A bioartificial system that incorporates enhanced liver cells can act as an analogous form of dialysis for the liver in pigs, effectively carrying out the organ's detoxifying roles and preventing further liver damage in animals with acute liver failure. With further development, the system could provide a new and much needed treatment for patients with acute liver failure, which can have a mortality rate of up to 80%. Acute liver failure can be caused by factors ranging from drug overdoses to liver surgery. The only effective intervention for acute liver failure is liver transplantation, but this approach is often impractical due to shortages of donor organs, the need for immunosuppressive drugs, and the fact that some patients are considered incompatible for transplantation. To address this treatment gap, Wei-Jian Li and colleagues created their air-liquid interactive bioartificial liver (Ali-BAL), a bioreactor-based extracorporeal system that cultures liver progenitor-like cells on scaffolds to provide complete liver function. When connected to the body's vasculature, the Ali-BAL takes in blood through a series of pumps and plasma filters, exposes it to the liver cells in the bioreactor, and returns detoxified blood to the body. The scientists tested their system in a pig model of acute liver failure induced by drug overdose and found that three hours of treatment was enough to detoxify compounds such as ammonia, prevent liver inflammation, and enhance liver regeneration. The treatment was also safe and greatly improved survival, with 5 out of 6 treated pigs surviving versus 1 out of 6 untreated pigs. Li et al. note that further experiments should test their system's effectiveness against other forms of acute liver failure, such as that induced by surgical procedures, before moving to clinical studies in humans.