Transient elastography

platelet ratio index you're not going to remember that and there's also some proprietary scores you have to pay a little extra for elf is probably the most commonly one which is enhanced liver fibrosis this is where clinicians and primary care can start Depending upon the risk score, we can then escalate to other more imaging studies.

The most common is called the VCTE, which is Vibration Controlled Transient Elastography.

A FibroScan is one of those that we can do.

FIB4, at least currently, which stands for Fibrosis 4, is the most commonly one done.

It has been recommended by consensus by multiple international guidelines across Europe and the United States.

And that's where a lot of our focus has gone into in recent years.

And with the help of blood tests to look at fibrosis markers, to use simple blood test FIB4 scores to predict people with fibrosis, and also something called a FibroScan or elastography, where you measure the sponginess of the liver.

We've established pathways to identify people who are going to be at risk of developing liver damage, which is good because if you think about it, trying to treat 60% of the population when only a tiny proportion of them are actually going to develop liver disease or liver damage is huge resource

implications.

And it's painful.

People don't like it.

And so we now do these other tests, blood tests and the FibroScan to check for fibrosis.

And we assume if there is fibrosis, there must be inflammation.

And then what I alluded to earlier, there is evidence now that fat cells can be associated with inflammation.

Another interesting study that we did a couple of years ago, we were looking at fatty liver with an ultrasound machine called FibroScan in people who have psoriatic arthritis.

And it seemed like one of the strongest correlates of how much disease activity people had in psoriatic arthritis was their waist circumference.

So if you don't consider anything else, if you just look at waist circumference, it correlated with people's psoriatic arthritis.

The threshold is 1.3, and if the patient is, uh, has a FIB-4 greater than 1.3, then a second line test is necessary.

A liver stiffness, for example, using, uh, VCTE or FibroScan, but you can also use other blood-based biomarkers as well.

Now we're moving on to what is the benefit of this case finding.

It's that now we can identify patient eligible for specific therapies for MASH.

So identifying the cases, ruling in or ruling out, uh, fibrosis using the, uh, before mentioned FIB-4.

And if available, also using the ultrasound-based, uh, transient elastography.

There is a specific tool which is called FibroScan, but there's now also other tools that can be used on a normal ultrasound machine.

And then also on the second step, the role of the diabetologist is once the diagnosis has been made and other causes have been excluded, also during the management of, uh, these people, taking care of the comorbidities.

Because these people are, as we know, at high risk of cardiovascular disease, chronic kidney disease, stroke.