Fecal Transplantation Reduced Hospitalizations and Improved Cognitive Function in Cirrhosis Trial

MedicalResearch.com Interview with:

Jasmohan S. Bajaj, M.D. Virginia Commonwealth University Associate Professor Department of Internal Medicine Division of Gastroenterology

Dr. Bajaj

Jasmohan S. Bajaj, M.D.
Virginia Commonwealth University
Associate Professor
Department of Internal Medicine
Division of Gastroenterology

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hepatic encephalopathy is a devastating complication of cirrhosis, which often recurs despite standard of care therapy with lactulose and rifaximin. This has a basis in an altered gut milieu therefore we need to change that in a more meaningful way to help patients. This was an FDA-monitored Phase I safety study of Fecal microbiome transfer (FMT) using a rationally-derived donor compared to standard of care.

We found that FMT was safe and was associated with lower all-cause and hepatic encephalopathy-related hospitalizations over 5 months compared to standard of care.

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Spermidine in Foods Such As Aged Cheese Prevents Liver Damage and Extends Life — in Mice

MedicalResearch.com Interview with:

Leyuan Liu, Ph.D., Assistant Professor Center for Translational Cancer Research Institute of Biosciences and Technology Texas A&M University Houston, Texas 77030

Dr. Liu

Leyuan Liu, Ph.D., Assistant Professor
Center for Translational Cancer Research
Institute of Biosciences and Technology
Texas A&M University
Houston, Texas 77030

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our research team has been working on the question why people develop cancers and how we can prevent or cure them. In contrast to public views, we concluded from our studies that cancers, similar to our age-related diseases, originate from inefficiencies of our body to clean up cellular wastes accumulated during our lifespan. The most important pathway to clean up those wastes is called autophagy, or cellular self-eating behavior. We study how autophagy is regulated, how autophagy causes cancers, and whether we can control autophagy to prevent or cure cancers.

Previously we found autophagy is regulated by a protein called MAP1S and mice without MAP1S are more likely to develop liver cancer. We have been seeking ways to improve MAP1S-mediated autophagy to prevent liver cancer. Our current study show that spermidine, a natural component existing in many foods, can increase the stability of MAP1S proteins and activate MAP1S-mediated autophagy. Concurrent with the benefits of expand mouse lifespans ours also reported, spermidine can suppress the development of liver fibrosis and liver cancer specifically through MAP1S if we add spermidine into the daily drinking water of mice.

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Trunk and Branch Drivers Distinguish Early vs Late Mutations in Hepatocellular Carcinoma

MedicalResearch.com Interview with:
Sara Torrecilla Recio

PhD Student
Mount Sinai Liver Cancer Program – Division of Liver Diseases Icahn School of Medicine at Mount Sinai
New York, NY

MedicalResearch.com: What is the background for this study?

Response: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which represents the second-leading cause of cancer related death worldwide. The landscape of molecular alterations in HCC has been thoroughly explored using next-generation sequencing technologies in single biopsies of tumors. However, in the recent years it has been demonstrated that not all the regions of a tumor harbor the same molecular alterations. This intra-tumor heterogeneity may lead to a misinterpretation of the molecular landscape of the malignancy since not all the molecular alterations would be captured by single-biopsies.

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Hepatitis C Can Be Successfully Treated in Homeless Population

MedicalResearch.com Interview with:
Joshua Barocas, MD
Clinical and Research Fellow
Division of Infectious Diseases
Massachusetts General Hospital and Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Boston Health Care for the Homeless Program began treating HCV-infected individuals with the new oral medications.

Based on clinical experience and previous experience with medication adherence in the setting of HIV, there were no clinical reasons that homeless persons should be excluded.

As a result, we began to track the experience of treated individuals including cure, side effects, and adherence.

We found that in the initial group of treated individuals, 62 of 64 persons achieved SVR. There were minimal side effects and adherence was excellent

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Most Baby Boomers Still Not Receiving Recommended Hepatitis C Testing

MedicalResearch.com Interview with:

Stacey Fedewa, MPH Strategic Director, Screening and Risk Factor Surveillance Surveillance and Health Services Research program American Cancer Society

Dr. Fedewa

Stacey Fedewa, Ph.D.
Strategic Director, Risk Factors & Screening Surveillance
American Cancer Society
Atlanta GA 30303-1002

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: About 3.5 million people in the US are chronically infected with Hepatitis C, the majority are unaware of their infection despite the availability of treatments that may reduce the risk of HCV-related diseases such as liver cancer. About 80% of those with the infection are baby-boomers (people born between 1945-1965). To help reduce growing burden of these HCV-associated diseases, the U.S. Preventive Services Task Force (USPSTF) recommended one-time HCV testing for baby-boomers in 2013.

We examined nationwide data between 2013-2015 to see if HCV testing in baby-boomers has increased since the USPSTF recommendation.  We found that only about 14% of baby-boomers had ever been tested in 2015, which represented a very small increase from 2013 where testing prevalence was about 12%. In 2015, we estimated that there were about 76.2 million baby boomers and only 10.5 reported ever receiving HCV testing.

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Hepatitis C Screening of Baby-Boomers Still Underutilized

MedicalResearch.com Interview with:
Cheryl Isenhour, DVM, MPH

Epidemiologist |Prevention Branch
Division of Viral Hepatitis | NCHHSTP
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study?

Response: It is estimated that there are over 3 million people in the United States living with Hepatitis C virus (HCV) infection. Risk factors for infection include, but are not limited to, injection drug use, history of incarceration, HIV coinfection, and blood transfusion prior to July 1992. Several direct acting antiviral medications have recently been approved to treat, and in the majority of cases, cure HCV.

The first step in identifying infected persons so that they may be cured of this infection is a blood test for antibodies to HCV.
The greatest burden of HCV is among persons born from 1945 through 1965; the baby boomer birth cohort. Therefore, in 2012, the Centers for Disease Control and Prevention (CDC) published updated HCV antibody testing recommendations to include one-time testing of persons in the birth cohort. The United States Preventive Services Task Force (USPSTF) published similar recommendations the following year. Additionally, in recent years there has been an increase in HCV infections related to injection drug use among younger people.

We used commercial insurance claims data to describe trends in HCV antibody testing over a 10-year period (2005 – 2014), both to assess the impact of the CDC and USPSTF testing recommendations, and to better understanding how trends varied by gender, age group, and geography.

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ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries

MedicalResearch.com Interview with:

Paul Y. Kwo, MD, FACG Stanford University School of Medicine

Dr. Paul Y. Kwo

Paul Y. Kwo, MD, FACG
Stanford University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: This guideline, which was jointly authored by Drs. Kwo, Cohen, and Lim provides a framework for physicians to approach the very common problem encountered of a patient whose liver chemistries are abnormal. This is particularly relevant as there remain large pools of individuals who have yet to be diagnosed with chronic hepatitis B and C, non-alcoholic fatty liver disease, advanced liver disease as well as less common conditions, all of whom will require evaluation.

In particular, the rise in the prevalence of non-alcoholic fatty liver disease worldwide will be addressed in part by identifying and evaluating these individuals prior to the development of advanced fibrosis. The guideline takes clinicians through a step-wise approach to the evaluation of elevated aminotransferase (ALT and AST), alkaline phosphatase, and bilirubin levels including appropriate historical questions, important physical examination findings, laboratory , radiological evaluation and finally liver biopsy if required.

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Metformin Associated With Lower Mortality in CKD, CHF and Chronic Liver Disease

MedicalResearch.com Interview with:

Matthew J. Crowley, MD, MHS Assistant Professor of Medicine Member in the Duke Clinical Research Institute Duke University Medical Center

Dr. Matthew Crowley

Matthew J. Crowley, MD, MHS
Assistant Professor of Medicine
Member in the Duke Clinical Research Institute
Duke University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although metformin is widely considered to be the first-line drug for type 2 diabetes, concerns about lactic acidosis have traditionally limited its use in some populations. However, FDA now indicates that metformin may be used safely for patients with mild-moderate chronic kidney disease and other historical contraindications like congestive heart failure. With the lactic acidosis question addressed for these groups, this review asked “what do we know about how metformin affects mortality and other outcomes for patients with historical contraindications and precautions?”

The main take-home message is that metformin appears associated with lower mortality in patients with mild-moderate chronic kidney disease, congestive heart failure, and chronic liver disease.

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New Microfluidic Technology Creates Microscale 3D Livers in a Droplet

MedicalResearch.com Interview with:

Prof. David A. Weitz Mallinckrodt Professor of Physics and Applied Physics School of Engineering and Applied Sciences Harvard University

Prof. David A. Weitz

Prof. David A. Weitz
Mallinckrodt Professor of Physics and Applied Physics
School of Engineering and Applied Sciences
Harvard University

MedicalResearch.com: What is the background for this technology study? What are the main findings?

Response: Currently, it is very time-consuming and expensive to develop new drugs. One reason is that many drugs fail in clinical trials after animal studies, simply because animals are very different from humans. One promising means of solving this problem is to replace animal experiments with artificial human tissues that can be used to directly screen a drug. However, it is a challenge to construct artificial human tissues, as almost all human tissues are composed of multiple types of cells and extracellular matrices in 3D structures.

In our studies, we have successfully developed a droplet-based microfluidic technique to fabricate large numbers of monodisperse, portable microtissues. We spatially assemble different types of cells in a 3D core-shell structure and construct an artificial human microtissue in each individual drop. The specific structures we create in the microdoplets are designed to mimic the behavior of the liver, and hence we call these structures a ‘liver in a drop.’  Continue reading

Incidence, Risk factors and Prevention of Hepatitis C Reinfection

MedicalResearch.com Interview with:
Naveed Zafar Janjua, MBBS, MSc, DrPH
Senior Scientist, Clinical Prevention Services
BC Centre for Disease Control
Clinical Associate Professor, School of Population and Public Health
University of British Columbia

MedicalResearch.com: What is the background for this study?

Response: Hepatitis C is a viral infection that affects the liver. About quarter of people infected with hepatitis C clear their infection spontaneously rest develop chronic infection. Left untreated, hepatitis C could results in scarring of liver (liver cirrhosis), liver cancer or death. New anti-viral drugs are highly effective in curing hepatitis C, about than 95 per cent of those treated can be cured. However, people who engage in high risk activities such as people who inject drugs (PWID) remain at risk of reinfection. As the cost of treatment is very high, re-infection is a concern among physicians and policy makers in Canada and around the world.

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Many High Risk Patients Not Screened for Hepatitis B

MedicalResearch.com Interview with:

Robert Wong MD, MS OakCare Medical Group Assistant Clinical Professor UCSF

Dr. Robert Wong

Robert Wong MD, MS
Assistant Clinical Professor of Medicine
Director of Research and Education
Division of Gastroenterology and Hepatology
Alameda Health System – Highland Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hepatitis B Virus infection is a leading cause of chronic liver disease leading to hepatocellular carcinoma and cirrhosis worldwide. Early detection of chronic HBV through implementation of effective screening programs can improve early treatment to reduce disease progression and risk of hepatocellular carcinoma. Sub-optimal awareness of the importance of HBV screening among patients and providers and sub-optimal awareness of who constitutes as high risk may further contribute to low HBV screening rates. Our current study prospectively evaluated rates of HBV screening and awareness of HBV screening results among patients at high risk for chronic HBV among an ethnically diverse underserved safety-net hospital population.

Among nearly 900 patients that were evaluated, 62% were high risk and eligible for Hepatitis B screening. However, among this high risk population, less than 25% received HBV screening. Furthermore, among patients that have undergone previous HBV testing only 22% of patients were aware of those results.

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Recent Hepatitis E Infection Associated With Guillain-Barre Syndrome

MedicalResearch.com Interview with:

Philip Van Damme, MD, PhD Department of Neurology and Department of Neurosciences, Experimental Neurology KU Leuven University of Leuven VIB, Vesalius Research Center, Leuven, Belgium

Philip Van Damme, MD, PhD
Department of Neurology and Department of Neurosciences, Experimental Neurology
KU Leuven University of Leuven
VIB, Vesalius Research Center,
Leuven, Belgium

MedicalResearch.com: What is the background for this study?

Response: The hepatitis E virus (HEV) has been discovered more that 60 years ago. Its clinical manifestations are usually self-limiting and mild. More recently, several immune-mediated neurological complications of this virus have been described, such as the Guillain-Barre syndrome (GBS) and neuralgic amyotrophy. In this study, we investigated the frequency of a preceding HEV infection in patients presenting with a GBS syndrome or one of its less common disease variants. At the same time, we tested for other known pathogens known to be associated with GBS.

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