A diseased liver with nonalcoholic steatohepatitis (NASH) showing liver cells containing large fat droplets, seen as empty spaces, with clusters of inflammatory cells
A normal liver with even-size liver cells
As the obesity epidemic continues to grow nationwide, so too has the incidence of related diseases such as nonalcoholic fatty liver disease (NAFLD). Estimates suggest that nearly one-third of all Americans have some form of fat in their liver, and as many as one-third of that population has the most worrisome form of NAFLD—nonalcoholic steatohepatitis (NASH), or liver inflammation and damage caused by fat buildup. Left unchecked, the disease may progress to a state of advanced scarring or cirrhosis, and also significantly increase the risk of developing primary liver cancer.
“There are approximately 20 to 35 million Americans who have NASH,” says Scott L. Friedman, MD, Dean for Therapeutic Discovery and the Irene and Dr. Arthur M. Fishberg Professor of Medicine and Liver Diseases at the Icahn School of Medicine at Mount Sinai. “The likelihood is that, within three years, NASH will supplant hepatitis C as the most common indication for liver transplantation.”
Long underappreciated and underdiagnosed, in part because there are often no specific symptoms that indicate liver disease, NASH is emerging as a primary focus of study. Dr. Friedman, who has been at the forefront of those efforts, is launching a new multidisciplinary working group that brings together the considerable resources of the Mount Sinai Health System and those of external stakeholders to advance the understanding, diagnosis, and treatment of NASH.
“This is an effort to link all the strengths of the Health System so we can establish standards for diagnosing and treating NASH,” Dr. Friedman says. “We also want to play a lead role in defining new therapies and offering them to our patients as quickly as possible, either through clinical trials or once they are approved, because there are currently no therapies approved for the treatment of NASH.”
In support of that effort, the Division of Liver Diseases has recruited Amon Asgharpour, MD, and Amreen Dinani, MD, Assistant Professors of Medicine (Liver Diseases), whose goal is to raise awareness about NASH and identify patients to participate in clinical trials.
“For example, I’m currently visiting the Mount Sinai Diabetes Center on Fridays to see patients and risk-stratify them because we know that patients with diabetes are more likely to have NAFLD,” Dr. Asgharpour says. “We have also started screening patients participating in the Weight and Metabolism Management Program at Mount Sinai St. Luke’s for liver disease, and we are providing them with strategies for weight loss. If we can help these patients lose weight, they can reduce the amount of fat and scarring in their liver and thus reduce their risk of developing potential complications from NASH.”
Many other collaborative initiatives are currently being discussed by the working group, ranging from researching the link between pathogenesis and fibrosis in liver adipose tissue, to engaging the Mount Sinai Liver Cancer Clinical Program to better understand the risk of liver cancer among NASH patients. “It’s going to be a very fertile and important time for generating ideas and establishing links across the different disciplines that are concerned about this disease,” Dr. Friedman says.