Discover and read the best of Twitter Threads about #NASH

Most recents (24)

馃毃El comit茅 asesor de @US_FDA vota en contra (12/16) de la aprobaci贸n del obetic贸lico para el tratamiento del #NASH

鈿狅笍Balance beneficio-riesgo desfavorable

No es definitivo, la FDA se pronunciar谩 el 22 de junio ... pero no pinta bien

El que iba a ser el primer f谩rmaco para tratar a personas con #NASH public贸 los datos preliminares del ensayo cl铆nico pivotal en el 2019!

鈻讹笍 Beneficio modesto en t茅rminos de eficacia y problemas en cuanto al perfil de seguridad


#LiverTwitter Image
Un aspecto positivo: la gran cantidad de informaci贸n p煤blica que facilita la @US_FDA, en la que ha basado el comit茅 asesor su resoluci贸n negativa:


#LiverTwitter Image
Read 4 tweets
Just doing some digging. #Pain is extremely nuanced. And the approach should also. W my kids #health & #pain there has been continued lack of knowledge, assumptions, & unwillingness to understand.
鉃★笍#Anatomy of those that had #TPAIT & lack of understanding
by many docs 1
how this can impact #pain
鉃★笍 Not identify or understanding impact of #MalabsorptionSyndrome
鉃★笍Assumption that removal of #pancreas should immediately 鈥榮olve鈥 issue of #ChronicPain
鉃★笍 #GastricEmptying issues
鉃★笍 Age of my kids (too young to have #pain)
鉃★笍 Lack of 2
understanding & identification of #MedicalTrauma
鉃★笍T3c #Diabetes
鉃★笍 Impact of #NASH on #pain & options for #care

There are numerous factors that are critical in #Treating an #ChronicPain in #Individuals. They list of few listed above that are factors w my kids, have often 3
Read 8 tweets
The findings of this one suggest a possible defect in the transfer of PUFA from peripheral tissues to the liver in NAFLD, with HDL composition being tightly connected to the rewiring of hepatic PUFA composition that occurs in NAFLD. Image
- NAFLD was characterised by a depletion in phospholipids (phosphatidylcholines, phosphatidylethanolamines, phosphatidylglycerols and sphingomyelins) specifically driven by their PUFA fraction.
- NAFLD patients had higher saturated and lower polyunsaturated FFAs.
Read 8 tweets
Back in the days of John Humphrey Noyes before he got suspended for posting a study indicating there's viral persistence in epithelium of kids, because everyone includes kids.
How does a twit like this get 108K views propagating 鈥渨hat if viral persistence is REAL鈥?

It鈥檚 almost like we are back to banning twitter accounts for insisting SARS is airborne!
WHEN the rest of non-SARS experts acknowledge that 鈥渧iral persistence is a thing鈥, we will be one step closer to acknowledging the true immunity dysfunction threat of SARS
Read 42 tweets
Bart Staels, PhD of Univ of Lille, France gave an outstanding talk on Interplay Between #NAFLD & #CVD at the #WCIRDC. CVD is the leading cause of death not liver disease. Fibrosis severity correlates with higher CVD risk. @WCIRDC @YHandelsmanMD鈥
Type 2 #diabetes and #NAFLD have a reciprocally injurious relationship mediated through common pathophysiology magnifying the risk for #CVD events. @zilbermint @AlinaAllenMD
#NAFLD is considered the hepatic manifestation of the metabolic syndrome and is closely linked to:
#Obesity, especially visceral adiposity
鉁匢nsulin resistance
鉁匔hronic inflammation
Read 9 tweets
In part 2 of the #ALD #NASH SIG, Stephen Harrison covers #NASH therapeutics and MoAs #TLM22
@juanpabloarab now covers the therapy landscape for alcohol-associated hepatitis - steroids suboptimal with benefits beyond 1 month limited #TLM22
In the US, lack of response indicates a huge unmet need - @juanpabloarab #TLM22
Read 7 tweets
In the #NAFLD #ALD SIG, @stefano_romeo76 begins with a discussion of mechanisms of disease #TLM22
Some classic genetic stories, and some more recent ones鈥 #TLM22
@mandrekp now discusses the corresponding mechanisms for #ALD #TLM22
Read 11 tweets
Thyroid hormones regulate liver enzymes via thyroid hormone receptors. When the liver is steatotic, hepatic thyroid hormone receptors don鈥檛 respond effectively. This results in an intrahepatic hormonal milieu where the liver is essentially hypothyroid. #livertwitter #endotwitter
Thyroid hormone receptor-尾 plays a key role in hepatic homeostasis including:
鉁匘e novo lipogenesis
鉁匜atty acid 尾-oxidation
鉁匨itochondrial biogenesis
鉁匔holesterol metabolism
鉁匔arbohydrate metabolism
#livertwitter #endotwitter
Thyroid hormone receptor-尾 agonism has demonstrated clinical benefits on hepatic lipid metabolism.鈥
Read 12 tweets
馃毃 Publication alert: largest to date multiancestry exome analysis of body fat distribution discovers INHBE mutations associated with favorable adiposity and PROTECTION from diabetes! 馃毃

Out today in @NatureComms

馃憞馃У key takeaways below鈥鈥 Image
Fat distribution: MAJOR BUT OVERLOOKED risk factor for diabetes & heart attacks globally

Storing猬嗭笍fat in waist and猬囷笍in hips gives 猬嗭笍猬嗭笍猬嗭笍risk 鈥 independent of overall body fat (馃憞)

馃毃Lots of drug development in obesity; almost none for fat distribution鈥 Image
Fat distribution is partly in our 馃К鈥

#exome #diabetes #obesity #NASH Image
Read 12 tweets
Our discovery of mutations in the CIDEB gene that protect against liver disease is published in @NEJM, leading to possible #RNAi therapeutics for NASH by Regeneron & Alnylam. 馃毃鈥

A short summary of the key findings 馃К馃У鈫 ImageImage
Liver disease is a big unsolved problem:

1鈨 1 in 3 adults globally have fatty liver, often due to #obesity.

2鈨 Liver inflammation due to fat (NASH) is becoming #1 cause of liver transplant.

3鈨o approved therapies.

Where can we find possible NASH targets?

鉃★笍In our DNA! Image
Studies of common genetic variants found PNPLA3 (2008 - risk-increasing, and HSD17B13 (2018 鈥 protective, variants associated with liver disease that are now potential #RNAi therapeutics currently in development. ImageImage
Read 11 tweets
This one found individuals with NAFLD to have lower peak-stimulated GH but similar IGF-1 levels, with a higher peak-stimulated GH to be associated with lower IHL and less hepatocellular damage, and a higher IGF-1 to be associated with more favorable fibrosis markers.
- Mean peak stimulated GH was lower in individuals with NAFLD, as compared to similar controls without NAFLD.
- Individuals with NAFLD had lower peak-stimulated GH versus non-NAFLD controls of similar age, BMI and sex, independent of confounders such as visceral adiposity and fasting glucose.
Read 10 tweets
馃摙Personalized medicine in #NAFLD by @DrLoomba

鉁匔urrent gaps in #NAFLD:
- Rapid progressors
- non-cirrhotic HCC

馃槯At risk NASH (F2 beyond)? Try these馃憞
鉁匜AST (low PPV) - exclude biopsy
鉁匨AST (PPV 91-97) - rule-in & treat
鉁匨EFIB (AUROC 0.9)

#ILC2022 #Livertwitter @EASLedu
Personalized medicine in #NAFLD by @DrLoomba

馃敟Gut microbiome (AUROC 0.936)
- Detect advanced #fibrosis
- Identify 1st-degree relative with #cirrhosis (ethnically universal)
馃憠DOI: 10.1016/j.cmet.2020.06.005

- FGF19 treatment response in #NASH

#ILC2022 #LiverTwitter @EASLedu
Personalized #NASH treatment by @DrLoomba

Choose yr drugs based on馃幆
#Fibrosis reversal vs #NASH resolution?

鉁匔ombination = way forward. Why?
鈴珼ose ( ?potentially 鈴珹E)

#ILC2022 #LiverTwitter @jturnesv @aelsharkawy75 @IanARowe @DharJahnvi @drshafikuchay
Read 4 tweets
GLP-1-based therapies are slowly approaching #bariatricsurgery level #weightloss and more exciting science to come. There is the impressive SURMOUNT-1 trial for tirzepatide #obesity鈥
Among the compelling findings, 63% of subjects achieved > 20% #weightloss with 15 mg once weekly Tirzepatide over 72 weeks #obesity鈥
The results obtained with semaglutide and now tirzepatide provide compelling examples of how investments in science over time enable new more effective therapies for metabolic disorders #T2D #Obesity perhaps #NASH. These results also raise the bar for new mechanisms in the space
Read 4 tweets
Fantastic lecture by @scottisaacsmd on the Fatty liver epidemic and introduction to the new AACE Fatty Liver Guidelines released today. First lecture by @scottisaacsmd #AACE2022 #endotwitter
NAFLD is a spectrum that includes NASH. First rule out secondary causes.
Difference between NAFL and NASH? NAFL is just the accumulation of fat w/o ballooning or much inflamation. NASH has hepatocyte changes from ballooning and inflammation. IIt is staged also based on fibrosis (F0-F4)
Read 8 tweets

Water & Wine/Fire = PEACE !!!



I tried SHOWING everyone #WHY this whole #WORLD was created for 1 person, 1 individual who is GIVING IT ALL BACK
To His people !!!

Water & Fire/Wine = PEACE !!

Watch The Water, #WW (Wet Willy) !!!!!!!
The Man Who Souled The World !!!

I Got Soul but I鈥檓 not A Soldier !!!!

The Man who SOLD the world = 鈥nd JUSTICE for all !!!

Read 8 tweets
A Russian defeat can be more disastrous than a Ukrainian surrender.
Russians have nuclear weapons and an egoistic president suffering from a #narcissistic personality disorder.
May God help us all!
Nuclear or Chemical Weapons exchange will destroy the global environment
There is literature available on how nuclear war can instigate a nuclear winter.
That means the #sunlight will not be able to permeate the agricultural ecosystem, most crops won't grow in darkness and cold weather and that will lead to global food production disruption and famine
Previously, Western Experts had studied the possibility of nuclear winter in the context of South Asia, where nuclear arch-rivals India and Pakistan have maintained unconventional weapon arsenals for a long time.
Never thought this geostrategic risk could emanate from Eurasia?
Read 6 tweets
"Americans increased the Defence Budget to the tune of USD 200 Billion per year between 1980 and 1987"
One must learn Crisis Management from Military leaders and Geostrategic Affairs Experts.
Leadership, management and entrepreneurship can all benefit from wargaming and decision-making did on the battlefield.
An interdisciplinary approach to problem-solving helps a lot!
#MacNamara is right about three things when he sums up a crisis situation
1. Misinformation exacerbates a crisis
2. Emotionalism can ruin strategic decision-making
3. First information received in the event of a crisis is always wrong leading to an error of judgement
Read 9 tweets
A case!
鈿狅笍11% of patients with incidentally discovered steatosis may be at risk for advanced hepatic fibrosis!
Read 16 tweets
It's Monday and time for us @GoggleDocs to #takeover the @cardiomet_CE account for the next few days.

It's time to revisit the recent #EASD2021 conference.

Highlights in what's new in
Just to remind you guys

The @GoggleDocs are a bunch of 馃嚞馃嚙 docs/馃 who are fascinated about the cardio-metabolic conditions we are increasingly managing.

Please check out our @YouTube channel鈥
This accredited educational program is intended for healthcare providers only, and is supported by grants from AstraZeneca, Bayer, Chiesi, and NovoNordisk. Follow this thread for a link to credit. CE/#CME credit for #physicians, #nurses, #pharmacists in US, Canada, GB, EU.
Read 22 tweets
How can Ultrasound Elastography be used to diagnose liver fibrosis? 馃憠

A #TWEETORIAL based on the first-ever @radiology_rsna Research In Practice article -- all images presented are from鈥!

#meded #RadInTraining #radres #futureradres #incomingradres

Dr. @AileenO_Shea and Dr. Theodore Pierce from @MGHImaging present a case of a patient with known liver steatosis and bridging fibrosis lost to follow-up. Eventually, this patient was diagnosed with cirrhosis after noninvasive investigation with ultrasound elastography.

2/ Image
Which of the following are clinical manifestations of chronic liver disease?

1锔忊儯 weight loss and jaundice
2锔忊儯 scleral icterus and rash
3锔忊儯 transaminitis and thrombocytosis
4锔忊儯 1 & 2
5锔忊儯 all of the above

Read 15 tweets
The devil is in the 'detailed' #drug history #clinical
22 yr male, underweight
Fatigue, appetite loss
Liver test AST 400 ALT 600
Viruses negative
Liver #biopsy 馃憞Severe #fatty #liver #disease, Mallory Denk++
#livertwitter #pathology #MedTwitter #MedStudentTwitter Image
The culprit 馃憞#Ayurveda #medicine
#Ayurvedic jam with butter, honey, milk as base given for premarital #weight gain! 3 months after stopping, liver tests normal
Consider #drug induced fatty liver in #patients. Not everyone is #metabolic #syndrome
#pseudoscience #Nash #nafld Image
Common drugs causing fatty liver
Steroids, Valproate
Inj Tetracycline
Rare - methotrexate, chemodrugs irinotecan, 5FU, tamoxifen
Also important is Amiodarone
Herbals with #Margosa oil too
Remember #alternative meds rich in fats are important causes too.
Read 3 tweets
Time to catch up on some #Senescence papers, starting with beautiful work by @corina_amor_MD, Judith Freucht & @JosefLeibold. They used #CART #CellTherapy to clear #Senescent cells, and you'll never guess what happened next!鈥
Just kidding, you guessed it: disease model mice got better. Props to the authors for A) inducing #Senescence in 3 different ways, B) using 2 models of #NASH/liver #Fibrosis, and C) validating their senescence observations in human samples of #Cancer and #Atherosclerosis.
The linchpin of the paper was identifying a specific membrane marker on #Senescent cells, uPAR. They used bulk #Transcriptomics to identify candidates, then narrowed down with #Proteomic data. Go #Omics!
They didn't explore whether uPAR is causative for the #Senescent phenotype.
Read 8 tweets
PLease welcome my favourite gastroenterologist Dr Lay Gan to the twitter world @theng_gan is my friend, colleague, an expert endoscopist, hepatologist and IBD specialist. An outstanding researcher with a PhD in #fattyliver
#IBD #livertwitter #NASH #NAFLD #MondaynightIBD
Read 3 tweets
What can patients with #NASH expect from clinical trials?

Recent negative results from $GILD and now $GNFT in Phase 3 highlight the uncertainties entering trials that patients face

Is there a minimum potential benefit a patient should accept when entering a trial?

In Phase 3, participants with #NASH entering a trial there is no certainty that the drug being tested will work and they are taking a risk with a new treatment

Is there a minimum threshold for benefit in a trial that participants might expect?

Earlier today, I asked #livertwitter what the minimally important difference would be for histologic improvement in phase 3 trials in NASH

The majority thought that at least a 25% absolute improvement in either NASH or fibrosis was the minimum

Read 16 tweets

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