Bio-Artificial Liver Support System: A Prospective Future Therapy
2. Materials and Methods
- What is the method of liver support system for treating chronic and acute liver failure?
- How do the advantages and disadvantages of each conventional liver support system provide liver failure treatment?
- What is the bio-artificial liver support system method, and how can it treat liver failure compared to the other systems?
- ScienceDirect (http://www.sciencedirect.com) (accessed on 15 June 2022)
- SpringerLink (http://www.springer.com/in/) (accessed on 25 June 2022)
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- Elsevier (https://www.elsevier.com/en-xs) (accessed on 10 June 2022)
- Cochrane (https://www.cochrane.org/) (accessed on 15 June 2022)
3.1. Liver Support System
3.1.1. Molecular Adsorbent Recirculation System (MARS)
3.1.2. Single-Pass Albumin Dialysis (SPAD)
3.2. Bio-Artificial Liver Support System
3.2.1. Animal Subject Study
3.2.2. Human Subject Study
3.3. Induced Pluripotent Stem Cells/iPSC
Animal Subject Study
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|No.||Liver Support Method||Advantages||Disadvantages|
|1.||Single-Pass Albumin Dialysis (SPAD)||Significant reduction (>50%) in total plasma bilirubin, conjugated bilirubin, blood urea nitrogen, and creatinine||Clinical studies about effectiveness in toxin removal are still limited (only 1–2 studies from the last five years).|
|3.||Molecular Adsorbent Recirculation System (MARS)||Eliminate toxins, and repair liver failure symptoms (toxin blood level 0%)|
Reduction in bilirubin, bile acid, ammonia, urea, lactate, and creatinine levels (>50% compared to previous levels)
MARS can stabilize the anhepatic condition in ALF and ACLF for 96 h before transplantation.
Effective in clearing bile acid compared to SPAD (bile acid clear 100%)
A significant increase (50%) in mean arterial pressure and systemic blood circulation resistance without a change in heart index.
Plasma renin activity reduction (up to 50%).
|The survival rate has not been reported (no studies). The mortality percentage did not significantly reduce (compared to the previous study, 0% reduction).|
Thrombocytopenia, coagulopathy, and bleeding risks up to 20–30%.
MARS is relatively more expensive (cost >1000 USD in Europe)
|4.||Bio-artificial Liver Support System (BALSS)||Improve neurological state and liver and kidney functions to bridge transplantation (the function status is usually based on assessment score).||BALSS might not reduce ALF deaths, but the survival rate is still controversial. It can either reduce or increase ALF deaths (the percentages are 50%)|
The delivery of bioreactors is expensive and impractical (it costs USD >500)
Limited study and case reports (there have only been 1–2 studies in the last five years.)
The risk of zoonosis disease transmission is up to 30%.
|5.||Induced-Pluripotent Stem Cells/iPSC||Increase the viability and function of human hepatocytes (from 20 to >40%)|
Improve the regeneration of liver function and facilitate a speedy recovery (up to 100%).
|There is no study with human subjects reported. Therefore, the method should be produced on a larger scale of up to <100 subjects.|
|No.||Liver Support Method||Human Subject||Animal Subject|
|1.||Hepatocyte-based Bio-Artificial Liver (BAL)||Not yet used in clinical trials.|
RCT meta-analysis results showed that BAL might not reduce ALF deaths.
|Pre-clinically modified and applied to large animals. As a result, six out of seven patients with liver failure bridged to transplantations, and one recovered without transplantation.|
|2.||Single-Pass Albumin Dialysis||Twelve patients with ALF and CLF were treated, and there was a reduction in total bilirubin levels.|
However, clinical experience in toxic removal is still limited. 
|One of the simplest methods for eliminating toxins and water-soluble compounds from albumin has been proven to be single-pass albumin dialysis (SPAD), which was tested on five pigs.|
|3.||Molecular Adsorbent Recirculation System (MARS)||A random clinical trial in 23 patients with ALF and CLF showed a reduction in bilirubin level.|
MARS has been proven to eliminate toxins and stabilize the anhepatic condition in humans.
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Jasirwan, C.O.M.; Muradi, A.; Antarianto, R.D. Bio-Artificial Liver Support System: A Prospective Future Therapy. Livers 2023, 3, 65-75. https://doi.org/10.3390/livers3010006
Jasirwan COM, Muradi A, Antarianto RD. Bio-Artificial Liver Support System: A Prospective Future Therapy. Livers. 2023; 3(1):65-75. https://doi.org/10.3390/livers3010006Chicago/Turabian Style
Jasirwan, Chyntia Olivia Maurine, Akhmadu Muradi, and Radiana Dhewayani Antarianto. 2023. "Bio-Artificial Liver Support System: A Prospective Future Therapy" Livers 3, no. 1: 65-75. https://doi.org/10.3390/livers3010006