Personalized Medicine Vital to Future of Liver Disease Care

The use of personalized medicine is vital for improving outcomes in patients with nonalcoholic fatty liver disease (NAFLD) in the future, say researchers.

“The current therapeutic landscape of NAFLD is rapidly evolving with an increasing number of molecules that treat key factors involved in its progression, but that still have a limited or no ability to effectively reverse fibrosis,” wrote Manuel Romero-Gomez of the University of Seville and his co-authors in the journal Liver International. “Management of this disease will probably require a combination of sequential and personalized treatments as a result of its complex and dynamic pathophysiology.”

The national multicenter study in Spain led by CIBER for Liver and Digestive Diseases (CIBEREHD) involved five years of monitoring patients with metabolic liver disease.

The prevalence of NAFLD has increased to 25% in the general population and could double by 2030, the researchers noted. Liver fibrosis is the main indicator of morbidity and mortality, and recent estimations suggest a substantial number of individuals with undiagnosed advanced liver disease.

“Strategies to monitor advanced fibrosis are essential for early detection, referral, diagnosis and treatment in primary care and endocrine units, where NAFLD and consequently liver fibrosis are more prevalent,” wrote Romero-Gomez and his colleagues.

Blood-based noninvasive methods such as liquid biopsy could be used to stratify patients according to the risk of the progression of fibrosis, they said, and could be combined with imaging techniques to improve stratification.

Powerful new diagnostic tools such as magnetic resonance electrography (MRE), a technology that combines MRI imaging with low-frequency vibrations to create a visual map, are emerging and might prevent the need for liver biopsy in the near future, the authors wrote.

Scott L. Friedman

Personalized medicine allows for clinicians to “establish a cause or predict risk of illness and design a personalized plan to prevent or detect diseases early,” said Scott L. Friedman, M.D., chief of the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai, in an article posted on Gastroenterology Learning Network.

“It allows for the use of medications and other treatments based on what would work best for each individual and also avoid adverse effects,” Friedman was quoted as saying,

One example of personalized medicine in liver disease care is utilizing whole exome sequencing, according to Friedman, who shared the example of a Yale University study in which the testing was used in 19 adults with idiopathic liver disease.

Five out of the 19 patients had identifiable monogenic disorders affecting five genes. The presenting features were typically lean nonalcoholic steatohepatitis (NASH) or cryptogenic cirrhosis, Friedman said.

“Personalized medicine will slowly but surely integrate into clinical hepatology, but this will be evolutionary, not revolutionary,” Friedman said. “Barriers to implementation will wane as we develop better systems to integrate this information into the medical record, so doctors don’t have to become geneticists.”