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Lead author Ali Aminian shares key findings from SPLENDOR on the impact of bariatric surgery on Major Adverse Cardiovascular Events (MACE) and Major Adverse Liver Outcomes (MALO).

Top-line: over a ten-year followup period, bariatric surgery led to a fourfold decrease in MALO and almost a twofold decrease in MACE. This led Stephen Harrison to ask whether it makes sense to combine MACE and MALO as an endpoint in future studies and to comment on the oddity that most specialties seek to include patients with relevant co-morbidities in their clinical drug development trials but NASH drugs seek to exclude them.

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Lead author Dr. Ali Aminian of the Cleveland Clinic joins the Surfers to discuss the recent SPLENDOR Study, which focuses on the effects of bariatric surgery on Major Adverse Cardiovascular Events (MACE) and Major Adverse Liver Outcomes (MALO). 

Stephen Harrison and Roger Green are joined by Fatty Liver Foundation President Wayne Eskridge.

9:02 - Ali Aminian begins to discuss the SPLENDOR study
11:38 - Ali explains the dual study outcomes
13:31 - Wayne has the first comment, then Stephen asks about sub-populations. Ali notes that the small sample size  of events limits the ability to do so.
16:25 - Stephen asks whether it will be a good idea to analyze for MACE and MALO together, rather than separately, and describes the large shift in trial enrollment thnking this might cause.
17:53 - Stephen asks whether study explored renal disease in a cardio-hepatic context. Ali discusses why not  
20:20 - Roger notes virtually identical declines in MACE (7.3%) and MALO (7.2%), asks whether  patients in the trial exhibited both 
23:30 - Ali shares preliminary analyses (not ye released) about the impact of bariatric surgery on disease outcomes. (CAN'T MISS)
24:35 - Stephen notes that these numbers look similar to the placebo group in the cenicriviroc trial
26:19 - Ali comments that having 100 F4 patients  does not provide much power for analysis. Stephen says it might be "25 times" what anyone else has.
28:51 - Ali asks Stephen whether he can envision new agents having the potential to drive regression in  cirrhosis patients.
30:02 - Stephen describes a small, recently reported efruxiferman trial that appears to do so,
goes on to hypothesize that over time we will find a strategy 
35:13 - Wayne worries whether "the siren song of surgery" will stop people from doing the hard behavioral work 
35:59 - Ali: the problem is 40% obesity, 10% severe and until recently, no way to treat it. Expresses optimism and hope for semaglutide and the GLP-1s to come
38:10 - Roger asks how the coming double and triple agonists that report 20+% weight loss will compare to surgery in outcomes
38:49 - Ali: we need to do trials, but effect should be the same. Stephen agrees
40:31 - Shardool Jain, Director of R&D at Altrix Bio, joins from audience to ask if members can envision a time where bariatric surgery becomes first line therapy for extremely obese patients
42:40 - Ali suggests it may make sense for severely obese patients with multiple weight-related morbidities, not otherwise
44:50 - Stephen asserts we do not have enough surgeons in the US to execute the strategy. His preference: solve challenges that will reduce adherence with the new weight loss medicines
46:29 - Roger makes three points. 1 -  surgery in cancer is not an early-stage strategy as Shardool suggests; 2 - from his own experience, diet and exercise can be exceptionally effective in the motivated patient; 3 - you get one shot at surgery, many at medication 
47:31 - Diet conversation continues...
50:57 - Shardool and Stephen exit
51:04 - Ali addresses NIT issue by noting that when data for these first patients were generated in 2004,  there were no practical NITs available
51:43 - Last question: the most powerful long lasting effects of SPLENDOR
52:03 - Ali: 1. Obesity is the main driver in Fatty Liver Disease. 2. Well populated, well-followed populations may provide unique insights
53:29 - Wayne: "the guidance that the heart-liver axis can be affected so dramatically is something we can use" with patients
54:12 - Roger: 1. Forecaster says investment in the double agonists and triple agonists becomes more attractive. 2. Advocate notes that weight loss can help patients all along the NASH spectrum
56:22 - Business section

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NASH-TAG 2022 takes place in Deer Valley Utah and on-line from January 7-8, 2022. Join Surfing NASH to learn about the last three sessions of the meeting, which include multi-stakeholder "fireside chats" about how to make progress in non-invasive testing for non-cirrhotic NASH and NASH cirrhosis.

Co-chair Stephen Harrison leads the panel through key sessions from NASH-TAG. This conversation starts with a review of Session 7, which features presentations on PNPLA3 and HSD17B13 knockdowns and a range of novel targets. Discussion proceeds to Session 8, which includes presentations on several key basic science topics ranging from transcriptomics to integrin. Finally, Stephen leads the group through discussion of the two fireside chats, where collections of governmental, commercial and academic stakeholders discuss how to make progress in using novel tests for products designed to treat patients with non-cirrhotic NASH and, separately, NASH cirrhosis.

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NASH-TAG 2022 takes place in Deer Valley Utah and on-line from January 7-8, 2022. Join Surfing NASH to learn about important updates from the three consortia (LITMUS, NIMBLE and the NIH Cirrhosis Network), "new news" in wet biomarkers and combination therapy and a stimulating session with PathAI and Histoindex covering artificial intelligence.

Co-chair Stephen Harrison leads the panel through key sessions from NASH-TAG. This conversation starts with a review of Session 4, in which Quentin Anstee presents updates from the LITMUS consortium, Arun Sanyal presents updates from NIMBUS, and Vijay Shah provides information about the NIH Cirrhosis Network. From there, Stephen reviews Session 5 with its focus on artificial intelligence leaders PathAI and Histoindex. The conversation concludes by reviewing the eclectic and intriguing Session 6, "What's New Out There and How To Interpret What It All Means," which has talks on the AASLD NASH Task Force, news on wet biomarkers and an update on combination therapy.

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NASH-TAG 2022 takes place in Deer Valley Utah and on-line from January 7-8, 2022. Join Surfing NASH to learn about the important and innovative drug development and basic science talks in the meeting.

Co-chair Stephen Harrison leads the panel through each of the sessions during the conference's first morning. The session starts with Michael Charlton's annual "Year in Review" talk, includes discussions on an array of drug classes and ends with a session on the biologic basis of NASH progression. He pauses at the end of his review of each session, thus leaving Steering Committee member Jörn Schattenberg and Surfers Louise Campbell and Roger Green to comment on favorite presentations, ask questions and place this information in the context of what we are learning elsewhere about Fatty Liver disease and the drugs that are being developed to treat it.

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NASH-TAG 2022 Co-chair Stephen Harrison and Steering Committee Member Jörn Schattenberg review the upcoming conference, focusing on major issues in NAFLD and NASH diagnosis, staging, treatment and monitoring.

NASH-TAG 2022 faculty, format and schedule suggest that this conference will produce breakthroughs in knowledge and consensus about NAFLD therapy. This week, NASH-TAG 2022 Steering Committee member Jörn Schattenberg joins the Surfers to discuss key presentations and critical issues in the conference. NASH-TAG co-chair Stephen Harrison walks the panel and audience through the entire NASH-TAG agenda, with Jörn, Louise Campbell and Roger Green contributing questions and comments throughout the session.

Highlights from the program:

8:54 – Stephen provides a little background on NASH-TAG
9:44 – Stephen begins to discuss Friday morning program
10:34 – Describing the first session, “A one-stop shop”
13:10 – Jörn Schattenberg comments on Session One
14:09 – Roger Green comments on Session One
15:10 – Louise Campbell comments on Session One
15:26 – Stephen discusses Sessions Two and Three, with comments on the oral presentations thrown in
18:24 – Louise comments specifically on the talk about why NASH-related HCC is resistant to treatment; Stephen agrees and amplifies
19:02 – Jörn comments on Sessions Two and Three
20:19 – Stephen discusses the break session and goes on to discuss Session Four
23:18 – Roger asks about which oral presentations will appear at the conference, Stephen demurs
23:55 – Jörn expresses enthusiasm that the LITMUS, NIMBLE and the NIH Cirrhosis Network
25:15 – Stephen discusses Session 5 
26:43 – Roger expresses enthusiasm for the entire afternoon program (Sessions 4 and 5)
27:09 – Stephen discusses the scope and scale of the efforts LITMUS and NIMBLE are making, and goes on to discuss recent progress against cirrhosis in the context of mentioning the cirrhosis network
28:29 – Jörn expresses positive outlook on the Path AI and HistoIndex presentations
29:05 – Stephen begins review of Day Two, Session Six.
]31:14 – Stephen: “This may be one of the most intriguing sessions”
32:25 – Roger begins comments on Session Six
33:02 – Louise comments on Session Six
35:07 – Stephen begins review of Session Seven
36:24 – Louise begins comments on Session Seven
37:06 – Stephen begins discussion of the second evening with Session Seven
37:56 – Jörn comments on Session Seven
38:22 – Stephen discusses the last two hours of the meetings – “fireside chats” with governmental, corporate and academic stakeholders about whether it is time to pivot away from semi-quantitative biopsy-based endpoints toward NITs.
40:04 – Roger agrees with Stephen’s exceptional excitement about the potential of the fireside chats; Stephen elaborates on what will make the chats so special
42:23 – Final question: one more thing each panelist would like to point out in the agenda?
42:34 – Jörn praises “great program,” wonders whether the fireside chats should have included a patient representative
43:04 – Louise echoes Jörn’s comments on program quality and wish for a patient representative in the fireside chats
43:50 – Roger asks whether talks on the PNPLA3 and HSD17B13 knockdowns presage a longer-term future for therapies
44:42 – Stephen is partial to the fireside chats, expresses belief that researchers will take away from this meeting something they can use in research
454:52 – Business section

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Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join Stephen Harrison, Louise Campbell, and Roger Green to discuss the groundbreaking paper "Advancing the Global Health Agenda for NAFLD." This conversation starts with Roger discussing the recent Episode 49, in which Kenneth Cusi presented the multi-specialty clinical care pathway approach fostered by the American Gastroenterological Association in harmony with other specialties and Scott Friedman's comments in Episode 55 about NASH as an environmental disease caused by changes in global diets and their effect on the liver through the microbiome. 

Jeff notes that he sees working in parallel with environmental and active lifestyle advocates as a cause for hope. The conversation shifts to the growth rates for cirrhosis in countries around the world and what that implies in terms of how fast the patient load will double or triple. This will cause increases in cost and worker demand nations are not prepared to address. The final question asks the group where panelists believe they can have the greatest impact, which leads to a follow-up question from Roger about whether stating aggressive incidence numbers might scare off payers, particularly private payers in the US. Jeff agrees this might be a risk as the session ends.

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Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join Stephen Harrison, Louise Campbell, and Roger Green to discuss the groundbreaking paper "Advancing the Global Health Agenda for NAFLD." This conversation focuses on what will happen now, why NAFLD is "the canary in the coal mine," and how we can combine strengths in different parts of the world to make all of our programs more robust.

For Jeff Lazarus, "what's next" includes a third, smaller Delphi study as well as a greater focus on Sustainable Development Goals (SDGs) around the environment and possible diet. As it continues, Stephen Harrison discusses ways to persuade patients (and perhaps societies?) to change habits, practices, and beliefs radically to fight this disease. Louise Campbell returns to the issue of SDGs to discuss how advocates can leverage the increasing volume of liver cancer patients to represent larger related issues, which leads Jeff Lazarus to comment on how prevalent and costly liver cancer is today, compared to other cancers. In the end, Stephen Harrison recommends a two-item impact strategy: clear messages supported richly through large, high-impact multimedia campaigns.

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Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join Stephen Harrison, Louise Campbell, and Roger Green to discuss the groundbreaking paper "Advancing the Global Health Agenda for NAFLD." This conversation centers largely on the issues of prevalence and cost data and the challenges of explaining the impact of NAFLD to non-stakeholders before Jeff ends with a remarkable anecdote.

This conversation kicks off with Stephen discussing the need for robust prevalence data. Jeff agrees but notes that past data in HIV and Hepatitis C have led to challenges and overconfidence after initial estimates were proven high. That said, Jeff notes that prevalence data will be key to accurately estimate the cost of what will be an extremely expensive disease in every world market. Louise amplifies Jeff's point on cost and Roger discusses the idea that NAFLD/NASH are different diseases at different fibrosis stages. Finally, Jeff tells a story about how all the Nature Reviews disease-specific journals coalesced around these recommendations in record time.

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Lead author Jeffrey Lazarus and co-author Jörn Schattenberg join Stephen Harrison, Louise Campbell and Roger Green to discuss the groundbreaking paper "Advancing the Global Health Agenda for NAFLD." This conversation focuses on study methodology, what it felt like to participate, and the NAFLD Global Health Agenda from a physician's point of view.
In this conversation, Jeff describes the rigorous and ambitious process for conducting the study and analyzing results, Jörn describes what it meant to him to be part of the process, and Stephen Harrison takes a physician's perspective, noting how valuable this paper is and discussing how the way medical practice is structured in the US will make its implementation more challenging here.

Jeff also discusses some key findings and lessons, including the low level of preparedness across the globe to deal with the coming increase in cirrhosis cases and the World Health Organization's failure to recognize liver disease in some pivotal publications, while Stephen focuses on how patient practice visits are structured to achieve HEDIS scores but not necessarily help patients fully.