Posted in Living with Liver Disease
Perhaps the most exciting aspect of modern medicine is that basic scientific advances made in the laboratory will lead to new diagnostic methods and treatments of diseases. Since the revolution in molecular biology and the emergent discipline of biotechnology that was built upon it, the amount of time it takes for discoveries in the laboratory to be translated to a patient’s bedside has decreased. One of the best examples of how the biotechnology industry has had a tremendous impact on a human disease, in fact, concerns a liver disease. This disease is hepatitis C.
Scientists at Chiron, a biotechnology company, discovered the hepatitis C virus in 1989. Before that time, it could not be diagnosed and the blood supply could not be adequately screened. Recombinant interferon alphas, made by cloning their genes and inserting them into cultured animal cells or microorganisms for protein expression, are used for treatment of this disease. While these interferons are now manufactured and marketed by different pharmaceutical companies, they were originally developed by the biotechnology industry. So the diagnosis and treatment of chronic hepatitis C has derived almost entirely from the biotechnology industry. However, the currently available treatments for chronic hepatitis are far from optimal, and much better ones are needed. A preventive vaccine also appears to be
a long way off. Hopefully, the biotechnology and larger pharmaceutical industry will make progress on this as well as treating other diseases.
Surveying the different liver diseases, it is unlikely that the fight against all of them will progress at equal rates. I am optimistic that, in the near future, more effective treatments will exist for several liver diseases. Top on my list for major advances in the next decade is the development of specific medications to treat chronic hepatitis C. Despite my current optimism, I must admit that since I wrote the first edition of The Liver Disorders Sourcesite in 1999, the advances in the treatment of chronic viral hepatitis C have sadly been relatively minor. They have merely been the development of modified versions of already available drugs or the development of similar imperfect drugs in the same class. Truly novel drugs have not been introduced into clinical practice since prior to the publication of that site. However, they now seem to be closer on the horizon.
I also think that better treatments may evolve for genetic diseases, such as hemochromatosis and Wilson disease, now that the genes for these disorders have been identified and they can be understood at the molecular level. It is also probable that transplant immunology will advance, making liver transplantation safer and more effective. However, major advances in these areas will probably not see the clinic for several years to come.
While still optimistic, I believe that the understanding of some liver diseases and the development of treatments will be slow. The autoimmune liver diseases are poorly understood and will probably remain a major challenge, without significant breakthroughs in treatment during the next several years. I also think that significant advances in slowing the liver’s response to chronic injury, namely the scarring and abnormal regeneration of the liver that leads to development of cirrhosis, are a long way off.
In some instances, socioeconomic factors and not science will slow the progress in our fight against liver diseases. An example is hepatitis B. At the present time, there are effective vaccines that could theoretically eradicate this virus. However, if cheap and easy-to-administer vaccines are not distributed to the underdeveloped countries of the world where hepatitis B virus infection is endemic, eradicating this disease will remain a dream.
I would like to provide some of my views on research and the near future for patients with liver diseases. I do not have a crystal ball, and basic scientific discoveries that are made today may change my opinions tomorrow. Based upon what I know now, however, I will speculate on where some of the most promising breakthroughs will occur during the next decade and also some of the most exciting areas of research for the more distant future.