Fatty liver expert: ‘We face a moral, ethical and medical imperative’

Arun Sanyal

SAN FRANCISCO — Beyond finding a “cure” to nonalcoholic fatty liver disease, one expert at The Liver Meeting 2018 called on physicians and governments alike to fight the root cause of the disease.

“While progress is being made to control liver outcomes, this is only a band aid,” Arun Sanyal, MD, of Virginia Commonwealth University, said during the Leon Schiff State-of-the-Art Lecture. “We face a moral, ethical and medical imperative to tackle the root cause of diabetes, cardiovascular disease and NASH — ie, diet-induced obesity.”

In his talk, Sanyal covered the current pharmacology solutions in the pipeline, some of which reported “very, very promising” results at this meeting, and discussed the path to a cure for NAFLD and subsequent nonalcoholic steatohepatitis.

“This is indeed a very exciting time in the study of NASH,” he said, but he showed the holes in the current pathway.

“Weight loss, in general, is linked to improvement in histology but weight loss is not a resolution of NASH. Furthermore, fibrosis improvement can occur with less than 10% weight loss,” he said. “There is biology there that we have left behind on the table.”

Sanyal also pointed to the current concentration on one organ in each specialty as a misstep, especially given the effects on the liver from cardiometabolic and diabetes medications and the cardiometabolic effects seen from some of the NAFLD medications in the pipeline.

“We need to look at it more holistically. We don’t treat organs, we treat patients. The patient not only is at risk for liver disease, but for others. As the liver becomes stiff, the arteries become stiff, the heart becomes stiff, the pancreas ... the kidneys become stiff,” he said. “Only looking at one particular organ in this disease – in the long run – is a mistake. ... We need to reevaluate how we do business.”

As these organs work together and it is known that lifestyle interventions can help all of them, Sanyal brought up joint counseling for patients suffering from obesity-related diseases and their caregivers and the prevalence of eating disorders associated with addictive behaviors.

“It’s so easy to say lifestyle interventions don’t work. We need to be serious about this and figure out why it doesn’t work,” Sanyal said. “We can leverage some of this for new science to actually impact the root cause. ... There is an opportunity to break through this gridlock.”

Sanyal called for not only a focus on biomarkers and root biological causes but for health policy at a government level.

“Nonalcoholic fatty liver disease is a global problem and it is currently projected that over the course of the next 2 decades, the number of people living with cirrhosis and the number of people with decompensated cirrhosis will double,” Sanyal said. “You cannot transplant your way out of this problem.” – by Katrina Altersitz

Reference:

Sanyal A, et al. Leon Schiff State-of-the-Art Lecture. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.

Disclosure: Sanyal reports consulting relationships with 89Bio, Albireo, Affimmune, Allergan, Amra, Ardelyx, BASF, Birdrock, Boehringer Ingelheim, Chemomab, Conatus, Durect, Echosens, Elsevier, ENYO, Fractyl, General Electric, Gilead, Hemoshear, Immuron, Intercept, Janssen, Lilly, Malinckrodt, Nimbus, Nitto Denko, Novartis, Novo Nordisk, OWL, Perspectum, Pfizer, Poxel, Salix, Sanofi, Second Genome, Servier, Takeda, Terns, Teva, Uptodate and Zydus; grant or research support from Bristol-Myers Squibb, Galectin, Merck and Sequana; and holding stocks in Akarna, Exhalenz, Genfit, Indalo and Tiziana. He is employed by Sanyal Bio.