Researchers at University College London’s Institute for Liver and Digestive Health have completed the first successful in-patient trial of liver dialysis.
The Dialive device, invented by the UCL team, was found to be safe and effective, research suggests.
The device is associated with substantial improvement in the severity of symptoms and organ function in a greater proportion of patients with acute-on-chronic liver failure (ACLF), when compared with patients receiving standard care, a study found.
The next step would be a larger clinical trial, which if successful could see Dialive approved for clinical use within the next three years.
Dialysis is a technique to clean the blood of harmful substances, more familiar in the treatment of those with reduced or no kidney function.
Patients on kidney dialysis must undergo treatment for several hours each day to live.
But due to the liver’s regenerative qualities, researchers expect dialysis will be able to provide longer term benefits after a short stint of treatment, lasting several days.
It is estimated that across the world there are about 100 million people living with cirrhosis of the liver and 10 million who have cirrhosis along with another complication.
Around three million of those have ACLF, a condition that can cause liver function to suddenly decline, placing patients at high risk of short-term death.
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The UK has about 15,000 ACLF patients each year whose treatment costs the National Health Service about £100,000 ($124,000) a patient, without decreasing their risk of death, the experts suggest.
“It gives me enormous pleasure to see the promise of this novel liver dialysis device for the treatment of acute-on-chronic liver failure," said Dr Banwari Agarwal, chief investigator of the Dialive trial from the Royal Free Hospital and honorary associate professor at the UCL division of medicine.
“The intervention has the potential to transform the care provided to the ever-increasing number of patients and their families suffering from the effects of living with what is essentially a terminal illness for many.
“It has the potential to transform the therapeutic options available to clinicians across the world for patients with ACLF.”
The liver is a complex organ that performs more than 500 functions, including removal of harmful substances from the blood and absorbing nutrients.
One of its roles is to produce large quantities of a protein called albumin, which travels around the body acting as a sort of "mobile liver", absorbing unwanted substances.
But when its function is seriously reduced, such as through alcohol abuse, obesity or viral infection, less albumin is produced.
In ACLF, its function is also seriously impaired. Liver cells die and the gut begins to leak bacteria into the bloodstream, which can cause an inappropriate immune response and multi-organ failure.
Researchers say the study is the first in-human randomised, controlled clinical trial of a liver dialysis device.
Thirty-two patients were treated with Dialive or standard care for up to five days and the outcomes were recorded at days 10 and 28.
According to the findings, Dialive treatment was associated with faster reversal of ACLF compared with standard care, with ACLF resolved in about twice the number of patients.
The treatment also led to a significant reduction in endotoxins, which are released when bacteria die, and improved albumin function.
The study further found that despite receiving as little as three days’ treatment, patients whose ACLF was resolved remained in remission for 28 days afterwards.
“As academics, it can be difficult to define a disease then translate this knowledge into a clinical solution that makes a real difference to people’s lives," said Prof Rajiv Jalan, of the division of medicine, the inventor of Dialive and co-founder of Yaqrit.
“So the results of the Dialive trial are an emotional moment, which wouldn’t have been possible without scientific collaboration between the UK, European colleagues and funding from the European Commission.
“My hope is that within a few years we will start to fulfil the urgent, unmet need for treating acute-on-chronic liver failure and improve outcomes for patients.”
The study, conducted by researchers from UCL, the Royal Free Hospital, UCL spin-off Yaqrit and collaborators, is published in The Journal of Hepatology.
Living in...
This article is part of a guide on where to live in the UAE. Our reporters will profile some of the country’s most desirable districts, provide an estimate of rental prices and introduce you to some of the residents who call each area home.
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Engine: twin-turbocharged 3.5-liter V6
Power: 450hp
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Available: Now
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Denmark 0-0 Ireland
19/11/2018, Nations League
Ireland 0-0 Denmark
13/10/2018, Nations League
Ireland 1 Denmark 5
14/11/2017, World Cup qualifier
Denmark 0-0 Ireland
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Chef Nobu's advice for eating sushi
“One mistake people always make is adding extra wasabi. There is no need for this, because it should already be there between the rice and the fish.
“When eating nigiri, you must dip the fish – not the rice – in soy sauce, otherwise the rice will collapse. Also, don’t use too much soy sauce or it will make you thirsty. For sushi rolls, dip a little of the rice-covered roll lightly in soy sauce and eat in one bite.
“Chopsticks are acceptable, but really, I recommend using your fingers for sushi. Do use chopsticks for sashimi, though.
“The ginger should be eaten separately as a palette cleanser and used to clear the mouth when switching between different pieces of fish.”
KILLING OF QASSEM SULEIMANI
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The specs
- Engine: 3.9-litre twin-turbo V8
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Benefits of first-time home buyers' scheme
- Priority access to new homes from participating developers
- Discounts on sales price of off-plan units
- Flexible payment plans from developers
- Mortgages with better interest rates, faster approval times and reduced fees
- DLD registration fee can be paid through banks or credit cards at zero interest rates
Key figures in the life of the fort
Sheikh Dhiyab bin Isa (ruled 1761-1793) Built Qasr Al Hosn as a watchtower to guard over the only freshwater well on Abu Dhabi island.
Sheikh Shakhbut bin Dhiyab (ruled 1793-1816) Expanded the tower into a small fort and transferred his ruling place of residence from Liwa Oasis to the fort on the island.
Sheikh Tahnoon bin Shakhbut (ruled 1818-1833) Expanded Qasr Al Hosn further as Abu Dhabi grew from a small village of palm huts to a town of more than 5,000 inhabitants.
Sheikh Khalifa bin Shakhbut (ruled 1833-1845) Repaired and fortified the fort.
Sheikh Saeed bin Tahnoon (ruled 1845-1855) Turned Qasr Al Hosn into a strong two-storied structure.
Sheikh Zayed bin Khalifa (ruled 1855-1909) Expanded Qasr Al Hosn further to reflect the emirate's increasing prominence.
Sheikh Shakhbut bin Sultan (ruled 1928-1966) Renovated and enlarged Qasr Al Hosn, adding a decorative arch and two new villas.
Sheikh Zayed bin Sultan (ruled 1966-2004) Moved the royal residence to Al Manhal palace and kept his diwan at Qasr Al Hosn.
Sources: Jayanti Maitra, www.adach.ae
Tearful appearance
Chancellor Rachel Reeves set markets on edge as she appeared visibly distraught in parliament on Wednesday.
Legislative setbacks for the government have blown a new hole in the budgetary calculations at a time when the deficit is stubbornly large and the economy is struggling to grow.
She appeared with Keir Starmer on Thursday and the pair embraced, but he had failed to give her his backing as she cried a day earlier.
A spokesman said her upset demeanour was due to a personal matter.
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Directors: Madeline Sharafian, Domee Shi, Adrian Molina
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The more serious side of specialty coffee
While the taste of beans and freshness of roast is paramount to the specialty coffee scene, so is sustainability and workers’ rights.
The bulk of genuine specialty coffee companies aim to improve on these elements in every stage of production via direct relationships with farmers. For instance, Mokha 1450 on Al Wasl Road strives to work predominantly with women-owned and -operated coffee organisations, including female farmers in the Sabree mountains of Yemen.
Because, as the boutique’s owner, Garfield Kerr, points out: “women represent over 90 per cent of the coffee value chain, but are woefully underrepresented in less than 10 per cent of ownership and management throughout the global coffee industry.”
One of the UAE’s largest suppliers of green (meaning not-yet-roasted) beans, Raw Coffee, is a founding member of the Partnership of Gender Equity, which aims to empower female coffee farmers and harvesters.
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