Dr. Rob Myers

Heritage Clinical Investigator Dr. Rob Myers says it’s a good time to be a Hepatologist (a specialist who treats liver diseases). “Previously, many liver diseases were considered untreatable. Now the situation for patients has changed dramatically. There are effective treatments for some diseases, and we can see many new treatments on the horizon. For example, 15 years ago there were no effective treatments for hepatitis C, a liver disease that affects nearly 1% of Albertans. Now we can cure close to 60% of patients. That is a huge advance. Similar strides are being made with hepatitis B, although the progress has been a bit slower.”

Dr. Myers joined the University of Calgary in January 2003, after completing an AHFMR-funded research fellowship in hepatology at the University of Paris with Dr. Thierry Poynard, an international authority on viral hepatitis. The Calgary position was a chance for Dr. Myers not only to treat patients, but also to continue his research on liver disease.

His research focuses on the 40% of hepatitis C patients for whom current treatments are not effective. The hepatitis C virus, which is spread primarily through contact with blood and blood products, is one of the most important causes of chronic liver disease. Chronic hepatitis C can cause cirrhosis, liver failure, and liver cancer. It’s estimated that at least 20% of patients with chronic hepatitis C develop cirrhosis, which results from progressive scarring(fibrosis) over many years. Liver failure from chronic hepatitis C is the most common reason for liver transplantation.

“For hepatitis C, the patients who get cirrhosis are the ones who have the serious complications: liver failure, liver transplantation, or hepatocellular cancer,” explains Dr. Myers. “The idea is to prevent the scarring that ultimately leads to cirrhosis. In this way, we’ll prevent these complications.”

One of the key steps in understanding fibrosis is assessing the degree of scarring in the liver. The only way to do this currently is by biopsy—taking a tiny piece of liver tissue. This procedure, however, has many limitations. It is expensive and invasive, and the chance of bleeding is 1 in 1,000. About 1 in 5 patients has pain following the procedure and must take at least one day off work. In addition, the scarring may be patchy, and because a biopsy takes only one 50,000th of the liver, it might not truly indicate the amount of scarring. A less invasive test that could be repeated frequently would help in the follow-up of patients and in the assessment of new anti-fibrotic therapies. Patients could be assessed numerous times to measure the effectiveness of the therapy.

“So the idea is to develop a combination of blood tests that would indicate the degree of fibrosis in the entire liver, rather than a fragment of it,” says Dr. Myers. He has just begun recruiting patients for this study. He plans to consider a number of markers in the blood, in order to come up with the best combination of markers for assessing liver scarring accurately.

“There’s no doubt that these blood tests will be expensive at first, but they won’t cost as much as a biopsy; and the price will fall. And their other advantages are compelling—no complications, and no indirect costs due to lost productivity. It makes sense to pursue this goal.”

Dr. Robert Myers, an AHFMR Clinical Investigator, is the director of Calgary’s Viral Hepatitis Clinic and an assistant professor in the Department of Medicine at the University of Calgary.

Photo: Trudie Lee

For further information, please contact Dr. Rob Myers using the Email contact form or by phone at 403 210-9837