Impact of Artificial Liver on the Levels of Regulatory Factors of Transdifferentiation in Acute-on-Chronic Liver Failure

BACKGROUND Acute-on-chronic liver failure (ACLF) is a severe liver disease. Artificial liver based on plasma exchange (PE) has undergone continuous innovation, particularly through the integration of the dual plasma molecular adsorption system (DPMAS), which has been widely validated clinically. Current research on artificial liver primarily focuses on the dynamic changes in inflammatory mediators and metabolites. However, there is limited study on the mechanism of mesenchymal stem cells differentiating into liver cells, specifically the level of transdifferentiation regulatory factors. AIM To investigate the potential and differences during liver cell regeneration in patients with ACLF receiving different modes of artificial liver. METHODS 90 patients with ACLF were divided into three groups: the control group (n = 30), the PE group (n = 30), and the DPMAS + PE group (n = 30). We compared changes in the levels of three regulatory factors of transdifferentiation—hepatocyte growth factor (HGF), oncostatin M (OSM), and fibroblast growth factor-4 (FGF-4)—before and after treatment in the three groups. RESULTS Compared to before treatment, both the PE group and the DPMAS + PE group showed a significant increase in HGF levels (P < 0.0001), while the control group exhibited no significant change. Pairwise comparisons among the three groups indicated that the levels and increases in HGF followed this order: DPMAS + PE group > PE group > control group (P < 0.05). CONCLUSION Artificial liver therapy can aid in regenerating and recovering liver cells by increasing HGF levels. DPMAS + PE demonstrates better performance in this regard compared to PE alone. Trial registration Chinese Clinical Trial Registry, ChiCTR2500098113, retrospectively registered on 3 March 2025.