Hepatitis and Liver Diseases

Biography

Biography: Asad Izziddin Dajani

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the commonest liver disease; its prevalence had increased over the past 10 years. The treatment of NAFLD is of prime concern due to the mortality and morbidity it implies and that standard of care medications remain experimental. Treatment is focused on lifestyle modification and managing the comorbid diseases with a possible role for hepatic protective agents. Weight reduction by dietary control, physical exercise, orlistat or surgery is a pivotal step in treating NAFLD. Insulin sensitizers: Metformin and pioglitazone were used alone or in combinations with other remedies to treat NAFLD. Pioglitazone induced a convincing effect; however relapse was common which raised concern about complications. DPP-IV inhibitors and GLP-1 agonists reduced Hepatocyte Steatosis and improved hepatocyte survival. Reduction of blood lipids: Statins and Ezetimibe have good effect when used for NASH with dyslipidemia. Antioxidants: Vitamin-E, alone and with vitamin-C, EPL, sylimarin and metformin revealed limited effects. A metanalysis demonstrated that high dose vitamin-E increased all cause mortality. Pentoxiphylline targeting fibrosis showed antioxidant and antifibrotic effects. UDCA had inconsistent results and was not recommended for the treatment of NAFLD/NASH. Probiotics research had shown encouraging results and indicated that they could be an emerging therapeutic option. Investigational medicines like obeticholic acid, ARBs, elafibranor (GFT 505), and simtuzumab are being evaluated; some of them seem to be promising. Medicines in pipeline preclinical studies revealed good results with DUR-928, GR-MD-02, Aramchol, RG-125 and Cenicriviroc. A decade of clinical trials did not reveal an intervention that improved all outcomes for NASH but research indicates promising prospects.