Key challenges to the development of extracorporeal bioartificial liver support systems.
BACKGROUND
For nearly three decades, extracorporeal bioartificial liver (BAL) support systems have been anticipated as promising tools for the treatment of liver failure. However, these systems are still far from clinical application. This review aimed to analyze the key challenges to the development of BALs.


METHODS
We carried out a PubMed search of English-language articles relevant to extracorporeal BAL support systems and liver failure.


RESULTS
Extracorporeal BALs face a series of challenges. First, an appropriate cell source for BAL is not readily available. Second, existing bioreactors do not provide in vivo-like oxygenation and bile secretion. Third, emergency needs cannot be met by current BALs. Finally, the effectiveness of BALs, either in animals or in patients, has been difficult to document.


CONCLUSIONS
Extracorporeal BAL support systems are mainly challenged by incompetent cell sources and flawed bioreactors. To advance this technology, future research is needed to provide more insights into interpreting the conditions for hepatocyte differentiation and liver microstructure formation.
Zhejiang University School of Medicine, Hangzhou, China.
Li-Fu
LF
Zhao
Xiao-Ping
XP
Pan
Lan-Juan
LJ
Li
D000818:Animals; D019149:Bioreactors; D002454:Cell Differentiation; D002478:Cells, Cultured; D004867:Equipment Design; D022781:Hepatocytes / Q000378:metabolism / Q000473:pathology / Q000637:transplantation*; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D017093:Liver Failure / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D019164:Liver, Artificial / Q000009:adverse effects; D016896:Treatment Outcome