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Selden C, Bundy J, Erro E, Puschmann E, Miller M, Kahn D, Hodgson H, Fuller B, Gonzalez-Molina J, Le Lay A, Gibbons S, Chalmers S, Modi S, Thomas A, Kilbride P, Isaacs A, Ginsburg R, Ilsley H, Thomson D, Chinnery G, Mankahla N, Loo L, Spearman CW. A clinical-scale BioArtificial Liver, developed for GMP, improved clinical parameters of liver function in porcine liver failure. Sci Rep 2017; 7:14518. [PMID: 29109530 PMCID: PMC5674071 DOI: 10.1038/s41598-017-15021-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022] Open
Abstract
Liver failure, whether arising directly from acute liver failure or from decompensated chronic liver disease is an increasing problem worldwide and results in many deaths. In the UK only 10% of individuals requiring a liver transplant receive one. Thus the need for alternative treatments is paramount. A BioArtificial Liver machine could temporarily replace the functions of the liver, buying time for the patient's liver to repair and regenerate. We have designed, implemented and tested a clinical-scale BioArtificial Liver machine containing a biomass derived from a hepatoblastoma cell-line cultured as three dimensional organoids, using a fluidised bed bioreactor, together with single-use bioprocessing equipment, with complete control of nutrient provision with feedback BioXpert recipe processes, and yielding good phenotypic liver functions. The methodology has been designed to meet specifications for GMP production, required for manufacture of advanced therapy medicinal products (ATMPs). In a porcine model of severe liver failure, damage was assured in all animals by surgical ischaemia in pigs with human sized livers (1.2-1.6 kg liver weights). The BioArtificial liver (UCLBAL) improved important prognostic clinical liver-related parameters, eg, a significant improvement in coagulation, reduction in vasopressor requirements, improvement in blood pH and in parameters of intracranial pressure (ICP) and oxygenation.
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Affiliation(s)
- Clare Selden
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom.
| | - James Bundy
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Eloy Erro
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Eva Puschmann
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Malcolm Miller
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Delawir Kahn
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Humphrey Hodgson
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Barry Fuller
- Dept. of Surgery, UCL Medical School, Royal Free Hospital, London, NW3 2QG, UK
| | - Jordi Gonzalez-Molina
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Aurelie Le Lay
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Stephanie Gibbons
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Sherri Chalmers
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Sunil Modi
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Amy Thomas
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Peter Kilbride
- UCL Institute for Liver and Digestive Health, UCL - Royal Free Hospital Campus, UCL Medical School, London, United Kingdom
| | - Agnes Isaacs
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Richard Ginsburg
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Helen Ilsley
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - David Thomson
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Galya Chinnery
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Ncedile Mankahla
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Lizel Loo
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - C Wendy Spearman
- Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Selden C, Spearman CW, Kahn D, Miller M, Figaji A, Erro E, Bundy J, Massie I, Chalmers SA, Arendse H, Gautier A, Sharratt P, Fuller B, Hodgson H. Evaluation of encapsulated liver cell spheroids in a fluidised-bed bioartificial liver for treatment of ischaemic acute liver failure in pigs in a translational setting. PLoS One 2013; 8:e82312. [PMID: 24367515 PMCID: PMC3867376 DOI: 10.1371/journal.pone.0082312] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/23/2013] [Indexed: 12/16/2022] Open
Abstract
Liver failure is an increasing problem. Donor-organ shortage results in patients dying before receiving a transplant. Since the liver can regenerate, alternative therapies providing temporary liver-support are sought. A bioartificial-liver would temporarily substitute function in liver failure buying time for liver regeneration/organ-procurement. Our aim: to develop a prototype bioartificial-liver-machine (BAL) comprising a human liver-derived cell-line, cultured to phenotypic competence and deliverable in a clinical setting to sites distant from its preparation. The objective of this study was to determine whether its use would improve functional parameters of liver failure in pigs with acute liver failure, to provide proof-of-principle. HepG2 cells encapsulated in alginate-beads, proliferated in a fluidised-bed-bioreactor providing a biomass of 4-6 × 10(10)cells, were transported from preparation-laboratory to point-of-use operating theatre (6000 miles) under perfluorodecalin at ambient temperature. Irreversible ischaemic liver failure was induced in anaesthetised pigs, after portal-systemic-shunt, by hepatic-artery-ligation. Biochemical parameters, intracranial pressure, and functional-clotting were measured in animals connected in an extracorporeal bioartificial-liver circuit. Efficacy was demonstrated comparing outcomes between animals connected to a circuit containing alginate-encapsulated cells (Cell-bead BAL), and those connected to circuit containing alginate capsules without cells (Empty-bead BAL). Cells of the biomass met regulatory standards for sterility and provenance. All animals developed progressive liver-failure after ischaemia induction. Efficacy of BAL was demonstrated since animals connected to a functional biomass (+ cells) had significantly smaller rises in intracranial pressure, lower ammonia levels, more bilirubin conjugation, improved acidosis and clotting restoration compared to animals connected to the circuit without cells. In the +cell group, human proteins accumulated in pigs' plasma. Delivery of biomass using a short-term cold-chain enabled transport and use without loss of function over 3 days. Thus, a fluidised-bed bioreactor containing alginate-encapsulated HepG2 cell-spheroids improved important parameters of acute liver failure in pigs. The system can readily be up-scaled and transported to point-of-use justifying development at clinical scale.
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Affiliation(s)
- Clare Selden
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Catherine Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Delawir Kahn
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Malcolm Miller
- Department of Anaesthetics, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Anthony Figaji
- Department Neurosurgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Eloy Erro
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - James Bundy
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Isobel Massie
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Sherri-Ann Chalmers
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Hiram Arendse
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Aude Gautier
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Peter Sharratt
- Biochemistry Department, University of Cambridge, Cambridge, United Kingdom
| | - Barry Fuller
- Division of Surgery and Interventional Science, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Humphrey Hodgson
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
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Enosawa S, Miyashita T, Saito T, Omasa T, Matsumura T. The significant improvement of survival times and pathological parameters by bioartificial liver with recombinant HepG2 in porcine liver failure model. Cell Transplant 2007; 15:873-80. [PMID: 17299991 DOI: 10.3727/000000006783981350] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We developed a bioartificial liver (BAL) containing human hepatoblastoma cell line, HepG2, with the addition of ammonia removal activity by transfecting a glutamine synthetase (GS) gene and estimated the efficacy using pigs with ischemic liver failure. GS-HepG2 cells showed 15% ammonia removal activity of porcine hepatocytes, while unmodified HepG2 had no such activity. The established GS-HepG2 cells were grown in a circulatory flow bioreactor to 3.5-4.1 x 10(9) cells. Survival time of the animals treated with GS-HepG2 BAL was significantly prolonged compared to the cell-free control (14.52 +/- 5.24 h vs. 8.53 +/- 2.52 h) and the group treated with the BAL consisting of unmodified wild-type HepG2 (9.58 +/- 4.52 h). Comparison showed the cell-containing BAL groups to have significantly fewer incidences of increased brain pressure. Thus, the GS-HepG2 BAL treatment resulted in a significant improvement of survival time and pathological parameters in pigs with ischemic liver failure.
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Affiliation(s)
- Shin Enosawa
- Department of Innovative Surgery, National Research Institute for Child Health and Development, Tokyo, Japan.
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