- with the participation of Helena Cortez Pinto
Liver diseases currently affect about 29 million people in Europe alone. Although they have similar initial symptoms, their evolution is different. Within the universe of liver diseases, cirrhosis, non-alcoholic fatty liver and viral hepatitis are the three most prominent. Cirrhosis alone causes about 170 000 deaths in Europe, of people aged 45-65 years.
Prevention and medication are the ways to fight the disease, which is still limited regarding treatment options.
With such high numbers and considering the health costs of this disease, Europe welcomes the Carbalive Consortium, a European project funded by H2020 that also involves a Portuguese.
After reading an official statement that advanced Carbalive's successes, we asked one of the parties involved in the process to explain how this new therapeutic strategy that brings together the academy and the industry in joint research works.
Helena Cortez Pinto, a gastroenterologist and Director of the University Clinic of Gastroenterology and of FMUL’s Nutrition Laboratory represents the Portuguese group. The right person to congratulate and to explain what Carbalive is all about.
What motivated and what is the main mission of the Carbalive project?
Helena Cortez Pinto: The Carbalive project is motivated by the discovery of a substance capable of reducing endotoxemia, which is involved in the pathogenesis of liver cirrhosis, as well as in other liver diseases, such as fatty liver. Preliminary evidence of this beneficial effect in studies in animals needed to be confirmed in human studies, and it is naturally necessary to first check its safety. In this first trial, safety was demonstrated in a particularly fragile population, such as patients with liver cirrhosis.
Why the name "Carbalive"? Is the name closely linked to the work you are doing?
Helena Cortez Pinto: The name Carbalive relates to the fact that the substance to be tested, Carbalive, consists of granules of controlled porosity carbons, with the suffix “live” having to do with life.
What exactly is the role of the Faculty of Medicine of the University of Lisbon as a partner of the European consortium Carbalive?
Helena Cortez Pinto: The Faculty of Medicine of Lisbon is one of the partners of the European Carbalive Consortium, which has been financed by the European Horizon 2020 Programme. We were involved in the first clinical trial of this substance, with the objective of evaluating the safety of Carbalive in patients with decompensated liver cirrhosis. We have also been involved in the definition and structuring of clinical trials, like the safety one l that has now ended, and in the non-alcoholic fatty liver trial, which will be carried out next.
Which initiatives/research would you highlight within the scope of Carbalive?
Helena Cortez Pinto: The positive results of this phase 2 equivalent clinical trial, as an innovative treatment for liver cirrhosis. In fact, this first safety trial, in which it was shown that, in addition to the safety of the test substance, it led to an improvement in several inflammatory parameters. This is particularly impressive because the substance is not absorbed, and its mechanism results from its ability to adsorb endotoxemia, which reinforces the importance of the intestinal microbiota in the genesis of liver disease and its worsening. A clinical trial with patients with non-alcoholic fatty liver and another with patients with liver cirrhosis are now planned, mainly to assess effectiveness.
How can the therapy inherent to the research carried out be decisive in combating liver diseases?
Helena Cortez Pinto: If the importance of intestinal microbiota and endotoxemia in liver disease is confirmed, as this preliminary evidence suggests, this substance may prove to be a very innovative way to control liver disease, or in some cases slow its progression.
What is the biggest challenge for doctors and scientists in the current liver disease scenario?
Helena Cortez Pinto: The decompensated phase of liver cirrhosis remains a challenge for doctors and scientists, given that in most cases we are only able to control symptoms, with liver transplantation being the only treatment and survival option for many patients. However, liver transplantation depends on the availability of organs, which is limited and, therefore, insufficient. In addition, there are many contraindications for transplantation, including age. Transplanting individuals over 65 years of age is rare.
Currently, the most frequent liver disease is fatty liver, either associated with metabolic risk factors, such as obesity, or excessive alcohol consumption. This situation can progress to liver cirrhosis and hepatocellular carcinoma. The latter has been increasing in frequency and has a high morbidity and mortality.