Imperial College London

ProfessorNagyHabib

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Hepatobiliary Surgery
 
 
 
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Contact

 

+44 (0)20 3313 8574nagy.habib

 
 
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Assistant

 

Mrs Benita White +44 (0)7960 986 387

 
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Location

 

BN1/18 B BlockHammersmith HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

474 results found

Gavriilidis P, Sutcliffe RP, Roberts KJ, Pai M, Spalding D, Habib N, Jiao LR, Sodergren MHet al., 2020, No difference in mortality among ALPPS, two-staged hepatectomy, and portal vein embolization/ligation: A systematic review by updated traditional and network meta-analyses, HEPATOBILIARY & PANCREATIC DISEASES INTERNATIONAL, Vol: 19, Pages: 411-419, ISSN: 1499-3872

Journal article

Debacker AJ, Voutila J, Catley M, Blakey D, Habib Net al., 2020, Delivery of Oligonucleotides to the Liver with GalNAc: From Research to Registered Therapeutic Drug, MOLECULAR THERAPY, Vol: 28, Pages: 1759-1771, ISSN: 1525-0016

Journal article

Sodergren MH, Mangal N, Wasan H, Sadanandam A, Balachandran VP, Jiao LR, Habib Net al., 2020, Immunological combination treatment holds the key to improving survival in pancreatic cancer, JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY, Vol: 146, Pages: 2897-2911, ISSN: 0171-5216

Journal article

Sarker D, Plummer R, Meyer T, Sodergren MH, Basu B, Chee CE, Huang K-W, Palmer DH, Ma YT, Evans TRJ, Spalding DRC, Pai M, Sharma R, Pinato DJ, Spicer J, Hunter S, Kwatra V, Nicholls JP, Collin D, Nutbrown R, Glenny H, Fairbairn S, Reebye V, Voutila J, Dorman S, Andrikakou P, Lloyd P, Felstead S, Vasara J, Habib R, Wood C, Saetrom P, Huber HE, Blakey DC, Rossi JJ, Habib Net al., 2020, MTL-CEBPA, a small activating RNA therapeutic upregulating C/EBP-α, in patients with advanced liver cancer: a first-in-human, multicenter, open-label, phase I trial, Clinical Cancer Research, Vol: 26, Pages: 3936-3946, ISSN: 1078-0432

PURPOSE: Transcription factor C/EBP-α (CCAAT/enhancer-binding protein alpha) acts as a master regulator of hepatic and myeloid functions and multiple oncogenic processes. MTL-CEBPA is a first-in-class small activating RNA oligonucleotide drug that upregulates C/EBP-α. PATIENTS AND METHODS: We conducted a phase I, open-label, dose-escalation trial of MTL-CEBPA in adults with advanced hepatocellular carcinoma (HCC) with cirrhosis, or resulting from nonalcoholic steatohepatitis or with liver metastases. Patients received intravenous MTL-CEBPA once a week for 3 weeks followed by a rest period of 1 week per treatment cycle in the dose-escalation phase (3+3 design). RESULTS: Thirty-eight participants have been treated across six dose levels (28-160 mg/m2) and three dosing schedules. Thirty-four patients were evaluable for safety endpoints at 28 days. MTL-CEBPA treatment-related adverse events were not associated with dose, and no maximum dose was reached across the three schedules evaluated. Grade 3 treatment-related adverse events occurred in nine (24%) patients. In 24 patients with HCC evaluable for efficacy, an objective tumor response was achieved in one patient [4%; partial response (PR) for over 2 years] and stable disease (SD) in 12 (50%). After discontinuation of MTL-CEBPA, seven patients were treated with tyrosine kinase inhibitors (TKIs); three patients had a complete response with one further PR and two with SD. CONCLUSIONS: MTL-CEBPA is the first saRNA in clinical trials and demonstrates an acceptable safety profile and potential synergistic efficacy with TKIs in HCC. These encouraging phase I data validate targeting of C/EBP-α and have prompted MTL-CEBPA + sorafenib combination studies in HCC.

Journal article

Kumar J, Habib NAGY, Huang KAI, Warwick JANE, MAURO P, ARASARADNAM Ret al., 2020, Immunological basis of genesis of hepatocellular carcinoma: unique challenges and potential opportunities through immunomodulation, Vaccines, Vol: 8, ISSN: 2076-393X

A majority of hepatocellular carcinoma (HCC) develops in the setting of persistent chronic inflammation as immunological mechanisms have been shown to play a vital role in the initiation, growth and progression of tumours. The index review has been intended to highlight ongoing immunological changes in the hepatic parenchyma responsible for the genesis and progression of HCC. The in-situ vaccine effect of radiofrequency (RF) is through generation tumour-associated antigens (TAAs), following necrosis and apoptosis of tumour cells, which not only re-activates the antitumour immune response but can also act in synergism with checkpoint inhibitors to generate a superlative effect with intent to treat primary cancer and distant metastasis. An improved understanding of oncogenic responses of immune cells and their integration into signaling pathways of the tumour microenvironment will help in modulating the antitumour immune response. Finally, we analyzed contemporary literature and summarised the recent advances made in the field of targeted immunotherapy involving checkpoint inhibitors along with RF application with the intent to reinstate antitumour immunity and outline future directives in very early and early stages of HCC.

Journal article

Sarker D, Sodergren M, Plummer ER, Basu B, Meyer T, Huang K-W, Evans TRJ, Spalding D, Ma YT, Palmer DH, Chee CE, Pinato DJ, Reebye V, McVeigh D, Raulf N, Vasara J, Andrikakou P, Habib R, Blakey D, Habib NAet al., 2020, Phase Ib dose escalation and cohort expansion study of the novel myeloid differentiating agent MTL-CEBPA in combination with sorafenib in patients with advanced hepatocellular carcinoma (HCC)., Publisher: AMER SOC CLINICAL ONCOLOGY, ISSN: 0732-183X

Conference paper

da Costa AC, Sodergren M, Jayant K, Santa Cruz F, Spalding D, Pai M, Habib Net al., 2020, Radiofrequency combined with immunomodulation for hepatocellular carcinoma: State of the art and innovations, WORLD JOURNAL OF GASTROENTEROLOGY, Vol: 26, Pages: 2040-2048, ISSN: 1007-9327

Journal article

Jayant K, Habib N, Huang KW, Warwick J, Arasaradnam Ret al., 2020, Recent Advances: The Imbalance of Immune Cells and Cytokines in the Pathogenesis of Hepatocellular Carcinoma, DIAGNOSTICS, Vol: 10

Journal article

Reebye V, Vasara J, Raulf N, Hashimoto A, Jarvis S, Andrikakou P, Habib R, Blakey D, Gabrilovich D, Rossi J, Habib Net al., 2020, Therapeutic saRNAstargeting CEBPA in Myeloid Cells. A potential Immunomodulatoryswitch for Anticancer Therapy, 23rd Annual Meeting of the American-Society-for-Gene-and-Cell-Therapy, Publisher: CELL PRESS, Pages: 51-52, ISSN: 1525-0016

Conference paper

Huang K-W, Reebye V, Czysz K, Ciriello S, Dorman S, Reccia I, Lai H-S, Peng L, Kostomitsopoulos N, Nicholls J, Habib RS, Tomalia DA, Saetrom P, Wilkes E, Cutillas P, Rossi JJ, Habib NAet al., 2020, Liver activation of hepatocellular nuclear factor-4 alpha by small activating RNA rescues dyslipidemia and improves metabolic profile, Molecular Therapy : Nucleic Acids, Vol: 19, Pages: 361-370, ISSN: 2162-2531

Non-alcoholic fatty liver disease (NAFLD) culminates in insulin resistance and metabolic syndrome. Because there are no approved pharmacological treatment agents for non-alcoholic steatohepatitis (NASH) and NAFLD, different signaling pathways are under investigation for drug development with the focus on metabolic pathways. Hepatocyte nuclear factor 4-alpha (HNF4A) is at the center of a complex transcriptional network where its disruption is directly linked to glucose and lipid metabolism. Resetting HNF4A expression in NAFLD is therefore crucial for re-establishing normal liver function. Here, small activating RNA (saRNA) specific for upregulating HNF4A was injected into rats fed a high-fat diet for 16 weeks. Intravenous delivery was carried out using 5-(G5)-triethanolamine-core polyamidoamine (PAMAM) dendrimers. We observed a significant reduction in liver triglyceride, increased high-density lipoprotein/low-density lipoprotein (HDL/LDL) ratio, and decreased white adipose tissue/body weight ratio, all parameters to suggest that HNF4A-saRNA treatment induced a favorable metabolic profile. Proteomic analysis showed significant regulation of genes involved in sphingolipid metabolism, fatty acid β-oxidation, ketogenesis, detoxification of reactive oxygen species, and lipid transport. We demonstrate that HNF4A activation by oligonucleotide therapy may represent a novel single agent for the treatment of NAFLD and insulin resistance.

Journal article

Clift A, Frilling A, Braat A, Alsafi A, Wasan H, Al-Nahhas A, Thomas R, Drymousis P, Habib N, Tait Pet al., 2020, Radioembolization for Neuroendocrine Liver Metastases: An Institutional Case Series, Systematic Review and Meta-Analysis, 17th Annual European-Neuroendocrine-Tumor-Society (ENETS) Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, Publisher: KARGER, Pages: 223-223, ISSN: 0028-3835

Conference paper

Sarker D, Sodergren M, Plummer ER, Basu B, Meyer T, Huang K-W, Evans TRJ, Spalding D, Ma YT, Palmer DH, Chee CE, Pinato DJ, Reebye V, McVeigh D, Raulf N, Vasara J, Andrikakou P, Habib R, Blakey D, Habib NAet al., 2020, First-in-human phase I trial of small activating RNA (saRNA) oligonucleotide MTL-CEBPA in combination with sorafenib in patients with advanced hepatocellular carcinoma (HCC), Gastrointestinal Cancers Symposium of the American-Society-of-Clinical-Oncology, Publisher: AMER SOC CLINICAL ONCOLOGY, ISSN: 0732-183X

Conference paper

Yoon S, Huang K-W, Andrikakou P, Vasconcelos D, Swiderski P, Reebye V, Sodergren M, Habib N, Rossi JJet al., 2019, Targeted delivery of C/EBP alpha-saRNA by RNA aptamers shows anti-tumor effects in a mouse model of advanced PDAC, Molecular Therapy : Nucleic Acids, Vol: 18, Pages: 142-154, ISSN: 2162-2531

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies; it preferentially metastasizes to the liver and is the main cause of death from this disease. In previous studies, small activating RNA against CCAAT/enhancer-binding protein-α (C/EBPα-saRNA) demonstrated efficacy of PDAC in a local subcutaneous tumor model. In this study, we focused on the efficacy of C/EBPα-saRNA in advanced stage PDAC. For targeted delivery, we selected a new anti-transferrin receptor aptamer (TR14), which demonstrated a high binding affinity to target proteins. The TR14 aptamer was internalized with clathrin-mediated endocytosis, distributed in early endosome, late endosome, and lysosome subcellularly. To investigate its anti-tumor effects to advanced PDAC, we conjugated C/EBPα-saRNA to TR14. Treatment of pancreatic cancer cells with the conjugates upregulated expression of C/EBPα and its downstream target p21, and inhibited cell proliferation. For in vivo assays, we established an advanced PDAC mouse model by engrafting luciferase reporter-PANC-1 cells directly into the livers of non-obese diabetic/severe combined immunodeficiency (NOD/SCID) mice. After treatment of aptamer-C/EBPα conjugates, we observed significant reduction of tumor growth in this advanced PDAC mouse model. Combinational treatment of the conjugates with gemcitabine also demonstrated enhanced anti-tumor effects in advanced PDAC. This suggests that aptamer-C/EBPα conjugates could be used as an adjuvant, along with other conventional anti-cancer drugs in advanced PDAC. In conclusion, targeted delivery of C/EBPα-saRNAs by aptamers might have potential therapeutic effects in advanced PDAC.

Journal article

Sodergren M, Tan C, Reebye V, Habib R, Blakey D, Habib Net al., 2019, Targeting myeloid-derived suppressor cells and T cells: Combination treatment with MTL-CEBPA and PD-1 antibody in a mouse syngeneic CT26 model, 44th Congress of the European-Society-for-Medical-Oncology (ESMO), Publisher: OXFORD UNIV PRESS, ISSN: 0923-7534

Conference paper

Sarker D, Plummer R, Basu B, Meyer T, Ma Y-T, Evans J, Palmer DH, Huang K-W, Chee E, Spalding D, Sodergren M, Habib Net al., 2019, First-in-human, first-in-class phase I study of MTL-CEBPA, a RNA oligonucleotide targeting the myeloid cell master regulator C/EBP-alpha, in patients with advanced hepatocellular cancer (HCC), 44th Congress of the European-Society-for-Medical-Oncology (ESMO), Publisher: OXFORD UNIV PRESS, Pages: 168-+, ISSN: 0923-7534

Conference paper

Patel BY, White L, Howard AM, Tait P, Thomas R, Habib N, Pai M, Spalding D, Gall T, Jiao Let al., 2019, A Retrospective Analysis of Portal Vein Embolisation In A Tertiary Hepato Pancreato Biliary Centre, International Surgical Conference of the Association-of-Surgeons-in-Training (ASIT), Publisher: WILEY, Pages: 74-74, ISSN: 0007-1323

Conference paper

Brian BF, Jolicoeur AS, Guerrero CR, Nunez MG, Sychev ZE, Hegre SA, Saetrom P, Habib N, Drake JM, Schwertfeger KL, Freedman TSet al., 2019, Unique-region phosphorylation targets LynA for rapid degradation, tuning its expression and signaling in myeloid cells, ELIFE, Vol: 8, ISSN: 2050-084X

Journal article

Habib NA, Huang K-W, Reebye V, Sodergren M, Rossi Jet al., 2019, MTLCEBPA, a drug candidate for hepatocellular-carcinoma enhances efficacy of Sorafenib, Annual Meeting of the American-Association-for-Cancer-Research (AACR), Publisher: AMER ASSOC CANCER RESEARCH, ISSN: 0008-5472

Conference paper

Frilling A, Clift AK, Braat AJAT, Alsafi A, Wasan HS, Al-Nahhas A, Thomas R, Drymousis P, Habib N, Tait PNet al., 2019, Radioembolisation with 90Y microspheres for neuroendocrine liver metastases: an institutional case series, systematic review and meta-analysis, HPB, Vol: 21, Pages: 773-783, ISSN: 1365-182X

BACKGROUND: Neuroendocrine liver metastases are clinically challenging due to their frequent disseminated distribution. This study aims to present a British experience with an emerging modality, radioembolisation with yttrium-90 labelled microspheres, and embed this within a meta-analysis of response and survival outcomes. METHODS: A retrospective case series of patients treated with SIR-Spheres (radiolabelled resin microspheres) was performed. Results were included in a systematic review and meta-analysis of published results with glass or resin microspheres. Objective response rate (ORR) was defined as complete or partial response. Disease control rate (DCR) was defined as complete/partial response or stable disease. RESULTS: Twenty-four patients were identified. ORR and DCR in the institutional series was 14/24 and 21/24 at 3 months. Overall survival and progression-free survival at 3-years was 77.6% and 50.4%, respectively. There were no grade 3/4 toxicities post-procedure. A fixed-effects pooled estimate of ORR of 51% (95% CI: 47%-54%) was identified from meta-analysis of 27 studies. The fixed-effects weighted average DCR was 88% (95% CI: 85%-90%, 27 studies). CONCLUSION: Current data demonstrate evidence of the clinical effectiveness and safety of radioembolisation for neuroendocrine liver metastases. Prospective randomised studies to compare radioembolisation with other liver directed treatment modalities are needed.

Journal article

Sodergren MH, Huang K-W, Reebye V, Chee C-E, Zacharoulis D, Habib R, Blakey D, Rossi J, Habib Net al., 2019, MTL-CEBPA combined with radiofrequency ablation and immunotherapy enhances immunological anti-tumour response in an HCC mouse model, Annual Meeting of the American-Association-for-Cancer-Research (AACR), Publisher: AMER ASSOC CANCER RESEARCH, ISSN: 0008-5472

Conference paper

Janikashvili N, Jayant K, Kikodze N, Mazmishvili K, Pantsulaia I, Sandhu B, Podda M, Iobadze M, Azrumelashvili T, Mizandari M, Habib N, Chikovani Tet al., 2019, Immunomodulatory changes following isolated RF ablation in colorectal liver metastases: a case report, Medicines, Vol: 6, ISSN: 2305-6320

Background: Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths in developed countries. The liver is the most prevalent site of metastasis from CRC. Currently, the gold-standard treatment for colorectal liver metastases (CLMs) is surgical resection. However, depending on the pattern of the disease, a significant number of patients may require different approaches alone or in combination with surgery, including thermal ablation (radiofrequency (RFA) or microwave (MWA) ablation) or transarterial liver-directed therapies, although the latter is not yet part of the standard treatment for CRC liver metastases. Methods and Results: We present the case of a 63-yearold man with bilobar CLM who was treated with transarterial embolization (TAE) and RFA followed by chemotherapy. A post-RFA study of immune parameters revealed the downregulation of CD39 expression in the circulating CD4+ T cell population and a reduction of the serum levels of cytokines IL-10, TGF-β, IFN-gamma and IL-17, which positively correlated with the diminished serum level of gamma-glutamyl transferase (GGT) and the subdued inflammatory markers: the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). Later, the patient underwent chemotherapy. Liver failure developed within two years and nine months following tumour ablation, leading to the death of the patient. Conclusions: However, the denial of adjuvant chemotherapy by the patient gave us the opportunity to assess the immunomodulatory changes following RFA in the absence of any other therapeutic modalities.

Journal article

Zhou J, Li H, Xia X, Herrera A, Pollock N, Reebye V, Sodergren MH, Dorman S, Littman BH, Doogan D, Huang K-W, Habib R, Blakey D, Habib NA, Rossi JJet al., 2019, Anti-inflammatory activity of MTL-CEBPA, a small activating RNA drug, in LPS-stimulated monocytes and humanized mice, Molecular Therapy, Vol: 27, Pages: 999-1016, ISSN: 1525-0016

Excessive or inappropriate inflammatory responses can cause serious and even fatal diseases. The CCAAT/enhancer-binding protein alpha (CEBPA) gene encodes C/EBPα, a transcription factor that plays a fundamental role in controlling maturation of the myeloid lineage and is also expressed during the late phase of inflammatory responses when signs of inflammation are decreasing. MTL-CEBPA, a small activating RNA targeting for upregulation of C/EBPα, is currently being evaluated in a phase 1b trial for treatment of hepatocellular carcinoma. After dosing, subjects had reduced levels of pro-inflammatory cytokines, and we therefore hypothesized that MTL-CEBPA has anti-inflammatory potential. The current study was conducted to determine the effects of C/EBPα saRNA - CEBPA-51 - on inflammation in vitro and in vivo after endotoxin challenge. CEBPA-51 led to increased expression of the C/EBPα gene and inhibition of pro-inflammatory cytokines in THP-1 monocytes previously stimulated by E. coli-derived lipopolysaccharide (LPS). Treatment with MTL-CEBPA in an LPS-challenged humanized mouse model upregulated C/EBPα mRNA, increased neutrophils, and attenuated production of several key pro-inflammatory cytokines, including TNF-α, IL-6, IL-1β, and IFN-γ. In addition, a Luminex analysis of mouse serum revealed that MTL-CEBPA reduced pro-inflammatory cytokines and increased the anti-inflammatory cytokine IL-10. Collectively, the data support further investigation of MTL-CEBPA in acute and chronic inflammatory diseases where this mechanism has pathogenic importance.

Journal article

Zhao X, Reebye V, Hitchen P, Fan J, Jiang H, Saetrom P, Rossi J, Habib NA, Huang K-Wet al., 2019, Mechanisms involved in the activation of C/EBP alpha by small activating RNA in hepatocellular carcinoma, ONCOGENE, Vol: 38, Pages: 3446-3457, ISSN: 0950-9232

Journal article

Habib NA, Sodergren M, Reebye V, Habib R, Blakey D, Rossi JJ, Huang K-Wet al., 2019, Drug Candidate MTL-CEBPA Sensitises Solid Tumours to Standard of Care Therapies, 22nd Annual Meeting of the American-Society-of-Gene-and-Cell-Therapy (ASGCT), Publisher: CELL PRESS, Pages: 333-333, ISSN: 1525-0016

Conference paper

Huang KW, Jayant K, Lee P-H, Yang P-C, Hsiao C-Y, Habib N, Sodergren MHet al., 2019, Positive immuno-modulation following radiofrequency assisted liver resection in hepatocellular carcinoma, Journal of Clinical Medicine, Vol: 8, ISSN: 2077-0383

Introduction: Hepatocellular carcinoma (HCC) often develops on a background of chronic inflammation and a complex immunosuppressive network with increased regulatory T cells, impaired CD8+ T cells and the secretion of immunosuppressive cytokines. Previous clinical studies have reported a superior disease-free survival (DFS) following a radiofrequency-based ablation or resection in HCC tumours compared to conventional liver resection techniques. The aim of this study was to investigate whether there is any correlation with the use of a radiofrequency-assisted liver resection and clinical outcome. Material and Methods: Patients’ peripheral blood was collected prior and 7 days following surgery from patients undergoing a liver resection for HCC. There were 5 liver resections performed using CUSA and 6 liver resections with the RF-based device, HabibTM 4X. The primary endpoint of the study was to assess the immunological parameters of circulating immune cell populations as well as serum cytokines. The Student’s t-test, chi-square or Fisher’s Exact test were applied for statistical comparisons, as appropriate. Results: Patients undergoing an RF-assisted liver resection with HabibTM 4X had a significant decrease in the inhibitory Treg cells (p = 0.002) and a significant increase in CD8+ T lymphocytes (p = 0.050) and CD4+CD45RO+/CD4+ memory T cells (p = 0.002) compared to those patients undergoing a liver resection with CUSA. It was also noted that the RF-assisted liver resection group had a significant decrease in circulating TGF-ß (p = 0.000), IL10 (p = 0.000) and a significant increase in IFN-gamma (p = 0. 027) and IL-17 compared to the CUSA group. Conclusion: A liver resection with RF-based device HabibTM 4X was associated with positive immunomodulatory changes in circulating immune cells and circulating cytokines which could explain the significant improvement in DFS.

Journal article

Yoon S, Wu X, Armstrong B, Habib N, Rossi JJet al., 2019, An RNA Aptamer Targeting the Receptor Tyrosine Kinase PDGFR alpha Induces Anti-tumor Effects through STAT3 and p53 in Glioblastoma, MOLECULAR THERAPY-NUCLEIC ACIDS, Vol: 14, Pages: 131-141, ISSN: 2162-2531

Journal article

Kwok A, Raulf N, Habib N, 2019, Developing small activating RNA as a therapeutic: current challenges and promises., Ther Deliv, Vol: 10, Pages: 151-164

RNA activation (RNAa) allows specific gene upregulation mediated by a small activating RNA (saRNA). Harnessing this process would help in developing novel therapeutics for undruggable diseases. Since its discovery in mid 2000s, improvements of saRNA design, synthetic chemistry and understanding of the biology have matured the way to apply RNAa. Indeed, MiNA therapeutics Ltd has conducted the first RNAa clinical trial for advanced hepatocellular carcinoma patients with promising outcomes. However, to fully realize the RNAa potential better saRNA delivery strategies are needed to target other diseases. Currently, saRNA can be delivered in vivo by lipid nanoparticles, dendrimers, lipid and polymer hybrids and aptamers. Further developing these delivery technologies and novel application of RNAa will prove to be invaluable for new treatment development.

Journal article

Jiao LR, Fajardo Puerta AB, Gall TMH, Sodergren MH, Frampton AE, Pencavel T, Nagendran M, Habib NA, Darzi A, Pai M, Thomas R, Tait Pet al., 2019, Rapid induction of liver regeneration for major hepatectomy (REBIRTH): A randomized controlled trial of portal vein embolisation versus ALPPS assisted with radiofrequency., Cancers, Vol: 11, ISSN: 2072-6694

To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency (RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPS for the pre-operative manipulation of liver volume in patients with a future liver remnant volume (FLRV) ≤25% (or ≤35% if receiving preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length and post-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS (n = 29) and PVE (n = 28). The mean percentage of increase in the FLRV was 80.7 ± 13.7% after a median 20 days following RALPPS compared to 18.4 ± 9.8% after 35 days (p < 0.001) following PVE. Twenty-four patients after RALPPS and 21 after PVE underwent stage-2 operation. Final resection was achieved in 92.3% and 66.6% patients in RALPPS and PVE, respectively (p = 0.007). There was no difference in morbidity, and one 30-day mortality after RALPPS (p = 0.991) was reported. RALPPS is more effective than PVE in increasing FLRV and the number of patients for surgical resection.

Journal article

Jiao LR, Fajardo Puerta AB, Gall T, Sodergren M, Frampton A, Pencavel T, Nagendran M, Habib NA, Darzi A, Pai M, Thomas R, Tait Pet al., 2019, Rapid induction of liver hypertrophy for major hepatecomy:PVE vs RAPPS - a randominsed clinical trial, Cancers, ISSN: 2072-6694

To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency(RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPSfor pre-operative manipulation of liver volume in patients with a FLRV ≤25% (≤35% if preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length andpost-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS(n=29) and PVE (n=28). The mean percentage of increase in the FLRV was 80·713·7% after a median 20 days followingRALPPScompared to 18·49·8% after 35 days (p<0.001) following PVE. Twenty-four patients after RALPPSand 21 after PVE underwent stage 2 operation. Final resection was achieved in 92·3% and 66·6% patients in RALPPSand PVE, respectively (p=0.007). There was no difference in morbidity and one 30-day mortality after RALPPS(p=0·991). RALPPSis more effective than PVE in increasing FLRV and the number of patients for surgicalresection.

Journal article

Gall TMH, Gerrard G, Frampton AE, Castellano L, Ahmad R, Habib N, Spalding D, Pai M, Foroni L, Jiao LRet al., 2019, Can we predict long-term survival in resectable pancreatic ductal adenocarcinoma?, Oncotarget, Vol: 10, Pages: 696-706, ISSN: 1949-2553

Objective: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive tumour associated with poor 5-year survival. We aimed to determine factors which differentiate short and long-term survivors and identify a prognostic biomarker. Methods: Over a ten-year period, patients with resected PDAC who developed disease recurrence within 12 months (Group I) and those who had no disease recurrence for 24 months (Group II) were identified. Clinicopathological data was analysed. Ion Torrent high-throughput sequencing on DNA extracted from FFPE tumour samples was used to identify mutations. Additionally, peripheral blood samples were analysed for variants in cell-free DNA, circulating tumour cells (CTCs), and microRNAs. Results: Multivariable analysis of clinicopathological factors showed that a positive medial resection margin was significantly associated with short disease-free survival (p = 0.007). Group I patients (n = 21) had a higher frequency of the KRAS mutant mean variant allele (16.93% ± 11.04) compared to those in Group II (n = 13; 7.55% ± 5.76, p = 0.0078). Group I patients also trended towards having a KRAS c.35G>A p.Gly12Asp mutation in addition to variants in other genes, such as TP53, CDKN2A, and SMAD4. Mutational status of cell-free DNA, and number of CTCs, was not found to be useful in this study. A circulating miRNA (hsa-miR-548ah-5p) was found to be significantly differentially expressed. Conclusions: Medial resection margin status and the frequency of KRAS mutation in the tumour tissue are independent prognostic indicators for resectable PDAC. Circulating miRNA hsa-miR-548ah-5p has the potential to be used as a prognostic biomarker.

Journal article

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