Contact: Rosanne Fohn
Phone: 210-567-3079
E-mail: fohn@uthscsa.edu

A five-year, $750,000 Clinical Scientist Award in Translational Research grant from the Burroughs Wellcome Fund will help researchers at The University of Texas Health Science Center at San Antonio conduct the first large-scale study of fatty liver disease in individuals with Type 2 diabetes.

The award was presented to Kenneth Cusi, M.D., associate clinical professor of medicine and a staff physician at the South Texas Veterans Health Care System, Audie L. Murphy Division.

This is a liver before treatment and biopsy, showing significant liver fat accumulation as lipid droplets (or "steatosis"), inflammation and hepatocyte damage (technically referred to as "ballooning degeneration with Mallory bodies"). Photo courtesy of Joseph Pulcini, M.D.
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Previous study revealed promising results
Last November, Dr. Cusi and his team published an article in The New England Journal of Medicine showing that the drug pioglitazone (brand name Actos®), commonly prescribed for blood sugar control in individuals with diabetes, also decreased the amount of fat in the liver by 50 percent. These promising results prompted Dr. Cusi and his team to apply for long-term funding to look further into the links between fatty liver disease in obesity and Type 2 diabetes.

The plan is to screen for fatty liver disease by using magnetic resonance imaging and spectroscopy at the Health Science Center Research Imaging Center (RIC), and then to treat those with fatty liver disease with pioglitazone to better understand the mechanisms of action as well as the long-term impact of pioglitazone in this population.

Dr. Cusi’s team includes Steven Schenker, M.D., clinical professor of medicine in gastroenterology; Jean Hardies, Ph.D., assistant director of administration at the RIC; and Stephen Harrison, assistant professor in gastroenterology at Brooke Army Medical Center.

This is the liver after treatment and biopsy, showing decreased steatosis, minor inflammation and no ballooning degeneration. Photo courtesy of Joseph Pulcini, M.D.

Fatty liver disease
Nonalcoholic fatty liver disease (NAFLD) is believed to affect up to one-third of the U.S. population, according to a study by Browning et al. in the December 2004 edition of Heptology, the journal of the American Association for the Study of Liver Diseases. NAFLD is a chronic condition associated with obesity and Type 2 diabetes in individuals in which alcoholism is not a health factor. While the liver typically contains some fat, when the fat content of the liver is more than 5 percent it is considered abnormal and is known as NAFLD. As time goes on, some people with NAFLD may develop an inflammation of the liver called nonalcoholic steatohepatitis (NASH), which can lead to cirrhosis and liver failure, liver cancer and eventually death.

No symptoms
Fatty liver disease frequently has no symptoms. It is usually discovered when individuals have elevated liver enzymes (transaminases), but many have a fatty liver without such an elevation. Some factors seem to predispose individuals to NAFLD, such as insulin resistance (a decreased ability of the body to respond to its own insulin) and high glucose (sugar) and triglyceride levels in their blood. “People who are obese or who have Type 2 diabetes usually have these conditions,” Dr. Cusi said.

“There are several other studies being conducted right now on fatty liver disease, but ours is the only one focusing on patients with Type 2 diabetes. We think diabetes is a major determinant of fatty liver disease, because high glucose levels promote fat accumulation,” he explained.

“Literature indicates that Hispanics are more likely to get NASH than other ethnic groups. They are also more prone to contract diabetes, so we feel that San Antonio will be the perfect place to study this disease,” he said.

Study requirements
Study leaders are seeking volunteers who have Type 2 diabetes to participate in the study. Participants will receive a free blood analysis to determine their glucose and lipid levels. They also will have an MRI spectroscopy, considered to be the gold standard for determining the amount of fat in the liver. Those with fatty liver disease will be asked to commit to a three-year follow-up period in which they are assigned to take either the study drug pioglitazone or a placebo.

For more information or to volunteer for the study, please contact study coordinator Joan Finch, R.N, at 210-617-5300, extension 14750.


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The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $536 million, the Health Science Center is the chief catalyst for the $14.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 22,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields.