Dr Afolabi Akanbi
Research Officer, Gallipoli Medical Research
On my way to work one morning, I noticed a billboard with large words printed across it: It is my choice. It struck me as an unusual statement to see on a billboard, and as I kept driving, I found myself wondering whether it was really true. The more I thought about it, the more I realised that in many ways it is. Our careers, the problems we choose to work on, and the impact we hope to make often begin with a simple decision to say ‘yes’.
For me, it was the decision to pursue research and to contribute, even in a small way, to improving treatments for people living with chronic liver diseases.
One of the most common of these conditions is Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), commonly referred to as fatty liver disease, which affects more than one in four Australians. As the name suggests, it occurs when excess fat accumulates in liver cells, typically when more than five percent of the liver is made up of fat.
Over time, this can interfere with how the liver functions and may lead to inflammation, scarring of the liver, and in severe cases, cirrhosis or liver cancer. Fatty liver disease is strongly linked to obesity, type 2 diabetes and other metabolic conditions, making it a growing health concern, which reinforces the need for effective treatments.
Our research group has also been interested in how iron levels in the body may influence the progression of fatty liver disease. This is particularly important for people with hereditary haemochromatosis, a genetic condition most often caused by mutations in the high iron (HFE) gene.
Individuals with this condition absorb too much iron from their diet, and much of that iron accumulates in the liver. Excess iron in the liver can worsen tissue injury and may accelerate the progression of liver disease.
Until recently, the main approach to managing fatty liver disease focused largely on lifestyle changes. Improvements in diet, particularly adopting a Mediterranean-style diet, reducing refined carbohydrates and sugar, and increasing physical activity remain important strategies. More recently, medications such as GLP-1 receptor agonists have shown promising results in reducing body weight and liver fat.
For people with hereditary haemochromatosis, the standard treatment remains phlebotomy, the removal of blood to reduce iron levels in the body. While effective, this approach can be inconvenient for patients and may lead to fatigue, dizziness, or vein damage with repeated procedures.
During my PhD, under the supervision of Dr Kim Bridle and Professor Darrell Crawford, we explored a therapeutic strategy that could potentially address both excess liver iron and liver fat at the same time. In our preclinical studies, we investigated a treatment that showed encouraging effects in reducing liver iron levels while also improving fatty liver disease.
Building on this work, our current research is exploring whether messenger RNA (mRNA) technology can be used as a delivery platform for this therapeutic approach. Using preclinical models, we are investigating whether this method can safely and effectively reduce liver iron and liver fat, ultimately improving liver health.
Research often moves forward in small steps, and many questions remain to be answered. But each experiment, each dataset, and each new idea contributes to a larger effort to better understand disease and develop improved treatments.
Looking back at that billboard phrase ‘It is my choice’, I was reminded that choosing a life in research is not always the easiest path, but it is a meaningful one. It is the choice to remain curious, to persist through uncertainty, and to keep searching for answers that may one day improve, and save, the lives of patients.
And for me, that is a choice worth making every day.
Dr Afolabi Akanbi’s episode on the Voices of Gallipoli Medical Research podcast will be available on 25 July. Follow the podcast.
Read more about Gallipoli Medical Research’s liver research.