Liver Education with Morgan da Organ

“Christmas is coming and a New Year is fast approaching. I feel it’s important to begin the coming year with great resolve and hope in our hearts. As I sit here reflecting on the past year, I realize there is much good news to share. Strides are being made in liver disease treatments and the cures are moving at a rapid pace. It’s as exciting as it is rare when a breakthrough occurs in medicine. This past year has seen great advances in Hepatology that are impacting the doctors’ abilities to diagnose and treat liver disease. I’ve hit a few of the highlights below:”

• Hepatitis C -    Worldwide, an estimated 150-180 million people have the Hepatitis C virus (HCV).  Also referred to as chronic hepatitis C (CHC), the virus has usually gone undetected for many years in people until major damage has occurred to the liver. Sometimes called the ‘silent killer,’ those with the virus become candidates for liver transplantation and liver cancer.  Not identified as “C” until 1989, the virus was referred to as non-A and non-B. The only treatment found for HCV was interferon shots and ribavirin pills, these were difficult on the patient physically and mentally, with a low rate of success of elimination of the virus. However, the light is now visible at the end of the tunnel. As written by Yale doctors Kim and Sarkar and published in Hepatology in early 2014:  “Few disease areas have experienced the rapid, paradigm-shifting change in screening, diagnosis, and treatment over the past three years than chronic hepatitis C virus (CHC) infection, and the pace of drug development is unlikely to slow for the next several years.”  2014 has seen that reality with the approval of drugs and a pipeline of additional drugs set for approval which give those with HCV a 90% plus chance of SVR, or sustained viral response.  

• NAFLD: Nonalcoholic Fatty Liver Disease - The pathology, or physiology, of non-alcohol fatty liver disease (NAFLD) is understood so much better, setting the foundation for the development of effective therapy. For example, new research has found that in patients with NAFLD, adiponectin (a protein involved in regulating glucose levels as well as fatty acid breakdown) is a better predictor of subclinical atherosclerosis than are liver function tests. This is because the new evidence suggests cardiovascular disease dictates the outcome in patients with NAFLD more frequently and to a greater extent than does the progression of liver disease.

• NASH: Nonalcoholic Steatohepatitis-  (the progressive form of NAFLD.  Steato means fat and hepatitis means inflammation of the liver). Clinical Gastroenterology and Hepatology published a report that researchers administered Galmed’s aramchol in a 3 month study.  It was found to potentially be a disease modifying treatment for non-alcoholic steatohepatitis.  Aramchol affects liver fat metabolism and has been shown, in a Phase II study, to significantly reduce liver fat content as well as improve metabolic parameters associated with fatty liver disease.  It has also been shown to be safe with no severe adverse effects.  A Phase III clinical trial is planned for 2015.

“But Morgan, what does that mean for you & your friends?” 

“Well Plucky, it means that new research has shown that measuring your cardiovascular health is a better predictor of NASH than measuring your liver health.” 

"Wow Morgan! How is that possible?"

“New technologies are allowing medical professionals, in all fields, to make advances that were not even possible in the past. Can you believe that people with liver disease can be treated with stem cells taken from their own skin or blood?! I even saw a 3D image of me. Plucky, if you will please let me finish I will tell you lots more.”

• CIRRHOSIS-(Damage to your liver as a result of several liver conditions. It cannot be reversed but it can be managed).  New approaches have been developed to manage the complication of cirrhosis. For example, in a study from Amsterdam, The Netherlands last year it was found that non-selective beta-blocker (NSBB) significantly reduce HVPG (hepatic venous pressure gradient), improves gastrointestinal permeability and decreases bacterial translocation levels.  In patients with cirrhosis, increasing blood pressure in the abdominal circulatory system (portal hypertension) leads to potentially lethal complications which might be prevented with simple medical treatment.  Patients with cirrhosis and portal hypertension have increased gastrointestinal permeability which allows the movement of bacteria through the lining of the gut into the blood stream in a process known as bacterial translocation.  Bacterial components can be involved in the onset of complications of cirrhosis.

• HCC- Hepatocellular carcinoma-  In liver cancer research, Arlin Rogers, a pathologist, has found that prolactin, a hormone that helps nursing mothers produce milk, may help prevent liver cancer.  This finding holds promise because drugs that can artificially amp up levels of prolactin have already been approved by the FDA. .

                      

• Tumor Targeting Drugs- New drugs are being developed that work differently from standard chemotherapy drugs.  These drugs target specific parts of cancer cells or their surrounding environment.  Tumor blood vessels are the target of several newer drugs.  Liver tumors need new blood vessels to grow beyond a certain size. The drug sorafenib (Nexavar), which is already being used for some liver cancers that can’t be removed surgically, works in part by hindering new blood vessel growth.  This drug is now being studied for use earlier in the course of the disease, such as after surgery or trans-arterial chemoembolization (TACE).  TACE is an image-guided procedure that is used to treat malignant lesions in the liver. Researchers are also studying whether combining it with chemotherapy may make it more effective.

• BA: Biliary Atresia- In this area of medical research so much more needs to be done. With all the new technologies I am hopeful this will happen soon.  Approximately 80-90% of currently affected infants will survive to adolescence following Kasai portoenterostom- a procedure to allow for bile drainage.  

• Medical Food??-  A study published by the American Gastroenterological Association found that the probiotic VSL#3 significantly improved liver function and reduced the risk of hospitalization. It also reduced the development of hepatic encephalopathy (the worsening of brain function that occurs when the liver is no longer able to remove toxins from the blood). VSL#3 caused no adverse effects. It should be noted that VSL#3 is not a drug but a “medical food” and has not been approved by the FDA. 

• Protecting Your Liver-  In January, the FDA released a highly anticipated statement regarding acetaminophen toxicity and prescription pain relievers.  According to the FDA no pain reliever should be prescribed that contains more than 325 mg per tablet or dosage of acetaminophen.

"These are just some of the highlights of what’s going on with hepatology research.  Liver disease causes tremendous suffering and we are by no means done but there is reason to be hopeful.  In the overall picture of liver disease, I believe the future lies in areas such as molecular biology, stem cell therapy and, 3D imaging.  For years I have heard things like “there is a cure right around the corner” and “tomorrow could bring a new treatment”.  I never really believed that until now.  There really can be a cure and, there really may be an effective treatment!  The quality of life, productivity and potential of millions of people can be much improved through science, research and innovation.  There are so many brilliant and dedicated people working tirelessly to make this happen.  As we head into 2015, there is so much to look forward to.  Let’s all take care of each other and think about our New Year’s resolutions!!"