory response, inappropriate compensatory anti-inflammatory response, multisystem extrahepatic organ failure, and high short-term mortality. Here, the authors evaluate the current status of potential treatments for ACLF and assess their efficacy and therapeutic potential.
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Affiliation(s)
- Ali Wakil
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA
| | - Mumtaz Niazi
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA
| | - Keri E Lunsford
- Department of Surgery, Division of Liver Transplant and HPB Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA
| | - Nikolaos Pyrsopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA.
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Ochenashko OV, Volkova NA, Mazur SP, Somov AY, Fuller BJ, Petrenko AY. Cryopreserved Fetal Liver Cell Transplants Support the Chronic Failing Liver in Rats with CCl4-Induced Cirrhosis. Cell Transplant 2017; 15:23-33. [PMID: 16700327 DOI: 10.3727/000000006783982232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hepatocyte transplantation is a promising method for supporting hepatic function in a broad spectrum of liver diseases. The aim of this work was to test the efficacy of human fetal liver cells to support the chronic failing liver in an experimental model of carbon tetrachloride (CCl4)-induced cirrhosis in rats. Liver cirrhosis was induced by intraperitoneal administration of CCl4 at a dose of 0.2 ml (50% v/v solution)/100 g body weight, twice a week for 3 months in rats. Ten days after stopping CCl4 administration (experimental day 0), rats received intrasplenic injection of cryopreserved fetal liver cells (FLC, 1 × 107 cells in 0.3 ml medium). As a cirrhotic control group, CCl4-induced cirrhotic rats were used with intrasplenic injection of an equal volume of medium alone. Animals were sacrificed on experimental day 15. Human fetal liver cell transplantation almost completely prevented the death of cirrhotic animals during the 2 weeks after treatment, while high ongoing mortality was seen in the cirrhotic control group. Cell transplantation into the spleen normalized total bilirubin and TBARSs levels and increased albumin levels in blood serum, as well as restoring mitochondrial function and liver detoxification function (assessed by cytochrome P450 contents and activity) compared with the activities seen in the cirrhosis control group. In parallel with this restoration of biochemical and functional liver indices, morphological patterns of liver recovery or regeneration after liver cell transplantation were demonstrated in day 15 samples by light microscopy. These were absent in the group that had received only medium alone.
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Affiliation(s)
- Olga V Ochenashko
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, Kharkov 61015, Ukraine
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Xiang JX, Zheng XL, Gao R, Wu WQ, Zhu XL, Li JH, Lv Y. Liver regeneration using decellularized splenic scaffold: a novel approach in tissue engineering. Hepatobiliary Pancreat Dis Int 2015; 14:502-8. [PMID: 26459726 DOI: 10.1016/s1499-3872(15)60423-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The potential application of decellularized liver scaffold for liver regeneration is limited by severe shortage of donor organs. Attempt of using heterograft scaffold is accompanied with high risks of zoonosis and immunological rejection. We proposed that the spleen, which procured more extensively than the liver, could be an ideal source of decellularized scaffold for liver regeneration. METHODS After harvested from donor rat, the spleen was processed by 12-hour freezing/thawing x 2 cycles, then circulation perfusion of 0.02% trypsin and 3% Triton X-100 sequentially through the splenic artery for 32 hours in total to prepare decellularized scaffold. The structure and component characteristics of the scaffold were determined by hematoxylin and eosin and immumohistochemical staining, scanning electron microscope, DNA detection, porosity measurement, biocompatibility and cytocompatibility test. Recellularization of scaffold by 5 x 10(6) bone marrow mesenchymal stem cells (BMSCs) was carried out to preliminarily evaluate the feasibility of liver regeneration by BMSCs reseeding and differentiation in decellularized splenic scaffold. RESULTS After decellularization, a translucent scaffold, which retained the gross shape of the spleen, was generated. Histological evaluation and residual DNA quantitation revealed the remaining of extracellular matrix without nucleus and cytoplasm residue. Immunohistochemical study proved the existence of collagens I, IV, fibronectin, laminin and elastin in decellularized splenic scaffold, which showed a similarity with decellularized liver. A scanning electron microscope presented the remaining three-dimensional porous structure of extracellular matrix and small blood vessels. The porosity of scaffold, aperture of 45.36 +/- 4.87 μm and pore rate of 80.14% +/- 2.99% was suitable for cell engraftment. Subcutaneous implantation of decellularized scaffold presented good histocompatibility, and recellularization of the splenic scaffold demonstrated that BMSCs could locate and survive in the decellularized matrix. CONCLUSION Considering the more extensive organ source and satisfying biocompatibility, the present study indicated that the three-dimensional decellularized splenic scaffold might have considerable potential for liver regeneration when combined with BMSCs reseeding and differentiation.
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Affiliation(s)
- Jun-Xi Xiang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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Iwasaki J, Hata T, Uemoto S, Fujimoto Y, Kanazawa H, Teratani T, Hishikawa S, Kobayashi E. Portocaval shunt for hepatocyte package: challenging application of small intestinal graft in animal models. Organogenesis 2013; 9:273-9. [PMID: 23974217 DOI: 10.4161/org.25968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In developing therapeutic alternatives to liver transplantation, we have used the strategy of applying a small intestinal segment as a scaffold for hepatocyte transplantation and also as a portocaval shunt (PCS) system to address both liver dysfunction and portal hypertension. The aim of this study was to investigate the feasibility of such an intestinal segment in animal models. Hepatocytes isolated from luciferase-transgenic Lewis rats were transplanted into jejunal segments of wild-type Lewis rats with mucosa removal without PCS application. Luciferase-derived luminescence from transplanted hepatocytes was stably detected for 30 days. Then, we performed autologous hepatocyte transplantation into the submucosal layer of an isolated and vascularized small intestinal segment in pigs. Transplanted hepatocytes were isolated from the resected left-lateral lobe of the liver. On day 7, hepatocyte clusters and bile duct-like structures were observed histologically. To create an intestinal PCS system in pigs, an auto-graft of the segmental ileum and interposing vessel graft were anastomosed to the portal vein trunk and inferior vena cava. However, thrombi were observed in vessels of the intestinal PCSs. We measured the correlation between infusion pressure and flow volume in whole intestines ex vivo in both species and found that the high pressure corresponding to portal hypertension was still insufficient to maintain the patency of the intestinal grafts. In conclusion, we demonstrated the feasibility of the small intestine as a scaffold for hepatocyte transplantation in rat and pig models, but PCS using an intestinal graft failed to maintain patency in a pig model.
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Affiliation(s)
- Junji Iwasaki
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto, Japan; Division of Development of Advanced Treatment; Center for Development of Advanced Medical Technology; Jichi Medical University; Tochigi, Japan
| | - Toshiyuki Hata
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto, Japan
| | - Yasuhiro Fujimoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto, Japan
| | - Hiroyuki Kanazawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto, Japan
| | - Takumi Teratani
- Division of Development of Advanced Treatment; Center for Development of Advanced Medical Technology; Jichi Medical University; Tochigi, Japan
| | - Shuji Hishikawa
- Division of Medical Skill Training; Center for Development of Advanced Medical Technology; Jichi Medical University; Tochigi, Japan
| | - Eiji Kobayashi
- Division of Development of Advanced Treatment; Center for Development of Advanced Medical Technology; Jichi Medical University; Tochigi, Japan
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Huang CK, Lee SO, Lai KP, Ma WL, Lin TH, Tsai MY, Luo J, Chang C. Targeting androgen receptor in bone marrow mesenchymal stem cells leads to better transplantation therapy efficacy in liver cirrhosis. Hepatology 2013; 57:1550-63. [PMID: 23150236 DOI: 10.1002/hep.26135] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/21/2012] [Accepted: 10/22/2012] [Indexed: 12/19/2022]
Abstract
UNLABELLED Transplantation of bone marrow mesenchymal stem cells (BM-MSCs) has been considered as an alternative therapy, replacing liver transplantation in clinical trials, to treat liver cirrhosis, an irreversible disease that may eventually lead to liver cancer development. However, low survival rate of the BM-MSCs leading to unsatisfactory efficacy remains a major concern. Gender differences have been suggested in BM-MSCs therapeutic application, but the effect of the androgen receptor (AR), a key factor in male sexual phenotype, in this application is not clear. Using two liver cirrhosis mouse models induced by CCl4 or thioacetamide, we showed that targeting AR in the BM-MSCs improved their self-renewal and migration potentials and increased paracrine effects to exert anti-inflammatory and anti-fibrotic actions to enhance liver repair. Mechanism dissection studies suggested that knocking out AR in BM-MSCs led to improved self-renewal and migration by alteration of the signaling of epidermal growth factor receptor and matrix metalloproteinase 9 and resulted in suppression of infiltrating macrophages and hepatic stellate cell activation through modulation of interleukin (IL)1R/IL1Ra signaling. Therapeutic approaches using either AR/small interfering RNA or the AR degradation enhancer, ASC-J9, to target AR in BM-MSCs all led to increased efficacy for liver repair. CONCLUSION Targeting AR, a key factor in male sexual phenotype, in BM-MSCs improves transplantation therapeutic efficacy for treating liver fibrosis.
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Affiliation(s)
- Chiung-Kuei Huang
- George Whipple Lab for Cancer Research, Department of Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Kim TH, Kim JK, Shim W, Kim SY, Park TJ, Jung JY. Tracking of transplanted mesenchymal stem cells labeled with fluorescent magnetic nanoparticle in liver cirrhosis rat model with 3-T MRI. Magn Reson Imaging 2011; 28:1004-13. [PMID: 20663626 DOI: 10.1016/j.mri.2010.03.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 02/22/2010] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
Abstract
In vivo visualization of transplanted stem cells with noninvasive technique is essential for the monitoring of cell implantation, homing and differentiation. At present, superparamagnetic iron oxide (SPIO) is most commonly used for cell labeling. However, stem cells lack phagocytic capacity and transfection agent is required for sufficient internalization of SPIO for cellular imaging. However, the potential hazards of transfection agents are not fully investigated. Instead of SPIO, we used commercially available new tagging material, fluorescent magnetic nanoparticle (MNP) containing rhodamine B isothiocyanate within a silica shell (Biterials, Seoul, Korea). This tagging material does not require transfection agents for the cell labeling. In addition to that, the core of this MNP is composed of ferrite and the inner portion of silica shell contains fluorescent materials, therefore, it has both magnetic and optical features. This study was designed to track intrasplenically injected bone marrow mesenchymal stem cells (MSCs) labeled with fluorescent MNP in liver cirrhosis rat model with 3-T magnetic resonance equipment. We compared magnetic resonance imaging (MRI) of livers in rats which were injected with non-labeled stem cells or labeled stem cells with MNP or SPIO. We found that the respective liver-to-muscle contrast-to-noise ratios at 3 and 5 h after MNP or SPIO-labeled stem cell injection was significantly lower than that of pre-injection and non-labeled group. There was no significant difference between MNP-labeled group and SPIO-labeled group. We can effectively detect intrasplenically injected MNP-labeled MSCs in an experimental rat model of liver cirrhosis with 3-T MRI.
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Affiliation(s)
- Tae Hee Kim
- Department of Radiology, Ajou University, School of Medicine, Kyongi-Do, South Korea
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Ito M, Nagata H, Miyakawa S, Fox IJ. Review of hepatocyte transplantation. ACTA ACUST UNITED AC 2008; 16:97-100. [PMID: 19110647 DOI: 10.1007/s00534-008-0023-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 07/15/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatocyte transplantation is a promising treatment for several liver diseases and can also be used as a "bridge" to liver transplantation in cases of liver failure. Although the first animal experiments with this technique began in 1967, it was first applied in humans only in 1992. Unfortunately, unequivocal evidence of transplanted human hepatocyte function has been obtained in only one patient with Crigler-Najjar syndrome type I and, even then, the amount of bilirubin-UDP-glucuronosyltransferase enzyme activity derived from the transplanted cells was not sufficient to eliminate the patient's eventual need for organ transplantation. METHODS A literature review was carried out using MEDLINE and library searches. RESULTS This review considers the following: (1) alternatives or bridges to orthotopic liver transplantation (OLT); (2) solutions to the shortage of organs-the shortage of organ donors has impeded the development of human hepatocyte transplantation, and immortalized hepatocytes in particular could provide an unlimited supply of transplantable cells in a nearly future; (3) future directions. We review these efforts along with hepatocyte transplantation over the last 13 years.
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Affiliation(s)
- Masahiro Ito
- Department of Surgery, Fujita-Health University, Toyoake, Aichi, Japan.
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Liu YD, Yang YS, Wang YF, Nan X, Peng LH, Sun G, Li MY, Pei XT. Curative effect of transsplenic human mesochymal stem cells transplantation on acetaminophen-induced acute liver injury in mice. Shijie Huaren Xiaohua Zazhi 2008; 16:1969-1973. [DOI: 10.11569/wcjd.v16.i18.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess efficacy of transsplenic human mesochymal stem cells (hMSCs) transplantation on acetaminophen-induced acute liver injury in mice.
METHODS: An animal model of acetaminophen-induced acute liver injury was established. Twenty severe combined immunodeficiency mice (SCID mice) were randomly divided into 2 groups: transsplenic hMSCs transplantation group (n = 10) and control group (n = 10). After transsplenic hMSCs transplantation, liver function test, immunofluorescence method, fluorescence microscopy and reticular fiber staining were performed to observe hepatic acinus and liver function of SCID rats.
RESULTS: Liver function of SCID mice after transsplenic hMSCs transplantation was improved significantly compared with controls (at d 28, ALT: 26.3 U/L vs 50.1 U/L, P < 0.01; AST: 108.0 U/L vs 154.3 U/L, P < 0.05; ALB: 40.0 g/L vs 31.9 g/L, P < 0.05). Fluorescence microscopy indicated hMSCs through transsplenic transplantation began to reside, differentiate and proliferate in spleen and liver in large number. Immunofluorescence method showed remarkable improvement of hepatic acinus following transsplenic hMSCs transplantation.
CONCLUSION: Transsplenic hMSCs transplantation improves acute liver injury induced by acetaminophen in SCID mice and human mesochymal stem cells are able to proliferate in liver. Transsplenic transplantation is effective for hMSCs transplantation.
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Clinical application of hepatocyte transplantation: what are the current limitations? Curr Opin Organ Transplant 2006. [DOI: 10.1097/mot.0b013e328010b86e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Allen KJ, Soriano HE. Liver cell transplantation: the road to clinical application. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2001; 138:298-312. [PMID: 11709654 DOI: 10.1067/mlc.2001.119148] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- K J Allen
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Guha C, Parashar B, Deb NJ, Sharma A, Gorla GR, Alfieri A, Roy-Chowdhury N, Roy-Chowdhury J, Vikram B. Liver irradiation: a potential preparative regimen for hepatocyte transplantation. Int J Radiat Oncol Biol Phys 2001; 49:451-7. [PMID: 11173140 DOI: 10.1016/s0360-3016(00)01495-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in the understanding of hepatocyte engraftment and repopulation of the host liver have already led to the use of hepatocyte transplantation (HT) with some success in the treatment of inherited and acquired liver diseases. Wider application of HT is severely limited by the unavailability of large number of transplantable hepatocytes and difficulties associated with transplanting an adequate number of cells for achieving therapeutically satisfactory levels of metabolic correction. Therefore, there is a need for preparative regimens that provide a growth advantage to the transplanted (healthy) hepatocytes over the host's own (diseased) hepatocytes so that the former can repopulate the host liver. We have recently shown that when the liver of recipient rats was subjected to radiotherapy and partial hepatectomy before HT, the transplanted hepatocytes engrafted in and massively repopulated the liver, and also ameliorated the adverse clinical and histopathological changes associated with hepatic irradiation. This protocol was then used as a preparative regimen for transplanting normal hepatocytes into jaundice mutant rats (Gunn strain), which lack hepatic bilirubin-uridinediphosphoglucuronate glucuronosyltransferase and is a model of Crigler-Najjar syndrome Type I. The results showed long-term correction of the metabolic abnormality, suggesting that the transplanted hepatocytes repopulated an irradiated liver and were metabolically functional. This strategy could be useful in the treatment of various genetic, metabolic, or malignant diseases of the liver.
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Affiliation(s)
- C Guha
- Department of *Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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