Abstract

Advanced liver diseases have very high morbidity and mortality due to associated complications, and liver transplantation represents the only current therapeutic option. However, due to worldwide donor shortages, new alternative approaches are mandatory for such patients. Regenerative medicine could be the more appropriate answer to this need. Advances in knowledge of physiology of liver regeneration, stem cells, and 3D scaffolds for tissue engineering have accelerated the race towards efficient therapies for liver failure. In this review, we propose an update on liver regeneration, cell-based regenerative medicine and bioengineering alternatives to liver transplantation.

Highlights

  • Acute and chronic liver diseases are leading causes of morbidity and mortality worldwide, accounting for about 1–2 million deaths annually [1]

  • We propose an update on liver regeneration, cell-based regenerative medicine approaches, and bioengineering alternatives to liver transplantation, along with futuristic approaches to overcome hurdles in liver tissue engineering

  • Evidence from patients with drug-induced liver injury (DILI) confirms these observations, suggesting that males show a delay in regenerative response to an acute liver injury, possibly related to a maturation shift in monocytes

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Summary

Introduction

Acute and chronic liver diseases are leading causes of morbidity and mortality worldwide, accounting for about 1–2 million deaths annually [1]. Cell-based regenerative therapies and novel technologies such as liver-on-chip [4] and bioprinted liver [5] are expected to be the next-generation therapies. These innovative approaches are all based on the extraordinary capacity of the liver to regenerate. For this reason, increasing our knowledge of liver regeneration mechanisms could bring significant benefits in the treatment of liver failure and may help patients needing large liver resections or transplantation. We propose an update on liver regeneration, cell-based regenerative medicine approaches, and bioengineering alternatives to liver transplantation, along with futuristic approaches to overcome hurdles in liver tissue engineering

Overview of Liver Development
Homeostasis and First Line of Response to Injury
Hepatic Stem Cells and Second Line of Response to Liver Injury
Alternatives to Liver Transplantation
Cell-Based Regeneration Therapy
Pluripotent Stem Cells
Adult Stem Cells
Hepatic Organoids
Liver Tissue Bioengineering
Decellularized Extracellular Matrix
Bioprinted Scaffolds
Bioreactor Systems
Micro-Bioreactors and Liver-on-Chip
Conclusions
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