Currently, the only cure for liver failure is orthotopic liver transplantation. However, there are insufficient donor organs available to treat every patient on the transplant list and many die before they are able to receive a liver transplant. The bioartificial liver (BAL) device is a potential extracorporeal treatment strategy utilising hepatocytes or hepatocyte-like cells (HLCs) within a bioreactor to recapitulate normal liver function and therefore ‘bridge’ a patient with liver failure until they receive a transplant. The work in this thesis utilised tissue engineering methods to develop novel approaches to BAL device design through development and characterisation of a polymer membrane scaffold (“PX”) for hollow fibre bioreactor (HFB) culture and a HLC source generated from the transdifferentiation of pancreatic AR42J-B13 (B13) cells. A flat sheet membrane model was used for the development of asymmetrical, hydrophobic polystyrene (PS) phase inversion membranes. Oxygen plasma significantly increased PS membrane surface wettability through addition of oxygen functional groups to create an environment conducive for cell culture. The treated membrane was henceforth referred to as “PX”. The culture medium HepatoZYME+ was investigated for its ability to induce transdifferentiation of B13 cells to HLCs and maintain the hepatic phenotype. Overall, HepatoZYME+-cultured cells experienced viability loss. A diluted version, “50:50”, showed induction of the hepatic markers carbamoylphosphate synthetase-1 (CPS-1) and HNF4α, as well as a change towards a HLC morphology. When using 50:50 as a maintenance medium, transdifferentiated HLCs retained loss of pancreatic amylase and also induction of hepatic markers, with comparable serum albumin secretion to the established Dex + OSM treatment. However, culture viability in 50:50 was still compromised. Therefore, HepatoZYME+ based media were deemed unsuitable for induction and maintenance compared to Dex-based protocols. PX flat sheet membranes were able to support culture of B13 cells and also the human osteosarcoma cell line, MG63, demonstrating improved cell attachment over non-surface treated PS membranes. PX membranes supported transdifferentiation of B13 cells to HLCs, presenting with loss of pancreatic amylase, induction of the hepatic markers transferrin, GS and CPS-1 and serum albumin secretion. Furthermore, PX showed no change in mass or loss of culture surface area over 15 days in culture conditions. Together, the novel membrane material and the media formulation and feeding regime developed have strong potential to be translated to a HFB setting and guide future BAL device design.

Aujourd’hui, la transplantation est le seul traitement efficace proposé aux patients souffrant d’une insuffisance hépatique fulminante. La nécessité de disposer d’un système de suppléance hépatique transitoire apparaît donc indispensable. C’est dans cet axe que se sont développés les systèmes qualifiés de foies bio artificiels (BAL). Leur principale caractéristique est d’incorporer un bioréacteur hébergeant des cellules pouvant restaurer l’activité hépatiques dans son ensemble. A l’heure actuelle, les hépatocytes primaire humains (HEP) issus de foies de donneurs non transplantables sont considérées comme le meilleur choix. Cependant, leur utilisation reste limitée par leur faible disponibilité et la difficulté à les maintenir différenciés en culture in vitro. Pour remédier à ce dernier point, l’approche la plus prometteuse semble être une co-culture des hépatocytes avec les cellules non parenchymateuses afin de recréer un environnement proche des sinusoïdes hépatiques. Ce travail de thèse repose sur la mise en place d’une nouvelle approche de co-culture tridimensionnelle sous la forme de sphéroïdes, d’HEP primaires avec les principaux types de cellules non-parenchymateuses (les cellules de Kupffer, les cellules endothéliales et les cellules étoilées) selon des proportions spécifiques. Puis de leurs encapsulations dans des billes d’alginate et leurs cultures au sein d’un bioréacteur à lit fluidisé. Ce modèle s’est révélé pertinent et approprié à maintenir les fonctions hépatiques dans le temps. Bien que beaucoup d’optimisation reste à définir, ce travail exploratoire témoigne de l’intérêt de cette approche intéressante pour le progrès des systèmes BAL. / Liver shortage makes transplantation inapplicable to all acute liver failure patients. Bioartificial Iiver (BAL) devices represent a temporary solution for these patients which are thereby bridged tilt Iiver transplantation or regeneration BAL treatment offers blood purification and substitution of metabolic functions through the activity of hepatocytes (HEPs), which are integrated in the device within acclimating containers, so-called bioreactors. Primary human hepatocytes are the ideal cell type to use in BAL, but they are scarcely available and difficult to maintain in vitro. Co-culture of HEPs with supporting cells has been proposed as the most promising strategy for preserving HEP behaviors in in vitro conditions. In fact, assisting cells types hold their ability to influence functional responses of the HEPs by providing them with cues of the native organ.This PhD work proposed a novel approach of co-culture for the functional sustain and preservation of the HEPs in the environment of the fluidized bed bioreactor (designed in our Iaboratory). Definition of this model took inspiration from the cellular organization in the organ; therefore, it employed three major sinusoidal non-parenchymal cell populations (liver sinusoidal, Kupffer, and hepatic stellate cells) which, together with HEPs, were cultured with three-dimensional arrangement (spheroids) and according to specific proportions. The resulting model was characterized in terms of functional benefits for the HEPs, and then applied in the microenvironment of alginate beads, which provide cells with immunological and mechanical protection in the fluidized bed bioreactor. This spheroidal multi-cultured model revealed its potentiality in sustaining in vitro HEP behaviors over time. Although much remains to be refined, this model may represent an interesting approach for the progress of BAL

La nécessité de nouveaux modes de suppléance hépatique se fait clairement ressentir pour maintenir en vie les patients en attente d’une greffe. Des traitements, basés sur l’utilisation de cellules cultivées dans un environnement adéquat, pourraient même permettre le rétablissement de certains patients en insuffisance hépatique sévère et ainsi éviter la greffe et les traitements immunosuppresseurs associés. Une suppléance hépatique efficace pourrait aussi servir au rétablissement des patients récemment greffés ou ayant subi une hépatectomie. L’objectif de cette thèse a été de développer, créer et valider un nouveau foie bioartificiel avec une prise en compte des contraintes réglementaires des médicaments combinés de thérapie innovante. Ce BAL doit pouvoir inclure des bioréacteurs à lit fluidisé perfusés par du plasma et contenant des sphéroïdes d’hépatocytes encapsulés. Des microparticules de verre, ajoutés aux billes d’alginate pour les alourdir, permettent d’obtenir une fluidisation optimale dans du plasma pathologique sans que des effets délétères ne soient observables ni pour les cellules ni pour les propriétés mécaniques des billes. Une méthode de culture cellulaire utilisant un revêtement anti-adhérent sur des boites de Petri en verre permet de produire un nombre important de sphéroïdes viables in vitro. Ces sphéroïdes encapsulés peuvent être maintenus vivants et métaboliquement actifs dans un bioréacteur à lit fluidisé pendant au minimum 4 jours.Pour assurer l’efficacité du BAL et la sécurité des patients, une circulation extracorporelle complexe a été mise au point pour être compatible avec une machine d’épuration extracorporelle commerciale, la Prismaflex® de la société Gambro, déjà utilisée en soins intensifs. Une étude préclinique sur un modèle ovin a montré que le traitement était bien toléré en ce qui concerne les aspects hémodynamiques. La prochaine étape concerne la mise en place d’une étude dans un modèle porcin d’insuffisance hépatique, avant de pouvoir procéder aux premiers essais cliniques. / The need for new liver support devices is clearly felt to allow keeping alive patients waiting for a transplant. Treatments, based on the use of cells cultured in an adequate environment, may even allow the recovery of some patients suffering from acute liver failure and avoid graft and associated immunosuppressive therapies. A hepatic substitution could also be used to reestablish patients recently transplanted or who had underwent an hepatectomy.. The objective of the thesis was to design, create and validate of a new bioartificial liver with consideration for the regulatory requirements of the Advanced Therapies Medical Product (ATMP). This device has to include fluidized bed bioreactors perfused with plasma and hosting alginate-encapsulated hepatocytes spheroids. Microparticles of glass have been added to weight down alginate beads in order to have an optimal fluidization in pathological plasma without negative effects neither on cells metabolism nor on mechanical properties of the beads. A cellular culture method using non adhesive coating in Petri dish led to the production of a large amount of viable spheroids in vitro. These encapsulated spheroids can be kept alive and metabolically active in a fluidized bed bioreactor during a minimum of four days. To ensure the efficacy of the BAL and the safety of patients, a complex extracorporeal circulation was designed to be compatible with a commercial medical device, the Prismaflex® monitor of the company Gambro, already used in intensive care units. A preclinical study on sheeps has shown that the treatment was well tolerated in terms of hemodynamics considerations. The next step is the establishment of a study in a porcine model of liver failure, before we can proceed to the first clinical trial.

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