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Welcome back to Mayo Clinic Radio.
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I'm Dr. Tom Shives.
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And I'm Tracy McRae.
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Tracy, every year, 40 ,000 people die of liver disease in the U .S.
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And the only proven therapy for end -stage liver disease is still a liver transplant.
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Unfortunately, there aren't enough organs to go around for those who need them.
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In fact, there are more than 150 ,000 people who are on the waiting list for a donor liver.
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Now, hopefully, treatment for liver disease is about to change for the better.
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Research at Mayo Clinic is focusing on new regenerative liver therapies to help repair diseased livers
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and improve the treatment options for liver disease patients.
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Here to discuss is Dr. Scott Nyberg, a transplant surgeon at Mayo Clinic.
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Dr. Nyberg is the director of the liver program at the Mayo Clinic Center for Regenerative Medicine
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and head of Mayo Clinic's artificial liver program.
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Welcome to the program, Dr. Nyberg.
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It's nice to meet you.
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It's great to be here, Tracy and Tom.
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Thank you for having me.
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Yeah, you bet.
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You have been studying the liver and liver disease for a long time, long enough to get all those titles, right?
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I started back in the early 80s, probably.
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I was both a chemical engineer and then a biomedical engineer.
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Had a mentor who said with that engineering background, why don't you build a liver dialysis machine?
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I asked him, how should I do that?
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That was in 1989, and he said, you figure it out.
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You're the engineer.
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So I've been working on this for almost 30 years.
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Well, I want to learn a lot more about the artificial liver program, but before we go there, we should probably just set the table.
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What is liver disease?
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What causes liver disease?
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I mean, there are many causes.
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They can range from Tylenol overdose, a common drug like Tylenol, alcohol.
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People are familiar with that, along with genetic causes.
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In the United States, I would say obesity is becoming a number one cause.
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Overweight contributes to a disease called NASH.
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It had been hepatitis C.
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Now there are pretty effective treatments for hepatitis C, so we're seeing a decrease.
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But the number one cause would be NASH, followed by alcohol, and then these others.
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Now explain NASH to us.
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And you mentioned that obesity is becoming a more common cause of liver disease.
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How does obesity cause liver disease?
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And I suspect that NASH is the answer.
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Right.
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It's not fully understood as far as the mechanisms, but there has been this association with as Americans and people around the world become heavier,
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there's more liver disease.
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If a pathologist looks at a biopsy of a NASH liver, it looks similar to an alcoholic liver, so it's probably a nutritional problem.
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Where too many calories cause an inflammatory response and do this over a long period of time,
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there becomes scarring and eventually cirrhosis and the manifestations of end -stage liver disease.
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And cirrhosis is pretty much just scarring of the liver.
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Advanced scarring to a point where the liver isn't able to regenerate.
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Fortunately, a healthy liver, if we cut it in half, will grow back to a full size within a couple of weeks.
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That's a normal response, but due to the scarring of fibrosis and cirrhosis,
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that regenerative response is impaired and the only real treatment for those end -stage livers is a liver transplant currently.
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Does NASH stand for something?
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Non -alcoholic steatohepatitis.
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So it looks pathologically like alcoholic liver injury,
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but it's non -alcoholic related presumably to diet and weight.
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How long can people live with liver disease before they need a transplant?
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well we have a scoring system now
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that was developed here at mayo called the meld score initially
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it was called the mayo end -stage liver disease score to
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predict how long people would survive what's their likelihood of being alive in two months
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it's been adopted nationally for organ allocation
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because it's very good at predicting the name was changed they took mayo out of the name
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and now it's just the model for end -stage liver disease so that's probably the best predictor.
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And in transplant, we use that score to determine who has highest priority.
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So it ranges from zero to 40, where if you have a score of 40, it's unlikely you're going to survive more than a few weeks.
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What can make if a patient is not eligible for transplant?
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I mean, there's being on the list means that you're eligible, but why would patients not be eligible for transplant?
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I mean, there's a variety of reasons.
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If you're an alcoholic that continues to drink
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and haven't recovered you wouldn't be eligible
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that wouldn't be a wise use of an organ
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if you have a disease that may involve other organs that's not corrected by a liver transplant
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or if you have a cancer that's spread outside of the liver that we wouldn't be able to help you and
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transplant an immunosuppressive patient you could actually shorten their life and that
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so there are a number
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you can be too old though we don't have a cutoff as far as age goes
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so you're still doing a lot of liver transplant right and
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and a fair number of those are from deceased donors
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but also you're using live donors yeah here at mayo
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we have a large living donor program one of the largest in the united states
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which means we do over 20 per year of the 130 liver transplants that we do.
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So that's a living donor, a family member, our friend who donates half of their liver.
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Two weeks later, the liver has regenerated, did you say, to its normal size?
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Probably two weeks in the donor, we do CAT scans to measure the volume.
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And they're within 90 % of the original volume within two weeks.
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So it's very rapid.
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In my lab, we have a number of animal models studying regeneration
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and we see this very quickly also all right what's new
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and regenerative medicine
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and artificial liver well here at mayo the the biggest problem in transplant is the shortage of organs
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so the things we do in regenerative medicine are to address
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that shortage of organs one option is a liver dialysis machine to allow the the liver to regenerate
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and hopefully avoid a liver transplant so that would be
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that would save the liver it could be used for someone else
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and avoid big surgery
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and all the immunosuppression lifelong immunosuppression for a patient that'd be a patient maybe with a tylenol overdose
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we also have a special pig that we've developed a genetically engineered pig
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and the goal there is to grow transplantable human livers in this pig sounds science fiction
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but in my lab we recently had a pig named eddie who beautiful a little piggy
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if you look at my instagram site
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you'll see a picture of eddie who essentially was created by a stem cell transplant into a day four embryo
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and this is sort of the future i see of organ production
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and then we're also
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so this is hopefully someday eddie's liver can be transplanted into a human eddie will eddie
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and pigs like eddie will be incubators to grow human livers.
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The concept would be to take a cell, reprogram it into a cell from a patient liver disease, reprogram it into a stem cell,
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fuse it with an embryo, and then grow a liver from that human stem cell.
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Whoa.
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I got to sit down.
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Oh, I am sitting down.
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Good.
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That's good.
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How are you using the patient's own liver cell?
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Is that what you're saying when you take a cell to help?
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In this case, you could even take a blood sample, like a white blood cell from just a blood sample.
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The Nobel Prize for Medicine about four years ago was a way to reprogram cells, adult cells, to become stem cells.
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And the theory would be that you could use those stem cells to grow livers.
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Well, hopefully you and Eddie will get the Nobel Prize next year.
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I think we're still a little ways off.
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eddie and pigs like eddie the other option that we're working with a local company is to take
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livers decellularize them and then repopulate them with cells from a patient
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so again you could avoid the need for immunosuppression
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so these would be a tissue engineered liver
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that would be identical to the patient so they wouldn't need an anti -rejection drug after the transplant
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If it works using your own cells, you shouldn't need to.
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We had a paper recently published in one of the science journals, Science Translational Medicine, showing that this concept would work in pigs,
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and it's a matter of scaling it up to humans.
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It's all really exciting.
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Thanks so much for being with us.
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Thank you very much.
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An update on the treatment of liver disease with Dr. Scott Nyberg,
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transplant surgeon and director of the liver program at the Mayo Clinic Center for Regenerative Medicine
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and head of Mayo Clinic's artificial liver program.
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Thanks, Dr. Nyberg.
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Yeah, thank you, Tom, Tracy.
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Vocabolario e note di pronuncia per questa lezione
Questa lezione di conversazione si basa sul video “Artificial Liver Program: Mayo Clinic Radio”. Le parole che ritornano più spesso: liver, disease, transplant, cell, mayo. Questo video contiene 136 frasi e 1533 parole da ripetere con lo shadowing. Il parlato dura 9:08. Chi parla ha un ritmo naturale di circa 168 parole al minuto, vicino a una conversazione quotidiana. Solo il 76% delle parole rientra nelle 3.000 più comuni dell’inglese, quindi il lessico è impegnativo.
Vocaboli chiave di questo video
15 parole del video che vale la pena imparare, con pronuncia e significato:
| Parola | Pronuncia | Significato |
|---|---|---|
| transplant verbo | /tɹænzˈplænt/ | trapiantare |
| organ sostantivo | /ˈɔːɡən/ | organo |
| liver sostantivo | /ˈlɪvɚ/ | fegato |
| donor sostantivo | /ˈdəʊnə/ | donante |
| stem sostantivo | /stɛm/ | ceppo, ramo |
| alcoholic sostantivo | /ˌæl.kəˈhɔ.lɪk/ | alcoldipendente, alcolista |
| eligible aggettivo | /ˈɛl.ɪ.d͡ʒɪ.bəl/ | eleggibile, idoneo |
| artificial aggettivo | /ˌɑː.tɪˈfɪʃ.əl/ | artificiale, artificioso |
| scar sostantivo | /skɑɹ/ | cicatrice |
| pig sostantivo | /ˈpɪɡ/ | maiale, porco |
| obesity sostantivo | /ə(ʊ)ˈbiːsɪti/ | obesità |
| surgeon sostantivo | /ˈsɝd͡ʒən/ | chirurgo |
| predict verbo | /pɹɪˈdɪkt/ | profetizzare |
| shortage sostantivo | /ˈʃɔː(ɹ)tɪd͡ʒ/ | scarsità, mancanza |
| overdose sostantivo | /ˈəʊvə(ɹ)ˌdəʊs/ | overdose |
I phrasal verb che sentirai
| Parola | Significato |
|---|---|
| sit down verbo | sedersi, accomodarsi |
Frasi da ripetere
Frasi brevi e complete del video che puoi riutilizzare nella conversazione di tutti i giorni:
- It's nice to meet you.
- I asked him, how should I do that?
- I mean, there's a variety of reasons.
- How are you using the patient's own liver cell?
- Is that what you're saying when you take a cell to help?
La grammatica di questo video
Le strutture che chi parla usa di più, con le parole esatte del video:
| Struttura | Nel video |
|---|---|
| Present perfect continuous have/has been + -ing — un’azione iniziata prima e ancora in corso | have been studying · I've been working |
| Forma passiva be + participio passato — conta ciò che accade, non chi lo fa | is impaired · was developed · was called |
| Present perfect have/has + participio passato — un’azione passata che conta ancora adesso | has been · it's been adopted · haven't recovered |
| Frasi relative who / which + frase — un’informazione in più su una persona o una cosa | those who need · people who are · friend who donates |
Pronuncia a cui fare attenzione
Chi parla usa 28 contrazioni e forme ridotte, come you're, we're, wouldn't. Pronunciale nella forma breve, così come le senti.
- I suoni “sh” e “zh”: artificial /ˌɑː.tɪˈfɪʃ.əl/, shortage /ˈʃɔː(ɹ)tɪd͡ʒ/, fiction /ˈfɪkʃən/, essentially /ɪˈsɛnʃəli/, tissue /ˈtɪʃ.(j)u/
- Parole lunghe — attenzione all’accento: alcoholic /ˌæl.kəˈhɔ.lɪk/, eligible /ˈɛl.ɪ.d͡ʒɪ.bəl/, artificial /ˌɑː.tɪˈfɪʃ.əl/, obesity /ə(ʊ)ˈbiːsɪti/, hepatitis /ˌhɛpəˈtaɪ̯tɪs/
I suoni difficili per chi parla italiano:
- /h/ — va soffiata, non è muta: alcoholic /ˌæl.kəˈhɔ.lɪk/, hepatitis /ˌhɛpəˈtaɪ̯tɪs/, likelihood /ˈlaɪklihʊd/
- Consonante finale — senza aggiungere una vocale dopo: transplant /tɹænzˈplænt/, alcoholic /ˌæl.kəˈhɔ.lɪk/, pig /ˈpɪɡ/, predict /pɹɪˈdɪkt/, shortage /ˈʃɔː(ɹ)tɪd͡ʒ/
- /æ/ — più aperta della “e”: transplant /tɹænzˈplænt/, alcoholic /ˌæl.kəˈhɔ.lɪk/, rapid /ˈɹæp.ɪd/, scan /skæn/, nationally /ˈnæʃənəli/
Come esercitarsi con questo video
- Ascolta tutto il video una volta senza parlare e annota le parole che non conosci.
- Inizia a velocità 0,75×, fai shadowing frase per frase e torna alla velocità normale quando diventa facile.
- Registrati e confronta con l’originale, facendo attenzione a parole come transplant, organ, liver.
Cos'è la tecnica dello Shadowing?
Shadowing è una tecnica di apprendimento delle lingue supportata da studi scientifici, originariamente sviluppata per la formazione dei traduttori professionisti e resa popolare dal poliglotta Dr. Alexander Arguelles. Il metodo è semplice ma potente: ascolti un audio in inglese di madrelingua e lo ripeti immediatamente ad alta voce — come un'ombra che segue il parlante con un ritardo di solo 1–2 secondi. A differenza dell'ascolto passivo o degli esercizi di grammatica, lo shadowing costringe il tuo cervello e i muscoli della bocca a elaborare e riprodurre simultaneamente i modelli di discorso reale. La ricerca dimostra che migliora significativamente la precisione della pronuncia, l'intonazione, il ritmo, il discorso connesso, la comprensione dell'ascolto e la fluidità del parlato — rendendolo uno dei metodi più efficaci per la preparazione alla prova di speaking dell'IELTS e per la comunicazione reale in inglese.