Liver Center investigators publish several key research findings
Investigators from Penn State Health Liver Center published their research findings in several academic journals in early 2020.
Research in the center is under the direction of Jonathan Stine, MD, MSc, assistant professor of medicine and public health sciences at Penn State College of Medicine and member of Penn State Cancer Institute. See more about liver research at the College of Medicine and Penn State Health here.
Among the center’s research highlights this year:
Randomized controlled trial of a supervised aerobic exercise program to reduce elevated clotting risk in patients with NASH
Authors: Jonathan Stine, Ian Schreibman, Seyedehsan Navabi, Mitchell Kang, Jessica Dahmus, Christopher Soriano, Gloriany Rivas, Breianna Hummer, Megan Beyer, Heather Tressler, Andrew Patterson, Kathryn Schmitz and Christopher Sciamanna
Published in: Contemporary Clinical Trials Communications, June 2020
Project summary: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide, affecting upward of one third the global population. For reasons not fully understood, individuals with NAFLD and its more severe variant, nonalcoholic steatohepatitis (NASH), are at increased risk for clotting-related complications that significantly increase the risk of illness and death. Lifestyle changes centering around exercise training are the mainstay of treatment for NAFLD and NASH. While exercise training can lessen risk in healthy people and those with cardiovascular disease, whether or not this benefit is seen in patients with NAFLD and NASH remains unknown.
In order to better understand how exercise training impacts thrombosis (clotting) risk in NAFLD, the researchers conducted a 32-week randomized controlled clinical trial, known as NASHFit, of 42 people ranging from 18 to 69 years old who have NASH in order to determine the impact of an aerobic exercise training program on the abnormal hemostatic (clotting) system unique to NAFLD and NASH. The study represents the first clinical trial of an exercise training program to reduce elevated clotting risk in such patients.
Early liver transplantation for severe alcoholic hepatitis
Authors: Jessica Mellinger (University of Michigan) and Jonathan Stine
Published in: Digestive Diseases and Sciences, June 2020
Project summary: Although alcohol-associated liver disease has long been a major component of the liver disease landscape, it was overshadowed by chronic hepatitis C until recently. With the declining incidence of hepatitis C in the wake of highly effective antiviral therapy, attention has shifted to the increasing burden of alcohol-associated liver disease, which is rising in parallel with increasing rates of alcohol-use disorders. As a result, alcohol-associated liver disease is now one of the most common indications for liver transplantation.
This research project explored guidance regarding candidate selection, counseling, postoperative care, long-term follow-up and other best practices for such transplants. The investigators concluded that more structured selection criteria should be put in place for liver transplant for patients with alcoholic hepatisis in order to ensure that more of these patients are appropriately considered for transplant and that the process proceeds in a scientifically rigorous, transparent and ethical manner.
Exercise attenuates ribosomal protein six phyosphorylation in fatty liver disease
Published in: Digestive Diseases and Sciences, April 2020
Project summary: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease worldwide. Nonalcoholic steatohepatitis (NASH) is a more severe type of NAFLD. Exercise improves NASH by reversing the accumulation of fat within cells and organs, and may stop fibrosis (the formation of scar tissue in the liver). However, the mechanisms underlying these effects are unknown.
In this study, investigators examined the effects of exercise on a specific liver protein in patients with NASH by following three study participants undergoing a structured 20-week exercise program. Their findings suggested that exercise may lead to improvement in fat levels within the liver independent of weight loss, and also underscored the value of future studies into the mechanism of how exercise improves NASH and possibly reverses fibrosis.
Nonalcoholic fatty liver disease – evidence for a thrombophilic state?
Authors: Margaret Spinosa and Jonathan Stine
Published in: Current Pharmaceutical Design, January 2020
Project summary: Nonalcoholic fatty liver disease can lead to a number of complications, including increased rates of both heart disease and deep-vein blood clots. This study examined changes to the blood-clotting process, known as hemostasis, that are found in nonalcoholic fatty liver disease and how those help to explain the increased rates of complications such as pulmonary embolism, deep vein thrombosis and portal vein thrombosis.
The study noted that these complications seem to happen in patients with this disease independent of obesity and other traditional risk factors. Given the complex interaction between obesity, body composition and nonalcoholic fatty liver disease and the potential for exercise to benefit all three, the study determined, more research is needed to further define the role of each in contributing to the clotting process in nonalcoholic fatty liver disease in order to improve patient outcomes.
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