Isolated Hepatocyte Transplantation in an Infant With a Severe Urea Cycle Disorder

Horslen, Simon P.; McCowan, Timothy C.; Goertzen, Timothy C.; Warkentin, Phyllis I.; Cai, Hung Bo; Strom, Stephen C.; Fox, Ira J.

doi:10.1542/peds.111.6.1262

Cited by 295Metabolism and Genetic DisordersOrgan Transplantation Techniques and OutcomesTissue Engineering and Regenerative Medicine

Isolated Hepatocyte Transplantation in an Infant With a Severe Urea Cycle Disorder

Horslen, Simon P., McCowan, Timothy C., Goertzen, Timothy C., Warkentin, Phyllis I., Cai, Hung Bo, Strom, Stephen C., Fox, Ira J.·2003·Pediatrics

DOI 10.1542/peds.111.6.1262

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Abstract

Objective. Transplantation of isolated hepatocytes in animal models has been shown to correct inborn errors of metabolism. Based on these studies and our experience with hepatocyte transplantation in a child with Crigler-Najjar syndrome, isolated hepatocyte transplantation was performed to attempt metabolic reconstitution in a male infant with severe ornithine transcarbamylase (OTC) deficiency. Methods. An infant with an antenatal diagnosis of OTC deficiency was managed intensively to prevent hyperammonemia. Isolated hepatocytes were obtained by collagenase perfusion of donated livers not used for transplantation. Hepatocytes were infused in batches over the first 4 weeks of life via an umbilical venous catheter positioned in the portal vein. Immunosuppression consisted of tacrolimus and corticosteroids. Results. Over 4 billion viable hepatocytes were transplanted during the first 3.5 weeks of life. A period of metabolic stability was achieved between days 20 and 31 during which normal protein intake was tolerated while phenylbutyrate was weaned. During this time, plasma ammonia and glutamine remained within normal limits. Hyperammonemia reappeared abruptly on day 31 of life. Protein tolerance diminished to baseline; metabolic stability was subsequently reattained only following successful liver transplantation at 6 months of age. Conclusions. Isolated hepatocyte transplantation appeared to result in temporary relief of hyperammonemia and protein intolerance attributable to OTC deficiency. The metabolic stability achieved was lost after 11 days presumably because of rejection of the transplanted cells because of insufficient immunosuppression. Future attempts at isolated hepatocyte transplantation for inborn errors of metabolism in humans should include adequate immunosuppression and a liver biopsy as a means of proving hepatocyte engraftment and function.

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Authors: Horslen, S. P., McCowan, T. C., Goertzen, T. C., Warkentin, P. I., Cai, H. B., Strom, S. C., & Fox, I. J.
Affiliations: University of Nebraska Medical Center (US)
University of Pittsburgh Medical Center (US)
ORCID: Horslen, Simon P.
Strom, Stephen C.
Fox, Ira J.
Venue: Pediatrics
Publisher: American Academy of Pediatrics (AAP)
Published: 2003-06-01
Volume: 111
Issue: 6
Pages: 1262-1267
ISSN: 0031-4005 (ISSN-L)
1098-4275
DOI: 10.1542/peds.111.6.1262
OpenAlex: W2058848231
Cited by: 295
References: 16
Citations by year: 2025: 3 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 7 · 2020: 4 · 2019: 8 · 2018: 11 · 2017: 6 · 2016: 12 · 2015: 17 · 2014: 10 · 2013: 22 · 2012: 22
FWCI: 12.23
Type: journal article
Language: en
Open access: closed
Locations: PEDIATRICS (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
Health Sciences › Medicine › Surgery › Tissue Engineering and Regenerative Medicine
Keywords: ornithine transcarbamylase deficiency, urea cycle disorders, hyperammonemia, inborn errors of metabolism, immunosuppression, tacrolimus, collagenase perfusion, liver transplantation, protein intolerance, 4-phenylbutyric acid
MeSH terms: Adult, Crigler-Najjar Syndrome, Female, Genetic Carrier Screening, Humans, Infant, Male, Prenatal Diagnosis, Urea, Liver Transplantation, Ornithine Carbamoyltransferase Deficiency Disease, Hyperammonemia, Hepatocytes

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Isolated Hepatocyte Transplantation in an Infant With a Severe Urea Cycle Disorder

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