# Assessment of liver and spleen stiffness and hepatic steatosis by transient elastography (Fibroscan®) in type 1 Gaucher disease: a single center case–control cohort study

## TL;DR

This study found that liver and spleen stiffness remain elevated in type 1 Gaucher disease patients despite enzyme replacement therapy, with factors like delayed treatment and metabolic syndrome contributing to liver issues.

## Contribution

The study is the first to use transient elastography to assess liver and spleen stiffness in type 1 Gaucher disease patients before and after enzyme replacement therapy.

## Key findings

- Liver fibrosis was present in 44% of GD patients but none in controls.
- GD patients had significantly higher liver and spleen stiffness compared to controls.
- Elevated ferritin, longer disease duration, and delayed ERT initiation were linked to liver fibrosis.

## Abstract

Gaucher disease (GD) is a lysosomal storage disorder characterized by glucosylceramide accumulation, which may lead to liver fibrosis and cirrhosis. Enzyme replacement therapy (ERT) could reverse fibrosis. This study aimed to assess liver and spleen stiffness and hepatic steatosis in adult type 1 GD patients receiving ERT, using transient elastography (TE) (Fibroscan®).

Twenty-five type 1 GD patients were evaluated pre- and post-ERT. TE findings of GD patients on ERT were compared cross-sectionally with a control group. Liver fibrosis was defined as ≥7 kPa, and significant steatosis was defined as a Controlled Attenuation Parameter (CAP) measurement ≥ 250 dB/min. Associations between TE findings and clinical, metabolic, genetic characteristics, FIB4 (fibrosis 4) and APRI (AST to platelet ratio index) scores, were investigated.

Fifty-six percent of GD patients were female, with a median disease duration of 13 years. Post-ERT, body weight (57.3 vs. 63.6 kg, p < 0.001), body mass index (22 vs. 23.8 kg/m2, p < 0.001), and metabolic syndrome (MetS) prevalence (12% vs. 40%, p = 0.016) were increased. Hepatic steatosis was more frequent (32% vs. 16%). Liver fibrosis was present in 44% of GD patients, but in none of the controls. GD patients exhibited significantly higher liver (6.6 vs. 3.7 kPa; p < 0.001) and spleen stiffness (17.6 vs. 11.1; p = 0.032). Liver fibrosis was positively correlated with ALT, GGT, ferritin levels, disease duration, and delayed initiation of ERT.

Although ERT improved fibrosis-related parameters, GD patients demonstrated higher liver and spleen stiffness. Elevated ferritin levels, longer disease duration, and delayed initiation of ERT were associated with liver fibrosis. Additionally, increased metabolic syndrome prevalence post-ERT may contribute to the development of hepatic steatosis in this patient population.