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Given the vast amount of information and insight from The Liver Meeting, this episode sought to identify and explore a few key highlights. The panel (Jörn Schattenberg, William Alazawi, Naim Alkhouri, Laurent Castera, Ken Cusi, Wayne Eskridge and Roger Green) addresses several topics from the program.

Naim begins this conversation with mentioning Labcorp’s announcement that a reflex ELF test is available for patients with high FIB-4. The latter will be computed if the patient has a complete blood count (CBC) and a comprehensive metabolic panel (CMP). As Naim notes, this is similar to the Hep C paradigm where patients with a positive Hep C antibody test receive the Hep C RNA. For Naim, this is “a game changer” in primary care where patients with the basic CBC and CMP results can be flagged for advanced fibrosis using two widely-studied NITs.

Will segues to discuss John Dillon’s work with the intelligent Liver Function Test (iLFT), which was covered on the podcast earlier in the year. Since then, an abnormal iLFT result now leads to an ELF test. Like the Labcorp program, this follow-up makes it easier for primary care to identify patients with abnormal livers. Will cautions that more research on different ethnicities and disease levels ought to be conducted. At this point, Will exits the discussion due to a poor internet signal. While signing off he raises one last trend that has likewise surfaced on the podcast earlier this year. The encouraging note is that researchers are working to link NITs directly to outcomes instead of biopsy.

In the remainder of this session, Ken discusses advances in the use of PPARs. He first notes the ongoing work with the pan-PPAR, lanifibranor, followed by Poxel’s work with PXL-065. The latter is a deuterium-stabilized form of pioglitazone that generates greater activity of the r-enantiomer and less of the s-enantiomer.  These are linked to mitochondrial benefit versus weight gain, respectively. Stephen Harrison discussed this molecule early last month in review of a recent string of press releases presaging some of the most promising data of the last decade in NASH drug development.