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FDA Testing Artificial Liver
NIckGorton writes "Research is now underway in the US to seek FDA approval for an artificial liver. The Extracorporeal Liver Assist Device (ELAD) filters blood through a cartridge containing immortalized human liver cells with fiber tubes running through that allow the patients blood to interact with them. This allows the matrix of liver cells to perform both the metabolic (cleansing the blood of toxins/waste) and synthetic (producing albumin, clotting factors, etc) functions of the patient's failing liver. A small trial in China showed a statistically and clinically significant difference in 30 day survival with ELAD."
Obligatory: http://www.youtube.com/watch?v=aclS1pGHp8o
"Don't worry, there's nobody who's had their Liver taken out by Us who's survived."
Now if we could just get some artificial onions to go with that...
And they take your blood... wooden stake anyone?
Just imagine... a beowulf cluster of cancer cells! Woo!
Until the FDA starts making food safe, I have no interest in their medical findings. I'm not sick YET.
Help stamp out iliturcy.
I for one, and this might just be my superstitious self, would be concerned about the prospect of my bodily fluids interacting with biological material that has been, so to speak, "immortalized."
Don't blame me, I voted for Baltar.
I'll drink to that!
I do believe I'll have another Manhattan!
Spring Break
how long until
Hm, immortal. How is that different from cancerous? And all of the immune cells are really carefully filtered out so there's no potential for graft-vs-host disease if one gets loose in the patient, right?
Bruce Perens.
As a two time kidney transplant recipient myself, I know how hard it is to live with organ failure. I met a guy who had gone through 3 liver transplants, and hepatitis had killed all of them. He is all right now,on his fourth transplant, but something like this can make all the difference in the world to people waiting for a liver. Especially since he had two small daughters.
A small trial in China showed a statistically and clinically significant difference in 30 day survival with ELAD.
So more people with this ELAD liver replacement were alive at 30 days than a control group, who presumably had their livers removed and replaced with nothing...
Nice way of saying "we're replacing your bad liver cancer with a good liver cancer in this handy take-home plug-in box".
Immortal cells - the deadliest cleansing force in all of Asia. We put their name to the test.
...save the liver!
"Nobody knows the age of the human race, but everybody agrees that it is old enough to know better." - Unknown
There's no information about the interface of this device to the patient. Blood flow to the liver is rather unique (http://biology.about.com/library/organs/bldigestliver.htm), with 3/4 of its bloodflow coming from the portal vein and 1/4 from the hepatic artery. The blood mixes before being processed by the liver.
Is the device similarly fed by both arterial and venous sources? How is the pressure compensated? Where is the output reintroduced? Does the device run in parallel to the natural liver or in series? If the latter, which receives the blood first? Does it attempt to handle any of the other numerous functions of the liver such as the creation of bile or lymph?
The product line itself will vary in capability and price. From the basic "Joe Sixpack" model, you can move up to the "Jazz Musician". If you've got enough money you can go all the way up to the full "Kieth Richards" model.
The problem with quotes on the internet, is that nobody bothers to check their veracity. -- Abraham Lincoln
I think I'd just ask if they could immortalize all of my body's cells.
Some background on why an artificial liver is a really big deal, and why it has been really hard until now to produce one:
(Any doctors or biologists more knowledgeable can fill in the gaps and correct me)
The liver breaks down toxins in the blood by metabolizing them. That is, they get broken down into simpler compounds by chemical reactions that take place in and around living cells. Contrast this with dialysis - an artificial kidney - which is able to work by filtering out chemicals based on molecular weight. Dialysis uses bundles of membranes that allow relatively light molecules (such as water) to pass through, but block heavier ones. The stuff the liver breaks down are too unwieldy or complex to be filtered out based just on weight - there are lots of other, good things in the blood that are of similar weight or complexity. A simple filter can't distinguish them; hepatocytes (liver cell clusters) can.
The task of creating the filtering membrane of a dialysis machine is a relatively well understood materials and processing problem. An artificial liver, which usually has a mini dialysis unit on the front or back end, also requires you to have living clusters of cells, and keep them alive, nourished, and healthy long enough for them to do some effective and therapeutic blood filtering. That's a much trickier biological problem, and we are only now getting decent at it.
The uses for a bio-artificial liver is huge. It can help people with chronic liver failure live longer and healthier lives, true, but it has more uses than that. The liver, as it turns out, is one of the few organs that can regenerate itself. If it is damaged by disease or some toxic insult, it is possible for it to repair itself if given the chance (in normally healthy people - the liver can also be damaged beyond repair). The problem is that in lots of cases the patient will die before the liver gets a chance to heal, leaving two options: hope for a liver transplant on really short notice, or die. A device like this can be a bridge to transplant or, in some cases, take the burden off the liver long enough for it to heal itself.
We could, but you almost certainly wouldn't like the results. (Well, we most likely could do so theoretically; the ethics board would kill us if we tried.)
Death of cells via apoptosis, phagocytosis and sometimes even necrosis is a very important part of normal processes in your body. WIthout them you'd be a continuously expanding ball of flesh (assuming you even made it to a stage of embryogenesis that could be called a "ball of flesh")
http://www.donarmstrong.com
Where do we put the funnel? (Don't answer that.)
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
albeit a not so pretty one...
Currently hemophiliacs must give themselves a shot in order to obtain the factor 8 they need to complete the factor chain and make a clot.
In an extreme accident where a person couldn't be able to give themselves the medicine immediately, the chances for survival drop greatly.
Knowing that they could walk around like a normal person would be a god-send to these people.
Oi, the fake bacon kicks ass. The fake liver can't hold a candle to it, I don't care how many fiber tubes it contains.
You guys think I can get them to immortalize the rest of my cells?
just asking......
All points of time and space are connected.
The FDA is only a regulatory body...this test is being run by Vital Therapies Inc along with a wide range of hospitals and research organizations
Not the FDA...know the basics...
"we didn't want to worry about medical ethics"
http://twitter.com/OLDTELEGRAM
Christopher Hitchens will be so relieved.
Kwisatz Haderach
Sell the spice to CHOAM
This Mahdi took Shaddam's Throne
Ok, seriously, the FDA is using material research from China? Whatever happened to the US doing it's own research?
Say, I wonder if the FDA has contracted human cancer trials in Darfur.
Seriously, human rights anyone?
I am open source, and Linux baby!
See also the comments above by rlseaman - this will address those as well.
The liver has multiple functions for both biochemical synthesis and detoxification. Unlike most organs and tissues, it has two circulatory inflows. The arterial circulation is the nutritive blood supply, just as the arterial circulation for any tissue. A portal circulation is one in which the venous effluent from a tissue does not return directly to the systemic circulation, but instead detours through another organ first. There are two portal circulations in most chordates - the hypothalamic-pituitary circulation, and the splanchnic portal system. The purpose of the splanchnic portal is to take raw digestate absorbed from the gut, and pass it through a chemical filter (the liver) which will detoxify or eliminate nasty exogenous compounds before they get back into the general circulation (via the hepatic veins). The hepatic artery supplies the liver; the portal vein is the business of the liver. Detoxified products that must be eliminated from the body are excreted into the bile, which is eliminated through the gut. Without a liver at all, death will occur within just a few days, about 3-7.
Renal failure is also lethal, but in the early 1950's, technologies were developed to keep renal failure patients alive - the dialysis machine. Dialysis is used as a bridge to organ transplantation, but for many people it is their permanent replacement kidney. It is an extraordinarily effective device. It could be "perfected" "back then" because the dialysis machine and the kidney are both relatively simple machines when it comes the elimination / detoxification aspects of its function. It depends simply on diffusion across semi-permeable membranes so that chemical concentrations can be equilibrated. No cells nor other active function is needed.
Compare this to heart function. We can transplant hearts quite successfully, but unlike the kidney, we cannot keep people alive without their native heart. Attempts in the past 10-20 years to develop mechanical bridge devices have all been technical, medical, and ethical failures, awaiting some future technologies to make the concept truly feasible.
The liver is in between. With regard to basic medical and ethical issues, an artificial liver should be comparable to the kidney. But technically and scientifically, making an artificial liver has been impossible until recently. Unlike the kidney, emulating liver function cannot be done by simple passive dialysis - the liver has MANY active chemical processes that must be actively metabolized. Attempts to run a patient's blood through a pig liver was the best available technology, and it doesn't work well at all, certainly not long term. What these researchers have done in this article is to mate living human cells to a dialysis device.
From the company's description of the product, it sounds like a fairly standard dialysis cartridge to start with. The key element, something that was NOT technically possible until the biotech revolution that we are now going through, is to put living cells in the device. I presume that the dialysis membranes are much more "porous" than renal dialysis membranes, allowing bigger molecules to get across, but hepatocytes remain sequestered on their side - there is no chance of "mixing and migration". All modern biotech "living cell" products go through ELABORATE testing and purification to get clean single cell lines. "Immortalized" means they have had their genome switched on so that they can mitose and replicate ad infinitum, without reaching the natural limits of mitosis that many differentiated cell lines have. Bile ducts, portal veins, and all that are not needed, because wastes come in through your normal arterio-venous dialysis shunt, and go out in the dialysis effluent. Because the device is not directly siphoning splanchnic blood, the clearance of potential dietary "toxins" is slower, but any patient with advanced liver disease has to make certain dietary adjustments anyway.
I'd say offhand that this is a relatively impressive stop-gap for those on the transplant list. Thirty extra days could easily save lives, especially of those in advanced liver failure. Should be interesting to see if they can extend the duration. Though, it may be too little to late for some, as TFA states that there is almost a 5:1 ratio of deaths to transplants. Maybe it just doesn't matter if they survive a month more, there might just not be a transplant waiting even then.
Surprisingly, it was revealed that funding for liver replacement research was provided entirely by the liquor industry.
A slashdotter who didn't build his own computer is like a Jedi who didn't build his own lightsaber.
who asked the transplant surgeon if the donor was still alive, to which the surgeon replied
"You're a sportswriter, aren't you?"
won't feel like such a roob anymore.
Game: Player 'Donald J Trump' now has AI skill level 'experimental'.
..containing immortalized human liver cells..
I, for one, welcome our new zombified-liver-cell overlords!
Are YOU using the TOOL, or is the TOOL using YOU? Think about it!
Just one question:
How long will it be before I can take out my liver and replace it with an alcohol resistent one?
...the year of the cyborgs!
There are two major reasons why a "liver dialysis" machine would be a major advance, even if you can only get it working for 30 days:
1) The liver regenerates. Unlike heart, brain, kidney, etc., if you whack out half the liver (to donate to someone else for example) it will eventually grow back. A lot of the tragic cases of liver failure are from a temporary insult (tylenol overdose, poisoning, etc.) If you can just keep them alive long enough, it will grow back. Currently these patients are treated with a liver transplant. This means they are doomed to a lifetime of immunosupression and complications just because they needed a liver for a month after the tylenol overdose
2) Some countries (Japan for example) do not recognize the concept of brain death, only "cardiac death." This means that liver transplants are impossible, because if you unplug the life support and wait for the heart to fully stop beating, the liver is usually too damaged to be useful. These countries desperately need "liver dialysis" because there is no alternative treatment.
Liver modding and overclocking! YEAH!
>As a two time kidney transplant recipient myself, I know how hard it is to
>live with organ failure. I met a guy who had gone through 3 liver transplants
A serious question:
With donation organs being the rarity that I've heard they are, and so many people I've heard are on waiting lists to get them, how does one successfully make the cut for 2 or even 3 organs?
A work that expires before its copyright never enters the public domain and thus enjoys eternal copyright protection.
The Scots have had this forever - Haggis is a bag of liver (and lungs, and hearts, and oats and onions).
Tiller's Rule: Never use a word in written form that you've only heard and never read. You will end up looking foolish.
How is that different from any other Wednesday?
Very different.
Today's Thursday. ;)
Without them you'd be a continuously expanding ball of flesh...
Isn't that the American Dream?
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
" A small trial in China showed a statistically and clinically significant difference in 30 day survival with LEAD."
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It's people!!!!!
Doctors also will ask if any benefit is big enough to cover what could be a $30,000 price tag.
Is this per use or per machine? Can a single machine be refitted and used multiple times ( like a dialysis machine)?
BBH
Try Clinton's - Bush was just maintaining the status quo and it isn't like we haven't had more success with the use of adult stem cells than embryonic ones anyway.
Some cells have genetic switches and gizmos that allow them to replicate almost indefinitely under appropriate hormonal and biochemical stimuli. Germ cells (sperm, eggs) and stem cells (like the hematopoietic stem cells) have this function. The important point, which the poster above alluded to, is that the process of cell division is tightly controlled. It starts and stops when demanded. Any deviation from protocol should cause immediate destruction via apoptosis.
In contrast, neoplastic cells (one subset of which includes cancer cells) do not respond to the normal start/stop signals of cell division and they escape quality control mechanisms (apoptotic signals).
Regarding graft-versus-host disease, that is more of an issue with hematopoietic (bone marrow) transplantation. The host's immune system could be an issue for a foreign graft, but this sounds more like a dialysis machine to replace the liver's function. (I have not yet read the source material.) With the prevalence of hepatitis B in the Asian population, and the desire of some countries there to show some muscle in the scientific arms race, I am not entirely surprised that some trials were conducted there.
You know you want it, baby - Gene-Co's got it!
La la la... I'm not listing to reason today...
I'm thinking, pate that never goes bad.