Prof Alastair O'Brien

Research summary

I was a Medical Research Council clinical training fellow (1999-2002) and completed my PhD thesis under Professor Mervyn Singer at UCL. This work led to a landmark paper on the use of terlipressin as rescue therapy for norepinephrine-resistant septic shock that was published in the Lancet.

My research group consists of 2 Clinical research fellows (Louise China and Alex Maini); 1 non clinical PhD student (Suvi Harmala); 1 Post-doctoral scientist (to be appointed) and 1 clinical research nurse (to be appointed). I was recently awarded the UCL Student Teaching Award for Outstanding Researcher Development.

Liver disease is now the third most common cause of premature death in the UK and the majority of patients will die in hospital due to bacterial infection. We have demonstrated that Prostaglandin E2 is a key mediator of leukocyte function in these patients (O’Brien et al, Nature Medicine 2014). This is bound by the plasma protein albumin which is reduced in patients with liver disease. This work led directly to our 40 site UK-wide clinical trial of albumin to reduce incidence and complications of infection which represents the largest trial ever performed in this group of patients (ATTIRE; www.attiretrial.com; http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=18450). This work is funded The Wellcome Trust & Department of Health under the Health Innovation Challenge Fund.

My laboratory team are using a wide variety of techniques to gain greater understanding of the aberrant immune response in patients with advanced liver disease. My great ambition is that we develop innovative methods to improve the terrible current survival rates in these patients.

An unfortunate consequence of the increased recognition of immune suppression in advanced liver disease has been an increase in empirical or prophylactic antibiotic prescriptions for these patients. This may lead to increased antimicrobial resistance and therefore worsen the problem. I will therefore use data from ATTIRE to attempt to identify patients who may not need antibiotics in the first place and those in which rapid de-escalation flowing from antibiotic sensitivity data should be the rule.

Teaching summary

I am actively involved in the teaching and training of undergraduate and postgraduate students in the UCL Division of Medicine. I am course organiser for the drug development module for the Neuroscience Physiology and Pharmacology BSc students, I lecture on the MSc drug development course, as well as teach the clinical medical students for the acute admissions firm, the junior doctors for the UCH PACES course and exam for MBBS finals. I also am one of the faculty for the Royal Free Liver teaching courses for junior doctors, GPs and consultants.

Education

University College London

Doctorate, Doctor of Philosophy | 2006

Royal College of Physicians

Doctorate, Member of the Royal College of Physicians | 1997

United Medical and Dental Schools of Guy's and St.. Thomas's Hospitals

Doctorate, Bachelor of Medicine/Bachelor of Surgery | 1994

United Medical and Dental Schools of Guy's and St.. Thomas's Hospitals

First Degree, Bachelor of Science | 1991

Publications

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