Recent news reports have announced the successful transplantation of pig kidneys and a heart into humans. Similar work is being done to use pig livers in humans. A number of members have asked me about this swine parts business so this will be a bit of background and my thoughts about the future for this strategy.

In my last newsletter I commented that I was proud that one of the things we do is help people die. Members who have followed me for a while got it but I made some newer folks uncomfortable so as a way to start the new year I thought a look at real life might be useful.

Before Rosemary and I created the Fatty Liver Foundation I never gave much thought to the non-profit community.  We always contributed a token to some big name organization with lots of slick ads and thought little more about it. Rosemary would respond to food banks and a few other local groups from time to time but I couldn't be bothered.

God appears to have a strange sense of humor as I find myself in this "old man" stage of my life running one of the newer small non-profit patient support groups and I often think about how little I cared for the less fortunate among us as a younger man. I don't think I lacked empathy but I just didn't know what life was like for those who fall into the darkness of chronic illness and then retreat from the tumult of "normal" life.

A lot of research is published but not a lot is sponsored by and performed by patients themselves.  We are pleased to announce that our SUNN Study (Screening for Undiagnosed NAFLD and NASH) report has been published and the paper is now live on PLOS ONE, an international, peer-reviewed, open-access, online science publication. You can read it by clicking the link below.

Screening for undiagnosed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): a population-based risk factor assessment using vibration controlled transient elastography (VCTE)

There are two big conferences in the world for people who deal with liver disease.  EASL is in Europe in the spring and AASLD is in the US in the fall. This is where the latest research is released, where the cutting edge of knowledge about the disease is shared, and where the future of liver medicine can be glimpsed.  It is a time for the superstars of the field to strut their stuff and be recognized by their peers and it is a window into the best of today and a glimpse of what we as patients can look to in the future.

We will follow this note with a more useful review of information we hope will be useful to you as patients, but I wanted to share a general perspective of what I see happening broadly.

This is just an update. Almost no one actually watches these little closing bell ceremonies but they are a nice part of our historical record. It was interesting to be mentioned on the big screen on Times Square for a half an hour. Here is a link to the event announcing the NAFLD Screening Fund.

https://youtu.be/KHYXuHCN4g0?t=112

The Fatty Liver Foundation is launching a public private partnership fund with the long-term goal of screening a million asymptomatic, undiagnosed individuals a year for nonalcoholic fatty liver disease (NAFLD).

NAFLD and its serious advanced version nonalcoholic steatohepatitis (NASH) are epidemic but largely unknown to people. These diseases have subtle symptoms until late stage when they are diagnosed as cirrhosis. Most people know cirrhosis as a disease of alcoholism, and the end result of destruction of the liver is the same, but the cause is different. NAFLD is primarily a disease caused by food. It was unknown before calories became abundant and obesity became common.

A first time is often a turning point, a new direction or a different way.  They come in an infinite variety but must flower in their season. Click the First Time button for a 25 second snippet of great wisdom.

I wrote about the danger of Delta while it was still just a problem for India.  Regular readers may recall my comment about it coming to your town.  We all know the tune for old folks and those with other illness at this point but it is important to understand that there is more to the story.  A booster is now available to some and I see questions about whether it is a good idea to get it.  I've had the booster but before I tell you my results lets step back and ask if the risks we face are the same with Delta as they were with our old chum Wuhan. A good measure is dying so a look at some case fatality rates might be fun.

ELF, cute little name but what does it mean to liver patients?

ELF was just approved as a blood test for fibrosis by the FDA and this is an important step in the efforts to develop better tools for diagnosing advanced liver disease and getting away from liver biopsy.

I'm sympathetic to the challenge the CDC faces but I hate the way they dumb down their messages about this virus. By talking to us like we are 6th graders they just add to the confusion.  There are things you need to understand about this virus so that you can respond appropriately. See the summary notes below.

Recently, we sent out a survey to our community to get an idea about COVID-19 vaccines and their impact among immunocompromised people with liver disease. We knew we were posing this survey to our community, which is likely more informed and focused on fatty liver disease, so these results should be considered in that context. Though we did not achieve statistical significance with any of our findings, thanks to you, we got over 100 responses and found some interesting, yet not completely surprising, insights. Click on the image below to see the top line results from the survey.

Twenty million people with the liver disease NASH, or non-alcoholic steatohepatitis, are also more likely than the average person to be infected with the COVID Delta variant and suffer from long COVID. Many of these chronically ill will become variant factories increasing the risk of developing new and deadlier strains. We’re working hard to prevent that, aren't we?

I really want to be mad at someone, but who?

You are here because you have an interest in health. Suppose you had a dangerous condition that takes a decade or two to develop but had no symptoms. Would it matter to you if no one told you?

Buzz off you say???  Life is like that you say, lots of things happen to people. There's nobody to blame. It's in the fine print on the back of the ticket. Life isn't fair and no one gets out alive. Don't waste the energy thinking it can be better?

PPAR -- Peroxisome proliferator-activated receptor

Lanifibranor by Inventiva leads the way

Wayne, you must be crazy to think I'll read something that starts out like that!!!

Be calm, I promise, it will make sense and if liver disease interests you this will be worth your time.

Therapies for NAFLD/NASH have been an elusive target and recent history is littered with promising molecules that many thought were finally going to lead to treatments for our disease. This is not a trivial problem. People are dying and our weapons are coffee and vitamin E.

Don't get on me about lifestyle right now.  I know that tune but I also connect through our peer groups with thousands of people who need more than that and drugs will be part of a proper management of this disease if we can ever find something that works.

Becky Taub and Paul Friedman, the founders of Madrigal Pharmaceuticals, are heroes of mine.

There has been a lot of disappointing news about NAFLD/NASH therapy research this past year.  I thought you might enjoy a look at some new data that is very encouraging. Terns Pharmaceutical just reported very positive 12 week results of the drug TERN-101. Below is a chart from their report about changes in results using a fairly new non-invasive test by Perspectum, the Liver MultiScan measuring a value called cT1 or corrected T1.  I'll explain it a bit later but for the moment just know that it is an indirect measure of fibrosis.  Click the image to see a larger view.  As a phase 2 study this is a small number of patients but the effect on their livers in only 12 weeks is among the best early data that we have seen.

We all know the issues. Too much disease, no treatments, a looming health crisis made worse by the pandemic. We are here on International NASH day and it seems like an apt time to wonder if there might be a better way.  If you haven't registered for the event I invite you to do so by clicking on the image below, but I also invite you to think about the future of research and how we as patients can support a better way.

Infection rates and vaccine failures - some points to ponder

We have been seeing the headlines about the COVID tragedy in India as hospitals turn patients away and the nation runs out of oxygen as people are literally dying in line waiting to refill oxygen tanks. India faces a historic crisis and you probably imagine the densely packed cities and poverty are the cause. But wait, what about the REST OF THE STORY?

If you or someone you care about has a chronic disease, there are things about the story of India that will likely affect you in coming months. I've written about COVID variants before, click here for a review. The UK strain has become the dominant variant in the US and it has done that because it is about 50% more infectious than the Wuhan original. The University of British Columbia recently released an actual image of the UK variant spike protein which helps us understand that. The image is an amazing science story about how they could take this picture but a story for another time.

I remember Google before it became mostly an advertising farm.  To be able to get to information easily was magic. Today no matter where you go it is a parade of ads and cleverly designed hustles. Like search, now that video is so easy to do, the webinar world has exploded with ads. Since we don't sell anything and our only interest is having you not die of liver disease, getting past all the noise so that you might consider joining us is a real challenge.