Endothelial Cell Therapy for the Acute and Chronic Liver Disease

Abstract Endothelial cell dysfunction and loss are key drivers of acute and chronic liver disease, underscoring a critical unmet need for liver vascular–targeted therapies. Liver sinusoidal endothelial cells are specialized endothelial cells that form a fenestrated microvascular niche regulating hepatocyte metabolism, immune homeostasis, and hepatic stellate cell activation. Repopulating this niche through transplantation of primary liver sinusoidal endothelial cells, endothelial progenitor cells, induced-pluripotent stem cell–derived liver sinusoidal endothelial cells, or engineered endothelial cells delivered within biomaterial aims to restore microvascular architecture, reestablish supportive angiocrine signaling, attenuate fibrosis, and promote liver regeneration. This review summarizes the biological rationale for endothelial cell–based therapy, compares cell sources and engineering strategies, evaluates cell delivery and engraftment approaches, and synthesizes preclinical evidence demonstrating therapeutic benefits across diverse animal models of liver injury. Finally, we highlight key translational challenges and propose future directions to accelerate the clinical development of endothelial cell–based therapies for liver disease.