Latest / Becker’s Healthcare - Clinical Leadership Podcast / New Treatments and a Turning Point in Fatty Liver Disease Care with Dr. Meena Bansal

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New Treatments and a Turning Point in Fatty Liver Disease Care with Dr. Meena Bansal · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Hello, and welcome to the Becker's Healthcare podcast.
• 0:02
  My name is Chanel Banger. And today, I
• 0:04
  have the pleasure of speaking with doctor Meena
• 0:06
  Bonsal,
• 0:07
  the assistant chief of the division of liver
• 0:10
  diseases and director of the MASH Center of
• 0:12
  Excellence
• 0:13
  at Mount Sinai who joins the podcast today
• 0:16
  to share insights into a new treatment available
• 0:18
  for fatty liver disease.
• 0:20
  Trent, she's watching and a bit more. Doctor
• 0:22
  Botzel, thank you so much for joining me
• 0:24
  today. Great to be here. Perfect. Well, to
• 0:26
  get us started out, could you tell us
• 0:28
  a bit about your background
• 0:30
  and MASCH Center of Excellence?
• 0:32
  Absolutely. So, yeah, I've been at Mount Sinai
• 0:35
  for a while, actually. I've been here for
• 0:37
  about twenty five years.
• 0:39
  And in that time, I've actually,
• 0:41
  held many hats and played many roles.
• 0:44
  I am a hepatologist
• 0:45
  and transplant hepatologist
• 0:47
  and over the years have led a,
• 0:51
  NIH funded research
• 0:53
  program
• 0:54
  focused on
• 0:55
  molecular mechanisms of liver fibrosis or scarring.
• 0:59
  I've also been, the transplant
• 1:02
  hepatology
• 1:03
  fellowship director
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  And actually had some population health roles here
• 1:08
  as well.
• 1:09
  Mount Sinai is a clinically integrated network that,
• 1:12
  takes risk for about five hundred thousand lives,
• 1:15
  and I served as the vice president of
• 1:18
  Papel for quality efficiency
• 1:20
  for Mount Sinai Health Partners, which is our
• 1:22
  pop health entity and was the chief medical
• 1:25
  officer of our ACO.
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  Most recently, I took over as division chief
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  in January
• 1:32
  2024.
• 1:33
  And Mount Sinai is unique in that we
• 1:36
  are really the only freestanding,
• 1:39
  division of liver diseases
• 1:41
  in the country. So division of liver diseases
• 1:43
  is its own home,
• 1:46
  separate, but works very collaboratively with the division
• 1:48
  of gastroenterology.
• 1:50
  And in 2022,
• 1:52
  we launched the MASH Center of Excellence, which
• 1:56
  is a full thickness program spanning from basic
• 1:59
  science
• 2:00
  to clinical trials
• 2:02
  in MASH, which
• 2:04
  is the new name for fatty liver disease.
• 2:06
  So many people kind of know what fatty
• 2:08
  liver disease is because oftentimes they've been told,
• 2:11
  oh, you have fatty liver disease.
• 2:14
  But a couple of years ago, a group
• 2:16
  was convened
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  to discuss a new nomenclature.
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  So fatty liver disease or nonalcoholic
• 2:22
  steatohepatitis,
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  was the initial name really based on
• 2:27
  the idea that on liver biopsy,
• 2:30
  there was fat associated with inflammation and scarring,
• 2:34
  but patients did not drink alcohol. And so
• 2:37
  it became nonalcoholic
• 2:38
  fatty liver disease or NASH.
• 2:42
  And it's kind of a recognition that
• 2:44
  one that could be a little stigmatizing,
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  to say fatty liver disease.
• 2:50
  And, also,
• 2:51
  there was a desire to call the disease
• 2:53
  what it is, not what it is not.
• 2:55
  So not a nondisease, but recognizing that metabolic
• 2:59
  dysfunction,
• 3:00
  things like diabetes
• 3:02
  or adiposity
• 3:03
  central adiposity,
• 3:05
  hypertension,
• 3:06
  hypercholesterolemia,
• 3:08
  underlie
• 3:09
  the disease pathophysiology.
• 3:11
  So now the name is metabolic
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  dysfunction
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  associated steatohepatitis
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  or MASH.
• 3:18
  Thank you so much. And now that we
• 3:20
  have a sense of your background in MASH,
• 3:23
  I understand that there's a new treatment available
• 3:25
  for fatty liver disease. Could you dig a
• 3:27
  little bit deeper in that? Yeah. Actually, there's
• 3:29
  two now. So the first FDA approved therapy
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  was in
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  March
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  2024.
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  So we're on a kind of a close
• 3:39
  to a two year anniversary,
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  and that drug is resmetabol,
• 3:44
  which is,
• 3:46
  commercially known as Residifra.
• 3:48
  And that's a thyroid hormone receptor beta agonist.
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  It's an oral pill,
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  once a day with or without food.
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  And the concept there is that
• 4:00
  low thyroid in the liver is partially responsible
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  for driving this disease. So what this drug
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  does is restore thyroid hormone signaling
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  in the liver specifically.
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  And in doing so, it helps burn the
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  fat so that that fat can't cause
• 4:19
  toxic things to accumulate
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  and activate all of the scarring process that
• 4:24
  could ultimately lead to cirrhosis.
• 4:26
  So that's was FDA approved in 2024.
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  And in August
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  2025,
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  sumaglutide,
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  which is a GLP one receptor agonist,
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  commercially known as Wegovy,
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  was the second approved therapy.
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  And many people have heard about this drug
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  because
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  it primarily works through weight loss
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  and through improving insulin sensitivity.
• 4:54
  Perfect. Thank you so much for walking us
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  through that. And now kinda zooming out a
• 4:58
  bit. Can you talk about what trends you're
• 5:00
  watching in health care overall?
• 5:02
  Yeah. I mean, I think that the with
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  the obesity
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  epidemic,
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  you know, I think the use of these
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  GLP one receptor agonist obviously has increased substantially.
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  Patients are on it to treat their diabetes,
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  but now the recognition that obesity is also
• 5:19
  chronic disease,
• 5:21
  you're seeing a large amount
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  of GLP one
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  usage. I think that's a a large trend
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  that's kind of happening
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  throughout The United States. We'll see how that
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  translates
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  into
• 5:34
  decreasing
• 5:35
  disease burden, you know, moving forward.
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  Also,
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  lots of therapies coming down the line. So,
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  you know, now with two therapies, it's a
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  very
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  active space for clinical trials,
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  and there are a number of
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  other
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  drugs and molecules that we anticipate
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  will also get FDA approved,
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  FDA approval
• 6:00
  over the next, you know, five years or
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  so. And so we're really gonna be entering
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  an era, I hope,
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  of kind of personalized medicine where one particular
• 6:09
  therapy may be more suited to an individual
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  versus another.
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  We know that these therapies don't work for
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  everybody. So when you look at the response
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  rates, you know, they're on the order of
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  thirty
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  percent. And so
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  who is gonna respond better? You know, patient
• 6:26
  a with drug
• 6:28
  a, patient b with drug b. It's gonna
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  be very fascinating,
• 6:32
  time in health care for this space.
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  Got it. Got it. Thank you so much.
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  And now there's a lot to be excited
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  about, obviously. But going into the rest of
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  the year, do you have anything in particular
• 6:43
  in your role that you're focused on and
• 6:45
  excited about?
• 6:46
  Well, I think we've got some so the
• 6:48
  two FDA approved so when you think about
• 6:51
  fibrosis, it's on a scale of zero to
• 6:53
  four, and four equals cirrhosis. And many people,
• 6:56
  you know, they hear that word and that
• 6:58
  that's a scary word for people.
• 7:00
  The two FDA approved therapies that we currently
• 7:03
  have are for stage two to three. So
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  patients who are kind of in that intermediate
• 7:09
  noncirrhotic
• 7:10
  fibrosis.
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  So I think we're excited that now we're
• 7:14
  seeing some data
• 7:16
  to show that patients with cirrhosis
• 7:19
  can also reverse with some of these,
• 7:22
  pharmacotherapies.
• 7:23
  Not yet FDA approved for cirrhosis, but I
• 7:26
  think that's a very exciting time that we
• 7:29
  could see treatments that actually also,
• 7:33
  reverse cirrhosis or at least early cirrhosis.
• 7:37
  Very exciting stuff. And now switching gears a
• 7:40
  bit, with all of your experience and how
• 7:42
  driven of a leader you are, I'm curious
• 7:45
  to hear what advice you'd give to evolving
• 7:47
  leaders looking to have that same drive and
• 7:49
  impact in their careers as you have.
• 7:52
  Well, I think that, you know, one of
• 7:54
  the things in my career is that I've
• 7:56
  worn many hats, and I think that gives
• 7:58
  great perspective,
• 8:00
  so that you, you know, at least for
• 8:02
  me personally,
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  having a basic science background all the way
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  to a population health background
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  has really allowed me to apply,
• 8:12
  things that we might learn from a research
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  perspective
• 8:15
  on an entire
• 8:17
  population. So for example,
• 8:19
  at Mount Sinai,
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  well, we care for about fifty five thousand
• 8:24
  patients living with diabetes.
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  And we have
• 8:27
  risk stratified
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  that group based on some noninvasive
• 8:31
  tests for liver fibrosis and apply kind of
• 8:34
  these,
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  algorithms to a population level
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  where we can now identify
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  the subset of our population that we're most
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  concerned about and proactively
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  link them to care as opposed to waiting
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  for badness to happen. And I think that's
• 8:52
  how leaders need to think in health care
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  is, you know, how can we focus more
• 8:58
  upstream
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  in identifying the pay patients who are most
• 9:02
  at risk for disease
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  as opposed to having a reactive
• 9:06
  stance when they present to us when it's
• 9:09
  often
• 9:10
  maybe in a quite advanced stage where we
• 9:12
  can't have the same impact.
• 9:14
  I love that. Excellent advice. Well, doctor Bonslow,
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  I wanna thank you for your time today.
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  But before I let you go, is there
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  anything else that listeners should know?
• 9:22
  It's exciting
• 9:23
  time to be in health care, so I
• 9:26
  I come at it with great optimism.
• 9:28
  Love it. That's a great note to end
• 9:29
  on. Doctor Bonsellona, thank you once again for
• 9:32
  your time today and for sharing your insights
• 9:33
  on the Becker's Health Care podcast. Thank you
• 9:35
  so much. Thank you.