Surfing the MASH Tsunami

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This discussion on ways to improve MASH patient management comes from the early July roundtable on "Major Issues of the First Six Months of 2025." As a reminder, that roundtable included the three co-hosts (Louise, Jörn Schattenberg and Roger Green) 

Roger drives this conversation, focusing on two very different, yet very important issues: the first is the increasing dynamism of the in-office scanning market, with leader Echosens developing new products and services, while companies like e-Scopics, Sonic Incytes, and Mindray (Hepatus) are introducing new devices with competing profiles. Roger di...

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Last month, The Lancet posted online an article from Stine Johansen, Fredrik Åberg, Emmanuel Tsochatzis and Aleksander Krag, titled "Screening for Advanced Liver Disease." The article aims to update the Wilson and Jungner criteria, initially developed in 1960, to address modern needs and issues. In this conversation, Professor Krag and Dr. Johansen join Roger Green to discuss their article. 

There are many nuances and high points to cover in this thoughtful, fairly lengthy conversation, but one key point is that screening a mass population for HCC or cirrhosis has an entirely different se...

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This discussion on ways to improve MASH patient management comes from the early July roundtable on "Major Issues of the First Six Months of 2025." As a reminder, that roundtable included the three co-hosts (Louise, Jörn Schattenberg and Roger Green) 

Louise drives this conversation based on two related issues she sees emerging: (i) increasing opportunities for motivated patients to manage their own health and (ii) managing the total patient in an environment where people may be taking incretin agonists as if they are consumer drugs. With increased access to scanning, providers ca...

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00:00:00 - Surf's Up: Season 6 Episode 13 
Louise Campbell, Jörn Schattenberg and Roger Green continue their discussion of some major issues from earlier this year, while co-authors Aleksander Krag and Stine Johanset join Roger to discuss their recent publication in The Lancet, titled "Screening for Advanced Liver Disease." 

00:XX:XX - Major Issues of the First Six Months: Integrated Patient Management

Louise drives this conversation based on two related issues she sees emerging: (i) increasing opportunities for motivated patients to manage their own health and (ii) managing the total pat...

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Key Opinion Leaders Manal Abdelmalek, Naim Alkhouri, Scott Isaacs and Zobair Younossi join Roger Green to discuss the FDA's approval of semaglutide for patients with non-cirrhotic MASH. This conversation centers on the roles that new technologies and an expanded APP population will play in MASLD and MASH management in the US, and concludes by exploring how care might look different 12 months from now, and then in subsequent years. 

As panelists identify some of the changes they foresee if we are to manage the tsunami of undiagnosed MASLD patients, many comments touch o...

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Key Opinion Leaders Manal Abdelmalek, Naim Alkhouri, Scott Isaacs and Zobair Younossi join Roger Green to discuss the FDA's approval of semaglutide for patients with non-cirrhotic MASH. This conversation focuses on how the US healthcare system must adapt to handle the growing number of MASH and MASLD patients who might seek treatment, given likely increases in publicity and education.

The conversation starts with a focus on the implications of semaglutide approval for hepatologists. Naim states that many hepatologists are currently uncomfortable managing patients on GLP-1 agonists. This will need to change...

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Key Opinion Leaders Manal Abdelmalek, Naim Alkhouri, Scott Isaacs and Zobair Younossi join Roger Green to discuss  FDA's approval of semaglutide for patients with non-cirrhotic MASH. This conversation focuses on benefits for patients and ways that having two drugs with different modes of action will change pharmacotherapy choices.

This conversation starts with the group describing the sense of "enthusiasm" and "fulfillment" hepatology drug developers feel to see two drugs approved in the US and many other major changes to come (more drug approvals, FDA acceptance of a path to approval that i...

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00:00:00 - Surf's Up, Season 6, Episode 12
This week's episode is a special three-part roundtable on the implications of the FDA's recent approval of semaglutide. Naim Alkhouri, Manal Abdelmalek, Scott Isaacs and Zobair Younossi join Roger Green in a discussion that focuses less on specifics of pharmacotherapy and more on how having two drugs available will change MASH management in the US.

00:08:45 - Part I: How Will The Semaglutide Approval Affect Patient Treatment and Pharmacotherapy?
The group starts by describing the sense of "enthusiasm" and "fulfillment" hepatology drug developers feel to...

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This week's expert interview is with Dr. Emily Andaya, Medical Director of the Cardiovascular Program at Major Health Partners of Shelbyville, IN. She joins Louise Campbell and Roger Green to discuss the American Heart Assocation's CKM initiative, why she believe it should be titled "CKLM" for liver, and how including liver in the CKM scoring system would make it stronger and provide a more robust tool to help improve patients' health. 

Emily begins by discussing her attendance at the American Society for Preventive Cardiology meeting in Boston the previous weekend, where D...

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Multi-Metabolic Week focuses on the idea that MASLD and MASH are elements in a systemic set of Multi-Metabolic issues. This conversation is the second of two looking at the concept of the "Multi-Metabolic Clinic," a clinic that treats the entire spectrum of multi-metabolic diseases.

This conversation starts by focusing on how the two clinics train other physicians and practices on multi-metabolic issues. The EDOM clinic in Spain is certified to provide nutritional training to other practices across the country, while the newer, smaller Trajectory Health Partners practice provides support on use...

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Multi-Metabolic Week focuses on the idea that MASLD and MASH are elements in a systemic set of Multi-Metabolic issues. This conversation is the first of two looking at the concept of the "Multi-Metabolic Clinic," a clinic that treats the entire spectrum of multi-metabolic diseases. 

The core of this episode starts during the weekly groundbreaker exercise, during which our guests began to describe the path that brought them from single-disease specialization to the broader multi-metabolic practice.. Immediately after the groundbreakers, participants describe their clinics today, including patient population and principles underlying their a...

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00:00:00 - Surf's Up: Season 6, Episode 11 

This week, we modify our usual episode structure to focus on multi-metabolic practices and constructs. The multi-metabolic practices covered this week are run by non-hepatologists who have chosen to focus on the liver in a broader cardiometabolic context. They include two practices discussed during a two-part roundtable, one run by US gastroenterologist Dr. Karen Jerome-Zapadka and the EDOM practice in Spain, run by endocrinologists. The expert interview is with Dr. Emily Andaya, an internist who helms a cardiometabolic practice in Indiana, US, that focuses on the l...

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This week's expert is Tim Jobson, Medical Director of Predictive Health Intelligence, a UK-based consultancy. Tim joins Louise Campbell and Roger Green to share an update on PHI's Somerset UK project and other activities. 

The Somerset pilot was designed to help the NHS identify untreated patients at high risk for liver disease and bring them to the office for screening. Tim describes hepatoSIGHT, a tool that "allows clinicians to get their hands on the data and to find patients both for treatment and for clinical trials."  He describes it as standard in...

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Roger Green talks with LiverRight CEO Brandon Tudor and Chief Medical Officer Alexander Lalos about the launch of LiverRight, America's first virtual hepatology clinic, which has recently begun treating patients.

Brandon starts the conversation by telling the story of how he and his partner, Pete Celano, started LiverRight: they saw liver disease as a growing disease in a medical system that was ill-equipped to provide front-line care. When the two men "secret shopped" getting doctor's appointments, they found extremely long waits (3-5 months in examples provided throughout this conversation) for appointments...

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This conversation is the first segment of SurfingMASH’s July discussion of key events from the first six months of 2025. Co-hosts Jörn Schattenberg, Louise Campbell and Roger Green each chose one topic of personal interest.  Today, Jörn Schattenberg discusses two recent papers that demonstrate differences in how individual patients respond to different proteomic tests and what this can mean for individualized treatment plans. 

Jörn begins by citing Modulation of megabolic, inflammatory and fibrotic pathways by semaglutide in metabolic dysfunction-associated steatohepatitis, a paper from researchers at Novo Nordisk that Nature...

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00:00 - Surf's Up 6.10.1
This conversation covers three topics. Jörn Schattenberg discusses two papers that suggest an exciting role NITs might play in future prescribing decisions, two executives from LiverRight describe the U.S.'s first virtual liver clinic, and Tom Jobson of Predictive Health Intelligence updates us on how simple analyses of large data bases can identify and motivate high-risk liver patients to visit their doctors. 

00:17:30 - Roundtable: NITs might help physicians determine the value of metabolic vs. specific anti-fibrotic effects for individual patients

The overall theme of...

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Hepatologist and hepatology key opinion leader Naim Alkhouri joins Roger Green to remember his longstanding relationship with Stephen Harrison, announce his new role as Chief Academic Officer at Summit Clinical Research and share how, in this role, he will have exciting new avenues make an impact on many elements of MASH drug development and patient care. 

The conversation can be divided into two sections. In the first, Naim recounts his relationship with Stephen Harrison, beginning with his move to a different San Antonio clinical trial practice and continuing through his tenure a...

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Fatty Liver Alliance President Mike Betel joins Roger Green to discuss his recent completion of the 3rd Annual Glucose Challenge, an event every July where Mike wears a continuous glucose monitor (CGM) device for a month, conducts food experiments, tracks glucose levels and shares all results with his LinkedIn and FattyLiver.ca friends and followers. 

The conversation starts with Mike sharing the history of the Glucose Challenge. Over its first three years, it has evolved from a means to demonstrate the adverse effects of certain foods on human glucose levels into a...

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This conversation is the third and final segment of SurfingMASH’s July discussion of #SLDThinkTank 2025. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include Dr. Kristina Curtis of Applied Behaviour Change, a UK-based consultancy. 

Louise begins this conversation by highlighting the low level of correct information (and, frequently, high level of passionately-held misinformation) that adults have about diet and her success in improving a family's behavior by educating parents about how to better help their children. Kristina replies that while knowledge and education are critical, they are...

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00:00:00 - Surf's Up: Episode 6.9
This conversation covers three topics. The first discusses the challenges of behavior change in dietary habits and ways governments can help, the second looks at what one can learn from wearing a CGM for 30 days, and the third celebrates the late Stephen Harrison while looking into the future of clinical trials and medical education. 

00:06:12 - Global Think-Tank on SLD Roundtable, Part 3
Behavior consultant Dr. Kristina Curtis joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss issues related to patient-centered care. This conversation starts by...

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This conversation is the fourth and final segment of SurfingMASH’s April discussion of drug development in memory of Stephen A. Harrison. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologist and key opinion leader Sven Francque. 

The discussion focuses on PPARs, genetic medicines, and other emerging drug classes while considering the idea that drug therapies can have an impact on the liver independent of their effect on fibrosis regression. It begins with Sven  discussing his experience as a lead investigator in clinical trial...

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Global Liver Institute President and CEO Larry Holden joins Roger Green to discuss recent Washington political and regulatory activities, their potential impact on the liver community, and ways we can respond.

Larry starts by acknowledging that we are in for "dark times" under the current administration and describes some current government actions that are causing major setbacks, as well as others that have the potential to do so. Specifically, he details the challenges caused by budget cuts, reallocation of funds away from major universities, staff reductions and, along with them, a...

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This conversation is the second segment of  SurfingMASH's coverage of the Global Think Tank on Steatotic Liver Diseases (#SLDThinkTank2025) held in Barcelona in June.  It focuses on the kinds of feedback most likely to produce successful behavioral interventions.

The conversation begins with Jörn discussing the Liver Screen Study, a "very ambitious effort" that starts with 30,000 members of the general European population, narrows down to a subgroup with liver disease, and then provides these individuals with information about MASLD and how to manage it, ultimately evaluating its impact. Many of these peo...

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00:00 - Surf's Up, Season 6 Episode 8
The conversation addresses three issues that are distinct, yet each is pivotal to the future of MASLD and MASH therapies. The first, from the Global Think-Tank on Steatotic Liver Disease, considers how personal and digital approaches can be combined to form the most effective strategy for patient management. In the second, Global Liver Institute President and CEO Larry Holden joins Roger Green to discuss the new challenges in Washington stemming from the Trump Administration and RFK Jr. The final section is the conclusion of our recent drug...

This conversation is the third segment of SurfingMASH’s April discussion of drug development in memory of Stephen A. Harrison. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologists and key opinion leaders Sven Francque and Naim Alkhouri. 

Louise starts the discussion by asking when a patient is metabolically and hepatically healthy instead of merely driving weight loss. She notes that basing therapy entirely on weight loss goals will breed failure and frustration while failing to address the actual pivotal goal of metabolic health. Sven agrees and notes how impo...

This week's newsmaker, Dutch Liver Patients Association President Jose Willemse, joins Roger Green to discuss the patient screening program at this year's EASL Congress, which took place in Amsterdam, and the general idea of what constitutes a patient-sensitive dialogue. 

Jose describes the phenomenal level of interest in the screening activity, in which hepatologists and APPs scanned 400 people per day for MASLD and MASH. Boosted by significant mass publicity in Amsterdam, the number of people seeking screening exceeded the 400/day quota, with some arriving in line hours before the scheduled start time and others traveling for hours to r...

This conversation is the opening segment of  SurfingMASH's coverage of the Global Think Tank on Steatotic Liver Diseases (#SLDThinkTank2025) held in Barcelona in June.  Co-hosts Louise Campbell and Roger Green are joined by Dr. Kristina Curtis, Managing Director of Applied Behaviour Change, a UK-based consultancy. 

This discussion starts with co-host Jörn Schattenberg discussing the history and evolution of the first four Global Think-Tanks as the focus shifts from educating medical professionals about liver disease to incorporating a broader group of stakeholders, including politicians and non-hepatologist MDs, to break down siloes and create broader awareness. Co-host Louise Camp...

00:00:00 - Surf's Up: Season 6 Episode 7
Host Roger Green explains our recent vacation from publishing episodes, assures the audience that the podcast will continue weekly for months and years ahead, and discusses the episode's sections, covering the Global Think-Tank on Steatotic Liver Disease (SLD), the EASL patient screening activity and the increasing role of NITs in drug development. While introducing roundtable guests, he introduces first-time Surfer Dr. Kristina Curtis of the UK-based consultancy, Applied Behaviour Change.

00:09:11 - Roundtable I: From the Global Think-Tank on SLD

This discussion starts with co-host Jörn Schattenberg discussing the h...

00:00:00 Surf's Up, Season 6, Episode 6.

On April 23, 2024, our colleague and co-founder, Stephen Harrison, passed away suddenly. This week, Surfing the MASH Tsunami remembers Stephen with two of his closest associates and continues our annual MASH Drug Development roundtable held in his honor. 

00:00:04:24 - A Deep Dive into Drug Development, Part 2

The second portion of the Drug Development roundtable primarily focuses on three key issues. The first, uptake of resmetirom, starts with Naim Alkhouri discussing his experience in the Arizona Liver Health Clinics with over 650 patients in the year since resmetirom was approved and shifts t...

This week’s expert, Hepatologist and Key Opinion Leader Scott Friedman, joins Roger to discuss advances in acceptance of gene therapy and knowledge in other areas of basic liver science. When discussing science, he pays particular attention to findings on the diversity of stellate cells and his interest in CAR-T as a therapy for liver disease.

This conversation starts with Scott discussing gene therapy. Specifically, he applauds the idea that gene therapy is  becoming accepted in many diseases after a faulty start years ago, due to an unfortunate patient death in a badly controlled trial.  He comments that...

This weekend’s Newsmaker, Indiana University hepatologist and key opinion leader Naga Chalasani, joins Roger Green to discuss Early Experience with Resmetirom To Treat Metabolic-Associated Steatohepatitis with Fibrosis in a Real-World Setting, an article his group published recently in Hepatology Communications. He shares highlights from the paper and points out the one key area in which his group found room for improvement in their initial protocol. 

Naga and colleagues wrote this paper after learning from Madrigal Pharmaceuticals that they were among the largest early prescribers of resmetirom and, relative to others, had achieved reimbursement with virtually all the...

This conversation is the opening segment of SurfingMASH's April discussion, in memory of Stephen A. Harrison, on drug development. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologists and key opinion leaders Sven Francque and Naim Alkhouri. This opening discussion focuses on exciting advances in one drug class (FGF-21s) and, more broadly, on exploring ways to treat cirrhosis. 

As Naim points out in his opening comment, these two issues— cirrhosis as a challenge and FGF-21s as a possible solution path —intersect in clear and exciting ways. He notes that the FG...

00:00:00 - Surf's Up: Season 6 Episode 5

Host Roger Green briefly describes this episode’s three sections and introduces Roundtable guests. The Roundtable panel shares groundbreakers. 

00:10:39 - Roundtable: A Deep Dive Into Drug Development, Part One

The opening portion of this month's roundtable centers around two issues: exciting data for FGF-21s and, more generally, treating patients with cirrhosis. Naim Alkhouri sets the tone in his opening comments, which start by focusing on the exciting SYMMETRY data from efruxifermin and then hones in on FGF-21s and resmetirom in cirrhosis. The rest of the conversation fea...

This week's expert, Hepatologist and Key Opinion Leader Mazen Noureddin, joins Roger to discuss major advances in drug development over the past year. He covers a range of different drug classes, focusing on stages of development and the range of options within each class. 

First, Mazen discusses a tremendously exciting group of FGF-21 agents, specifically mentioning Akero Therapeutics's efruxifermin, 89bio's pegozafermin, and Boston Pharmaceuticals's efimosfermin. He points to efruxifermin’s 96-week results to suggest that FGF-21s might be appropriate for a wide range of patients, the idea that the drug's duration of effect may make the ide...

This weekend's Newsmaker, Fatty Liver Alliance Founder Mike Betel, joins Roger Green to discuss the wide range of conferences where he has been invited to speak or sit on a panel this year. Specifically, he shares his belief on what this says about interest in MASLD and describes the messages he delivers at the conferences he attends. 

The interview starts with Roger asking about the benefits societies and the broader community get from having Mike at these programs. As he puts it, "I feel quite fortunate that I get to be, as you've shared before, the one s...

This conversation is the concluding segment of  SurfingMASH's coverage of the AASLD Emerging Trends Conference on the SLD Spectrum diseases: MASLD, MetALD and ALD. In addition to co-hosts Louise Campbell and Roger Green, panelists include EASL Secretary General Aleksander Krag, hepatologist Alex Lalos and Jenn Leigh Jones, Founder of the Society for Sober Livers Survival patient advocacy group.

The conversation starts with Roger questioning whether it is a good or bad idea to conduct separate studies on medicines' effect on MetALD patients. He notes Anna-Mae Diehl's presentation at the Conference, which suggested that regardless of organ, all c...

00:00:00 - Surf's Up: Season 6 Episode 4 

Surfing the MASH Tsunami concludes its coverage of the AASLD Emerging Trends Conference on MASLD, MetALD and ALD. This week, the panelists focus on pivotal messages that attendees took away from the conference and what messages they would like to share with listeners. Our newsmaker, Fatty Liver Alliance and CEO Mike Betel, discusses the lessons he has taken from being invited to a far wider swath of conferences this year and shares the messages he delivers to these new audiences. Finally, our expert, hepatology research and key opinion leader Mazen Noureddin, discusses r...

This week's Expert is Jeff McIntyre, Vice President, Liver Programs at the Global Liver Institute. His major topic is how recent high-level FDA job cuts might affect MASH drug and diagnostics development. He also shares reactions to FibroSIGHT, HistoIndex's new digital pathology service for clinical practice. 

Highlight: Recent job cuts at the FDA will produce chaos in government and slow response to any emerging crises.

Second Highlight: Patient self-advocacy becomes even more important in this environment.

The conversation takes place on April 1, which lends context to Jeff's opening comment about the rate and n...

This week's newsmaker, Yukti Choudhury, Director of Clinical Development at HistoIndex, joins Roger Green to discuss FibroSIGHT, a new HistoIndex service that allows clinicians to use HistoIndex's Second Harmonic Generation (SHG) technology and analytics to determine specific CRN fibrosis level for patients with inconclusive NIT results.  

One reason FibroSIGHT is worthy of attention: This is the first time an in-depth analysis of clinical trial biopsy results is being placed at the service of clinical treatment. 

Another reason: Yukti states that demand for this technique could equal 163,000 cases this year, rising to one million by 2028. 

T...

Surfing the MASH Tsunami continues its coverage of the AASLD Emerging Trends Conference on MASLD, MetALD and ALD. 

This week, the panelists focus on what studies on bariatric surgery and drugs in development can tell us about future treatment and explore some clinical trial questions. Guest Surfers include Professor Aleksander Krag of the University of Southern Denmark, the current Secretary-General of EALS, hepatologist Alexander Lalos of Robert Wood Johnson hospital, and Jenn Leigh Jones, founder of the Society for Sober Livers Survival, now part of the Fatty Liver Foundation. 

Aleksander Krag starts by discussing a pr...