10 recent reports from The Liver Meeting Digital Experience

Healio Gastroenterology and Hepatology presents the following report on highlights from The Liver Meeting Digital Experience.

Presented research included noninvasive tests for nonalcoholic steatohepatitis, obeticholic acid for primary biliary cholangitis, hepatocellular carcinoma detection and more.

Progress made toward understanding best noninvasive tests for NASH, fibrosis diagnosis

To streamline and validate diagnosis of and clinical trials in nonalcoholic steatohepatitis, one group is on a mission to determine the best noninvasive tests for all physicians to use, according to a presentation.

“As you know, there are many noninvasive tests that are in development, but there are very few that are actually approved for any context of use,” Arun J. Sanyal, MBBS, MD, professor in the department of internal medicine in the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University School of Medicine, said during The Liver Meeting Digital Experience. “In this cross-sectional analysis of multiple biomarker panels in the same blood sample from a highly phenotyped NAFLD population, multiple biomarkers met a priori criteria for preliminary success. ... There was differential performance across biomarkers for both NASH and for fibrosis making it likely that future combinatorial approaches could be used to enhance diagnostic position.” Read more.

VIDEO: Obeticholic acid improves survival in primary biliary cholangitis

In a video exclusive, Gideon Hirschfield, PhD, FRCP, of the University of Toronto, reported the potential of obeticholic acid for improving transplant-free survival among patients with primary biliary cholangitis.

Specific data from the long-term extension of the phase 3 POISE trial revealed, compared with primary biliary cholangitis (PBC) natural history data from the Global PBC and UK-PBC databases, patients treated with obeticholic acid had a 77% to 80% lower risk for death or liver transplant. Read more.

Combinatorial serum protein panel ‘promising’ in early HCC detection

Use of a transforming growth factor-beta pathway-based combinatorial serum protein panel may aid in the early detection of hepatocellular carcinoma, according to research presented at The Liver Meeting Digital Experience.

“Current screening of HCC is based on ultrasound and serum alpha-fetoprotein but it has very limited sensitivity. Ideally, we want our new biomarkers to be easy to use and low cost with high sensitivity and specificity; we are still looking for new biomarkers,” Shuyun Rao, MD, of the Feinstein Institutes for Medical Research and Cold Spring Harbor Laboratory, said. “Our hypothesis is proteomic alteration in the pathological state will reflect a function consequence of ongoing biological abnormality to identify tissue and blood-based proteomic biomarkers with a focus on the transforming growth factor-beta (TGF-B) pathway.” Read more.

Novel incretin co-agonist improves disease activity in noncirrhotic NASH

Cotadutide was safe and effective in improving markers of disease activity and fibrosis among patients with biopsy-proven noncirrhotic nonalcoholic steatohepatitis, according to research presented at The Liver Meeting Digital Experience.

“While many agents [for NASH] are under development, none are approved and current drugs in development also have specific limitations, providing a rationale for further drug development for NASH,” Arun J. Sanyal, MBBS, MD, professor in the department of internal medicine in the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University School of Medicine, said. “MEDI0382, cotadutide (cota), is a novel oxyntomodulin-like single peptide with dual activity at GLP-1 and glucagon receptors. By having this dual activity and oxyntomodulin-like profile, it is differentiated from GLP-1s alone as shown in this preclinical animal model where cota produced greater improvement in steatosis, inflammation and ballooning as well as improvement in some circulating biomarkers of fibrosis. This was the basis for fast-track designation from the FDA.” Read more.

Undiagnosed anxiety present in 17% of patients with cirrhosis

Using a cirrhosis-centric model, researchers found a high prevalence for anxiety in patients with cirrhosis, according to a presentation at The Liver Meeting Digital Experience.

“The prevalence of anxiety on cirrhosis remains poorly established,” Kinjal Patel, MD, internal medicine resident at the University of Alberta in Canada, said during her presentation. Read more.

Pegbelfermin improves markers of fibrosis in NASH

Pegbelfermin was safe and effective in improving markers of steatosis, fibrosis and inflammation among patients with nonalcoholic steatohepatitis with stage 3 fibrosis, according to a presentation at The Liver Meeting Digital Experience.

“FGF21 is a non-mitogenic hormone predominantly secreted by the liver which is an important regulator of glucose and lipid metabolism. FGF21 may have direct and indirect beneficial effects on NASH and NASH-related fibrosis. Healthy liver secretes endogenous FGF21. A main problem for developing pharmacology has been that the half-life is very short,” Rohit Loomba, MD, MHSc, professor of medicine in the division of gastroenterology and adjunct professor in the division of epidemiology at the University of California, San Diego, said. “Pegbelfermin (PGBF) is a PEGylated recombinant human FGF21 analog with a prolonged half-life supporting weekly dosing. We previously conducted a phase 2 trial in patients with biopsy proven NASH who underwent advanced imaging modalities where we showed improvement in MRI PDF and various other noninvasive biomarkers.” Read more.

Increased fatty liver disease awareness needed to mitigate burden among young adults

Increased awareness is needed to mitigate burden fatty liver disease and modifiable risk factors among adolescents and young adults, according to research presented at The Liver Meeting Digital Experience.

“The prevalence of fatty liver disease is potentially increasing in adolescents and young adults, what we call the AYA population, and this is due to increased rates of alcohol consumption in recent years leading to an increase in alcohol-associated fatty liver disease, or ALD, and the obesity pandemic leading to an increase in the prevalence of nonalcoholic fatty liver disease, or NAFLD,” Naim Alkhouri, MD, vice president of academic affairs and director of the Fatty Liver Program at Arizona Liver Health, said. “Previous studies that estimated the prevalence of fatty liver disease in the AYA population relied on liver enzymes or liver ultrasound with known issues in terms of sensitivity and specificity.” Read more.

FMT restores gut barrier function, improves severe alcohol associated hepatitis outcomes

Improvements in intrahepatic and circulatory inflammation markers were observed after fecal microbiota transplantation in patients with severe alcohol associated hepatitis, according to a presenter at The Liver Meeting Digital Experience.

“The gut permeability was reversed, which suggests the effectiveness of cellular remodeling and reasons for a better survival after FMT,” Sukriti Baweja, PhD, assistant professor of molecular and cellular medicine at the Institute of Liver and Biliary Sciences, said during the presentation. “Our study provides evidence that improvement in severe alcoholic hepatitis patients post-FMT by day 28, [mucosal associated invariant T cells] cells may aid in antimicrobial activity in circulation and increase the overall mortality.” Read more.

Odevixibat reduces markers of progressive familial intrahepatic cholestasis in children

Odevixibat treatment reduced levels of peripheral blood autotaxin, pruritus and serum bile acid among pediatric patients with progressive familial intrahepatic cholestasis, according to pooled data.

“Progressive familial intrahepatic cholestasis, or PFIC, is a group of rare genetic liver diseases characterized by chronic cholestasis, high serum bile acids and severe pruritis being the hallmarks of the disease and progressive liver disease. Lysophosphatidic acid mainly produced by autotaxin and serum bile acids are both possible pruritic mediators,” Emmanuel Gonzales, MD, PhD, of the Hôpital Bicêtre at the Universite Paris-Sud, said during his presentation at The Liver Meeting Digital Experience. “While some previous studies have shown a correlation between cholestatic pruritus and peripheral blood autotaxin levels on one hand, and serum bile acid levels on the other hand, other studies have not.” Read more.

Tenofovir alafenamide prevents mother-to-infant HBV transmission

Tenofovir alafenamide therapy was safe, well-tolerated and prevented the transmission of hepatitis B virus from pregnant mothers to infants, according to research presented at The Liver Meeting Digital Experience.

Currently, few data exist investigating the safety and effectiveness of tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) administration among pregnant women with chronic HBV despite being indicated for use during pregnancy in China, Qing-Lei Zeng, MD, associate professor at The First Affiliated Hospital of Zhengzhou University, said during the presentation. In a multicenter study, researchers aimed to investigate the safety and effectiveness of TAF therapy in preventing mother-to-child HBV transmission. Read more.

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