fibrosis

Joining us for his second appearance on the show, Dr Jack Auty is a lecturer in the Medical Sciences in the School of Medicine at the University of Tasmania. Jack leads research on the intricate connections between inflammation and disease. With a diverse array of interests, ranging from the impact of microplastics on lung and gut inflammation to the potential use of common anti-inflammatories in treating Alzheimer's disease, Jack's work is at the forefront of medical research.

If this is your first introduction to Dr Auty, please take time to listen to his first podcast episode with us here, as it will give you a more detailed background on his fascinating work to date. In this episode we focus in on Jack’s work with AdriftLab, where he’s been looking at wildlife impacted by microplastic exposure and the ability of plastic to directly induce severe, organ-wide scar tissue formation.

In this episode we discuss:

• Jack’s background and previous research
• Various hypotheses which may explain the rise in allergies
• The work of AdriftLab, led by the wonderful Dr Jennifer Lavers
• ‘Plasticosis’ – evidence for a new plastic-induced fibrotic disease
• The types of plastics commonly found in seabirds and the global marine plastic load
• Plastics, microplastics and their unique inflammatory potential
• How inflammation impacts the body and how plastic can make its way into cells throughout the body
• Potential implications of these findings for both humans and other wildlife
• The need for an interdisciplinary approach when researching pollution’s impact on wildlife and human health
• Identifying laboratory sources of microplastic and nanoplastic contamination
• Top tips for reducing plastic exposure in daily life
• Plastics as a delivery mechanism for a wide range of toxic chemicals
• Future research projects for Jack and AdriftLab
  
  

To view all the links to the websites and documents, visit the show notes on our website. Don't forget to subscribe to this podcast, leave us a review and share this episode with your friends and family.

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Throughout the month of July, Surfing NASH embarks on a series of episodes dedicated to takeaways emerging from a busy past month at both the 2023 EASL Congress and the American Diabetes Association's 83rd Scientific Sessions. For this feature, Sven Francque (University of Antwerp) and Ian Rowe (University of Leeds) join Jörn Schattenberg and Roger Green to discuss a range of fascinating topics to emerge at the EASL Congress meeting held in Vienna.

This conversation begins with Roger's note of a population study from South Korea looking to identify patients with steatotic liver disease, but not cirrhosis, that will progress to HCC over a ten year period. After sharing the study details, both Ian and Jörn express common concern around the relatively small size of the identified patient group. Jörn shares his hope that with new disease classification which combines metabolic and alcoholic components we will be able to study these issues more broadly in populations that might be more finely tuned for the study aims. Next, Jörn highlights a paper that leads the group to unpack how little is known about the mechanisms of fibrosis resolution beyond the idea that there are clear differences between the progression and regression processes.

If you have questions or comments around the EASL Congress meeting, new nomenclature, discussed papers or any other topics addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

Throughout the month of July, Surfing NASH embarks on a series of episodes dedicated to takeaways emerging from a busy past month at both the 2023 EASL Congress in Vienna and the American Diabetes Association's 83rd Scientific Sessions meeting in San Diego. To reflect on the insight-laden occasion, Stephen Harrison and Jörn Schattenberg join Roger Green to explore emerging drug development stories in detail.

This conversation starts with a discussion about the importance of treating early stage cirrhosis patients. Jörn suggests that with new agents in place we may soon be looking to treat other patient populations such as, for example, those with HCC. In such instances NASH drugs will become adjuvant therapy to improve treatment against the primary disease target. Stephen agrees, noting that we will need a better test to diagnose HCC and, once available, there will be fewer presentations of advanced HCC because we will have treated more of them earlier with better agents and adjuvant therapies. Again, all this will await the approval of NASH and ideally cirrhosis drugs in the future. Roger asks how to identify the 20 to 30% of HCC patients who develop cancer before NASH. Stephen suggests it depends largely on NIT development. From there the panelists each share final thoughts around what the session has yet to cover that is important. Stephen comes up with a new idiom and Jörn speculates a new concept. Listen to the session to find out what they are.

If you have questions or comments around the EASL Congress or ADA meetings, the discussed therapeutics, new nomenclature, or any other topic addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

Throughout the month of July, Surfing NASH embarks on a series of episodes dedicated to takeaways emerging from a busy past month at both the 2023 EASL Congress in Vienna and the American Diabetes Association's 83rd Scientific Sessions meeting in San Diego. To reflect on the insight-laden occasion, Stephen Harrison and Jörn Schattenberg join Roger Green to explore emerging drug development stories in detail.

In this session, conversation shifts from resmetirom to Mazen Noureddin's "NASH Monopoly" game and focus on the value of FGF-21s and glucagon agents. Stephen posits two comments about GLP-1s. First, there is now adequate data suggesting that GLP-1s will not melt away all liver fat and as a result lead to dramatic fibrosis regression. Second, we know from a small sub-cohort of patients in Akero's SYMMETRY trial that patients already on fairly low doses of GLP-1s saw what Stephen describes as an 'incredible' and incremental benefit for the FGF-21 agent, efruxifermin. The group notes that while glucagon dual and treble agents are likely to produce dramatically more robust results in weight loss and liver defatting than GLP-1s alone, they still seem unlikely to 'usurp the need for other types of agents.' From here discussion considers the FGF-21 class. Stephen notes that two drugs, efruxifermin and pegozafermin, have demonstrated significant efficacy against fibrosis. As the conversation concludes, the panelists agree that earlier, more aggressive screening to arrest cirrhosis will become pivotal and will not occur until the right drug becomes available. 

If you have questions or comments around the EASL Congress or ADA meetings, the discussed therapeutics, new nomenclature, or any other topic addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

In this episode, Tarik Asselah, MD, PhD, and Ira Jacobson, MD, provide expert insight on HDV screening, diagnosis, and management, including:

• Approach to screening
• Barriers to screening (eg, test availability)
• Disease progression and complications
• Differentiating between coinfection and superinfection
• Approach to treatment (eg, whom to treat and when, treatment options, considerations for combination therapy)
• Management of patients with decompensated cirrhosis
• Surrogate markers to measure treatment success
• Role of correcting thrombocytopenia before initiating therapy

Faculty:

Tarik Asselah, MD, PhD
Professor of Medicine 
Department of Hepatology
Hôpital Beaujon
Université de Paris
Clichy, France

Ira Jacobson, MD
Professor of Medicine
NYU School of Medicine
Director of Hepatology
Division of Gastroenterology and Hepatology
NYU Langone Health
New York, New York

Link to full program: https://bit.ly/3yp1Lxf

In this episode, Nancy Reau, MD, and Heiner Wedemeyer, MD, provide expert insight on HDV management, including:

• Use of noninvasive imaging or biopsy for staging liver disease
• Screening for hepatocellular carcinoma
• HBV treatment
• Role of comedications (eg, erythropoietin, eltrombopag)
• Approach to complex cases, such as patients with:
  • Significant fibrosis and low HDV RNA levels
  • Hepatitis delta antibody positivity, but HDV RNA negativity
  • HIV coinfection
  • Decompensated or recently decompensated cirrhosis

Faculty:

Nancy Reau, MD
Professor of Medicine
Chief, Section of Hepatology
Associate Director, Solid Organ Transplantation
Richard B. Capps Chair of Hepatology
Rush University Medical Center
Chicago, Illinois

Heiner Wedemeyer, MD
Professor and Chairman
Department of Gastroenterology, Hepatology and Endocrinology 
Hannover Medical School
Hannover, Germany

Link to full program: 
http://bit.ly/3yp1Lxf

As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology. This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and she is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute.

This conversation begins with Jörn concurring with Cyrielle's statement about the importance of regular interaction and communication. Roger also agrees before asking Jörn for what he considers to be key in getting liver patients picked up earlier by endocrinologists, primary care or even gastroenterologists. Jörn replies that this specific health system pathway will matter, but the role of nurse practitioners will be the key. He also emphasizes the importance of offering better information to patients. Finally, he says we need to stress that there are things physicians can do with these patients and this will become easier to discuss once drugs have been approved. Louise notes that this aligns with her focus on the role of allied health providers. She goes on to comment on the value of VCTE in identifying disease in all kinds of different patients. Jörn adds that at least once a week he is asked to consult on a patient whose unrelated surgery led to a decompensating cirrhotic event. As the session winds down, Roger asks the panelists what they would do if they had a magic wand to touch one thing in their hospital to make a change. Listen on to hear their varying and surprising answers.

If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology. This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and she is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute.

Louise leads this conversation with a question around designing a more comprehensive metabolic blood profile in light of the vastness of metabolic syndrome and diseases. Jörn responds that while a metabolic screening would be of strong research interest, the message discussed in this episode champions simplicity, practicality and the ability to empower physicians for the identification and risk stratification of their patient population. From here, Cyrielle describes discovering patients with NAFLD-driven diabetes and the implications that various subtypes have on disease prognosis.

Jörn takes an amusing turn to a recently published article in Nature which points to liver disease, viral hepatitis and alcohol consumption as causes of the composer Beethoven’s demise. Tune in to the full conversation to learn more about this unique case.

If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology. This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute.

This conversation starts with Louise’s question around how patients respond when informed of liver-related conditions in the endocrinology clinic setting. Cyrielle shares a positive anecdote where a patient with obesity and Type-2 diabetes ultimately managed to improve weight in striving for a healthier liver status. For many patients, the notion that improving liver health will holistically improve their overall condition is a powerful and resonating source of motivation. Jörn notes this sort of positive relationship around biofeedback to be a recurring subject on the podcast. From here, Louise steers conversation to consider Cyrielle’s Paris NASH presentation which investigates how different phenotypes for chronic kidney patients may imply elevated risk of NAFLD and NASH. After elaborating briefly on this note, Cyrielle concludes with a powerful takeaway: “classifying your patient based on the presence of NAFLD or not is also classifying your patient regarding the prognosis of diabetes and not only the prognosis of liver.” As the session winds down, Jörn adds fascinating thoughts around the mechanisms and relationship between staging of liver disease, fibrogenesis and the metabolic drive that concerns the kidneys in parallel.

If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology. This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute.

This conversation begins with Roger’s note that around 50% of all cirrhosis is diagnosed for the first time during a decompensation event at the emergency department. He asks whether the endocrinology clinic is the right place to identify patients much sooner. Jörn suggests the answer is yes considering that we know the risk and prevalence of advanced fibrosis in this population to be high. The group goes on to discuss requesting and receiving lab results in their respective different systems and how hitching a test, like FIB-4, to routine care protocols could be an effective route for implementation. Cyrielle suggests that “the most important thing is convincing the endocrinologists” of NAFLD/NASH prevalence and our concerted ability to identify disease and stop progression at their clinics. She goes on to highlight the building momentum and consensus of guidelines from a range of different fields and organizations that formally recognize the relevance of Fatty Liver and the adoption of FIB-4 as a simple and cheap frontline test. She points out that In the most recent wave of published guidelines, there is a notedly improved sense of clarity in recommendations around how to identify and respond to patients with NAFLD/NASH.

Roger raises the point that the US might be one of the only countries, if not the only, that includes ALT values on blood panels. He asks Cyrielle what the process looks like in France for requesting ALT values to which she describes a relatively simple set of protocols. Jörn next describes his experiences within the German system. As the conversation winds down, discussion focuses on patient management and the importance of risk stratification in identifying those with more severe progression of disease.

If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology. This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute.

New to the podcast, Cyrielle takes a moment to outline her career trajectory and how she became interested in Fatty Liver disease and its growing area of overlap within the wider scope of medical care. From here, Roger describes overarching questions that the episode aims to cover:

• What does the interaction between endocrinologists and hepatologists look like from their relative perspectives? 
• In practical terms, how does each approach care pathways, referrals and collaboration? 
• What about either speciality would be key for the other to learn more about, develop and integrate?

Jörn first comments on the value of deploying the NITs developed by the hepatology community to endocrinology clinics. He notes the practical barriers which could hinder uptake and utilization as many may have lingering questions. How will this make a difference in the management of my patient? How do I potentially deal with a positive test? Do I need to refer this patient and what if I have nobody to refer to? Jörn looks to Cyrielle for advice on how to entice endocrinologists to align with the need of identifying Fatty Liver disease in their at-risk populations. Among other insights, Cyrielle underscores the importance behind raising awareness with endocrinologist colleagues that patients in routine screening are regularly diagnosed with advanced fibrosis and cirrhosis in the absence of symptoms.

If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology. This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and she is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute. 

02:14 Introducing Cyrielle Caussy and Her Professional Background
New to the podcast, Cyrielle takes a moment to outline her career trajectory and how she became interested in Fatty Liver disease and its growing area of overlap within the wider scope of medical care.

08:42 Educating Endocrinologists on the Power of NITs Developed in Hepatology
From here, Roger describes overarching questions that the episode aims to cover:

• What does the interaction between endocrinologists and hepatologists look like from their relative perspectives? 
• In practical terms, how does each approach care pathways, referrals and collaboration? 
• What about either speciality would be key for the other to learn more about, develop and integrate? 

Jörn comments on the value of deploying the NITs developed by the hepatology community to endocrinology clinics. He notes the practical barriers which could hinder uptake and utilization. Among other insights, Cyrielle underscores the importance behind raising awareness among our endocrinology colleagues that patients in routine screening are regularly diagnosed with advanced fibrosis and cirrhosis in the absence of symptoms.

14:32 The Importance of Early Identification in At-Risk Populations and Implementing Guidelines

Roger notes that around 50% of all cirrhosis is diagnosed for the first time during a decompensation event at the emergency department. He asks whether the endocrinology clinic is the right place to identify patients much sooner. Jörn suggests the answer is yes considering that we know the risk and prevalence of advanced fibrosis in this population to be high. The group goes on to discuss requesting and receiving lab results in their respective different systems.

25:55 Discussing the Patient Perspective in Endocrinology Clinics
Louise asks how do patients respond when informed of fibrosis or other liver related conditions in the endocrinology clinic setting.

33:40 Biomarkers, Holistic Metabolic Assessment and Pathways
The groups discusses takeaways from various studies on the interrelatedness of  concurrent metabolic conditions and the influence of liver health.

40:57 Calling All Parties to Invest in Fighting Fatty Liver

If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.

Stay Safe and Surf On!

In this episode, Tatyana Kushner, MD, MSCE, and Stefan Zeuzem, MD, address key considerations when screening, diagnosing, and treating patients with HDV, such as:

• Barriers to HDV screening, including limitations to AASLD guideline recommendations
• Use of double reflex testing to improve HDV diagnosis
• Considerations for repeat HDV testing in patients who are HBsAg positive who previously tested negative for HDV
• Updated CDC recommendations for HBV screening for all adults using a triple panel test 
• Staging advanced liver disease in patients with HDV
• Indications for HDV treatment, including patients with low ALT levels and advanced or progressive liver disease
• Treatment landscape for HDV
• Personal experiences with use of pegylated interferon for HDV treatment, including considerations for use in patients with compensated cirrhosis
• Updates on novel HDV therapies, including:
  • Summary of efficacy data on bulevirtide from clinical trials
  • Interpretation of results from D-LIVR, a phase III trial assessing the safety and efficacy of lonafarnib 

Link to full program: 
bit.ly/3yp1Lxf

In this episode, Coleman I. Smith, MD, and Lydia Tang, MBChB, discuss how to screen for hepatitis delta virus (HDV), including:

• Algorithm for evaluation of HDV
• Diagnosis of different stages of HDV infection 
• Strategies to increase HDV testing rates 

Faculty:
Coleman I. Smith, MD
Professor of Medicine
Hepatologist
Georgetown Transplant Institute
Georgetown University
Washington, DC

Lydia Tang, MBChB 
Assistant Professor
Department of Infectious Diseases
University of Maryland School of Medicine
Institute of Human Virology
Baltimore, Maryland

Link to full program:
http://bit.ly/41oYawr

Follow along with the slides at: 
http://bit.ly/3XW6m4g

In this episode, Nancy Reau, MD, and Lydia Tang, MBChB, discuss how to increase linkage to care rates for persons with hepatitis D virus, including:

• Updates on currently low rates of linkage to care
• Barriers preventing patients with HBV/HDV 
  coinfection from engaging in care
• Interventions to increase retention in care for patients with HDV

Faculty: 
Nancy Reau, MD
Professor of Medicine
Chief, Section of Hepatology 
Associate Director, Solid Organ Transplantation 
Richard B. Capps Chair of Hepatology
Rush University Medical Center
Chicago, Illinois

Lydia Tang, MBChB 
Assistant Professor
Department of Infectious Diseases
University of Maryland School of Medicine
Institute of Human Virology
Baltimore, Maryland

Link to full program: 
https://bit.ly/41oYawr

Follow along with the slides at: 
https://bit.ly/3XW6m4g

NASH-TAG 2023 proved to be a watershed moment for Fatty Liver disease as exciting drug development readouts, powerful academic work on non-invasive tests and the willingness to dive into the toughest questions aligned in Deer Valley, Utah. In this weekend’s conversation series, Surfing NASH reviews its diverse coverage of the conference by showcasing key excerpts across six recordings with various KOLs, patient advocates and stakeholders.

This conversation with Naim Alkhouri, Amy Articolo and Jörn Schattenberg begins with Naim illustrating some of the high points of the meeting. First, he recaps the resmetirom data. He then highlights that Intercept’s study of patient response to obeticholic acid (OCA) revealed improvements among the F3 population. He concludes that in the wake of these aforementioned results, there remains plenty of opportunity to improve and other biotechs “are still in the game” with the energy to back them. Jörn notes the high level of engagement from academia in supporting development through the consortia, NIMBLE and LITMUS. Amy credits the collaborative spirit of the meeting and the milestones achieved in improving the field’s understanding of how best to utilize NITs to provide insight and serve patient needs. 

Roger Green steers conversation toward the challenges of payers and gaps in therapeutic efficacy for certain populations. He connects these ideas to slides presented by Naim on AI-driven zonal analysis developed by HistoIndex. The assessment provides a geographic vantage point that offers perspective on how to combine agent benefits and trial emerging opportunities. Amy agrees that some of the complex analytics will help pharma build its case for patients. Naim questions what we call “futility” – if patients stay the same, are they futile? He suggests that AI can help us determine whether people who do not reduce fibrosis are actually benefiting from therapy. Roger notes that Naim outlined three categories: patients whose fibrosis regressed, others who progressed and a third group somewhere in the middle yet to be defined. Naim agrees and underscores that with the non-invasive tests available, we can learn far more than what’s known today. Amy responds with questions around how tests will be used practically, noting that stacked tests are pivotal to the story. As the conversation ends, Jörn notes biopsy is only one way to generate a conditional endpoint for drug approvals.

In this exclusive interview, Hannes Hagström joins Jörn Schattenberg, Louise Campbell and Roger Green to explore papers emerging from Scandinavia which offer fascinating insights to the field at large.

Hannes opens the conversation with his idea that 2022 was an encouraging year for research, specifically in that the mechanisms of drugs in development “feel more realistic.” When asked what he means by realistic, Hannes explains his interpretation of NAFLD to be a public health problem by which the metabolic system is overloaded with nutrients. He suggests a general pathway would aim to reduce this burden, citing examples like GLP-1s and possibilities surrounding an imminent announcement on resmetirom. From here Hannes describes developing a population-based cohort of liver disease patients using relatively accurate registers in Sweden. He highlights that this system enables studies to navigate issues around selection bias and capture the whole of a population with any diagnosed liver disease dating back to the sixties - roughly 350,000 unique patients in Sweden. The data available in this cohort can be linked back to the general population and used to examine several important research considerations. Long-term outcomes of chronic liver diseases, risk factors for disease progression, impact of dispensed drugs, disease panorama and time trends are among examples.

Segueing to several studies utilizing this cohort, Hannes first introduces a paper which examines cardiovascular disease (CVD) risk and life expectancy in patients with NAFLD compared with the general population. While NAFLD was associated with a higher risk of nonfatal CVD, it notably did not affect post-CVD mortality risk. Another conclusion: patients diagnosed with NAFLD have a lower life expectancy than the general population. Strikingly, this loss in life expectancy was accentuated depending on the age of patient at time of diagnosis. The younger in age one has a diagnosis of NAFLD, the more one can expect to have a drop in life expectancy. Hannes suggests this may summon an urgency in screening younger populations. A caveat of this cohort is noted to be the reality of true incidence rates could be higher than what has been captured in diagnosis in specialty care. At this point, Jörn and Louise ask a series of thought-provoking questions which spur Hannnes to describe additional compelling facets of working with this rich data set. Studies can link research cohorts examining biopsies of patients with NAFLD to these registers, allowing for long-term follow-up. Hannes also mentions collaboration with the Swedish Diabetes Register which captures at least 90% of patients with type 2 diabetes. Such granularity enables investigation into the influence of comorbidities on the risk of liver disease. Roger notes a theme of recent guidelines is to assume that diabetic patients have NAFLD, therefore the recommendation is to immediately search for NASH in the evidence of fibrosis. As these databases are pooled, NAFLD can be examined through a diabetes lens or vice versa. The group goes on to briefly discuss elements of screening, guidelines and the influence of NITs on interpreting prevalence. Hannes bridges this discussion to a just-accepted paper whereby his team looked at developing FIB-4 in a more meaningful way through stratifying subgroups within the overarching risk categories. Simply, the three parameters used are age, presence of diabetes and a gamma-glutamyl transferase test. The latter is noted to be useful in linking cardiac outcomes and an imperfect marker for alcohol use. 

As the session winds down, the panelists explore speculative questions around genetics and the microbiome, and any foresight into how these factors could be filtered through the aforementioned registers and databases. In closing, Hannes provides a glimpse at what awaits for his research in 2023. Surf on to find out. 

In this episode, Nancy Reau, MD, and Coleman I. Smith, MD, discuss the burden of undiagnosed hepatitis delta virus (HDV) infection and who should be tested, including:

• Epidemiology of HDV infection
• Clinical course of HDV infection
• Populations at high risk of HDV infection
• Guidelines for HDV testing

Faculty: 
Nancy Reau, MD
Professor of Medicine
Chief, Section of Hepatology 
Associate Director, Solid Organ Transplantation 
Richard B. Capps Chair of Hepatology
Rush University Medical Center
Chicago, Illinois

Coleman I. Smith, MD
Professor of Medicine
Hepatologist
Georgetown Transplant Institute
Georgetown University
Washington, DC

Link to full program: 
https://bit.ly/3WmJnzi

Follow along with the slides at:
https://bit.ly/3NpAYI1

When it comes to managing adults with HBV, should age factor into your treatment decision—or is it important to treat everyone, regardless of age?

Listen as Dr George Lau discusses these questions and more for strategizing the monitoring and treatment of older adults with HBV. 

Presenter: 
George Lau, MBBS (HKU), MD (HKU), FRCP (Edin, Lond), FAASLD (USA)
Chairman
Humanity and Health Medical Group
Hong Kong, China
Chair, Professor, and Co-Director
Liver Diseases & Transplant Centre
The Fifth Medical Centre of Chinese PLA General Hospital
Beijing, China

Link to full program:
https://bit.ly/3fg9fwB

When it comes to managing older adults with hepatitis B virus (HBV), what comorbidity, comedication, and adherence issues should be considered?

Listen as Graham R. Foster, FRCP, PhD, discusses these considerations and more for strategizing the monitoring and treatment of older adults with HBV. 

Presenter: 

Graham R. Foster, FRCP, PhD
Professor of Hepatology
The Liver Unit
Consultant Hepatologist
Queen Mary University of London
London, United Kingdom

Link to full program:
https://bit.ly/3fg9fwB