Author Interviews, Hepatitis - Liver Disease, Kidney Disease / 14.12.2020

MedicalResearch.com Interview with: Kevin Moore, MD UCL Institute of Liver and Digestive Health Royal Free Hospital, University College London MedicalResearch.com: What is hepatorenal syndrome – acute kidney injury (HRS-AKI) and how does terlipressin fit into the treatment landscape?  Response: HRS-AKI, also known as hepatorenal syndrome type 1 (HRS-1), is an acute and life-threatening syndrome involving acute kidney failure in people with cirrhosis.[i] HRS-1 can progress to life-threatening renal failure within daysi and has a median survival time of approximately two weeks and greater than 80 percent mortality within three months if left untreated.[ii],[iii] Terlipressin, a potent vasopressin analogue selective for V1 receptors, is an investigational agent, and its safety and effectiveness have not yet been established by the U.S. Food and Drug Administration. In the U.S., there are currently no approved pharmacologic treatments for HRS-1; however, terlipressin is approved in most other countries, where it has been a standard of care for the last 20 years in the treatment of patients with HRS-1.[iv],[v] The current standard of care for HRS-1 in the U.S. includes other vasoconstrictors such as midodrine (a drug which can increase blood pressure and potentially improve blood flow into the kidneys) along with concomitant albumin and frequent monitoring, but current data do not support good efficacy.2 Dialysis (a type of renal replacement therapy) is sometimes used in hepatorenal syndrome, but dialysis is not curative and it can be costly.  (more…)
Author Interviews, Cancer Research, Hepatitis - Liver Disease / 07.10.2020

MedicalResearch.com Interview with: Donna R. Cryer, JD President & CEO of the Global Liver Institute  MedicalResearch.com: What is the background for this announcement? What is the mission of the GLI? Response: Global Liver Institute 's (GLI) mission is to improve the impact of the liver community by promoting innovation, collaboration, and scaling optimal approaches to eradicating liver diseases. Our vision is for liver health to take its proper place on the global public health agenda consistent with its prevalence and impact. One of the ways we seek to fulfill that mission is through a #OctoberIs4Livers worldwide awareness campaign for the fight against liver cancer, reinforcing October as liver disease and liver cancer awareness month. Not only are we seeing a continuous rise of prevalence of liver cancers, but survival rates for liver cancers are also some of the lowest of any cancer. Even more concerning is that the startling truth about the rise of liver cancer rates began before the COVID-19 pandemic. With the added burden of COVID-19, patients directly at risk from the virus may be diagnosed at a later stage due to delayed screening, and are getting sicker due to limitations on access to care during this pandemic. GLI is appealing to the US Congress to act now to secure the health and well-being of people living with liver disease and liver cancers during COVID-19. Funding is crucial to ensure federal agencies can restart and continue medical research, implement targeted prevention, and support awareness efforts for those impacted by liver disease as they are at increased risk for severe illness from COVID-19. [1] (more…)
Author Interviews, Gout, Hepatitis - Liver Disease, Rheumatology / 15.06.2020

MedicalResearch.com Interview with: Brian LaMoreaux, M.D., M.S. Medical Director, Medical Affairs Horizon Therapeutics   MedicalResearch.com: What is the background for this study? Response: Hyperuricemia is associated with non-alcoholic fatty liver disease (NAFLD) but the relationship to fibrosis remains uncertain. Moreover, it is not known whether lowering serum urate will affect the course of NAFLD.   (more…)
Author Interviews, Coffee, Hepatitis - Liver Disease, JAMA, OBGYNE, Pediatrics / 30.07.2019

MedicalResearch.com Interview with: Prof Hui Wang PhD Wuhan University China MedicalResearch.com: What is the background for this study? What are the main findings? Response: We started our work in the adverse outcome of maternal caffeine intake during pregnancy about 15 years ago. Then, we found that prenatal caffeine intake could result in nonalcoholic fatty liver disease in the offspring. However, the underlying mechanism was unclear. So, we start the current work, and found that hat maternal caffeine intake disrupts liver development before and after birth, which might be the trigger of the adult non-alcoholic fatty liver disease in the offspring rats. Moreover, we further found that the fetal programming of liver glucocorticoid – insulin like growth factor 1 axis, a new endocrine axis first reported by our team, might participate in such process.  (more…)
Alcohol, Author Interviews, Hepatitis - Liver Disease, JAMA / 07.05.2019

MedicalResearch.com Interview with: Robert Wong, MD, MS, FACG Assistant Clinical Professor of Medicine Director, GI Education & Research Highland Hospital   I A member of Alameda Health System Oakland, CA 94602  MedicalResearch.com: What is the background for this study?   Response: Alcoholic liver disease is a major cause of chronic liver disease in the United States and has become the leading indication for liver transplantation in the U.S.  However, accurate estimates of the true burden among U.S. adults is not well studies due to challenges in accurately identifying alcoholic liver disease or lack of awareness is screening individuals for alcohol use disorder.  Given the gaps in knowledge regarding the epidemiology of alcoholic liver disease in the U.S., our current study attempts to further contribute to the understanding of alcoholic liver disease epidemiology in the U.S We utilized a U.S. national cross sectional database and focused on the specific subset of alcoholic fatty liver disease, which is the earlier stage of disease along the spectrum of alcoholic liver disease.  Focusing on alcoholic fatty liver disease allowed us to more accurately define and capture the prevalence of this disease.  Furthermore, given that alcoholic fatty liver disease is early on the overall spectrum of alcoholic liver disease, it is a disease state that early identification provides opportunities to implement therapy and counseling for alcohol abstinence that can prevent further liver damage and disease progression. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Nutrition, Sugar / 23.01.2019

MedicalResearch.com Interview with: Miriam Vos, MD, MSPH Associate Professor of Pediatrics and Director Pediatric Fatty Liver Program Emory and Children’s Healthcare of Atlanta MedicalResearch.com: What is the background for this study? What are the main findings? Response: Fatty liver disease has quickly become a common problem in children and adolescents, affecting an estimated 7 million children in the U.S.  This study resulted from our previous research demonstrating that fructose increases cardiometabolic risk factors in children with NAFLD in addition to other research that had demonstrated associations between NAFLD and sugar.    (more…)
Author Interviews, Hepatitis - Liver Disease, Imperial College, Technology / 14.02.2018

MedicalResearch.com Interview with: Marcus Dorner, PhD Non-Clinical Senior Lecturer in Immunology Wellcome Trust Investigator Imperial College London Department of Medicine, Section of Virology School of Medicine London United Kingdom  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Hepatitis B virus (HBV) infection globally affects over 250 million people and is currently not curable. This infection can lead to liver cirrhosis and liver cancer and is among the leading causes for liver transplantation. Unfortunately, HBV is among the most difficult viruses to study in the laboratory, since model systems are not very good at recapitulating what happens in infected humans. We have just described the first model to effectively change this. Using an artificial “Liver-on-a-Chip”, we have developed a tool, which can potentially revolutionise how we study viral infections by merging the study of viruses with tissue engineering. This model is over 10,000-fold more susceptible to HBV infection and accurately mimics, what happens in an infected patient. This can now be utilised to develop novel and potentially curative therapies, which would benefit millions of people currently living with chronic HBV infection.  (more…)
Author Interviews, Brigham & Women's - Harvard, Hepatitis - Liver Disease, Transplantation / 05.01.2018

MedicalResearch.com Interview with: Jagpreet Chhatwal, PhD Assistant Professor, Harvard Medical School MGH Institute for Technology Assessment Boston, MA and Sumeyye Samur PhD Postdoctoral Fellow MGH-Harvard Medical School MedicalResearch.com: What is the background for this study? Response: The number of patients who are in need of liver transplant continues to rise whereas the availability of organs remains limited, therefore, it becomes is important to utilize all available livers. Under the current practices, only Hep-C infected patients are eligible to receive infected livers. However, with the advent of high efficacy drugs, number of infected recipients has decreased over the last decade. On the other hand, with the rise of opioid use, number of Hep-C infected organs increased. With this contradiction, it becomes paramount of importance to utilize the infected livers which could help save more lives on the transplant waiting list. (more…)
Author Interviews, Hepatitis - Liver Disease / 23.10.2017

MedicalResearch.com Interview with:
Donna R. Cryer, JD
CEO, Global Liver Institute
MedicalResearch.com: What is the background for this Council? Response: The Global Liver Institute operates my constantly assessing the liver health landscape for what we call advocacy gaps to determine where we allocate our time and resources. We identified NASH 2 years ago as an imminent global public health crisis due to the tens of millions of diagnosed and estimated undiagnosed patients rising with rates of obesity and diabetes with no concomitant recognition and activity by public, patients, or physicians. We decided to launch the NASH Council with collaborative patient and physician leadership and involving Hepatology but deliberately reaching out to primary care, endocrine, cardiology, and obesity organizations. (more…)
Author Interviews, Diabetes, Hepatitis - Liver Disease / 18.08.2017

MedicalResearch.com Interview with: Dr. Mauricio Berriel Diaz Deputy Director & Head of Division Metabolic Dysfunction and Cancer Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program Heidelberg University Hospital, Molecular Metabolic Control Medical Faculty, Technical University Munich Neuherberg, Germany  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our institute takes part in a german collaborative research consortium (https://www.klinikum.uni-heidelberg.de/index.php?id=132204&L=1), in which the key objective is to understand why in diabetes mellitus late complications occur even when blood sugar is well controlled. Our study focused the role of the liver and of inflammatory signaling, as the latter is known to be increased in metabolic diseases such as obesity and diabetes mellitus. We found that TNF-α-induced reactive oxygen species (ROS) formation in the liver abolished the function of the transcription factor GAbp. Impaired hepatic GAbp function resulted in transcriptional inactivation of the cellular energy sensor AMPK, which in turn induced hepatic cholesterol secretion, hypercholesterolemia and eventually atherosclerotic lesion formation. (more…)
Author Interviews, Gastrointestinal Disease, Hepatitis - Liver Disease / 10.05.2017

MedicalResearch.com Interview with: Dr. Winston Dunn, MD Assistant Professor The University of Kansas Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is widely believed that everyone with HCV can be cured with the medications now a day. But sadly, about 5% of the patients already have very bad damage done to the liver. We call this decompensated cirrhosis. Our medication is still very effective in curing the virus, but in decompensated cirrhosis, curing the virus is not always enough. Only about half to two-thirds of patients with decompensated cirrhosis clinically gets better, but the remaining struggles along or even gets worse after the cure. That is the problem. So, our research was to understand why that was. We used genetic factor to predict which patient would get better and which patient would not. We found that a gene previous found to be predictive of fatty liver and fibrosis is also predictive of recovery in this setting. (more…)
Annals Thoracic Surgery, Author Interviews, Diabetes, Duke, Heart Disease, Hepatitis - Liver Disease, Pharmacology / 04.01.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Hepatitis - Liver Disease, UCSF / 16.11.2016

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Gastrointestinal Disease, Genetic Research, Hepatitis - Liver Disease, Weight Research / 15.10.2016

MedicalResearch.com Interview with: Annette Schürmann PhD Department of Experimental Diabetology German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) Nuthetal Germany German Center for Diabetes Research (DZD München-Neuherberg Germany MedicalResearch.com: What is the background for this study? Response: The aim of our study was to clarify why genetically identical mice respond very different to a high fat diet. Some of the mice react with an elevated body weight, others not. We analyzed the expression pattern of liver at two time points, at the age of 6 weeks, (the earlierst time point to distiguish between those that respond to the diet (responder mice) and those that did not (non-responders)), and at the age of 20 weeks. One transcript that was significantly reduced in the liver of responder mice at both time points was Igfbp2. The reason for the reduced expression was an elevated DNA-methylation at a position that is conserved in the mouse and human sequence. The elevated DNA-methylation of this specifc site in human was recently described to associate with elevated fat storage (hepatosteatosis) and NASH. However, as 6 weeks old mice did not show differences in liver fat content between responder and non-responder mice we conclude that the alteration of Igfbp2 expression and DNA metyhlation occurs before the development of fatty liver. Our data furthermore showed that the epigenetic inhibition of Igfbp2 expression was associated with elevated blood glucose and insulin resistance but not with fatty liver. (more…)
Author Interviews, Hepatitis - Liver Disease, NEJM / 17.08.2016

MedicalResearch.com Interview with: Prof. Dr. F. Nevens, MD, PhD Professor of Medicine Hepatology and liver transplantation University Hospitals KU Leuven, Belgium Prof. Dr. F. Nevens, MD, PhD Professor of Medicine Hepatology and liver transplantation University Hospitals KU Leuven, Belgium MedicalResearch.com: What is the background for this study? Response: Primary biliary cholangitis (PBC) is a rare, autoimmune cholestatic liver disease that puts patients at risk for life-threatening complications. PBC is primarily a disease of women, affecting approximately one in 1,000 women over the age of 40. If left untreated, survival of PBC patients is significantly worse than the general population. The POISE trial evaluated the safety and efficacy of once-daily treatment with Ocaliva® (obeticholic acid) in PBC patients with an inadequate therapeutic response to, or who are unable to tolerate, ursodeoxycholic acid (UDCA), the current standard of care. Ocaliva is the first PBC therapy that targets the farnesoid X receptor (FXR), a key regulator of bile acid, inflammatory, fibrotic and metabolic pathways. The trial’s primary endpoint was an alkaline phosphatase (ALP) level of less than 1.67 times the upper limit of the normal range, with a reduction of at least 15% from baseline, and a total bilirubin level at or below the upper limit of the normal range after 12 months of obeticholic acid therapy. These liver biomarkers have been shown to predict progression to liver failure and resulting liver transplant or premature death in patients with PBC. (more…)
Annals Internal Medicine, Author Interviews, Diabetes, Hepatitis - Liver Disease, Pharmacology / 22.06.2016

MedicalResearch.com Interview with: Kenneth Cusi, M.D., F.A.C.P., F.A.C.E. Professor of Medicine VAMC staff Chief, Division of Endocrinology, Diabetes and Metabolism The University of Florida Gainesville, FL 32610-0226 MedicalResearch.com: What is the background for this study? Dr. Cusi: Many patients with prediabetes or Type 2 Diabetes Mellitus (T2DM) are not diagnosed with Nonalcoholic steatohepatitis (NASH), a disease that is the second cause of liver transplantation in the United States. It is also associated with worse cardiovascular disease and harder to control T2DM. We had done in this population a proof-of-concept study published in Nov 2006 in the NEJM. But we lacked a larger, long-term study for definitive proof. This is the largest SINGLE center study, and the longest ever (3 years). NASH is an overlooked problem for perhaps as many as one-third of patients with Type 2 Diabetes Mellitus. There is now a safe and effective treatment option for patients with T2DM and NASH – pioglitazone will become for NASH what metformin is to the treatment of T2DM: a safe, effective, the “backbone therapy" to which other treatments will be added. (more…)
Author Interviews, Coffee, Hepatitis - Liver Disease / 24.05.2016

MedicalResearch.com Interview with: Sikarin Upala MD, MS, LLB Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York Preventive and Social Medicine Mahidol University, Bangkok, Thailand MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Upala: Chronic hepatitis C virus infection is the most common cause of chronic liver disease and cirrhosis as well as the most common cause of liver transplantation in the United States. As caffeine has been found to be related to decreased liver enzymes, chronic liver disease,cirrhosis, and risk of hepatocellular carcinoma in several liver disease pathologies. There is inconclusive findings on the effect of caffeine on hepatitis C infected patients. Thus, we conducted a systematic review and meta-analysis to summarize the effect of caffeine consumption in patients with chronic hepatitis C. We found that caffeine consumers have a 61% reduced risk of developing advanced hepatic fibrosis, which is one of the consequence of chronic hepatitis C. Our meta-analysis result is in the same way with other studies who found that coffee consumption could prevent the development of hepatic fibrosis in patients with liver disease. However, we cannot conclude about the effect of caffeine on HCV viral load as there is not enough information. (more…)
Author Interviews, Diabetes, Genetic Research, Hepatitis - Liver Disease, Weight Research / 24.05.2016

MedicalResearch.com Interview with: Prof-Dr. Annette Schürmann Department of Experimental Diabetology German Institute of Human Nutrition Potsdam-Rehbruecke Nuthetal, Germany MedicalResearch.com: What is the background for this study? Dr. Schürmann: The aim of our study was to clarify why genetically identical mice respond very different to a high fat diet. Some of the mice react with an elevated body weight, others not. We analyzed the expression pattern of liver at two time points, at the age of 6 weeks, (the earliest time point to distinguish between those that respond to the diet (responder mice) and those that did not (non-responders)), and at the age of 20 weeks. One transcript that was significantly reduced in the liver of responder mice at both time points was Igfbp2. The reason for the reduced expression was an elevated DNA-methylation at a position that is conserved in the mouse and human sequence. The elevated DNA-methylation of this specific site in human was recently described to associate with elevated fat storage (hepatosteatosis) and NASH. However, as 6 weeks old mice did not show differences in liver fat content between responder and non-responder mice we conclude that the alteration of Igfbp2 expression and DNA methylation occurs before the development of fatty liver. Our data furthermore showed that the epigenetic inhibition of Igfbp2 expression was associated with elevated blood glucose and insulin resistance but not with fatty liver. (more…)
Author Interviews, Beth Israel Deaconess, Hepatitis - Liver Disease, NEJM / 18.11.2015

MedicalResearch.com Interview with: Dr. Michael P. Curry, MD Medical Director for Liver Transplantation Harvard Medical Faculty Physicians Beth Israel Deaconess Medical Center Medical Research: What is the background for this study? What are the main findings Dr. Curry: As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase. For many years, the only treatment option for these patients was liver transplantation. Recently, however, clinical trials of newly approved direct-acting antiviral agents (DAAs) have shown that it is possible to treat HCV infection safely and effectively in patients with decompensated cirrhosis. We conducted this Phase 3, open-label trial to assess the efficacy and safety of a fixed dose combination of sofosbuvir/velpatasvir with or without ribavirin for 12 weeks or sofosbuvir/velpatasvir for 24 weeks in patients infected with hepatitis C virus genotypes 1 through 6 and with decompensated cirrhosis. We found that treatment with sofosbuvir/velpatasvir resulted in high rates of sustained virologic response (SVR) and early improvements in hepatic function in this patient population. SVR rates were 83 percent  in patients who received sofosbuvir/velpatasvir for 12 weeks, 94 percent among those who received sofosbuvir/velpatasvir plus ribavirin, and 86 percent among those who received sofosbuvir/velpatasvir for 24 weeks. (more…)
Author Interviews, Hepatitis - Liver Disease / 23.02.2015

Andrew L. Mason MBBS MRCPI Professor of Medicine, Senior Scholar, Alberta Heritage Foundation for Medical Research Director, The Applied Genomic Core, Division of Gastroenterology and Hepatology University of Alberta, EdmontonMedicalResearch.com Interview with: Andrew L. Mason MBBS MRCPI Professor of Medicine, Senior Scholar, Alberta Heritage Foundation for Medical Research Director, The Applied Genomic Core, Division of Gastroenterology and Hepatology University of Alberta, Edmonton Medical Research: What is the background for this study? What are the main findings? Response: The study of viruses resembling mouse mammmary tumour virus (MMTV) dates back to the 1970s when virus like particles were discovered in breast milk of breast cancer patients. The virus was detected at low levels and ultimately researchers met a stalemate by the 1980s because no one could prove the existence of this agent. Interest waned in the study of betaretroviruses in humans when HIV was discovered in the 1980s. We first found a similar agent in patients with primary biliary cirrhosis, an autoimmune liver disease in 2003. History repeated itself in as much as others could not find the virus and challenged us to show that a significant amount of patients had evidence of proviral integrations into the human genome, the gold standard for providing proof of retroviral infection. This we achieved by isolating biliary epithelium from patients undergoing liver transplantation and then investigating the presence of betaretrovirus proviral integrations in DNA extracted from liver, lymph nodes and biliary epithelial cells using a ligation mediated PCR technique coupled with next generation sequencing. The majority of patients with primary biliary cirrhosis had viral integration and RNA detected in their biliary epithelium, the site of disease and lymph nodes; however, the virus was difficult to detect in whole liver, reflecting the problem with prior studies. (more…)
Author Interviews, Gastrointestinal Disease, Lancet / 21.02.2014

Norbert Stefan, MD Heisenberg Professorship for Clinical and Experimental Diabetology Department of Internal Medicine IV University Hospital Tübingen Tübingen, GermanyMedicalResearch.com Interview with: Norbert Stefan, MD Heisenberg Professorship for Clinical and Experimental Diabetology Department of Internal Medicine IV University Hospital Tübingen Tübingen, Germany MedicalResearch.com: What are the main findings of the study? Dr. Stefan: Currently there is little evidence for an effective and safe pharmacological treatment of nonalcoholic fatty liver disease (NAFLD). Based on the fact that inhibition of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), the enzyme, that converts inactive cortisone into active cortisol in metabolic tissues such as liver and adipose, was found to be effective to improve lipid metabolism in animals, we hypothesized that inhibition of 11β-HSD1 may also prove to be effective to decrease liver fat content in patients with NAFLD. In our 12 week trial in 82 patients with NAFLD, inhibition of 11β-HSD1 with RO5093151 resulted in a 14 % decrease of liver fat content and in a resolution of NAFLD in 20 % of the patients. This was accompanied by a decrease of liver enzymes. Furthermore, inhibition of 11β-HSD1 brought about a reduction of body weight and total body- and visceral adipose tissue mass, while insulin sensitivity did not change. In agreement with findings from other trials, also in our study 11β-HSD1 inhibition was well tolerated and safe. (more…)