Highly Porous Polymer Matrices as a Three-Dimensional Culture System for Hepatocytes

Hepatocyte-based therapies (e.g., hepatocyte transplantation and extracorporeal support devices) may provide alternative therapies to treat patients with liver disease, but suitable approaches to localize these cells to a given location while maintaining liver-specific gene expression must be developed. The suitability of highly porous three-dimensional sponges fabricated from poly (l-lactic acid) [PLLA] as an hepatocyte culture system was evaluated in this study. Sponges were fabricated utilizing a particulate leaching technique, and were approximately 95% porous, with an average pore diameter of 180 μm. Hepatocytes seeded into these sponges adhered and remained viable for 14 days. However, the secretion rate of albumin from these cells, an indication of liver-specific gene expression, was low (approximately 6 pg/cell/day at day 1), and decreased steadily over the 14 days of the experiment. Coating sponges with collagen, and more preferably, immobilizing cells within the PLLA sponges with a collagen gel, led to enhanced cell survival and albumin secretion at all time points. These data suggest that porous PLLA sponges may provide a novel system for long-term culture of hepatocytes, and proper design of the system may allow the liver-specific gene expression of hepatocytes transplanted in these matrices to be enhanced.

Transurethral microwave thermotherapy for the treatment of BPH: still a challenger?

Minimally invasive therapies for treatment of benign prostatic hyperplasia (BPH) compete with the gold standard transurethral resection of the prostate (TURP). Comparisons of efficacy and safety have broadened the knowledge of different treatment modalities. Concerns of quality of life such as unaltered sexual function as well as cost considerations drive the market to develop techniques of lower level invasiveness. Among the competitors the office based transurethral microwave thermotherapy (TUMT) provides the broadest scale of scientific data. Numerous manufacturers sell various modifications of this technology. According to different clinical studies TUMT proved to be an effective, safe, and durable therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. However, TURP still holds the steadier long-term results and is more effective to reduce obstruction as well as other LUTS.

Biologische vaskularisierte Matrix (BioVaM)

A new technique is presented to harvest an acellular matrix from a porcine small bowel segment preserving the mesenteric arterial and venous pedicles. Reseeding of this biological vascularized matrix (BioVaM) with functional cells, i.e. smooth muscle and urothelial cells isolated from the urinary tract, and resurfacing of its vascular structures with endothelial precursor cells results in a vascularized tissue engineered graft for reconstruction and augmentation of the urinary bladder. First promising short term implantation experiments using a porcine model for the evaluation of early graft perfusion after vascular anastomosis are presented.

In vitro function of islets of Langerhans encapsulated with a membrane of porcine chondrocytes for immunoisolation

BACKGROUND/AIMS

Widespread clinical application of islet transplantation remains restricted, because of insufficient methods to prevent rejection and autoimmune destruction of islet grafts. In this study we demonstrate long-term function of islets of Langerhans within a capsule of porcine chondrocytes which may serve as an immunoisolation barrier utilizing the immunoprivileged properties of the chondrocyte matrix.

METHODS

Islets of Langerhans were isolated from Lewis rats, seeded on biodegradable polyglycolic acid polymer, and encapsulated with a monolayer of porcine chondrocytes. The encapsulated constructs and controls were kept in culture for 5 weeks. One group was exposed to a glucose challenge every 5th day. The insulin concentration of the culture medium was measured. Histological and insulin-immunohistochemical studies were performed.

RESULTS

Hematoxylin and eosin histology demonstrated viability of the islets of Langerhans. The intact morphology was demonstrated by Heidenhain staining. Toluidine blue showed viability of surrounding chondrocyte layers. Immunohistochemistry was positive for insulin within the beta cells of the islets. Both encapsulated constructs and nonencapsulated controls showed increasing insulin levels after glucose challenge.

CONCLUSIONS

We can tissue engineer a chondrocyte encapsulation membrane which permits diffusion of glucose and insulin. Islets of Langerhans survive within the chondrocyte capsule, and the glucose/insulin feedback mechanism remains intact.

Hepatic tissue engineering on 3-dimensional biodegradable polymers within a pulsatile flow bioreactor

BACKGROUND

An optimal method for hepatocyte transplantation is not yet determined. With the principles of tissue engineering in vitro conditioning of hepatocytes on biodegradable polymer in a flow bioreactor before implantation forming spheroids may achieve increased cell mass and function to replace lost organ function in vivo.

METHODS

Biodegradable poly-L-lactic (PLLA) polymer discs were seeded with rat hepatocytes in a concentration of 10 x 10(6) cells per ml and exposed to a medium flow of 24 ml/min for 1, 2, 4 and 6 days. The number and diameter of spheroidal aggregates was measured by phase-contrast microscopy. H&E histology was performed. Albumin production as hepatocyte specific function was determined by ELISA.

RESULTS

Spheroids of viable hepatocytes of 50-200 microm in diameter were formed. Both the number and diameter of the spheroids increased during the first 2 days and then remained constant until day 6. Albumin production was maintained throughout the culture period.

CONCLUSION

Short (2- 3 days) pre-transplant conditioning of hepatocytes in a flow bioreactor on biodegradable PLLA resulted in formation of spheroids with a liver-like morphology and preserved specific metabolic function. Tissue engineered hepatocyte spheroids on polymer may represent a functionally active and easy transplantable neotissue and may serve as an in vivo substitute for lost liver function.

Optimization of hepatocyte spheroid formation for hepatic tissue engineering on three-dimensional biodegradable polymer within a flow bioreactor prior to implantation

We hypothesize that in vitro conditioning of hepatocytes within biodegradable poly-L-lactic acid (PLLA) polymer matrices prior to implantation may increase hepatocyte survival and function after transplantation. The purpose of this study was to optimize the culture conditions of hepatocytes in a pulsatile flow bioreactor. PLLA discs were seeded with rat hepatocytes in a concentration of 2.5, 5, 10, 20 and 40 x 10(6) cells/ml. Seeded discs were exposed to recirculated perpendicular flow of 0, 7, 15, 24, 32, 52 ml/min of supplemented Williams' Medium E and harvested after 6 days in flow culture. Only under flow conditions the hepatocytes formed spheroidal aggregates (SphA) of 50-260 microm in diameter with a liver-like morphology and active metabolic function. The number of SphA was examined by phase contrast microscopy and the reductive enzyme function of the hepatocytes was tested using MTT. Hematoxylin and eosin histology showed vital hepatocytes within the SphA less than 200 microm in diameter but central necrosis in the SphA exceeding this size. Immunohistochemical staining confirmed albumin production of hepatocytes within the SphA. The optimal cell seeding concentration was 10 x 10(6) cells/ml with a flow speed of 24 ml/min. SphA of hepatocytes cultured with this flow bioreactor method may prove useful as a functional unit for tissue engineering of an in vivo liver substitute.

Hepatocyte transplantation using biodegradable matrices in ascorbic acid-deficient rats: comparison with heterotopically transplanted liver grafts

BACKGROUND

Hepatocyte transplantation using polymeric matrices is under investigation as an alternative therapy for metabolic liver diseases. Long-term engraftment of hepatocytes in polymers has been demonstrated. However, the metabolic activity of hepatocytes in such devices has never been assessed in direct comparison with liver grafts.

METHODS

Hepatocyte and partial liver transplantation were evaluated in the scurvy-prone osteogenic disorder Shionogi rat model. Biodegradable poly glycolic acid matrices seeded with hepatocytes equivalent to 20% of the recipient's liver mass, or 20% liver grafts were heterotopically transplanted into ascorbic acid- (AsA) deficient recipients. Recipients of cell-free matrices or AsA-deficient liver grafts served as controls. Recipients were set on AsA-free diet after transplantation. Plasma AsA levels, AsA concentrations in liver and adrenal gland tissue, and body weight ratios were assessed and H&E histology was performed.

RESULTS

Recipients from the control groups showed symptoms of scurvy at 1 month after cessation of AsA supply. Hepatocyte transplantation and auxiliary liver transplantation prevented symptoms of scurvy and increased plasma and tissue AsA levels and body weight ratios. AsA levels in recipients of 20% liver grafts were comparable to normal control animals.

CONCLUSIONS

Hepatocytes transplanted in polymeric matrices are able to compensate for liver-based metabolic deficiencies. Hepatocyte transplantation improves plasma AsA levels in AsA-deficient recipients. However, auxiliary liver grafts are superior to hepatocyte grafts in improving metabolic parameters. Further research work is needed to increase the efficiency of liver cell transplantation with regard to a clinical application.

New procedures to assess executive functions in preschool children

Executive functions are difficult to assess in preschool children, yet the preschool period is particularly important, both in the development of behavioral control and of the brain, particularly the prefrontal cortex. Several tasks were adapted from developmental and neuroscience literature and then administered to 98 preschool children (30-, 36-, 42-, 48- and 60-month age groups). Executive function task performance was related largely to age group, but not to sex or intelligence. These tasks, then, were sensitive in this age range and may be useful to delineate distinct cognitive profiles among preschool children with various neurological and developmental disorders.

Chemotherapeutic CNS prophylaxis and neuropsychologic change in children with acute lymphoblastic leukemia: a prospective study

OBJECTIVE

To determine whether prophylactic CNS chemotherapy for childhood acute lymphoblastic leukemia is associated with declines in neuropsychological abilities.

METHODS

Growth curve analysis was used to examine neuropsychological outcome and treatment-related change in children (N = 30) who were treated at two childhood cancer centers. A comprehensive test battery was administered at baseline (8 months), 2, 3, and 4 years postdiagnosis (age at diagnosis M = 5.90 years, SD = 4.2C).

RESULTS

Results indicated modest declines in arithmetic, visual motor integration, and verbal fluency. Intrathecal and systemic treatment was related to poorer visual motor integration at 4 years postdiagnosis and a faster rate of decline in visual motor integration skills across the observation period than intrathecal treatment alone. Arithmetic proficiency at 4 years after diagnosis was related to maternal education, but the rate of decline was not. Verbal fluency was unrelated to demographic or treatment variables.

CONCLUSIONS

These findings suggest that neuropsychological outcome and declines are related to both demographic and treatment characteristics depending on the cognitive domain examined.

Priming of hepatocytes for cell culture by partial hepatectomy prior to cell isolation

The combination of ex vivo gene transfer and a sufficient transplant model for hepatocytes may permit treatment of single enzyme-based metabolic liver diseases. Induction of replicative potential (priming) in hepatocyte cultures may enhance the efficiency of gene transfer under stable in vitro conditions. It is known that hepatocyte replication is increased in vivo after partial hepatectomy. We investigated the effect of partial hepatectomy prior to cell isolation on hepatocytes in vitro. Male Lewis rats served as donors. Hepatocytes were isolated by collagenase digestion from either intact livers or from livers 48 h after 70% hepatectomy (PH). Cells were seeded on collagen-coated culture dishes with hormone-supplemented culture media. Hepatocyte morphology, number, albumin secretion rate, and mono-ethyl-glycin-xylidid (MEGX)-biotransformation capacity were assessed on days 1, 3, and 5 in culture. PH significantly increased hepatocyte number and albumin secretion of cultured hepatocytes over the whole observation period. In contrast, MEGX-biotransformation capacity was significantly decreased. Morphology of cultured hepatocytes was not affected by PH prior to hepatocyte isolation. These results suggest a prolonged and complex response of hepatocytes to PH in vitro. Hepatocyte priming by PH is a promising approach toward stable cultures of proliferating hepatocytes and may provide a model for in vitro studies of hepatic regeneration mechanisms. Further research on hepatocyte priming toward an application in ex vivo gene transfer and hepatic tissue engineering seems justified.

Long-term differentiated function of heterotopically transplanted hepatocytes on three-dimensional polymer matrices

Hepatocyte transplantation using porous matrices is under investigation as an alternative therapy for certain liver diseases. For this purpose, long-term function of transplanted hepatocytes is mandatory. This problem has not been sufficiently investigated yet. In this study Lewis rats were used as donors and recipients. Stimulated (group A, portocaval shunt) or unstimulated (group B) hepatocytes were transplanted into prevascularized polyvinyl-alcohol matrices. Cell-free matrices served as controls (group C). Matrices were harvested between 1 h and 1 year after implantation and analyzed by morphometry; albumin RNA in situ hybridization; and cytokeratin-, actin-, desmin-, and macrophage-specific antigen immunohistology. The hepatocyte number significantly decreased within the first week following implantation. Between 1 month and 1 year after transplantation a significant increase in hepatocyte number was noted in groups A and B. Albumin transcripts of transplanted hepatocytes were at normal levels at all times except for group B after 1 year. The immunohistology suggested engraftment of nonparenchymal liver cells. We conclude that 3-dimensional matrices provide a sufficient environment for long-term engraftment of transplanted liver cells. The hepatocytes are able, despite suboptimal initial engraftment, to repopulate the scaffold for at least half of the recipient's life span and maintain cell-specific function after sufficient stimulation.

Influence of pancreatic islets on growth and differentiation of hepatocytes in co-culture

Improvement of cell culture conditions in hepatic tissue engineering may permit cell/tissue banking and the generation of liver tissue equivalents for transplantation. In these systems, continuous hepatotrophic stimulation is still necessary. We investigated the stimulatory effects of pancreatic islets on hepatocytes in co-culture and characterized the stimulatory mechanisms. Hepatocytes and pancreatic islets were harvested from Lewis rats. Cells were cultured on collagen dishes either with nonstimulated media (controls and co-cultures with low or high islet rate) or stimulated media (controls and co-cultures). To characterize stimulatory mechanisms, additional co-cultures with membrane separation, with antiinsulin, antiglucagon, and with both antibodies were examined. Hepatocyte numbers, albumin secretion rate by enzyme-linked immunoadsorbent assay, and monoethylglycinxylidid biotransformation values by fluorescence polarization immunoassay were assessed. A radioimmunoassay measured insulin and glucagon concentrations. In groups with nonstimulated media, cell number was higher in co-cultures with low islet rate, and albumin secretion rate was increased in co-cultures with high islet rate compared to controls. MEGX biotransformation was decreased in co-cultures. In groups with stimulated media, co-culture had no impact on cell number or albumin secretion rate. Hepatocyte numbers and albumin secretion rates were not changed in co-cultures after membrane separation. Islet effects on hepatocytes were reduced in co-cultures with antiinsulin, antiglucagon, or both antibodies. Pancreatic islets provide stimulation for hepatocytes in vitro. Islet effects were mediated by soluble factors, and are dependent on insulin and glucagon. These results permit further investigations towards three-dimensional transplantable hepatocyte-islet devices for continuous in vitro and in vivo stimulation.

Executive functioning in preschool children: performance on A-not-B and other delayed response format tasks

The A-not-B (AB) task has been hypothesized to measure executive/frontal lobe function; however, the developmental and measurement characteristics of this task have not been investigated. Performances on AB and comparison tasks adapted from developmental and neuroscience literature was examined in 117 preschool children (ages 23-66 months). Age significantly predicted performance on AB, Delayed Alternation, Spatial Reversal, Color Reversal, and Self-Control tasks. A four-factor analytic model best fit task performance data. AB task indices loaded on two factors with measures from the Self-Control and Delayed Alternation tasks, respectively. AB indices did not load with those from the reversal tasks despite similarities in task administration and presumed cognitive demand (working memory). These results indicate that AB is sensitive to individual differences in age-related performance in preschool children and suggest that AB performance is related to both working memory and inhibition processes in this age range.

Interaction of hepatocytes and pancreatic islets cotransplanted in polymeric matrices

Heterotopic hepatocyte transplantation (HcTx) in polymeric matrices may become an alternative to liver transplantation for metabolic disorders. Hepatotrophic stimulation by means of a portocaval shunt operation is an established, but invasive, procedure used to optimize hepatocyte engraftment in matrices. We evaluated hepatocyte and pancreatic islet cotransplantation (ICT) as an alternative noninvasive approach to hepatotrophic stimulation. Lewis rats served as donors and recipients. Hepatocytes and islets were isolated using collagenase digestion and seeded into polyvinylalcohol matrices. HcTx and ICT were compared with HcTx plus portocaval shunt and HcTx without stimulation. Matrices were investigated at 1, 3, and 6 months after implantation: the test methods applied were trichrome staining, PAS, immunohistochemistry for insulin, glucagon and incorporated BrdU, and in situ hybridization for albumin RNA. Hepatocytes expressed albumin RNA and formed conglomerates without atypias in all animals. ICT and portocaval shunting increased the number of hepatocytes and BrdU uptake. Alpha cells migrated into the islet-surrounding hepatocytes, whereas beta cells remained immobile. It is concluded that ICT and portocaval shunting supported engraftment of hepatocytes in polymeric matrices equally well. ICT did not interfere with recipient glucose metabolism and did not induce hyperproliferative premalignant foci within the transplanted hepatocytes. The technique is an attractive approach to hepatotrophic stimulation of bioartificial liver equivalents.

Is there an optimal concentration of cotransplanted islets of Langerhans for stimulation of hepatocytes in three dimensional matrices?

BACKGROUND

Hepatocyte transplantation using three-dimensional matrices is under investigation as an alternative therapy for several liver diseases. For sufficient transplantation results hepatotrophic stimulation is necessary. We investigated the stimulatory effect of cotransplanted pancreatic islets in different ratios.

METHODS

Lewis rats were used as donors and recipients. A portocaval shunt (group A) or sham operation (groups B-G) was performed 1 week before hepatocyte transplantation. Four polyvinyl-alcohol matrices each containing 1.25 x 10(7) hepatocytes (groups A and B) or 1.25 x 10(7) hepatocytes and 125 (C), 250 (D), 500 (E), or 750 (F) islets were implanted between small bowel mesenteric leaves. In group G, medium soaked matrices were implanted. One month after implantation, specimens were harvested and investigated using albumin-RNA in situ hybridization, and insulin, glucagon, and bromodesoxy uridine immunohistochemistry. The hepatocyte area was assessed using image analysis.

RESULTS

Hepatocyte area and proliferation ratio increased depending on the number of cotransplanted islets with a peak at 40 islets per 1 million hepatocytes (group E). Cotransplantation of islets in higher concentrations did not further increase hepatocyte area or proliferation ratio. Hepatocytes in all groups expressed albumin RNA at normal transcription levels as compared to standard liver sections. Islets displayed insulin and glucagon in physiological distribution.

DISCUSSION

Three-dimensional matrices provide a sufficient environment for transplanted hepatocytes and islets. The hepatotrophic effect of cotransplanted islets is comparable to portocaval shunting and has a saturation limit at 40 islets per 1 million hepatocytes. For further application of islet cotransplantation, this ratio seems to be preferable.

Evaluation of methods of hepatotrophic stimulation in rat heterotopic hepatocyte transplantation using polymers

BACKGROUND

Hepatocyte transplantation has been studied as an alternative to organ transplantation. Hepatocyte transplant models should provide sufficient cell mass for replacement function and hepatotrophic stimulation of the transplanted cells in heterotopic locations.

METHOD

The authors used three-dimensional porous polyvinyl-alcohol matrices as cell carriers, which were implanted between mesenteric leaves of the intestine. In this study, different methods were evaluated for hepatotrophic stimulation. Fifty million transplanted hepatocytes (approximately 10% liver mass) were implanted in Lewis rats. We compared 70% partial hepatectomy, portacaval shunt, cotransplantation of enterocytes, cotransplantation of islets of Langerhans, and methylprednisolone injection to a control group with only hepatocyte transplantation. Portacaval shunt and islet cotransplantation also were used in combination. Specimens were harvested 2 weeks after transplantation, and area per histological cross section compromised by hepatocytes was measured.

RESULTS

Seventy percent partial hepatectomy, enterocyte cotransplantation, and methylprednisolone injection resulted in hepatocyte maintenance similar to control group (3,100 +/- 7,592 microm2). Portacaval shunt (96,866 +/- 55,039 microm2) and islet cotransplantation (173,020 +/- 75,977 microm2) yielded a highly significant increase in hepatocyte area. The combination of portacaval shunt and islet cotransplantation resulted in a significant increase compared with using these methods individually (288,930 +/- 86,726 microm2). Additional immunohistochemical stains for active DNA synthesis, insulin, and glucagon demonstrated the proliferative abilities of the hepatocytes and the synthesis of insulin and glucagon in the cotransplanted islets.

CONCLUSION

Hepatocyte transplantation can be performed using polymer carriers and that hepatocyte survival and maintenance can be improved with portacaval shunt and islet cotransplantation.

Long-term insulin-secretory function of islets of Langerhans encapsulated with a layer of confluent chondrocytes for immunoisolation

Islet transplantation is a potential cure for diabetes mellitus. The major problem for broad clinical application remains the prevention of transplant rejection without major side effects. Immunoisolation is an experimental strategy to prevent rejection by separating the transplanted cells from the host immune system using a barrier device. Current methods use artificial, not completely inert materials as barrier devices and induce an unwanted foreign-body (FB) reaction. Using the recipients of own cells for encapsulation, the FB reaction could be prevented. This study describes a new method of encapsulation of islets of Langerhans within a capsule of chondrocytes, which may serve as an immunoisolation barrier utilizing the immunoprivileged properties of the chrondrocyte matrix, and demonstrates the functional survival of the encapsulated islets in vitro.

Heterotopic hepatocyte transplantation utilizing pancreatic islet cotransplantation for hepatotrophic stimulation: morphologic and morphometric evaluation

Hepatocyte transplantation using three-dimensional (3D) matrices is under evaluation as an alternative therapy for liver diseases. It is known that hepatotropic stimulation optimizes hepatocyte engraftment. We investigated hepatotrophic stimulation by portocaval shunt operation (PCS) or pancreatic islet cotransplantation (ICT) over a period of 6 months. Lewis rats served as donors and recipients, respectively. One week prior to hepatocyte implantation PCS (group A) or a sham operation (groups B-D) was performed. Four polyvinyl-alcohol matrices, each containing 1.25 x 10(7) hepatocytes (groups A and C), 1.25 x 10(7) hepatocytes and 500 islets (group B), or cell-free culture medium (group D, control) were implanted between recipients' small-bowel mesenteric leaves. One, 3, and 6 months after implantation eight polymers from each group were harvested and analyzed by morphometry, PAS reaction, and immunohistochemistry for insulin, glucagon, and bromodesoxyuridine. Morphologically healthy-appearing hepatocytes were found in all cell transplantation groups at all times. Stimulation by either PCS or ICT significantly increased hepatocyte area at 1 and 6 months compared to unstimulated specimens (group C). Over time, an increase in hepatocyte area was noted in all groups. There were no significant differences in proliferation ratios between the three experimental groups. The initially reduced PAS reaction became normal after 3 months. 3D matrices provided a sufficient environment for transplanted hepatocytes and islets. Hepatocytes proliferated and maintained differentiation independent of hepatotrophic stimulation for at least 6 months when 3D matrices were utilized. ICT efficiently stimulated transplanted hepatocytes by means of hepatocyte area. These results justify further research on hepatocyte transplantation and ICT with regard to clinical application.

Modulation of VEGF production by pH and glucose in retinal Müller cells

PURPOSE

To investigate the influence of pH and glucose concentration, both of which represent significant biochemical variables in tissue ischemia, on the production of VEGF protein by retinal Müller cells and C6 glioma cells, under normoxic and hypoxic conditions.

METHODS

Rat retinal Müller cells and C6 glioma cells grown in tissue culture monolayers were studied. The effect of pH (range 7.0-8.0) and glucose concentration (0.6-25 mmol/L) on VEGF protein production, under both normoxic and hypoxic conditions, were evaluated by ELISA analysis of the conditioned media. Establishment of significant cell hypoxia was verified by measurement of lactate release into the conditioned media.

RESULTS

Hypoxia caused a 7.9-fold increase in VEGF production in C6 cells at 24 h, and a 3.4-fold increase in Müller cells after 48 h. Under hypoxic conditions, VEGF protein production was increased further by increasing pH and increasing glucose, and decreased by low pH and low glucose. Varying the glucose concentration or pH of the medium did not result in significant induction of VEGF protein production by either cell type under normoxic conditions.

CONCLUSIONS

Both glucose and pH significantly affected VEGF production induced by low oxygen. However, neither exerted a measurable stimulatory effect on VEGF production in normoxic conditions. Coexisting hypoxia and acidosis or hypoglycemia, as might occur in severe tissue ischemia, may render glial cells incapable of effectively upregulating VEGF synthesis, while alkalosis or hyperglycemia may augment hypoxia-induced VEGF production.

Long-term engraftment of hepatocytes transplanted on biodegradable polymer sponges

Hepatocyte transplantation may provide an alternative to orthotopic liver transplantation to treat liver failure. However, suitable systems to transplant hepatocytes and promote long-term engraftment must be developed. In this study, highly porous, biodegradable sponges were fabricated from poly (L-lactic acid) (PLA), and poly (DL-lacticco-glycolic acid) (PLGA), and utilized to transplant hepatocytes into the mesentery of three groups of Lewis rats. The portal vein was shunted to the inferior vena cava in one group of rats (PCS). The second group of animals received a PCS and a 70% hepatectomy on the day of sponge-hepatocyte implantation (PCS + HEP), and the control group (CON) received no surgical stimulation. The sponges were vascularized by ingrowth of fibrovascular tissue over the first 7 days in vivo. Approximately 95-99% of the implanted hepatocytes (determined utilizing computer-assisted image analysis) died in all three experimental groups during this time. The number of engrafted hepatocytes in the CON group further decreased over the next 7 days to 1.3 +/- 1.1% of the original cell number. However, the number of engrafted hepatocytes in the PCS and PCS + HEP increased over this time to 6 +/- 1% and 5 +/- 2%, respectively. The number of engrafted hepatocytes in the PCS group continued to increase over the next 2.5 months to a value of 26 +/- 12% of the initial cell number, and a large number of engrafted hepatocytes was still present at 6 months. These results indicate that stable new tissues can be engineered by transplanting hepatocytes on biodegradable sponges into heterotopic locations if appropriate stimulation is provided.

Highly porous polymer matrices as a three-dimensional culture system for hepatocytes

Hepatocyte-based therapies (e.g., hepatocyte transplantation and extracorporeal support devices) may provide alternative therapies to treat patients with liver disease, but suitable approaches to localize these cells to a given location while maintaining liver-specific gene expression must be developed. The suitability of highly porous three-dimensional sponges fabricated from poly (L-lactic acid) [PLLA] as an hepatocyte culture system was evaluated in this study. Sponges were fabricated utilizing a particulate leaching technique, and were approximately 95% porous, with an average pore diameter of 180 microns. Hepatocytes seeded into these sponges adhered and remained viable for 14 days. However, the secretion rate of albumin from these cells, an indication of liver-specific gene expression, was low (approximately 6 pg/cell/day at day 1), and decreased steadily over the 14 days of the experiment. Coating sponges with collagen, and more preferably, immobilizing cells within the PLLA sponges with a collagen gel, led to enhanced cell survival and albumin secretion at all time points. These data suggest that porous PLLA sponges may provide a novel system for long-term culture of hepatocytes, and proper design of the system may allow the liver-specific gene expression of hepatocytes transplanted in these matrices to be enhanced.

Assessment of pragmatic communication skills in adolescents after traumatic brain injury

Deficits in pragmatic communication ability have a significant impact on functional outcome from traumatic brain injury (TBI), particularly during adolescence, when sophisticated social communication skills are developing. There are few published tests designed to assess pragmatic skills in this age group. In the present study, four tasks designed to tap various aspects of pragmatic communication ability were administered to three brain-injured adolescents and 36 of their uninjured peers aged 15-18 years. The tasks evaluated the ability to negotiate, hint, describe a simple procedure, and understand sarcasm. The four tasks were found to tap distinct aspects of pragmatic ability in control subjects. Further, within the control group, task performance was related more to non-verbal reasoning ability than vocabulary skills. Scores for two of the three TBI subjects were poorer than those of their peers, while a third mildly injured subject performed within normal limits. Pragmatic task scores were consistent with the results of neuropsychological testing in the three TBI subjects. Implications for clinical management and recommendations for future research are discussed.

Biodegradable sponges for hepatocyte transplantation

Liver cell transplantation may provide a means to replace lost or deficient liver tissue, but devices capable of delivering hepatocytes to a desirable anatomic location and guiding the development of a new tissue from these cells and the host tissue are needed. We have investigated whether sponges fabricated from poly-L-lactic acid (PLA) infiltrated with polyvinyl alcohol (PVA) would meet these requirements. Highly porous sponges (porosity = 90-95%) were fabricated from PLA using a particulate leaching technique. To enable even and efficient cell seeding, the devices were infiltrated with the hydrophilic polymer polyvinyl alcohol (PVA). This reduced their contact angle with water from 79 to 23 degrees, but did not inhibit the ability of hepatocytes to adhere to the polymer. Porous sponges of PLA infiltrated with PVA readily absorbed aqueous solutions into 98% of their pore volume, and could be evenly seeded with high densities (5 x 10(7) cells/mL) of hepatocytes. Hepatocyte-seeded devices were implanted into the mesentery of laboratory rats, and 6 +/- 2 x 10(5) of the hepatocytes engrafted per sponge. Fibrovascular tissue invaded through the devices' pores, leading to a composite tissue consisting of hepatocytes, blood vessels and fibrous tissue, and the polymer sponge.

Attentional disturbance after pediatric closed head injury

The influence of severity of closed head injury and age on attentional functioning was prospectively investigated in 36 children (age range, 7 to 16 years) 6 months after injury. Children were placed into mild, moderate, and severe injury groups using established neurologic criteria. Each child received the Wechsler Intelligence Scale for Children-Revised Digit Span subtest and a continuous performance test. Children with severe closed head injury demonstrated significantly poorer continuous performance test scores than mildly or moderately injured children. Injury severity had no effect on Digit Span scores. Younger children exhibited more pronounced impairment on the continuous performance test relative to uninjured age peers. These results extend the persistence of attentional impairments beyond those of previous reports. Closed head injury is not associated with preferential sparing of sustained attention in younger children 6 months after injury. Brain injury earlier in life may result in delayed vulnerability of information processing skills.

Delivery of whole liver-equivalent hepatocyte mass using polymer devices and hepatotrophic stimulation

Using hepatocytes injected into prevascularized polymer sponge devices, we studied hepatocyte survival and function after delivery of a whole liver-equivalent of cells into rats. LEW rats and enzyme-deficient Gunn rats served as recipients, respectively. Totally, 28.5 cm2 (0.5-cm thick) of polyvinyl alcohol sponges were implanted per animal. Hepatotrophic stimulation was induced by portacaval shunt and partial (70% or 30%) hepatectomy. Recipient rats received 5 x 10(8) hepatocytes (equivalent to whole rat liver) which were harvested from LEW and Wistar donors, respectively. After engraftment, histologic examination revealed hepatocyte remodeling in the device with capillaries lining plates of hepatocytes, and also tubular structures resembling early biliary radicles. BrdU staining revealed DNA synthesis in hepatocytes, providing evidence of regeneration within the grafts. Quantification of viable hepatocyte area at various time points was performed using computer-assisted morphometry. We then estimated a range of cell numbers from the quantitated cell area. The number of hepatocytes viable at day 7 was estimated at 27.5-46.0% and 6.6-11.0% in the mesentery and subcutaneous site, respectively. Thus the average number was estimated between 10.8% and 18.0% of initially injected hepatocytes. In the Gunn rat experiment, experimental rats that received normal Wistar hepatocytes showed a significantly greater decrease in total serum bilirubin compared with the concurrent control Gunn rats (P < 0.01). At week 1, serum bilirubin in experimental rats decreased to 74.7% (6.80 +/- 0.46 mg/dl) of pretransplantation level (9.10 +/- 0.47 mg/dl) and this was 71.4% of the control rats' bilirubin level (9.53 +/- 0.37 mg/dl). In conclusion, a hepatocyte mass equivalent to a whole rat liver can be delivered into prevascularized polymer sponge devices. At day 7 between 10.8% and 18.0% of these hepatocytes were estimated to be engrafted and functioning. Further optimization of this technique is necessary before clinical application is considered.