From the Journals

Bioengineered liver models screen drugs and study liver injury

Thirty to 50 new drugs are approved in the United States annually, which costs approximately $2.5 billion/drug in drug development costs. Nine out of 10 drugs never make it to market, and of those that do, adverse events affect their longevity. Hepatotoxicity is the most frequent adverse drug reaction, and drug-induced liver injury, which can lead to acute liver failure, occurs in a subset of affected patients. Understanding a drug’s risk of hepatotoxicity before patients start using it can not only save lives but also conceivably reduce the costs incurred by pharmaceutical companies, which are passed on to consumers.

Dr. Rotonya Carr Assistant professor of medicine, division of gastroenterology, University of Pennsylvania

Dr. Rotonya Carr

In Cellular and Molecular Gastroenterology and Hepatology, Underhill and Khetani summarize available and emerging cell-based, high-throughput systems that can be used to predict hepatotoxicity. These modalities include cellular microarrays of single cells; cocultures of liver parenchymal and nonparenchymal cells; organoids (3-D organ-like structures); and liver-on-a-chip devices (complex perfusion bioreactors that allow for modulation of the cellular micro-environment). These in vitro systems have not only enabled investigators to screen multiple drugs at the same time but also have informed the clinical translation of these technologies. For example, the extracorporeal liver assist device – essentially, a liver bypass – and similar bioartificial liver devices can in principal temporarily perform some of the major liver functions while a patient’s native liver heals from drug-induced liver injury or other hepatic injury.

However, just as we have seen with the limitations of the in vitro systems, bioartificial livers are unlikely to be successful unless they integrate the liver’s complex functions of protein synthesis, immune surveillance, energy homeostasis, and nutrient sensing. The future is bright, though, as biomedical scientists and bioengineers continue to push the envelope by advancing both in vitro and bioartificial technologies.

Rotonya Carr, MD, is an assistant professor of medicine in the division of gastroenterology at the University of Pennsylvania, Philadelphia. She receives research support from Intercept Pharmaceuticals.


 

FROM CELLULAR AND MOLECULAR GASTROENTEROLOGY AND HEPATOLOGY

Some of the limitations of perfusion systems include the potential binding of drugs to tubing and materials used, large dead volume requiring higher quantities of novel compounds for the treatment of cell cultures, low throughput, and washing away of built-up beneficial molecules with perfusion.

The ongoing development of more sophisticated engineering tools for manipulating cells in culture will lead to continued advances in bioengineered livers that will show improving sensitivity for the prediction of clinically relevant drug and disease outcomes.

This work was funded by National Institutes of Health grants. The author Dr. Khetani disclosed a conflict of interest with Ascendance Biotechnology, which has licensed the micropatterned coculture and related systems from Massachusetts Institute of Technology, Cambridge, and Colorado State University, Fort Collins, for commercial distribution. Dr. Underhill disclosed no conflicts.

SOURCE: Underhill GH and Khetani SR. Cell Molec Gastro Hepatol. 2017. doi: org/10.1016/j.jcmgh.2017.11.012.

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