New drug for liver disease

Another item from the BBC's website, this time on the Health front:

A cheap and readily available drug could reverse severe liver disease, even in patients who find it impossible to give up booze, research suggests.

Sulphasalazine is currently used to treat arthritis and inflammatory bowel disease. But a University of Newcastle team has found that it can also reverse the scarring associated with cirrhosis of the liver.

Liver disease is the fifth highest cause of death in the UK. It is estimated that up to 10% of the UK population have problems with their liver - and most are linked to lifestyle factors, such as heavy drinking and obesity.

Scientists had thought that the scarring associated with cirrhosis - known as fibrosis - was irreversible. However, recent studies have shown that is not the case. Now the Newcastle team, in tests on animals, have shown that Sulphasalazine can aid the recovery process.

Regeneration

When the liver is injured specialised cells called hepatic myofibroblasts create scar tissue, and secrete proteins which prevent it being broken down. In healthy liver tissue the scars eventually melt away and are replaced by new normal tissue. However, in diseased tissue this process does not happen. Instead the scar tissue proliferates, and spreads throughout the whole organ. The Newcastle team showed that Sulphasalazine could aid recovery by blocking the production of proteins that keep the scar tissue cells alive.

They plan to carry out trials in humans, but already believe the drug has the potential to provide an alternative to a liver transplant. The drug will initially be given to heavy drinkers who have given up alcohol, but too late for their liver to recover naturally. If this proves successful, the medicine will also be prescribed to alcoholics who continue to drink but show a determination to fight their addiction by reducing their intake. Professor Derek Mann, who led the research, said just a 5% to 10% recovery of the organ could have a huge impact on quality of life. 

Efforts needed

Professor Chris Day, head of Newcastle University's School of Clinical Medical Sciences, said the drug was likely to work best on people who had made some effort to kick their boozing habit. But he said it offered a potential solution to the tricky ethical problem of offering people who abused alcohol a liver transplant. Many people believe it is wrong to use organs that are in very short supply on people who have not demonstrated their ability to reform their drinking.

Professor Day said: "In that situation you may not give somebody a transplant, but you are not going to stop them getting a tablet, particularly if it only costs £10 a week. "Cirrhosis is the fifth highest cause of death in the UK today, and it would not be too optimistic to say this drug could halve that death rate."

Professor David Jones, another member of the Newcastle liver team, said he and his colleagues regularly saw patients in their twenties with severe liver disease. He said: "There is no point at which an alcoholic patient won't benefit from stopping drinking, but now we can actually help the healing process."

Anne Jenkins, of the charity Alcohol Concern, said: "The last 20 years have seen a significant increase in rates of liver cirrhosis, particularly among the 34-45 age group. "Research that could help to reverse harm is obviously to be welcomed, but this work is at an early stage, and more needs to be done.

COMMENT

It is good that an alternative to liver transplants may be on the horizon. Sulphasalazine is an old drug, which started life as an antibiotic in the 1950s. It has serious side-effects, such as an impact on the bloodcells, nausea and vomiting. In my opinion, it is borderline ethical to give liver transplants to people who have knowingly destroyed their own liver. I appreciate that alcoholism is a disease in itself, and an addiction.

Please bear in mind that this is early days yet, and a lot more work needs doing, as the last paragraph of this piece stresses.