The art of liver healing: novel prognostic biomarkers and therapeutic approaches around liver transplantation

The art of liver healing: novel prognostic biomarkers and therapeutic approaches around liver transplantation is the result of two years of research at the Department of Gastroenterology and Hepatology at UMCG. This dissertation by Maria Trillos Almanza aims to investigate the role of dietary components and extracellular vesicles as prognostic biomarkers after liver transplantation, as well as therapeutic targets for liver fibrosis in the context of end-stage liver diseases.
The key findings are listed below:

1. The mutual interaction between skeletal muscle and liver metabolism of branched-chain amino acids suggests that interventions targeting both organs simultaneously may be more effective in managing cirrhosis.
2. Integrating measurements of branched-chain amino acids into existing scores has the potential to enhance the accuracy in assessing the stage and prognosis of end-stage liver diseases.
3. The inhibitory effects of branched-chain amino acids on human hepatic stellate cells imply that these amino acids could be a potential therapeutic target for treating chronic liver diseases in a selected group of patients.
4. Not all branched-chain amino acids are equal: distinct antifibrotic responses of individual branched-chain amino acids highlight the importance of evaluating the effects of different combinations in clinical research.
5. Metabolic imbalances during end-stage liver disease and their restoration post-transplantation may affect metabolic health and survival outcomes.

The dissertation is divided into two parts, separated by an intermezzo that features a printed gallery of the author’s artwork, which is one of the novel elements of this book. The title is inspired by the findings, which demonstrate that medical sciences are not simply black and white; even the gold standards for treatments and diagnoses evolve and vary depending on populations. This adaptability is precisely what elevates medical science to an art form: the nuances and shades of gray, the constant transformation in our understanding of health and disease, and the realization that responses within an organism can differ based on varying circumstances and predispositions. Every individual is unique. This ongoing transformation makes medical science a beautiful art, a vibrant canvas filled with diverse colors, representing the exploration of countless possibilities that will hopefully lead to clinical benefits.