For now, liver transplant is the only cure for hepatocellular carcinoma, the most common liver cancer in the United States. Patients with cirrhosis are most likely to develop hepatocellular carcinoma. It is expected to become even more common, since obesity, along with drug and alcohol use disorders, is a primary cause of cirrhosis. Clinician-scientist Christie Binder, M.D., Ph.D., a resident in the School of Medicine Department of Radiation Medicine, is on a mission to find a way to detect this cancer in its early stages, something that can make a real difference in prognosis.
What are you researching now—and why does it matter?
I’m looking for biomarkers in urine that would help us detect hepatocellular carcinoma at an early stage, when treatments make a real difference in survival.
Hepatocellular carcinoma, or HCC, is a leading cause of death worldwide, particularly in low-income countries. Right now, we diagnose it using ultrasound or, in patients with obesity, a CAT scan or MRI. This kind of imaging is expensive and requires trained medical staff, something that is challenging in rural areas and developing countries. A urine test could have a real impact — it would be less expensive and urine samples can be mailed to a lab from anywhere.
Obesity and drug and alcohol use disorders are the primary causes of cirrhosis, which is the primary risk factor for this cancer. Because of the obesity epidemic, the incidence of HCC is expected to double in the next 25 to 30 years. Having an early detection method that is not too expensive would be an important breakthrough for a lot of patients.
What’s been your most exciting moment in discovery?
Before liver biomarkers make it to the urine for us to find them, the liver releases extracellular vesicles that enter the blood and get filtered by the kidney. We need vesicles to go through that process but stay in the urine. We weren’t sure we’d be able identify markers in the urine that are specific to the liver. So before we began the research, we needed to know if we could do that. And we did — we identified liver-specific markers. So that was very exciting. If we can identify liver-specific markers, we can measure and evaluate them to determine if any are associated with HCC.
What’s your day-to-day life as a researcher look like?
I’m a clinician scientist and spend a lot of time in clinics. In my role as a scientist, mostly I’ve been collecting the urine samples.
For me, each urine sample is so valuable. I’ve talked with the patients and explained the study. It’s powerful when they agree to take part in the study – it isn’t going to help them, but they want to help other people. Then they give me a part of their body and entrust me with it to try and help other people.
What’s next? This is a pilot study. If we identify candidate urinary biomarkers for hepatocellular carcinoma, the next step would be a larger validation study. That could involve following these people through time and see how these markers behave as people progress through the process of being cirrhotic to having HCC. But that’s an ideal outcome and in the future. Our goal is to get good leads in order to justify doing a large trial.
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