Monash gastroenterology research showcased at world’s largest scientific meeting

Dr Ray Boyapati

Monash research into inflammatory bowel disease (IBD) and acute variceal bleeding was presented in two oral presentations recently at the American Gastroenterological Association’s annual scientific meeting in Chicago—the largest international gathering of physicians, researchers and academics in the field.

Monash Health gastroenterologist Dr Ray Boyapati presented his research investigating the role of mitochondrial DNA as a damage associated molecular pattern (DAMP) in IBD. DAMPs are host molecules released from injured cells that can initiate an inflammatory response by binding to targets such as Toll-like receptors (TLRs) that activate immune cells.

In a world-first, Dr Boyapati and his team implicated mitochondrial damage and resultant mitochondrial DAMPs in IBD-related inflammation using multiple lines of evidence.

“We found elevated circulating mitochondrial DAMPs in human IBD and mouse models of colitis,” Dr Boyapati said.

Dr Boyapati’s other findings include the gut being a potential source of these mitochondrial genome fragments and that the cellular targets of mtDNA, such as TLR-9, are present in IBD.  He also found that genetic deletion of TLR-9 is protective in an animal model of colitis.

“Overall, these novel findings suggest a potential new avenue of investigation in IBD pathogenesis,” he said.

Dr Marcus Robertson

Also at the scientific meeting, Monash University’s Dr Marcus Robertson presented research relating to risk stratification of patients presenting with acute variceal bleeding.

A common emergency in patients with liver cirrhosis and portal hypertension, acute variceal bleeding has a published inpatient mortality risk of 14-43% despite current standards of care and remains a common cause of death in patients with cirrhosis.

Dr Robertson investigated whether patients presenting with acute variceal bleeding could be accurately risk assessed by a risk stratification score in the emergency department which may facilitate intensive treatment in those patients at highest risk and ultimately improve patient survival.

“By examining over 160 patients presenting to Monash Health and Austin Health with variceal bleeding, we found that the AIMS65 risk stratification score (a simple score which assigns 1 point for each of the following: albumin level < 30g/L, INR > 1.5, altered mental status, systolic blood pressure < 90mmHg and age > 65 years) very accurately predicts inpatient mortality,” Dr Robertson said.

“No patient with an AIMS65 score of 0 passed away, while patients with an AIMS65 score of 3 or 4 had a mortality rate of 34% and 57% respectively."