An interview with Dr. Mark Swain: Offering cutting-edge innovation to liver and inflammatory disease patients

Q. Tell us about your research journey with inflammatory disease.

Dr. Swain: My research journey started with liver disease, but with time, I became more and more curious about understanding the communication of the human body with the brain. Traditional medicines prescribed during chronic illnesses are designed to fix the damage that is happening within specific organs (e.g., liver, gut), but not the brain. Patients suffering from chronic inflammatory disease experience a lot of symptoms that by definition must arise from changes in brain function.  So, there has been growing interest in addressing these symptoms that are a prominent feature of chronic inflammatory diseases. We therefore have focused on developing approaches and therapies aimed at addressing symptoms and understanding the impact of disease at a behavioral level.

Q. Can you explain inflammatory disease and how it causes symptoms?

Dr. Swain: In general, inflammatory disease occurs when a local reaction in a tissue causes the immune system to be activated which can lead to cellular damage within the tissue. Inflammatory diseases also commonly make people feel ‘sick’. When I say sick, this  includes feelings like fatigue, depression, anxiety, ‘brain fog’, and sleep disturbances. It's interesting how symptoms associated with inflammatory diseases have attracted even greater attention after people started reporting about chronic COVID. I have been very interested in investigating these symptoms commonly faced by patients suffering from chronic liver disease, Inflammatory Bowel Disease (IBD), multiple sclerosis, and so on. Along with providing a cure for a disease at a tissue level, it’s also necessary to understand how people develop and cope with symptoms caused by chronic disease that disrupts the daily lives of our patients. To do so, our research team uses state-of-the-art techniques to look ‘into’ the brain, including functional MRI and near infrared spectroscopy, to better understand how the brain reacts to chronic inflammation within the body to cause disease-associated symptoms. 

Q. You are one of the founding members of the Calgary Liver Unit. Tell us about your work in liver research. 

Dr. Swain: The Calgary Liver Unit was created as the outcome of my clinical and research collaborations with Dr. Sam Lee. It has been internationally recognized for its excellence in patient care, research, and education. Started in 1993 by Dr Lee and myself, the Calgary Liver Unit now has 11 hepatologists (liver specialists), making it the biggest non-liver transplant centre hepatology group in North America. It was started with the aim of providing the best care for patients with liver disease through a dedicated hepatology service. Our unit has one of the most advanced clinical patient care and clinical research facilities in Canada, and the spectrum of research activities occurring within the Liver Unit range from clinical research like epidemiology,  health economics, quality improvement, and basic science.

Q. The Liver Unit runs the largest clinical trials group in the University of Calgary, which allows patients to access treatments long before they are available in the market. What are the recent accomplishments of the Liver Unit? 

Dr. Swain: At our unit, we have developed breakthrough clinical pathways of care. A recent pathway developed as part of an Alberta Health Services PRIHS grant I lead includes a unique-to-Canada care pathway for diagnosing and treating hepatitis C (a virus which affects the liver) through community-based pharmacies/pharmacists closely linked to front-line community-based organizations. Previously, patients were required to be referred to a specialist, often outside of their community, which delayed and often prevented starting curative treatment. In particular, the traditional model of hepatitis C care posed challenges for marginalized, unhoused, and Indigenous people who often slipped through the cracks. Our pathway attempts to eliminate this barrier and allows pharmacists to perform tests and subsequent care, which has turned out to be lifesaving in many cases.

Q. Your breakthrough liver pathway for non-alcoholic fatty liver disease (NAFLD) has reduced the waiting list for liver patients from years to months. Can you explain more about it? 

Dr. Swain: NAFLD affects roughly one quarter of the adult population in Canada. Our group created a unique-in-Canada fatty liver disease clinical care pathway for patients. This pathway has strikingly reduced the waitlist of liver patients with NAFLD. Launched in 2016, this breakthrough pathway was developed in collaboration with primary care networks and EFW Radiology. It allows primary care physicians to use an ultrasound-based technique to distinguish between patients who need to consult a hepatologist and those who can be cared for by their family doctors, without a referral to a specialist. Our pathway has been one of the top downloaded pathways in Calgary through the primary care network ‘Specialistlink’ service from the time it was launched, and it is also being used outside of Alberta.

Q. How has COVID affected liver research? 

Dr. Swain: During COVID, the number of patients with alcohol-associated liver disease increased at an alarming rate. In many parts of the world, including Canada, the sales and consumption of alcohol increased by many folds, which posed new challenges for liver specialists. It was shocking to see even so many younger patients, especially younger women, being diagnosed with severe alcohol-related liver disease. So, researchers across the world are working towards understanding and solving challenges posed by COVID. 

Q. There has been a huge emphasis on translating research from labs to human lives. Over the years, how has your research reached the masses?

Dr. Swain: I started as a basic science clinician, and my passion has always been in basic discovery science, but over time I have grown to see the critical importance of translational science. When I came to the University of Calgary, I was in a basic science silo. Even though I was a clinician, I mainly focused on animal models of disease, and I resisted moving to translation. Then about 18 years ago, I began to shift my thinking and started working closely with Dr. Keith Sharkey, and together we translated our research. I started out studying liver disease, but now my focus includes inflammatory  diseases in general: why inflammation in the body causes people to feel unwell, both mentally and physically.

Our research is aimed at embracing the whole spectrum of care which extends all the way from discovering disease mechanism, to providing the newest treatments and care models at the early stages of disease, to providing support in end-of-life situations.  We are always seeking an opportunity to bring clinical trials to Calgary so that we can offer cutting-edge innovation to our patients as early as possible.