Figure 2.

(A) Mix meal test before and after metreleptin. (B) Liver biopsy before and 12 months after metreleptin. The liver biopsy prior to metreleptin shows steatohepatitis with bridging fibrosis and cirrhosis by histology in the area that was biopsied. NASH scoring before metreleptin: Fibrosis 4, hepatocellular injury 2, steatosis 2, parenchymal inflammation 1, and total NASH score: 9 and after metreleptin: fibrosis 3, injury 2, steatosis 1, inflammation 1, and total NASH score 7. (C) Liver biopsy showing evidence for autoimmune hepatitis obtained when liver tests results were elevated ten-fold. This acute elevation in liver tests occurred upon discontinuation of metreleptin and sequential addition of fenofibrate and pioglitazone. Both agents were then discontinued and patient was treated with a short course of prednisone. Arrow heads indicate bile ductular reaction with mild chronic inflammation, including plasma cells.