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In this issue: This Friday edition of the ILC 2018 daily news includes updates on the latest scientific advances presented today, what is the state-of-the-art in cirrhosis, and what hepatology nurses are up to. Scroll down to read more!

Today, Professor Tom Hemming Karlsen led the EASL General Assembly meeting, the Meet the Experts sessions continued to attract a good audience, and the Grand Roundsproved a hit amongst ILC participants.

The Oral ePosters sessions this morning and afternoon were particularly interesting and generated much debate. If you missed them, remember to check out the ePosters on the ILC app, on the plasma screens at the congress, or on LiverTree™ on the EASL website.

Parisian prize! Top hepatology research is awarded

In the first of two awards ceremonies, the annual EASL Recognition Award 2018 was presented to three scientists – Drs Didier Samuel (Paris, France), Anna Lok (Ann Arbour, USA) and Mario Mondelli (Pavia, Italy) – who have dedicated their long and distinguished careers and made major scientific contributions to the field of hepatology research.

State-of-the-art at ILC 2018

In the session, Jean-Pierre Benhamou clinical state-of-the-art: Is it time to abandon the term cirrhosis? Professor Jaime Bosch, Switzerland, proposed that due to the array of causes, inaccurate diagnosis, and often negative connotations, the term ‘cirrhosis’ be substituted to “advanced chronic liver disease” or ACLD. This was suggested at the 2015 Baveno VI consensus conference on portal hypertension and serves to better distinguish the substages of the disease and hence the choice of treatments.

Allied to this topic, the EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis were discussed in the CPG session, and have also been recently published. This CPG is the first specifically developed on the management of decompensated cirrhosis. As the mortality of patients with advanced and decompensated liver disease is very high, these practice guidelines are extremely important to daily clinical management in improve the outcome of our patients.

Don’t miss:
Tomorrow’s SoA lecture, Karl Wilhelm von Kupffer basic state-of-the-art: Beyond albumin and IgG – the unexpected prospects of the neonatal Fc receptor presented by Richard Blumberg, MD, at 12:00–12:30 in the Main Plenary

This morning’s general session covered several advances in therapies of several liver diseases, proving that treatment options for hepatitis C, HCC, NASH and PBC are continuously improving, thereby reducing the burden of liver disease in Europe – another topic of the session that described the HEPAHEALTH data.
Key clinical data included:

  • ENDURANCE-5, 6 study showed that glecaprevir/pibrentasvir treatment achieves high SVR12 rates (97%) in patients infected with rare HCV 5/6 genotypes, a population historically under-represented in clinical trials
  • Furthermore, interim analyses of the first real-world results of glecaprevir/pibrentasvir from the German Hepatitis C Registry (DHC-R) confirmed the high SVR12 rates (100% in the per protocol population) and favourable safety profile observed in clinical trials
  • 12-week data from the 36-week Phase 2 study of MGL-3196, a selective thyroid hormone receptor beta (THR-β) agonist, showed effective reduction atherogenic lipids and liver fibrosis in patients with NASH. Novel non-invasive multiparametric MRI substudy hopes to show correlation with liver biopsies at the 36-week point
  • Budesonide add-on therapy improves biomarkers of disease activity but failed to improve the liver histology primary endpoint in high-risk patients with primary biliary cholangitis. Recruitment challenges led to insufficient power, and importantly although studies in PBC with histology endpoints are challenging due to biopsy collection, they are important and necessary to confirm disease pathology when biomarker data may give a false negative

Don’t Miss – Late breaker session:
starting at 4pm tomorrow in the Main Plenary

The waiting game and other complications in liver transplantation

Hot topics in liver transplantation
This extensive session was co-organised with EASL, ELITA, ILTS, and LICAGE, and covered a comprehensive range of topics in LT, from how to manage patients on the waiting list, transplants in patients with cancers other than HCC, and finally the latest strategies for managing the patient post transplant.

Don’t Miss – EASL Award Ceremony II:
find out who’s recognized for their achievements in liver research, presented during the General Session at 10am in the Main Plenary

ALD: Useful biomarkers, treatment and abstinence

Continuing alcohol abstinence is essential for good outcomes after LT. A new scoring system, the Relative Risk Factors for Relapse (RRFR), was described that may help predict which patients will relapse to harmful alcohol intake after LT, potentially aiding LT patient selection. Another presentation suggested baclofen treatment as one way to reduce alcohol intake and maintain abstinence – 12 month results of the French OBADE-ANGH study were presented.

The measurement of collagen proportionate area (CPA) predicts clinical outcomes in patients with chronic hepatitis C and NAFLD, and has now been shown to also be a predictor of death in alcoholic hepatitis. We also heard that M30, a caspase-cleaved cytokeratin-18 and a marker of apoptosis, could be a useful biomarker for grading subclinical, alcoholic hepatitis inflammation and has high diagnostic accuracy for severe hepatic inflammation.

Hepatologists must become activists to tackle liver disease related to alcohol

Alcohol consumption is one of the main barriers to liver health and Europe is the heaviest drinking region of the world. The message from this session was clear; urgent action is required to reduce alcohol use. Policies and public health interventions required to achieve this, including the much-applauded minimum price per alcohol unit legislation that will be implemented in Scotland next month, were discussed. The panel agreed that EASL has the opportunity to drive policy by being the authoritative medical voice in the public debate around alcohol.

Don’t miss
Find out what up and coming researchers are up to in the YI Fusion: Career opportunities in hepatology: an emerging generation of NAFLD researchers – 14:00–15:30 in East 3

Developments in difficult to treat ACLFs

Very important data for the daily clinical management of the patients with infections and advanced liver disease were presented this afternoon. Dr Michele Bartoletti, Italy, recounted that a continuous infusion of betalactam antibiotics, piperacillin-tazobactam or carbapenems in cirrhotic patients with bloodstream infection was associated with significantly better survival than with intermittent administration of the antibiotics.

The treatment of ascites with long-term human albumin on top of standard of care was shown to reduce hospitalization rate and incidence to overt hepatic encephalopathy, ascites, and infections, as well as improving survival in a single centre study in Padova, Italy.

Liver regeneration and tissue engineering

Dr Luca Frenguelli from UCL, London, described a key advance in the development of personalized 3D technologies for the study of regenerative medicine and models in liver disease. His study demonstrated that hepatocyte-like cells derived using iPSC technology matured on 3D human liver extracellular matrix hydrogel. The best differentiation was obtained with longer culture times in 3D ECM hydrogel from the earlier hepatoblast stage.

Don’t miss
EASL-WHO symposium: Meeting the 2030 elimination goals of the WHO viral hepatitis strategy – from 14:00–15:30 in South 3

NAFLD: Clinical and therapy
Early phase studies show promise in NASH

In a proof-of-concept study, 12-week data showed the combination of selonsertib (an ASK1 inhibitor) with GS-0976 (an ACC inhibitor) or GS-9674 (a FXR agonist) to be safe and led to improvements in noninvasive markers of disease severity in patients with NASH.

Other early-phase trials demonstrated that SGM-1019, a first-in-class novel small molecule modulator of inflammasome activity in NASH, reduced liver fibrosis in animals, as well as its safety in healthy volunteers.

Patient counseling programmes for NAFLD

A web-based educational intervention aimed at lifestyle changes in NAFLD was found to be as good as standard group counselling in helping patients lose weight, but they had to be motivated to engage in the program, said the researchers from Italy

Don’t miss
Fit in a Key Opinion Leader guided Poster tour over lunch and coffee break – running from 12:30–14:00 and 15:30–16:00. Check your Meeting Point (floor 7.2) in the programme!

Important role of hepatology nurses

Friday was a big day at the ILC for hepatology nurses. This is the first year they have had their own Nurses’ Research in Hepatology poster area. The two well-attended Nurses and Associates Forums highlighted the key role nurses play in delivering quality care for patients with chronic liver disease throughout the course of their illness. These sessions will be available on webcast after the congress, so be sure to catch up if you missed them.

Don’t miss
Skills in hepatology sessions – with expert tutors – running from 18:30–20:00 in West 5 and 6

Industry symposia – Meeting physician and patient educational needs

AbbVie: HCV Unsymposium: Your Meeting, Your Agenda!

The expert panel, led by Professor Jean-Michel Pawlotsky discussed the audience’s top five favourite topics, selected from a range of trending themes, such as the HCV care cascade, HCV elimination and high-risk populations, to name a few. The audience greatly enjoyed this ‘perfect meeting’ format and the debate it generated.

GENFIT: Game changers in NASH management

The symposium was an opportunity to get a comprehensive overview of current challenges in NASH medical and educational fields, especially regarding treatment, diagnosis and awareness. The event was organized by The NASH Education Program™ supported by GENFIT and presented by four renowned NASH experts, including the Chair, Dr Rohit Loomba.

Don’t miss
Get the authors’ perspective in the Oral ePosters sessions – poster pods 1–4 in the poster areas in hall 7.2 at 13:00–14:00 and 15:30–16:00

Acknowledgements

‘Today at ILC’ was supported by grants from: Abbvie, Alexion, Boehringer Ingelheim, Gilead, Janssen, MSD and Pfizer.