@US_FDA

@US_FDA

@US_FDA

Reality Check Marker

@RealCheckMarker

https://twitter.com/RealCheckMarker/status/1533290695531839488

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.

https://twitter.com/RealCheckMarker/status/1533290695531839488

https://twitter.com/cjmaddison/status/1609691723243945985

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!

https://twitter.com/cjmaddison/status/1609691723243945985

https://twitter.com/realcheckmarker/status/1605543494709153792

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

https://twitter.com/realcheckmarker/status/1605543494709153792

Read 42 tweets

Scott Isaacs, MD, FACP, FACE

@scottisaacsmd

@WCIRDC

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…

@zilbermint

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

#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…

Read 9 tweets

The Lancet Gastroenterology & Hepatology

@LancetGastroHep

In part 2 of the #ALD #NASH SIG, Stephen Harrison covers #NASH therapeutics and MoAs #TLM22

@juanpabloarab

@juanpabloarab now covers the therapy landscape for alcohol-associated hepatitis - steroids suboptimal with benefits beyond 1 month limited #TLM22

@juanpabloarab

In the US, lack of response indicates a huge unmet need - @juanpabloarab #TLM22

Read 7 tweets

The Lancet Gastroenterology & Hepatology

@LancetGastroHep

@stefano_romeo76

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… #TLM22

@mandrekp

@mandrekp now discusses the corresponding mechanisms for #ALD #TLM22

Read 11 tweets

Scott Isaacs, MD, FACP, FACE

@scottisaacsmd

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

Thyroid hormone receptor-β agonism has demonstrated clinical benefits on hepatic lipid metabolism.
frontiersin.org/articles/10.33…

Read 12 tweets

Jonas Bovijn

@jonasbovijn

@NatureComms

🚨 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…

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…

Fat distribution is partly in our 🧬

nature.com/articles/s4146…

#exome #diabetes #obesity #NASH

Read 12 tweets

Niek Verweij

@Niek_verweij

@NEJM

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 🧬🧵↓

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!

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.

Read 11 tweets

Nick Krontiris

@nick_krontiris

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

Wong yujun

@wong_yujun

@DrLoomba

📢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

@DrLoomba

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

@DrLoomba

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

Read 4 tweets

Daniel J Drucker

@DanielJDrucker

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…

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

Lissa Bauer

@lissabauer

@scottisaacsmd

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

I AM

@VVission123

https://twitter.com/bartoneism/status/1353436470703394822

#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

https://twitter.com/bartoneism/status/1353436470703394822

To His people !!!

Water & Fire/Wine = PEACE !!

Watch The Water, #WW (Wet Willy) !!!!!!!

@MrDrewENT

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

Read 8 tweets

Risk Manager(ERM/Actuarial Sciences/Finance)

@SAH16928046

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

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

Risk Manager(ERM/FRM/Actuarial Sciences/IS031000)

@SAH16928046

"Americans increased the Defence Budget to the tune of USD 200 Billion per year between 1980 and 1987"
#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!

#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

John Damianos, M.D.

@john_damianosMD

@klkrok

Therapies for #NAFLD by @klkrok

@AmCollegeGastro #ACG2021 #LiverTwitter #Liver #fattyliver #GITwitter

A case!

⚠️11% of patients with incidentally discovered steatosis may be at risk for advanced hepatic fibrosis!

Read 16 tweets

cardio-met

@cardiomet_CE

@GoggleDocs

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

@GoggleDocs

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…

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

Nikita Consul, MD

@nikitaconsul

@radiology_rsna

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/

@AileenO_Shea

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/

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/

Read 15 tweets

(Cyriac) Abby Philips

@drabbyphilips

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

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

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.

Read 3 tweets

Martin Borch Jensen

@MartinBJensen

@corina_amor_MD

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.

Read 8 tweets

Steven Bollipo

@stevenbollipo

@theng_gan

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

@renumathyd

I have managed to bring a colleague to twitter! #livertwitter @renumathyd @drkeithsiau @jturnesv @KapuriaMd @AtoosaRabiee @RashidLui @HyeWonLee20 @sconglymd @ZarathustrMehta @gilbenyakov

@MondayNightIBD

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

Read 3 tweets

Ian Rowe

@IanARowe

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

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

https://twitter.com/IanARowe/status/1260484524670103552?s=20

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

https://twitter.com/IanARowe/status/1260484524670103552?s=20

3/n

Read 16 tweets

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