#stages of liver disease

[harmeet-saggi]

Liver Disease: How To Identify Liver Problems?

Are you aware of the vital role your liver plays in keeping your body in harmony? What is liver disease, and how can you identify potential problems early on? In this comprehensive guide, we'll delve into the world of liver health, exploring the stages, symptoms, diagnosis, and treatment of liver disease. Discover proactive measures to prevent liver issues and learn when it's crucial to consult a doctor, all within the comfort of your online space.

[l3irdl3rain]

according to Google, red lored amazons can live up to 80 years????? that’s so insane to think about a bird living that long

They can live up to 80 years but even with good care their lifespan is often much shorter. Just from personal experience at the shelter and at the vet clinic 60 years or so is a much more average lifespan for an amazon. It’s like saying a cat can live to be 30. They can, but they’re much more likely to live 15-20 years.

There are genetics to consider but and also the fact that parrots in captivity aren’t able to fly like they can in the wild. Even with some of the best possible setups they just don’t need/want to travel as much as they would in the wild. Amazons in particular are prone to being fat, lazy blobs in captivity and ending up with liver failure because of it.

And then last but not least most large parrots go through many homes in their lifetimes and nearly just as many of them go through some kind of neglect. We saw a lot of parrots at the shelter who had pretty bad arthritis relatively early into their older years because they weren’t housed properly. Or parrots who already had liver damage from poor diets.

[emotional-blender]

luke sating THAT before older really just drove the song home for me.

[seemabhatnagar]

"High Court Orders Expedited Approval for Minor's Donation of liver tissue to Save Father's Life"

The High Court of Madhya Pradesh directed state authorities to expedite the approval process for a minor to donate her liver tissue to her father, emphasizing the father's severe health condition and the minor's medical fitness for the donation.

Shiv Narayan Batham v. Vishesh Jupitor Hospital & Others

W.P. 16491/2024

Before the High Court of Madya Pradesh at Indore

Heard by Hon'ble Mr. Justice Vishal Mishra J

Fact

The petitioner, Shivnarayan Batham, was suffering from end-stage chronic liver disease and urgently needed a liver transplant to save his life. His daughter, Preeti Batham, who was under 18, was willing to donate a part of her liver. However, due to her minor status, the doctor had refused the organ donation without prior state approval.

Legal Issue

Whether the court can direct the state authorities to permit a minor, who is medically fit, to donate liver tissue to save the life of her father.

Court's Observation

The court noted the urgency of the situation, the medical fitness of the donor (Preeti Batham), and the need for prior state approval as per Rule 5(3)(g) of the Transplantation of Human Organs and Tissues Rules, 2014. The court criticized the state's delay in decision-making, emphasizing the severe health condition of the petitioner and the necessity for prompt action.

Order

The High Court of Madhya Pradesh directed the respondents to permit Preeti Batham to donate liver tissue to her father, Shivnarayan Batham, subject to the following conditions:

The procedure should be conducted in a specialized center with an expert team of at least three doctors who will inform the family about the risks and related factors.

Doctors must take all necessary precautions and provide essential medical facilities during the procedure.

Post-operative care must be extended to the donor.

The procedure must be carried out expeditiously with all required precautions.

The petition was disposed of without any order as to costs.

[arctic-hands]

[Image Described: excerpt from Wikipedia's page on brewer's yeast that says "Many proteins important in human biology were first discovered by studying their homologs in yeast; these proteins include cell cycle proteins, signaling proteins, and protein-processing enzymes. S. cerevisiae is currently the only yeast cell known to have Berkeley bodies present, which are involved in particular secretory pathways. Antibodies against S. cerevisiae are found in 60–70% of patients with Crohn's disease and 10–15% of patients with ulcerative colitis, and may be useful as part of a panel of serological markers in differentiating between inflammatory bowel diseases (e.g. between ulcerative colitis and Crohn's disease), their localisation and severity.[2]" End I.D]

Someone with more understanding of gut biology and alcohol fermentation tell me if this is why I am incapable of getting drunk, because I have antibodies against brewer's yeast??

[drforambhuta]

Liver transplantation serves as a definitive and potentially life-saving remedy for individuals dealing with portal hypertension and end-stage liver disease. The primary goal is to replace the malfunctioning or diseased liver with a healthy one, thereby restoring typical liver function and mitigating complications linked to portal hypertension.

The Transplantation Procedure

Patient Assessment: A thorough evaluation examines a patient's suitability for a liver transplant. This evaluation encompasses medical, psychological, and financial aspects to ensure the patient's ability to undergo the procedure and adhere to post-transplant care. It also takes into account the patient's social support system and their capacity to follow medication regimens, which are vital for long-term success.

Waiting List: Eligible patients are added to a waiting list for a compatible donor liver. The waiting period can vary, ranging from a few days to several months, contingent on factors like donor availability, the patient's medical condition, and considerations such as blood type and organ size compatibility.

Surgical Procedure: When a suitable donor liver becomes accessible, the transplantation surgery is scheduled. The patient's diseased liver is meticulously replaced with the donor liver. This intricate procedure necessitates a highly skilled surgical team and can take several hours.

Recovery and Post-Transplant Care: Following the transplantation, patients require intensive care and monitoring to ensure the new liver functions as anticipated. Anti-rejection medications are prescribed to prevent the immune system from attacking the transplanted organ. Managing these immunosuppressants is crucial, as they have side effects and require long-term use. Regular follow-up appointments with transplant specialists are essential to monitor the patient's progress and address potential complications.

You can contact a good gastroenterologist, like Dr. Amit Maydeo practicing at H N Reliance Hospital in Mumbai, to assess your liver condition and know about your different treatment options , including a liver transplant procedure.

[slurpingnoise]

my almost 15 year old cat has some sort of liver disease, i cant afford the ultrasounds required to determine exactly what is wrong. please anyone who has ever enjoyed a picture of my Pumpkin help

[scientia-rex]

I also spend a lot of time trying to convince people to prevent problems, because prevention still works better than cures. Don't fucking smoke! I would instantly become the best doctor who ever lived if I could just convince all my patients to quit smoking. Avoid alcohol! Don't do meth! Don't do fentanyl! Things that are poisons will poison you in ways you understand, in the short term, but also ways you can't really understand until you've watched dozens of people die from it thirty years later, struggling to breathe from their COPD or weak and nauseated beyond bearing from their end-stage liver disease. I watched a man take 3 weeks in the ICU to die from what meth did to his heart. Your heart isn't meant to beat 145 times a minute for weeks on end. Your liver isn't meant to metabolize 5 shots of gin a day. You aren't going to be able to use denial and willpower to repair the damage your own habits did.

I drink a lot less now than I did before I went into medicine. Lot of different reasons, including that I'm older and more settled. But I can't look at it the same way I used to; I can't brush off as a "fun quirk" what I know is alcohol use on a level that risks withdrawal seizures if they were to suddenly stop, like some of my family members do, nervously asking me about their loved one's drinking when we're alone because beneath the jokes they know it's a problem.

If you're having more than one, maybe two drinks a day on average, over a long period of time, you are damaging your body in ways you don't understand. You're setting up a permanent heightened inflammatory state. Your heart cells don't like alcohol; Google "alcohol-induced cardiomyopathy." Your esophagus and stomach respond to incessant bathing in poison by first developing wounds and then cancer. Your liver, of course, doesn't like it. Your liver not only converts poisons to harmless substances you can excrete, it also makes your platelets, so your blood can clot. It makes albumin, a protein that's essentially for keeping water in your blood vessels and not letting it leach into your tissues. So people who are dying of liver failure are in pain and weak and tired and sad the whole fucking time! And the only solution, a liver transplant, will come with a lifetime of medication and specialist check-ups and the knowledge that if you fuck up and kill this liver, too, no one is going to be eager to give you another try.

I don't guilt-trip my alcoholic patients with liver disease. I don't guilt-trip my smokers with COPD. They chose to cope with substances for reasons, even if I disagree with their reasons, even if those reasons are opaque to me. They will suffer the natural consequences of those actions whether I guilt-trip them or not. I want them to continue to see me, I want them to be honest with me. Other people will lay enough guilt on them. And nothing I can say or do would ever compare to the physical and mental suffering that goes with those diseases.

But if you can prevent these diseases in yourself, prevent them. Quit smoking. Do it now. Your lungs are going to look better starting almost immediately, with positive changes continuing for many years. Drink less alcohol. Sure, it's fun, sure, it's a longstanding human tradition, but it is also unfortunately a straight up poison and your body knows that no matter how persuasively you argue about the obvious failure of Prohibition. You can't argue with a cell. You can't convince your kidneys that high blood pressure shouldn't damage them. They are a system; they do what they do; they existed long before prefrontal cortex existed to justify what we want to do but know to be harmful.



[mistydeyes]

141 and what their patient file looks like

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summary: This is what I imagine everyone's favorite pharmacist as well as medics see when they look at 141's medical file.

Based on this pharmacist and 141 interactions

pairing: Task Force 141 x pharmacist!Reader

warnings: medical/pharmacy terminology, medical inaccuracies, swearing, depiction of wounds, mention of substance use disorder and abuse

Terms

PMH - Past medical history - the total sum of a patient's health status prior to the presenting problem

FH - Family history - contributing family history, generally parents and siblings

SH - Social history - contributing social behavior and routine

a/n: not canon at all! this is just a reference for me

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Price

PMH

Height: 1.88 m (6' 2'')

Weight: 93 kg (205 lbs)

Blood type: O+

Extensive physical injuries

21+ stab wounds - 2 required antibiotics for recurrent infection

9x bullet wound - 5x in the extremities, 4x in the chest (no perforation of vital organs), healed without complication

5x abrasion collar - 1 near right eyebrow became infected following medical eval and stitches

3x diagnosed concussion

Aspirin-sensitivity

Previously evaluated for tinnitus and hearing loss

FH

Father - deceased at 76 from liver disease - 50 pack years, mycardial infarction (x2)

Mother - deceased at 84 due to chronic heart failure (CHF) -Glaucoma, asthma, CHF

Sister - Sports induced asthma, hypothyroidism

Negative family history of diabetes, hypertension, and cancer

SH

Smokes - 30 pack years

Drinks regularly - 4-5 hard liquor each weekend; 1 glass of whiskey occasionally

Physically active - Enjoys recreational activities such as hiking, swimming, and biking

Has 1 dog, currently under the care of pt's younger sister

History of monogynous long term relationships, currently single

Medication list + indications

Amoxicillin/Clavulanic acid 625mg - Infection

Morphine 15mg + Ketamine 3mg - IV - Pain

Paracetamol 750mg - Pain

Buproprion SR 150mg - Smoking cessation - not-taking est 2004

Allergies

Aspirin allergy - Reaction: hives and asthma - ONLY PRESCRIBE PARACETAMOL

No environmental, food, or animal allergies

Notes

Patient has denied smoking cessation options

Soap

PMH

Height: 1.88 m (6' 2'')

Weight: 91 kg (200 lbs)

Blood type: O+

7x stab wound - 6 required antibiotics for recurrent infection, 2 MRSA resistant

2x bullet wound - 2x in lower extremities, healed with no complication

6x abrasion collar

2x broken collar bone - healed, with no complication

Lactose sensitivity - Recurrent IBS if ingested

Chipped first left molar following opening a beer with teeth

FH

Father deceased at 68 due to heart failure - Type 2 Diabetes Mellitus, high cholesterol

Mother - Stage I HTN (hypertension)

Sister #1 - Postpartum depression, generalized anxiety disorder

Sister #2 - Elevated cholesterol/triglycerides

Brother - No known chronic health issues

Positive family history of diabetes and hypertension, but no cancer

SH

Drinks regularly and heavily - 8-12 beers and 2-3 glasses of hard liquor each weekend; 1 glass of scotch occasionally

Smokes socially - 5 pack years

Physically active

Close relationship with family, has 4 dogs at home under the care of pt's mothers

Avid fan of The Glasgow Football Club

Medication list + indications

Clindamycin 300mg with ciprofloxacin 400mg - Infection

Amoxicillin/Clauvanic acid 625mg - Infection

Vancomycin 18mg/kg - MRSA resistant infection

Paracetamol 500mg - Pain

Morphine 15mg IV - Pain

Doxycycline 100mg - Acne discontinued in 2004

Allergies

Insect stings - Observed anaphylaxis to childhood bee sting

Notes

Patient demonstrates medication non-adherence, counsel ESPECIALLY with antibiotics

Scored 6 on Alcohol use disorders identification test for consumption (AUDIT C)

Gaz

PMH

Height: 1.86 m (6' 1'')

Weight: 93 kg (205 lbs)

Blood type: B-

3x stab wound - healed, no complications

1x broken collar bone

2x broken femur

Diagnosed concussion - evaluated in Oct. '19

FH

Father - Type 1 Diabetes, high cholesterol

Mother - Vitiligo, Stage 3 breast cancer

Positive family history of maternal cancer and diabetes, but no hypertension

SH

Social drinker - 3-4 beers each weekend

Does not smoke

Physically active - Enjoys morning and evening runs

Enjoys spicy food and tries to introduce into diet

When on leave, enjoys attending concerts and music festivals

Medication list + indications

Piriteze 10mg - Allergic rhinitis

Fluticasone Propionate - 93 mcg/actuation - Allergic rhinitis

Paracetamol 500mg - Pain

Allergies

Seasonal - Pollen and pet dander

β-Lactam allergy - Reaction: anaphylaxis evaluated in '19

Notes

Organ donor

Ghost

PMH

Height: Weight: 1.93 m (6' 4'')

WeighT: 100 kg (220 lbs)

Blood type: AB-

Extensive cuts and scarring to entire body

4+ stab wounds - healed, no complications

Gun shot to lower abdomen - healed, no complications, evaluated in Nov. '22

13+ collar abrasion

2x broken nose

Childhood injury of broken tibia and large toe

Psych eval - History of depression and post traumatic stress disorder, childhood history indicates emotional and physical abuse

FH

Father - status unknown Diagnosed alcohol use disorder

Brother - deceased, cause of death non-contributory - Substance use disorder

Mother - deceased, cause of death non-contributory - Hypertension, thrombophilia (blood clotting disorder)

Positive family history of hypertension, but no diabetes or cancer

SH

Social drinker - 3-4 glasses of hard liquor each weekend

Smokes socially - 10 pack years

Physically active - Enjoys nightly walks

Psych eval - Other squad members act as his emotional support

Expressed interest in cats and tattoo art (FLAGGED: Further input and comments from other medical professionals would be appreciated)

Medication list + indications

Paracetamol 1000mg - Pain

Amoxicillin/Clavulanic acid 625mg - Infection

Morphine 20mg + Ketamine 4.5mg IV - Pain

Mafenide acetate 5% topical - Antimicrobial, burn wounds

Fluoxetine 20mg twice daily - Depression - not taking est 2001

Allergies

NKDA - No known drug allergies

No environmental, food, or animal allergies

Psych recommends evaluation of a pet, such as cat, for pt while on leave

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[fascistsarefreefood]

So when I wanted birth control pills I went to my local pharmacy and asked for them, I'm very lucky I have this option to autonomy over my body however it's important to note that birth control pills can have a lot of side effects that aren't properly investigated because of how underfunded reproductive health research is. Side effects of the contraceptive pill include (according to the patient information leaflet):

Serious: blood clots (in leg or foot ie DVT, in a lung ie PE, heart attack, stroke, mini stroke, clots in eye liver stomach or intestine, allergic reaction, breast cancer, cervical cancer, severe liver problems

Less serious: feeling sick, stomach ache, putting on weight, headaches, depressive mood or mood swings, sore breasts, being sick, fluid retention, migraine, loss of interest in sex, breast enlargement, skin rash, poor tolerance of contact lenses, weight loss, increase interest in sex, vaginal or breast discharge, bleeding and spotting between periods, chloasma, occurrence or deterioration of movement disorder chorea, crones disease or ulcerative colitis

In the UK if you want birth control you can go directly to some pharmacies and get it or you go to one GP appointment and get it even if you are under 16

Alternatively you might want an iud. iud insertions are painful women are told to just take an ibuprofen (which some research shows is less effective in women but again that hasn't been fully investigated) during insertion women have reported crying and passing out due to pain levels but it is still not advised that GPS use local anaesthetic during insertion. And again since there is no age restriction for contraception in the UK people under 16 also have to go through this. But that's considered totally acceptable.

What isn't acceptable according to the labour party, are puberty blockers which were obtained by first having a referral to a GP followed by appointments with a multidisciplinary team including a clinical psychologist, child psychotherapist, child and adolescent psychiatrist, family therapist and social worker over three to six months where their then mainly offered psychological treatment finally if your very lucky and also haven't already finished puberty by the time you get to this stage (because NHS waitlist are crazy) you might be sent to a hormone specialist where you might have been given puberty blockers which yes are indeed reversible (the onse that cause irreversible change are oestrogen and testosterone) you can read more about this topic here but this is no longer a possibility because puberty blockers are now considered too dangerous and why is this? What side effects could be worse than the ones caused by contraception that is also available to understand sixteens well apparently puberty blockers are oh so dangerous because they affect bone density. So AFAB people both adults and minors have to suffer from lots of side effects from birth control and no one ever once thought to try create a better version of the pill or they suffer large amounts of pain during iud insertion where again hardly anyone will get anaesthetic however puberty blockers are these terrible things because they may cause bone density issues if that were the case for contraceptives we'd be told to take some calcium and stop whining. Both contraceptives and puberty blockers perform essential functions that save lives and both deserve to be made as safe as possible but this is not about safety this is about hoping trans people will just disappear.

[lua-magic]

Planets and your health.

Ketu or south node gives diseses which could go undiagnosed till last stage.

Sometimes, diseases can't be diagnosed by any doctor, even patient will not able to understand but he/she can feel something wrong with her body..

Rahu is poison, any infection in your body that spreads rapidly, or poisonous insects or animals like snakes, bees are North node.

Food poisoning is also due to North node.

Any sudden event or disease is caused by north and south node.

People suffering from self harm or suicidal tendancy has bad north node or north node with moon.

Mars is blood, afflicted Mars will give skin problems and allergies

Remedy is to take Neem leaves or tablets every day and keep your blood clean.

Venus rules your tongue and your throat region, blisters and ulcers on throat and tongue are due to bad Venus.

Venus is also your skin glow and texture, so if you don't have skin glow it is due to afflicted Venus.

Mercury rules nervous system, bad Mercury gives neural problems and Mercury also rules your teeth, bad breath, cavity, and germs in your teeth is due to bad Mercury.

Jupiter rules your fat inside your body and your liver, bad liver, fatty liver, fat inside body is due to Jupiter.

Remedy is to drink turmeric water every morning.

Bad Saturn gives hair loss or hair fall, also Saturn rules all the joints inside your body, any pain in joints like arthritis is caused by bad Saturn.

Saturn also gives diseses which takes more time to be cured and heals slowly.

Moon is responsible for your mental health, problems related to stress, insomnia anxiety, phobias shows afflicted moon.

[captainsolocide]

lost psych episode where they find the dead bodies of two middle aged men in some random ass motel, no easily discernible cause of death for either of them they're just laying there on the bed together. only one of them has any kind of ID and it's from fucking new jersey??? so with that and the rest of their room plus some statements from the motel workers shawn can only tell two things 1) these guys were definitely in a romantic relationship with each other and 2) they were some kind of road trip. neither of these things are helpful right now and nobody really suspects foul play but shawn has a weird feeling so they go to woody and he gives them some more info. they both have the same cause of death, morphine overdose, and the guy with the ID was actually suffering from late stage thymoma and was quite literally days away from dying of that, so he was most likely euthanized, but the other guy is weird. cause he wasn't suffering from any immediately life threatening diseases or anything. well, his liver had definitely taken a severe beating during his life, some form of addiction, and there was a significant amount of muscle removed from his leg at some point which would have made walking incredibly painful, but nothing immediate. so shawn goes back to them being a couple so like okay maybe the no-ID guy euthanized his partner and then killed himself? but that's so dramatic, nobody really thinks that kind of stuff happens in real life, and there's still something bothering shawn about this but they let it go. and then shawn remembers like five months ago hearing about this crazy doctor who had gone to jail for driving a car through his boss' house, was released for some reason, and then destroyed the plumbing in the hospital he worked at so he was going to go back to jail, but then died in a fire of some abandoned building. and when shawn looks up that story it's the dude without an ID which means this crazy ass man faked his death only to kill himself and his partner five months later — oh wait he would've gone to jail he wouldn't be with his partner when he died that's why he faked his death he wanted to be with his partner — so he makes some calls to the hospital this guy worked at and sure enough the administrator there tells him in an incredibly annoyed voice that yes James Wilson used to work here before he got cancer and his "best friend" died in a fire, yes he left town pretty much immediately after his "best friend's" funeral oh he's not actually dead? that is incredibly shocking thank you. shawn can't believe this guy is so calm about this because what the fuck. what the fuck was wrong with these two old men why did they decided to kill themselves here?? and the administrator is just like "well Santa Barbara is the murder capital of the US. they probably thought it'd be funny." and hangs up. credits roll.

[mariacallous]

On a recent Thursday afternoon, researchers Lanuza Faccioli and Zhiping Hu wheeled an inconspicuous black and white plastic cooler from an operating room at a hospital in downtown Pittsburgh. Inside was a badly scarred liver, just removed from a 47-year-old man undergoing a transplant to receive a new one from a donor.

But what if patients could avoid that fate? Faccioli and Hu are part of a University of Pittsburgh team led by Alejandro Soto-Gutiérrez attempting to revive badly damaged livers like these—as well as kidneys, hearts, and lungs. Using messenger RNA, the same technology used in some of the Covid-19 vaccines, they’re aiming to reprogram terminally ill organs to be fit and functioning again. With donor livers in short supply, they think mRNA could one day provide an alternative to transplants. The team plans to begin a clinical trial next year to test the idea in people with end-stage liver disease.

Alcohol use, hepatitis infection, and a buildup of fat in the liver can cause scarring over time. When there’s too much damage, the liver starts to fail. “Right now, if you get end-stage liver disease, it’s irreversible,” Soto-Gutiérrez says. “Well, we found that is not true. It is reversible.”

Soto-Gutiérrez and his team have been experimenting on rats and organs taken from people undergoing transplants at the University of Pittsburgh Medical Center, one of the busiest transplant centers in the US. To help design the mRNA and figure out how to deliver it to the human liver, they’ve partnered with Drew Weissman, a physician and immunologist at the University of Pennsylvania who won the 2023 Nobel Prize in Physiology or Medicine for his pioneering work on mRNA. Together, Soto-Gutiérrez and Weissman lead the Center for Transcriptional Medicine, launched in April with the goal of bringing these medicines to patients.

On the day I visited, I followed Faccioli and Hu through a maze of hallways until they deposited the freshly explanted liver at a pathology lab, where a team of scientists was anticipating the special delivery. After infusing the liver with an experimental mRNA therapy, they placed the organ in an oxygenated bath meant to maintain its function for several days.

A healthy liver is spongy and reddish-brown in color with a smooth appearance. But when the surgeons took this one out of the cooler, it was hard, marbled, and covered in bumps—evidence of cirrhosis, a type of end-stage liver disease. Over time, the man’s healthy liver cells had been replaced by scar tissue, and eventually, his liver stopped working. His only option was to get a new one.

Livers are the second most in-demand organ. In 2023, a record 10,660 liver transplants were performed in the US, driven in part by a steadily growing number of living donors. In a living liver transplant, a piece is taken from a healthy person’s liver and transplanted into a recipient. But even with this uptick in transplants, not everyone who needs a new liver receives one. Patients may have other health problems that disqualify them from a transplant, and others may die while waiting for one. In 2022, the latest year for which data is available, the Centers for Disease Control and Prevention recorded nearly 55,000 deaths due to chronic liver disease.

Living donor transplants are possible because of the liver’s unique capacity to regenerate itself—more so than any other organ in the body. In a healthy person, the liver can regrow to its normal size even after up to 90 percent of it has been removed. But disease and lifestyle factors can cause permanent damage, rendering the liver unable to repair itself.

When Soto-Gutiérrez was studying medicine at the University of Guadalajara in Mexico, his uncle died of liver disease. From then on, he became dedicated to finding a treatment for patients like his uncle. In the early years of his medical career, he noticed that some patients with scarred livers were bound to a hospital bed waiting for a transplant, while other people with cirrhosis were walking around, seemingly living normal lives. He figured there must be cellular differences in these livers.

He teamed up with UPMC transplant surgeon Ira Fox to look for transcription factors—master regulators that can dial up or down the expression of groups of genes—that can potentially reprogram injured organs. Genes rely on transcription factors to perform many essential functions in organs. Together, Soto-Gutiérrez and Fox have analyzed more than 400 failing livers donated by transplant patients. When they compared them with dozens of normal donated livers that acted as controls, they identified eight transcription factors essential for organ development and function.

They zeroed in on one in particular, HNF4 alpha, that seems to act like a main control panel, regulating much of the gene expression in liver cells. In healthy liver cells, levels of HNF4 alpha were turned up, and so were other proteins it controls. But in the cirrhotic livers they examined, HNF4 alpha was almost nonexistent.

The team needed a way to get the transcription factor into liver cells, so they turned to mRNA technology. Used in some of the Covid-19 vaccines, mRNA is a molecule that carries instructions for making proteins, including transcription factors. In the Covid vaccines, the mRNA codes for a part of the virus known as the spike protein. When injected into a person’s arm, the mRNA enters cells and kicks off the protein-making process. The body recognizes these spike proteins as foreign and generates antibodies and other defenders against it.

The Pitt team is using mRNA instead to essentially turn back time in injured organs. “What we’re proposing to do with mRNA is use it to deliver proteins that have the capacity to repair those damaged liver cells,” Weissman says. “Our hope is that we can treat end-stage liver disease and turn the livers around, maybe forever, or at least until patients can get a transplanted organ liver.” Instead of delivering instructions for a foreign protein to generate an immune response, they’re delivering the genetic code for producing a transcription factor—HNF4 alpha.

In a paper published in 2021, the approach revived human liver cells in lab dishes. The researchers have since tested the mRNA therapy in rats with cirrhosis and liver failure. They treated a group of rats every three days for three weeks while a second group served as a control. The animals that were receiving the injection of HNF4 alpha started being more active. The untreated rats continued to decline and eventually died, the expected result at their stage of disease. Some of the treated rats were still living six weeks after receiving the mRNA medicine. Those results have not yet been published in a peer reviewed journal.

The team is also testing the mRNA infusions in human livers removed from patients undergoing transplants—the process I got to observe. Unlike live rats, explanted human livers can’t be observed for weeks on end. Livers have to be retrieved quickly and infused with the mRNA treatment soon after they’re removed from the body. They stay fresh for just four days or so in a preservation fluid. Six hours after the mRNA infusion, levels of HNF4 alpha start going up and last for two to three days. When HNF4 alpha peaks, other essential liver proteins, such as albumin, start to increase as well. That’s important, Soto-Gutiérrez says, because maintaining those protein levels could mean the difference between a patient needing a transplant or not.

Ideally, Soto-Gutiérrez says the mRNA therapy would be something patients could get once a week or every other week in an outpatient facility and go back home. But initially, they’ll need to test the experimental treatment in very sick patients, likely ones that are hospitalized, to make sure it’s safe. The team is gathering data from the rat and human liver experiments to submit a clinical trial application to the Food and Drug Administration in the coming months.

While livers are the first target, Fox thinks other injured organs may be amenable to this approach. “We’ve been wondering whether the same process might be taking place in other organs,” he says. Currently, the team is searching for similar transcription factors in lungs with chronic obstructive pulmonary disease and kidneys with chronic kidney disease.

Josh Levitsky, a liver transplant specialist at Northwestern University who isn’t involved in the work, says new treatments for chronic liver disease are sorely needed. Current therapies can help slow down scar tissue buildup and ease symptoms but don’t address the underlying disease. “The concept of reprogramming and being able to reverse liver failure could be really game changing if it were to pan out in clinical studies,” he says.

But lots of questions remain. How much damage could be reversed? Would patients need to be on the therapy indefinitely? Or would their livers rebound enough to go off it? Could a liver ever be restored back to normal?

“It certainly has a lot of promise,” Levitsky says, “but the clinical development is going to take a long time.”

[awetistic-things]

❗️please, stay

View this post on Instagram

A post shared by Ola Abu Jbara (@olaabujbara)

listen to her story, share to the best of your resources, donate even if you don’t have much to give

Ola doesn’t have to do this alone, no one does—offer your hand, we must keep one another going

〰️

“I am Ola Ferwana from Palestine ,Gaza. I'm a mother of 3 kids Yamen, Qusai and Mira. My husband travelled to Egypt to get medicines before 2 days of the war 7 of October on Gaza.

I faced very great challenges and the responsibilities of my three children in the absence of my husband, as he had traveled and the crossing was closed and we could not see each other. The amount of suffering I was feeling cannot be described.I am reaching out to you today with a heavy heart and a plea for urgent assistance. I have left my home and have been displaced more than 8 times with my children. I am living in the war_torn region of Gaza, facing unimaginable challenges, with lack of water, food scarcity, and constant threats to their safety.

I have delivered a girl baby,Mira, through the war, She was 10 months old and my husband didn't see her until this moment.

Yaman was 7 years old, and his simplest dream was to complete the first grade at school, but his school was completely destroyed. He lost the most beautiful thing that he was happy with and enjoyed that he had reached this stage.

Qusai is 5 years old, and until this moment I do not have the courage to tell him that his kindergarten was also destroyed, the first place and refuge in which he was happy, but in this war he lost everything beautiful. He lost his father’s hug, which was his only refuge when he slept at night, telling him his daily story to fall asleep safety.

Mira, my daughter, who had never seen an hour or a moment devoid of fear, came into this world and was surprised by a war that destroyed many, many things. It destroyed her house and her room, which I was waiting for as I prepared and brought her all the beautiful clothes and colorful dresses she needed. She was surprised by the sound of missiles. She could not sleep because of it. My husband hopes to get a smile and a hug from her daughter Which he had been waiting for some time.

We lack of the basic human needs, no food no electricity no water. We were poisoned and infected because of the unhealthy water that we drink.

My three children and I had to be hospitalized. We suffered from liver dysfunction as a result of malnutrition, widespread diseases, and recurring infection.

During this period, I felt remorseful about how difficult it is for a mother to see her children sick and unable to treat them because she is also very sick.

The Rafah border crossing, which is the only way to escape from the war, is closed now.

If it is opened, I can't go to Egypt as I don't have the money because my husband is the sole breadwinner for my family.

I hope to provide us by giving support in order to cover the costs associated with ensuring our safe passage of Egypt through the borders. Please stand with me, we are now homeless, with absence of children needs like milk, diapers, with no food. Please help us to stay a live and leave Gaza with my children. Share this link as you can as possible.

Thank you for your kindness, empathy and generosity during this challenging time.With sincere thanks and warm regards, Ola”