Anno 2004 freshly isolated or cryopreserved porcine or human hepatocytes have been most frequently used as biocomponent in
clinically applied bioartificial livers (BALs). Phase 1 studies of all biocomponent modalities showed safety, feasibility,
and improvement of biochemical, neurological, and hemodynamic parameters. However, both the pilot-controlled clinical trial
with C3A cells and the randomized larger clinical trial with cryopreserved porcine hepatocytes did not show significant improvement
of survival by intention-to-treat analysis. Because of the xenotransplantation-related disadvantages of porcine cells and
the shortage of primary human hepatocytes, other sources of biocomponents have to be explored. The future lies in the development
of one or more human hepatocyte cell lines, which will have minimal immunogenicity, no risk of xeno-zoonosis, and the requested
functionality and availability. Primary sources for the development of such human cell lines are liver-tumor-derived cell
lines, immortalized fetal or adult hepatocytes, and stem cells of hepatic, hematopoietic, or embryonic origin. At present
the most promising results for BAL application have been obtained by immortalization of human fetal liver cells by reconstitution
of telomerase activity. However, in all cell types tested so far, the in vitro differentiation cannot be stimulated to such
an extent that their functionality reaches that of primary human hepatocytes. More insight in differentiation-promoting factors
and the influence of matrix and co-culture conditions is needed.
Keywords Bioartificial liver - hepatocyte - immortalized liver cell line - embryonic stem cell - human fetal liver cell