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Screening for fibrosis to diagnose liver diseases early: the LIVERSCREEN project

Nature Medicine volume 29, pages 774–775 (2023)Cite this article

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Chronic liver diseases are common and represent a leading cause of death worldwide and a significant economic burden for healthcare systems1,2. Several etiological factors can cause chronic liver disease, the most frequent being excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis B and C virus infections. Although the prevalence of hepatitis B and C virus infections is decreasing in many areas of the world owing to vaccination and effective antiviral drugs, the rates of alcohol-related liver diseases and NAFLD are growing as a result of increasing alcohol consumption as well as obesity and diabetes in the population2,3,4. Any of these etiological factors, acting either alone or in combination (for example, obesity plus excessive alcohol consumption), may cause continuous liver inflammation and hepatocyte necrosis, resulting in liver fibrosis due to collagen deposition within the liver parenchyma5. Progressive disruption of liver architecture by scarring fibrosis together with hepatocyte necrosis leads to the development of cirrhosis with portal hypertension and liver failure. Cirrhosis results in life-threatening complications, which are responsible for multiple hospital admissions, impaired quality of life and high mortality6. Moreover, a substantial proportion of patients with cirrhosis may develop hepatocellular carcinoma. Notably, the entire process, from the start of subclinical liver inflammation to the occurrence of complications, progresses very slowly, usually over more than 20 years, and is asymptomatic. For this reason, in most cases a diagnosis is not made until cirrhosis is advanced and patients are symptomatic from complications of portal hypertension and/or liver cancer7. At these late stages, cirrhosis is irreversible and has a high mortality, with survival dependent on liver transplantation, which unfortunately is only available and feasible in a minority of patients. Therefore, there is an urgent need to change the current paradigm for diagnosing chronic liver diseases away from diagnosis after patients have advanced cirrhosis with complications and toward the early diagnosis of asymptomatic, reversible liver fibrosis before cirrhosis develops, as emphasized recently by the European Association for the Study of the Liver (EASL)-Lancet Liver Commission7. Such a change of paradigm could allow the application of personalized therapeutic intervention(s) to stop disease progression, thereby reducing morbidity, mortality and healthcare burden from these diseases.

In this context, the goal of the LIVERSCREEN project is to provide an easy-to-use, cost-effective screening program for the early detection of liver fibrosis using non-invasive markers. These include serological tests and vibration-controlled transient elastography (VCTE)8. The screening program will be implemented and evaluated in different European countries to investigate its efficacy in the diagnosis of liver fibrosis as well as its potential long-term impact on morbidity and mortality due to cirrhosis and liver cancer. The project is funded by the European Commission H2020 program under the call SC1-BHC-30-2019, “Towards risk-based screening strategies for non-communicable diseases” (project no. 847989). The consortium comprises 20 partners from 10 European countries, mainly academic partners but also private companies, as well as patient and physician associations, including the European Liver Patient Association and EASL. The main bodies of the Consortium are the General Assembly and the Project Management Team. The General Assembly consists of one member for each partner and is responsible for approving the Consortium’s rules and strategic decisions. The Project Management Team is the executive body responsible tasked with ensuring that the project achieves the proposed goals, monitoring its implementation and proposing major strategic decisions. There is also an external Advisory Board composed of physicians with specific expertise in liver disease.

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Acknowledgements

The LiverScreen project is funded by European Union’s Horizon2020 programme under grant agreement no. 847989.

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Authors and Affiliations

  1. Liver Unit Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Pere Ginès & Isabel Graupera

  2. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Pere Ginès, Isabel Graupera, Núria Fabrellas & Anita Arslanow

  3. Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain

    Pere Ginès, Isabel Graupera & Núria Fabrellas

  4. Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Pere Ginès, Isabel Graupera & Núria Fabrellas

  5. Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark

    Maja Thiele & Aleksander Krag

  6. Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark

    Maja Thiele & Aleksander Krag

  7. Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland

    Miquel Serra-Burriel

  8. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands

    Robert J. de Knegt

  9. Department of Medicine II, Saarland University Medical Center, Homburg, Germany

    Frank Lammert

  10. Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany

    Frank Lammert

  11. Hannover Medical School (MHH), Hannover, Germany

    Frank Lammert

  12. Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France

    Laurent Castera

  13. European Liver Patients Association (ELPA), Brussels, Belgium

    Marko Korenjak

  14. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA

    Patrick S. Kamath

  15. Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia

    Ivica Grgurević

  16. Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia

    Ivica Grgurević

  17. Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy

    Salvatore Piano

Authors
  1. Pere Ginès
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  2. Maja Thiele
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  12. Núria Fabrellas
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  13. Anita Arslanow
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  14. Aleksander Krag
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Corresponding author

Correspondence to Pere Ginès.

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Competing interests

P.G. has received research funding from Gilead, Mallinckrodt, Grifols and Ferring; consulting fees from Grifols SA, Ferring Pharmaceuticals, Gilead, Intercept, Martin Pharmaceuticals, Promethera, Sequana, RallyBio and Behring. M.T. has been funded by a grant from the Novo Nordisk Foundation (DECIDE project, grant no. NNF20OC0059393), and received speaker’s fee from Echesens, Siemens Healthcare, Norgine and Tillotts Pharma and an advisory fee from GE Healthcare. R.J.dK. has received honoraria for consulting or speaking in the past 5 years from AbbVie, BMS, Echosens, Gilead, Jansen-Cilag and Norgine; fees for contract research for current trials from Echosens, GSK, Inventiva-Pharma and Jansen-Cilag; and research grants from Gilead. L.C. has received a research grant from Gilead; consulting fees from Echosens, Madrigal, MSD, Novo Nordisk, Pfizer and Sagimet; and lecture fees from Echosens and Novo Nordisk. I. Grgurević has received speaker fees from Echosens, Siemens and Roche and holds an advisory board position at General Electric. S.P. has received consulting fees from Plasma Protein Therapeutics Association and Resolution therapeutics. N.F. has received consulting fees from Intercept. All other authors report no competing interests.

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Ginès, P., Thiele, M., Graupera, I. et al. Screening for fibrosis to diagnose liver diseases early: the LIVERSCREEN project. Nat Med 29, 774–775 (2023). https://doi.org/10.1038/s41591-023-02265-z

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