October is liver cancer awareness month around the world, and it is a perfect time to share today's blog for some Saturday reading. Why is early detection critical? What is the spectrum of disease from MASLD to MASH to HCC? Why is early case finding so important? Can early detection prevent liver cancer? Is it time to shift our thinking to cancer prevention? Check out our blog today where we share our thoughts on this life saving topic. American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Global NASH Council, The Forum for Collaborative Research: Liver Forum, Global Liver Institute, European Liver Patients' Association - ELPA, LPI LIVER PATIENTS INTERNATIONAL, Livera Health, Predictive Health Intelligence, Aegle Medical, Echosens, Nature Portfolio, Perspectum Ltd, E-Scopics, LiverScan Direct, KNS Canada Inc., American College of Radiology, American Diabetes Association, Canadian Association for the Study of the Liver
Fatty Liver Alliance
Non-profit Organizations
Awareness, Education, Research and Advocacy to support patients living with fatty liver disease and MASH.
About us
Our mission is to raise awareness about the risks, causes and complications of fatty liver disease and help those already diagnosed with non-alcoholic fatty liver disease (NAFLD/MASLD) and non-alcoholic steatohepatitis (NASH/MASH) by advocating for access to approved treatments and care.
- Website
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http://www.fattyliver.ca
External link for Fatty Liver Alliance
- Industry
- Non-profit Organizations
- Company size
- 2-10 employees
- Headquarters
- Toronto, Ontario
- Type
- Nonprofit
- Founded
- 2021
Locations
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Primary
Toronto, Ontario, CA
Updates
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Here are a few key takeaways from this just published Lancet comment paper: “Expanding the Armamentarium for Metabolic Dysfunction-Associated Steatohepatitis”. Congratulations to Sven Francque et al. for this insightful update. 1. Resmetirom and Liver-Targeted Approaches: The recent approval of resmetirom by the FDA for treating fibrotic MASH shows promise in using a liver-targeted thyroid hormone β receptor agonist. This approach demonstrates that a more isolated liver-focused treatment, without addressing extrahepatic drivers like metabolic inflammation, can still induce fibrosis regression and improve MASH. 2. Denifanstat and Intrahepatic Focus: The FASCINATE-2 trial of denifanstat, a fatty acid synthase inhibitor, shows a significant improvement in MASH through targeted intrahepatic effects without influencing bodyweight or glycemic control. This suggests that denifanstat’s effects are resilient to persistent metabolic stress, positioning it as a potentially strong candidate for MASH treatment. 3. Combination Therapies and Stepwise Approach: With MASH treatments evolving, combination therapies—like combining liver-targeted treatments with metabolic drugs (e.g., GLP-1 receptor agonists)—are being considered. A stepwise approach is recommended: first, optimize the cardiometabolic environment and then assess the liver for specific anti-MASH treatments based on residual disease severity. 4. Challenges in Advanced MASH: Treating MASH in patients with cirrhosis poses unique challenges, as the disease mechanisms shift toward portal hypertension and vascular biology. Whether drugs like denifanstat will be effective in this population requires further study. Source: https://lnkd.in/g4MtGeB5 EASL | The Home of Hepatology, American Association for the Study of Liver Diseases (AASLD), Global NASH Council, The Forum for Collaborative Research: Liver Forum, European Liver Patients' Association - ELPA, LPI LIVER PATIENTS INTERNATIONAL, Global Liver Institute, Rohit Loomba Summarized in collaboration with CHATGPT4o.
Expanding the armamentarium for metabolic dysfunction-associated steatohepatitis
thelancet.com
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A great week in London and Harrogate, England! Thank you Tim Jobson from Predictive Health Intelligence for taking the time to explain all the great work you and your team are doing to identify new MASLD/MASH naive patients who can be identified and assessed for care. Thank you Louise Campbell MSc (AP), RMN, RN, FRCP from Tawazun Health for your kind hospitality and expert Fibroscan assessment skills (and my lowest CAP score yet). Suzanne Walker videographer extraordinaire, thanks. Thank you Rajarshi Banerjee at Perspectum Ltd and team for explaining how the LiverMultiScan works to fully assess liver health (fat, inflammation and iron) and Roberto Salvati, my newest friend who did my scan personally and explained the results. I did meet a lot of new people from The British Liver Trust, Novo Nordisk, Madrigal Pharmaceuticals, and caught up with Sven Francque, William Alazawi, Philip Newsome, Paul Brennan and Robert Mitchell-Thain.
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Augusto Villanueva presents a very informative update on "Finding a needle in a haystack: MASLD and HCC". Conclusions • HCC can develop in MASLD without cirrhosis. Magnitude of risk is still unclear but likely very low • Early detection in HCC suboptimal, and there is need for HCC-risk stratification of patients with MASLD • НСС surveillance is recommended in MASLD cirrhosis • Liquid biopsy is a promising technology to improve HCC surveillance American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Barcelona Institute for Global Health (ISGlobal), Global Liver Institute, European Liver Patients' Association - ELPA, LPI LIVER PATIENTS INTERNATIONAL, Canadian Association for the Study of the Liver, American Diabetes Association, Meena Bansal, Mount Sinai Health System
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The 13th speaker today is Reshmi Srinath, M.D. presenting on "Empowering Change: Lifestyle, Medical and Surgical Management of Obesity and their Role in Management of MASH/MASLD". • The CDC estimates that as much as 80% of heart disease, stroke, and type 2 diabetes cases and 40% of cancer cases could be prevented through modification of lifestyle behaviors • Most employers (>90%) believe that their healthcare costs could be reduced by improvements in healthy behaviors • Most large employers (70%-85%) offer basic health screenings, less than 25% provide a comprehensive worksite population health program that includes comprehensive health screening Summary: • Obesity is a chronic disease and has multiple complications including MASH • Stepwise approach to treatment starts with lifestyle modification, weight loss, treatment of cardiovascular risk factors • There is growing interest in the role of anti-obesity pharmacotherapy in MASH/MASLD • More research is needed regarding long term consequences and efficacy of medications, devices and surgery American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Barcelona Institute for Global Health (ISGlobal), Global Liver Institute, European Liver Patients' Association - ELPA, LPI LIVER PATIENTS INTERNATIONAL, Canadian Association for the Study of the Liver, American Diabetes Association, Meena Bansal, Mount Sinai Health System
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The 9th speaker today is Fernando Carnavali, a Primary Care Physician who presented: "Screening for MASLD/MASH from PCP Perspective". Screening for MASLD/MASH from a PCP Perspective: Primary Care providers are ideally placed to identify at-risk individuals and manage comorbidities Evidence-based consensus guidelines are available for the screening, diagnosis, and treatment of patients However, greater awareness and implementation of these guidelines are required among primary care providers
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Jaime Chu is the 7th speaker today at the Mount Sinai Health System Symposium and presented: "Eye of the Storm: Intersection of Genetics, Lifestyle, and Environment in Pediatric MASLD/MASH". 15 - 30% of adolescents have steatotic liver disease (SLD) Most SLD is metabolic dysfunction associated SLD (MASLD) Fibrosis: MASLD is the most common etiology (51%) (Liver stiffness ≥ 7.4 kPa, SLD with CAP ≥ 240 dB/m ) Only 8.8% adolescents with MASLD-fibrosis meet criteria for hepatology referral (ALT ≥ 80 U/L and overweight/obese) Steatosis is present in the fetal liver in offspring from obese pregnancies. Risk factors include family history of MASLD, central adiposity, signs of insulin resistance, prediabetes or diabetes mellitus, dyslipidemia, and sleep apnea. Pediatric MASLD: Unanswered questions and research priorities • Understand unique pathogenesis of pediatric MASLD - maternal, microbiome, genetic and environmental factors; - highlights importance of biobank • Risk stratification to identify children at high risk for MASH fibrosis - Referral of first-degree relatives of MASH with advanced fibrosis • Validation of non-invasive diagnostics and biomarkers • Scarcity of treatment options: - Role of dietary interventions - Use of promising therapeutics, including obesity medications - Pediatric MASH clinical trials American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Global NASH Council, Meena Bansal, Global Liver Institute, European Liver Patients' Association - ELPA
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Our 8th speaker, Tatyana Kushner shared her presentation: "Catch Me When You Can. Maximizing Opportunities for Engagement by Screening for MASLD/ MASH in OB/GYN".
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The 6th speaker today, who covered this emerging topic expertly, is Jörn M. Schattenberg, who presented: 'Powering the Future. Leveraging New Al algorithms for Risk Stratification and Prediction of Outcomes'. Artificial intelligence in hepatology: 1. Data analysis Text mining, clustering analysis, data visualization Machine learning (supervised and unsupervised) Deep learning (learning algorithms and interpretation) 2. Data layer Electronic health records Imaging, laboratory, and histology data Patient cohorts with clinical outcome in the scientific setting 3. Basic layer Cloud computing (availability of platforms and software in the healthcare setting) Internet of medical things (access through consumer mobile - Al builds a model based on data -External validation in independent cohorts needed - Relevant data relevant to the outcomes could be missing Identification of patients in prospective studies: Evidence level needed to be accepted by payers and regulators. Leveraging New Al algorithms considerations as conclusion Health Care System: • harmonize data adopt data security standard • provide reimbursement Research: • Open source and open data (no black box science) • clinical relevance + avoid overinterpretation (endless computational power and huge data sets) • quality of data and input Physicians: • Overcome low awareness + expertise • Need to standardize data acquisition ! Al must be explainable Patients maximize benefit - maintain a relation of trust (man vs machine) • Education and empowerment American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Global NASH Council, European Liver Patients' Association - ELPA, Global Liver Institute, Mount Sinai Health System, Scott Friedman
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The fifth speaker today is Bachir Taouli from Mount Sinai Health System and he presented, an "Overview of Imaging Modalities for the Assessment of MASLD/MASH". In and out-of-phase imaging: In-phase images at TE=4.6 ms and out-of-phase images at TE=2.3ms (1.5T) Widely used and validated, simple to use Good correlation with histopathology (corr. 0.86-0.98) Qualitative and quantitative FF (%)=100 x (IP- OP)/2x|P Limitations: Water-fat ambiguity (for FF > 50%) T1 and T2* effects (dependence on TR, TE and flip angle)-concomitant iron deposition Meta-analysis of noninvasive tests in NAFLD (Xiao, Hepatology 2017) 64 articles/13,046 NAFLD subjects included Mean prevalence of significant fibrosis, advanced fibrosis and cirrhosis: 45.0%, 24.0%, and 9.4% in NAFLD patients MRE and SWE: highest diagnostic accuracy for staging fibrosis in NAFLD Stratification for resmetirom treatment: Results from randomized phase 3 trial (Harrison. NEJM 2024): Fibrosis improvement (at least 1 stage): 24.2%-25.9% in treatment group vs 14.2% in placebo PDFF at w52: -35.4/-46.6% vs -8.7% in placebo Per FDA, resmetirom currently indicated for F2-F3 disease Enrollment based on noninvasive tests: VCTE vs MRE Retrospective study in patients with MASLD who had VCTE+MRE at ISMMS (n=103): VCTE tends to overestimate fibrosis stage compared to MRE 35 vs 18 patients would qualify for treatment based on VCTE vs MRE Estimated cost savings: $802,695 with MRE Limitations of US elastography: - VCTE failure rate: 5%-26%, SWE failure rate: 0%-9% - VCTE failure assessed in 13,369 examinations with M probe (Castera et al. Hepatology 2010) Failure: 3.1% Unreliable measurements in further 15.8% of cases BMI: significant contributor - XL probe: has improved reliability of VCTE Reliable measurements in 73% of patients with XL probe compared to only 50% for M probe (Myers. Hepatology 2012) - Confounding factors: ALT flares, cholestasis, congestive heart failure, excessive alcohol intake and acute viral hepatitis - Influence of steatosis: conflicting data - pSWE and 2D-SWE: Failure rate lower Inter-vendor variability Summary: - US and MR elastography techniques: accurate methods for quantitative, non-invasive diagnosis of liver fibrosis in MASLD - MRE: equivalent to slightly better diagnostic accuracy than VCTE/SWE in MASLD, requires wider validation, and the higher cost and limited availability may limit wider adoption - Work remains to be done: Assess changes with therapy (should incorporate test-retest variability) Establish cost-effective strategies for NASH stratification for therapy American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Barcelona Institute for Global Health (ISGlobal), Global Liver Institute, European Liver Patients' Association - ELPA, LPI LIVER PATIENTS INTERNATIONAL, Canadian Association for the Study of the Liver
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