生物人工肝研究和应用进展

人工肝支持系统是用来为肝衰竭患者提供体外肝脏功能支持的技术方法.非生物人工肝在已经广泛应用肝衰竭患者的临床治疗,生物人工肝(BAL)以分离的哺乳动物肝细胞构成的生物反应器为解毒系统,可有效替代肝脏的解毒功能和合成功能,并可预防肝性脑病、肝昏迷和脑水肿.可作为肝移植前的过渡辅助,同时改善患者自身肝脏的功能以利于其功能的恢复.本文主要对生物人工肝的研究及应用进展进行综述.生物人工肝研究虽然取得了重大进展,但仍然面临寻找理想肝细胞来源,长期维持肝细胞的活性和功能,进一步优化反应器设计等问题.     

肝细胞永生化的研究与应用

正常体外培养的细胞在体外有一定的寿命,一般传代不超过50代,被称为有限细胞系,但有些体外培养的细胞可经过自发或外界因素的影响从凋亡危机中逃离出来,从而形成具有无限增殖能力的细胞系,成为永生化细胞系.由于肝细胞在体外增殖能力极弱,培养困难,其应用受到较大限制,而肝细胞经永生化后具有了无限增殖优势,使其在肝细胞移植,生物人工肝以及药理、毒理学等研究方面有广阔的应用前景.就近年来肝细胞永生化方法及其应用作简要的综述.     

三维肝细胞模型及其在化学性肝损伤评价中的应用

肝脏是机体代谢外源性化学物的主要场所,也是化学物及其代谢产物毒作用的重要靶器官。为了更加快速、准确地对化学物引起的肝损伤进行评估,选择贴近人体的细胞模型和培养方法至关重要。近年来研究发展了多种人源体外肝细胞模型,其中新兴的三维(3D)肝细胞体外模型具有类似体内肝脏表型、代谢能力,并适于长期体外培养,为药物等化学物的肝毒性测试提供了有力的体外评价工具。本文主要介绍目前常用的肝细胞模型的特点,以及球体模型、生物反应器、3D打印和肝脏芯片等3D培养系统,概述了这些模型在化学性肝损伤评估中的应用进展。     

胚胎肝细胞用于肝组织工程的体外培养研究

目的:观察三维受控组装系统下,胚胎肝细胞在三维立体结构的体外生长状态,探讨胚胎肝细胞在肝组织工程中应用的可行性。方法:用清华大学机械工程系研制的"三维受控组装系统",将第15 d小鼠胚胎肝细胞作为肝组织工程的种子细胞,与以明胶为主的复合材料混合,构建成复杂三维立体结构,观察其体外生长发育状态。对体外培养1周及4周的三维类肝组织标本进行苏木精-伊红(HE)染色,免疫组织化学方法检测甲胎蛋白(AFP)及白蛋白(ALB)的表达,并对体外培养4周的三维类肝组织用PAS显色法检测肝糖原表达。结果:HE染色结果显示体外培养的胚胎肝细胞在三维支架材料中,可形成含有类血管和肝组织样结构;体外培养1周的类肝组织AFP表达呈阳性,体外培养4周的三维类肝组织ALB表达呈阳性,PAS显色亦呈阳性。结论:在三维受控组装系统的构建下,呈立体状生长的胚胎肝细胞,可逐渐形成肝组织样结构,并显示一定的肝脏功能。     

大鼠部分肝切后血清对体外培养肝细胞的刺激作用

目的探讨大鼠部分肝切后血清对体外培养肝细胞生长状况的影响。方法对Sprague-Dawley大鼠进行肝部分切除,分别在术后第12、24、36h于心腔内穿刺取血,制备刺激血清。采用酶消化法分离获取Sprague-Dawley乳鼠的肝细胞,在加有10％上述刺激血清的DMEM培养基中进行肝细胞体外培养。倒置显微镜下观察培养细胞的生长状态,采用免疫细胞化学方法检测肝细胞中白蛋白和纤维蛋白原的表达情况。结果发现在肝切后血清刺激作用下,原代培养的肝细胞生长加快,存活时间增长。细胞传代培养后仍用制备血清加以刺激,可产生胶原样细胞外基质,并且在基质上粘附的肝细胞呈现克隆样生长状态,其胞浆内白蛋白和纤维蛋白原均呈阳性表达。结论研究初步表明,体外培养乳鼠肝细胞时加入大鼠部分肝切后血清,可以有效刺激细胞的生长,促进细胞外基质的产生,从而利于肝细胞在体外较长时间存活、增殖和功能保持,同时此种肝细胞体外培养方式还为肝脏细胞生物学研究增添了新的实验途径。     

两种原代树鼩肝细胞的分离和培养方法的研究

目的 探讨体外原代培养树嗣肝细胞的分离方法.方法 以成年树鼩和新生树鼦做为肝供体,分别采用体外两步灌流法和Percoll梯度液离心方法获取肝细胞并进行体外培养;以台盼蓝染色法测细胞存活率,在相差倒置显微镜下观察细胞形态变化,MTT法测培养细胞活性,并采用PAS染色法鉴定.结果 分离收获成年树鼩肝细胞较新生树鼩肝细胞存活率高;培养过程中,新生树胸肝细胞较成年树鼩肝细胞生长快,增殖能力强,具有统计学意义;PAS染色观察,新生树鼩和成年树鼩的肝细胞中充满大量糖原颗粒,两者差异无显著性.结论 两种方法均可用于原代树鼩肝细胞的体外培养.     

胎肝滤液诱导大鼠胎盘间充质干细胞向肝细胞的分化

目的探讨PDMSCs向肝细胞增殖和分化的体外培养条件及方法。方法孕20 d的大鼠无菌条件下取胎盘,经胶原酶消化、密度离心、贴壁筛选法分离培养胎盘源间充质干细胞,并对其表面抗原进行鉴定。在体外培养体系中加入胎肝滤液,模拟体内肝脏微环境,诱导PDMSCs向肝细胞定向分化,以免疫细胞化学检测干细胞标志物;PAS检测糖原表达。结果在体外培养条件下,PDMSCs贴壁生长为成纤维样细胞,CD44表面标志物检测阳性;PDMSCs经胎肝滤液诱导14d时细胞呈现圆形、卵圆形的特征性改变,AFP、CK19表达阳性。结论胎肝滤液能够诱导PDMSCs定向分化为肝细胞样细胞。     

人胚胎肝上皮样细胞的体外培养

用胶原酶直接消化人胚肝组织小块,可以简便、快速地获得大量活率较高和较纯的肝上皮样细胞。在低钙、低血清浓度加有多种因素的培养液中,胚肝上皮样细胞可以体外培养一月以上。原代培养的胚肝上皮样细胞一次传代后,仍可保持一定的生长能力。表皮生长因子、霍乱毒素、转铁蛋白及肝细胞生长因子等均对培养的胚肝上皮样细胞具有一定的生长刺激作用。本文还用r-GT染色、AFP和白蛋白测定,以及~3H-TdR掺入等指标观察了培养过程中胚肝上皮样细胞的生长、增殖和生物学功能。人胚肝上皮样细胞的较长期体外培养,可望成为研究肝细胞生长、分化及癌变的一个有用的实验模型。     

匹兹堡大学的研究人员成功地使肝培养细胞生长

当Geoffrey Block宣布他找到了使肝培养细胞生长的方法时,许多人对此抱怀疑态度。虽然肝脏本身能。够再生,但30年来许多专家尝试在体外培养肝细胞使之生长都以失败告终。而匹兹堡大学的研究人员却在这方面获得了成功:成批的肝细胞在培养条件下生长并增殖。     

Present and Future Developments in Hepatic Tissue Engineering for Liver Support Systems

The liver is the most important organ for the biotransformation of xenobiotics, and the failure to treat acute or acute-on-chronic liver failure causes high mortality rates in affected patients. Due to the lack of donor livers and the limited possibility of the clinical management there has been growing interest in the development of extracorporeal liver support systems as a bridge to liver transplantation or to support recovery during hepatic failure. Earlier attempts to provide liver support comprised non-biological therapies based on the use of conventional detoxification procedures, such as filtration and dialysis. These techniques, however, failed to meet the expected efficacy in terms of the overall survival rate due to the inadequate support of several essential liver-specific functions. For this reason, several bioartificial liver support systems using isolated viable hepatocytes have been constructed to improve the outcome of treatment for patients with fulminant liver failure by delivering essential hepatic functions. However, controlled trials (phase I/II) with these systems have shown no significant survival benefits despite the systems’ contribution to improvements in clinical and biochemical parameters. For the development of improved liver support systems, critical issues, such as the cell source and culture conditions for the long-term maintenance of liver-specific functions in vitro, are reviewed in this article. We also discuss aspects concerning the performance, biotolerance and logistics of the selected bioartificial liver support systems that have been or are currently being preclinically and clinically evaluated.     

一种非酒精性脂肪性肝病的超声影像人工智能辅助诊断系统开发

摘要 目的：结合人工智能方法设计针对肝脏超声影像的辅助诊断系统，辅助医生对大样本肝脏超声影像数据的标准化和高效化诊断，实现基于肝脏超声图像的非酒精性脂肪性肝病的精准诊断。方法：通过开发肝脏超声影像的识别与分类、脂肪肝分级分析和肝脏脂肪含量定量分析三个模块，建立一套非酒精性脂肪性肝病的超声影像人工智能辅助诊断系统，该系统能够自动区分输入到系统中不同采样视野的超声影像类型，并对肝脏超声图像进行数字化分析，给出待测超声图像是否呈现脂肪肝以及其肝脏脂肪含量的百分比值。结果：本研究中的超声图像识别分类模块可高通量区分出肝肾比图像和衰减率图像的两类超声影像，其分类的准确率达100%。脂肪肝分级分析模块在测试集数据的准确率达到84%，展现出可胜任辅助医生诊断的能力。基于人工肝脏脂肪含量定量方法开发的肝脏脂肪含量定量分析模块的准确率达到67.74%。结论：本研究已开发出一套基于肝脏超声影像的智能辅助诊断系统，可以辅助医生快速、简单、无创地筛选出潜在患有脂肪肝的患者，虽然现阶段实现肝脏脂肪定量分析仍有难度，但已展现出较大的临床应用潜力。     

Long-term liver cell cultures in bioreactors and possible application for liver support

Hybrid artificial liver systems are being developed as a temporary extracorporeal liver support therapy. A short overview is given which emphasizes the development of hepatocyte culture models for bioreactors, subsequent in vitro studies, animal studies and the clinical application of hybrid liver support systems.An own bioreactor construction has been designed for the utilization of hepatocytes and sinusoidal endothelial cells. The reactor is based on capillaries for hepatocyte aggregate immobilization, coated with biomatrix. Four separate capillary membrane systems, each permitting a different function, are woven in order to create a three-dimensional network. Cells are perfused via independent capillary membrane compartments. Decentralized oxygen supply and carbon dioxide removal with low gradients is possible. There is a decentralized co-culture compartment for nonparenchymal liver cells. The use of identical parallel units to supply a few hepatocytes facilitates scale-up.     

Characterization of the three-compartment gel-entrapment porcine hepatocyte bioartificial liver

A hybrid bioartificial liver device supporting a large mass of cells expressing differentiated hepatocyte metabolic capabilities is necessary for the successful treatment of fulminant hepatic failure. The three-compartment gel-entrapment porcine hepatocyte bioartificial liver was designed to provide "bridge" support to transplantation or until native liver recovery is achieved for patients with acute liver failure. The device is an automated mammalian cell culture system supporting 6-7 × 109 porcine hepatocytes entrapped in a collagen matrix and inoculated into the capillary lumen spaces of two 100 kDa molecular mass cut-off hollow fiber bioreactors. Gel contraction recreates a small lumen space within the hollow fiber which allows for the delivery of a nutrient medium. This configuration supported hepatocyte viability and differentiated phenotype as measured by albumin synthesis, ureagenesis, oxygen consumption, and vital dye staining during both cell culture and ex vivo application. The hollow fiber membrane was also shown to isolate the cells from xenogenic immunoglobulin attack. The gel-entrapment bioartificial liver maintained a large mass of functional hepatocytes by providing a three-dimensional cell culture matrix, by delivering basal nutrients through lumen media perfusion, and by preventing rejection of the xenocytes. These features make this device a favorable candidate for the treatment of clinical fulminant hepatic failure.     

Liver bioengineering

Liver bioengineering has been a field of intense research and popular excitement in the past decades. It experiences great interest since the introduction of whole liver acellular scaffolds generated by perfusion decellularization^1–3. Nevertheless, the different strategies developed so far have failed to generate hepatic tissue in vitro bioequivalent to native liver tissue. Even notable novel strategies that rely on iPSC-derived liver progenitor cells potential to self-organize in association with endothelial cells in hepatic organoids are lacking critical components of the native tissue (e.g., bile ducts, functional vascular network, hepatic microarchitecture, etc)⁴. Hence, it is vital to understand the strengths and short comes of our current strategies in this quest to re-create liver organogenesis in vitro. To shed some light into these issues, this review describes the different actors that play crucial roles in liver organogenesis and highlights the steps still missing to successfully generate whole livers and hepatic organoids in vitro for multiple applications.     

Pluripotent plasticity of stem cells and liver repopulation

Different types of stem cells have a role in liver regeneration or fibrous repair during and after several liver diseases. Otherwise, the origin of hepatic and/or extra‐hepatic stem cells in reactive liver repopulation is under controversy. The ability of the human body to self‐repair and replace the cells and tissues of some organs is often evident. It has been estimated that complete renewal of liver tissue takes place in about a year. Replacement of lost liver tissues is accomplished by proliferation of mature hepatocytes, hepatic oval stem cells differentiation, and sinusoidal cells as support. Hepatic oval cells display a distinct phenotype and have been shown to be a bipotential progenitor of two types of epithelial cells found in the liver, hepatocytes, and bile ductular cells. In gastroenterology and hepatology, the first attempts to translate stem cell basic research into novel therapeutic strategies have been made for the treatment of several disorders, such as inflammatory bowel diseases, diabetes mellitus, celiachy, and acute or chronic hepatopaties. In the future, pluripotent plasticity of stem cells will open a variety of clinical application strategies for the treatment of tissue injuries, degenerated organs. The promise of liver stem cells lie in their potential to provide a continuous and readily available source of liver cells that can be used for gene therapy, cell transplant, bio‐artificial liver‐assisted devices, drug toxicology testing, and use as an in vitro model to understand the developmental biology of the liver. Copyright © 2010 John Wiley & Sons, Ltd.     

基于深度学习的肝脏病理图像中肝脂肪变性分级研究

摘要 目的：设计基于深层神经网络模型用来分析肝脏全景病理切片图像（Whole slide images, WSI）的肝脂肪变性分级方法,以实现对非酒精性脂肪性肝病（Non-alcoholic fatty liver disease, NAFLD）病程的辅助诊断。方法：结合临床诊断,以非酒精性脂肪肝活动度积分（NAFLD activity score, NAS）为评价标准,将肝脂肪变性程度分为无、轻度、中度和重度等四级病程,本研究采用多示例学习的策略构建并训练深度神经网络模型,将训练获得的人工智能模型用来实现计算机自动化诊断肝脏病理切片中肝脂肪变性程度分级。结果：通过使用本研究中的人工智能方法可以在3分钟内对一张WSI进行完整的分析,得到该病患肝脏病理切片中肝脂肪变性分级,训练获得的人工智能模型的AUC为0.97,肝脂肪变性分级的平均准确率为78.18%,macro-F1 score、macro-Precision和macro-Recall分别为79.49、82.03和77.10,其结果展示获得的人工智能模型已满足可辅助临床诊断的水平。结论：本研究基于深度学习技术开发的人工智能方法初步实现快速自动化诊断肝脂肪变性分级,展现了其潜在的临床使用价值。     

Preclinical characterization of alginate‐poly‐L‐lysine encapsulated HepaRG for extracorporeal liver supply

We recently demonstrated that HepaRG cells encapsulated into 1.5% alginate beads are capable of self‐assembling into spheroids. They adequately differentiate into hepatocyte‐like cells, with hepatic features observed at Day 14 post‐encapsulation required for external bioartificial liver applications. Preliminary investigations performed within a bioreactor under shear stress conditions and using a culture medium mimicking acute liver failure (ALF) highlighted the need to reinforce beads with a polymer coating. We demonstrated in a first step that a poly‐l ‐lysine coating improved the mechanical stability, without altering the metabolic activities necessary for bioartificial liver applications (such as ammonia and lactate elimination). In a second step, we tested the optimized biomass in a newly designed perfused dynamic bioreactor, in the presence of the medium model for pathological plasma for 6 h. Performances of the biomass were enhanced as compared to the steady configuration, demonstrating its efficacy in decreasing the typical toxins of ALF. This type of bioreactor is easy to scale up as it relies on the number of micro‐encapsulated cells, and could provide an adequate hepatic biomass for liver supply. Its design allows it to be integrated into a hybrid artificial/bioartificial liver setup for further clinical studies regarding its impact on ALF animal models.     

东方蝾螈肝脏形态学与组织学观察

对东方蝾螈Synops orientalis的肝脏进行了组织学观察.结果 如下:东方蝾螈肝脏分为5叶,每叶由许多肝小叶组成.中央静脉位于小叶中央,肝细胞排列成肝细胞索(肝板),以中央静脉为中心向周围呈放射状排列.肝细胞索或肝细胞团之间的间隙为形状不规则、大小不等的肝血窦,窦壁由一层内皮细胞构成,间有枯否氏细胞,其核为细长状,有数目不等突起.肝细胞间有狄氏间隙,肝细胞呈多边形,胞核为圆形或卵圆形.肝实质内有大量色素沉着.并将东方蝾螈肝脏和其他动物肝脏进行了比较.