The Liver: A Vulnerable Helper
2013; Elsevier BV; Volume: 35; Issue: 3 Linguagem: Inglês
10.1016/j.clinthera.2013.02.018
ISSN1879-114X
Autores Tópico(s)Liver Disease and Transplantation
ResumoThe late Art Buchwald was known for his sense of humor. After his service as a US Marine and a few years of college, Buchwald became a correspondent for Variety in Paris. His years in Paris inspired a saying that has always amused me: “A bad liver is to a Frenchman what a nervous breakdown is to an American. Everyone has had one and everyone wants to talk about it.”1Buchwald A. Liver Quotes.http://www.brainyquote.com/quotes/keywords/liver.html#IOF9Xm6m GW37t7A6.99Google Scholar The French and their wines are a well-worn topic of humor. In the United States, drinking is more often associated with drunkenness, driving while under the influence of alcohol, and alcoholism—all subjects of public concern. Nonetheless, we do have our share of really bad bar jokes, such as, “A potato walks into a bar and all eyes were on him,” and, “A guy with dyslexia walks into a bra.”2Central Indiana Beer Appreciation SocietyA Guy Walks Into A Bar and More Bar Jokes.http://www.schiesshouse.com/a_guy_walks_into_a_bar_and_more.htmGoogle ScholarAs a clinical pharmacologist, I think about the liver with awe. It is the heaviest organ in the body and as important to life and survival as are the heart and brain. Its life-preserving functions are too numerous to tabulate completely. For example, the liver converts the fats and carbohydrates we ingest into energy; it synthesizes amino acids, the building blocks of proteins; and it metabolizes and removes many substances from our blood, including medications and alcohol. Unfortunately, these important functions can be compromised by excessive exposure to certain substances (eg, acetaminophen, alcohol) and by a variety of illnesses (eg, hepatitis C). Although frequently asymptomatic, hepatitis C, a viral illness spread by blood-to-blood transmission, affects an estimated 130 to 170 million persons across the globe. In some persons, particularly those who are immunocompromised, it can lead to cirrhosis, liver failure, and death.3World Health OrganizationHepatitis C.www.who.int/mediacentre/factsheets/fs164/en/Google ScholarThis past year the US Food and Drug Administration (FDA) has paid increased attention to the dangers of acetaminophen.4US Dept. of Health and Human Services, Food and Drug AdministrationConsumer Updates Don't Double Up on Acetaminophen.www.fda.gov/ForConsumers/ConsumerUpdates/ucm336581.htmGoogle Scholar, 5US Dept. of Health and Human Services, Food and Drug AdministrationKnow Concentration Before Giving Acetaminophen to Infants.http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm284563.htmGoogle Scholar We have seen the approval in the past few years of several treatments of hepatitis C (ie, telaprevir and boceprevir). In contrast, a randomized, controlled study of a natural product Silymarin (from milk thistle) failed to establish its popularly believed efficacy in hepatitis C.6Fried M.W. Navarro V.J. Afdhal N. et al.Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial.JAMA. 2012; 308: 274-282Crossref PubMed Scopus (130) Google ScholarIn this third issue, our Topic Editor, John Markowitz, has chosen to focus on several papers related to the liver. His editorial discusses them and the linkages between them. John's next collation will focus on natural products, with an emphasis on their impact on or from concurrent medications. We invite scientists and clinicians working in this area to submit their studies for publication in future issues. Pharmacokinetics and drug–drug interactions are topics to which we will often return as they are central themes in clinical therapeutics.Finally, I am pleased to announce the establishment of formal ties with the European Association for Clinical Pharmacology and Therapeutics (EACPT). Moving forward, we will be their preferred provider for the publication of educational materials from their congresses. We welcome the member organizations of EACPT and their individual members to Clinical Therapeutics.We also wish to bring to the attention of our readership the 2013 SPIRIT statement, recently published in the Annals of Internal Medicine, which provides valuable recommendations for the conduct of clinical trials.7Chan A.-W. Tetzlaff J.M. Altman D.G. et al.SPIRIT 2013 Statement: Defining standard protocol items for clinical trials.Ann Intern Med. 2013; 158: 200-207Crossref PubMed Scopus (2909) Google Scholar The late Art Buchwald was known for his sense of humor. After his service as a US Marine and a few years of college, Buchwald became a correspondent for Variety in Paris. His years in Paris inspired a saying that has always amused me: “A bad liver is to a Frenchman what a nervous breakdown is to an American. Everyone has had one and everyone wants to talk about it.”1Buchwald A. Liver Quotes.http://www.brainyquote.com/quotes/keywords/liver.html#IOF9Xm6m GW37t7A6.99Google Scholar The French and their wines are a well-worn topic of humor. In the United States, drinking is more often associated with drunkenness, driving while under the influence of alcohol, and alcoholism—all subjects of public concern. Nonetheless, we do have our share of really bad bar jokes, such as, “A potato walks into a bar and all eyes were on him,” and, “A guy with dyslexia walks into a bra.”2Central Indiana Beer Appreciation SocietyA Guy Walks Into A Bar and More Bar Jokes.http://www.schiesshouse.com/a_guy_walks_into_a_bar_and_more.htmGoogle Scholar As a clinical pharmacologist, I think about the liver with awe. It is the heaviest organ in the body and as important to life and survival as are the heart and brain. Its life-preserving functions are too numerous to tabulate completely. For example, the liver converts the fats and carbohydrates we ingest into energy; it synthesizes amino acids, the building blocks of proteins; and it metabolizes and removes many substances from our blood, including medications and alcohol. Unfortunately, these important functions can be compromised by excessive exposure to certain substances (eg, acetaminophen, alcohol) and by a variety of illnesses (eg, hepatitis C). Although frequently asymptomatic, hepatitis C, a viral illness spread by blood-to-blood transmission, affects an estimated 130 to 170 million persons across the globe. In some persons, particularly those who are immunocompromised, it can lead to cirrhosis, liver failure, and death.3World Health OrganizationHepatitis C.www.who.int/mediacentre/factsheets/fs164/en/Google Scholar This past year the US Food and Drug Administration (FDA) has paid increased attention to the dangers of acetaminophen.4US Dept. of Health and Human Services, Food and Drug AdministrationConsumer Updates Don't Double Up on Acetaminophen.www.fda.gov/ForConsumers/ConsumerUpdates/ucm336581.htmGoogle Scholar, 5US Dept. of Health and Human Services, Food and Drug AdministrationKnow Concentration Before Giving Acetaminophen to Infants.http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm284563.htmGoogle Scholar We have seen the approval in the past few years of several treatments of hepatitis C (ie, telaprevir and boceprevir). In contrast, a randomized, controlled study of a natural product Silymarin (from milk thistle) failed to establish its popularly believed efficacy in hepatitis C.6Fried M.W. Navarro V.J. Afdhal N. et al.Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial.JAMA. 2012; 308: 274-282Crossref PubMed Scopus (130) Google Scholar In this third issue, our Topic Editor, John Markowitz, has chosen to focus on several papers related to the liver. His editorial discusses them and the linkages between them. John's next collation will focus on natural products, with an emphasis on their impact on or from concurrent medications. We invite scientists and clinicians working in this area to submit their studies for publication in future issues. Pharmacokinetics and drug–drug interactions are topics to which we will often return as they are central themes in clinical therapeutics. Finally, I am pleased to announce the establishment of formal ties with the European Association for Clinical Pharmacology and Therapeutics (EACPT). Moving forward, we will be their preferred provider for the publication of educational materials from their congresses. We welcome the member organizations of EACPT and their individual members to Clinical Therapeutics. We also wish to bring to the attention of our readership the 2013 SPIRIT statement, recently published in the Annals of Internal Medicine, which provides valuable recommendations for the conduct of clinical trials.7Chan A.-W. Tetzlaff J.M. Altman D.G. et al.SPIRIT 2013 Statement: Defining standard protocol items for clinical trials.Ann Intern Med. 2013; 158: 200-207Crossref PubMed Scopus (2909) Google Scholar
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