Early Insights from RSA 2023

-Contributed by Abi Kasberg, PhD

I had so many delightful “firsts” while attending the Research Society on Alcohol (RSA) annual meeting in Bellevue, Washington. It was my first time attending an RSA meeting (spoiler, it was great), my first time in the Seattle area (trees, mountains, and lakes, what a dream), and it was the first time I heard a new term (hint, it’s an emerging area of study). In attendance at RSA 2023 was an intellectual collective of over a thousand brilliant minds, stemming from diverse backgrounds and areas of expertise. Hepatologists, transplant surgeons, neuroscientists, anthropologists, psychiatrists, psychologists, social workers, and more came together to participate in vital discussions on how to improve the landscape of alcohol-related disorders and damage.

Being a DiaPharma scientist, my goal for attending the meeting was to keep a pulse on alcohol-related research; How is alcohol-related science being done and what areas need to be explored next? I also went to RSA keeping in mind the interests of our partner VLVBio, the Swedish manufacturer of the cytokeratin 18 (CK18 or K18) M30® and M65® ELISA kits. I wanted to gain a better understanding of where and how the CK18 biomarkers could best serve the needs of alcohol-related liver research.

I have to say, it was well worth the trip. Here are some highlights of what I learned.

Focus on Early Signs of Liver Damage

I came away with a resounding sense of urgency to focus research efforts and resources on the early detection of damage caused by alcohol consumption. Hepatologists are leading the way in identifying early stages of alcohol use disorder (AUD) and alcohol-related diseases. Yet to keep the efforts progressing, better mechanistic, diagnostic, and theragnostic biomarkers are needed to identify early signs of liver damage. For example, early stages of liver damage do not typically show up on standard liver panels. The misuse of alcohol causes liver damage and yet early signs of liver damage are typically missed in most alcohol-consuming individuals until they have progressed to advanced stages of alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), or cirrhosis. This theme was echoed in AUD discussions, describing the need to detect early stages of liver injury while treating AUD in order to prevent, identify, and treat liver damage as soon as possible.

The new-to-me term (that no doubt has bound you in suspense) is the exposome. The exposome, which is actually not new in that it was coined over 15 years ago by Christopher Wild, describes every exposure that occurs to an individual over a lifetime. The murmurings at RSA suggested that I was not alone in being new to this term. However, exposome research is a growing area of interest and for good reason, especially in the context of alcohol. Alcohol exposure commonly coincides with co-morbidities (ex. obesity, NASH), substance use (ex. opioids, cannabis), and environmental toxin exposures (ex. vinyl chloride). Together, these factors can influence and exacerbate the ways that alcohol-associated damage impacts the body. Avoidance of exposures and early detection of damage are crucial to public health. One talk given by Dr. Craig McClain (University of Louisville) suggested that the CK18 M30® and M65® liver biomarkers are superior to ALT and AST in detecting liver damage and should be used in environmental surveillance studies. Overall, the alcohol research field is on the hunt for biomarkers and additional tools to identify early signs of liver damage caused by alcohol-consumption.

Emerging Applications for Liver Biomarkers in Alcohol Research

There are several up-and-coming research applications where sensitive liver injury biomarkers are needed to provide mechanistic insight into alcohol-related liver damage. Relevant research areas include:

Early ALD detection

Indicators of early liver damage are needed to enable early ALD detection.

Alcohol intervention studies

Alcohol intervention research groups are searching for organ-specific injury biomarkers to empower alcohol intervention studies and indicate signs of organ damage.

The potential to screen for AUD

The prevalence of ALD in AUD populations can be as high as 51% (Amonker et al. 2023). There is potential to leverage liver injury biomarkers as a tool to screen for AUD.

Detection of liver damage in patients with AUD during AUD treatment.

Given the statistic above, there is a need to streamline and standardize liver function tests to better detect liver injury in individuals with AUD during AUD treatment.

Correlation studies of gut and oral microbiomes to liver health.

Changes to the oral and gut microbiomes in patients with AUD can lead to inflammation and total gut leak. To identify the impact of different microbiomes on liver health, liver biomarkers are needed to stratify individuals with ALD and AUD during comparative analysis studies.

Exposome studies

Early detection of liver injury can be pivotal in exposome studies that investigate the impacts of environmental toxin exposures, co-morbidities, and substance use.

Environmental surveillance studies and toxicant-associated steatohepatitis (TASH) research

The liver has an important function to store and metabolize chemicals that pass through the body. This makes the liver sensitive to the effects of environmental chemical and toxin exposures. Identifying early signs of liver injury and hepatotoxicity is a key step in environmental toxicity surveillance.

Due to the accelerating rates of alcohol-associated disorders, the damaging impacts of alcohol are being managed in the clinic and researched at the bench. There are needs to meet and avenues still to explore in the field of alcohol research, with liver health being a key consideration. Thank you, RSA and the generous panel of speakers, for highlighting alcohol research efforts and priming important conversations to improve outcomes of alcohol-related health.

Early Insights from RSA 2023

Focus on Early Signs of Liver Damage

Emerging Applications for Liver Biomarkers in Alcohol Research

Further reading