Functional Characterization of Organoids Derived From Irreversibly Damaged Liver of Patients With NASH

Background and Aims NASH will soon become the leading cause of liver transplantation in the United States and is also associated with increased COVID‐19 mortality. Currently, there are no Food and Drug Administration–approved drugs available that slow NASH progression or address NASH liver involvement in COVID‐19. Because animal models cannot fully recapitulate human NASH, we hypothesized that stem cells isolated directly from end‐stage liver from patients with NASH may address current knowledge gaps in human NASH pathology. Approach and Results We devised methods that allow the derivation, proliferation, hepatic differentiation, and extensive characterization of bipotent ductal organoids from irreversibly damaged liver from patients with NASH. The transcriptomes of organoids derived from NASH liver, but not healthy liver, show significant up‐regulation of proinflammatory and cytochrome p450–related pathways, as well as of known liver fibrosis and tumor markers, with the degree of up‐regulation being patient‐specific. Functionally, NASH liver organoids exhibit reduced passaging/growth capacity and hallmarks of NASH liver, including decreased albumin production, increased free fatty acid–induced lipid accumulation, increased sensitivity to apoptotic stimuli, and increased cytochrome P450 metabolism. After hepatic differentiation, NASH liver organoids exhibit reduced ability to dedifferentiate back to the biliary state, consistent with the known reduced regenerative ability of NASH livers. Intriguingly, NASH liver organoids also show strongly increased permissiveness to severe acute respiratory syndrome–coronavirus 2 (SARS‐CoV‐2) vesicular stomatitis pseudovirus as well as up‐regulation of ubiquitin D, a known inhibitor of the antiviral interferon host response. Conclusion Expansion of primary liver stem cells/organoids derived directly from irreversibly damaged liver from patients with NASH opens up experimental avenues for personalized disease modeling and drug development that has the potential to slow human NASH progression and to counteract NASH‐related SARS‐CoV‐2 effects.