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Allen AM, Charlton M, Cusi K, Harrison SA, Kowdley KV, Noureddin M, Shubrook JH. Guideline-based management of metabolic dysfunction-associated steatotic liver disease in the primary care setting. Postgrad Med 2024:1-17. [PMID: 38465573 DOI: 10.1080/00325481.2024.2325332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. Primary care providers play a critical role in the screening, diagnosis, and management of MASLD and/or metabolic dysfunction-associated steatohepatitis (MASH), though they can face challenges in this setting, particularly where healthcare resources are limited and barriers to care exist. To address these challenges, several guidelines have been developed to provide evidence-based recommendations for the clinical assessment and management of patients with MASLD/MASH. AIMS To provide a unified, simple-to-understand, practical guide for MASLD screening, diagnosis, and management based on current guideline recommendations, for use by primary care providers in daily practice. METHODS Evidence-based recommendations from several international guidelines were summarized, focusing on the similarities and differences between them. RESULTS Recommendations are broadly aligned across the guidelines, but several key differences are evident. Practical guidance is provided on screening, identifying target populations for risk stratification, initial evaluation of individuals with suspected MASLD, surveillance, risk stratification and referral, as well as approaches to the management of MASLD and associated comorbidities, with specific considerations for the primary care setting. CONCLUSIONS Primary care providers are ideally placed to identify at-risk individuals, implement evidence-based interventions to prevent the development of fibrosis and cirrhosis, and effectively manage comorbidities. Equipping primary care providers with the necessary knowledge and tools to effectively manage MASLD/MASH may help to improve patient outcomes and reduce the burden of liver disease.
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Affiliation(s)
- Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Michael Charlton
- Transplantation Institute, University of Chicago Medicine, Chicago, IL, USA
| | - Kenneth Cusi
- Division of Endocrinology, University of Florida, Gainesville, FL, USA
| | | | - Kris V Kowdley
- Liver Institute Northwest and Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Liver Institute, Houston, TX, USA
| | - Jay H Shubrook
- Department of Clinical Sciences and Community Health, Touro University California, Vallejo, CA, USA
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Kwak M, Kim HS, Jiang ZG, Yeo YH, Trivedi HD, Noureddin M, Yang JD. MASLD/MetALD and mortality in individuals with any cardio-metabolic risk factor: a population based study with 26.7 years of follow-up. Hepatology 2024:01515467-990000000-00877. [PMID: 38739848 DOI: 10.1097/hep.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/24/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AIMS A new term, metabolic dysfunction-associated steatotic liver disease(MASLD), has been proposed by a multi-society expert panel. However, it remains unclear whether hepatic steatosis per se in MASLD contributes to an increased risk of mortality in individuals with any cardio-metabolic risk factor(CMRF), which are also significant risk factors for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the 'MASLD/MetALD' and 'no steatotic liver disease(SLD)' groups in individuals with any CMRF. APPROACH AND RESULTS A population-based cohort study was conducted using 10,750 participants of NHANES III. All-cause and cause-specific(cardiovascular, cancer, diabetes, and liver) mortality risks were compared between the 'MASLD', 'MetALD', and 'no SLD' groups using the Cox proportional hazards model with complex survey design weights, adjusted for confounders. Over 26 years, the 'MASLD' group did not show significantly increased all-cause(adjusted hazard ratio 1.04[95% confidence interval 0.95-1.14], p=0.413), cardiovascular(0.88[0.75-1.04], p=0.139), or cancer(1.06[0.84-1.33], p=0.635) mortality risk compared to the 'no SLD' group in individuals with any CMRF. The MetALD group was associated with increased all-cause(1.41 [1.05-1.89], p=0.022), cancer(2.35[1.33-4.16], p=0.004) and liver(15.04[2.96-76.35], p=0.002) mortality risk compared with the no SLD group. This trend was more pronounced in MetALD group with advanced fibrosis assessed by FIB-4. CONCLUSION In individuals with CMRF, the presence of steatotic liver disease (MASLD) alone did not increase the risk of mortality, except in cases with more alcohol consumption (MetALD). Therefore controlling metabolic risk factors and reducing alcohol consumption in people with MASLD or MetALD will be crucial steps to improve long-term health outcomes.
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Affiliation(s)
- Minsun Kwak
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Seok Kim
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zhenghui Gordon Jiang
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hirsh D Trivedi
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mazen Noureddin
- Houston Methodist Hospital
- Department of Houston Research Institute, Houston, Texas, USA
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Danpanichkul P, Ng CH, Muthiah M, Suparan K, Tan DJH, Duangsonk K, Sukphutanan B, Kongarin S, Harinwan N, Panpradist N, Takahashi H, Kawaguchi T, Vichitkunakorn P, Chaiyakunapruk N, Nathisuwan S, Huang D, Arab JP, Noureddin M, Mellinger JL, Wijarnpreecha K. From Shadows to Spotlight: Exploring the Escalating Burden of Alcohol-Associated Liver Disease and Alcohol Use Disorder in Young Women. Am J Gastroenterol 2024; 119:893-909. [PMID: 38147513 DOI: 10.14309/ajg.0000000000002642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION The burden of alcohol-related complications is considerable, particularly alcohol-associated liver disease and alcohol use disorder (AUD). However, there are deficiencies in comprehensive epidemiological research focusing on these issues, especially among young women who display higher susceptibility to such complications compared with their male counterparts. We thus aimed to determine the global burden of these conditions in this vulnerable group. METHODS Leveraging data from the Global Burden of Disease Study 2019, we analyzed the prevalence, mortality, and disability-adjusted life years of alcohol-associated cirrhosis (AC), liver cancer from alcohol, and AUD in young women. The findings were categorized by region, nation, and sociodemographic index. RESULTS The highest age-standardized prevalence rates were observed in AUD (895.96 [95% uncertainty interval (UI) 722.6-1,103.58]), followed by AC (65.33 [95% UI 48.37-86.49]) and liver cancer from alcohol (0.13 [95% UI 0.09-0.19]) per 100,000 people. The highest age-standardized mortality rates were observed in AC (0.75 [95% UI 0.55-0.97]), followed by AUD (0.48 [95% UI 0.43-0.53]) and liver cancer from alcohol (0.06 [95% UI 0.04-0.09]). The highest burdens of AC and AUD were observed in Central Europe, whereas the high-income Asia Pacific had the highest burden of liver cancer from alcohol. DISCUSSION Throughout the past decade, the trend of AUD varied among regions while the impact of alcohol-associated liver disease has increased, requiring urgent public health strategy to mitigate these complications, particularly in female patients in Europe and the Asia-Pacific region.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kanokphong Suparan
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kwanjit Duangsonk
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Nateeluck Harinwan
- Department of Surgery, School of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Nuttada Panpradist
- Global Center for Integrated Health for Women, Adolescents, and Children (Global WACh), Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Polathep Vichitkunakorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Daniel Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Mazen Noureddin
- Houston Methodist and Houston Research Institute, Houston, Texas, USA
| | - Jessica Leigh Mellinger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine and Division of Gastroenterology and Hepatology, Phoenix, Arizona, USA
- Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
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Tsochatzis EA, Valenti L, Thiele M, Péloquin S, Lazure P, Masson MH, Allen AM, Lazarus JV, Noureddin M, Rinella M, Tacke F, Murray S. Use of non-invasive diagnostic tools for metabolic dysfunction-associated steatohepatitis: A qualitative exploration of challenges and barriers. Liver Int 2024. [PMID: 38634796 DOI: 10.1111/liv.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/04/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIMS Non-invasive tests (NITs) are underutilized for diagnosis and risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD), despite good accuracy. This study aimed to identify challenges and barriers to the use of NITs in clinical practice. METHODS We conducted a qualitative exploratory study in Germany, Italy, United Kingdom and United States. Phase 1 participants (primary care physicians, hepatologists, diabetologists, researchers, healthcare administrators, payers and patient advocates; n = 29) were interviewed. Phase 2 participants (experts in MASLD; n = 8) took part in a group discussion to validate and expand on Phase 1 findings. Finally, we triangulated perspectives in a hybrid deductive/inductive thematic analysis. RESULTS Four themes hindering the use of NITs emerged: (1) limited knowledge and awareness; (2) unclear referral pathways for patients affected by liver conditions; (3) uncertainty over the value of NITs in monitoring and managing liver diseases; and (4) challenges justifying system-level reimbursement. Through these themes, participants perceived a stigma associated with liver diseases, and primary care physicians generally lacked awareness, adequate knowledge and skills to use recommended NITs. We identified uncertainties over the results of NITs, specifically to guide lifestyle intervention or to identify patients that should be referred to a specialist. Participants indicated an ongoing need for research and development to improve the prognostic value of NITs and communicating their cost-effectiveness to payers. CONCLUSIONS This qualitative study suggests that use of NITs for MASLD is limited due to several individual and system-level barriers. Multi-level interventions are likely required to address these barriers.
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Affiliation(s)
- Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Precision Medicine, Biological Resource Center Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maja Thiele
- Center for Liver Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Mary Rinella
- Prizker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Danpanichkul P, Aboona MB, Sukphutanan B, Kongarin S, Duangsonk K, Ng CH, Muthiah MD, Huang DQ, Seko Y, Díaz LA, Arab JP, Yang JD, Chen VL, Kim D, Noureddin M, Liangpunsakul S, Wijarnpreecha K. Incidence of liver cancer in young adults according to the global burden of disease database 2019. Hepatology 2024:01515467-990000000-00835. [PMID: 38598364 DOI: 10.1097/hep.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The worldwide burden of cancer is increasing in younger populations. However, the epidemiology of primary liver cancer remains understudied in young adults compared to other cancer forms. METHODS This study analyzed data from the Global Burden of Disease (GBD) study between 2010 and 2019 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) associated with primary liver cancer in the young (15-49 y), stratified by region, nation, sociodemographic index, and sex. RESULTS The study found a global estimate of 78,299 primary liver cancer cases, 60,602 deaths, and 2.90 million DALYs in the young population. The Western Pacific region exhibited the highest burden in 2019, showing the most significant increase compared to other regions between 2010-2019. More than half of countries worldwide have undergone an increase in primary liver cancer incidence rates in young adults. Around 12.51% of deaths due to primary liver cancer occur in young individuals. Throughout the study period, there was a significant decline in primary liver cancer mortality due to most etiologies, except for metabolic dysfunction-associated steatotic liver disease (MASLD)-attributable primary liver cancer (annual percentage change [APC] +0.87%, 95% confidence interval 0.70-1.05%) and alcohol-attributable primary liver cancer (APC +0.21%, 95% confidence interval 0.01-0.42%). Limitations of the GBD database include reliance on the quality of primary data and possible underestimation of alcohol consumption. CONCLUSION Over the past decade, there has been a marked increase in the burden of primary liver cancer, especially that originating from steatotic liver disease. This trend calls for the development of urgent and comprehensive strategies to mitigate this rising burden globally.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Majd B Aboona
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | | | | | - Kwanjit Duangsonk
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- MASLD Research Center, Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
| | - Yuya Seko
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyou-ku, Kyoto, 602-8566, Japan
| | - Luis Antonio Díaz
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago,Chile
- Observatorio Multicéntrico de Enfermedades Gastrointestinales, OMEGA, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago,Chile
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vincent L Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine and Division of Gastroenterology and Hepatology, Phoenix, Arizona, USA
- Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
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6
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Mózes FE, Lee JA, Vali Y, Selvaraj EA, Jayaswal ANA, Boursier J, de Lédinghen V, Lupșor-Platon M, Yilmaz Y, Chan WK, Mahadeva S, Karlas T, Wiegand J, Shalimar, Tsochatzis E, Liguori A, Wong VWS, Lee DH, Holleboom AG, van Dijk AM, Mak AL, Hagström H, Akbari C, Hirooka M, Lee DH, Kim W, Okanoue T, Shima T, Nakajima A, Yoneda M, Thuluvath PJ, Li F, Berzigotti A, Mendoza YP, Noureddin M, Truong E, Fournier-Poizat C, Geier A, Tuthill T, Yunis C, Anstee QM, Harrison SA, Bossuyt PM, Pavlides M. Diagnostic accuracy of non-invasive tests to screen for at-risk MASH-An individual participant data meta-analysis. Liver Int 2024. [PMID: 38573034 DOI: 10.1111/liv.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 02/07/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND & AIMS There is a need to reduce the screen failure rate (SFR) in metabolic dysfunction-associated steatohepatitis (MASH) clinical trials (MASH+F2-3; MASH+F4) and identify people with high-risk MASH (MASH+F2-4) in clinical practice. We aimed to evaluate non-invasive tests (NITs) screening approaches for these target conditions. METHODS This was an individual participant data meta-analysis for the performance of NITs against liver biopsy for MASH+F2-4, MASH+F2-3 and MASH+F4. Index tests were the FibroScan-AST (FAST) score, liver stiffness measured using vibration-controlled transient elastography (LSM-VCTE), the fibrosis-4 score (FIB-4) and the NAFLD fibrosis score (NFS). Area under the receiver operating characteristics curve (AUROC) and thresholds including those that achieved 34% SFR were reported. RESULTS We included 2281 unique cases. The prevalence of MASH+F2-4, MASH+F2-3 and MASH+F4 was 31%, 24% and 7%, respectively. Area under the receiver operating characteristics curves for MASH+F2-4 were .78, .75, .68 and .57 for FAST, LSM-VCTE, FIB-4 and NFS. Area under the receiver operating characteristics curves for MASH+F2-3 were .73, .67, .60, .58 for FAST, LSM-VCTE, FIB-4 and NFS. Area under the receiver operating characteristics curves for MASH+F4 were .79, .84, .81, .76 for FAST, LSM-VCTE, FIB-4 and NFS. The sequential combination of FIB-4 and LSM-VCTE for the detection of MASH+F2-3 with threshold of .7 and 3.48, and 5.9 and 20 kPa achieved SFR of 67% and sensitivity of 60%, detecting 15 true positive cases from a theoretical group of 100 participants at the prevalence of 24%. CONCLUSIONS Sequential combinations of NITs do not compromise diagnostic performance and may reduce resource utilisation through the need of fewer LSM-VCTE examinations.
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Affiliation(s)
- Ferenc E Mózes
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OCMR, University of Oxford, Oxford, UK
| | - Jenny A Lee
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yasaman Vali
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emmanuel A Selvaraj
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OCMR, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Arjun N A Jayaswal
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OCMR, University of Oxford, Oxford, UK
| | - Jérôme Boursier
- Laboratoire HIFIH, UPRES EA 3859, SFR ICAT 4208, Université d'Angers, Angers, France
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Victor de Lédinghen
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
- INSERM1312, Bordeaux University, Bordeaux, France
| | - Monica Lupșor-Platon
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology "Prof.Dr. Octavian Fodor", Cluj-Napoca, Romania
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thomas Karlas
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Emmanouil Tsochatzis
- Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London, UK
| | - Antonio Liguori
- Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London, UK
- Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Dae Ho Lee
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne-Marieke van Dijk
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Linde Mak
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hannes Hagström
- Division of Liver and Pancreatic diseases, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Akbari
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Touon, Ehime, Japan
| | - Dong Hyeon Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Won Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Paul J Thuluvath
- Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Feng Li
- Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA
| | - Annalisa Berzigotti
- Department for Visceral Medicine and Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Yuly P Mendoza
- Department for Visceral Medicine and Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Emily Truong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Andreas Geier
- Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
| | - Theresa Tuthill
- Internal Medicine Research Unit, Pfizer Inc, Cambridge, Massachusetts, USA
| | - Carla Yunis
- Clinical Development and Operations, Global Product Development, Pfizer, Inc, Lake Mary, Florida, USA
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Stephen A Harrison
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OCMR, University of Oxford, Oxford, UK
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Pavlides
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OCMR, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
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7
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Danpanichkul P, Suparan K, Ng CH, Dejvajara D, Kongarin S, Panpradist N, Chaiyakunapruk N, Muthiah MD, Chen VL, Huang DQ, Díaz LA, Noureddin M, Arab JP, Wijarnpreecha K. Global and regional burden of alcohol-associated liver disease and alcohol use disorder in the elderly. JHEP Rep 2024; 6:101020. [PMID: 38515553 PMCID: PMC10956070 DOI: 10.1016/j.jhepr.2024.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background & Aims Alcohol-associated liver diseases (ALDs) and alcohol use disorder (AUD) pose a global health risk. AUD is underrecognized in the elderly, and the burden of AUD complications, including ALD, may increase with aging populations and rising alcohol intake. However, there is a lack of epidemiological evidence on AUD and ALD in the elderly. Methods Using the Global Burden of Disease Study 2019, we analyzed the prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates (ASRs), and temporal change from 2000 to 2019 of ALD and AUD in the overall population and the elderly (65-89 years). The findings were categorized by sex, region, nation, and sociodemographic index. Results The prevalence rates of ALD in the elderly were higher than those in adolescents and young adults, whereas AUD levels were lower than those in adolescents and young adults. In 2019, there were 9.39 million cases (8.69% of cases in the overall population) of AUD, 3.23 million cases (21.8% of cases in the overall population) of alcohol-associated cirrhosis, and 68,468 cases (51.27% of cases in the overall population) of liver cancer from alcohol among the elderly. ASRs of the prevalence of ALD and AUD in the elderly increased in most regions; on the contrary, ASRs of death and DALYs decreased in most regions. Nevertheless, ASRs of death and DALYs from liver cancer from alcohol increased in many areas. Conclusions Our findings highlighted the increased prevalence of ALD in the elderly, with a burden of AUD comparable with that in the overall population. Public health strategies on ALD and AUD targeting the elderly are urgently needed. Impact and implications The burden of alcohol-associated liver disease (ALD) and alcohol use disorder (AUD) is increasing. Advances in healthcare and education have resulted in a remarkable spike in life expectancy and a consequential population aging. Nevertheless, little is known about the epidemiology of ALD and AUD in the elderly. Our study indicates the increasing burden of ALD and AUD in the elderly population, necessitating early detection, intervention, and tailored care to the unique needs and complexities faced by older individuals grappling with these conditions.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokphong Suparan
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | | | - Nuttada Panpradist
- Global Center for Integrated Health for Women, Adolescents, and Children (Global WACh), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Mark D. Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Vincent L. Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Luis Antonio Díaz
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Mazen Noureddin
- Houston Methodist and Houston Research Institute, Houston, TX, USA
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA
- BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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8
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Noureddin M. MASH clinical trials and drugs pipeline: An impending Tsunami. Hepatology 2024:01515467-990000000-00811. [PMID: 38502810 DOI: 10.1097/hep.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as NAFLD, has ascended to prominence as the predominant chronic liver disease in Western countries and now stands as a leading cause of liver transplantations. In the more advanced stage, Metabolic Dysfunction-Associated Steatohepatitis (MASH), may lead to fibrosis, a gateway to cirrhosis, liver cancer, and liver failure. Despite extensive research and exploration of various drug mechanisms, the anticipation for the inaugural approved drug to materialize by 2024 is palpable, marking a significant milestone. Numerous pathways have been investigated for MASH treatment, exploring thyroid hormone receptors, glucagon-like peptides 1, peroxisome proliferator-activated receptors, and agents influencing hepatic steatosis synthesis, inflammatory pathways, genetic components, fibrosis mechanisms, and an array of other avenues. Over time, key regulatory directions have crystallized, now manifesting in two primary endpoints under investigation: resolution of steatohepatitis without worsening fibrosis and/or improvement of fibrosis stage without worsening of steatohepatitis, especially used in Phase 3 clinical trials, while alternative non-invasive endpoints are explored in Phase 2 trials. The prospect of proving efficacy in clinical trials opens doors to combination therapies, evaluating the ideal combination of drugs to yield comprehensive benefits, extending beyond the liver to other organs. Certain combination drug trials are already underway. In this review, we discuss the forefront of MASH drug research as of 2023/2024, illuminating mechanisms, outcomes, and future trajectories. Furthermore, we tackle the challenges confronting MASH trials and propose potential strategies for surmounting them.
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Affiliation(s)
- Mazen Noureddin
- Sherrie & Alan Conover Center for Liver Disease & Transplantation , Underwood Center for Digestive Disorders Department of Medicine, Houston Methodist Hospital, Houston, Texas
- Houston Research Institute, Houston, Texas
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9
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Chan KE, Ong EYH, Chung CH, Ong CEY, Koh B, Tan DJH, Lim WH, Yong JN, Xiao J, Wong ZY, Syn N, Kaewdech A, Teng M, Wang JW, Chew N, Young DY, Know A, Siddiqui MS, Huang DQ, Tamaki N, Wong VWS, Mantzoros CS, Sanyal A, Noureddin M, Ng CH, Muthiah M. Longitudinal Outcomes Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Meta-analysis of 129 Studies. Clin Gastroenterol Hepatol 2024; 22:488-498.e14. [PMID: 37775028 DOI: 10.1016/j.cgh.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND & AIMS The progression of metabolic dysfunction-associated steatotic liver disease (MASLD) has been found to manifest in a series of hepatic and extrahepatic complications. A comprehensive meta-analysis of the longitudinal outcomes associated with MASLD has yet to be conducted. METHODS To investigate the longitudinal outcomes associated with MASLD, Medline and Embase databases were searched to identify original studies that evaluated the longitudinal risks of incident clinical outcomes among MASLD patients compared with non-MASLD individuals. DerSimonian Laird random-effects meta-analysis was performed. Pooled effect estimates were calculated, and heterogeneity among studies was evaluated. RESULTS One hundred twenty-nine studies were included in the meta-analysis. Meta-analysis revealed a significant increase in the risk of cardiovascular outcomes (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.27-1.60; P < .01), various metabolic outcomes such as incident hypertension (HR, 1.75; 95% CI, 1.46-2.08; P < .01), diabetes (HR, 2.56; 95% CI, 2.10-3.13; P < .01), pre-diabetes (HR, 1.69; 95% CI, 1.22-2.35; P < .01), metabolic syndrome (HR, 2.57; 95% CI, 1.13-5.85; P = .02), chronic kidney disease (HR, 1.38; 95% CI, 1.27-1.50; P < .01), as well as all cancers (HR, 1.54; 95% CI, 1.35-1.76; P < .01) among MASLD patients compared with non-MASLD individuals. By subgroup analysis, MASLD patients with advanced liver disease (HR, 3.60; 95% CI, 2.10-6.18; P < .01) were also found to be associated with a significantly greater risk (P = .02) of incident diabetes than those with less severe MASLD (HR, 1.63; 95% CI, 1.0-2.45; P = .02) when compared with non-MASLD. CONCLUSIONS The present study emphasizes the association between MASLD and its clinical outcomes including cardiovascular, metabolic, oncologic, and other outcomes. The multisystemic nature of MASLD found in this analysis requires treatment targets to reduce systemic events and end organ complications.
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Affiliation(s)
- Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elden Yen Hng Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charlotte Hui Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhen Yu Wong
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Jiong-Wei Wang
- Department of Surgery, Cardiovascular Research Institute (CVRI), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Nanomedicine Translational Research Programme, Centre for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Alfred Know
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Christos S Mantzoros
- Division of Endocrinology, Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
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10
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Lim WH, Tay P, Ng CH, Tan DJH, Ong C, Koh JH, Teng M, Chee D, Wong ZY, Kawaguchi T, Takahashi H, Muthiah M, Tan EXX, Wijarnpreecha K, Lee GH, Noureddin M, Lee BP, Mathurin P, Loomba R, Huang DQ. Meta-analysis: Prevalence and impact of alcohol abstinence in alcohol-associated cirrhosis. Aliment Pharmacol Ther 2024; 59:730-741. [PMID: 38303565 DOI: 10.1111/apt.17888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/21/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Although alcohol abstinence may be an effective intervention for alcohol-associated cirrhosis, its association with prognosis has not been systematically assessed or quantified. AIMS To determine the prevalence of alcohol abstinence, factors associated with alcohol abstinence and the impact of abstinence on morbidity and overall survival in people with alcohol-associated cirrhosis. METHODS We searched Medline and Embase from inception to 15 April 2023 for prospective and retrospective cohort studies describing alcohol abstinence in people with known alcohol-associated cirrhosis. Meta-analysis of proportions for pooled estimates was performed. The method of inverse variance, employing a random-effects model, was used to pool the hazard ratio (HR) comparing outcomes of abstinent against non-abstinent individuals with alcohol-associated cirrhosis. RESULTS We included 19 studies involving 18,833 people with alcohol-associated cirrhosis. The prevalence of alcohol abstinence was 53.8% (CI: 44.6%-62.7%). Over a mean follow-up duration of 48.6 months, individuals who continued to consume alcohol had significantly lower overall survival compared to those who were abstinent (HR: 0.611, 95% CI: 0.506-0.738). These findings remained consistent in sensitivity/subgroup analysis for the presence of decompensation, study design and studies that assessed abstinence throughout follow-up. Alcohol abstinence was associated with a significantly lower risk of hepatic decompensation (HR: 0.612, 95% CI: 0.473-0.792). CONCLUSIONS Alcohol abstinence is associated with substantial improvement in overall survival in alcohol-associated cirrhosis. However, only half of the individuals with known alcohol-associated cirrhosis are abstinent.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Phoebe Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christen Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jia Hong Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Zhen Yu Wong
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | | | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Eunice X X Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | - Guan Huei Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | | | - Brian P Lee
- Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Philippe Mathurin
- Service des Maladies de l'appareil Digestif, Hôpital Huriez, CHU, Lille, France
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
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11
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Danpanichkul P, Ng CH, Tan DJ, Muthiah MD, Kongarin S, Srisurapanont K, Kanjanakot Y, Duangsonk K, Huang DQ, Suzuki H, Harnois DM, Yang JD, Noureddin M, Wijarnpreecha K. The Global Burden of Early-Onset Biliary Tract Cancer: Insight From the Global Burden of Disease Study 2019. J Clin Exp Hepatol 2024; 14:101320. [PMID: 38261906 PMCID: PMC10796968 DOI: 10.1016/j.jceh.2023.101320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Backgrounds/objectives The escalating incidence of early-onset gastrointestinal cancers is becoming a primary global health concern. Biliary tract cancer (BTC) has been relatively understudied in this regard. We conducted an epidemiological study regarding the burden of this condition. Methods We utilized data from the Global Burden of Disease Study 2019 to investigate the temporal trends in early-onset BTC (EOBTC), encompassing the estimation of frequencies and age-standardized rates (ASRs) of EOBTC incidence, mortality, and disability-adjusted life-years (DALYs), from 2010 to 2019. Results EOBTC constituted nearly 7%of all BTC cases worldwide. The incidence rates of EOBTC decreased significantly in most regions, except in the Eastern Mediterranean (annual percentage change +1.04 %), where the incidence is rising. Stratified by the sociodemographic index (SDI), countries with low middle SDI (annual percentage change +0.5 %) show increasing incidence of EOBTC. The ASR of death and DALYs decreased in most regions. The ASR of EOBTC-related death and disability attributable to high body mass index increased in most regions, with the highest increase in Southeast Asia and low, middle SDI strata. Conclusions There was a reduction in the burden of EOBTC globally, except for Eastern Mediterranean countries and low-middle SDI countries.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Cheng H. Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Darren J.H. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark D. Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Yatawee Kanjanakot
- Department of Surgery, School of Medicine, Mae Fah Luang University, Thailand
| | - Kwanjit Duangsonk
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Hiroyuki Suzuki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Denise M. Harnois
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ju D. Yang
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Methodist Hospital, Houston, TX, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA
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12
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Danpanichkul P, Ng CH, Tan DJH, Wijarnpreecha K, Huang DQ, Noureddin M. The Global Burden of Alcohol-associated Cirrhosis and Cancer in Young and Middle-aged Adults. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00217-9. [PMID: 38428708 DOI: 10.1016/j.cgh.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
Alcohol is a substance that impacts premature mortality and morbidity.1 The liver is invariably subjected to the impact of alcohol, which can result in cirrhosis and cancer. Alcohol also has detrimental effects that extend beyond the liver. While traditionally associated with advanced age, emerging data reported a rising burden of cancers and alcohol-associated liver disease in the young.1-3 Thus, the primary objective was to evaluate the trend of alcohol-associated cirrhosis and cancer in young and middle-aged adults (aged 15-49) utilizing the Global Burden of Disease Study (GBD) 2019.4 We chose the age group less than 50 years old based on the definition of early-onset cancer and the inherent selection of the age group in the GBD database.4-6 The detailed methods are provided in the Supplementary Appendix. Briefly, data were sourced from population-based cancer registries, vital registration systems, or verbal autopsy studies. Verbal autopsy is a well-established approach for monitoring health, providing valuable information on mortality patterns and the reasons behind deaths in areas lacking robust medical death certification processes. The researchers employed the Cause of Death Ensemble model to estimate the burden linked to cancer and cirrhosis associated with alcohol use.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona; BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Mazen Noureddin
- Houston Research Institute and Houston Methodist Hospital, Houston, Texas
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13
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Chang M, Chang D, Kodali S, Harrison SA, Ghobrial M, Alkhouri N, Noureddin M. Degree of Discordance Between FIB-4 and Transient Elastography: An Application of Current Guidelines on General Population Cohort. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00213-1. [PMID: 38428706 DOI: 10.1016/j.cgh.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND & AIMS In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population. METHODS Using the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement. RESULTS Among the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all P < .05). Misclassified subjects were also more likely to have prediabetes/diabetes. CONCLUSION Using FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies.
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Affiliation(s)
| | - Devon Chang
- Arnold O. Beckman High School, Irvine, California
| | | | - Stephen A Harrison
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Pinnacle Research Center, San Antonio, Texas
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Kalligeros M, Mylonakis E, Noureddin M. Reply. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00164-2. [PMID: 38346568 DOI: 10.1016/j.cgh.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Markos Kalligeros
- Division of Internal Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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Harrison SA, Bedossa P, Guy CD, Schattenberg JM, Loomba R, Taub R, Labriola D, Moussa SE, Neff GW, Rinella ME, Anstee QM, Abdelmalek MF, Younossi Z, Baum SJ, Francque S, Charlton MR, Newsome PN, Lanthier N, Schiefke I, Mangia A, Pericàs JM, Patil R, Sanyal AJ, Noureddin M, Bansal MB, Alkhouri N, Castera L, Rudraraju M, Ratziu V. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Engl J Med 2024; 390:497-509. [PMID: 38324483 DOI: 10.1056/nejmoa2309000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Nonalcoholic steatohepatitis (NASH) is a progressive liver disease with no approved treatment. Resmetirom is an oral, liver-directed, thyroid hormone receptor beta-selective agonist in development for the treatment of NASH with liver fibrosis. METHODS We are conducting an ongoing phase 3 trial involving adults with biopsy-confirmed NASH and a fibrosis stage of F1B, F2, or F3 (stages range from F0 [no fibrosis] to F4 [cirrhosis]). Patients were randomly assigned in a 1:1:1 ratio to receive once-daily resmetirom at a dose of 80 mg or 100 mg or placebo. The two primary end points at week 52 were NASH resolution (including a reduction in the nonalcoholic fatty liver disease [NAFLD] activity score by ≥2 points; scores range from 0 to 8, with higher scores indicating more severe disease) with no worsening of fibrosis, and an improvement (reduction) in fibrosis by at least one stage with no worsening of the NAFLD activity score. RESULTS Overall, 966 patients formed the primary analysis population (322 in the 80-mg resmetirom group, 323 in the 100-mg resmetirom group, and 321 in the placebo group). NASH resolution with no worsening of fibrosis was achieved in 25.9% of the patients in the 80-mg resmetirom group and 29.9% of those in the 100-mg resmetirom group, as compared with 9.7% of those in the placebo group (P<0.001 for both comparisons with placebo). Fibrosis improvement by at least one stage with no worsening of the NAFLD activity score was achieved in 24.2% of the patients in the 80-mg resmetirom group and 25.9% of those in the 100-mg resmetirom group, as compared with 14.2% of those in the placebo group (P<0.001 for both comparisons with placebo). The change in low-density lipoprotein cholesterol levels from baseline to week 24 was -13.6% in the 80-mg resmetirom group and -16.3% in the 100-mg resmetirom group, as compared with 0.1% in the placebo group (P<0.001 for both comparisons with placebo). Diarrhea and nausea were more frequent with resmetirom than with placebo. The incidence of serious adverse events was similar across trial groups: 10.9% in the 80-mg resmetirom group, 12.7% in the 100-mg resmetirom group, and 11.5% in the placebo group. CONCLUSIONS Both the 80-mg dose and the 100-mg dose of resmetirom were superior to placebo with respect to NASH resolution and improvement in liver fibrosis by at least one stage. (Funded by Madrigal Pharmaceuticals; MAESTRO-NASH ClinicalTrials.gov number, NCT03900429.).
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Affiliation(s)
- Stephen A Harrison
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Pierre Bedossa
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Cynthia D Guy
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Jörn M Schattenberg
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Rohit Loomba
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Rebecca Taub
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Dominic Labriola
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Sam E Moussa
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Guy W Neff
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Mary E Rinella
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Quentin M Anstee
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Manal F Abdelmalek
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Zobair Younossi
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Seth J Baum
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Sven Francque
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Michael R Charlton
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Philip N Newsome
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Nicolas Lanthier
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Ingolf Schiefke
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Alessandra Mangia
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Juan M Pericàs
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Rashmee Patil
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Arun J Sanyal
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Mazen Noureddin
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Meena B Bansal
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Naim Alkhouri
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Laurent Castera
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Madhavi Rudraraju
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
| | - Vlad Ratziu
- From the University of Oxford, Oxford (S.A.H.), the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne (Q.M.A.), and the National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham (P.N.N.) - all in the United Kingdom; Pinnacle Clinical Research, San Antonio (S.A.H., M.R.), South Texas Research Institute, Edinburg (R.P.), and Houston Methodist Hospital, Houston Research Institute, Houston (M.N.) - all in Texas; Liverpat and University of Paris (P.B.), INSERM, Unité Mixte de Recherche Scientifique (UMRS) 1139, Centre de Recherche sur l'Inflammation (L.C.), and Sorbonne Université, ICAN Institute for Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), INSERM, UMRS 1138, Centre de Recherche des Cordeliers (V.R.), Paris, and Université Paris-Cité, Department of Hepatology, Beaujon Hospital, APHP, Clichy (L.C.) - all in France; Duke University Health System, Durham, NC (C.D.G.); the Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of Johannes Gutenburg University Mainz, Mainz (J.M.S.), the Department of Internal Medicine II, Saarland University Medical Center, Homburg (J.M.S.), and Klinikum St. Georg Leipzig, Leipzig (I.S.) - all in Germany; MASLD Research Center, the Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla (R.L.); Madrigal Pharmaceuticals, West Conshohocken, PA (R.T., D.L.); University of Arizona for Medical Sciences (S.E.M.) and Arizona Liver Health (N.A.) - both in Tucson; Covenant Metabolic Specialists, Sarasota (G.W.N.), and Flourish Research, Boca Raton (S.J.B.) - both in Florida; the Transplant Institute, Department of Medicine, University of Chicago Pritzker School of Medicine, and the Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences - both in Chicago (M.E.R., M.R.C.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (M.F.A.); the Department of Medicine, Inova Fairfax Medical Campus, Falls Church (Z.Y.), and Virginia Commonwealth University, Richmond (A.J.S.) - both in Virginia; the Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem (S.F.), and Cliniques Universitaires Saint-Luc, Service d'Hépato-gastroentérologie, UCLouvain, Brussels (N.L.) - both in Belgium; the Liver Unit at the IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy (A.M.); the Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.M.P.); and the Division of Liver Diseases, Icahn School of Medicine at Mt. Sinai, New York (M.B.B.)
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16
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Alabdul Razzak I, Noureddin M, Trivedi HD. From Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Steatotic Liver Disease: Out with the Old, in with the New. J Clin Med 2024; 13:880. [PMID: 38337575 PMCID: PMC10856125 DOI: 10.3390/jcm13030880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease (CLD) affecting a quarter of the global population [...].
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Affiliation(s)
- Iyiad Alabdul Razzak
- Department of Medicine, St. Elizabeth’s Medical Center, Tufts School of Medicine, Boston, MA 02111, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Methodist Hospital, Houston, TX 77030, USA
| | - Hirsh D. Trivedi
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Karsh Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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17
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Noureddin M, Jorkasky D, Khan S, Sanyal AJ. Uncoupler therapy for NAFLD: is flushing a possible harbinger of a safety concern? - Authors' reply. Lancet Gastroenterol Hepatol 2024; 9:105-106. [PMID: 38215776 DOI: 10.1016/s2468-1253(23)00446-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, TX 77079, USA.
| | | | | | - Arun J Sanyal
- Stravitz-Sanyal Institute of Liver Disease and Metabolic Health, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, USA
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18
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Lazarus JV, Mark HE, Allen AM, Arab JP, Carrieri P, Noureddin M, Alazawi W, Alkhouri N, Alqahtani SA, Anstee QM, Arrese M, Bataller R, Berg T, Brennan PN, Burra P, Castro-Narro GE, Cortez-Pinto H, Cusi K, Dedes N, Duseja A, Francque SM, Gastaldelli A, Hagström H, Huang TT, Ivancovsky Wajcman D, Kautz A, Kopka CJ, Krag A, Newsome PN, Rinella ME, Romero D, Sarin SK, Silva M, Spearman CW, Terrault NA, Tsochatzis EA, Valenti L, Villota-Rivas M, Zelber-Sagi S, Schattenberg JM, Wong VWS, Younossi ZM. A global action agenda for turning the tide on fatty liver disease. Hepatology 2024; 79:502-523. [PMID: 37540183 PMCID: PMC10789386 DOI: 10.1097/hep.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. APPROACH AND RESULTS We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of "agree" responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% "agree"). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. CONCLUSIONS This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce the prevalence of fatty liver disease and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.
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Affiliation(s)
- Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
| | - Henry E. Mark
- European Association for the Study of the Liver (EASL), Geneva, Switzerland
- Independent consultant, Nottingham, UK
| | - Alina M. Allen
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Pablo Arab
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute, Houston, Texas, USA
| | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Naim Alkhouri
- Fatty Liver Program, Arizona Liver Health, Phoenix, Arizona, USA
| | | | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ramon Bataller
- Liver Unit, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Thomas Berg
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Paul N. Brennan
- Division of Hepatology, University of Dundee, Dundee, Scotland, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology at the Padua University Hospital, Padua, Italy
| | - Graciela E. Castro-Narro
- Department of Hepatology and Transplant, Hospital Médica Sur, Mexico City, Mexico
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Asociación Latinoamericana para el Estudio del Hígado (ALEH), Santiago, Chile
| | - Helena Cortez-Pinto
- Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Kenneth Cusi
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Florida, Gainesville, Florida, USA
| | | | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sven M. Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
- InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Amalia Gastaldelli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Terry T.K. Huang
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
- CUNY Center for Systems and Community Design and NYU-CUNY Prevention Research Center, New York, New York, USA
| | - Dana Ivancovsky Wajcman
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Philip N. Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Mary E. Rinella
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Diana Romero
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Marcelo Silva
- Hepatology and Clinical Research Units, Hospital Universitario Austral, Buenos Aires, Argentina
| | - C. Wendy Spearman
- Department of Medicine, Division of Hepatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Norah A. Terrault
- Gastrointestinal and Liver Disease Division, University of Southern California, Los Angeles, California, USA
| | | | - Luca Valenti
- Precision Medicine, Biological Resource Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Gastroenterology, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany
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Harrison SA, Ratziu V, Anstee QM, Noureddin M, Sanyal AJ, Schattenberg JM, Bedossa P, Bashir MR, Schneider D, Taub R, Bansal M, Kowdley KV, Younossi ZM, Loomba R. Design of the phase 3 MAESTRO clinical program to evaluate resmetirom for the treatment of nonalcoholic steatohepatitis. Aliment Pharmacol Ther 2024; 59:51-63. [PMID: 37786277 DOI: 10.1111/apt.17734] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/20/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Non-alcoholic steatohepatitis (NASH) is a progressive form of non-alcoholic fatty liver disease (NAFLD) associated with steatosis, hepatocellular injury, inflammation and fibrosis. In a Phase 2 trial in adults with NASH (NCT02912260), resmetirom, an orally administered, liver-targeted thyroid hormone receptor-β selective agonist, significantly reduced hepatic fat (via imaging) and resolved NASH without worsening fibrosis (via liver biopsy) in a significant number of patients compared with placebo. AIMS To present the design of the Phase 3 MAESTRO clinical programme evaluating resmetirom for treatment of NASH (MAESTRO-NAFLD-1 [NCT04197479], MAESTRO-NAFLD-OLE [NCT04951219], MAESTRO-NASH [NCT03900429], MAESTRO-NASH-OUTCOMES [NCT05500222]). METHODS MAESTRO-NASH is a pivotal serial biopsy trial in up to 2000 adults with biopsy-confirmed at-risk NASH. Patients are randomised to a once-daily oral placebo, 80 mg resmetirom, or 100 mg resmetirom. Liver biopsies are conducted at screening, week 52 and month 54. MAESTRO-NAFLD-1 is a 52-week safety trial in ~1400 adults with NAFLD/presumed NASH (based on non-invasive testing); ~700 patients from MAESTRO-NAFLD-1 are enrolled in MAESTRO-NAFLD-OLE, a 52-week active treatment extension to further evaluate safety. MAESTRO-NASH-OUTCOMES is enrolling 700 adults with well-compensated NASH cirrhosis to evaluate the potential for resmetirom to slow progression to hepatic decompensation events. Non-invasive tests (biomarkers, imaging) are assessed longitudinally throughout, in addition to validated patient-reported outcomes. CONCLUSION The MAESTRO clinical programme was designed in conjunction with regulatory authorities to support approval of resmetirom for treatment of NASH. The surrogate endpoints, based on week 52 liver biopsy, serum biomarkers and imaging, are confirmed by long-term clinical liver-related outcomes in MAESTRO-NASH (month 54) and MAESTRO-NASH-OUTCOMES (time to event).
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Affiliation(s)
- Stephen A Harrison
- Pinnacle Clinical Research Center, San Antonio, Texas, USA
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Arun J Sanyal
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | | | | | | | - Rebecca Taub
- Madrigal Pharmaceuticals, Conshohocken, Pennsylvania, USA
| | - Meena Bansal
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Rohit Loomba
- University of California, San Diego, La Jolla, California, USA
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Francque SM, Noureddin M, Krag A. Learnings From the Graveyard of Phase 2 and 3 Nonalcoholic Steatohepatitis Trials. Clin Gastroenterol Hepatol 2024; 22:16-19. [PMID: 37517632 DOI: 10.1016/j.cgh.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Sven M Francque
- Department of Gastroenterology Hepatology, Antwerp University Hospital, Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Mazen Noureddin
- Houston Research Institute, Houston, Texas; Houston Methodist Hospital, Houston, Texas
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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21
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Noureddin M, Harrison SA, Alkhouri N. MEFIB vs. MAST and FAST: Not a competition but useful tools. J Hepatol 2024; 80:e35-e36. [PMID: 36370950 DOI: 10.1016/j.jhep.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Mazen Noureddin
- Houston Methodist Hospital, Houston, Texas, United States; Houston Research Institute, Houston, Texas, United States.
| | - Stephen A Harrison
- Pinnacle Research, San Antonio, Texas, United Kingdom; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Naim Alkhouri
- Arizona Liver Health, Phoenix, Arizona, United States
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22
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Wong ZY, Koh JH, Muthiah M, Koh B, Ong EYH, Ong CEY, Ou KQ, Lim WH, Tan DJH, Chee D, Siah KTH, Wong Y, Kaewdech A, Wijarnpreecha K, Kulkarni AV, Nah B, Huang DQ, Noureddin M, Ng CH, Teng M. Proton Pump Inhibitors Increases Longitudinal Risk of Mortality, Decompensation, and Infection in Cirrhosis: A Meta-Analysis. Dig Dis Sci 2024; 69:289-297. [PMID: 37968557 DOI: 10.1007/s10620-023-08150-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND/AIMS Proton pump inhibitors (PPIs) are frequently prescribed to cirrhotic patients, but there is limited longitudinal evidence regarding their effects. This study aimed to assess the impact of PPIs on adverse events in cirrhotic patients. METHODS A comprehensive search was conducted using the Medline and Embase databases to identify relevant articles. Pooled hazard ratios (HRs) using DerSimonian and Laird random-effects model were calculated to evaluate the risk of adverse events such as long-term mortality, hepatic decompensation, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and overall infection in cirrhotic patients with PPI use. RESULTS The analysis included 28 studies with 260,854 cirrhotic patients. The prevalence of PPI use among cirrhotic patients was 55.93%. The use of PPIs was not significantly associated with short-term mortality in cirrhotic patients. However, long-term mortality (HR 1.321, 95% CI 1.103-1.581, P = 0.002), decompensation (HR 1.646, 95% CI 1.477-1.835, P < 0.001), HE (HR 1.968, 95% CI 1.372-2.822, P < 0.001), SBP (HR 1.751, 95% CI 1.649-1.859, P < 0.001), and infection (HR 1.370, 95% CI 1.148-1.634, P < 0.001) were significantly associated with PPI use. Sensitivity analysis with prospective studies yielded similar results. CONCLUSION PPIs should be reserved for appropriate indications at lowest effective dose for cirrhotic patients due to the potential harm.
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Affiliation(s)
- Zhen Yu Wong
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jia Hong Koh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Benjamin Koh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Elden Yen Hng Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Kai Qi Ou
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Yujun Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Apichat Kaewdech
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Benjamin Nah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | | | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
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Noureddin M, Wei L, Castera L, Tsochatzis EA. Embracing Change: From Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Steatotic Liver Disease Under the Steatotic Liver Disease Umbrella. Clin Gastroenterol Hepatol 2024; 22:9-11. [PMID: 37848118 DOI: 10.1016/j.cgh.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Mazen Noureddin
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Underwood Center for Digestive Disorders, Department of Medicine, Houston Methodist Hospital, Houston, Texas; Houston Research Institute, Houston, Texas
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Laurent Castera
- Université Paris-Cité, Inserm, Centre de Recherche sur l'Inflammation, Paris, France; Service d'Hé patologie, Hô pital Beaujon, Assistance-Publique Hô pitaux de Paris, Clichy, France
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
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Noureddin M, Truong E, Mayo R, Martínez-Arranz I, Mincholé I, Banales JM, Arrese M, Cusi K, Arias-Loste MT, Bruha R, Romero-Gómez M, Iruzubieta P, Aller R, Ampuero J, Calleja JL, Ibañez-Samaniego L, Aspichueta P, Martín-Duce A, Kushner T, Ortiz P, Harrison SA, Anstee QM, Crespo J, Mato JM, Sanyal AJ. Serum identification of at-risk MASH: The metabolomics-advanced steatohepatitis fibrosis score (MASEF). Hepatology 2024; 79:135-148. [PMID: 37505221 PMCID: PMC10718221 DOI: 10.1097/hep.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Early identification of those with NAFLD activity score ≥ 4 and significant fibrosis (≥F2) or at-risk metabolic dysfunction-associated steatohepatitis (MASH) is a priority as these patients are at increased risk for disease progression and may benefit from therapies. We developed and validated a highly specific metabolomics-driven score to identify at-risk MASH. METHODS We included derivation (n = 790) and validation (n = 565) cohorts from international tertiary centers. Patients underwent laboratory assessment and liver biopsy for metabolic dysfunction-associated steatotic liver disease. Based on 12 lipids, body mass index, aspartate aminotransferase, and alanine aminotransferase, the MASEF score was developed to identify at-risk MASH and compared to the FibroScan-AST (FAST) score. We further compared the performance of a FIB-4 + MASEF algorithm to that of FIB-4 + liver stiffness measurements (LSM) by vibration-controlled transient elastography (VCTE). RESULTS The diagnostic performance of the MASEF score showed an area under the receiver-operating characteristic curve, sensitivity, specificity, and positive and negative predictive values of 0.76 (95% CI 0.72-0.79), 0.69, 0.74, 0.53, and 0.85 in the derivation cohort, and 0.79 (95% CI 0.75-0.83), 0.78, 0.65, 0.48, and 0.88 in the validation cohort, while FibroScan-AST performance in the validation cohort was 0.74 (95% CI 0.68-0.79; p = 0.064), 0.58, 0.79, 0.67, and 0.73, respectively. FIB-4+MASEF showed similar overall performance compared with FIB-4 + LSM by VCTE ( p = 0.69) to identify at-risk MASH. CONCLUSION MASEF is a promising diagnostic tool for the assessment of at-risk MASH. It could be used alternatively to LSM by VCTE in the algorithm that is currently recommended by several guidance publications.
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Affiliation(s)
- Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute Houston, Texas, USA
- Houston Research Institute, Houston, Texas, USA
| | - Emily Truong
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | - Jesus M. Banales
- Biodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV-EHU), CIBERehd, IKERBASQUE, Donostia, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kenneth Cusi
- University of Florida, Gainesville, Florida, USA
| | | | - Radan Bruha
- General University Hospital and the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Paula Iruzubieta
- Marqués de Valdecilla University Hospital, Cantabria University, IDIVAL, Santander, Spain
| | - Rocio Aller
- Clinic University Hospital, University of Valladolid, Valladolid, Spain
| | | | | | | | - Patricia Aspichueta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain
| | | | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Javier Crespo
- Marqués de Valdecilla University Hospital, Cantabria University, IDIVAL, Santander, Spain
| | - José M. Mato
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain
- CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Arun J. Sanyal
- Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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Majeed M, Nagabhushanam K, Noureddin M, Paulose S, Barik C, Saklecha S, Mundkur L. A scientifically validated combination of garcinol, curcuminoids, and piperine for mild to moderate nonalcoholic steatohepatitis patients-results from a randomized, double-blind, placebo-controlled study. Front Nutr 2023; 10:1201186. [PMID: 38170037 PMCID: PMC10760641 DOI: 10.3389/fnut.2023.1201186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Background Garcinol is a naturally occurring compound from the fruit rind of the Garcinia indica, with antioxidant, anti-inflammatory, and anticancer properties. Curcuminoids are the active molecule from the rhizome of Curcuma longa, studied extensively for its health benefits as an anti-inflammatory and antioxidant activities. Non-alcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic steatohepatitis characterized by liver fat and inflammation. Objective To evaluate the clinical efficacy and safety of Garcinol, Curcuminoids and piperine (GCP) combination in patients with mild to moderate NASH in a randomized, double-blind, placebo-controlled study. Methods The patients received one tablet (450 mg) of GCP containing garcinol-50 mg, curcuminoids -250 mg and piperine 5 mg or a placebo (450 mg of microcrystalline cellulose) twice daily for 90 days. Changes in circulating aspartate aminotransferase (AST), alanine transaminase (ALT) levels, liver stiffness measurement (LSM), and controlled attenuation parameter (CAP) using Fibroscan were compared from baseline to day 90. Anthropometric parameters, serum levels of lipids, Interleukin (IL-6), hsCRP, and adiponectin were estimated. Safety was evaluated by laboratory parameters and by monitoring adverse events. Results Seventy-two patients were randomized and 63 (GCP = 32, Placebo = 31) completed the study. The mean age of the patients was 48.3 ± 8.7 years (36 males and 27 females). The mean reduction in AST (U/L) was 9.53 in GCP and 3.16 in placebo (p < 0.001) and that of ALT (U/L) was 13.47 in GCP and 7.43 in Placebo (p = 0.002). The liver stiffness and CAP scores showed a better reduction in GCP (0.56 kPa and 12.38 db/m) compared to placebo (0.064 kPa and 10.42 db/m) p < 0.05. Consequently, the noninvasive Fibroscan-AST (FAST) score reduction was also found to be significant in GCP compared to placebo. Additionally, body weight, lipid levels, hsCRP, and IL-6 in serum decreased, while adiponectin levels increased in GCP-supplemented participants compared to placebo. The combination of garcinol and curcuminoids was well tolerated with no significant changes in hematological and clinical laboratory parameters during the 90-day supplementation. Conclusion Our results suggest that GCP could be a possible supplement for the management of NASH.Clinical trial registration: https://clinicaltrials.gov/, identifier CTRI/2019/11/022147.
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Affiliation(s)
- Muhammed Majeed
- Sami-Sabinsa Group Limited, Bangalore, Karnataka, India
- Sabinsa Corporation, East Windsor, NJ, United States
| | | | - Mazen Noureddin
- Houston Liver Institute, Houston Research Institute, Houston, TX, United States
| | - Shaji Paulose
- Sami-Sabinsa Group Limited, Bangalore, Karnataka, India
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26
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Noureddin M, Khan S, Portell F, Jorkasky D, Dennis J, Khan O, Johansson L, Johansson E, Sanyal AJ. Safety and efficacy of once-daily HU6 versus placebo in people with non-alcoholic fatty liver disease and high BMI: a randomised, double-blind, placebo-controlled, phase 2a trial. Lancet Gastroenterol Hepatol 2023; 8:1094-1105. [PMID: 37806314 DOI: 10.1016/s2468-1253(23)00198-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND HU6 is a controlled metabolic accelerator that is metabolised in the liver to the mitochondrial uncoupler 2,4-dinitrophenol and increases substrate utilisation so that fat and other carbon sources are oxidised in the body rather than accumulated. We aimed to assess the safety and efficacy of HU6 compared with placebo in people with non-alcoholic fatty liver disease (NAFLD) and high BMI. METHODS This randomised, double-blind, placebo-controlled, phase 2a trial was done at a single community site in the USA. Adults (aged 28-65 years) with a BMI of 28-45 kg/m2, a FibroScan controlled attenuation parameter score of more than 270 decibels per metre, and at least 8% liver fat by MRI-proton density fat fraction (MRI-PDFF) were randomly assigned (1:1:1:1) to receive, under fasting conditions, either once-daily HU6 100 mg, HU6 300 mg, HU6 450 mg, or matching placebo by oral administration for 61 days. Randomisation was blocked (groups of four) and stratified by baseline glycated haemoglobin (<5·7% vs ≥5·7%; 39 mmol/mol). All participants and study personnel involved with outcome assessments were masked to treatment assignment. The primary endpoint was the relative change in liver fat content from baseline to day 61, as assessed by MRI-PDFF, and was analysed in the full analysis set (FAS), which comprised all participants who were randomly assigned, received at least one dose of treatment, and had less than 4·5 kg of weight gain or weight loss from the time of screening to day 1 of treatment. The safety population included all participants who were randomly assigned and received at least one dose of study drug. This study was registered at ClinicalTrials.gov, NCT04874233, and is complete. FINDINGS Between April 28, 2021, and Nov 29, 2021, 506 participants were assessed for eligibility and 80 adults (39 [49%] women and 41 [51%] men) were enrolled and randomly assigned to placebo (n=20), HU6 150 mg (n=20), HU6 300 mg (n=21), or HU6 450 mg (n=19). One participant in the HU6 450 mg group was excluded from the FAS due to weight gain. Relative mean change in liver fat content from baseline to day 61 was -26·8% (SD 17·4) for the HU6 150 mg group, -35·6% (13·8) for the HU6 300 mg group, -33·0% (18·4) for the HU6 450 mg group, and 5·4% (19·8) for the placebo group. Three people treated with HU6 (two treated with 150 mg and one treated with 300 mg) and two people treated with placebo discontinued treatment due to treatment-emergent adverse events (TEAEs). No serious TEAEs were reported. In those treated with HU6, flushing (19 [32%] participants), diarrhoea (15 [25%] participants), and palpitations (seven [12%] participants) were the most frequently reported TEAEs (in the placebo group, two [10%] participants had flushing, none had diarrhoea, and one [5%] had palpitations). There were no deaths. INTERPRETATION HU6 could be a promising pharmacological agent for treating patients with obesity and NAFLD and its metabolic complications. FUNDING Rivus Pharmaceuticals.
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Affiliation(s)
- Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, TX, USA.
| | | | | | | | | | - Omer Khan
- Rivus Pharmaceuticals, Charlottesville, VA, USA
| | | | | | - Arun J Sanyal
- Stravitz-Sanyal Institute of Liver Disease and Metabolic Health, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, USA
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27
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Yeo YH, Liang J, Lauzon M, Luu M, Noureddin M, Ayoub W, Kuo A, Sankar K, Gong J, Hendifar A, Osipov A, Friedman ML, Lipshutz HG, Steinberger J, Kosari K, Nissen N, Abou-Alfa GK, Singal AG, Yang JD. Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma. Am J Gastroenterol 2023; 118:2201-2211. [PMID: 37561061 DOI: 10.14309/ajg.0000000000002467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/25/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The efficacy and safety of combined immunotherapy and transarterial radioembolization (TARE) were suggested in preclinical and early-phase trials, but these were limited by small sample sizes. We sought to compare the efficacy of combined therapy and immunotherapy alone in patients with advanced hepatocellular carcinoma (HCC). METHODS The National Cancer Database was used to identify patients with advanced HCC diagnosed between January 1, 2017, and December 31, 2019. We included patients who received combined therapy or immunotherapy alone as first-line treatment. Multivariable logistic regression was conducted to determine predictors of combined therapy. Kaplan-Meier and Cox regression approaches were used to identify predictors of overall survival and to compare hazards of mortality between the patients who received combined therapy and immunotherapy alone. RESULTS Of 1,664 eligible patients with advanced-stage HCC, 142 received combined TARE/immunotherapy and 1,522 received immunotherapy alone. Receipt of combination therapy was associated with care at an academic center and inversely associated with racial/ethnic minority status (Hispanic and Black individuals). The median overall survival was significantly higher in the combination group than in the immunotherapy alone group (19.8 vs 9.5 months). In multivariable analysis, combined therapy was independently associated with reduced mortality (adjusted hazard ratio 0.50, 95% confidence interval: 0.36-0.68, P < 0.001). Results were consistent across subgroups and in sensitivity analyses using propensity score matching and inverse probability of treatment weighting. DISCUSSION The combination of TARE and immunotherapy was associated with improved survival compared with immunotherapy alone in patients with advanced-stage HCC. Our findings underly the importance of large clinical trials evaluating combination therapy in these patients.
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Affiliation(s)
- Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeff Liang
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marie Lauzon
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mazen Noureddin
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Walid Ayoub
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alexander Kuo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kamya Sankar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jun Gong
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew Hendifar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Arsen Osipov
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marc L Friedman
- Division of Interventional Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - H Gabriel Lipshutz
- Division of Interventional Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jonathan Steinberger
- Division of Interventional Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kambiz Kosari
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicholas Nissen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Medical College at Cornell University, New York, NY, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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28
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Kim BK, Bergstrom J, Loomba R, Tamaki N, Izumi N, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Truong E, Yang JD, Noureddin M, Allen AM, Loomba R, Ajmera V. Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study. Hepatology 2023; 78:1858-1866. [PMID: 37203233 PMCID: PMC10663382 DOI: 10.1097/hep.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD. APPROACH AND RESULTS This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts ( p < 0.05). CONCLUSIONS An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
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Affiliation(s)
- Beom Kyung Kim
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaclyn Bergstrom
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Rohan Loomba
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey
| | - Mesut Gumussoy
- Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey
| | - Digdem Kuru Oz
- Ankara University School of Medicine, Department of Radiology, Ankara Turkey
| | - Ayse Erden
- Ankara University School of Medicine, Department of Radiology, Ankara Turkey
| | - Emily Truong
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Ju Dong Yang
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Mazen Noureddin
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- School of Public Health, University of California, San Diego
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
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Abdelrahim M, Esmail A, Abudayyeh A, Murakami N, Victor D, Kodali S, Cheah YL, Simon CJ, Noureddin M, Connor A, Saharia A, Moore LW, Heyne K, Kaseb AO, Gaber AO, Ghobrial RM. Transplant Oncology: An Emerging Discipline of Cancer Treatment. Cancers (Basel) 2023; 15:5337. [PMID: 38001597 PMCID: PMC10670243 DOI: 10.3390/cancers15225337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Transplant oncology is an emerging concept of cancer treatment with a promising prospective outcome. The applications of oncology, transplant medicine, and surgery are the core of transplant oncology to improve patients' survival and quality of life. The main concept of transplant oncology is to radically cure cancer by removing the diseased organ and replacing it with a healthy one, aiming to improve the survival outcomes and quality of life of cancer patients. Subsequently, it seeks to expand the treatment options and research for hepatobiliary malignancies, which have seen significantly improved survival outcomes after the implementation of liver transplantation (LT). In the case of colorectal cancer (CRC) in the transplant setting, where the liver is the most common site of metastasis of patients who are considered to have unresectable disease, initial studies have shown improved survival for LT treatment compared to palliative therapy interventions. The indications of LT for hepatobiliary malignancies have been slowly expanded over the years beyond Milan criteria in a stepwise manner. However, the outcome improvements and overall patient survival are limited to the specifics of the setting and systematic intervention options. This review aims to illustrate the representative concepts and history of transplant oncology as an emerging discipline for the management of hepatobiliary malignancies, in addition to other emerging concepts, such as the uses of immunotherapy in a peri-transplant setting as well as the use of circulating tumor DNA (ctDNA) for surveillance post-transplantation.
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Affiliation(s)
- Maen Abdelrahim
- Section of GI Oncology, Department of Medical Oncology, Houston Methodist Cancer Center, Houston, TX 77030, USA; (A.E.)
- Cockrell Center of Advanced Therapeutics Phase I Program, Houston Methodist Research Institute, Houston, TX 77030, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Abdullah Esmail
- Section of GI Oncology, Department of Medical Oncology, Houston Methodist Cancer Center, Houston, TX 77030, USA; (A.E.)
| | - Ala Abudayyeh
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Naoka Murakami
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - David Victor
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Sudha Kodali
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Yee Lee Cheah
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Caroline J. Simon
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Mazen Noureddin
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ashton Connor
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ashish Saharia
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Linda W. Moore
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Kirk Heyne
- Section of GI Oncology, Department of Medical Oncology, Houston Methodist Cancer Center, Houston, TX 77030, USA; (A.E.)
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Ahmed O. Kaseb
- Department of Gastrointestinal (GI) Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - A. Osama Gaber
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Rafik Mark Ghobrial
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA
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Kalligeros M, Vassilopoulos A, Vassilopoulos S, Victor DW, Mylonakis E, Noureddin M. Prevalence of Steatotic Liver Disease (MASLD, MetALD, and ALD) in the United States: The National Health and Nutrition Examination Survey 2017-2020. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00914-X. [PMID: 37949334 DOI: 10.1016/j.cgh.2023.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/22/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
Following the Delphi consensus process, the term steatotic liver disease (SLD) was introduced to replace fatty liver disease, while the term metabolic dysfunction-associated steatotic liver disease (MASLD) emerged as the successor to the term nonalcoholic fatty liver disease (NAFLD).1 This revised nomenclature aims to enhance precision and mitigate negative connotations and potential stigmatization, while refining comprehension and disease categorization. Concurrently, a novel category was introduced to capture individuals whose alcohol consumption exceeded the previously defined thresholds of NAFLD but remained unclassified within the existing system. This category, termed MetALD, now delineates a spectrum of conditions and is defined as a daily intake of 20 to 50 g of alcohol (or weekly 140-350 g) for females and 30 to 60 g daily for males (or weekly 210-420 g).1 Within the MetALD spectrum, some individuals might predominantly exhibit MASLD characteristics, whereas others might be more inclined toward alcoholic liver disease (ALD).1 In the present study, we used a US nationally representative data set to calculate the prevalence of SLD and its subcategories in the United States.
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Affiliation(s)
- Markos Kalligeros
- Division of Internal Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Athanasios Vassilopoulos
- Division of Internal Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Stephanos Vassilopoulos
- Division of Internal Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - David W Victor
- Division of Gastroenterology and Hepatology, Houston Methodist, Houston, Texas
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31
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Danpanichkul P, Ng CH, Muthiah MD, Duangsonk K, Yong JN, Tan DJH, Lim WH, Wong ZY, Syn N, Tsusumi T, Takahashi H, Siddiqui MS, Wong VWS, Mantzoros CS, Huang DQ, Noureddin M, Loomba R, Sanyal AJ, Wijarnpreecha K. The silent burden of non-alcoholic fatty liver disease in the elderly: A global burden of disease analysis. Aliment Pharmacol Ther 2023; 58:1062-1074. [PMID: 37694808 DOI: 10.1111/apt.17714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) represents a significant health threat worldwide. The growing trend towards an aging population, along with an alarming rise in obesity and diabetes, may have significant implications for the burden of NAFLD. AIM To assess the impact of NAFLD on the elderly. METHODS We utilised data from the Global Burden of Disease study between 2010 and 2019 to conduct a comprehensive analysis of the prevalence, mortality, and disability-adjusted life years (DALYs) associated with NAFLD in the elderly (65-89 years), stratified by region, nation, sociodemographic Index and sex. RESULTS Globally, there were an estimated 228 million cases, 87,230 deaths and 1.46 million DALYs attributed to NAFLD in the elderly. Geographically, the Western Pacific region had the highest burden of NAFLD in the elderly. From 2010 to 2019, there was an increasing prevalence rate in all areas, with the most pronounced change observed in the Western Pacific region (annual percentage change (APC) +0.95%, p < 0.001). Over the study period, there was a more rapid increase in NAFLD prevalence in men (APC +0.74%, p < 0.001) than in women (APC +0.63%, p < 0.001). In most regions, death and DALYs rates have declined, with the exception of the Americas, where there was a slight increase (APC +0.25%, p = 0.002 and 0.38%, p < 0.001, respectively). CONCLUSION Over the past decade, the burden of NAFLD in the elderly has been increasing, necessitating immediate and inclusive measures to tackle the rising burden.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Kwanjit Duangsonk
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhen Yu Wong
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tsubasa Tsusumi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan
| | - Mohammad Shadab Siddiqui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vincent Wai-Sun Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Christos S Mantzoros
- Department of Internal Medicine, Boston VA Healthcare System, and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine, Harvard University, Boston, Massachusetts, USA
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | | | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, California, USA
| | - Arun J Sanyal
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
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32
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Lim WH, Yong JN, Ong CEY, Ng CH, Tan DJH, Zeng RW, Chung CH, Kaewdech A, Chee D, Tseng M, Wijarnpreecha K, Syn N, Bonney GK, Kow A, Huang DQ, Noureddin M, Muthiah M, Tan E, Siddiqui MS. Ethnic disparities in waitlist outcomes of patients with nonalcoholic steatohepatitis listed for liver transplantation in the US. Liver Transpl 2023; 29:1181-1191. [PMID: 37039547 DOI: 10.1097/lvt.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/06/2023] [Indexed: 04/12/2023]
Abstract
NASH is the fastest-growing cause of liver cirrhosis and is the leading indication for liver transplantation (LT). However, significant racial and ethnic disparities in waitlist outcomes and LT allocation may unfairly disadvantage minorities. Our aim was to characterize racial and ethnic disparities in waitlist mortality and transplantation probability among patients with NASH. This is a retrospective analysis of the United Network for Organ Sharing registry data of LT candidates from January 1, 2000 to December 31, 2021. Outcomes analysis was performed using competing risk analysis with the Fine and Gray model. The multivariable adjustment was conducted, and mixed-effect regression was used to compare the model for end-stage liver disease scores at listing and removal. Of 18,562 patients with NASH cirrhosis, there were 14,834 non-Hispanic Whites, 349 African Americans, 2798 Hispanics, 312 Asians, and 269 of other races/ethnicities; African American (effect size: 2.307, 95% CI: 1.561-3.053, and p < 0.001) and Hispanic (effect size: 0.332, 95% CI: 0.028-0.637, p = 0.032) patients were found to have a significantly higher model for end-stage liver disease scores at the time of listing than non-Hispanic Whites. African Americans had a higher probability of receiving LT relative to non-Hispanic Whites (subdistribution HR: 1.211, 95% CI: 1.051-1.396, and p = 0.008). However, Hispanic race/ethnicity was associated with a lower transplantation probability (subdistribution HR: 0.793, 95% CI: 0.747-0.842, and p < 0.001) and increased waitlist mortality (subdistribution HR: 1.173, CI: 1.052-1.308, and p = 0.004) compared with non-Hispanic Whites. There are significant racial and ethnic disparities in waitlist outcomes of patients with NASH in the US. Hispanic patients are less likely to receive LT and more likely to die while on the waitlist compared with non-Hispanic Whites despite being listed with a lower model for end-stage liver disease scores.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Charlotte Hui Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Apichat Kaewdech
- Department of Medicine, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Prince of Songkla University, Hat Yai, Thailand
| | - Douglas Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Michael Tseng
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karn Wijarnpreecha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Glenn K Bonney
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, National University Hospital Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Alfred Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, National University Hospital Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | | | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Eunice Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mohammad Shadab Siddiqui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
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Lim WH, Lin SY, Ng CH, Tan DJH, Xiao J, Yong JN, Tay PWL, Syn N, Chin YH, Chan KE, Khoo CM, Chew N, Foo RSY, Shabbir A, Tan EX, Huang DQ, Noureddin M, Sanyal AJ, Siddiqui MS, Muthiah MD. Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals. Hepatobiliary Surg Nutr 2023; 12:658-670. [PMID: 37886204 PMCID: PMC10598314 DOI: 10.21037/hbsn-21-520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 10/28/2023]
Abstract
Background Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease (NAFLD). However, there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters, especially for histological outcomes. Thus, this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic, biochemical, and histological parameters for patients with NAFLD. Methods Medline and Embase were searched for articles relating to bariatric procedures and NAFLD. Pairwise meta-analysis was conducted to compare efficacy of bariatric procedures pre- vs. post-procedure with subgroup analysis to further compare restrictive against foregut bypass procedures. Results Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures (n=1,460) and foregut bypass (n=1,895) were included. Both foregut bypass (P<0.01) and restrictive procedures (P=0.03) significantly increased odds of fibrosis resolution. Compared to restrictive procedures, foregut bypass resulted in a borderline non-significant decrease in fibrosis score (P=0.06) and significantly lower steatosis score (P<0.001). For metabolic parameters, foregut bypass significantly lowered body mass index (P=0.003) and low-density lipoprotein (P=0.008) compared to restrictive procedures. No significant differences were observed between both procedures for aspartate aminotransferase (P=0.17) and alkaline phosphatase (P=0.61). However, foregut bypass resulted in significantly lower gamma-glutamyl transferase than restrictive procedures (P=0.01) while restrictive procedures resulted in significantly lower alanine transaminase than foregut bypass (P=0.02). Conclusions The significant histological and metabolic advantages and comparable improvements in biochemical outcomes support the choice of foregut bypass over restrictive bariatric procedures in NAFLD management.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Roger S. Y. Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Eunice X. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
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Anstee QM, Lucas KJ, Francque S, Abdelmalek MF, Sanyal AJ, Ratziu V, Gadano AC, Rinella M, Charlton M, Loomba R, Mena E, Schattenberg JM, Noureddin M, Lazas D, Goh GB, Sarin SK, Yilmaz Y, Martic M, Stringer R, Kochuparampil J, Chen L, Rodriguez-Araujo G, Chng E, Naoumov NV, Brass C, Pedrosa MC. Tropifexor plus cenicriviroc combination versus monotherapy in nonalcoholic steatohepatitis: Results from the phase 2b TANDEM study. Hepatology 2023; 78:1223-1239. [PMID: 37162151 PMCID: PMC10521801 DOI: 10.1097/hep.0000000000000439] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS With distinct mechanisms of action, the combination of tropifexor (TXR) and cenicriviroc (CVC) may provide an effective treatment for NASH. This randomized, multicenter, double-blind, phase 2b study assessed the safety and efficacy of TXR and CVC combination, compared with respective monotherapies. APPROACH AND RESULTS Patients (N = 193) were randomized 1:1:1:1 to once-daily TXR 140 μg (TXR 140 ), CVC 150 mg (CVC), TXR 140 μg + CVC 150 mg (TXR 140 + CVC), or TXR 90 μg + CVC 150 mg (TXR 90 + CVC) for 48 weeks. The primary and secondary end points were safety and histological improvement, respectively. Rates of adverse events (AEs) were similar across treatment groups. Pruritus was the most frequently experienced AE, with highest incidence in the TXR 140 group (40.0%). In TXR and combination groups, alanine aminotransferase (ALT) decreased from baseline to 48 weeks (geometric mean change: -21%, TXR 140 ; -16%, TXR 140 + CVC; -13%, TXR 90 + CVC; and +17%, CVC). Reductions in body weight observed at week 24 (mean changes from baseline: TXR 140 , -2.5 kg; TXR 140 + CVC, -1.7 kg; TXR 90 + CVC, -1.0 kg; and CVC, -0.1 kg) were sustained to week 48. At least 1-point improvement in fibrosis stage/steatohepatitis resolution without worsening of fibrosis was observed in 32.3%/25.8%, 31.6%/15.8%, 29.7%/13.5%, and 32.5%/22.5% of patients in the TXR 140 , CVC, TXR 140 + CVC, and TXR 90 + CVC groups, respectively. CONCLUSIONS The safety profile of TXR + CVC combination was similar to respective monotherapies, with no new signals. TXR monotherapy showed sustained ALT and body weight decreases. No substantial incremental efficacy was observed with TXR + CVC combination on ALT, body weight, or in histological end points compared with monotherapy.
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Affiliation(s)
- Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kathryn J. Lucas
- Diabetes and Endocrinology Consultants, Morehead City, North Carolina, USA
| | - Sven Francque
- Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp, Belgium
- InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | | | - Arun J. Sanyal
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vlad Ratziu
- Sorbonne Université, Hôpital Pitié Salpêtrière, ICAN Paris, France
| | | | - Mary Rinella
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Rohit Loomba
- University of California at San Diego, La Jolla, California, USA
| | - Edward Mena
- California Liver Research Institute, Pasadena, California, USA
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Germany
| | | | - Donald Lazas
- Digestive Health Research and ObjectiveHealth, Nashville, Tennessee, USA
| | - George B.B. Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | | | | | - Li Chen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | - Clifford Brass
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Eskridge W, Cryer DR, Schattenberg JM, Gastaldelli A, Malhi H, Allen AM, Noureddin M, Sanyal AJ. Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective. J Clin Med 2023; 12:6216. [PMID: 37834859 PMCID: PMC10573476 DOI: 10.3390/jcm12196216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Diagnosing and managing metabolic dysfunction-associated steatotic liver disease (MASLD) remains a major challenge in primary care due to lack of agreement on diagnostic tools, difficulty in identifying symptoms and determining their cause, absence of approved pharmacological treatments, and limited awareness of the disease. However, prompt diagnosis and management are critical to preventing MASLD from progressing to more severe forms of liver disease. This highlights the need to raise awareness and improve understanding of MASLD among both patients and physicians. The patient perspective is invaluable to advancing our knowledge of this disease and how to manage it, as their perspectives have led to the growing recognition that patients experience subtle symptoms and that patient-reported outcomes should be incorporated into drug development. This review and expert opinion examine MASLD and metabolic dysfunction-associated steatohepatitis from the patient and physician perspective from pre-diagnosis to diagnosis and early care, through to progression to advanced liver damage. Specifically, the paper dives into the issues patients and physicians experience, and, in turn, what is required to improve diagnosis and management, including tips and tools to empower patients and physicians dealing with MASLD.
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Affiliation(s)
| | | | - Jörn M. Schattenberg
- Metabolic Liver Research Program, Department of Medicine, University Medical Center of the Johannes Gutenberg University, 155131 Mainz, Germany
| | - Amalia Gastaldelli
- Cardiometabolic Risk Laboratory, Institute of Clinical Physiology, Italian National Research Council CNR, 00133 Pisa, Italy
| | - Harmeet Malhi
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Mazen Noureddin
- Fatty Liver Program, Karsh Division of Gastroenterology and Hepatology, Cedar Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Arun J. Sanyal
- Stravitz-Sanyal Institute of Liver Disease and Metabolic Health, VCU School of Medicine and Health System and Division of Gastroenterology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA 23298, USA
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Pais R, Cariou B, Noureddin M, Francque S, Schattenberg JM, Abdelmalek MF, Lalazar G, Varma S, Dietrich J, Miller V, Sanyal A, Ratziu V. A proposal from the liver forum for the management of comorbidities in non-alcoholic steatohepatitis therapeutic trials. J Hepatol 2023; 79:829-841. [PMID: 37001695 DOI: 10.1016/j.jhep.2023.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
The current document has been developed by the Liver Forum who mandated the NAFLD-Associated Comorbidities Working Group - a multistakeholder group comprised of experts from academic medicine, industry and patient associations - to identify aspects of diverse comorbidities frequently associated with non-alcoholic steatohepatitis (NASH) that can interfere with the conduct of therapeutic trials and, in particular, impact efficacy and safety results. The objective of this paper is to propose guidance for the management of relevant comorbidities in both candidates and actual participants in NASH therapeutic trials. We relied on specific guidelines from scientific societies, when available, but adapted them to the particulars of NASH trials with the aim of addressing multiple interacting requirements such as maintaining patient safety, reaching holistic therapeutic objectives, minimising confounding effects on efficacy and safety of investigational agents and allowing for trial completion. We divided the field of action into: first, analysis and stabilisation of the patient's condition before inclusion in the trial and, second, management of comorbidities during trial conduct. For the former, we discussed the concept of acceptable vs. optimal control of comorbidities, defined metabolic and ponderal stability prior to randomisation and weighed the pros and cons of a run-in period. For the latter, we analysed non-hepatological comorbid conditions for changes or acute events possibly occurring during the trial, including changes in alcohol consumption, in order to detail when specific interventions are necessary and how best to manage concomitant drug intake in line with methodological constraints. These recommendations are intended to act as a guide for clinical trialists and are open to further refinement when additional data become available.
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Affiliation(s)
- Raluca Pais
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition, France; Centre de Recherche Saint Antoine, INSERM UMRS_938 Paris, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du Thorax, F-44000 Nantes, France
| | | | - Sven Francque
- Department of Gastroenterology Hepatology, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Belgium
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manal F Abdelmalek
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC, USA
| | - Gadi Lalazar
- Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sharat Varma
- Novo Nordisk A/S, Vandtårnsvej 108-110, 2860 Søborg Denmark
| | - Julie Dietrich
- GENFIT, Parc Eurasanté 885, Avenue Eugène Avinée, 59120, Loos, France
| | - Veronica Miller
- Forum for Collaborative Research, University of California Berkeley School of Public Health, Washington D.C., USA
| | - Arun Sanyal
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Vlad Ratziu
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition, France; INSERM UMRS 1138 CRC, Paris, France.
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37
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Lazarus JV, Mark HE, Allen AM, Arab JP, Carrieri P, Noureddin M, Alazawi W, Alkhouri N, Alqahtani SA, Arrese M, Bataller R, Berg T, Brennan PN, Burra P, Castro-Narro GE, Cortez-Pinto H, Cusi K, Dedes N, Duseja A, Francque SM, Hagström H, Huang TTK, Wajcman DI, Kautz A, Kopka CJ, Krag A, Miller V, Newsome PN, Rinella ME, Romero D, Sarin SK, Silva M, Spearman CW, Tsochatzis EA, Valenti L, Villota-Rivas M, Zelber-Sagi S, Schattenberg JM, Wong VWS, Younossi ZM. A global research priority agenda to advance public health responses to fatty liver disease. J Hepatol 2023; 79:618-634. [PMID: 37353401 DOI: 10.1016/j.jhep.2023.04.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND & AIMS An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. METHODS Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. RESULTS The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of 'agree' responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement ('agree' + 'somewhat agree'); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% 'agree'), 13 priorities had <80% 'agree', with greater reliance on 'somewhat agree' to achieve >90% combined agreement. CONCLUSIONS Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community's efforts to advance and accelerate responses to this widespread and fast-growing public health threat. IMPACT AND IMPLICATIONS An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA.
| | - Henry E Mark
- European Association for the Study of the Liver (EASL), Geneva, Switzerland; Independent Consultant, Nottingham, UK
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan Pablo Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute, Houston, TX, USA
| | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Naim Alkhouri
- Fatty Liver Program, Arizona Liver Health, Phoenix, AZ, USA
| | - Saleh A Alqahtani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ramon Bataller
- Liver Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Paul N Brennan
- Division of Hepatology, University of Dundee, Dundee, Scotland, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology at the Padua University Hospital, Padua, Italy
| | - Graciela E Castro-Narro
- Department of Hepatology and Transplant, Hospital Médica Sur, Mexico City, Mexico; Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Asociación Latinoamericana para el Estudio del Hígado (ALEH), Santiago, Chile
| | - Helena Cortez-Pinto
- Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sven M Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Terry T-K Huang
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA; CUNY Center for Systems and Community Design and NYU-CUNY Prevention Research Center, New York, NY, USA
| | - Dana Ivancovsky Wajcman
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Veronica Miller
- University California Berkeley School of Public Health, Berkeley, CA, USA
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Mary E Rinella
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Diana Romero
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Marcelo Silva
- Hepatology and Clinical Research Units, Hospital Universitario Austral, Buenos Aires, Argentina
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Luca Valenti
- Precision Medicine, Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany
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Liang JX, Ampuero J, Niu H, Imajo K, Noureddin M, Behari J, Lee DH, Ehman RL, Rorsman F, Vessby J, Lacalle JR, Mózes FE, Pavlides M, Anstee QM, Harrison SA, Castell J, Loomba R, Romero-Gómez M. An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography. J Hepatol 2023; 79:592-604. [PMID: 37121437 PMCID: PMC10623141 DOI: 10.1016/j.jhep.2023.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND & AIMS We conducted an individual patient data meta-analysis to establish stiffness cut-off values for magnetic resonance elastography (MRE) in staging liver fibrosis and to assess potential confounding factors. METHODS A systematic review of the literature identified studies reporting MRE data in patients with NAFLD. Data were obtained from the corresponding authors. The pooled diagnostic cut-off value for the various fibrosis stages was determined in a two-stage meta-analysis. Multilevel modelling methods were used to analyse potential confounding factors influencing the diagnostic accuracy of MRE in staging liver fibrosis. RESULTS Eight independent cohorts comprising 798 patients were included in the meta-analysis. The area under the receiver operating characteristic curve (AUROC) for MRE in detecting significant fibrosis was 0.92 (sensitivity, 79%; specificity, 89%). For advanced fibrosis, the AUROC was 0.92 (sensitivity, 87%; specificity, 88%). For cirrhosis, the AUROC was 0.94 (sensitivity, 88%, specificity, 89%). Cut-offs were defined to explore concordance between MRE and histopathology: ≥F2, 3.14 kPa (pretest probability, 39.4%); ≥F3, 3.53 kPa (pretest probability, 24.1%); and F4, 4.45 kPa (pretest probability, 8.7%). In generalized linear mixed model analysis, histological steatohepatitis with higher inflammatory activity (odds ratio 2.448, 95% CI 1.180-5.079, p <0.05) and high gamma-glutamyl transferase (GGT) concentration (>120U/L) (odds ratio 3.388, 95% CI 1.577-7.278, p <0.01] were significantly associated with elevated liver stiffness, and thus affecting accuracy in staging early fibrosis (F0-F1). Steatosis, as measured by magnetic resonance imaging proton density fat fraction, and body mass index(BMI) were not confounders. CONCLUSIONS MRE has excellent diagnostic performance for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Elevated inflammatory activity and GGT level may lead to overestimation of early liver fibrosis, but anthropometric measures such as BMI or the degree of steatosis do not. IMPACT AND IMPLICATIONS This individual patient data meta-analysis of eight international cohorts, including 798 patients, demonstrated that MRE achieves excellent diagnostic accuracy for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Cut-off values (significant fibrosis, 3.14 kPa; advanced fibrosis, 3.53 kPa; and cirrhosis, 4.45 kPa) were established. Elevated inflammatory activity and gamma-glutamyltransferase level may affect the diagnostic accuracy of MRE, leading to overestimation of liver fibrosis in early stages. We observed no impact of diabetes, obesity, or any other metabolic disorder on the diagnostic accuracy of MRE.
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Affiliation(s)
- Jia-Xu Liang
- Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain; Department of Diagnostic Radiology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, China
| | - Javier Ampuero
- Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain
| | - Hao Niu
- Digestive System and Clinical Pharmacology Unit, Virgen de la Victoria University Hospital, Biomedical Research Institute of Malaga and Nanomedicine Platform-IBIMA (Plataforma BIONAND), University of Malaga, Málaga, Spain; Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
| | - Kento Imajo
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine; Yokohama, Japan
| | - Mazen Noureddin
- Fatty Liver Program, Division of Digestive and Liver Diseases, Comprehensive Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jaideep Behari
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dae Ho Lee
- Department of Internal Medicine, Gachon University College of Medicine (Gachon University Gil Medical Center), Incheon, South Korea
| | - Richard L Ehman
- Department of Diagnostic Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Fredrik Rorsman
- Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Johan Vessby
- Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Juan R Lacalle
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Ferenc E Mózes
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Quentin M Anstee
- Translational and Clinical Research Institute; Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle Upon Tyne Hospitals, NHS Trust, Newcastle Upon Tyne, UK
| | - Stephen A Harrison
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Javier Castell
- Department of Radiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Rohit Loomba
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Manuel Romero-Gómez
- Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain.
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Huang DQ, Noureddin N, Ajmera V, Amangurbanova M, Bettencourt R, Truong E, Gidener T, Siddiqi H, Majzoub AM, Nayfeh T, Tamaki N, Izumi N, Yoneda M, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Allen AM, Noureddin M, Loomba R. Type 2 diabetes, hepatic decompensation, and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: an individual participant-level data meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:829-836. [PMID: 37419133 PMCID: PMC10812844 DOI: 10.1016/s2468-1253(23)00157-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Data are scarce regarding the development of hepatic decompensation in patients with non-alcoholic fatty liver disease (NAFLD) with and without type 2 diabetes. We aimed to assess the risk of hepatic decompensation in people with NAFLD with and without type 2 diabetes. METHODS We did a meta-analysis of individual participant-level data from six cohorts in the USA, Japan, and Turkey. Included participants had magnetic resonance elastography between Feb 27, 2007, and June 4, 2021. Eligible studies included those with liver fibrosis characterisation by magnetic resonance elastography, longitudinal assessment for hepatic decompensation and death, and included adult patients (aged ≥18 years) with NAFLD, for whom data were available regarding the presence of type 2 diabetes at baseline. The primary outcome was hepatic decompensation, defined as ascites, hepatic encephalopathy, or variceal bleeding. The secondary outcome was the development of hepatocellular carcinoma. We used competing risk regression using the Fine and Gray subdistribution hazard ratio (sHR) to compare the likelihood of hepatic decompensation in participants with and without type 2 diabetes. Death without hepatic decompensation was a competing event. FINDINGS Data for 2016 participants (736 with type 2 diabetes; 1280 without type 2 diabetes) from six cohorts were included in this analysis. 1074 (53%) of 2016 participants were female with a mean age of 57·8 years (SD 14·2) years and BMI of 31·3 kg/m2 (SD 7·4). Among 1737 participants (602 with type 2 diabetes and 1135 without type 2 diabetes) with available longitudinal data, 105 participants developed hepatic decompensation over a median follow-up time of 2·8 years (IQR 1·4-5·5). Participants with type 2 diabetes had a significantly higher risk of hepatic decompensation at 1 year (3·37% [95% CI 2·10-5·11] vs 1·07% [0·57-1·86]), 3 years (7·49% [5·36-10·08] vs 2·92% [1·92-4·25]), and 5 years (13·85% [10·43-17·75] vs 3·95% [2·67-5·60]) than participants without type 2 diabetes (p<0·0001). After adjustment for multiple confounders (age, BMI, and race), type 2 diabetes (sHR 2·15 [95% CI 1·39-3·34]; p=0·0006) and glycated haemoglobin (1·31 [95% CI 1·10-1·55]; p=0·0019) were independent predictors of hepatic decompensation. The association between type 2 diabetes and hepatic decompensation remained consistent after adjustment for baseline liver stiffness determined by magnetic resonance elastography. Over a median follow-up of 2·9 years (IQR 1·4-5·7), 22 of 1802 participants analysed (18 of 639 with type 2 diabetes and four of 1163 without type 2 diabetes) developed incident hepatocellular carcinoma. The risk of incident hepatocellular carcinoma was higher in those with type 2 diabetes at 1 year (1·34% [95% CI 0·64-2·54] vs 0·09% [0·01-0·50], 3 years (2·44% [1·36-4·05] vs 0·21% [0·04-0·73]), and 5 years (3·68% [2·18-5·77] vs 0·44% [0·11-1·33]) than in those without type 2 diabetes (p<0·0001). Type 2 diabetes was an independent predictor of hepatocellular carcinoma development (sHR 5·34 [1·67-17·09]; p=0·0048). INTERPRETATION Among people with NAFLD, the presence of type 2 diabetes is associated with a significantly higher risk of hepatic decompensation and hepatocellular carcinoma. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- Daniel Q Huang
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Nabil Noureddin
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maral Amangurbanova
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ricki Bettencourt
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Emily Truong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tolga Gidener
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Harris Siddiqi
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Abdul M Majzoub
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Tarek Nayfeh
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Department of Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Digdem Kuru Oz
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mazen Noureddin
- Houston Methodist Transplant Center, Houston, TX, USA; Houston Liver Institute, Houston, TX, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Truong E, Gornbein JA, Yang JD, Noureddin N, Harrison SA, Alkhouri N, Noureddin M. MRI-AST (MAST) Score Accurately Predicts Major Adverse Liver Outcome, Hepatocellular Carcinoma, Liver Transplant, and Liver-Related Death. Clin Gastroenterol Hepatol 2023; 21:2570-2577.e1. [PMID: 36813013 DOI: 10.1016/j.cgh.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND & AIMS The MRI-AST (MAST) score accurately identifies patients with at-risk nonalcoholic steatohepatitis, defined as nonalcoholic steatohepatitis with nonalcoholic fatty liver disease activity score ≥4 and fibrosis stage ≥2 at highest risk for disease progression. It is important to determine the robustness of the MAST score in predicting major adverse liver outcomes (MALO), hepatocellular carcinoma (HCC), liver transplant, and death. METHODS This retrospective analysis included patients with nonalcoholic fatty liver disease from a tertiary care center who underwent magnetic resonance imaging proton density fat fraction, magnetic resonance elastography, and laboratory testing within 6 months from 2013 to 2022. Other causes of chronic liver disease were excluded. Hazard ratios between logit MAST and MALO (ascites, hepatic encephalopathy, or bleeding esophageal varices), liver transplant, HCC, or liver-related death were computed using a Cox proportional hazards regression model. We computed the hazard ratio of MALO or death associated with MAST scores 0.165-0.242 and 0.242-1.000, using MAST scores 0.000-0.165 as the reference group. RESULTS Among 346 total patients, average age was 58.8 years with 52.9% females and 34.4% with type 2 diabetes. Average alanine aminotransferase was 50.7 IU/L (24.3-60.0 IU/L), aspartate aminotransferase was 38.05 IU/L (22.00-41.00 IU/L), platelets were 242.9 × 109/L (193.8-290.0 × 109/L), proton density fat fraction was 12.90% (5.90%-18.22%), and liver stiffness on magnetic resonance elastography was 2.75 kPa (2.07-2.90 kPa). Median follow-up was 29.5 months. Fourteen had adverse outcomes, including 10 MALO, 1 HCC, 1 liver transplant, and 2 liver-related deaths. The Cox regression of MAST versus adverse event rate had a hazard ratio of 2.01 (95% confidence interval, 1.59-2.54; P < .0001) for each 1 logit unit increases in MAST. The corresponding Harrell concordance statistic (C statistic) was 0.919 (95% confidence interval, 0.865-0.953). The MAST score ranges of 0.165-0.242 and 0.242-1.0, respectively, had adverse event rate hazard ratio of 7.75 (1.40-42.9; P = .0189) and 22.11 (6.59-74.2; P < .0000) relative to MAST 0-0.165. CONCLUSIONS The MAST score noninvasively identifies at-risk nonalcoholic steatohepatitis and accurately predicts MALO, HCC, liver transplant, and liver-related death.
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Affiliation(s)
- Emily Truong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeffrey A Gornbein
- Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California
| | - Nabil Noureddin
- Division of Gasteroenterology, University of California San Diego, San Diego, California
| | | | | | - Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute, Houston, Texas.
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Noureddin M. Utilization of Noninvasive Tests to Diagnose At-Risk Metabolic Dysfunction-Associated Steatohepatitis. Gastroenterol Hepatol (N Y) 2023; 19:568-570. [PMID: 37771796 PMCID: PMC10524407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Mazen Noureddin
- Professor of Clinical Medicine, Academic Institute Full Clinical Member, Research Institute Houston Methodist Hospital Director, Houston Research Institute Houston, Texas
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Chan KE, Ng CH, Fu CE, Quek J, Kong G, Goh YJ, Zeng RW, Tseng M, Aggarwal M, Nah B, Chee D, Wong ZY, Zhang S, Wang JW, Chew NWS, Dan YY, Siddiqui MS, Noureddin M, Sanyal AJ, Muthiah M. The Spectrum and Impact of Metabolic Dysfunction in MAFLD: A Longitudinal Cohort Analysis of 32,683 Overweight and Obese Individuals. Clin Gastroenterol Hepatol 2023; 21:2560-2569.e15. [PMID: 36202348 DOI: 10.1016/j.cgh.2022.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metabolic associated fatty liver disease (MAFLD) was recently proposed as an alternative name change for better encapsulation of disease. However, there exists a spectrum of MAFLD where both metabolically healthy (MH) and metabolically unhealthy (MU) individuals are included. In view of limited evidence, we sought to examine the prevalence, clinical characteristics, and differences in outcomes of MH-MAFLD at the population level. METHODS Data were used from the United States National Health and Nutrition Examination Survey 1999 to 2018. Multivariate logistic regression analysis was used to obtain odds ratios for the estimation of events. Survival analysis was conducted with Cox regression and the Fine-Gray subdistribution model. RESULTS There were 32,683 overweight and obese individuals included in the analysis. In MAFLD patients, the prevalence of MH-MAFLD was 6.92% (95% confidence interval [CI], 6.58%-7.27%), and 93.08% (95% CI, 92.73%-93.42%) were considered as MU-MAFLD. Multivariate analysis found a significantly higher risk of MACE (odds ratio, 1.38; 95% CI, 1.28-1.49; P < .01), all-cause (hazard ratio, 1.24; 95% CI, 1.17-1.32; P < .01), cardiovascular disease (SHR, 1.20; 95% CI, 1.02-1.42; P = .03), and cancer mortality (SHR, 1.24; 95% CI, 1.07-1.44; P < .01) in MU-MAFLD relative to non-MAFLD. However, MH-MAFLD individuals were not associated with a statistically significant increased risk of these adverse outcomes compared with non-MAFLD. MU-MAFLD diabetics were also at a higher risk of adverse events compared with non-diabetics. CONCLUSIONS This study reports on the heterogeneity and spectrum of metabolic dysfunction that exists in overweight and obese MAFLD. Although MAFLD may potentially be advantageous in improving awareness and patient outcomes, there remains substantial heterogeneity within patients included in MAFLD on the basis of the underlying metabolic burden.
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Affiliation(s)
- Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Jie Goh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | | | - Michael Tseng
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Manik Aggarwal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Zhen Yu Wong
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sitong Zhang
- Department of Surgery, Cardiovascular Research Institute (CVRI), National University Heart Centre, Singapore; Nanomedicine Translational Research Programme, Centre for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiong-Wei Wang
- Department of Surgery, Cardiovascular Research Institute (CVRI), National University Heart Centre, Singapore; Nanomedicine Translational Research Programme, Centre for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Yock Young Dan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
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Tun KM, Noureddin N, Noureddin M. Noninvasive tests in the evaluation of nonalcoholic fatty liver disease: A review. Clin Liver Dis (Hoboken) 2023; 22:103-112. [PMID: 37799634 PMCID: PMC10550044 DOI: 10.1097/cld.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/08/2023] [Indexed: 10/07/2023] Open
Abstract
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Affiliation(s)
- Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Nevada, USA
| | - Nabil Noureddin
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, School of Medicine, California, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Liver Institute, Texas, USA
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Wang Z, Kim SY, Tu W, Kim J, Xu A, Yang YM, Matsuda M, Reolizo L, Tsuchiya T, Billet S, Gangi A, Noureddin M, Falk BA, Kim S, Fan W, Tighiouart M, You S, Lewis MS, Pandol SJ, Di Vizio D, Merchant A, Posadas EM, Bhowmick NA, Lu SC, Seki E. Extracellular vesicles in fatty liver promote a metastatic tumor microenvironment. Cell Metab 2023; 35:1209-1226.e13. [PMID: 37172577 PMCID: PMC10524732 DOI: 10.1016/j.cmet.2023.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/20/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Liver metastasis is a major cause of death in patients with colorectal cancer (CRC). Fatty liver promotes liver metastasis, but the underlying mechanism remains unclear. We demonstrated that hepatocyte-derived extracellular vesicles (EVs) in fatty liver enhanced the progression of CRC liver metastasis by promoting oncogenic Yes-associated protein (YAP) signaling and an immunosuppressive microenvironment. Fatty liver upregulated Rab27a expression, which facilitated EV production from hepatocytes. In the liver, these EVs transferred YAP signaling-regulating microRNAs to cancer cells to augment YAP activity by suppressing LATS2. Increased YAP activity in CRC liver metastasis with fatty liver promoted cancer cell growth and an immunosuppressive microenvironment by M2 macrophage infiltration through CYR61 production. Patients with CRC liver metastasis and fatty liver had elevated nuclear YAP expression, CYR61 expression, and M2 macrophage infiltration. Our data indicate that fatty liver-induced EV-microRNAs, YAP signaling, and an immunosuppressive microenvironment promote the growth of CRC liver metastasis.
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Affiliation(s)
- Zhijun Wang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - So Yeon Kim
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wei Tu
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Division of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030 China
| | - Jieun Kim
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Alexander Xu
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Yoon Mee Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Pharmacy, Kangwon National University, Chuncheon 24341, South Korea
| | - Michitaka Matsuda
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Lien Reolizo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Takashi Tsuchiya
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Alexandra Gangi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mazen Noureddin
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Houston Methodist Hospital, Houston Research Institute, Houston, TX 77030, USA
| | - Ben A Falk
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wei Fan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sungyong You
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Michael S Lewis
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Pathology, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA 90073, USA
| | - Stephen J Pandol
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dolores Di Vizio
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Akil Merchant
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Edwin M Posadas
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil A Bhowmick
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Shelly C Lu
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ekihiro Seki
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Castera L, Noureddin M, Wei L, Kahi C. Caring for the Liver: Updates on Global Prevalence, Cutting-Edge Diagnosis, and State-of-the-Art Management for Researchers and Clinicians, 2023 and Beyond. Clin Gastroenterol Hepatol 2023; 21:1975-1977. [PMID: 37353281 DOI: 10.1016/j.cgh.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Laurent Castera
- UMR1149 (Center of Research on Inflammation), French Institute of Health and Medical Research, Université Paris Cité, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, Texas
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Charles Kahi
- Indiana University School of Medicine, Indianapolis, Indiana
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Harrison SA, Loomba R, Dubourg J, Ratziu V, Noureddin M. Clinical Trial Landscape in NASH. Clin Gastroenterol Hepatol 2023; 21:2001-2014. [PMID: 37059159 DOI: 10.1016/j.cgh.2023.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Abstract
Nonalcoholic fatty liver disease consists of a spectrum starting from nonalcoholic fatty liver disease that may progress to nonalcoholic steatohepatitis (NASH), which can lead to fibrosis, cirrhosis, hepatocellular carcinoma, or even liver failure. The prevalence of NASH has increased in parallel with the rising rate of obesity and type 2 diabetes. Given the high prevalence and deadly complications of NASH, there have been significant efforts to develop effective treatments. Phase 2A studies have assessed various mechanisms of action across the spectrum of the disease, while phase 3 studies have focused mainly on NASH and fibrosis stage 2 and higher, as these patients have a higher risk of disease morbidity and mortality. The primary efficacy endpoints also vary, by using noninvasive tests in early-phase trials while relying on liver histological endpoints in phase 3 studies as required by regulatory agencies. Despite initial disappointment due to the failure of several drugs, recent phase 2 and 3 studies have shown promising results, with the first Food and Drug Administration-approved drug for NASH expected to be approved in 2023. In this review, we discuss the various drugs under development for NASH, their mechanisms of action, and the results of their clinical trials. We also highlight the potential challenges in developing pharmacological therapies for NASH.
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Affiliation(s)
- Stephen A Harrison
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Pinnacle Clinical Research, San Antonio, Texas.
| | - Rohit Loomba
- NAFLD Liver Center, Division of Gastroenterology, University of California San Diego, San Diego California
| | | | - Vlad Ratziu
- Institute for Cardiometabolism and Nutrition, Hospital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, Texas
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Xiao J, Ng CH, Chan KE, Fu C, Tay P, Yong JN, Lim WH, Tan DJH, Syn N, Wong ZY, Tseng M, Chew N, Huang DQ, Dan YY, Wong VWS, Loomba R, Siddiqui MS, Sanyal AJ, Noureddin M, Muthiah MD. Hepatic, Extra-hepatic Outcomes and Causes of Mortality in NAFLD - An Umbrella Overview of Systematic Review of Meta-Analysis. J Clin Exp Hepatol 2023; 13:656-665. [PMID: 37440949 PMCID: PMC10333954 DOI: 10.1016/j.jceh.2022.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease globally. While the prevalence, impact, and causes of mortality have been described in various meta-analyses, a systematic all-encompassing umbrella review has yet to be conducted to consolidate the evidence on outcomes associated with NAFLD. Methods Search was conducted on Medline and Embase for meta-analysis investigating associated complications and causes of mortality in NAFLD patients. Summary estimates were presented with original units, sample size, and I2 for heterogeneity. The Assessment of Multiple Systematic Reviews 2 was employed for article selection. Results 25 meta-analyses were included in the present review. NAFLD increased the risks of systemic complications, including cardiovascular diseases, systemic malignancies, diabetes, and chronic kidney disease. Regarding hepatic outcomes, the incidence of hepatocellular carcinoma in NAFLD was 2.39 per 100 person years (CI: 1.40 to 4.08). Individuals with NAFLD were also found to have an increased likelihood of cholangiocarcinoma (OR: 1.88, CI: 1.25 to 2.83) and gallstone disease (OR: 1.55, CI: 1.31 to 1.82) compared to individuals without NAFLD. NAFLD was associated with a higher risk of fatal and non-fatal CVD events (HR: 1.45, CI: 1.31 to 1.61) compared to individuals without NAFLD. Coronary heart disease and subclinical and clinical coronary heart disease were also significantly elevated in NAFLD individuals compared to individuals without NAFLD. Additionally, NAFLD was associated with an increased risk of all-cause mortality (HR: 1.34, CI: 1.17 to 1.54) and cardiovascular (HR: 1.30, CI: 1.08 to 1.56) but not cancer-related mortality. Conclusion The study summarizes high-level evidence from published meta-analyses to provide a much-needed update on the outcomes in patients with NAFLD. The significant systemic burden associated with NAFLD and impending fatty liver epidemic requires prompt action from multidisciplinary providers, policy providers, and stakeholders to reduce the burden of NAFLD.
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Affiliation(s)
- Jieling Xiao
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Fu
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phoebe Tay
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Syn
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhen Yu Wong
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Michael Tseng
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Daniel Q. Huang
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Yock Yong Dan
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Vincent Wai-Sun Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Rohit Loomba
- NAFLD Research Centre, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, CA, USA
| | - Mohammad S. Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mazen Noureddin
- Houston Research Institute, Houston Liver Institute, Houston, TX, USA
| | - Mark D. Muthiah
- MBBS Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
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Mózes FE, Lee JA, Vali Y, Alzoubi O, Staufer K, Trauner M, Paternostro R, Stauber RE, Holleboom AG, van Dijk AM, Mak AL, Boursier J, de Saint Loup M, Shima T, Bugianesi E, Gaia S, Armandi A, Lupșor-Platon M, Wong VWS, Li G, Wong GLH, Cobbold J, Karlas T, Wiegand J, Sebastiani G, Tsochatzis E, Liguori A, Yoneda M, Nakajima A, Hagström H, Akbari C, Hirooka M, Chan WK, Mahadeva S, Rajaram R, Zheng MH, George J, Eslam M, Petta S, Pennisi G, Viganò M, Ridolfo S, Aithal GP, Palaniyappan N, Lee DH, Ekstedt M, Nasr P, Cassinotto C, de Lédinghen V, Berzigotti A, Mendoza YP, Noureddin M, Truong E, Fournier-Poizat C, Geier A, Martic M, Tuthill T, Anstee QM, Harrison SA, Bossuyt PM, Pavlides M. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol 2023:S2468-1253(23)00141-3. [PMID: 37290471 DOI: 10.1016/s2468-1253(23)00141-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. METHODS This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226. FINDINGS Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression. INTERPRETATION Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. FUNDING Innovative Medicines Initiative 2.
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Affiliation(s)
- Ferenc E Mózes
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jenny A Lee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Yasaman Vali
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Osama Alzoubi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Katharina Staufer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rafael Paternostro
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rudolf E Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Anne-Marieke van Dijk
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Anne Linde Mak
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Jérôme Boursier
- Laboratoire HIFIH, UPRES EA 3859, SFR ICAT 4208, Université d'Angers, Angers, France; Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc de Saint Loup
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | | | - Silvia Gaia
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Angelo Armandi
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Monica Lupșor-Platon
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Guanlin Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jeremy Cobbold
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, University of Oxford, Oxford, UK
| | - Thomas Karlas
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology and Division of Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Emmanuel Tsochatzis
- Sheila Sherlock Liver Unit, Royal Free London NHS Foundation Trust, London, UK; Institute for Liver and Digestive Health, University College London, London, UK
| | - Antonio Liguori
- Sheila Sherlock Liver Unit, Royal Free London NHS Foundation Trust, London, UK; Institute for Liver and Digestive Health, University College London, London, UK; Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hannes Hagström
- Division of Liver and Pancreatic diseases, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Akbari
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Touon, Japan
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ruveena Rajaram
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Wenzhou Key Laboratory of Hepatology, Wenzhou, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou, China; Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, Palermo, Italy
| | - Grazia Pennisi
- Section of Gastroenterology and Hepatology, PROMISE, Palermo, Italy
| | - Mauro Viganò
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sofia Ridolfo
- Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy
| | - Guruprasad Padur Aithal
- NIHR Nottingham Biomedical Research Centre and Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre and Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dae Ho Lee
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Mattias Ekstedt
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Patrik Nasr
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christophe Cassinotto
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, Montpellier, France
| | - Victor de Lédinghen
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France; INSERM1312, Bordeaux University, Bordeaux, France
| | - Annalisa Berzigotti
- Department for Visceral Medicine and Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Yuly P Mendoza
- Department of Biomedical Research, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Mazen Noureddin
- Houston Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Emily Truong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Andreas Geier
- Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
| | - Miljen Martic
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Theresa Tuthill
- Digital Sciences and Translational Imaging, Pfizer, Cambridge, MA, USA
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Stephen A Harrison
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, University of Oxford, Oxford, UK.
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Tan B, Pan XH, Chew HSJ, Goh RSJ, Lin C, Anand VV, Lee ECZ, Chan KE, Kong G, Ong CEY, Chung HC, Young DY, Chan MY, Khoo CM, Mehta A, Muthiah MD, Noureddin M, Ng CH, Chew NWS, Chin YH. Efficacy and safety of tirzepatide for treatment of overweight or obesity. A systematic review and meta-analysis. Int J Obes (Lond) 2023:10.1038/s41366-023-01321-5. [PMID: 37253796 DOI: 10.1038/s41366-023-01321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Recent studies suggest that tirzepatide, a dual glucose-dependent insulinotropic-peptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has significant weight loss effects. This systematic review and meta-analysis aims to assess the efficacy and safety of tirzepatide for weight loss in patients with overweight or obesity. METHODS Medline, Embase and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) on tirzepatide's weight loss efficacy for these patients. A single arm meta-analysis of proportions estimated primary outcomes, ≥5%, ≥10%, and ≥15% weight loss, and adverse events (AEs); while meta-analysis of means estimated secondary outcomes. Comparative meta-analysis was conducted between tirzepatide and control arms where mean differences and odds ratios were estimated for continuous and dichotomous outcomes respectively. RESULTS RCTs included in this study revealed that among 5800 patients, 78.22% (95% CI: 72.15% to 83.73%), 55.60% (95% CI: 46.54% to 64.47%), 32.28% (95% CI: 23.17% to 42.12%) achieved ≥5%, ≥10%, and ≥15% weight loss, respectively. Tirzepatide 5 mg demonstrated weight loss superiority relative to placebo (MD: -12.47 kg, 95% CI: -13.94 kg to -11.00 kg) and semaglutide (n = 1409, MD: -1.90 kg, 95% CI: -2.97 kg to -0.83 kg) with dose-dependent increase for 10 mg and 15 mg doses. The comparison between tirzepatide and semaglutide was examined in the SURPASS-2 trial that was included in this systematic review. For AEs, there was increase odds of experiencing gastrointestinal AEs with tirzepatide compared to placebo, but no significant difference with semaglutide. CONCLUSION Tirzepatide has significant potential as a weight loss drug in patients with overweight and obesity, with little increase in AEs compared to other weight loss drugs. With its ability to concurrently target multiple aspects of metabolic syndrome, it should be considered as the next helm of weight loss therapies.
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Affiliation(s)
- Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Charlotte Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Centre, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Cheng Han Ng
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore.
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore.
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50
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Chang D, Truong E, Noureddin M. Reply: Machine learning models for NAFLD/NASH and cirrhosis diagnosis and staging: accuracy and routine variables are the success keys. Hepatology 2023; 77:E105-E106. [PMID: 37018138 DOI: 10.1097/hep.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 04/06/2023]
Affiliation(s)
| | - Emily Truong
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
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