O transplante de hepatócitos é uma modalidade terapêutica atrativa para as doenças hepáticas, assim como uma alternativa para o transplante hepático. O objetivo do presente estudo é investigar a efetividade do transplante de hepatócitos de ratos nos modelos de hepatotoxicidade aguda induzida por paracetamol (1g/kg e 1,5g/kg). Os hepatócitos foram isolados de ratos Wistar machos e transplantados 24 horas após em receptoras fêmeas com hepatotoxicidade de 1g/kg. Os ratos fêmeas receberam 1x107 hepatócitos (grupo 1, n=20) ou PBS (grupo 2, n=24) através da veia porta ou no baço. A análise de sobrevida em 3 dias demonstrou que todos os animais do grupo 1 sobreviveram, enquanto 5 animais do grupo 2 morreram (P=0,03), todas as mortes ocorreram nos ratos que receberam PBS através da veia porta (P=0,001). Os níveis de alanina aminotransferase e fator V que foram medidos no experimento não mostraram diferença entre o grupo 1 e o grupo 2 em nenhum momento. A análise molecular e a histologia mostraram a presença de hepatócitos no fígado de animais transplantados através da veia porta ou pelo baço. O modelo de hepatotoxicidade aguda induzida por paracetamol (1g/kg) demonstrou que o transplante de hepatócitos de ratos aumenta a sobrevida quando o local de injeção é na veia porta. No modelo de hepatotoxicidade aguda induzida por paracetamol (1,5g/kg), os hepatócitos foram isolados de ratos Wistar machos, e transplantados 6 horas após em receptoras fêmeas. Os ratos fêmeas receberam 1x107 hepatócitos (grupo 1, n=33) ou PBS (grupo 2, n=24) no baço. A análise de sobrevida em 3 dias demonstrou que 9 animais do grupo 1, e 9 animais do grupo 2 morreram no dia 2. Não houve diferença estatística significativa na análise de sobrevida entre o grupo 1 e o grupo 2. Nossos dados demonstram que o isolamento de hepatócitos é um procedimento factível. O transplante de hepatócitos é uma técnica que pode ser aplicada em modelos animais de IHA levando ao aumento da sobrevida. Entretanto, o modelo utilizado no presente estudo apresentou um alto grau de variabilidade, tornando necessária a avaliação do transplante de hepatócitos em um modelo mais reprodutível. / Hepatocyte transplantation is an attractive therapeutic modality for liver disease as an alternative for liver transplantation. The aim of the current study was to investigate the effectiveness of rat hepatocyte transplantation in the acetaminophen-induced acute hepatotoxicity models (1g/kg and 1,5g/kg). Hepatocytes were isolated from male Wistar rats and transplanted 24 hours later in female recipients with hepatotoxicity of 1g/kg of acetaminophen. Female rats received either 1x107 hepatocytes (group1, n=20) or PBS (group 2, n=24) through the portal vein or into the spleen. Survival analyses in 3 days showed that all animals from group 1 survived, whereas 5 rats from group 2 died (P=0.03), all deaths occurred in rats that received PBS into the portal vein (P=0.001). Alanine aminotransferase and factor V levels measured within the experiment did not differ between groups 1 and 2 at any time point. Molecular analysis and histology showed presence of hepatocytes in liver of transplanted animals injected either through portal vein or spleen. Our data in acetaminophen-induced hepatotoxicity model (1g/kg) demonstrate that rat hepatocyte transplantation increases survival when the site of injection is into portal vein in this hepatotoxicity model. In the acetaminophen-induced acute hepatotoxicity model (1,5g/kg), hepatocytes were isolated from male Wistar rats and transplanted 6 hours later in female recipients. Female rats received either 1x107 hepatocytes (group1, n=33) or PBS (group 2, n=24) into the spleen. Survival analyses in 3 days showed that 9 rats from group 1 and 9 rats from group 2 died at day 2. There was no statistical significance in survival between group 1 and group 2. Our data demonstrate that hepatocyte isolation is a feasible procedure. Hepatocyte transplantation can be used in animal models of acute liver failure increasing survival. The model of the present study show a higher variability, therefore it´s necessary to evaluate hepatocyte transplantation in a more reproducible model.

O transplante de hepatócitos é uma modalidade terapêutica atrativa para as doenças hepáticas, assim como uma alternativa para o transplante hepático. O objetivo do presente estudo é investigar a efetividade do transplante de hepatócitos de ratos nos modelos de hepatotoxicidade aguda induzida por paracetamol (1g/kg e 1,5g/kg). Os hepatócitos foram isolados de ratos Wistar machos e transplantados 24 horas após em receptoras fêmeas com hepatotoxicidade de 1g/kg. Os ratos fêmeas receberam 1x107 hepatócitos (grupo 1, n=20) ou PBS (grupo 2, n=24) através da veia porta ou no baço. A análise de sobrevida em 3 dias demonstrou que todos os animais do grupo 1 sobreviveram, enquanto 5 animais do grupo 2 morreram (P=0,03), todas as mortes ocorreram nos ratos que receberam PBS através da veia porta (P=0,001). Os níveis de alanina aminotransferase e fator V que foram medidos no experimento não mostraram diferença entre o grupo 1 e o grupo 2 em nenhum momento. A análise molecular e a histologia mostraram a presença de hepatócitos no fígado de animais transplantados através da veia porta ou pelo baço. O modelo de hepatotoxicidade aguda induzida por paracetamol (1g/kg) demonstrou que o transplante de hepatócitos de ratos aumenta a sobrevida quando o local de injeção é na veia porta. No modelo de hepatotoxicidade aguda induzida por paracetamol (1,5g/kg), os hepatócitos foram isolados de ratos Wistar machos, e transplantados 6 horas após em receptoras fêmeas. Os ratos fêmeas receberam 1x107 hepatócitos (grupo 1, n=33) ou PBS (grupo 2, n=24) no baço. A análise de sobrevida em 3 dias demonstrou que 9 animais do grupo 1, e 9 animais do grupo 2 morreram no dia 2. Não houve diferença estatística significativa na análise de sobrevida entre o grupo 1 e o grupo 2. Nossos dados demonstram que o isolamento de hepatócitos é um procedimento factível. O transplante de hepatócitos é uma técnica que pode ser aplicada em modelos animais de IHA levando ao aumento da sobrevida. Entretanto, o modelo utilizado no presente estudo apresentou um alto grau de variabilidade, tornando necessária a avaliação do transplante de hepatócitos em um modelo mais reprodutível. / Hepatocyte transplantation is an attractive therapeutic modality for liver disease as an alternative for liver transplantation. The aim of the current study was to investigate the effectiveness of rat hepatocyte transplantation in the acetaminophen-induced acute hepatotoxicity models (1g/kg and 1,5g/kg). Hepatocytes were isolated from male Wistar rats and transplanted 24 hours later in female recipients with hepatotoxicity of 1g/kg of acetaminophen. Female rats received either 1x107 hepatocytes (group1, n=20) or PBS (group 2, n=24) through the portal vein or into the spleen. Survival analyses in 3 days showed that all animals from group 1 survived, whereas 5 rats from group 2 died (P=0.03), all deaths occurred in rats that received PBS into the portal vein (P=0.001). Alanine aminotransferase and factor V levels measured within the experiment did not differ between groups 1 and 2 at any time point. Molecular analysis and histology showed presence of hepatocytes in liver of transplanted animals injected either through portal vein or spleen. Our data in acetaminophen-induced hepatotoxicity model (1g/kg) demonstrate that rat hepatocyte transplantation increases survival when the site of injection is into portal vein in this hepatotoxicity model. In the acetaminophen-induced acute hepatotoxicity model (1,5g/kg), hepatocytes were isolated from male Wistar rats and transplanted 6 hours later in female recipients. Female rats received either 1x107 hepatocytes (group1, n=33) or PBS (group 2, n=24) into the spleen. Survival analyses in 3 days showed that 9 rats from group 1 and 9 rats from group 2 died at day 2. There was no statistical significance in survival between group 1 and group 2. Our data demonstrate that hepatocyte isolation is a feasible procedure. Hepatocyte transplantation can be used in animal models of acute liver failure increasing survival. The model of the present study show a higher variability, therefore it´s necessary to evaluate hepatocyte transplantation in a more reproducible model.

O transplante de hepatócitos é uma modalidade terapêutica atrativa para as doenças hepáticas, assim como uma alternativa para o transplante hepático. O objetivo do presente estudo é investigar a efetividade do transplante de hepatócitos de ratos nos modelos de hepatotoxicidade aguda induzida por paracetamol (1g/kg e 1,5g/kg). Os hepatócitos foram isolados de ratos Wistar machos e transplantados 24 horas após em receptoras fêmeas com hepatotoxicidade de 1g/kg. Os ratos fêmeas receberam 1x107 hepatócitos (grupo 1, n=20) ou PBS (grupo 2, n=24) através da veia porta ou no baço. A análise de sobrevida em 3 dias demonstrou que todos os animais do grupo 1 sobreviveram, enquanto 5 animais do grupo 2 morreram (P=0,03), todas as mortes ocorreram nos ratos que receberam PBS através da veia porta (P=0,001). Os níveis de alanina aminotransferase e fator V que foram medidos no experimento não mostraram diferença entre o grupo 1 e o grupo 2 em nenhum momento. A análise molecular e a histologia mostraram a presença de hepatócitos no fígado de animais transplantados através da veia porta ou pelo baço. O modelo de hepatotoxicidade aguda induzida por paracetamol (1g/kg) demonstrou que o transplante de hepatócitos de ratos aumenta a sobrevida quando o local de injeção é na veia porta. No modelo de hepatotoxicidade aguda induzida por paracetamol (1,5g/kg), os hepatócitos foram isolados de ratos Wistar machos, e transplantados 6 horas após em receptoras fêmeas. Os ratos fêmeas receberam 1x107 hepatócitos (grupo 1, n=33) ou PBS (grupo 2, n=24) no baço. A análise de sobrevida em 3 dias demonstrou que 9 animais do grupo 1, e 9 animais do grupo 2 morreram no dia 2. Não houve diferença estatística significativa na análise de sobrevida entre o grupo 1 e o grupo 2. Nossos dados demonstram que o isolamento de hepatócitos é um procedimento factível. O transplante de hepatócitos é uma técnica que pode ser aplicada em modelos animais de IHA levando ao aumento da sobrevida. Entretanto, o modelo utilizado no presente estudo apresentou um alto grau de variabilidade, tornando necessária a avaliação do transplante de hepatócitos em um modelo mais reprodutível. / Hepatocyte transplantation is an attractive therapeutic modality for liver disease as an alternative for liver transplantation. The aim of the current study was to investigate the effectiveness of rat hepatocyte transplantation in the acetaminophen-induced acute hepatotoxicity models (1g/kg and 1,5g/kg). Hepatocytes were isolated from male Wistar rats and transplanted 24 hours later in female recipients with hepatotoxicity of 1g/kg of acetaminophen. Female rats received either 1x107 hepatocytes (group1, n=20) or PBS (group 2, n=24) through the portal vein or into the spleen. Survival analyses in 3 days showed that all animals from group 1 survived, whereas 5 rats from group 2 died (P=0.03), all deaths occurred in rats that received PBS into the portal vein (P=0.001). Alanine aminotransferase and factor V levels measured within the experiment did not differ between groups 1 and 2 at any time point. Molecular analysis and histology showed presence of hepatocytes in liver of transplanted animals injected either through portal vein or spleen. Our data in acetaminophen-induced hepatotoxicity model (1g/kg) demonstrate that rat hepatocyte transplantation increases survival when the site of injection is into portal vein in this hepatotoxicity model. In the acetaminophen-induced acute hepatotoxicity model (1,5g/kg), hepatocytes were isolated from male Wistar rats and transplanted 6 hours later in female recipients. Female rats received either 1x107 hepatocytes (group1, n=33) or PBS (group 2, n=24) into the spleen. Survival analyses in 3 days showed that 9 rats from group 1 and 9 rats from group 2 died at day 2. There was no statistical significance in survival between group 1 and group 2. Our data demonstrate that hepatocyte isolation is a feasible procedure. Hepatocyte transplantation can be used in animal models of acute liver failure increasing survival. The model of the present study show a higher variability, therefore it´s necessary to evaluate hepatocyte transplantation in a more reproducible model.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18457号 / 医博第3912号 / 新制||医||1004(附属図書館) / 31335 / 京都大学大学院医学研究科医学専攻 / (主査)教授 坂井 義治, 教授 羽賀 博典, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Le foie possède une capacité de régénération importante qui lui permet de reconstituer son volume suite à une agression. L’induction d’une régénération hépatique est réalisée en pratique courante en chirurgie hépatique afin de préparer le foie à une hépatectomie majeure. Elle est également utilisée dans de nombreux modèles animaux afin de favoriser la prise de greffe hépatocytaire au cours de la transplantation d’hépatocytes pour le traitement de maladies métaboliques héréditaires hépatiques. Les principaux objectifs de ce travail ont été d’étudier une méthode peu invasive pour induire une importante régénération hépatique : d’une part pour élargir les possibilités de prise en charge des patients nécessitant une hépatectomie, et d’autre part pour favoriser la prise de greffe des hépatocytes transplantés pour le traitement des maladies métaboliques héréditaires hépatiques.Dans un premier temps, nous avons mis au point chez le rat une technique d’embolisation portale partielle résorbable répétée (EPPRR) visant à entrainer un stimulus additionnel de régénération hépatique. Ces travaux ont validé le concept de la méthode d’EPPRR en montrant une augmentation de la prolifération hépatocytaire et une hypertrophie dans la partie du foie non embolisée.Ce protocole d’EPPRR a ensuite été appliqué dans un modèle préclinique de gros animal. Nous avons étudié chez le porc les conséquences de l’EPPRR et montré que cette technique était reproductible, bien tolérée, et qu’elle permettait une hypertrophie de la partie du foie non embolisée.Parallèlement, nous avons appliqué l’EPPRR avant transplantation d’hépatocytes chez le rat. A partir du foie de rats transgéniques exprimant la GFP (green fluorescent protein), nous avons pu isoler des hépatocytes GFP+. Ces cellules ont été transplantées dans le foie de rats receveurs GFP- en association avec une EPPRR. Nous avons montré que le stimulus de régénération répété provoqué par l’EPPRR permettait une augmentation de la prise de greffe.En conclusion, l’EPPRR est une technique peu invasive capable d’induire une régénérative hépatique efficace. Cette approche pourrait jouer un rôle dans la prise en charge des tumeurs hépatique et l’optimisation de la transplantation d’hépatocytes pour le traitement des maladies métaboliques héréditaires hépatiques. / The liver has an important regenerative capacity allowing reconstitution of the hepatic volume after an aggression. The induction of liver regeneration is used in routine clinical practice before liver surgery in order to prepare the liver for major hepatectomy. It is also used in numerous animal models in order to increase hepatocyte engraftment during hepatocyte transplantation for the treatment of inherited metabolic liver diseases. The main objective of this work was to evaluate a minimally invasive approach to induce substantial liver regeneration: firstly, to expand the therapeutic options for patients requiring an hepatectomy, and secondly to increase the engraftment of transplanted hepatocytes for the treatment of inherited metabolic liver diseases.In a first study, we developed in the rat model a technique of repeated reversible portal vein embolization (RRPVE) to induce an additional stimulus of liver regeneration. This study established the proof of concept of the RRPVE method, showing an increase in hepatocyte proliferation and hypertrophy in the non-embolized liver.This RRPVE protocol was then used in a preclinical model of large animal. We studied in swine the consequences of the RRPVE and showed that the procedure was reproducible, well tolerated, and allowed hypertrophy of the non-embolized liver.In parallel, we applied RRPVE before hepatocyte transplantation in the rat model. From the liver of transgenic rats expressing GFP (green fluorescent protein), we were able to isolate GFP+ hepatocytes. These cells were transplanted in the liver of recipient GFP- rats in association with RRPVE. We demonstrated that the repetition of the regeneration stimulus induced by RRPVE allowed increased hepatocyte engraftment.In conclusion, RRPVE is a minimally invasive technique able to induce efficient liver regeneration. This approach could play a part in the management of hepatic malignancies and the optimization of hepatocyte transplantation in the treatment of inherited metabolic liver diseases.

La maladie de Wilson est une maladie héréditaire due à un déficit du transporteur du cuivre, l’ATP7B. Cette maladie se présente sous forme d’insuffisance hépatique aiguë ou chronique, pour lesquels le traitement médical actuel consiste en l’administration d’agents chélateurs, ce qui ne résulte cependant pas en une guérison complète de la maladie. La transplantation orthotopique du foie est le seul traitement définitif actuellement, avec tous les désavantages qu’elle comporte. Un traitement alternatif à cette option est donc souhaitable. Cette étude porte sur la faisabilité de la transplantation d’hépatocytes chez le modèle animal de la maladie de Wilson, le rat Long Evans Cinnamon (LEC), avec pour buts d’en déterminer la sécurité et l’efficacité tant sur le plan clinique (amélioration de la survie, prévention de l’hépatite) que pathologique. Douze rats LEC ont reçu une injection intrasplénique de 2,6 x 105 – 3,6 x 107 hépatocytes prélevés chez des rats donneurs de souche LE. Ils ont été suivis durant 6 mois puis sacrifiés. Ils ont ensuite été comparés à un groupe contrôle de douze autres rats LEC. Aucune différence significative n’a été notée au niveau du poids, du bilan hépatique et des concentrations de cuivre biliaire et hépatique. Cependant, une amélioration de l’activité oxydase de la céruloplasmine post-transplantation a été démontrée chez le groupe de rats transplantés (49,6 ± 31,5 versus 8,9 ± 11,7). Les rats transplantés ont aussi eu une amélioration sur tous les critères histologiques étudiés. Enfin, l’ARNm de l’atp7b a été retrouvé chez 58% des rats transplantés avec un taux d’expression de 11,9% ± 13,6 par rapport à un rat LE normal. L’immunohistochimie a quant à elle démontré la présence de l’atp7b chez tous les rats transplantés. Les résultats obtenus sont considérés favorables à ce traitement alternatif, et indiquent que la transplantation d’hépatocytes est une technique sécuritaire qui peut contribuer à renverser le processus pathologique en cours dans la maladie de Wilson. / Wilson’s disease (WD) is a hereditary metabolic disease caused by a deficiency of copper-transporting ATP7B, resulting in copper accumulating to toxic levels in the liver. Its manifestations range from acute or chronic hepatic insufficiency to fulminant liver failure. The mainstay of therapy is the use of chelating agents. However selected patients may also require orthotopic liver transplantation (OTL), an invasive and complex procedure with life-long implications. Hepatocyte transplantation is an appealing alternative to OLT. Its safety and efficacy were evaluated in the animal model of WD, the Long Evans Cinnamon (LEC) rat. Twelve LEC rats received an intrasplenic injection of 2,6 x 105 – 3,6 x 107 hepatocytes obtained from LE donor rats. They were followed for 6 months before sacrifice. They were then compared to a control group of twelve rats. No difference was found when comparing their weights, biochemical parameters such as liver function tests and bilirubin, as well as their biliary and hepatic copper concentrations. However, the ceruloplasmin oxydase activity was improved in the transplanted rats (49,6 ± 31,5 versus 8,9 ± 11,7). After sacrifice, histologic evaluation and demonstration of atp7b mRNA in the recipient liver were performed. There was evidence of histological improvement and atp7b mRNA was found in 58% of transplanted rats with an expression of 11,9% ± 13,6 when compared to a normal LE rat. Evidence of successful engraftment of the transplanted cells was found in every transplanted rat using the technique of immunohistochemistry. These encouraging results are in accordance with previous studies on hepatocyte transplantation in the LEC rat. Its application to the human clinical setting is the next step, as it has already been tried in other metabolic liver diseases.

La maladie de Wilson est une maladie héréditaire due à un déficit du transporteur du cuivre, l’ATP7B. Cette maladie se présente sous forme d’insuffisance hépatique aiguë ou chronique, pour lesquels le traitement médical actuel consiste en l’administration d’agents chélateurs, ce qui ne résulte cependant pas en une guérison complète de la maladie. La transplantation orthotopique du foie est le seul traitement définitif actuellement, avec tous les désavantages qu’elle comporte. Un traitement alternatif à cette option est donc souhaitable. Cette étude porte sur la faisabilité de la transplantation d’hépatocytes chez le modèle animal de la maladie de Wilson, le rat Long Evans Cinnamon (LEC), avec pour buts d’en déterminer la sécurité et l’efficacité tant sur le plan clinique (amélioration de la survie, prévention de l’hépatite) que pathologique. Douze rats LEC ont reçu une injection intrasplénique de 2,6 x 105 – 3,6 x 107 hépatocytes prélevés chez des rats donneurs de souche LE. Ils ont été suivis durant 6 mois puis sacrifiés. Ils ont ensuite été comparés à un groupe contrôle de douze autres rats LEC. Aucune différence significative n’a été notée au niveau du poids, du bilan hépatique et des concentrations de cuivre biliaire et hépatique. Cependant, une amélioration de l’activité oxydase de la céruloplasmine post-transplantation a été démontrée chez le groupe de rats transplantés (49,6 ± 31,5 versus 8,9 ± 11,7). Les rats transplantés ont aussi eu une amélioration sur tous les critères histologiques étudiés. Enfin, l’ARNm de l’atp7b a été retrouvé chez 58% des rats transplantés avec un taux d’expression de 11,9% ± 13,6 par rapport à un rat LE normal. L’immunohistochimie a quant à elle démontré la présence de l’atp7b chez tous les rats transplantés. Les résultats obtenus sont considérés favorables à ce traitement alternatif, et indiquent que la transplantation d’hépatocytes est une technique sécuritaire qui peut contribuer à renverser le processus pathologique en cours dans la maladie de Wilson. / Wilson’s disease (WD) is a hereditary metabolic disease caused by a deficiency of copper-transporting ATP7B, resulting in copper accumulating to toxic levels in the liver. Its manifestations range from acute or chronic hepatic insufficiency to fulminant liver failure. The mainstay of therapy is the use of chelating agents. However selected patients may also require orthotopic liver transplantation (OTL), an invasive and complex procedure with life-long implications. Hepatocyte transplantation is an appealing alternative to OLT. Its safety and efficacy were evaluated in the animal model of WD, the Long Evans Cinnamon (LEC) rat. Twelve LEC rats received an intrasplenic injection of 2,6 x 105 – 3,6 x 107 hepatocytes obtained from LE donor rats. They were followed for 6 months before sacrifice. They were then compared to a control group of twelve rats. No difference was found when comparing their weights, biochemical parameters such as liver function tests and bilirubin, as well as their biliary and hepatic copper concentrations. However, the ceruloplasmin oxydase activity was improved in the transplanted rats (49,6 ± 31,5 versus 8,9 ± 11,7). After sacrifice, histologic evaluation and demonstration of atp7b mRNA in the recipient liver were performed. There was evidence of histological improvement and atp7b mRNA was found in 58% of transplanted rats with an expression of 11,9% ± 13,6 when compared to a normal LE rat. Evidence of successful engraftment of the transplanted cells was found in every transplanted rat using the technique of immunohistochemistry. These encouraging results are in accordance with previous studies on hepatocyte transplantation in the LEC rat. Its application to the human clinical setting is the next step, as it has already been tried in other metabolic liver diseases.