S4-E40.4 - Challenges in Treating and Assessing Adequately

Send us Fan MailAlong with NASH-TAG, Paris NASH is one of two famously small, science-based and publicly available events every year for the liver community. Given the depth of topics and ideas explored in Paris, the event in its entirety would be nearly impossible to cover in a single conclusive episode. That said, the Surfers (Jörn Schattenberg, Louise Campbell and Roger Green) are joined by two presenting KOLs, Scott Friedman and Laurent Castera, for a neatly packaged conversation to capture some of the key dynamics of the meeting. Particularly, the group hone in on developments in the landscape around NITs.This conversation starts with a question from Louise about whether utilizing CAP would provide added insight in light of what the group has discussed around NITs in the preceding conversations. Laurent responds that CAP is more related to inflammation and steatosis than to fibrosis, and Scott agrees. Laurent suggests that MRI-PDFF would be an ideal test for addressing this issue, but it is not cost-effective for regular practice. Therefore, he uses VCTE measures, including CAP, because the numbers he provides are motivating to patients. Louise asks how activation of stellate cells depends on disease and Scott notes that most stellate cell activation is driven by inflammation, not fat. However, this raises two challenges: whether lipotoxic mediators drive fibrosis directly or act through inflammation and, more broadly, that current clinical tools for measuring fat are quite broad. On this point, Jörn notes that as the liver progresses toward cirrhosis, it loses fat and thus makes  the entire issue more complex. Roger raises the question whether patient compliance and adherence might be affected negatively by uncertainty about the meaning of results. The rest of this conversation centers around Scott’s comment about the complicated impact of using GLP-1s and other incretins to treat obesity will have on Steatotic Liver Disease (SLD) and challenges in treating and assessing adequately.  This episode and its conversations cover a range of fascinating insights stemming from yet another impactful Paris NASH meeting. If you have questions or comments around Paris NASH, NITs or any other themes addressed, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected] Safe and Surf On!