The Division of Hepatology incorporates both the Liver and Porphyria Clinics associated with Groote Schuur Hospital and the Liver Research Centre, a research institution established within the University of Cape Town by the South African Medical Research Council. We are a unique institution, offering highly specialised services not available elsewhere in Southern Africa, including dedicated hepatological expertise, liver transplantation services and a unique porphyria diagnostic and clinical service, coupled with both clinical and laboratory-based research on liver disease and porphyria. The Department of Medicine has had a special interest in porphyria extending over 50 years, arising from the pioneering work of Prof Lennox Eales, one of the original investigators in this field who gained worldwide renown for his work on porphyria. On his retirement, the Porphyria Research Unit he headed was incorporated into the Liver Research Centre. The division remains one of the leading centres in the world for porphyria research and clinical expertise.
The Division provide lectures on liver disease to undergraduate medical students in their clinical years. We also provide teaching on liver disease to medical registrars, most of whom spend a period attached to our division at some stage of their training.
Staff within the Liver Research Centre supervise postgraduate students for higher degrees at Honours, Masters and Doctoral level and lecture to Honours and Masters students in the Division of Pharmacology and in the Dept. of Clinical Laboratory Medicine (Divisions of Medical Biochemistry, Human Biology and Human Genetics.
Clinical staff undertake regular outreach teaching activities including lectures and seminars on liver disease and porphyria to health professionals at local and national level.
The research direction of the research laboratories of the Liver Research Centre are aligned with the goals of various MRC research programmes and are related to questions arising from clinical problems within the Department of Medicine. Wherever possible, the projects are conducted in collaboration with other universities in South Africa and international teams. The approach of the small group of scientists and students in the laboratory is diverse and multidisciplinary. Through the research activities of the Liver Research Center, the scientific capacity of emerging scientists as well as biotechnology skills are developed so that relevant clinical health research can be a sustainable activity. Several projects are concerned with the investigation of the role of the immune system in the etiology of liver disease. Investigation of immune processes involved in intravascular coagulation observed in patients with cirrhosis and/or portal vein thrombosis, liver transplantation, in non-alchoholic steatohepatitis and in auto-immune hepatitis are long term projects of the laboratory. The possibility of isolating novel drugs from natural products that may modulate immune processes in these clinical diseases is also a goal of the research efforts. Exposure to environmental toxins and their role in the development of chronic liver disease, cirrhosis, and hepatocellular carcinoma, form part of other research projects. Other projects are investigating immune mechanisms involved in viral and bacterial infections disease of the liver. Our clinical research interests include autoimmune liver disease, non-alcoholic steatohepatitis, iron overload and liver transplantation.
Over the years we have undertaken important research into the biochemical basis and diagnosis of porphyria, and since 1994 our major interest has been the molecular biology of variegate porphyria, one of the commonest genetic disorders in South Africa. Our aim is to fully characterise variegate porphyria at the protein, gene and clinical level, leading to better prognosis and therapeutic intervention for patients. Secondly, to extrapolate knowledge gained from this work to the study of all the acute and photocutaneous porphyrias generally. This work has led:
to the establishment of a DNA-based ("R59W") test for variegate porphyria, now in widespread use for diagnosis throughout SA;
to the identification of 10 discrete protoporphyrinogen oxidase gene mutations linked to variegate porphyria, and the recreation of these by site-directed mutagenesis, which have proven suitable for kinetic and CD/UV melt characterisation and structural comparisons;
to the recognition that there are more "silent" variegate porphyria (R59W) carriers than previously recognised;
to the establishment of an R59W porphyric mouse model which exhibits positive porphyrin biochemistry, reminiscent of the human condition;
to the establishment of "green fluorescent protein" - protoporphyrinogen oxidase vectors for studying mitochondrial targeting of the enzyme.
We also have a strong research interest in the clinical expression of the porphyrias and on their treatment, including the association of mutations within haemochromatosis gene with porphyria cutanea tarda, the biochemical and clinical expression of variegate porphyria and the management of the acute porphyric attack.
Liver clinics for new patients as well as for the follow-up of patients with established liver disease are held on Tuesday mornings at Groote Schuur Hospital. A joint porphyria-liver clinic is held on Wednesday afternoons. Transplant patients are seen on Wednesday mornings.
We admit patients directly to our beds at Groote Schuur Hospital for the diagnosis and management of liver disease, evaluation for liver transplantation and the management of porphyria.
We provide clinical advice and assistance with the diagnosis and treatment of liver related illnesses and porphyria to our colleagues in Groote Schuur hospital and its associated district hospitals and the Red Cross War Memorial Children's Hospital.
Ms Fozia Francis
Tel: +27 (21) 406 6394
Fax: +27 (21) 447 9670 Email Fozia.
UCT Liver Research Centre,
South Africa 7925
UCT Liver Research Centre
K47 K Floor,
Old Main Building
Groote Schuur Hospital
Observatory South Africa.