February 03, 2022 First meeting of the Inspiring & Writing Group Twenty-seven participants, including internationally renowned leading researchers and EF Clif staff, discussed ways of advancing knowledge and education on acute-on-chronic liver failure in the 1st meeting of the Inspiring & Writing Group

Acute-on-chronic liver failure (ACLF) was recently described as a syndrome that leads to acute hepatic decompensation, multiorgan failure and a high risk of short-term mortality. Most common precipitating factors in ACLF, include bacterial infections, alcoholism and persistence and reactivation of viral hepatitis, although for some patients neither of these are observed. Current treatment strategies include organ support, liver transplantation and immunomodulating therapy, yet the mechanisms underlying ACLF remain unclear and the needs for critically ill patients with cirrhosis unmet.

The CANONIC study conducted by the European Association for the Study of the Liver–Chronic Liver Failure (EASL-Clif) Consortium was the first prospective study with the largest number of patients that aimed at establishing a definition for ACLF. New studies derived from seminal works of CANONIC, and its ancillaries PREDICT and ACLARA, may contribute to further our understanding of the pathophysiology of ACLF.

The 1st Inspiring & Writing Group kicked off on 21 January 2022. This event was held online and gathered 27 EF Clif members and collaborators across Europe to discuss and exchange ideas on the use and analysis of data collected through former studies supported by EF Clif with the aim to discover predictors for the development and clinical course of ACLF.

Paolo Angeli, Professor at University of Padova, Italy, and Chairman of the EASL-Clif Consortium at EF Clif, welcomed all participants and encouraged junior researchers at EF Clif to continue sharing research results for completed and ongoing projects for the advancement of knowledge in the field of hepatology. Angeli invited participants to contribute to the analysis of clinical data from former studies and the conceptualization of new hypothesis that may lead to novel breakthrough research.

Anna Bosch, General Manager at EF Clif, talked about the long-term strategy of the Foundation in advancing excellence in research and education on acute-on-chronic liver failure. Bosch presented the major achievements of the Foundation throughout 2020 and introduced the Inspiring & Writing Group as a new structure within the EF Clif organization.

Joan Clària, Group Leader at IDIBAPS and Associate Professor at University of Barcelona, Spain, Grifols Chair Director and Director of Translational Operations at EF Clif, introduced the main objectives and outcomes of the CANONIC, PREDICT and ACLARA studies. Clària also provided an overview of the clinical data collected, patients’ samples stored in the biorepository and omics data analyzed within the framework of previous prospective studies.

Rajiv Jalan, Professor at University College London, UK, founding member of the EASL-Clif Consortium and Scientific Director at EF Clif, talked about the objectives of the CHANCE study – a prospective non-interventional observational global study aimed at assessing survival rates of cirrhotic patients with and without ACLF after liver transplantation. Jalan encouraged participants to bring in embedded studies to complement the current data available as well as searching for external funding opportunities.

Richard Moreau, Senior Scientist at INSERM, France, founding member of the EASL-Clif Consortium and Grifols Chair Vice-Director at EF Clif, presented unpublished data from the ACLARA study – a prospective observational study supported by EF Clif aimed at identifying the prevalence, epidemiology and pathophysiology of ACFL in Latin American patients with cirrhosis.

Vicente Arroyo, founding member of the EASL-Clif Consortium and Director at EF Clif, talked about the benefits of incorporating the newly established Inspiring and Writing Group into its organizational structure towards achieving common goals. Arroyo provided an overview of EF Clif research activities throughout the years since the foundation of the EASL-Clif Consortium and the completion of the CANONIC study. According to Arroyo, future areas of investigation should focus on common complications of liver cirrhosis (i.e., bacterial infections, acute kidney injury, and encephalothy).

Thierry Gustot, Director of the Liver Transplant Unit at Erasmus Hospital and Senior Lecturer at Université libre de Bruxelles, Belgium, Vice-Chairman of the EASL-Clif Consortium and Chairman of the Inspiring and Writing Group at EF Clif, introduced the members of the Inspiration and Writing Group and provided some insights for the success of this new joint venture. Gustot called all junior members of EF Clif to actively support this initiative for the future of the Foundation.

Finally, Eric Trepo, Hepatologist at Erasmus Hospital, presented preliminary results of a recent genome-wide association study in 3000 patients included in the CANONIC, PREDICT and ACLARA studies.

At the final Q&A session, Thierry Gustot provided answers to all questions and concerns raised by participants, and again emphasized the priority to propose topics for new projects that may derived from former prospective studies.

The European Foundation for the Study of Chronic Liver Failure (EF Clif) is a private nonprofit organization which mission is to promote research and education in hepatic chronic failure with the aim to contribute to improving the quality of life and to increase the survival of patients with liver cirrhosis. Since its foundation in 2009, the European Association for the Study of the Liver (EASL) Chair supports research activities through the EASL-Clif Consortium, a network of more than 100 European university hospitals and more than 300 clinical researchers. The Grifols Chair promotes translational studies across centers throughout Europe and North America within the framework of the European Network for Translational Research (ENTR) with 25 centers and more than 40 investigators.