Obeticholic acid and hepatic bile acids: Excellent study faulty conclusion

Reply to: “Obeticholic acid and hepatic bile acids: Excellent study faulty conclusion”

“…We read with great interest the study by Garcia-Tsao and colleagues published in Journal of Hepatology, assessing emricasan in 263 patients with non-alcoholic steatohepatitis (NASH)related cirrhosis and severe portal hypertension, defined as a hepatic venous pressure gradient (HVPG) > − 12 mmHg. 1 Interestingly, the diagnosis of cirrhosis was not based on histology in 48% of the patients in this study, but on platelet count <150 G/L, AST >ALT, and either a nodular liver surface on imaging or splenomegaly. Previous studies have shown that patients with non-alcoholic fatty liver disease (NALFD) can have portal hypertension in the absence of cirrhosis, 2,3 but whether they can have severe portal hypertension is unknown.…”

“…First, PET does not include aspects of isotope dilution or decay of plasma radioactivity concentration after tracer administration. Thus, the references to Gurpide and others in Dr. Javitt's Letter 1 are not relevant in the present context.…”

“…We appreciate the interest of Dr Javitt 1 in our recent study in patients with primary biliary cholangitis concerning the effect of obeticholic acid on the transport of the bile acid tracer [Nmethyl- 11 C]cholylsarcosine ( 11 C-CSar) from blood to bile, using positron emission tomography (PET). 2 Dr. Javitt questions the conclusion of our study that obeticholic acid enhances the secretion of endogenous conjugated bile acids.…”

Obeticholic Acid, FXR Agonists, Liver Disease and Plasma Biomarkers

“…hepatocellular transport system and can be informative but requires PET scanning and currently is of relatively little clinical use [6]. Also, without knowledge of changes in total bile acid pool size, the information can be misleading [7].…”