In autoimmune hepatitis - a disease that strikes both children and adults – the body’s immune system attacks the liver. Medications to suppress the immune system are used to treat this disease, but they have side effects. If left untreated, autoimmune hepatitis leads to liver failure and the need for a liver transplant.
Although genetic factors are thought to play a role in autoimmune hepatitis, doctors aren’t entirely sure what causes the disease. The prevalence of autoimmune disease appears to be higher in western cultures, where salt consumption is high. Animal studies suggest that a high-salt diet increases the production of certain cells known as Th17 cells that have been linked to worsening symptoms of autoimmune disease.
Pediatric Transplant Hepatologist Dr. Udeme Ekong, is looking at whether a high-salt diet may also play a role in autoimmune hepatitis. She is conducting a clinical trial for patients aged 1 through 65 who have been diagnosed with the condition to find out if a low-salt diet will reduce the number of Th17cells and hopefully reduce inflammation in the liver.
Study participants meet with a dietician so that a meal plan can be prepared according to what each person likes to eat. Participants are randomly placed in one of two groups: one group follows a normal diet, while the other group follows a low-salt diet. Yale provides all of the food for participants for two 10-day periods. In between, participants come to the clinic for collection of blood, urine and stool samples so that Dr. Ekong can look for changes in their blood cells. She is also examining changes in their microbiome - the normal bacteria that live in a person’s digestive tract – for changes that may be linked to autoimmune hepatitis.
“We’re looking for other ways to treat autoimmune hepatitis,” she said, noting that research often leads to new and better treatments. “A lot of the improvements we’ve been able to achieve in the level of care for various diseases have come about because of research.”
A lot of the improvements we’ve been able to achieve in the level of care for various diseases have come about because of research.
Dr. Udeme Ekong
In the early years of liver transplantation, liver transplants were performed exclusively using organs from deceased donors. For pediatric patients, this meant that there were very few livers available, so many children died waiting for transplants. This prompted doctors to look for alternatives and gave them the idea of using living donors for liver transplants. Today, living donor transplants are commonly performed and have saved the lives of many children and adults.
Dr. Ekong points out that clinical research has evolved over the years and there are many safety checks that are done both before a clinical trial begins and while it is taking place. Some studies have higher risks than others, but all studies are governed by strict federal regulations and are overseen by a special committee that evaluates safety. Some studies test new surgical techniques or medications, while others, such as her study on the role of salt in autoimmune hepatitis, look at lifestyle interventions.
“If we are able to show that a change in diet in some way improves autoimmune hepatitis, that’s something very worthwhile that we can add to the care of patients,” said Dr. Ekong.