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Blackford SJ, Ng SS, Segal JM, King AJ, Austin AL, Kent D, Moore J, Sheldon M, Ilic D, Dhawan A, Mitry RR, Rashid ST. Validation of Current Good Manufacturing Practice Compliant Human Pluripotent Stem Cell-Derived Hepatocytes for Cell-Based Therapy. Stem Cells Transl Med 2019; 8:124-137. [PMID: 30456803 PMCID: PMC6344902 DOI: 10.1002/sctm.18-0084] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/22/2018] [Accepted: 09/25/2018] [Indexed: 01/04/2023] Open
Abstract
Recent advancements in the production of hepatocytes from human pluripotent stem cells (hPSC-Heps) afford tremendous possibilities for treatment of patients with liver disease. Validated current good manufacturing practice (cGMP) lines are an essential prerequisite for such applications but have only recently been established. Whether such cGMP lines are capable of hepatic differentiation is not known. To address this knowledge gap, we examined the proficiency of three recently derived cGMP lines (two hiPSC and one hESC) to differentiate into hepatocytes and their suitability for therapy. hPSC-Heps generated using a chemically defined four-step hepatic differentiation protocol uniformly demonstrated highly reproducible phenotypes and functionality. Seeding into a 3D poly(ethylene glycol)-diacrylate fabricated inverted colloid crystal scaffold converted these immature progenitors into more advanced hepatic tissue structures. Hepatic constructs could also be successfully encapsulated into the immune-privileged material alginate and remained viable as well as functional upon transplantation into immune competent mice. This is the first report we are aware of demonstrating cGMP-compliant hPSCs can generate cells with advanced hepatic function potentially suitable for future therapeutic applications. Stem Cells Translational Medicine 2019;8:124&14.
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Affiliation(s)
- Samuel J.I. Blackford
- Centre for Stem Cells and Regenerative MedicineKing's College LondonLondonUnited Kingdom
| | - Soon Seng Ng
- Centre for Stem Cells and Regenerative MedicineKing's College LondonLondonUnited Kingdom
| | - Joe M. Segal
- Centre for Stem Cells and Regenerative MedicineKing's College LondonLondonUnited Kingdom
| | - Aileen J.F. King
- Diabetes Research GroupFaculty of Life Sciences & Medicine, King's College LondonLondonUnited Kingdom
| | - Amazon L. Austin
- Diabetes Research GroupFaculty of Life Sciences & Medicine, King's College LondonLondonUnited Kingdom
| | - Deniz Kent
- Centre for Stem Cells and Regenerative MedicineKing's College LondonLondonUnited Kingdom
| | - Jennifer Moore
- RUCDR Infinite BiologicsRutgers UniversityNew BrunswickNew JerseyUSA
| | - Michael Sheldon
- RUCDR Infinite BiologicsRutgers UniversityNew BrunswickNew JerseyUSA
| | - Dusko Ilic
- Stem Cell Laboratory, Department of Women and Children's HealthFaculty of Life Sciences and Medicine, King's College LondonLondonUnited Kingdom
| | - Anil Dhawan
- Institute for Liver StudiesKing's College Hospital, King's College LondonLondonUnited Kingdom
| | - Ragai R. Mitry
- Institute for Liver StudiesKing's College Hospital, King's College LondonLondonUnited Kingdom
| | - S. Tamir Rashid
- Centre for Stem Cells and Regenerative MedicineKing's College LondonLondonUnited Kingdom
- Institute for Liver StudiesKing's College Hospital, King's College LondonLondonUnited Kingdom
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2
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Rammohan A, Reddy MS, Narasimhan G, Rajalingam R, Kaliamoorthy I, Shanmugam N, Rela M. Auxiliary Partial Orthotopic Liver Transplantation for Selected Noncirrhotic Metabolic Liver Disease. Liver Transpl 2019; 25:111-118. [PMID: 30317682 DOI: 10.1002/lt.25352] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
Auxiliary partial orthotopic liver transplantation (APOLT) in selected noncirrhotic metabolic liver diseases (NCMLDs) is a viable alternative to orthotopic liver transplantation (OLT) as it supplements the function of the native liver with the missing functional protein. APOLT for NCMLD is not universally accepted due to concerns of increased technical complications and longterm graft atrophy. Review of a prospectively collected database of all pediatric patients (age ≤16 years) who underwent liver transplantation for NCMLD from August 2009 up to June 2017 was performed. Patients were divided into 2 groups: group 1 underwent APOLT and group 2 underwent OLT. In total, 18 OLTs and 12 APOLTs were performed for NCMLDs during the study period. There was no significant difference in the age and weight of the recipients in both groups. All APOLT patients needed intraoperative portal flow modulation. Intraoperative peak and end of surgery lactate were significantly higher in the OLT group, and cold ischemia time was longer in the APOLT group. There were no differences in postoperative liver function tests apart from higher peak international normalized ratio in the OLT group. The incidence of postoperative complications, duration of hospital stay, and 1- and 5-year survivals were similar in both groups. In conclusion, we present the largest series of APOLT for NCMLD. APOLT is a safe and effective alternative to OLT and may even be better than OLT due to lesser physiological stress and the smoother postoperative period for selected patients with NCMLD.
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Affiliation(s)
- Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India
| | - Mettu S Reddy
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India
| | - Gomathy Narasimhan
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India
| | - Rajesh Rajalingam
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India
| | - Ilankumaran Kaliamoorthy
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India
| | - Naresh Shanmugam
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Global Hospitals & Health City, Chennai, India.,The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, India.,Institute of Liver Studies, King's College Hospital, London, United Kingdom
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3
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Kohli R, Cortes M, Heaton ND, Dhawan A. Liver transplantation in children: state of the art and future perspectives. Arch Dis Child 2018; 103:192-198. [PMID: 28918383 DOI: 10.1136/archdischild-2015-310023] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022]
Abstract
In this review, we provide a state of the art of liver transplantation in children, as the procedure is now carried out for more than 30 years and most of our paediatric colleagues are managing these patients jointly with liver transplant centres. Our goal for this article is to enhance the understanding of the liver transplant process that a child and his family goes through while explaining the surgical advances and the associated complications that could happen in the immediate or long-term follow-up. We have deliberately introduced the theme that 'liver transplant is a disease' and 'not a cure', to emphasise the need for adherence with immunosuppression, a healthy lifestyle and lifelong medical follow-up.
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Affiliation(s)
- Rohit Kohli
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Miriam Cortes
- Department of Adult and Pediatric Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, UK
| | - N D Heaton
- Department of Adult and Pediatric Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, UK
| | - Anil Dhawan
- Pediatrics Liver GI and Nutrition Centre and MowatLabs, King's College Hospital, London, UK
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4
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Bhattacharjee J, Das B, Sharma D, Sahay P, Jain K, Mishra A, Iyer S, Nagpal P, Scaria V, Nagarajan P, Khanduri P, Mukhopadhyay A, Upadhyay P. Autologous NeoHep Derived from Chronic Hepatitis B Virus Patients' Blood Monocytes by Upregulation of c-MET Signaling. Stem Cells Transl Med 2016; 6:174-186. [PMID: 28170202 PMCID: PMC5442753 DOI: 10.5966/sctm.2015-0308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/13/2016] [Indexed: 12/16/2022] Open
Abstract
In view of the escalating need for autologous cell‐based therapy for treatment of liver diseases, a novel candidate has been explored in the present study. The monocytes isolated from hepatitis B surface antigen (HBsAg) nucleic acid test (NAT)‐positive (HNP) blood were differentiated to hepatocyte‐like cells (NeoHep) in vitro by a two‐step culture procedure. The excess neutrophils present in HNP blood were removed before setting up the culture. In the first step of culture, apoptotic cells were depleted and genes involved in hypoxia were induced, which was followed by the upregulation of genes involved in the c‐MET signaling pathway in the second step. The NeoHep were void of hepatitis B virus and showed expression of albumin, connexin 32, hepatocyte nuclear factor 4‐α, and functions such as albumin secretion and cytochrome P450 enzyme‐mediated detoxification of xenobiotics. The engraftment of NeoHep derived from HBsAg‐NAT‐positive blood monocytes in partially hepatectomized NOD.CB17‐Prkdcscid/J mice liver and the subsequent secretion of human albumin and clotting factor VII activity in serum make NeoHep a promising candidate for cell‐based therapy. Stem Cells Translational Medicine2017;6:174–186
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Affiliation(s)
| | - Barun Das
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Disha Sharma
- Institute of Genomics and Integrative Biology, New Delhi, India
| | - Preeti Sahay
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Kshama Jain
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Alaknanda Mishra
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Srikanth Iyer
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Puja Nagpal
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Vinod Scaria
- Institute of Genomics and Integrative Biology, New Delhi, India
| | - Perumal Nagarajan
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | | | - Asok Mukhopadhyay
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Pramod Upadhyay
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
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5
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Na GH, Kim DG, Jung ES. Culture with Growth Factor Supplements Improves the Viability and Function of Rat Hepatocytes. KOREAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.4285/jkstn.2015.29.3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gun Hyung Na
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Goo Kim
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Jung
- Department of Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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6
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Zhou H, Liu H, Ezzelarab M, Schmelzer E, Wang Y, Gerlach J, Gridelli B, Cooper DKC. Experimental hepatocyte xenotransplantation--a comprehensive review of the literature. Xenotransplantation 2015; 22:239-48. [PMID: 25950141 PMCID: PMC4519403 DOI: 10.1111/xen.12170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/18/2015] [Indexed: 12/11/2022]
Abstract
Hepatocyte transplantation (Tx) is a potential therapy for certain diseases of the liver, including hepatic failure. However, there is a limited supply of human livers as a source of cells and, after isolation, human hepatocytes can be difficult to expand in culture, limiting the number available for Tx. Hepatocytes from other species, for example, the pig, have therefore emerged as a potential alternative source. We searched the literature through the end of 2014 to assess the current status of experimental research into hepatocyte xenoTx. The literature search identified 51 reports of in vivo cross-species Tx of hepatocytes in a variety of experimental models. Most studies investigated the Tx of human (n = 23) or pig (n = 19) hepatocytes. No studies explored hepatocytes from genetically engineered pigs. The spleen was the most common site of Tx (n = 23), followed by the liver (through the portal vein [n = 6]) and peritoneal cavity (n = 19). In 47 studies (92%), there was evidence of hepatocyte engraftment and function across a species barrier. The data provided by this literature search strengthen the hypothesis that xenoTx of hepatocytes is feasible and potentially successful as a clinical therapy for certain liver diseases, including hepatic failure. By excluding vascular structures, hepatocytes isolated from genetically engineered pig livers may address some of the immunological problems of xenoTx.
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Affiliation(s)
- Huidong Zhou
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Kidney Transplantation, Second Affiliated Hospital of the University of South China, Heng(1)yang, Hunan, China
| | - Hong Liu
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
- Department of General Surgery, First Hospital of Shanxi Medical University, ShanXi, China
| | - Mohamed Ezzelarab
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eva Schmelzer
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yi Wang
- Center for Kidney Transplantation, Second Affiliated Hospital of the University of South China, Heng(1)yang, Hunan, China
| | - Jörg Gerlach
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruno Gridelli
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - David K. C. Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Sufiandi S, Obara H, Enosawa S, Hsu HC, Matsuno N, Mizunuma H. Improvement of Infusion Process in Cell Transplantation: Effect of Shear Stress on Hepatocyte Viability Under Horizontal and Vertical Syringe Orientation. CELL MEDICINE 2015; 7:59-66. [PMID: 26858894 PMCID: PMC4733837 DOI: 10.3727/215517914x685150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Improving cell viability and function are important for enhancing the clinical results of cell transplantation. The relationship between cell viability and shear stress remains unexplained, and sedimentation effects during the infusion process are important to the hepatocyte transplantation process. In the present study, the relationship between cell viability and shear stress in the presence of sedimentation effect was investigated using a microchannel simulating the cell transplantation process under several shear stress conditions. Horizontal and vertical syringe orientations were employed to investigate the sedimentation effect. The vertical syringe orientation resulted in lower viability loss than the horizontal orientation. In summary, removing a sedimentation effect is important to improving cell viability by preventing high shear stress.
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Affiliation(s)
- Sandi Sufiandi
- *Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Hiromichi Obara
- *Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
- †Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Shin Enosawa
- †Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Huai-Che Hsu
- †Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Naoto Matsuno
- *Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
- †Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Hiroshi Mizunuma
- *Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
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8
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Na GH, Kim DG, Kim YH, Han JH, Jung ES. Effects of glucose concentration in the medium on rat hepatocyte culture. Ann Surg Treat Res 2014; 87:53-60. [PMID: 25114883 PMCID: PMC4127907 DOI: 10.4174/astr.2014.87.2.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/07/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine the optimum culture conditions by investigating isolated rat hepatocytes cultured in medium containing different glucose concentrations. Methods Hepatocytes were isolated from rats using a two-step perfusion technique and divided into the following two groups cultured in medium containing different glucose concentrations: (1) low-glucose group and (2) high-glucose group. Total cell count and viability of cultured rat hepatocytes and liver function parameters (i.e., concentrations of albumin, ammonia, and urea in the culture medium) were measured. The morphology of cultured rat hepatocytes was examined by staining with hematoxylin and eosin, and albumin receptor expression was confirmed by immunofluorescence. Results Total cell count and viability showed smaller increases in the low-glucose group than the high-glucose group, although the difference was not statistically significant (P = 0.112 and P = 0.147, respectively). The levels of albumin (P = 0.943), ammonia (P = 0.744), and urea (P = 0.709) were not significantly different between the two groups. In both groups, the function of cultured hepatocytes decreased significantly over time. The morphology of hepatocytes was well maintained in both groups at 3 days. On day 7, the cytoplasm was transformed into a spindle shape. On day 10, these changes were exaggerated, and were more prominent in the high-glucose group. Conclusion Morphological assessment indicated that low-glucose culture medium is better than high-glucose culture medium for culturing of hepatocytes, although there was not significantly different in functional assessment. The cultured hepatocytes with low-glucose culture medium could be maintained for 7 days.
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Affiliation(s)
- Gun Hyung Na
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong Goo Kim
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Hui Kim
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Hyun Han
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun Sun Jung
- Department of Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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9
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Khademi F, Verdi J, Soleimani M, Roozafzoon R, Keshel SH, Raeisossadati R, Ai J. Human endometrial adult stem cells can be differentiated into hepatocyte cells. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2014. [DOI: 10.1016/j.jmhi.2013.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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10
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Tormos AM, Taléns-Visconti R, Nebreda AR, Sastre J. p38 MAPK: a dual role in hepatocyte proliferation through reactive oxygen species. Free Radic Res 2013; 47:905-16. [PMID: 23906070 DOI: 10.3109/10715762.2013.821200] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
p38 MAPKs are important mediators of signal transduction that respond to a wide range of extracellular stressors such as UV radiation, osmotic shock, hypoxia, pro-inflammatory cytokines, and oxidative stress. The most abundant family member is p38α, which helps to couple cell proliferation and growth in response to certain damaging stimuli. In fact, increased proliferation and impaired differentiation are hallmarks of p38α-deficient cells. It has been reported that reactive oxygen species (ROS) play a critical role in cytokine-induced p38α activation. Under physiological conditions, p38α can function as a mediator of ROS signaling and either activate or suppress cell cycle progression depending on the activation stimulus. The interplay between cell proliferation, p38 MAPK activation, and ROS production plays an important role in hepatocytes. In fact, low levels of ROS seem to be needed to activate several signaling pathways in response to hepatectomy and to orchestrate liver regeneration. p38 MAPK works as a sensor of oxidative stress and cells that have developed mechanisms to uncouple p38 MAPK activation from oxidative stress are more likely to become tumorigenic. So far, p38α influences the redox balance, determining cell survival, terminal differentiation, proliferation, and senescence. Further studies would be necessary in order to clarify the precise role of p38 MAPK signaling as a redox therapeutical target.
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Affiliation(s)
- A M Tormos
- Department of Physiology, Faculty of Pharmacy, University of Valencia , Valencia , Spain
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11
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Wan Z, Zhang XG, Liu ZW, Lv Y. Therapeutic liver repopulation for metabolic liver diseases: Advances from bench to bedside. Hepatol Res 2013; 43:122-30. [PMID: 22971121 DOI: 10.1111/j.1872-034x.2012.01081.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 12/14/2022]
Abstract
Metabolic liver diseases are characterized by inherited defects in hepatic enzymes or other proteins with metabolic functions. Therapeutic liver repopulation (TLR), an approach of massive liver replacement by transplanted normal hepatocytes, could be used to provide the missing metabolic function elegantly. However, partial and transient correction of the underlying metabolic defects due to very few integrated donor cell mass remains the major obstacle for the effective and widespread use of this approach. Little engraftment and proliferation insufficiency lead to the poor outcome. This article reviews the advances in the mechanisms of initial engraftment and selective proliferation and suggests some effective treatment strategies, from pharmacological preconditioning to stem cell transplantation, to optimize liver repopulation with liver cell transplantation. Enhancing cell viability and plating efficiency, increasing sinusoidal spaces, regulation of sinusoidal endothelial cell barrier and controlling inflammatory reaction may promote initial cell engraftment. Liver-directed irradiation, reversible portal vein embolization and fetal liver stem/progenitor cell transplantation induce preferential proliferation of donor cells substantially without severe side-effects. Furthermore, it seems better to use combined approaches to achieve a high level of liver repopulation for the management of metabolic liver diseases.
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Affiliation(s)
- Zhen Wan
- Hepatobiliary Surgery; Institute of Advanced Surgical Techniques and Tissue Engineering Research, Xi'an Jiaotong University, Xi'an, China
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Carbone M, Lerut J, Neuberger J. How regenerative medicine and tissue engineering may complement the available armamentarium in gastroenterology? World J Gastroenterol 2012; 18:6908-17. [PMID: 23322988 PMCID: PMC3531674 DOI: 10.3748/wjg.v18.i47.6908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 09/10/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023] Open
Abstract
The increasing shortage of donors and the adverse effects of immunosuppression have restricted the impact of solid organ transplantation. Despite the initial promising developments in xenotransplantation, roadblocks still need to be overcome and this form of organ support remains a long way from clinical practice. While hepatocyte transplantation may be effectively correct metabolic defects, it is far less effective in restoring liver function than liver transplantation. Tissue engineering, using extracellular matrix scaffolds with an intact but decellularized vascular network that is repopulated with autologous or allogeneic stem cells and/or adult cells, holds great promise for the treatment of failure of organs within gastrointestinal tract, such as end-stage liver disease, pancreatic insufficiency, bowel failure and type 1 diabetes. Particularly in the liver field, where there is a significant mortality of patients awaiting transplant, human bioengineering may offer a source of readily available organs for transplantation. The use of autologous cells will mitigate the need for long term immunosuppression thus removing a major hurdle in transplantation.
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13
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Pareja E, Cortés M, Bonora A, Mir J. [New alternatives to liver transplantation: transplantation of hepatocytes]. Med Clin (Barc) 2011; 137:513-8. [PMID: 20416905 DOI: 10.1016/j.medcli.2010.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 01/26/2010] [Accepted: 02/09/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Eugenia Pareja
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario La Fe, Valencia, Spain.
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Clinical and laboratory evaluation of patients with end-stage liver cell failure injected with bone marrow-derived hepatocyte-like cells. Eur J Gastroenterol Hepatol 2011; 23:936-41. [PMID: 21900788 DOI: 10.1097/meg.0b013e3283488b00] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM One of the defining features of the liver is the capacity to maintain a constant size despite injury. Extrahepatic stem cells especially bone marrow-derived stem cells are thought to undertake an important role in liver repopulation. This study was carried out to evaluate the outcome of autologous bone marrow-derived hepatocytes transplantation in patients with end-stage liver cell failure due to chronic hepatitis C. METHODS Forty patients were included, divided into two groups. Group I: 20 patients receiving autologous bone marrow-derived mesenchymal stem cells stimulated to hepatic lineage. They were subdivided into two groups regarding the route of transplantation: intrasplenic (10) and intrahepatic (10). Group II: included 20 patients who received traditional supportive treatment. Patients were followed up using examination, laboratory investigations, abdominal ultrasonography, and evaluated by Child score, Model for End Stage Liver Disease score, fatigue scale, and performance status. RESULTS The results showed significant improvement in group I regarding ascites, lower limb edema, and serum albumin, over the control group. Group I also showed statistically significant improvement in Child score, Model for End Stage Liver Disease score, fatigue scale, and performance status over the controls. No difference was observed between intrahepatic and intrasplenic groups. CONCLUSION This study demonstrated the safety and short-term efficacy of autologous bone marrow-derived mesenchymal stem cell injection in liver cell failure. Further study is necessary to standardize the cell dose, determine the life span of the injected cells, and detect the appearance of long-term complications.
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Kisseleva T, Brenner DA. Anti-fibrogenic strategies and the regression of fibrosis. Best Pract Res Clin Gastroenterol 2011; 25:305-17. [PMID: 21497747 PMCID: PMC3086317 DOI: 10.1016/j.bpg.2011.02.011] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 02/18/2011] [Accepted: 02/23/2011] [Indexed: 01/31/2023]
Abstract
Liver fibrosis is an outcome of many chronic diseases, and often results in cirrhosis, liver failure, and portal hypertension. Liver transplantation is the only treatment available for patients with advanced stage of fibrosis. Therefore, alternative methods are required to develop new strategies for anti-fibrotic therapy. Available treatments are designed to substitute for liver transplantation or bridge the patients, they include inhibitors of fibrogenic cytokines such as TGF-β1 and EGF, inhibitors of rennin angiotensin system, and blockers of TLR4 signalling. Development of liver fibrosis is orchestrated by many cell types. However, activated myofibroblasts remain the primary target for anti-fibrotic therapy. Hepatic stellate cells and portal fibroblasts are considered to play a major role in development of liver fibrosis. Here we discuss the origin of activated myofibroblasts and different aspects of their activation, differentiation and potential inactivation during regression of liver fibrosis.
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Affiliation(s)
| | - David A. Brenner
- Dept. of Medicine, University of California, San Diego, CA, USA,Corresponding author, Contact information: David Brenner, M.D., 1318 Biomedical Sciences Building, 9500 Gilman Drive, La Jolla, CA 92093-0602, T: 858-534-1501 / F: 858-822-0084,
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Okura H, Saga A, Fumimoto Y, Soeda M, Moriyama M, Moriyama H, Nagai K, Lee CM, Yamashita S, Ichinose A, Hayakawa T, Matsuyama A. Transplantation of human adipose tissue-derived multilineage progenitor cells reduces serum cholesterol in hyperlipidemic Watanabe rabbits. Tissue Eng Part C Methods 2010; 17:145-54. [PMID: 20698754 DOI: 10.1089/ten.tec.2010.0139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal codominant disease characterized by high concentrations of proatherogenic lipoproteins and premature atherosclerosis secondary to low-density lipoprotein (LDL) receptor deficiency. We examined a novel cell therapy strategy for the treatment of FH in the Watanabe heritable hyperlipidemic (WHHL) rabbit, an animal model for homozygous FH. We delivered human adipose tissue-derived multilineage progenitor cells (hADMPCs) via portal vein and followed by immunosuppressive regimen to avoid xenogenic rejection. Transplantation of hADMPCs resulted in significant reductions in total cholesterol, and the reductions were observed within 4 weeks and maintained for 12 weeks. (125)I-LDL turnover study showed that the rate of LDL clearance was significantly higher in the WHHL rabbits with transplanted hADMPCs than those without transplanted. After transplantation hADMPCs were localized in the portal triad, subsequently integrated into the hepatic parenchyma. The integrated cells expressed human albumin, human alpha-1-antitrypsin, human Factor IX, human LDL receptors, and human bile salt export pump, indicating that the transplanted hADMPCs resided, survived, and showed hepatocytic differentiation in vivo and lowered serum cholesterol in the WHHL rabbits. These results suggested that hADMPC transplantation could correct the metabolic defects and be a novel therapy for inherited liver diseases.
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Affiliation(s)
- Hanayuki Okura
- Department of Somatic Stem Cell Therapy and Health Policy, Foundation for Biomedical Research and Innovation, Kobe, Japan
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Pareja E, Cortés M, Martínez A, Vila JJ, López R, Montalvá E, Calzado A, Mir J. [Hepatic cell transplantation: a new therapy in liver diseases]. Cir Esp 2010; 88:3-11. [PMID: 20510402 DOI: 10.1016/j.ciresp.2010.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 12/16/2009] [Accepted: 03/12/2010] [Indexed: 12/17/2022]
Abstract
Liver transplantation has been remarkably effective in the treatment in patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the greatest limitation, resulting in longer waiting times and increase in mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation.Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients. The procedure consists of transplanting individual cells to a recipient organ in sufficient quantity to survive and restore the function. The capacity of hepatic regeneration is the biological basis of hepatocyte transplantation. This therapeutic option is an experimental procedure in some patients with inborn errors of metabolism, fulminant hepatic failure and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. In the Hospital La Fe of Valencia, we performed the first hepatocyte transplantation in Spain creating a new research work on transplant program.
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Affiliation(s)
- Eugenia Pareja
- Unidad de Cirugía y Trasplante Hepático, Hospital Universitario La Fe, Valencia, España.
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Abstract
PURPOSE OF REVIEW The capacity of the liver to regenerate and maintain a constant size despite injury is unique. However, the exact mechanisms are not completely clear. Cell transplantation has been proposed as an alternative treatment of liver diseases. Recent progress has been reported on the generation of stem/progenitor cells that may differentiate toward the hepatic lineage. However, it is currently difficult to determine which of the stem/progenitor cell populations are the best for therapy of a given disease. RECENT FINDINGS The limited access to donor human hepatocytes has led to a great interest in the generation of hepatocyte-like cells. Several potential cell sources have been identified. However, general standardization of the methods to evaluate these cells is particularly important for the promise of stem/progenitor-derived hepatocyte-based therapies. Moreover, innovations aimed at improving hepatocyte delivery, survival, and engraftment have recently opened the field of organ engineering that may improve liver repopulation. SUMMARY Here we review current evidence reported from the perspective of potential clinical applications of different hepatic cell sources with repopulation capacities and the future perspectives and tools that can facilitate the translation of laboratory work into clinical success.
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Wu Y, Shatapathy CC, Minger SL. Isolation, in vitro cultivation and characterisation of foetal liver cells. Methods Mol Biol 2009; 481:181-192. [PMID: 19096801 DOI: 10.1007/978-1-59745-201-4_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hepatocyte transplantation has recently become an efficient clinical method in the treatment of patients with metabolic liver diseases. The shortage of donor cells remains an obstacle to treat more patients. Foetal liver tissues may therefore be useful as an alternative source of generating functional hepatocytes after in vitro culture and maturation.
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Affiliation(s)
- Yue Wu
- Stem Cell Biology Laboratory, Wolfson Centre for Age-Related Diseases King's College London, London, UK
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Enns GM, Millan MT. Cell-based therapies for metabolic liver disease. Mol Genet Metab 2008; 95:3-10. [PMID: 18640065 DOI: 10.1016/j.ymgme.2008.06.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 06/05/2008] [Accepted: 06/05/2008] [Indexed: 12/15/2022]
Abstract
Liver transplantation is an important therapeutic option for many individuals with metabolic liver disease. Nevertheless, the invasive nature of surgery and limitations of donor organ availability have led to the search for alternatives to whole-organ transplantation. Cell-based therapies have been a particularly active area of investigation in recent years. Hepatocyte transplantations have been performed for a variety of indications, including acute liver failure, end-stage liver disease, and inborn errors of metabolism. Individuals with inborn errors of metabolism who have undergone hepatocyte transplantation have shown clinical improvement and partial correction of the underlying metabolic defect. In most cases, sustained benefits have not been observed. This may be related to inadequate cell dose, variations in the quality of hepatocyte preparations, rejection of the transplanted cells, or senescence of transplanted hepatocytes. Though initial proof of concept with hepatocyte transplantation has been demonstrated by a number of investigators, wide application of this technology has been hindered by the inability to secure a reliable and well-characterized cell source(s) for transplantation and by the challenges of sustained engraftment and expansion of transplanted cells in vivo. Cell-based therapies, including those based on stem cells or more differentiated progenitor cells, may represent the future of cell transplantation for treatment of metabolic liver disease.
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Affiliation(s)
- Gregory M Enns
- Division of Medical Genetics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94305-5208, USA.
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Akhter J, Johnson LA, Gunasegaram A, Riordan SM, Morris DL. Hepatocyte transplantation: A review of laboratory techniques and clinical experiences. Surgeon 2007; 5:155-64. [PMID: 17575669 DOI: 10.1016/s1479-666x(07)80043-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Orthotopic liver transplantation (OLT) is standard clinical practice for patients with severe and end-stage chronic liver disease. However, the chronic shortage of donor livers and parallel growth of the transplant waiting list mean that a substantial proportion of patients die while waiting for a donor liver. Attempts to reduce the waiting list by use of split-liver and living-related live donor techniques have had some impact, but additional approaches to management are vital if the death rate is to be significantly reduced. Extensive laboratory research work and limited clinical trials have shown that hepatocyte transplantation may be useful in bridging some patients to OLT. A major limiting factor has been the shortage of mature functioning human hepatocytes, which are currently mostly obtained from livers rejected for OLT. This review examines potential hepatocyte sources, hepatocyte isolation methods and preservation protocols that have been successfully established, along with an overview of clinical results.
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Affiliation(s)
- J Akhter
- Cancer Research Laboratories, UNSW Department of Surgery St George Hospital, Sydney, NSW 2217, Australia
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Abstract
Hepatocyte transplantation has been used for temporary metabolic support of patients in end-stage liver failure awaiting whole organ transplantation as a method to support liver function and facilitate regeneration of the native liver in cases of fulminant hepatic failure and as a "cellular therapy" for patients with genetic defects in vital liver functions. The aim of this paper was to discuss the basic research that led to clinical hepatocyte transplantation, the published clinical experience with this experimental technique, and some possible future uses of hepatocyte transplantation.
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Affiliation(s)
- P Bruzzone
- Department of Surgery and Transplantation Paride Stefanini, University of Rome La Sapienza, Italy.
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Nussler A, Konig S, Ott M, Sokal E, Christ B, Thasler W, Brulport M, Gabelein G, Schormann W, Schulze M, Ellis E, Kraemer M, Nocken F, Fleig W, Manns M, Strom SC, Hengstler JG. Present status and perspectives of cell-based therapies for liver diseases. J Hepatol 2006; 45:144-59. [PMID: 16730092 DOI: 10.1016/j.jhep.2006.04.002] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In recent years the interest in liver cell therapy has been increasing continuously, since the demand for whole liver transplantations in human beings far outweighs the supply. From the clinical point of view, transplantation of hepatocytes or hepatocyte-like cells may represent an alternative to orthotopic liver transplants in acute liver failure, for the correction of genetic disorders resulting in metabolically deficient states, and for late stage liver disease such as cirrhosis. Although the concept of cell therapy for various diseases of the liver is widely accepted, the practical approach in humans often remains difficult. An international expert panel critically discussed the recent published data on clinical and experimental hepatocyte transplantation and the possible role of stem cells in liver tissue repair. This paper aims to summarise the present status of cell based therapies for liver diseases and to identify areas of future preclinical and clinical research.
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Affiliation(s)
- Andreas Nussler
- Fresenius Biotech Bad Homburg, Division of Cell Therapy, Bad Homburg, Germany.
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Terry C, Dhawan A, Mitry RR, Hughes RD. Cryopreservation of isolated human hepatocytes for transplantation: State of the art. Cryobiology 2006; 53:149-59. [PMID: 16793034 DOI: 10.1016/j.cryobiol.2006.05.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 05/08/2006] [Accepted: 05/15/2006] [Indexed: 01/16/2023]
Abstract
Hepatocytes isolated from unused donor livers are being used for transplantation in patients with acute liver failure and liver-based metabolic defects. As large numbers of hepatocytes can be prepared from a single liver and hepatocytes need to be available for emergency and repeated treatment of patients it is essential to be able to cryopreserve and store cells with good thawed cell function. This review considers the current status of cryopreservation of human hepatocytes discussing the different stages involved in the process. These include pre-treatment of cells, freezing solution, cryoprotectants and freezing and thawing protocols. There are detrimental effects of cryopreservation on hepatocyte structure and metabolic function, including cell attachment, which is important to the engraftment of transplanted cells in the liver. Cryopreserved human hepatocytes have been successfully used in clinical transplantation, with evidence of replacement of missing function. Further optimisation of hepatocyte cryopreservation protocols is important for their use in hepatocyte transplantation.
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Affiliation(s)
- Claire Terry
- King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, Bessemer Road, London SE5 9PJ, UK
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Abstract
Acute liver failure (ALF) in neonates is a rare but often fatal event. Though in adults and older children, a main symptom of ALF is hepatic encephalopathy, this is very difficult to diagnose and prove in infants. Causes of ALF in neonates encompass metabolic, infectious and haematological disorders, congenital vascular/heart abnormalities, and drugs. Infants with ALF should only be treated in specialised paediatric hepatology centres with facilities for liver transplantation, since for many liver transplant, with a long term survival of over 60%, is the only therapeutic option.
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Affiliation(s)
- Anil Dhawan
- Paediatric Liver Centre, Institute of Liver Studies, Variety Club Children's Hospital, King's College School of Medicine at King's College Hospital, Denmark Hill, London SE5 9RS, UK
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