A ‘silent’ liver condition known as nonalcoholic steatohepatitis (NASH) could generate a treatment market worth between $20 billion and $35 billion, according to Business Insider.

NASH is an untreatable form of liver disease that causes liver fat to build up in a way that can lead to cirrhosis and liver failure. The condition can be very hard for patients to identify as it has no real symptoms until liver damage has reached a critical level; it is thought that the disease could be affecting 16 million people in the US and yet it is generally unheard of. Making diagnosis even more difficult is that it cannot be detected with certainty without a liver biopsy, an invasive test that many patients may be unwilling to take when their health appears to be fine.

While the condition was first defined in 1980, our understanding of it is still limited because of the lack of research into it. It is known that the disease is linked to diet, with patients with obesity, Type 2 diabetes, and insulin resistance demonstrating a higher risk of developing it. Some new research is hoping to use these connections to other, more well-known diseases to better understand and detect the condition in undiagnosed patients.

 

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Despite the poor understanding and low diagnosis rate, NASH looks set to surpass hepatitis as the leading cause of liver transplants in the next two years. According to a new article from Business Insider, the eventual value of the treatment market for the condition could be between $20-30 billion. The current vacuum for effective diagnostics and treatment are creating an increasingly tense competition for biopharma companies to develop new products.

As part of this, some groups are looking into possible genetic links to the condition. NASH has been associated with a few genes over the past few years, most notably the PNPLA3 gene, which has been connected to an increased risk of liver disease. Last month, biotech company Regeneron also announced that they had identified the HSD17B13 gene as linked to a reduced risk of NASH.

At the same time, the microbiome might play a role in the condition. The reasoning behind this is that the prevalence of NASH has increased dramatically since its discovery in 1980 and yet, in the time since then, our genomes have not changed substantially. In contrast, our diets and, thus, our microbiomes are very different now when compared with forty years ago. It is reasonable, therefore, to conclude that the change in our microbiome could be connected to the rapid increase in disease frequency.

Research into the condition is on-going, and it is likely that we will gain a better understanding of NASH over the next few years. At the moment, it looks like the most developed NASH treatments will get the results of late-stage trials next year.