Multi-modal non-invasive biomarker screening for high-risk undiagnosed liver disease

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Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are becoming increasingly prevalent in the UK, with an estimated 20% of the adult population affected. These conditions are associated with obesity and type 2 diabetes, and can lead to serious liver damage, including cirrhosis and liver cancer. The cost of treating liver disease in the UK is estimated to be around £6.5 billion per year because it presents late, putting a significant strain on the National Health Service (NHS) resources.Patients with NASH and NAFLD have a reduced life expectancy and a higher risk of cardiovascular disease, liver cancer, and liver failure. Furthermore, these conditions are often asymptomatic, meaning that patients are often not diagnosed until the disease has progressed to a more serious stage. This increases the complexity and cost of treatment, as well as reducing the effectiveness of interventions.In addition to the direct cost of treating NASH and NAFLD, the wider economic impact of these conditions cannot be ignored. Reduced productivity and increased absenteeism due to illness can have a significant impact on the UK economy as a whole estimated at between £7 and £13 billion per year.A promising solution to the growing problem of NASH and NAFLD is the use of cost-effective non-invasive approaches to identify at-risk patients at an earlier stage. This application proposes combining longitudinal biomarker analysis, non-invasive liver scanning, and non-invasive genetic testing can identify high-risk liver disease cases far earlier than existing approaches, with a particular focus on early-onset (25-35 years old) and fast-progressing liver disease.Algorithms developed by Somerset FT in collaboration with Predictive Health Intelligence have been shown to identify high-risk liver disease cases from common blood tests already present in NHS records (funded by NIHR i4i Programme -- 200965), thus reducing the need for further testing of healthy people. In parallel, Sano Genetics have developed a platform for non-invasive genetic testing, remote sample collection, and longitudinal patient reported outcomes. This proposal will enable a collaboration between these two SMEs that can be rapidly validated in two independent NHS contexts.