Warfarin may prevent liver failure in hepatitis C

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Warfarin may prevent liver failure in hepatitis C

http://www.news-medical.net

Published: Thursday, 31-Jul-2008

warfarin may help prevent liver failure in thousands of people with

Hepatitis C, according to new research.

In a study published tomorrow (1 August) in the Journal of Thrombosis

and Haemostasis, researchers show that warfarin reduces the scarring

on the liver caused by Hepatitis C. This scarring, or fibrosis,

replaces normal liver cells and can lead to cirrhosis of the liver

and ultimately liver failure.

Following the new findings in mouse models, the Imperial College

Londonresearchers are now embarking on a clinical trial of warfarin

as a treatment for people with Hepatitis C, funded by the Medical

Research Council (MRC).

There are an estimated 300,000 people in the UK with chronic

Hepatitis C. The disease progresses much more quickly in some

patients than in others and around one in five of those infected will

develop cirrhosis.

Treatment to clear the infection is currently effective in only

around 50 percent of patients and can have considerable unpleasant

side effects such as fatigue, nausea and depression. If this

treatment fails, there are no currently effective therapies to slow

the progression of fibrosis.

The new research looks at how warfarin affects the progression of

fibrosis in mice with chronic liver injury. Warfarin is already used

to prevent and treat blood clots in people with artificial heart

valves, deep vein thrombosis, and a host of other conditions.

A previous study by the same researchers demonstrated that in

Hepatitis C, scarring of the liver accelerates in those patients who

are prone to form blood clots. This led the researchers to believe

that warfarin's anti-clotting properties might enable the drug to

fight the disease.

The new study showed that treatment with warfarin significantly

reduces the progression of fibrosis in normal mice with chronic liver

injury. It also shows that warfarin reduces the progression of

fibrosis in mice with chronic liver injury and a genetic mutation

known as Factor V Leiden (FVL), which causes fibrosis to progress at

a much faster rate than usual because it amplifies the body's

clotting mechanisms.

Professor Mark Thursz, one of the authors of the study from the

Division of Medicine at Imperial College London, said: " At the moment

there are a great many people with Hepatitis C who have no treatment

options left and it would transform their lives if we could prevent

them from developing liver failure. We are looking forward to seeing

the results of our upcoming trial in humans now that we've had such

promising results in the trial in mice. "

Dr Quentin Anstee, an MRC Clinical Research Fellow and the

corresponding author of the study from Imperial College London,

added: " If we have positive results from the new trial, we will have

a potential treatment that is already available and very cheap, and

which should be safe enough for people to take. If we are successful

in Hepatitis C patients, we are hopeful that such treatment might

benefit people with liver damage from other causes, and this is

something we would be keen to study further. "

The researchers are recruiting 90 patients for the new trial who have

undergone a liver transplant as a result of liver failure caused by

hepatitis C. A third of such patients progress very rapidly to

fibrosis following transplantation.

The researchers hope that treating these patients with warfarin will

prevent this liver damage and improve their prognosis. Transplant

patients have a liver biopsy every year following transplantation to

assess their progress, and the researchers will analyse data from

this biopsy to establish the effectiveness of the warfarin treatment.

The two-year trial will take place across five centres including

Imperial College Healthcare NHS Trust, which has integrated with

Imperial College London to form the UK's first Academic Health

Science Centre.

The trial is taking place in transplant patients because the

researchers estimate that it would take 10-15 years to conduct a

trial in patients in whom the disease was progressing at a normal

rate.