The first general session of Digital ILC included two presentations indicating the potential therapeutic value of manipulating the gut microbiota.
The first general session of Digital ILC included two presentations indicating the potential therapeutic value of manipulating the gut microbiota. The first of these evaluated bacterial virulence factors encoded by bacterial genes that help the organisms colonize the intestine or mediate disease. Significantly more virulence factors were found in patients with alcoholic hepatitis than those with alcohol use disorder or controls. In addition, patients with virulence factors had a 5-fold increased risk of mortality versus those without. Using a mouse model of steatohepatitis, the second presentation demonstrated that the gut microbiota drives steatohepatitis progression towards HCC by promoting TLR4-dependent expansion of monocytic myeloid-derived suppressor cells and thus shaping the hepatic inflammatory microenvironment. Modulating or reconstituting the microbiota opens new therapeutic windows for future cancer prevention and therapy.
In other news from this session:
- Exciting data supported a survival advantage with bezafibrate and UDCA versus UDCA alone in patients with primary biliary cholangitis. The clinical benefits of bezafibrate in patients with PBC who have an incomplete response to UDCA are well documented, but this is the first report of a significant improvement in liver transplantation-free survival in this population.
- A detailed characterization of patients with telomere-related gene mutations found that liver abnormalities were common in this population, but were associated with few symptoms. Histological lesions were heterogeneous, including vascular porto-sinusoidal disease and advanced fibrosis/cirrhosis. A FIB-4 score ≥3.25 and/or association with excessive alcohol consumption, overweight and iron overload were risk factors for liver transplant or death.
- Results from a study in more than 5000 patients evaluating the potential impact of using MELD-Na vs MELD for liver allocation found that MELD-Na-based allocation has the potential to reduce 90-day waiting list mortality by almost 5% in the Eurotransplant region.
- Results from a randomized controlled trial conducted in Korea demonstrated that 24 weeks of L-carnitine administration in patients with liver cirrhosis and covert hepatic encephalopathy resulted in improved quality of life and cognitive function.
- In an international randomized controlled trial in 121 patients with NASH, 12 weeks of nidufexor, a non-bile acid farnesoid X receptor (FXR) partial agonist, resulted in significant decreases in ALT, hepatic fat fraction and body weight vs placebo. The study reinforces FXR agonism as a therapeutic approach in NASH.