Dr. Nicolas Lanthier (Belgium) reviews the interaction between the gut microbiota and PPARs in NAFLD. He discusses the microbiota and its link to NAFLD and IR, where he explains the key role of the gut microbes in the metabolism of their host and highlights how liver becomes the first organ to be exposed to gut changes. He also reviews the role of peroxisome proliferator-activated receptor (PPARs) in metabolism, inflammation and in vascular and fibrosis modulation. He explains the human bacterial microbiota changes and how it can relate to other metabolic changes such as adipose tissue expansion, muscle mass and myosteatosis. To clinicians, he presents patient studies on probiotic and prebiotics, and its impact at various disease stages such as NAFLD, NASH, overweight and obesity.
Dr. Robert Chilton - NASH is increasing with the current obesity pandemic. Prof. Robert Chilton (San Antonio - USA) reminds us that the current best practices to tackle the burden of this multi-system disease are currently lifestyle interventions (including weight loss and maintaining a healthy lifestyle while adhering to the guideline treatments of CV risk factors). He reviews se risk factors, association and latest clinical considerations of NASH and cardiovascular disease. He also discusses the potential role of a PanPPAR approach.
Dr. Moritz Peiseler (La Charité - Germany), discusses new scientific insights into the role of inflammation in NAFLD / NASH. He presents the spectrum of NAFLD and explains how inflammation can drive all the progressive stages of NAFLD. He also reviews hepatocellular carcinoma (HCC) risks and presents several studies and evolving treatments for NASH.
Currently, there are no Food and Drug Administration (FDA)-approved or European Medicines Agency (EMA)-approved therapies for NASH and only lifestyles interventions are recommended for the treatment of NAFLD. Prof Zelber-Sagi (Haifa, Israel) reviews best practices for lifestyle interventions in patients with NAFLD. She warns us against ultra-processed foods and drinks, that are so common in the Western world. She also highlights the benefits of the Mediterranean diet and physical activity.
Prof. Pierre-E.Rautou (France) discusses the effects of Liver Sinusoidal endothelial cell (LSEC) capillarization in patients with NASH. He also reviews the occurrences of LSEC capillarization at the early stages of NASH and its contribution to NASH progression by favoring inflammation and liver fibrosis. For the clinicians, he demonstrates a 24 week study of patients with NASH, exposed placebo and lanifibranor treatments strategies to determine LSEC changes.
Prof. Manuel Romero-Gomez discusses the course of liver histology and its impact on mortality and morbidity in patients with NAFLD and NASH. He clarifies how fibrosis determines the prognosis of NAFLD and is the main therapeutic target. The importance of steatosis is also discussed both at the early phase and advanced phase. Finally he reviews the association with HCC and CV risks.
NAFLD places a substantial burden on healthcare systems and receives little attention from public health authorities. Ambitious measures are needed to improve preparedness globally. Prof Lazarus, Spain, discusses how to establish care pathways tailored to meet patients needs but also that optimally use existing resources. Modifiable risks factors are particularly important in a comprehensive strategy.
Prof Bugianesi, Italy, reviews a burning issue: hepatocellular carcinoma (HCC) in patients with NAFLD/ NASH. She reviews the epidemiology globally and impact on liver transplant. There are multiple risks factors for HCC in NASH patients such as obesity, type 2 diabetes (T2D), and the metabolic syndrome in general. For clinicians, she presents the main studies, the profiles of the patients particularly at risk and risk stratifications strategies.