Pathophysiology

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.

As the International NASH day draws more attention to NASH, it’s important to remember that hepatocarcinoma (HCC) is the 2nd most common cause of cancer related death. Dr M. Peiseler and Dr F. Tacke, Charité hospital, Berlin, Germany present the latest scientific information about NASH as a systemic disease, represented by a common inflammatory ‘NAFLD phenotype’ of myeloid cells in liver and bone marrow. They highlight the role of inflammation and its multiple markers.

Prof Tacke, Germany reviews the epidemiological challenge of NAFLD and NASH worldwide, especially with the obesity pandemic. He describes the clinical impact of inflammation and fibrosis in NAFLD and the role of macrophages. Finally, he discusses the possible therapeutic implications.

Insulin resistance is tightly linked to NAFLD, particularly in those with Type 2 Diabetes. In this video, Prof. Michael Roden, Germany discusses this link, its origins that can inherited or acquired. He also sheds light on the consequences of insulin resistance.

In this Expert perspective video, Prof Sven Francque explains how to make the distinction between NAFL and NASH. This is important even though in clinical practice there is a continuum between the two. In the pathophysiology of NASH there is a complex interplay between different organs. Adipose tissue dysfunction is an important driver of disease.

Prof Kenneth Cusi, USA, discusses the role of insulin sensitizers in NASH, and particularly how lifestyle interventions including weight loss can, in this context, be beneficial together with a pharmacological approach.