Cirrhosis

Cirrhosis is a condition of the liver arising usually over a long period of time in which there has been repeated damage to the organ. The damage can be done by such toxic materials as alcohol that can be taken into the body in  quantities so large that the detoxifying mechanism is inadequate. A number of viruses are also known that attack the liver and, though the repair capacity of the organ is enormous, over many years the repair mechanism fails to put back what was there before. In fact most of the many known diseases of the liver in which long term damage occurs have cirrhosis as an end point.

Typically the cirrhosed liver has become smaller and harder. It internal structure has  changed dramatically and its numerous functions that are vital for the well being of the body may have declined quantitatively in such a way as to menace life. In addition to these deficiencies that can arise in such products of the liver as albumin and thrombopoietin there are mechanical problems that arise as a consequence of reduction in blood flow through the organ. There arises a hypertensive condition particularly important in the hepatic portal vein that carries blood from the intestine to the liver. The so-called portal hypertension has the consequence that between the gut and organs adjacent to the liver numerous new and imperfect channels for passage of blood  called varices arise. These new thin-walled blood vessels may rupture without warning and with potentially disastrous consequences.

Cirrhosis of the liver is therefore a very serious condition seriously affecting the quality of life of those suffering from it. The clinical management of cirrhosis is potentially very expensive and to date there is no way of reversing the changes that have taken place during the formation of the cirrhosed condition. Aside from arresting further decline in the state of the liver, which is sometimes possible, the only available remedy for cirrhosis of the liver is a liver transplant. George Best the one-time footballer and well known heavy drinker underwent this process. Transplantation  of the liver is difficult, dangerous and commits those who undertake it to a life time of taking unpleasant drugs to prevent the rejection of the new liver. More practically there are very few livers available for transplantation neither, at present, are there artificial organs that can substitute for a liver.

Professor Habib has taken three approaches to cirrhosis, none of which are curative but all of which are potentially palliative.

• firstly,  he invented a pump to go in the hepatic portal vein to help blood flow through the cirrhosed liver.
• secondly,   he devised a gene therapeutic device to restore the capacity to synthesise albumin
• thirdly, he explored the possibility of using gene therapy to restore the capacity to generate platelets the production of which is helped by thrombopoietin.

Presently all three strategies are being carried forward by active research projects that are considered in more detail in the Academic section.