September 30, 2022 Looking ahead after ACLARA Connecting and strengthening relationships with the Latin American hepatology community is one of our strategic priorities. The ACLARA study set the framework to conduct large-scale investigations in Latin America and opened the possibility to establish future collaboration with tertiary care centers and university hospitals across the region

We were pleased to welcome Principal Investigator of the ACLARA study, Prof. Flair José Carrilho, this month at the EF CLIF Headquarters in Barcelona. During his visit, he met with Prof. Vicente Arroyo, Director of EF CLIF, and Prof. Richard Moreau, Emeritus Researcher at the French Institute of Health and Medical Research (INSERM), Consultant in Hepatology at Hôpital Beaujon, France, and Honorary Director of the Grifols Chair at EF CLIF, who acted as Principal Investigator for Europe for the ACLARA study. They hold long meetings with our data managers, biostatisticians and bioinformaticians to discuss further about the results of the ACLARA study and polish a manuscript that will be submitted shortly for publication.

Image: Flair José Carrilho and Vicente Arroyo. © European Foundation for the Study of Chronic Liver Failure.

Image: From left to right, Flair Carrilho, Yolanda Godoy (Scientific Assistant), Anna Bosch (General Manager), and Cristina Sanchez-Garrido (Head of the Data Management Center). © European Foundation for the Study of Chronic Liver Failure.

Working with hepatologists in Latin America

For us to broaden our research activities outside of Europe, we expanded our network in 2017, launching our first investigation ever conducted in Latin America to gain a global perspective on the epidemiology and pathophysiology of acute-on-chronic liver failure (ACLF). The ACLARA study aimed to determined the race differences in the prevalence and clinical course of ACLF in the Latin American population. This effort was greatly facilitated through the establishment of the ACLARA Consortium and the support of Prof. Carrilho, Hepatologist at Hospital das Clínicas da Universidade de São Paulo in Brazil.

Working with hepatologists in 51 hospitals from 7 countries, we were able to conduct such a large-scale study, recruiting 1247 patients. Clinical, laboratory, and demographic data were collected at enrollment and one-year follow-up. Biological samples where managed from a centralized office created ad hoc in São Paulo, Brazil, that worked as an extension of our Data Management Center. When the recruiting period was closed, the Data Management Center was able to import to Barcelona more than 100,000 aliquots from blood, serum, plasma, and urine to perform measurements in laboratory tests and multiomics.

Expanding our global research network

Building on this success we are developing new research activities in collaboration with our colleagues in Latin American centers. This experience has also allowed us to establish collaborative relationships with tertiary care centers and university hospitals worldwide.

Growing our network of regionally-based research coordinators will help us to conduct large, global-scale investigations to further our understanding of the epidemiology and pathophysiology of chronic liver disease. Our Global Projects chapter will better support our collaborators across different geographical regions and improve communication within each of the regions. With the launch of the CHANCE study we have been able to continue expanding our global research network. The CHANCE Consortium includes 80 centers in 28 countries across the world. To support research activities within CHANCE, we have appointed 15 Regional Coordinators each of which oversee activities within their region. Regional Coordinators in North America, Latin America, Europe, Asia and Oceania, help us to engage and provide support to the teams across their area. Overseeing ethical and legal approval processes and patient recruitment, Regional Coordinators are able to ensure effective coordination and communication of all relevant research activities and events related to the CHANCE study.

Building a global, collaborative future for liver disease research

Having put in place this structure in such a short time has represented a huge step forward for our consolidation and growth. We are now better equipped to achieve our ambition to become a global reference for the study of chronic liver disease.

As part of our research strategy, the ongoing CHANCE study will address important questions that remain unanswered. In collaboration with the European Society for Liver and Intestine Transplantation (ELITA) and the International Liver Transplantation Society (ILTS), this study aims to assess the potential benefits of liver transplantation for the treatment of patients with ACLF. This great collaborative research effort is expected to pave the way towards equitable access to liver transplantation for patients with ACLF grades 2 and 3.

Hospital das Clínicas da Universidade de São Paulo in Brazil is one of the centers that more patients has recruited within CHANCE since the start of the study. The team lead by Prof. Carrilho together with those in other Latin American centers in Argentina, Brazil,Colombia and Mexico are contributing greatly to the progress of the CHANCE study. We are confident that our approach to building bridges between countries will translate into shaping the future of liver disease research and patient care.

With Prof. Carrilho's visit we took the opportunity to celebrate our shared history and long-lasting friendship.