Liver failure.   One of the deadliest afflictions.  The standard treatment is to obtain a liver transplant- and they are hard to come by.  Some 100 million folks suffer from liver cirrhosis, with 10 million saddled with an additional complication.

Of those, 3 million of them manifest ACLF, which leads to even more rapid liver function decline.  (The issue is that even with expensive treatment, the risk of death is little changed.)  Acute-on-chronic-liver-failure manifests in some30% of cirrhosis patients, which leads to some 1 million deaths annually.

A complex organ, the liver effects some 500 functions, primarily the removal of harmful substances from the blood, as well as the absorption of vital nutrients.  This is accomplished by the production and secretion of albumin that then traverse the body, whereby the albumin acts like miniature livers.   Once the liver is compromised (obesity, alcoholism, viral infection), less albumin is produced, and these functions are minimized.

Then, there’s ALCF, in which the liver cells die and the gut leaks microbes into the blood stream- leading to multiorgan failure and Dr. Nathan Davies and diminished immune responses.

One of its roles is to produce large quantities of a protein called albumin, which travels around the body acting as a sort of ‘mobile liver’ that absorbs unwanted substances.

However, when its function is seriously reduced, such as through alcohol abuse, obesity or viral infection, less albumin is produced.

In ACLF, its function is also seriously impaired – liver cells die and the gut begins to leak bacteria into the bloodstream, which can cause an inappropriate immune response and multiorgan failure.

This is what lead Dr. Rajiv Jalan, University College of London (Institute for Liver and Digestive Health) and Dr. Nathan Davies to invent what he calls the Dialive device.  IT provides (hopefully) enough time for the liver to regenerate itself (the liver has an incredibly capability to regenerate itself) and let the patients lead a normal life.

Based upon the concept of dialysis, the Dialive uses two unique filters.   These remove the toxins from the blood and after an 8 to 12 hours treatment, patients are in better shape than when  they underwent the standard drug treatment.

Dialive is based upon a normal dialysis machine, where the filters are arranged in series.  The first filter afford ultrafiltration of albumen and cytokines (Septex from Baxter), which the second unit absorbs PAMPS (endotoxins) and DAMPS (genomic DNA) [Oxiris from Baxter].

Dr. Banwari Agarwal was the head of the clinical trial(Royal Free Hospital), with Dr. Steffen Mitzner (Rostock University, German) as co-lead.  As you can see from the first page of the preprint, a slew of clinicians at hospitals across Europe were also involved.  32 patients underwent treatment for up to five days.  The patients manifest faster reversal of ACLF (compared to standard care), with twice as many seeming to be symptom free.  (Endotoxin reduction, which allows for better albumin functionality,  was also greater when patients were treated with the Dailive).Interestingly, the patients remained in remission for 28 days post treatment.  Unfortunately, mortality was not diminished by the treatment.

The device has been licensed to Mallinckrodt for mass production.  However, it is expected that three years oaf additional trails will be effected to improve the device and to discern if mortality can be affected by the treatment.

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