The research program of Jorge Rakela, M.D., is focused on the treatment of acute and chronic liver diseases.
- Treatment of hepatitis C and hepatitis B. Dr. Rakela is actively participating in evaluating the safety and efficacy of new agents — direct-acting antivirals (DAAs) — in the treatment of chronic hepatitis C.
He and his colleagues are active participants in Mayo Clinic's liver transplant program, where about 40 percent of the candidates are infected with hepatitis C virus (HCV). The recurrence of HCV after transplantation is almost universal; this observation has stimulated Dr. Rakela and his colleagues to seek effective preventive measures and treatment of HCV reinfection. The new antiviral agents, DAAs, are being evaluated in the setting of recurrent HCV infection after transplantation.
Dr. Rakela is also evaluating new agents for the treatment of chronic hepatitis B. These new treatment modalities, although more efficacious, are accompanied by a higher rate of adverse events and the possibility that resistant viral strains could emerge. Dr. Rakela and his colleagues are setting up a focused team to treat patients with new treatment modalities, manage untoward effects from these treatments and monitor the emergence of resistant viral strains.
- Applications of cardiotrophin-1 (CT-1). Dr. Rakela and his colleagues are collaborating with the gene therapy team of the University of Navarra in Pamplona, Spain, with a special interest in the potential clinical application of CT-1. CT-1 is an effective hepatocyte protector agent that would also stimulate hepatic regeneration.
There are phase I studies being conducted in Europe, and Dr. Rakela and his fellow researchers are planning a trial designed to assess the safety and efficacy of CT-1 in acute liver failure. They are collaborating with the University of Texas Southwestern in Dallas and the Acute Liver Failure Study Group (ALFSG), a National Institutes of Health-sponsored clinical research network, to evaluate CT-1 in patients with acute hepatic failure in a multicenter trial among participants of the ALFSG.
- Evaluation of liver fibrosis. Dr. Rakela and his group have obtained research support for a collaborative project with TGen in Phoenix to investigate the diagnostic and prognostic value of microRNA patterns among patients with varying degrees of fibrosis. The aim is to evaluate patterns of microRNA as a substitute to liver biopsy in determining the degree of liver fibrosis present in a patient with chronic liver disease.
Significance to patient care
Dr. Rakela is working to assess whether CT-1 would be an effective therapeutic agent as a hepatocyte protector and stimulant of hepatic regeneration in the setting of fulminant hepatitis. He is also assessing the viability of a transplantable recellularized liver graft in the setting of acute hepatic failure.