The Midlands Liver Research Alliance - A partnership to optimise obesity-related liver disease research: targeting areas of high incidence and underserved communities

Background

The prevalence of liver disease is rising in the United Kingdom (UK), with obesity underpinning surging metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD is associated with an increased cardiometabolic risk, particularly when co-existing with type 2 diabetes. Progression to metabolic dysfunction-associated steatohepatitis (MASH) with hepatic fibrosis represents a clinical milestone strongly linked to serious liver disease and mortality.

Therefore, clinically meaningful and sustained weight loss (≥10%) is a primary therapeutic target for patients with MASLD. Unfortunately, this is difficult for most people who adopt traditional lifestyle approaches. However, new obesity pharmacotherapies hold promise in MASLD, given their ability to produce dramatic weight loss (10–25%) and improve cardiometabolic health. Questions remain about the ability of these agents to improve liver fibrosis and patient-reported outcomes/quality of life in patients with advanced liver disease.

Methods

Led from the Midlands (UK) but with national representation, we developed a network of stakeholders (clinicians, academics, third-sector, industry, and PPIE representatives) with an interest in obesity-related liver diseases. This network was called the Midlands Liver Research Alliance (MLRA), which sought to 1) establish a PPIE stakeholder network, 2) identify research priorities, and 3) map the network infrastructure and expertise. Health inequalities within liver disease are a core priority within the MLRA.

Results

The MLRA developed a large PPIE stakeholder network in collaboration with other local liver partnerships. These networks facilitated the identification of key research priorities that led to three NIHR funding applications. Priorities centered around: 1) the importance of patient-centered outcomes in obesity-related liver disease research; 2) the potential of glucagon-like peptide 1 (GLP-1)-based obesity pharmacotherapy in alcohol use disorder; and 3) early identification and management of liver disease in primary care/community.

Conclusions

The MLRA has created a multidisciplinary hub of research expertise in obesity-related liver disease. This foundation provides a springboard for research activities in this area.

Plain Language Summary

Liver disease is a major cause of death worldwide and is becoming more common each year. This is mostly due to fat in the wrong place in the liver, which can cause liver cirrhosis (scarring). The causes include obesity, type 2 diabetes, and excessive alcohol consumption. These problems are often linked to lifestyle choices such as not exercising enough and eating unhealthy foods.

The Midlands Liver Research Alliance (MLRA) is a partnership made up of researchers, health care professionals, people with liver disease, and charities, funded by the NIHR to identify gaps in liver disease care and research in areas most in need. Leicester, Nottingham, and Birmingham’s Biomedical Research Centers are leading experts in liver and obesity research and have led the MLRA partnership.

The MLRA established an inclusivity and engagement network, identified research experts and centers, and set important liver research priorities. The three liver research priority areas the MLRA has and will continue to focus on are:

Experimental medicine - research focusing on the impact of obesity medications and lifestyle activities such as exercise on this type of liver disease.

Addressing health inequalities in liver disease - within our diverse region, working with expert centers and charities to reduce inequalities relating to ethnicity, socioeconomic position, and coastal communities within liver disease.

Liver disease management in primary care: work with GP practices to provide liver disease education for healthcare professionals to help early identification and management. Provide education and support for people at risk of liver disease.

The MLRA uses this extensive knowledge gathered from MLRA priority setting activities and collaborative activities with other liver partnerships to inform future research and continue collaborations in this important area.