Ira M. Jacobson, MD, professor in the Department of Medicine, joined the Division of Gastroenterology and Hepatology as director of hepatology in 2017. An internationally renowned clinician and researcher, Dr. Jacobson quickly joined with colleagues across the institution to lead new liver disease programs and to build on existing momentum in the division, all aimed at enhancing care for patients with liver disease.
A Pioneer in Hepatology Takes Aim at Fatty Liver Disease
Most recently, Dr. Jacobson has been directing his efforts toward nonalcoholic fatty liver disease (NAFLD), a condition whose prevalence in the United States has grown in recent years along with the rapid rise in obesity.
Much of Dr. Jacobson’s current research focuses on exploring new treatments for patients with nonalcoholic steatohepatitis (NASH), the most serious form of nonalcoholic fatty liver disease, with the goal of halting disease progression and preventing serious liver damage.
“NASH is on a trajectory to replace hepatitis C as the leading indicator for liver transplantation, yet there are currently no FDA-approved therapies,” says Dr. Jacobson. “It’s urgent that we develop novel therapies aimed at reversing the progression of fibrosis.”
NASH often goes undiagnosed in its early stages, leaving patients at high risk for cirrhosis, liver failure, and cancer. The latest experimental treatments target different molecular stages in the disease process, with the goal of slowing or even reversing fibrosis.
“Dr. Jacobson is a leader in testing new strategies for a disease that is rapidly becoming an epidemic in the Western world,” says Mark B. Pochapin, MD, the Sholtz/Leeds Professor of Gastroenterology, director of the Division of Gastroenterology and Hepatology, and vice chair of clinical affairs in the Department of Medicine. “His research is shedding new light on the pathophysiology of the disease and helping to develop novel therapeutic strategies.”
Dr. Jacobson works closely with the NYU Langone Transplant Institute and the Asian Liver Health Program. Widely known for his groundbreaking research in developing antiviral therapy for hepatitis C, he has been involved in more than 100 clinical trials, including some of the field’s most promising studies of novel drugs for interferon-based and direct-acting antiviral therapies. Dr. Jacobson also was lead investigator in the national WIN-R trial, which established the role of weight-based ribavirin dosing in the treatment of hepatitis C infection in African Americans.
A variety of liver-related clinical trials are currently underway.
Growth in Liver Transplant Program
NYU Langone’s Liver Care and Transplant Program offers complete medical and surgical care for a wide range of acute and chronic liver diseases. The program has tripled in size during the past two years and now offers both liver–heart and liver–kidney dual-organ transplantation.
The program includes a robust multidisciplinary group of hepatobiliary and liver cancer specialists from across NYU Langone, says Nabil N. Dagher, MD, associate professor in the Department of Surgery, director of abdominal transplant surgery and the Transplant Surgery Fellowship. Dr. Dagher works closely with James S. Park, MD, associate professor in the Department of Medicine, director of the Asian Liver Health Program, and medical director of transplant hepatology, as well as other specialists in surgical and medical oncology, pathology, and interventional and diagnostic radiology.
Specialists offer liver surgery related to hepatitis B and C, cholestatic liver disease, sclerosing cholangitis, acute fulminant liver failure, hepatocellular carcinoma, and biliary tract disorders. In addition to conventional surgery, physicians are skilled in the latest minimally invasive techniques, notes Dr. Dagher, including laparoscopic and robotic-assisted procedures.
“With a one-year patient survival rate exceeding 94 percent, our liver transplant program ranks among the top in New York State,” says Dr. Dagher. “The wait-list mortality rate at NYU Langone is one of the lowest in the state even though the program is transplanting some of the sickest patients. This is due to the excellent multidisciplinary care each patient is provided and growing initiatives to expand the organ donor pool. These include the living donor program and transplanting hepatitis C positive and HIV positive donor livers.”
Antiviral Therapy during Pregnancy Key to Preventing HBV Transmission at Birth
Preventing mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) is recognized as one of the most effective strategies for eliminating HBV worldwide. However, management during pregnancy remains a challenge in countries with the highest infection rates, such as low-income areas of Africa and Asia.
In a comprehensive review article, NYU Langone researchers propose a multipronged approach to managing patients during pregnancy based on viral load—the single most important risk factor for MTCT. Co-authors James S. Park, MD, and world-renowned researcher Calvin Q. Pan, MD, clinical professor in the Department of Medicine, recommend that women with HBV DNA levels above 200,000 IU/mL be treated with antiviral therapy during pregnancy. The article was published online in Hepatology International in October 2017.
Initiating antiviral therapy in late pregnancy can prevent failure of postnatal immunization in infants—which occurs in 5 percent to 10 percent of cases when maternal HBV DNA levels exceed 200,000 IU/mL, Dr. Park and Dr. Pan note. The failure rate is substantially higher, up to 30 percent, among mothers with a high viral load.
Adopting a practical approach to reducing viral loads to below 200,000 IU/mL at delivery would be a major step toward eliminating HBV globally by 2030—the goal set by the World Health Organization, the authors state. In addition to receiving the HBV vaccination at birth, they recommend the following strategies for eradicating MTCT:
- universal screening of all pregnant mothers
- increased access to delivery in facilities with well-trained healthcare providers
- provision of early perinatal care to identify high-risk mothers and reduce maternal HBV DNA viral loads to below 200,000 IU/mL at delivery
- simplification of immunoprophylaxis regimens by developing potent new HBV vaccines
“HBV is a leading cause of cirrhosis and hepatocellular carcinoma, and preventing mother-to-child transmission is critical to reducing the global burden of these diseases,” says Dr. Park. “We need a risk stratification approach that minimizes adverse events from fetal exposure while maximizing the benefits of blocking transmission.”
Disclosures: Ira M. Jacobson, MD, reported grant and research support from Assembly Biosciences, Bristol-Myers Squibb, Enanta Pharmaceuticals, GENFIT, Gilead, and Janssen. He is also a consultant–advisor for AbbVie, Arrowhead Pharmaceuticals, Assembly Biosciences, Gilead, Intercept, Janssen, Merck, Novo Nordisk, and Spring Bank Pharmaceuticals. Calvin Q. Pan, MD, is a speaker and consultant for Gilead. James S. Park, MD, is a speaker and consultant for Gilead.