Development and perspectives of bioartificial liver support.
Development and perspectives of bioartificial liver support.
复制标题
生物人工肝支持的发展和前景。
作者：
K. Naruse;M. Makuuchi
含有吸附装置、异种全肝灌注和混合型生物人工肝的生物人工肝支持系统预计可有效治疗严重肝衰竭。目前，全肝灌流和混合型生物人工肝是生物人工肝领域的两大主流，但两者是否对肝功能衰竭患者有显著的有益效果尚不清楚。我们开发了一种新的异种直接血液灌流系统，包括白细胞吸附剂、免疫球蛋白吸附剂和肝功能替代单位，即全肝或生物反应器。使用该系统后，肝功能替代单位的灌注有效率和供氧量明显提高。我们的系统的进一步改进，包括白细胞分离装置返回白细胞丰富的部分灌注的血液直接回到病人的身体进行。此外，我们的系统不仅可以作为生物人工肝，也可以作为生物人工肾。为了解决体外生物人工肝支持中异种蛋白质流入人体的问题，开发转人蛋白基因的转基因牛具有重要意义。猪内源性逆转录病毒进入人体一直是一个有争议的话题。关于这个问题，交叉血液灌流方法是有希望的，因为患者的回路和生物人工肝回路被半透膜隔开，这可以防止任何类型的病毒流入患者的回路。
Bioartificial liver support systems containing adsorbent devices, xenogeneic whole liver perfusion, and hybrid bioartificial liver are anticipated to be effective for the treatment of severe hepatic failure. At present, whole liver perfusion and the hybrid bioartificial liver are two mainstreams in the field of the bioartificial liver, but it is still unclear whether either of them has significant beneficial effects in hepatic failure patients. We developed a new system of xenogeneic direct hemoperfusion consisting of a leukocyte adsorbent, an immunoglobulin adsorbent, and a substitute unit for hepatic function, that is, whole liver or bioreactor. Using this system, the perfusion efficiency rate and oxygen supply of the substitute unit for hepatic function were significantly increased. A further improvement of our system by incorporating a leukocytapheresis device to return the leukocyte-rich portion of the perfused blood back to the patient's body directly was undergone. Moreover, our system can be applied not only as a bioartificial liver, but also as a bioartificial kidney. To solve the problem of xenogeneic protein influx into the human body associated with extracorporeal bioartificial liver support, it is important to develop transgenic cattle in which human protein genes are transduced. Influx of porcine endogenous retrovirus into the human body has been a controversial subject. In relation to this issue, the cross-hemoperfusion method is promising in that the patient's circuit and the bioartificial liver circuit are separated by a semipermeable membrane, which can prevent any kind of virus from flowing into the patient's circuit.