Discover and read the best of Twitter Threads about #Nash
Most recents (24)
1/4
🚨El comité asesor de @US_FDA vota en contra (12/16) de la aprobación del obeticólico para el tratamiento del #NASH
⚠️Balance beneficio-riesgo desfavorable
No es definitivo, la FDA se pronunciará el 22 de junio ... pero no pinta bien
#livertwitter
bit.ly/3OKSQj8
🚨El comité asesor de @US_FDA vota en contra (12/16) de la aprobación del obeticólico para el tratamiento del #NASH
⚠️Balance beneficio-riesgo desfavorable
No es definitivo, la FDA se pronunciará el 22 de junio ... pero no pinta bien
#livertwitter
bit.ly/3OKSQj8
2/4
El que iba a ser el primer fármaco para tratar a personas con #NASH publicó los datos preliminares del ensayo clínico pivotal en el 2019!
▶️ Beneficio modesto en términos de eficacia y problemas en cuanto al perfil de seguridad
📰 bit.ly/3q7LfRn
#LiverTwitter
El que iba a ser el primer fármaco para tratar a personas con #NASH publicó los datos preliminares del ensayo clínico pivotal en el 2019!
▶️ Beneficio modesto en términos de eficacia y problemas en cuanto al perfil de seguridad
📰 bit.ly/3q7LfRn
#LiverTwitter
3/4
Un aspecto positivo: la gran cantidad de información pública que facilita la @US_FDA, en la que ha basado el comité asesor su resolución negativa:
🔓 bit.ly/438Zd4h
#LiverTwitter
Un aspecto positivo: la gran cantidad de información pública que facilita la @US_FDA, en la que ha basado el comité asesor su resolución negativa:
🔓 bit.ly/438Zd4h
#LiverTwitter
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.
➡️#Anatomy of those that had #TPAIT & lack of understanding
by many docs 1
➡️#Anatomy of those that had #TPAIT & lack of understanding
by many docs 1
how this can impact #pain
➡️ Not identify or understanding impact of #MalabsorptionSyndrome
➡️Assumption that removal of #pancreas should immediately ‘solve’ issue of #ChronicPain
➡️ #GastricEmptying issues
➡️ Age of my kids (too young to have #pain)
➡️ Lack of 2
➡️ Not identify or understanding impact of #MalabsorptionSyndrome
➡️Assumption that removal of #pancreas should immediately ‘solve’ issue of #ChronicPain
➡️ #GastricEmptying issues
➡️ Age of my kids (too young to have #pain)
➡️ Lack of 2
understanding & identification of #MedicalTrauma
➡️T3c #Diabetes
➡️ 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
➡️T3c #Diabetes
➡️ 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
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.
- 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.
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 “what if viral persistence is REAL”?
It’s almost like we are back to banning twitter accounts for insisting SARS is airborne!
It’s almost like we are back to banning twitter accounts for insisting SARS is airborne!
WHEN the rest of non-SARS experts acknowledge that “viral persistence is a thing”, we will be one step closer to acknowledging the true immunity dysfunction threat of SARS
#AirborneAIDS
#AirborneAIDS
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
healio.com/news/endocrino…
healio.com/news/endocrino…
Type 2 #diabetes and #NAFLD have a reciprocally injurious relationship mediated through common pathophysiology magnifying the risk for #CVD events.
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
#NAFLD is considered the hepatic manifestation of the metabolic syndrome and is closely linked to:
✅#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
✅#Lipotoxicity
nature.com/articles/s4141…
✅#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
✅#Lipotoxicity
nature.com/articles/s4141…
@juanpabloarab now covers the therapy landscape for alcohol-associated hepatitis - steroids suboptimal with benefits beyond 1 month limited #TLM22
Some classic genetic stories, and some more recent ones… #TLM22
Thyroid hormones regulate liver enzymes via thyroid hormone receptors. When the liver is steatotic, hepatic thyroid hormone receptors don’t respond effectively. This results in an intrahepatic hormonal milieu where the liver is essentially hypothyroid. #livertwitter #endotwitter
Thyroid hormone receptor-β plays a key role in hepatic homeostasis including:
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
Thyroid hormone receptor-β agonism has demonstrated clinical benefits on hepatic lipid metabolism.
frontiersin.org/articles/10.33…
frontiersin.org/articles/10.33…
🚨 Publication alert: largest to date multiancestry exome analysis of body fat distribution discovers INHBE mutations associated with favorable adiposity and PROTECTION from diabetes! 🚨
Out today in @NatureComms
👇🧵 key takeaways below…
nature.com/articles/s4146…
Out today in @NatureComms
👇🧵 key takeaways below…
nature.com/articles/s4146…
Fat distribution: MAJOR BUT OVERLOOKED risk factor for diabetes & heart attacks globally
Storing⬆️fat in waist and⬇️in hips gives ⬆️⬆️⬆️risk – independent of overall body fat (👇)
🚨Lots of drug development in obesity; almost none for fat distribution
nature.com/articles/s4146…
Storing⬆️fat in waist and⬇️in hips gives ⬆️⬆️⬆️risk – independent of overall body fat (👇)
🚨Lots of drug development in obesity; almost none for fat distribution
nature.com/articles/s4146…
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. 🚨
nejm.org/doi/full/10.10…
A short summary of the key findings 🧬🧵↓
nejm.org/doi/full/10.10…
A short summary of the key findings 🧬🧵↓
Liver disease is a big unsolved problem:
1⃣ 1 in 3 adults globally have fatty liver, often due to #obesity.
2⃣ Liver inflammation due to fat (NASH) is becoming #1 cause of liver transplant.
3⃣No approved therapies.
Where can we find possible NASH targets?
➡️In our DNA!
1⃣ 1 in 3 adults globally have fatty liver, often due to #obesity.
2⃣ Liver inflammation due to fat (NASH) is becoming #1 cause of liver transplant.
3⃣No approved therapies.
Where can we find possible NASH targets?
➡️In our DNA!
Studies of common genetic variants found PNPLA3 (2008 - risk-increasing, rb.gy/rgyped) and HSD17B13 (2018 – protective, rb.gy/mn2rce) variants associated with liver disease that are now potential #RNAi therapeutics currently in development.
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.
📢Personalized medicine in #NAFLD by @DrLoomba
✅Current gaps in #NAFLD:
- Rapid progressors
- non-cirrhotic HCC
😧At risk NASH (F2 beyond)? Try these👇
✅FAST (low PPV) - exclude biopsy
✅MAST (PPV 91-97) - rule-in & treat
✅MEFIB (AUROC 0.9)
#ILC2022 #Livertwitter @EASLedu
✅Current gaps in #NAFLD:
- Rapid progressors
- non-cirrhotic HCC
😧At risk NASH (F2 beyond)? Try these👇
✅FAST (low PPV) - exclude biopsy
✅MAST (PPV 91-97) - rule-in & treat
✅MEFIB (AUROC 0.9)
#ILC2022 #Livertwitter @EASLedu
Personalized medicine in #NAFLD by @DrLoomba
🔥Gut microbiome (AUROC 0.936)
- Detect advanced #fibrosis
- Identify 1st-degree relative with #cirrhosis (ethnically universal)
👉DOI: 10.1016/j.cmet.2020.06.005
- FGF19 treatment response in #NASH
#ILC2022 #LiverTwitter @EASLedu
🔥Gut microbiome (AUROC 0.936)
- Detect advanced #fibrosis
- Identify 1st-degree relative with #cirrhosis (ethnically universal)
👉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🎯
⏩#Fibrosis reversal vs #NASH resolution?
✅Combination = way forward. Why?
⏫Efficacy
⏬Dose ( ?potentially ⏬AE)
#ILC2022 #LiverTwitter @jturnesv @aelsharkawy75 @IanARowe @DharJahnvi @drshafikuchay
Choose yr drugs based on🎯
⏩#Fibrosis reversal vs #NASH resolution?
✅Combination = way forward. Why?
⏫Efficacy
⏬Dose ( ?potentially ⏬AE)
#ILC2022 #LiverTwitter @jturnesv @aelsharkawy75 @IanARowe @DharJahnvi @drshafikuchay
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 nejm.org/doi/full/10.10…
Among the compelling findings, 63% of subjects achieved > 20% #weightloss with 15 mg once weekly Tirzepatide over 72 weeks #obesity nejm.org/doi/full/10.10…
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)
#WORLD
Water & Wine/Fire = PEACE !!!
[NEW WORLD ORDER]
#WE ARE ALL 1 PEOPLE, 1 SOUL, 1 BREATHE, 1 MIND, 1 BODY & 1 SPIRIT !!!
I tried SHOWING everyone #WHY this whole #WORLD was created for 1 person, 1 individual who is GIVING IT ALL BACK
Water & Wine/Fire = PEACE !!!
[NEW WORLD ORDER]
#WE ARE ALL 1 PEOPLE, 1 SOUL, 1 BREATHE, 1 MIND, 1 BODY & 1 SPIRIT !!!
I tried SHOWING everyone #WHY this whole #WORLD was created for 1 person, 1 individual who is GIVING IT ALL BACK
The Man Who Souled The World !!!
I Got Soul but I’m not A Soldier !!!!
The Man who SOLD the world = …And JUSTICE for all !!!
.@MrDrewENT
I Got Soul but I’m not A Soldier !!!!
The Man who SOLD the world = …And JUSTICE for all !!!
.@MrDrewENT
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
#climate
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
#climate
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
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?
Never thought this geostrategic risk could emanate from Eurasia?
"Americans increased the Defence Budget to the tune of USD 200 Billion per year between 1980 and 1987"
#MacNamara.
#MacNamara.
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!
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
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
Therapies for #NAFLD by @klkrok
@AmCollegeGastro #ACG2021 #LiverTwitter #Liver #fattyliver #GITwitter
@AmCollegeGastro #ACG2021 #LiverTwitter #Liver #fattyliver #GITwitter
A case!
⚠️11% of patients with incidentally discovered steatosis may be at risk for advanced hepatic fibrosis!
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
#T1D
#type2diabetes
#NAFLD
#CKD
#HeartFailure
It's time to revisit the recent #EASD2021 conference.
Highlights in what's new in
#T1D
#type2diabetes
#NAFLD
#CKD
#HeartFailure
Just to remind you guys
The @GoggleDocs are a bunch of 🇬🇧 docs/🤓 who are fascinated about the cardio-metabolic conditions we are increasingly managing.
Please check out our @YouTube channel
youtube.com/channel/UC8Tzu…
The @GoggleDocs are a bunch of 🇬🇧 docs/🤓 who are fascinated about the cardio-metabolic conditions we are increasingly managing.
Please check out our @YouTube channel
youtube.com/channel/UC8Tzu…
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.
How can Ultrasound Elastography be used to diagnose liver fibrosis? 👉
A #TWEETORIAL based on the first-ever @radiology_rsna Research In Practice article -- all images presented are from pubs.rsna.org/doi/10.1148/ra…!
#meded #RadInTraining #radres #futureradres #incomingradres
1/
A #TWEETORIAL based on the first-ever @radiology_rsna Research In Practice article -- all images presented are from pubs.rsna.org/doi/10.1148/ra…!
#meded #RadInTraining #radres #futureradres #incomingradres
1/
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/
2/
Which of the following are clinical manifestations of chronic liver disease?
1️⃣ weight loss and jaundice
2️⃣ scleral icterus and rash
3️⃣ transaminitis and thrombocytosis
4️⃣ 1 & 2
5️⃣ all of the above
3/
1️⃣ weight loss and jaundice
2️⃣ scleral icterus and rash
3️⃣ transaminitis and thrombocytosis
4️⃣ 1 & 2
5️⃣ all of the above
3/
1/3
The devil is in the 'detailed' #drug history #clinical
22 yr male, underweight
Teetotaler
Fatigue, appetite loss
Liver test AST 400 ALT 600
Viruses negative
Liver #biopsy 👇Severe #fatty #liver #disease, Mallory Denk++
#livertwitter #pathology #MedTwitter #MedStudentTwitter
The devil is in the 'detailed' #drug history #clinical
22 yr male, underweight
Teetotaler
Fatigue, appetite loss
Liver test AST 400 ALT 600
Viruses negative
Liver #biopsy 👇Severe #fatty #liver #disease, Mallory Denk++
#livertwitter #pathology #MedTwitter #MedStudentTwitter
2/3
The culprit 👇#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
The culprit 👇#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
3/3
Common drugs causing fatty liver
Steroids, Valproate
Inj Tetracycline
#HIV #AIDS meds NRTIs
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.
Common drugs causing fatty liver
Steroids, Valproate
Inj Tetracycline
#HIV #AIDS meds NRTIs
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.
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! nature.com/articles/s4158…
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.
They didn't explore whether uPAR is causative for the #Senescent phenotype.
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
#IBD #livertwitter #NASH #NAFLD #MondaynightIBD
I have managed to bring a colleague to twitter! #livertwitter @renumathyd @drkeithsiau @jturnesv @KapuriaMd @AtoosaRabiee @RashidLui @HyeWonLee20 @sconglymd @ZarathustrMehta @gilbenyakov
Now hoping there is another voice on #gitwitter from Australia. @MondayNightIBD @DCharabaty @KralJan @KM_Pawlak @BilalMohammadMD @Samir_Grover @LizzieAbyMD @mikepotterMBBS @DrTomGoodsall @MJA_Editor @simonkeely @PRCDigestHealth @HMRIAustralia
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?
THREAD
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?
THREAD
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?
2/n
Is there a minimum threshold for benefit in a trial that participants might expect?
2/n
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
3/n
The majority thought that at least a 25% absolute improvement in either NASH or fibrosis was the minimum
3/n
