1. BY RAFAT RABEEYA UNDER THE GUIDANCE OF MR.ARUN KUMAR.J.M

2. Contents  Introduction  Liver Assisting Therapies  What does Bioartificial Liver need to do  Instrumentation  Process of Bioartificial Liver  Methods In Designing The Bioartificial Liver  Clinical Status Of Bioartificial Liver  Advantages And Disadvantages  Future Prospects  Conclusion  References

3. Introduction A bioartificial liver device (BAL) is an artificial extracorporeal supportive device for individuals suffering from liver failure. The purpose of BAL is to serve as a supportive device untill transplantation or regeneration of liver. As the device contains both biological and manufactured components, it is called a "bio-artificial liver."

4. Liver Liver is the largest internal organ and largest gland in the human body. Functions The liver produces bile, which aids in the digestion and absorption of fats. The liver performs several roles in carbohydrate metabolism, amino acid synthesis and in lipid metabolism. It stores glycogen, vitamins, and other substances. It synthesizes blood-clotting factors. It removes wastes and toxic matter from the blood. The liver is able to regenerate.

5. Liver Failure Liver failure is a condition that occurs when large parts of the liver become damaged and the liver is no longer able to function. Causes Of Liver Failure There are several causes of liver failure. The most common causes of liver failure are: Long term, excessive alcohol consumption Ingestion of poisonous wild mushrooms Malnutrition Acetaminophen (Tylenol) overdose

6. Liver Assisting Therapies Some of the fundamental methods used early on are; Hemodialysis- removes water soluble toxins. Plasma exchange- certain toxins present in the plasma are removed. hemofiltration- has limited application because of its major complication of thrombocytopenia, leading to bleeding in patients. Liver transplantation- The only treatment available for liver failure is liver transplant surgery; but donor organs are difficult to obtain, and the procedure, which is expensive and complex, is frequently unsuccessful..

7. Statistics On Liver Transplants

8. What does BAL need to do? Cellular components must be purified and every component in it must be clearly identified. The cellular preparation must be clearly shown to not transmit any infectious diseases of any kind. The cellular component must stay viable and active. The device must be able to introduce the therapeutic and regulatory molecules that a healthy liver provides, and it must also filter substances from the blood the way that the normal liver does. Blood must perfuse properly through system.

9. Instrumentation BAL device consists of: Plasma separator Charcoal column Bioreactor Reservoir Temperature regulator and oxygenator Pump

10. Process of BAL Bioartificial liver has the following steps:  Isolation, purification and attachment of hepatocytes to microcarriers..  Inoculation of microcarrier attached hepatocytes into the hollow fibre module.  Separation of plasma from blood.  Removal of toxins.  Reconstitution.  Re infusion.

12. Methods In Designing The BAL Two methods in designing the bioartificial liver are:  Using synthetic membrane  Extra corporeal hepatitis bioreactor

13. Clinical Status Of Bioartificial Liver Several BAL devices are currently undergoing clinical testing for the treatment of liver disease HepatAssist  BAL (Bioartificial Liver): Circe Biomedical, Inc., Lexington, MA -Phase I/II study.

14. Advantages BAL therapy is marked as the most promising solution to bridge to liver transplantation or to liver regeneration. It performs metabolic functions in addition to detoxification. Bioartificial liver (BAL) systems have shown their efficacy in experimental Acute liver failure (ALF) models in small and large animals, and have shown to be suitable and safe in phase 1 studies in humans with ALF.

15. Disadvantages Maintaining cell viability. Lack of knowledge regarding the necessary metabolic functions. Possibility of introducing viruses with live cell use.

16. Future Prospects Development of an effective and safe bio-artificial liver. Creation of sufficient amounts of human liver cells to charge the bioartificial liver, by genetic manipulation of adult or foetal human liver cells.

17. Conclusion As the indications for liver transplantation have expanded and as donor organs have failed to keep pace, the need for an bioartificial liver has become more critical. Given that the regenerative capacity of the liver is practically unlimited, the liver can usually recover sufficient function to sustain life if function can be supported for a few weeks. If an bioartificial liver were routinely available, many patients with liver failure might recover without liver transplantation. In the end, bioartificial livers will probably be used as a bridge to transplantation.

18. References Websites  http://doi.wiley.com/10.1111/j.1744- 9987.2006.00359.x; keyword: disadvantages of bioartificial liver  http://en.wikipedia.org/wiki/Liver; keyword: liver  http://en.wikipedia.org/wiki/Bioartificial_liver_dev ice;keyword : bioartificial liver  http://en.wikipedia.org/wiki/Liver_dialysis; keyword: liver dialysis.