S4-E40.1 - Liver as a Regenerative Organ and the Use and Limitations of NITs

Along with NASH-TAG, Paris NASH is one of two famously small, science-based and publicly available events every year for the liver community. Given the depth of topics and ideas explored in Paris, the event in its entirety would be nearly impossible to cover in a single conclusive episode. That said, the Surfers (Jörn Schattenberg, Louise Campbell and Roger Green) are joined by two presenting KOLs, Scott Friedman and Laurent Castera, for a neatly packaged conversation to capture some of the key dynamics of the meeting. Particularly, the group hone in on developments in the landscape around NITs.<br/><br/>This conversation starts with Scott discussing the session he shared with Fabio Marra which investigates the link between fibrosis and regeneration. Scott points out that the liver’s ability to regenerate is unique among organs and a pivotal question for which a new answer arises every ten years, none of which turns out to cover the topic adequately. He goes on to note that injured livers are less likely to regenerate and that regenerative livers are less likely to create scar. He suggests that while we do not know which one comes first, the answer is likely to have broad implications not only for liver disease but also a range of other organs. In response to a question from Roger, Scott says he considers it more likely that regenerating liver tissue sends a message to break down scarring. This inclination is based on thorough experience of observing the natural history of treating viral hepatitis. Jörn asks about the degree to which the underlying etiology of disease causes this response. Scott states that the response is fairly common across etiologies but, as he notes, the devil is in the details.<br/><br/>The rest of this conversation is devoted to Laurent and his session with Dr. Mark Muthiah about the use and limitations of NITs. This talk evolved from a case study about an individual patient. Laurent’s point, in a nutshell, is that we need a range of tests depending on the question we are trying to answer – initial screening vs. staging vs. monitoring - but that the entire issue runs the risk of overwhelming front-line treaters who are not aware of these issues. In this context, he sites the value of FIB-4, and also its major drawback related to ages and cutoffs.  <br/><br/>This episode and its conversations cover a range of fascinating insights stemming from yet another impactful Paris NASH meeting. If you have questions or comments around Paris NASH, NITs or any other themes addressed, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.<br/><br/>Stay Safe and Surf On!