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AW Morrow Gastroenterology and Liver Centre Research

The AW Morrow Gastroenterology and Liver Centre has a strong and robust research base. Key research strengths include Hepatology, Liver Transplant, Hepatocellular Carcinoma, Inflammatory Bowel Disease, Colorectal and Endoscopy.

Our Research Themes at the Laboratory Level

The role of liver stem cells in liver disease This work is lead by Professor McCaughan and has defined a novel characteristic of liver stem cells within the inflammatory/fibrotic niche that develops during chronic liver disease and cirrhosis.  This work has found that a cellular structure, called the primary cilium, transduces signals from the local environment to the liver stem cell compartment leading to proliferation and migration of cells.  One of the key mediators is the hedgehog molecule and we have defined this hedgehog pathway and the response of these cells in mouse liver models.  We have confirmed these findings in human liver disease and are now working in collaboration with the Cellular and Molecular Regenerative Institute at Edinburgh University to grow organoids and are using a unique mouse model to explore the exact function of these signals.  These cells can repopulate an injured liver and replace hepatocytes, significantly improving liver function.

The role of molecular pathways in primary liver cancer

 

This work has been exploring pathogenic pathways in hepatocellular cancer and more recently biliary cancer.  This research includes reduced liver cancer development in knockout mice for SP1 and SP2  and microRNA 181a. Currently, in close collaboration with Dr Maintain Palendira in the Charles Perkins Centre at the University of Sydney, we are using tissue Immune mass cytometry to explore cell-cell interactions within human liver cancer tissues . This is the only attempt to do this in Australia as we have access to one of only two machines capable of providing this technology. We are able to label cells with over thirty unique antibodies to detect complex cell subsets that are undetectable using usual approaches. 

Recently we have developed a unique mouse model of primary biliary cancer which has similarities to human disease. We have also used new strategies that target the tumour endothelium and the tumour associated immune infiltrate in experimental models. We believe that such multiple approaches to liver cancer is crucial to understand the complex nature of the problem and to produce new effective therapeutics. 

The role of the Oligopeptidase Gene family in liver diseases and cancer This work is lead by Professor Mark Gorrell and has made major breakthroughs in the study of Type II Diabetes associated with liver disease, liver cancer and also liver fibrosis.  The work has been able to show that the serum Fibroblast Activation Protein (FAP) is able to show how liver transplants are spontaneously accepted and the potential to select humans for immunosuppressive withdrawal.  The work has identified that liver cytotoxic T cells which would normally reject and damage the liver are eliminated by the liver in the early phases of transplantation by a normal mechanism whereby liver cells actually eat the activated immune cells.  The process has been named by us as suicidal empiriopolesis.  The work also increases our understanding of how viruses and autoimmune liver diseases are associated with progression to chronicity and non-resolution of disease.
 
In collaboration with Professor Heath at the Walter and Eliza Hall Institute in Melbourne, Dr Bertolino has furthermore identified blood memory cells that reside in the liver.  These cells are very efficient in protecting against malaria infection and this potentially provides new strategies to protect individuals against pathogens that attack the liver such as malaria and other viruses.  More recently, a novel type of macrophage cell has been discovered by Dr Bertolino's group, where a novel liver macrophage which is located in the liver capsule is currently under examination for playing a role in protecting the liver against pathogenic effects from the peritoneal cavity. Professor McCaughan has been part of an international consortium that has developed molecular signatures for human liver allograft rejection and injury that is already helping in treatment decision making following liver transplantation in our patients. 

Our Research Themes at the Clinical Level

New therapies for Hepatitis B and C 

 

New HCV therapies are one of the most exciting advances in the whole of medicine for many years leading the potential to eventually eradicate HCV infection worldwide. We have significant community care nurse lead programs to deliver these therapies to the wider HCV infected populations.

Chief Investigator studies in Australia have lead to the use of the new Hepatitis C treatments in patients with liver failure and undergoing liver transplantation. For the first time we have seen reversibility of HCV related liver failure resulting in a decrease in the need for transplantation in these patients.  

Professor McCaughan and Associate Professor Strasser have also been active participants and leaders in the International Liver Transplant Society consensus statements for the treatment and management of hepatitis C. Treatment outcomes in First nations peoples have also been investigated and outcomes published.

New therapies are emerging to cure HBV infection and we have been involved in those studies .Furthermore we have participated in the development of national and Asian pacific  consensus guidelines for the management of hepatitis B infection.

New therapies for Hepatocellular Cancer (HCC)

 

HCC accounts for the vast majority of primary liver cancers, representing the 4th leading cause of cancer-related death worldwide. The WHO has estimated that >1 million people will die from liver cancer in 2030. Despite recent advances, 5-year survival remains dismal at <20%.  In Australia HCC is the fastest growing solid cancer apart from thyroid cancer.

We have been involved in key studies that have examined the outcomes of HCC therapies in national studies. Outcomes of HCC in our liver transplant patients have also been studied together with quality care parameters through a national consensus process.

In a collaborative study with St George Hospital and UNSW we have been studying the role of the microbiome in HCC patients associated with fatty liver diseases and have described outcomes of patients with non - viral associated HCC. 

Improving Outcomes for patients with advanced liver disease This population has a high mortality and an increasing need for improved therapies. Dr Avik Majumdar and Dr Ken Liu, together with our dieticians Helen Vidot and Joanne Heyman, have lead studies involving nutritional intervention including developing sarcopenia and frailty guidelines for intervention in gastrointestinal bleeding, treatment of infections together with management of hepatic encephalopathy and ascites. Furthermore, we have been investigating the use of non-invasive markers for the diagnosis of cirrhosis.
Outcomes in Primary Sclerosing Cholangitis (PSC) and drug induced liver injury Our patients with PSC and inflammatory bowel disease were  analysed in the largest Australian study of PSC and has lead to a national outcomes study including studies of the microbiome. We have published a large study of drug induced severe liver injury indicating that  herbal medicines play a major role in these cases.
Endoscopy research
  • Colonoscopy guidelines 
  • New therapy for leaks and perforations of the bowel
  • New therapy for achalasia, the new POEM procedure
  • Double balloon ERCP to treat biliary strictures in patients without a native bile duct
  • New techniques to biopsy the biliary tree 
  • Endoscopic ultrasound (EUS) procedures to diagnose and treat intra-abdominal collections, tumours and pancreatic cysts
  • Use of EUS to drain the biliary system 
  • Development of a screening protocol for development of pancreatic cancer
Inflammatory bowel disease research
  • Clinical trials for new therapies in Ulcerative Colitis and Inflammatory Bowel Disease
  • Detection of pre cancer lesions in IBD
  • Guidelines for the use of biological agents 
Outcomes in liver transplantation includes the following studies
  • Outcomes following the use of split liver techniques in liver transplantation 
  • Prolonged function of human livers in machine perfusion devises 
  • Development of new scoring systems for the allocation of livers for patients on the liver transplant waiting list

Selected Grants

Amount awarded Grant and project details
$4,000,000 Cancer Institute NSW, 2021-2026

The APRICA  program - Accelerated translational research in Liver Cancer

RPA Investigator: McCaughan G (CIB)
$3,989,422 MRFF, 2021-2025

Improving Diagnosis in Cancers with Low Survival Rates : Microbial based biomarkers powered by artificial intelligence for early detection of liver cancer in Australia. The Australian Liver Cancer Microbiome Consortium.

RPA Chief Investigator: McCaughan G
$1,800,000 Australian Cancer Research Foundation, 2022-2026

ACRF Molecular Theranostics Laboratory

Investigators: Hogg PJ, Simes J, Stockler M, Gorrell M, McCaughan G, Codd R. 
$450,000 Cancer Council NSW Project Grant, 2020-2022

New therapies for Liver Cancer

Investigators: McCaughan G, Chen J

Our Publications

2023

Abdelmalak J, Strasser SI, Ngu N, Dennis C, Sinclair M, Majumdar A, Collins K, Bateman K, Dev A, Abasszade JH, Valaydon Z, Saitta D, Gazelakis K, Byers S, Holmes J, Thompson AJ, Pandiaraja D, Bollipo S, Sharma S, Joseph M, Nicoll A, Batt N, Sawhney R, Tang MJ, Lubel J, Riordan S, Hannah N, Haridy J, Sood S, Lam E, Greenhill E, Majeed A, Kemp W, Zalcberg J, Roberts SK. Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study. Cancers (Basel). 2023 Dec 7;15(24):5741. doi: 10.3390/cancers15245741.
Allen NC, Martin AJ, Snaidr VA, Eggins R, Chong AH, Fernandéz-Peñas P, Gin D, Sidhu S, Paddon VL, Banney LA, Lim A, Upjohn E, Schaider H, Ganhewa AD, Nguyen J, McKenzie CA, Prakash S, McLean C, Lochhead A, Ibbetson J, Dettrick A, Landgren A, Allnutt KJ, Allison C, Davenport RB, Mumford BP, Wong B, Stagg B, Tedman A, Gribbin H, Edwards HA, De Rosa N, Stewart T, Doolan BJ, Kok Y, Simpson K, Low ZM, Kovitwanichkanont T, Scolyer RA, Dhillon HM, Vardy JL, Chadban SJ, Bowen DG, Chen AC, Damian DL. Nicotinamide for Skin-Cancer Chemoprevention in Transplant Recipients. N Engl J Med. 2023 Mar 2;388(9):804-812. doi: 10.1056/NEJMoa2203086.
Anderson E, Waller K, Tamilarasan AG, Lin H, Paramsothy S, Leong RW. Adalimumab originator versus adalimumab biosimilars in inflammatory bowel disease in Australia. Expert Opin Biol Ther. 2023 Jul-Dec;23(8):819-825. doi: 10.1080/14712598.2023.2203812. Epub 2023 Apr 19.
Chetwood JD, Sabih AH, Chan K, Salimi S, Sheiban A, Lin E, Chin S, Gu B, Sastry V, Coulshed A, Tsoutsman T, Bowen DG, Majumdar A, Strasser SI, McCaughan GW, Liu K. Epidemiology, characteristics, and outcomes of patients with acute-on-chronic liver failure in Australia. J Gastroenterol Hepatol. 2023 Aug;38(8):1325-1332. doi: 10.1111/jgh.16197. Epub 2023 Apr 25.
Choi KKH, Bonnichsen M, Liu K, Massey S, Staudenmann D, Saxena P, Kaffes AJ. Outcomes of patients with hepaticojejunostomy anastomotic strictures undergoing endoscopic and percutaneous treatment. Endosc Int Open. 2023 Jan 4;11(1):E24-E31. doi: 10.1055/a-1952-2135.
Clark PJ, Valery PC, Strasser SI, Weltman M, Thompson AJ, Levy M, Leggett B, Zekry A, Rong J, Angus P, George J, Bollipo S, McGarity B, Sievert W, Macquillan G, Tse E, Nicoll A, Wade A, Chu G, Harding D, Cheng W, Farrell G, Roberts SK. Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort. Dig Dis Sci. 2023 Jan;68(1):291-303. doi: 10.1007/s10620-022-07483-y. Epub 2022 May 13.
De Martin E, McCaughan GW. Antibody-mediated rejection in liver transplant recipients: Some questions, some answers. Liver Transpl. 2023 Dec 1;29(12):1260-1261. doi: 10.1097/LVT.0000000000000239. Epub 2023 Aug 7.
Ganley M, Holz LE, Minnell JJ, de Menezes MN, Burn OK, Poa KCY, Draper SL, English K, Chan STS, Anderson RJ, Compton BJ, Marshall AJ, Cozijnsen A, Chua YC, Ge Z, Farrand KJ, Mamum JC, Xu C, Cockburn IA, Yui K, Bertolino P, Gras S, Le Nours J, Rossjohn J, Fernandez-Ruiz D, McFadden GI, Ackerley DF, Painter GF, Hermans IF, Heath WR. mRNA vaccine against malaria tailored for liver-resident memory T cells. Nat Immunol. 2023 Sep;24(9):1487-1498. doi: 10.1038/s41590-023-01562-6. Epub 2023 Jul 20.
Gill M, Mudaliar S, Prince D, Than NN, Cordina R, Majumdar A. Poor correlation of 2D shear wave elastography and transient elastography in Fontan-associated liver disease: A head-to-head comparison. JGH Open. 2023 Sep 14;7(10):690-697. doi: 10.1002/jgh3.12967.
Grootveld AK, Kyaw W, Panova V, Lau AWY, Ashwin E, Seuzaret G, Dhenni R, Bhattacharyya ND, Khoo WH, Biro M, Mitra T, Meyer-Hermann M, Bertolino P, Tanaka M, Hume DA, Croucher PI, Brink R, Nguyen A, Bannard O, Phan TG. Apoptotic cell fragments locally activate tingible body macrophages in the germinal center. Cell. 2023 Mar 16;186(6):1144-1161.e18. doi: 10.1016/j.cell.2023.02.004. Epub 2023 Mar 2.
Howell J, Van H, Pham MD, Sawhney R, Li F, Bhat P, Lubel J, Kemp W, Bloom S, Majumdar A, McCaughan GW, Hall S, Spelman T, Doyle JS, Hellard M, Visvanathan K, Thompson A, Drummer HE, Anderson D. Validation of a novel point-of-care test for alanine aminotransferase measurement: A pilot cohort study. Liver Int. 2023 May;43(5):989-999. doi: 10.1111/liv.15531. Epub 2023 Feb 16.
Jacob R, Danta M, Feller R, Williams D, Sanagapalli S. Empiric Esophageal Dilatation for Solid-Food Dysphagia: Presence of Mucosal Tear on Relook Endoscopy Predicts Symptomatic Response. Am J Gastroenterol. 2023 Oct 1;118(10):1888-1890. doi: 10.14309/ajg.0000000000002319. Epub 2023 May 12.
Jacob R, Prince DS, Kench C, Liu K. Alcohol and its associated liver carcinogenesis. J Gastroenterol Hepatol. 2023 Aug;38(8):1211-1217. doi: 10.1111/jgh.16248. Epub 2023 Jun 1.
Jacob R, Prince DS, Pipicella JL, Nguyen A, Bagatella M, Alvaro F, Maley M, Foo H, Middleton P, Kayes T, DiGirolamo J, Davison SA, Levy MT. Routine screening of emergency admissions at risk of chronic hepatitis (SEARCH) identifies and links hepatitis B cases to care. Liver Int. 2023 Jan;43(1):60-68. doi: 10.1111/liv.15414. Epub 2022 Sep 14.
Janko N, Majeed A, Clements W, Fink MA, Lubel J, Goodwin M, Nicoll A, Strasser SI, Sood S, Bollipo S, Bate J, Bowers KA, George J, Kemp W, Roberts SK. Wide variation in pre-procedural blood product transfusion practices in cirrhosis: a national multidisciplinary survey. Hepatol Commun. 2023 Apr 26;7(5):e0147. doi: 10.1097/HC9.0000000000000147.
Kaur R, Hakim J, Jeremy R, Coorey G, Kalman E, Jenkin R, Bowen DG, Hart J. Students' perceived research skills development and satisfaction after completion of a mandatory research project: results from five cohorts of the Sydney medical program. BMC Med Educ. 2023 Jul 12;23(1):502. doi: 10.1186/s12909-023-04475-y.
Knapp L-K. An update to the management of hepatocellular carcinoma. Medicine Today. 2023;24:23-8.
Koh B, Tan DJH, Ng CH, Fu CE, Lim WH, Zeng RW, Yong JN, Koh JH, Syn N, Meng W, Wijarnpreecha K, Liu K, Chong CS, Muthiah M, Luu HN, Vogel A, Singh S, Yeoh KG, Loomba R, Huang DQ. Patterns in Cancer Incidence Among People Younger Than 50 Years in the US, 2010 to 2019. JAMA Netw Open. 2023 Aug 1;6(8):e2328171. doi: 10.1001/jamanetworkopen.2023.28171.
Lau NS, Ly M, Dennis C, Ewenson K, Ly H, Huang JL, Cabanes-Creus M, Chanda S, Wang C, Lisowski L, Liu K, Kench J, McCaughan G, Crawford M, Pulitano C. Liver splitting during normothermic machine perfusion: a novel method to combine the advantages of both in-situ and ex-vivo techniques. HPB (Oxford). 2023 May;25(5):543-555. doi: 10.1016/j.hpb.2023.02.003. Epub 2023 Feb 8.
Lau NS, Ly M, Dennis C, Jacques A, Cabanes-Creus M, Toomath S, Huang J, Mestrovic N, Yousif P, Chanda S, Wang C, Lisowski L, Liu K, Kench JG, McCaughan G, Crawford M, Pulitano C. Long-term ex situ normothermic perfusion of human split livers for more than 1 week. Nat Commun. 2023 Aug 8;14(1):4755. doi: 10.1038/s41467-023-40154-8.
Laube R, Liu K. Gut microbiome and immune responses in gastrointestinal cancer. In: Microbiome in Gastrointestinal Cancer. Springer Nature; 2023.
Lin A, Wong K, Visser SK, Jo H, Al-Hindawi Y, Kosbab-Jackson K, Cocks M, Volovets A, Haber P, Hammond K, Taylor N, Yozghatlian V, Lau EM, Marshall NS, Aquino-Salomon T, Sivam S. Diagnosis of cystic fibrosis in adults: Australian Cystic Fibrosis Data Registry data, 2000-2019. Med J Aust. 2023 Feb 20;218(3):138-139. doi: 10.5694/mja2.51797. Epub 2022 Dec 1.
Lin H, Yiu DC, Chin S, Liu K, Yip TC. Metformin in patients with hepatocellular carcinoma receiving immunotherapy. J Hepatol. 2023 May;78(5):e180-e182. doi: 10.1016/j.jhep.2022.12.011. Epub 2022 Dec 23.
Liu K, Chen J, Zhao Y, Boland J, Ting KK, Lockwood G, McKenzie C, Kench J, Vadas MA, Gamble JR, McCaughan GW. Novel miRNA-based drug CD5-2 reduces liver tumor growth in diethylnitrosamine-treated mice by normalizing tumor vasculature and altering immune infiltrate. Front Immunol. 2023 Sep 18;14:1245708. doi: 10.3389/fimmu.2023.1245708.
Liu K, Dennis C, Prince DS, Marsh-Wakefield F, Santhakumar C, Gamble JR, Strasser SI, McCaughan GW. Vessels that encapsulate tumour clusters vascular pattern in hepatocellular carcinoma. JHEP Rep. 2023 May 11;5(8):100792. doi: 10.1016/j.jhepr.2023.100792.
Ly M, Lau NS, McKenzie C, Kench JG, McCaughan G, Crawford M, Pulitano C. Does an Additional Bile Duct Flush With Low-viscosity Preservation Solution Reduce Bile Duct Injury? A Single-blinded Randomized Clinical Trial. Transplant Direct. 2023 Feb 8;9(3):e1443. doi: 10.1097/TXD.0000000000001443.
Ly M, Lau NS, McKenzie C, Kench JG, Seyfi D, Majumdar A, Liu K, McCaughan G, Crawford M, Pulitano C. Histological Assessment of the Bile Duct before Liver Transplantation: Does the Bile Duct Injury Score Predict Biliary Strictures? J Clin Med. 2023 Oct 27;12(21):6793. doi: 10.3390/jcm12216793.
McMullen L, Khoo L, Anderson L, Strasser S, Gracey DM. BK viraemia as a cause of anaemia in after ABO-incompatible liver transplant: a case report. BMC Infect Dis. 2023 Sep 18;23(1):609. doi: 10.1186/s12879-023-08601-5.
Nash E, Kench J, Watson G, Liu K. A case of drug reaction with eosinophilia and systemic symptoms (DRESS) due to rivaroxaban. Pathology. 2023 Dec;55(7):1022-1024. doi: 10.1016/j.pathol.2023.05.012. Epub 2023 Jul 20.
Pollok JM, Tinguely P, Berenguer M, Niemann CU, Raptis DA, Spiro M; ERAS4OLT.org collaborative. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference. Lancet Gastroenterol Hepatol. 2023 Jan;8(1):81-94. doi: 10.1016/S2468-1253(22)00268-0. Erratum in: Lancet Gastroenterol Hepatol. 2023 Feb;8(2):117. doi: 10.1016/S2468-1253(22)00429-0.
Prince DS, Nash E, Liu K. Alcohol-Associated Liver Disease: Evolving Concepts and Treatments. Drugs. 2023 Nov;83(16):1459-1474. doi: 10.1007/s40265-023-01939-9. Epub 2023 Sep 25.
Rodríguez-Perálvarez ML, Gómez-Orellana AM, Majumdar A, Bailey M, McCaughan GW, Gow P, Guerrero M, Taylor R, Guijo-Rubio D, Hervás-Martínez C, Tsochatzis EA. Development and validation of the Gender-Equity Model for Liver Allocation (GEMA) to prioritise candidates for liver transplantation: a cohort study. Lancet Gastroenterol Hepatol. 2023 Mar;8(3):242-252. doi: 10.1016/S2468-1253(22)00354-5. Epub 2022 Dec 14.
Sim YK, Chong MC, Gandhi M, Pokharkar YM, Zhu Y, Shi L, Lequn L, Chen CH, Kudo M, Lee JH, Strasser SI, Chanwat R, Chow PKH; Asia-Pacific Hepatocellular Carcinoma Trials Group. Real-World Data on the Diagnosis, Treatment, and Management of Hepatocellular Carcinoma in the Asia-Pacific: The INSIGHT Study. Liver Cancer. 2023 Oct 9;13(3):298-313. doi: 10.1159/000534513.
Song SJ, Yip TC, Wong GL, Wong VW, Liu K. Editorial: Can liver fat quantification stratify cardiovascular risk in type 2 diabetes? Aliment Pharmacol Ther. 2023 Nov;58(10):1107-1108. doi: 10.1111/apt.17677.
Teoh AYB, Napoleon B, Kunda R, Arcidiacono PG, Kongkam P, Larghi A, Van der Merwe S, Jacques J, Legros R, Thawee RE, Saxena P, Aerts M, Archibugi L, Chan SM, Fumex F, Kaffes AJ, Ma MTW, Messaoudi N, Rizzatti G, Ng KKC, Ng EKW, Chiu PWY. EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial). Gastroenterology. 2023 Aug;165(2):473-482.e2. doi: 10.1053/j.gastro.2023.04.016. Epub 2023 Apr 28.
Thompson AJ, Jackson K, Bonanzinga S, Hall SAL, Hume S, Burns GS, Sundararajan V, Ratnam D, Levy MT, Lubel J, Nicoll AJ, Strasser SI, Sievert W, Desmond PV, Ngu MC, Sinclair M, Meredith C, Matthews G, Revill PA, Littlejohn M, Bowden DS, Canchola JA, Torres J, Siew P, Lau J, La Brot B, Kuchta A, Visvanathan K. Baseline serum HBV RNA is associated with the risk of hepatitis flare after stopping nucleoside analog therapy in HBeAg-negative participants. Hepatol Commun. 2023 Jul 17;7(8):e0188. doi: 10.1097/HC9.0000000000000188.
Verdina M, Seibold F, Grandmaison G, Michetti P, Barras-Moret AC, Liu K, Vaucher J, Staudenmann D. Survey of dietary beliefs and habits of inflammatory bowel disease patients. Clin Nutr ESPEN. 2023 Oct;57:624-629. doi: 10.1016/j.clnesp.2023.07.090. Epub 2023 Aug 13.
Waller KMJ, Bowen DG, Strasser SI. Transforming Genes to Protect Against Liver Disease: Will siRNA-based Therapeutics Reduce the Need for Liver Transplantation? Transplantation. 2023 Mar 1;107(3):556-557. doi: 10.1097/TP.0000000000004474. Epub 2023 Feb 21.
Wu CW, Lui RN, Wong VW, Yam TF, Yip TC, Liu K, Lai JC, Tse YK, Mok TS, Chan HL, Ng KK, Wong GL, Chan SL. Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma. Cancers (Basel). 2023 Apr 26;15(9):2480. doi: 10.3390/cancers15092480.