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Addissouky T A. Integrating Bioartificial Liver Systems and Liver Organoids for Enhancing Tertiary Prevention of Liver Diseases: A Review. Iran J Health Sci 2025; 13 (3) :201-212
URL: http://jhs.mazums.ac.ir/article-1-1015-fa.html

Background and Purpose: Liver diseases remain a major global health challenge, with limited therapeutic options primarily due to donor organ scarcity and inadequate preclinical models. Bioartificial liver (BAL) support systems and liver organoids have emerged as innovative technologies for liver disease modeling, drug screening, and therapeutic development. This study systematically reviews current advances and challenges in both technologies, aiming to identify knowledge gaps and propose future directions for integrating these approaches to improve liver disease research and therapy.
Materials and Methods: This narrative review was conducted on related articles in English published from January 2015 to May 2024. Searches were performed in PubMed, Scopus, Web of Science, and Embase databases using keywords related to “bioartificial liver,” “liver organoids,” “drug screening,” and “liver disease modeling.” The PICO framework was used to form the research question: Human-relevant liver models (population), BAL systems and liver organoids (intervention), conventional models or comparative technologies (comparison), and outcomes related to metabolic functionality and drug screening efficacy (outcome). 
Results: BAL systems primarily provide extracorporeal detoxification and metabolic support, with clinical trials demonstrating transient liver function improvement but limited long-term efficacy. Advances in cell source optimization, notably induced pluripotent stem cell (iPSC)-derived hepatocytes, and perfusion bioreactors have improved viability and function. Liver organoids, derived from stem cells or adult tissues, exhibit higher fidelity in replicating liver metabolic pathways, including albumin synthesis and bile acid metabolism, enabling superior predictive accuracy in drug toxicity screening and personalized disease modeling. Genetic engineering enhances organoid applicability for precision medicine. However, organoid scalability and vascularization remain challenges.
Conclusion: While BAL systems offer valuable temporary liver support, liver organoids outperform BAL in metabolic functionality and drug screening applications. Future research should focus on integrating organoids with BAL systems, advancing bioreactor design, and standardizing protocols to accelerate clinical translation and personalized therapeutics development.