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Institute for Liver Disease and Metabolic Health: What VCU’s newest institute means for our community — and the world — an interview with Dr. Arun Sanyal

Illustration of the human body, with the liver highlighted Photo: Getty Images

Dr. Arun Sanyal, a researcher and liver disease specialist at VCU Health and a professor in the Division of Gastroenterology, Hepatology and Nutrition in the VCU School of Medicine’s Department of Internal Medicine, explains the significance of VCU’s new Institute for Liver Disease and Metabolic Health. Dr. Sanyal will lead the new institute.

Arun SanyalWhy is this institute important?

VCU established the Institute for Liver Disease and Metabolic Health to meet a very specific vision — to be a platform for scientific research and innovation. Our goal is to seamlessly integrate scientific discovery into clinical care, ultimately improving the health of the people we serve here in Virginia, as well as those suffering from liver disease around the world.

Right now, the only cure for end-stage liver disease is a liver transplant. But you can’t just walk in and order a liver transplant off the shelf. We're limited by the number of organs available.

Across the country, around 9,000 liver transplants take place each year — not because only 9,000 people need them, but because there are only about 9,000 livers donated each year. Nine to 10 people die for every one person who makes it to transplant. Around the world, this number is even higher.  In the end, we just don't have enough organs for everybody who could benefit from a transplant.

The cost of taking care of people with-end stage liver disease is very high. And I’m talking physical, emotional and financial cost. We are managing those patients but not increasing their lifespan to any significant degree because other than liver transplant, there is no viable alternative.

It is urgent that we engage in more research to find better treatments. But we must also educate society about the many causes of liver disease, which cut across every stratum of society, and reduce the stigma. Alcohol is not the only cause of liver disease — but many people don’t know this.

Most academic medical centers have a heart, cancer or diabetes center, but it is relatively rare within the United States to have a university-level institute that cuts across different disciplines, such as microbiology, cardiology, diabetes, regulatory science and social sciences, to focus on liver disease with the goal of better diagnostics and the translation of scientific discovery into better treatments.

Our institute will end up saving hundreds of thousands of lives in this country and perhaps millions around the world, which makes this institute both unique and relevant.

Outside of alcohol, what else causes liver disease?

The most common liver disease having nothing to do with alcohol is non-alcoholic fatty liver disease. In this situation, the liver accumulates fat, which can injure the liver and progress to cirrhosis.

Approximately one out of three adults in the United States has excess fat in their liver, and one out of 20 has enough fat that it scars the liver over time. This can lead to cirrhosis and liver cancer.

Non-alcoholic fatty liver disease is now the leading indicator for liver transplantation, particularly in women. It is a leading cause of liver cancer as well as coronary artery disease. It is also closely linked to chronic kidney disease.

In a world preoccupied with COVID-19, why build a liver institute now?  

We should not forget that just because there is COVID, all of the other things that kill people have not gone away. People are still dying of cirrhosis. They’re still dying of heart attacks. They're still dying from diabetes, and they are still dying from liver disease and liver cancer.

Even before COVID, the United States was the only country in the Western world where life expectancy was actually declining. One thing at the root of this decline is liver disease — and that is because liver disease is closely tied to obesity and alcohol use, which are at epidemic levels in this country. Two-thirds of our population is obese. And if you’re obese, there is a three out of four chance that you’ll have liver disease.

It is also not well appreciated that liver disease has a significant impact on how other organs work. We have shown that fatty liver disease is closely linked to heart disease and also affects the acceleration of heart disease after liver transplant.

More recently we have shown that people with fatty liver develop high blood pressure and kidney disease at very high rates.

Finally, when cirrhosis develops and your liver shuts down, your brain shuts down. Your heart shuts down. Your kidneys shut down. All of the organs shut down, making it difficult to save the patient.

All of these make it really important to understand how the liver interacts with other organs in the body. By better managing liver disease, we not only prevent death from liver disease, but we also reduce the ill effects of high blood pressure, diabetes, heart and kidney disease and even Alzheimer’s disease.

Liver disease is also a major risk factor for severe COVID-19. 

Liver disease is a silent killer. Just like high blood pressure, it can kill you without your ever knowing you had it.

Will VCU be constructing a new building for the institute?  

We will probably work in stages, using our existing space first and then creating a consolidated space for people working within the institute to come together.

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