New VCU Institute Aims to Transform Treatment of Liver Disease Care

One of the priorities of the new institute at Virginia Commonwealth University’s medical school will be research into nonalcoholic steatohepatitis (NASH) as a key component in the emerging construct of metabolic health, says its leader, Arun J. Sanyal, M.D.

Virginia Commonwealth University will be able to “radically expand” treatment options for liver and liver-related metabolic diseases, thanks to a historic $104 million research gift.

The second largest publicly shared gift to support liver research in U.S. history came from by R. Todd Stravitz, M.D., a physician-philanthropist in the Department of Internal Medicine at the VCU School of Medicine who retired in 2020. His family’s Barbara Brunckhorst Foundation is also responsible for the gift.

“The vision for this institute is to make liver transplant the last, but not the only, option for patients,” Stravitz said in a news release. “We will do this by investing in gene therapy and working hand in hand with biotech companies. In the process, VCU will train and educate the next generation of world-renowned liver experts.”

The new Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at VCU in Richmond, Virginia, willbe led by Arun J. Sanyal, M.D., professor in VCU School of Medicine’s Department of Internal Medicine and a researcher and liver disease specialist at VCU Health.

Managed Healthcare Executive® spoke with Sanyal about the importance of transforming liver disease care along with the research priorities for the new Institute.

What are the top research priorities for the institute?

One of the top research priorities in the immediate future is to consolidate and accelerate the scientific momentum addressing the central role of the liver and nonalcoholic steatohepatitis (NASH) as a key component of the emerging construct of metabolic health, which breaks down the siloed approach to diabetes, cardiac, and renal care. Aside from COVID-19, these are some of the key contributors to population burden of disease, morbidity and inability to work.

Another top priority is to work with our partners to establish a global population cohort with and without liver disease that is deeply phenotyped and genotyped.

We also will develop digital technology-based solutions to bridge the gaps between ideal care scenarios and resources available to reduce care fragmentation and optimize care and care delivery.

The current global health system is siloed with major knowledge gaps within provider groups, leading to fragmented care (and) dissonant messaging to patients or treatments started by providers without appropriate consideration of other end-organ function.

In areas where patients live a distance away, the patient has to be brought to care. We seek to shift this paradigm by bringing care to the patient.

Which liver-related diseases do you believe need the most attention and focus?

The major focus will be nonalcoholic fatty liver disease (NAFLD) and its linkage to conditions that affect other organs in the context of metabolic health (heart failure, chronic kidney disease, neurocognitive decline, diabetes)

We view the disease along three axes: From early to advanced disease, including transplant and post-transplant state; from pure NAFLD to pure alcohol induced liver disease and everything in between; and the profile of comorbidities present based on where the patient is on first and second axis.

This allows us to understand why some people get one type of outcome versus another.

There are other liver diseases that are also important and will be areas of study, including alcohol-induced liver disease such as alcoholic hepatitis — we are already part of the National Institute on Alcohol Abuse and Alcoholism Alcoholic Hepatitis Consortia — and cholestatic liver disease, especially primary sclerosing cholangitis.

Finally, we will continue to study the very special circumstances surrounding end-stage liver disease regardless of etiology, which remains a very challenging area, especially since transplant is not an option for all. The incidence and burden of these are rising in the US, and we are therefore committed to tackle it.