In this episode of MD Newsline, Dr. Christopher Kaisa, Assistant Professor of Medicine in the Section of Gastroenterology, Hepatology, and Nutrition at the University of Chicago Medicine, provides an in-depth discussion on Metabolic Dysfunction-Associated Steatohepatitis (MASH) and the evolving strategies for its management. He explains the latest non-invasive diagnostic tools, pharmacologic advancements, and the importance of multidisciplinary care in improving outcomes for patients with metabolic liver disease.

He discusses existing gaps in primary care screening, emphasizing the importance of education and access to specialized metabolic liver clinics. Early identification of at-risk patients using tools like FibroScan and non-invasive fibrosis scores can dramatically change patient trajectories.

Dr. Kaisa details how fibrosis staging correlates with both cardiovascular and liver-related mortality. He explains the use of non-invasive tests (NITs)—including FibroScan and fibrosis scores—to monitor disease progression and therapy response over time.

The episode highlights new treatments, such as resmetirom and GLP-1 receptor agonists (e.g., semaglutide), which have shown fibrotic and inflammatory benefits in clinical trials. Dr. Kaisa explains how these agents are monitored, when to adjust dosages, and how to manage common gastrointestinal side effects.

Dr. Kaisa emphasizes the value of a multidisciplinary team, including hepatologists, endocrinologists, dietitians, and pharmacists, to manage the complex comorbidities associated with MASH. This integrated approach enables personalized and effective care for each patient.

He also discusses the PNPLA3 genetic variant, a known risk factor among certain ethnic groups, particularly those of Hispanic descent. Recognizing genetic predispositions helps clinicians counsel patients on modifiable risk factors such as diet, exercise, and metabolic control.

Dr. Kaisa explains how clinical trials serve as vital access points for emerging therapies, especially for patients who may not tolerate or qualify for current treatments. He stresses the need to broaden patient participation in research to ensure equitable advancement in the field.

Key Takeaway

Dr. Kaisa underscores the critical importance of early detection, comprehensive metabolic management, and multidisciplinary collaboration in treating MASH. With the recent FDA approval of semaglutide for MASH, and ongoing advancements in personalized medicine, clinicians have powerful new tools to change the trajectory of this increasingly prevalent disease.

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Dr. Litzow shares deep insights into how immunotherapy has transformed survival outcomes, how clinicians can balance efficacy and neuropsychiatric side effects, and why cross-disciplinary collaboration is key to advancing oncology care.

Real-World Evidence and Clinical Practice Dr. Litzow explains the growing importance of real-world data in validating and refining clinical trial outcomes. While clinical trials have strict eligibility criteria, real-world settings introduce more patient diversity, offering valuable insights into treatment efficacy and tolerability across broader populations.

The ECOG-ACRIN E1910 Trial and Immunotherapy Advances Dr. Litzow details the E1910 trial, which compared standard chemotherapy with and without blinatumomab, an immunotherapy agent targeting CD19 and CD3. The study demonstrated a significant survival benefit—85% versus 68%— for patients receiving blinatumomab, establishing it as a new standard of care for MRD-negative ALL patients.

Integrating MRD and Genomic Profiling in Decision-Making He highlights how MRD testing and molecular risk profiling are shaping treatment pathways, enabling clinicians to better identify patients who can potentially avoid bone marrow transplantation through effective immunotherapy.

Adapting Pediatric Regimens for Adult Patients Dr. Litzow discusses the use of pediatric-inspired chemotherapy regimens in younger adults and the challenges in adapting these treatments for older or high-risk patients. He emphasizes careful monitoring for toxicities such as hepatic and neuropsychiatric effects.

Balancing Treatment Intensity and Quality of Life With immunotherapy showing strong efficacy, Dr. Litzow anticipates future strategies that reduce chemotherapy exposure, lower toxicity, and improve patient quality of life—especially for older adults or those with comorbidities.

Future Directions: AI, Cross-Specialty Collaboration, and Inflammation Research Dr. Litzow shares his optimism about artificial intelligence enhancing trial data analysis and calls for cross-disciplinary collaboration between cancer biologists and clinicians. He also emphasizes the emerging role of inflammation in cancer development, urging broader, non-linear approaches to understanding disease mechanisms.

Dr. Litzow underscores a new era in ALL treatment—where immunotherapy, real-world evidence, and molecular diagnostics intersect to personalize care, extend survival, and minimize toxicity. As clinical science evolves, the focus is shifting from intensifying chemotherapy to optimizing immune-based precision therapies that improve both outcomes and quality of life.

Resources

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In this episode of MD Newsline, Dr. Sassan Mirfakhraee, adult endocrinologist and associate professor at the University of Texas Southwestern Medical Center, shares groundbreaking insights into the management of adrenal insufficiency. At the Endocrine 2025 conference, Dr. Mirfakhraee presented his research on utilizing insulin pumps to deliver hydrocortisone—an innovative off-label approach that is showing promising results for patients who remain symptomatic on oral therapy.

He explains how this strategy better mimics the body's natural cortisol rhythm, improves quality of life, and reduces ER visits and hospitalizations for patients with persistent symptoms. Dr. Mirfakhraee also outlines patient selection criteria, training protocols, safety considerations, and the potential for remote monitoring via pump data.

This conversation highlights the importance of personalized care in endocrinology, bridging innovation with clinical practice to improve outcomes for patients with challenging conditions.

New Approach to Adrenal Insufficiency Dr. Mirfakhraee introduces the use of insulin pumps for hydrocortisone infusion, addressing limitations of oral steroids that often fail to fully resolve symptoms.

Mimicking Cortisol's Natural Rhythm The pump allows for overnight delivery and tailored boluses, reducing symptoms such as dizziness, nausea, fatigue, and morning crashes that patients often face with oral therapy.

Patient Selection and Benefits He outlines which patients may benefit most—those with persistent symptoms, frequent adrenal crises, malabsorption issues, or shift-work challenges—while ensuring other conditions are ruled out.

Remote Monitoring and Safety Insulin pumps enable cloud-based data sharing, allowing clinicians to monitor dosing, adjustments, and stress dosing remotely. While generally safe, clinicians must remain vigilant for issues like skin infections or infusion interruptions.

Training and Quality of Life Through support from diabetes educators, patients learn how to manage pump settings and troubleshoot. Many report dramatic improvements—returning to work, engaging in family life, and regaining independence.

Future Research Needs Dr. Mirfakhraee stresses the need for standardized pump settings, broader data collection, and insurance approval pathways to make this therapy more accessible.

Insulin pump-based hydrocortisone delivery offers a promising new avenue for patients with adrenal insufficiency who remain symptomatic on oral therapy. By improving quality of life, reducing crises, and allowing for tailored dosing, this approach may represent a paradigm shift in endocrine care.

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High Amputation Risk in Diabetic Foot Ulcers Dr. Myers shares sobering statistics, noting that 44% of patients who present with a diabetic foot ulcer undergo an amputation within five years. This reality highlights the urgency of early screening, prevention, and intervention in diabetes care. She stresses that DFUs are not only medical complications but also markers of systemic inequity and missed opportunities for prevention.

The Role of Social Determinants of Health Dr. Myers explores how socioeconomic status, racial disparities, and provider bias profoundly shape patient outcomes. In the Bronx and other underserved areas, patients often face delays in diagnosis, limited access to care, and inconsistent follow-up, all of which contribute to worse outcomes. She emphasizes the importance of addressing these systemic barriers alongside clinical treatment.

Innovative Technology for Prevention Emerging tools, such as thermal-sensing mats and sensor-equipped socks, offer promising ways to identify foot ulcers before they progress. These devices can detect subtle temperature changes that indicate early tissue damage, allowing patients and providers to intervene earlier. Dr. Myers highlights the potential of technology to improve adherence and reduce disparities by making self-care more accessible.

Building Multidisciplinary DFU Clinics Dr. Myers describes the creation of a multidisciplinary DFU clinic in the Bronx, modeled after programs at institutions like Stanford. By integrating endocrinology, podiatry, vascular surgery, infectious disease, and behavioral health, this model ensures that patients receive comprehensive, coordinated care. She explains how this approach can drastically reduce amputation rates and improve long-term patient outcomes.

Patient and Caregiver Education Education remains a cornerstone of DFU prevention. Dr. Myers emphasizes strategies such as ensuring patients wear proper footwear, involving caregivers and family members in diabetes care, and simplifying self-care routines. She points out that community-based education and culturally sensitive approaches are essential for building trust and improving adherence.

Advocacy and Policy Change Beyond clinical care, Dr. Myers stresses the importance of advocacy and systemic reform. She calls for insurance coverage expansion for proven therapies, including GLP-1 receptor agonists and PAD (peripheral arterial disease) screenings, which can significantly improve outcomes. Her message is clear: reducing disparities in diabetes care requires action at every level—from the exam room to healthcare policy.

Diabetic foot ulcers are a leading cause of amputation, yet they remain preventable with the right tools and care models. Through early detection technologies, multidisciplinary clinics, culturally sensitive education, and equitable access to therapies, healthcare providers can dramatically improve patient outcomes and close persistent gaps in diabetes care.

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