Advances in non-invasive assessment of hepatic fibrosis

Abstract

Liver fibrosis should be assessed in all individuals with chronic liver disease as it predicts the risk of future liver-related morbidity and thus need for treatment, monitoring and surveillance. Non-invasive fibrosis tests (NITs) overcome many limitations of liver biopsy and are now routinely incorporated into specialist clinical practice. Simple serum-based tests (eg, Fibrosis Score 4, non-alcoholic fatty liver disease Fibrosis Score) consist of readily available biochemical surrogates and clinical risk factors for liver fibrosis (eg, age and sex). These have been extensively validated across a spectrum of chronic liver diseases, however, tend to be less accurate than more ‘complex’ serum tests, which incorporate direct measures of fibrogenesis or fibrolysis (eg, hyaluronic acid, N-terminal propeptide of type three collagen). Elastography methods quantify liver stiffness as a marker of fibrosis and are more accurate than simple serum NITs, however, suffer increasing rates of unreliability with increasing obesity. MR elastography appears more accurate than sonographic elastography and is not significantly impacted by obesity but is costly with limited availability. NITs are valuable for excluding advanced fibrosis or cirrhosis, however, are not sufficiently predictive when used in isolation. Combining serum and elastography techniques increases diagnostic accuracy and can be used as screening and confirmatory tests, respectively. Unfortunately, NITs have not yet been demonstrated to accurately reflect fibrosis change in response to treatment, limiting their role in disease monitoring. However, recent studies have demonstrated lipidomic, proteomic and gut microbiome profiles as well as microRNA signatures to be promising techniques for fibrosis assessment in the future.

Ursolic acid improves the bacterial community mapping of the intestinal tract in liver fibrosis mice

“…Therefore, changes in the intestinal microbiota have been found in an increasing number of chronic liver diseases (Bashiardes et al, 2016;Ferrere et al, 2017;Qin et al, 2014). Recently, based on these associations, some researchers have attempted to develop characteristic microbiota as a non-invasive test and microbiota signature for the classification, diagnosis, and treatment of liver fibrosis (Caussy et al, 2019;Dong et al, 2020;Loomba & Adams, 2020). However, there are few studies on changes in intestinal microbiota during liver fibrosis.…”

Wisteria floribunda Agglutinin-Positive Mac-2 Binding Protein as a Screening Tool for Significant Liver Fibrosis in Health Checkup

“…CLD, such as NAFLD, occurs widely in the general population [3], and identification of fibrotic subjects is needed. To screen a large population, the use of an easily available blood test has been proposed [5,6]. Therefore, we conducted this prospective study.…”

“…Serum biomarkers are widely used to evaluate liver fibrosis and prognosis in patients with CLD. As serum markers have high accessibility and low cost, a two-step screening strategy to detect fibrotic subjects in large populations has been suggested [5,6]. In a first-line screening, serum biomarkers would be used to narrow down subjects with potential fibrosis, and imaging modalities or liver biopsy would then be used as a second-line, more detailed test.…”

“…In a first-line screening, serum biomarkers would be used to narrow down subjects with potential fibrosis, and imaging modalities or liver biopsy would then be used as a second-line, more detailed test. Although the utility of serum markers for detecting or excluding subjects with fibrosis has been reported [5,6], most studies have been performed in hospital cohorts, and the utility of serum markers in a population-based cohort is limited, while a suitable serum marker for screening a population-based cohort has not yet been determined.…”

Biomarkers for the clinical development of antiviral therapies

“…Since these serum biomarkers offer reasonable negative predictive value, they are able to rule out liver fibrosis of advanced stages (e.g., cirrhosis), but their usage is diminished by the potential for false positive results. These serum tests assess fibrosis by including biomarkers that measure the degree of hepatic injury and/or complications of portal hypertension; and/or biomarkers that measure extracellular matrix degradation/fibrogenesis (Agbim & Asrani, 2019; Loomba & Adams, 2020; Rana et al, 2020). Some examples of these serum tests include the NAFLD fibrosis score, BARD score, FIB‐4, aspartate aminotransferase to platelet ratio index and enhanced liver fibrosis score.…”