MB ChB MRCS
Novo Nordisk Clinical Research Training Fellow (2016-2020)
- Project: Understanding improvements in non-alcoholic fatty liver disease. Defining the impact of very low calorie diet and bariatric surgery on lipid flux.
My research has two main aims:
1) To investigate the mechanisms underlying improvements in Non-Alcoholic Fatty Liver Disease (NAFLD) after bariatric surgery. NAFLD-associated cirrhosis is rapidly becoming the leading indication for liver transplantation worldwide and can also lead to hepatocellular carcinoma. No licensed pharmacotherapy directly treats NAFLD but bariatric surgery is known to be beneficial.
2) To compare the diagnostic accuracy of non-invasive NAFLD biomarkers for predicting liver biopsy histology in obese patients. Liver biopsy (routinely performed during bariatric surgery) is the gold standard for NAFLD staging but is painful, invasive and prone to sampling error. Non-invasive biomarkers that accurately diagnose and monitor NAFLD would reduce its necessity and enable pre-operative NAFLD staging (important since the most common bariatric operation (Roux-en-Y Gastric Bypass) is relatively contraindicated in the presence of cirrhosis).
To meet these aims, I have commenced recruitment into a Bariatric Surgery biobank. This combines preoperative, intraoperative and postoperative clinical data and sample collection. It will be used to determine the diagnostic accuracy of non-invasive biomarkers, measure postoperative biomarker changes and for in vitro studies.
I have also secured funding for the Effects of Dietary Intervention and Surgery on NAFLD (EDISON) study (award value: £234,378.48), which will be the first surgical Randomised Controlled Trial with NAFLD improvement as its primary endpoint. Non-invasive biomarkers will be used to stage NAFLD and stable isotope tracers will define postoperative changes in lipid homeostasis pathways (which may present pharmaceutical targets) for the first time.