SEMMLER Georg

Previous University and Subject: Medical University of Vienna / Human Medicine

Thesis since: 10/2020

Invasive and Non-Invasive Risk Stratification in Advanced Chronic Liver Disease

The clinical characterization of patients with chronic liver disease (CLD) primarily relies on invasive methods (e.g., liver biopsy and hepatic venous pressure gradient measurement [HVPG]), but the use of non-invasive tests such as liver stiffness measurement (LSM) and laboratory parameters is increasing. Despite increasing evidence and expanding knowledge on the value of these methods, several unmet clinical needs remain:
(I)    Longitudinal non-invasive monitoring: LSM and laboratory tests likely represent promising tools to monitor liver disease severity in patients with advanced chronic liver disease (ACLD). We aim to confirm the prognostic value of the dynamics of non-invasive tests to predict liver-related outcomes such as hepatic decompensation and hepatocellular carcinoma, with a particular focus on patients who achieved etiological (e.g., eradication of hepatitis C) cure.
(II)    Impact of disease-modifying genetic polymorphisms: Several genetic variants have been shown to accelerate or ameliorate liver disease progression to ACLD. However, further and more comprehensive data in well-characterized cohorts are needed to confirm their “interactive impact” on liver disease progression, and importantly, also on regression after etiological cure.
(III)    Porto-sinusoidal vascular disease (PSVD) is a novel disease entity comprising patients with evidence of portal hypertension and/or specific histological changes in the absence of cirrhosis. While most non-invasive tests have been developed for staging liver fibrosis (i.e., accumulation of extracellular matrix in the liver parenchyma), PSVD primarily affects the hepatic vasculature. Diagnosis and staging rely on complex clinical criteria and liver biopsy, however, we aim to connect histological and radiological features with specific clinical features and outcomes to improve the understanding of the underlying pathophysiology and the natural course of the disease. Moreover, we aim to characterize the serum metabolome as a potential non-invasive diagnostic tool for identification of patients with PSVD. 

Methods and Skills:

Clinical Studies; liver biopsy

Publications:

Wöran K, Semmler G, Jachs M, Simbrunner B, Maria Bauer DJ, Binter T, Pomej K, Stättermayer AF, Schwabl P, Bucsics T, Paternostro R, Lampichler K, Pinter M, Trauner M, Mandorfer M, Stift J, Reiberger T, Scheiner B. Clinical Course of Porto-Sinusoidal Vascular Disease Is Distinct From Idiopathic Noncirrhotic Portal Hypertension. Clin Gastroenterol Hepatol 2020 (online ahead of print)

Semmler G, Scheiner B, Schwabl P, Bucsics T, Paternostro R, Chromy D, Stättermayer AF, Trauner M, Mandorfer M, Ferlitsch A, Reiberger T. The impact of hepatic steatosis on portal hypertension.
PLoS One 14: e0224506, 2019

Semmler G, Wöran K, Scheiner B, Unger LW, Paternostro R, Stift J, Schwabl P, Bucsics T, Bauer D, Simbrunner B, Stättermayer AF, Pinter M, Trauner M, Reiberger T, Mandorfer M. Novel reliability criteria for controlled attenuation parameter assessments for non-invasive evaluation of hepatic steatosis.
United European Gastroenterol J 8: 321-331, 2020

Semmler G, Datz C, Reiberger T, Trauner M. Diet and exercise in NAFLD/NASH: Beyond the obvious.
Liver Int 2021 (online ahead of print)