Nomenclature change brings new opportunities for research, drug development
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The renaming of nonalcoholic steatohepatitis and nonalcoholic fatty liver disease to metabolic dysfunction-associated steatohepatitis and metabolic dysfunction-associated steatotic liver disease is a long time coming.
It is something that people have wanted to have for quite some time, but nobody ever took the time or effort to pull together all the stakeholders to discuss what is in a name, what is in this disease and how it should be properly referenced.
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The takeaway is that this change is absolutely a good thing for the field. It will take a couple years, I think, for people to ingrain the new nomenclature in their minds and vernacular, but the good news is that AASLD, EASL and other prominent global liver congresses and societies have adopted this change, as have the FDA and other regulatory authorities in the United States.
One of the main concerns people had when we jumped into this name change was that we did not want to change the definition, and I think we were true to that. The definition has not changed; in fact, if you look at recent publications, there is about 98% homology between NASH and MASH, so they really can be used interchangeably.
The other thing I like about this umbrella term of steatotic liver disease is it begins to give us a more granular way to evaluate fatty liver. We have MASLD and underneath that heading MASH but, interestingly, we also have a new heading that connotates a new opportunity to identify patients who have not been properly characterized in the past.
This new term is metabolic dysfunction-associated steatotic liver disease and increased alcohol intake, or, what we call Met-ALD. These are patients who have metabolic syndrome, they are diabetic and have lots of reasons for their dysregulated energy and metabolism but, on top of that, they are consuming more alcohol than what has classically been defined as pure MASLD and MASH.
Alcohol-associated liver disease, or alcohol-related liver disease, has always been there but its definition has been a bit muddied. This nomenclature change gives us a whole new set of patients to study with Met-ALD and increases opportunities for clinical trials and drug development that target mechanisms of action that both suppress alcohol craving but also address the underlying steatohepatitis.
There are then those with specific etiology steatotic liver disease like drug-induced liver disease, monogenetic diseases and miscellaneous conditions, including hepatitis C virus and even HIV. The fifth and final category is called cryptogenic SLD.
This new nomenclature is, in one vein, more clarified, refining and descriptive and, in another vein, helps bring awareness to the field, to providers, to patients and to pharmaceutical companies about the heterogeneity of steatotic liver disease and the need to find specific therapies that target each of these five different categories.
It has been a captivating year utilizing the Delphi process championed in this case by Mary Rinella, MD, and Philip Newsome, PhD, FRCPE, which was performed very intentionally, methodically and by the book. The new name is a mouthful, for sure, but I think it is absolutely what the field needed and I am glad to support it.
- For more information:
- Stephen A. Harrison, MD, FAASLD, is founder of Pinnacle Clinical Research and Summit Clinical Research in San Antonio and is a visiting professor of hepatology at the University of Oxford. He can be reached at stephenharrison87@gmail.com.
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