Parvae Res Crescunt - The New Millennium with Michael H. Nathanson

Transcript

• 00:04Good morning everyone.
• 00:05I'd like to welcome you to the next talk.
• 00:08You know you know meeting today and the
• 00:12speaker is Doctor Michael Levinson,
• 00:14who's the Gladys Phillip Crawford professor
• 00:16of medicine in the section of digestive
• 00:19disease and professor of cell biology.
• 00:21As in as mentioned earlier today by Jim,
• 00:23is the director of the Year Liver
• 00:25Center and also serve as Chief of
• 00:28Digestive Disease for 15 years.
• 00:29And also was the editor in Chief
• 00:31of Hepatology for five years.
• 00:33It's like pleasure to welcome Michael and.
• 00:36The title of this talk will be Concordia,
• 00:38Poway, rest crescut the
• 00:40new Millennium Michael,
• 00:42please go ahead.
• 00:46Thank you very much, Gary.
• 00:48So during my session I will be talking
• 00:52about the current state of liver related
• 00:56activities at Yale to build on the the
• 01:01background that that that Jim nicely
• 01:04provided during the previous talk.
• 01:06Next slide, please.
• 01:09And I'll be talking about
• 01:10three different things.
• 01:11First, I'll talk about liver related
• 01:14related research activities at Yale.
• 01:17Then I'll talk about the the clinical
• 01:20practice of hepatology at Yale,
• 01:22and then finally,
• 01:24I'll talk about education and
• 01:27training for liver related
• 01:29research and clinical practice.
• 01:31Next slide, please.
• 01:32So first, a liver related research at Yale.
• 01:35Next slide, please.
• 01:38So I think in order to talk about this,
• 01:41it really is important to begin by
• 01:43talking about the the Yale Liver Center
• 01:46because that really has for the past 36
• 01:48almost 37 years served as the home for
• 01:52liver research at Yale's next slide.
• 01:56So I I would point out that that
• 01:59Yale is one of only three currently
• 02:01funded NIH that is in IDK,
• 02:04sponsored research centers that
• 02:05are focused entirely on the liver.
• 02:08We are now concluding our 36th
• 02:10year of funding.
• 02:11Next slide.
• 02:13And we currently have 86 Members
• 02:15that is full and associate members who
• 02:18draw from 24 different departments
• 02:21and sections around the university
• 02:23and 75% of our Members have joint
• 02:26publications with other center members.
• 02:29Next slide please.
• 02:32Let's go, Yep, there forward one.
• 02:35So this illustrates on the left
• 02:39the basic science departments
• 02:41that have a liver center members,
• 02:44and so you can see there's quite
• 02:46broad representation throughout the
• 02:48medical school and even from the
• 02:50main campus on the right are the
• 02:52clinical departments and sections that
• 02:54have liver center members and about
• 02:56half our as one might expect from
• 02:58the section of digestive diseases,
• 03:00but you can see that we have.
• 03:02Active members involved in in
• 03:03in liver research in a number of
• 03:05other clinical departments as well,
• 03:06and a number of other sections
• 03:08within the Department of Medicine.
• 03:10Next slide, please.
• 03:13This shows the distribution of the
• 03:15types of research being done and you
• 03:18can see that things are relatively.
• 03:20The membership is relatively
• 03:21evenly distributed.
• 03:22Basic science faculty constitute.
• 03:24Just under a third of the center members,
• 03:29clinical faculty involved in
• 03:31clinical research constitute also
• 03:32almost a third of our Members,
• 03:35and then finally,
• 03:36just over a third of our Members in
• 03:38Gray are individuals in clinical
• 03:41departments but engaged in basic
• 03:43or translational research,
• 03:46so there's really quite a wide spectrum
• 03:48of liver related research going on
• 03:51at our institution by a number of
• 03:53investigators in a very collaborative.
• 03:56Environment next slide please.
• 03:59Our center is divided into 3 thematic
• 04:03areas that represent the the main areas
• 04:06of strength of of of liver research.
• 04:09At our institution,
• 04:10one is immunology and inflammation,
• 04:13one is hepatic metabolism and
• 04:15one is epithelial biology.
• 04:17Next slide please.
• 04:18So this Venn diagram illustrates that
• 04:21and you can see that there's overlap,
• 04:23and indeed I would say that
• 04:25many of our Members,
• 04:26although their main research interests, may.
• 04:28May be described by one
• 04:30of these three topics.
• 04:32They generally are involved in
• 04:34research that I would say overlaps
• 04:36with these other topics as well,
• 04:38and here too you can see that there's
• 04:41a relatively even distribution of
• 04:43the number of Members in each of
• 04:45the three main areas of research
• 04:47and and each of these three areas
• 04:49relate to one or more specific types
• 04:53of liver disease states next slide,
• 04:55please.
• 04:58I would just like to mention the
• 05:00three core facilities that our center
• 05:03offers and this is to highlight the
• 05:07sorts of institutional resources that
• 05:10support liver related research at Yale.
• 05:13One is the advanced light microscopy core,
• 05:16the next is a molecular and
• 05:17cellular and organoid core,
• 05:18and the third is the clinical
• 05:20and translational core.
• 05:21The next slide explains these in
• 05:22just a little bit more detail.
• 05:24The morphology core,
• 05:25which is really at this point.
• 05:28Largely in advanced light microscopy,
• 05:29core offers confocal and super
• 05:32resolution microscopy,
• 05:33light sheet microscopy multiphoton
• 05:35imaging and swept field microscopy.
• 05:37The molecular and cellular core
• 05:39offers mouse models that are
• 05:41relevant to liver disease.
• 05:43Also a number of relevant cell lines.
• 05:45We provide cell isolations from
• 05:48mouse and more recently, human liver.
• 05:51We also provide mouse and human kalangis
• 05:54site organoids and also access to.
• 05:58Certain types of common molecular
• 06:00biology equipment and resources.
• 06:02Our clinical and translational core
• 06:04provides access to a research coordinator.
• 06:06Also biostatisticians,
• 06:08and now a bioinformatics expert.
• 06:10We also maintain a growing patient database,
• 06:14biospecimen repository and most recently
• 06:16we've added in access to patient
• 06:19imaging data to this repository.
• 06:21Next slide please.
• 06:24I'd like to say a word about the
• 06:26productivity of of people doing
• 06:28liver related research at Yale.
• 06:30Members who have used the three cores
• 06:33that I've just described published
• 06:36395 liver related papers during our
• 06:38most recent five year funding period,
• 06:41and this includes papers that were in
• 06:43such high impact journals as nature science,
• 06:46PNAS, cell, cell metabolism, JC, I,
• 06:50gastroenterology and hepatology.
• 06:51Now I thought long and hard.
• 06:54About what are some of the
• 06:57more important or high profile?
• 07:00Publications to come from
• 07:01Yale related to the liver,
• 07:03and it's a bit of a Sophie's choice
• 07:06type thing there really were.
• 07:09So many to choose from,
• 07:10but I did come up with a list
• 07:11of some of the things that
• 07:13in my mind were most notable.
• 07:14Next slide please,
• 07:16and I'll show you three
• 07:18different slides that each have
• 07:20different sorts of discoveries.
• 07:24The first slide is ones that I think are.
• 07:28Clinically highly relevant today.
• 07:30The first observation.
• 07:31The oldest was that greater than
• 07:34250 neutrophils per milliliter of
• 07:36ascites can be taken to indicate
• 07:39spontaneous bacterial peritonitis
• 07:40in patients with cirrhosis.
• 07:42The second was figuring out how
• 07:46to measure the hepatic venous
• 07:48pressure gradient and then figuring
• 07:49out that that measurement can be
• 07:51used to reflect a portal pressure,
• 07:53and this really opened up just
• 07:56a wide field of research.
• 07:58In terms of what one can calculate
• 08:00based on knowing the portal
• 08:02pressure next was the experimental
• 08:04evidence that beta blockers improve
• 08:07portal hypertension.
• 08:08And of course this ultimately was
• 08:10the cornerstone of the entire
• 08:11idea that one could treat portal
• 08:14hypertension with beta blockers.
• 08:15Next I would say Jim Boyer and his
• 08:20colleagues discovered the bilasa
• 08:22transporter OST Alpha and beta 20 years ago,
• 08:26and then Sylvia Villa Renho,
• 08:28also at Yale,
• 08:29identified just a few years ago
• 08:31that it was the defect responsible
• 08:34for a human disease in in, in,
• 08:36in a in a particular patient.
• 08:40There also was the observation 10
• 08:42years ago that the microbiome can
• 08:45affect the progression from fatty
• 08:47liver to Nash and then three different
• 08:51fatty liver or metabolic syndrome
• 08:53genes were identified here at Yale.
• 08:57Next slide,
• 08:58I would say these are observations that
• 09:01I all but one are fairly recent and I
• 09:04think these all have the potential to
• 09:06have very high translational value,
• 09:08but that is in the process of being
• 09:11evaluated first is the role of nitric
• 09:15oxide in developing the hyperdynamic,
• 09:17circulation and cirrhosis.
• 09:20Second was the observation more
• 09:22recently that a gut path of violence
• 09:26drives autoimmune hepatitis.
• 09:27Third was the observation that a
• 09:31non toxic mitochondrial protoform
• 09:33can reduce liver fat and this,
• 09:35I believe is now in clinical trials.
• 09:39Next is the role for a toll like
• 09:41receptor 9 in the development of Nash,
• 09:43and I have to say more broadly, Dr.
• 09:45Mahallan colleagues have really
• 09:47been the forefront of advancing the
• 09:49concept of sterile inflammation in the liver,
• 09:52and what mediates it and finally
• 09:54was another relatively recent
• 09:56observation that the microbiome is
• 09:58able to communicate with the central
• 10:01nervous system to mediate metabolic
• 10:03syndrome and and fatty liver.
• 10:05Next slide, please.
• 10:06And here are a few more basic
• 10:09concepts that were established here.
• 10:12First,
• 10:12Jim Boyer alluded to this in his talk,
• 10:15but he.
• 10:17He was the first to publish
• 10:19that hepatocytes are polarized
• 10:21epithelium and he recognized distinct
• 10:23transporters and channels on the
• 10:26apical versus the basolateral
• 10:28membrane of the hepatocyte.
• 10:29And this observation led to literally
• 10:33hundreds of subsequent publications,
• 10:35both here at Yale and around the world
• 10:38that characterized the different
• 10:39transporters and channels that are on
• 10:41the apical versus the base lateral side
• 10:44of the parasite and that characterize
• 10:46the regulation of expression of these.
• 10:49Membrane proteins and the characterized
• 10:51what goes awry in the various cholestatic
• 10:55conditions in these particular transporters.
• 10:59This work was all facilitated by
• 11:01development of models to study bio
• 11:03secretion at the single cell level.
• 11:05Doctor Boyer mentioned petite couplets
• 11:09which which they reported in 1984.
• 11:12His group,
• 11:12and I believe it around the same time,
• 11:14the group, the Mayo Clinic
• 11:16described isolated balduck units,
• 11:18which similarly allowed.
• 11:19These sorts of studies to characterize
• 11:23secretory mechanisms in in
• 11:25cholangiocytes and more recently
• 11:28Doctor Strzalkowski and his group.
• 11:30Reported a particular way to make
• 11:34collegiate organoids from patients
• 11:36which allows the world of personalized
• 11:39medicine to intersect with the
• 11:41field of cholangiohepatitis.
• 11:43I'll also mention that Doctor Bennett's
• 11:47group and my group identified separate
• 11:51machinery and signaling pathways
• 11:53in the nucleus that were distinct
• 11:55from what was in the cytosol and
• 11:57that these offered different ways
• 11:59to control metabolism and cell
• 12:01proliferation in hepatocytes.
• 12:02And I'll say more broadly.
• 12:05We we've had a program project grant
• 12:07for the past 20 years which is now
• 12:10ending to examine and characterize the
• 12:12biology of the parasite nucleus and
• 12:15this PPG resulted in 170 publications
• 12:17and we also created and distributed
• 12:20novel constructs to probe different
• 12:22subcellular pools of calcium and
• 12:25over 270 labs around the world have
• 12:28requested and received these constructs.
• 12:31Next slide,
• 12:32please.
• 12:33Now I'd like to talk about what's the
• 12:36current state of clinical practice in the
• 12:38area of hepatology at our institution.
• 12:40Next slide, please.
• 12:43So first of all,
• 12:44this is the volume of liver patients seen
• 12:47at Yale during the past year over 5000,
• 12:50unique patients with a primary or
• 12:52secondary liver diagnosis were admitted
• 12:54to the Yale New Haven Health System.
• 12:57Total liver related admissions
• 12:59were over 7000.
• 13:01In the outpatient setting,
• 13:03over 15,500 unique patients with a
• 13:06liver related diagnosis were seen,
• 13:08and over 46,800 outpatient visits
• 13:12were for a liver related diagnosis.
• 13:15Next slide, please.
• 13:18I'd like to just talk about a few
• 13:21liver related activities and procedures
• 13:22during the past year at our institution,
• 13:25one in seven discharges from Yale,
• 13:28New Haven Hospital had a primary
• 13:31or secondary liver diagnosis.
• 13:32There is a weekly tumor board which
• 13:35is run by Mario Strozewski and in
• 13:38the past year 619 patients were
• 13:40discussed and it's important to
• 13:42highlight the multidisciplinary
• 13:43nature of these discussions at every
• 13:46single weekly tumor board meeting
• 13:48there was representation.
• 13:49Like Hepatologist medical and surgical
• 13:52oncologist transplant physicians
• 13:54and diagnostic interventional
• 13:56radiologists and pathologists,
• 13:58our interventional radiology
• 14:00program is also extremely busy in
• 14:02terms of liver related activities.
• 14:04Over 2000 procedures have been
• 14:06performed in the past year,
• 14:08including tips transjugular,
• 14:10percutaneous liver biopsies and
• 14:12local regional therapy of HCC.
• 14:14I would point out that that's almost
• 14:16seven liver related procedures a day.
• 14:20365 days a year, and then similarly,
• 14:22the surgical pathology department
• 14:24has processed and reviewed over 1000
• 14:26liver biopsies in the past year.
• 14:28That's over three that's about 3 per day,
• 14:31so there's a lot of liver related
• 14:33activity going out in our institution.
• 14:36Next slide, please.
• 14:38I'd like to say a few words
• 14:41about the Hepatology faculty.
• 14:43That is, the faculty that
• 14:44are engaged in clinical care.
• 14:46We currently have 24 hepatologists
• 14:48on our full-time faculty,
• 14:50and this includes 50% women and
• 14:535% underrepresented minorities.
• 14:55We also have four nurse practitioners
• 14:58or advanced practitioners and
• 15:01two adjunct faculty.
• 15:02I'll say a word about them in a few minutes.
• 15:05We currently staff 65 liver clinics per week.
• 15:09In 10 different locations across the state,
• 15:13and we also run the klatskin service,
• 15:17which is a dedicated inpatient liver
• 15:18unit at Yale, New Haven Hospital,
• 15:20and I'll say a bit more about that later.
• 15:23Next slide, please.
• 15:26So one thing that I personally find
• 15:29particularly impressive is not just how
• 15:31many outpatient liver clinics we have,
• 15:33but really the variety and the the
• 15:36degree of subspecialty of these clinics.
• 15:39So this is in order of how many clinics
• 15:43per week we have in each of these areas.
• 15:46Our fatty liver clinics total
• 15:4819 clinics per week.
• 15:50I have to say that this was built entirely
• 15:53by Doctor Michael five or ten years ago.
• 15:56And and he doctor, Doe,
• 16:00and Benini and APRN.
• 16:02Maureen Kelly are the ones that staff these.
• 16:06There are 8 autoimmune and cholestatic
• 16:08liver disease clinics per week.
• 16:10Doctor Boyer, of course,
• 16:11was the person that began this effort.
• 16:13But more recently,
• 16:14doctors assistant Silvera have joined
• 16:17in and and now I I would say see
• 16:20the lion share of these patients.
• 16:22The liver cancer program is
• 16:23something that also has been growing
• 16:25tremendously in recent years.
• 16:27Was established by Doctor Strozier
• 16:29Bosco and now Doctor Jaffe is
• 16:32his junior associate and APRN.
• 16:33Sylvia Limpet works with them as well
• 16:36and they staffed 7 clinics per week.
• 16:38Doctor Mistry runs clinics
• 16:41and gauche's disease.
• 16:42His own personal area of intra of research,
• 16:45interest and other inherited liver diseases,
• 16:48Dr Lim and one of our appearance.
• 16:51Kristen draws Steph 4 viral
• 16:52hepatitis clinics per week.
• 16:54We also have three clinics
• 16:56per week that that.
• 16:58Ensure access by patients that are
• 17:01uninsured for their liver problems.
• 17:03We also have two clinics per week
• 17:06for hospital discharge follow UPS.
• 17:08We try very hard to see all liver patients
• 17:12within a week of hospital discharge.
• 17:15Dr Lim,
• 17:16who runs a number of clinical trials,
• 17:19has a clinical research trial
• 17:21clinic that meets twice a week.
• 17:23Doctor Schilsky is a long standing
• 17:25interest in Wilson's disease and.
• 17:27Has a clinic for that as well.
• 17:30Our liver transplant program
• 17:32evaluates new patients every week
• 17:35and we have two new clinics that I
• 17:38think are particularly noteworthy.
• 17:41One is staffed by Lamia Hock,
• 17:43one of our newest faculty members,
• 17:46and it's on alcohol and addiction
• 17:48in liver disease,
• 17:49and she's double boarded
• 17:50in addiction medicine,
• 17:51and in GI and transplant as well.
• 17:55In fact, and I think there is a few clinics.
• 17:57Like this around the country,
• 17:58but not not a lot,
• 18:00and it's a very important resource.
• 18:03Similarly,
• 18:04Dr Villa Renho Staffs clinic that
• 18:09she created an undiagnosed liver
• 18:11diseases and this is a largely
• 18:13an effort given her expertise in
• 18:15genetics to understand the genetic
• 18:17basis for a number of diseases and
• 18:20patients that people haven't been
• 18:22able to figure out beforehand.
• 18:24And then there's a number of general
• 18:26hepatology clinics and pre and post.
• 18:28Let's follow up clinics that
• 18:29we have each week as well.
• 18:31Next slide,
• 18:33please.
• 18:34Oh,
• 18:34so the next four slides are
• 18:37just going to show you who the
• 18:40faculty are and I'll leave.
• 18:42Each of these up here for a moment
• 18:44I guess I'll just point out a few
• 18:46things up so if we can go back one
• 18:48not to exclude anybody but Doctor Assise who
• 18:51you'll hear from at the end of the day runs
• 18:54the digestive Disease Fellowship program.
• 18:57Doctor dranoff. Was trained here,
• 19:00then was the section chief in Arkansas for
• 19:03a number of years and we just recruited
• 19:06him back to our faculty. Dr Garcia tsao.
• 19:08I think it's speaking after me and she's
• 19:11the chief of GI and liver at the VA.
• 19:13Doctor Gupta is one of our newest
• 19:16recruits who's engaged largely
• 19:17in basic liver research.
• 19:19Next slide, please.
• 19:22Doctor Hulk is the one that I mentioned
• 19:25who runs the alcohol and Addiction clinic.
• 19:29Doctor Jacob is the director of
• 19:32our inpatient klatskin service.
• 19:34Doctor Lim runs our viral hepatitis
• 19:37program and is actually the vice
• 19:40chair of clinical liver activities
• 19:42in our section and Doctor Mahal
• 19:45I mentioned is the person who.
• 19:48Formed our fatty liver program,
• 19:50which now is really taking off in a huge way.
• 19:53Next slide please.
• 19:55I mentioned doctors,
• 19:56mystery and schilsky.
• 19:57This is Doctor Silvera also on the
• 19:59top row who would doctor Assise and
• 20:01Doctor Boyer runs our cholestatic
• 20:03liver program Doctor Strozewski.
• 20:05I think I already mentioned.
• 20:09Is the Co director of the of
• 20:12the Liver Center and also runs
• 20:15our liver cancer program.
• 20:16Doctor Teddy runs the liver cancer
• 20:19program at the VA and Doctor
• 20:21Vilarinho I mentioned is the person
• 20:24who established the undiagnosed
• 20:26liver Disease Clinic and next slide.
• 20:30So the four women on top are
• 20:34the the APRN's in our section.
• 20:37Marianne McDonough is a PRN who
• 20:39works in dedicated fashion on the
• 20:41Klatskin inpatient liver service.
• 20:42Doctor Gross works.
• 20:44Christine Draz works largely with
• 20:46Joe Lim and our hepatitis program
• 20:49and some general hepatology.
• 20:51Sylvie Olympic splits her time
• 20:53between the liver cancer program
• 20:55and also working with me at the
• 20:58Bridgeport Liver Clinic that serves.
• 21:00From under and uninsured patients
• 21:02and then a moron,
• 21:03Kelly works with Doctor Mahal and
• 21:06others in the fatty liver program.
• 21:08Doctors Hoffman and Caldwell down at
• 21:10the bottom are both adjunct faculty
• 21:12that work with her transplant program.
• 21:15The next slide please.
• 21:17Finally,
• 21:17I'd like to say a few words about
• 21:20education and training in liver at Yale.
• 21:23Next slide,
• 21:24please.
• 21:26So I I'd like to focus really
• 21:29in this slide on postdoctoral
• 21:31liver research training at Yale.
• 21:33Dr Boyer mentioned that we
• 21:36have a current training grant.
• 21:39Here and it's one of only two N IDK
• 21:42sponsored postdoctoral training grants
• 21:44that are dedicated specifically and
• 21:47exclusively to liver research training.
• 21:50It's now in its 43rd year.
• 21:52A doctor Boyer was the person who
• 21:54initially obtained this grant
• 21:55and was a Pi for many years.
• 21:57Doctor Anderson took it over
• 21:59while he was section chief,
• 22:00and then I've had the honor
• 22:02of of being in charge of this
• 22:05during the past 20 years or so.
• 22:08This this.
• 22:08Training Grant has been used
• 22:10to train nearly 80 fellows in
• 22:12the time that we've had it.
• 22:14Most of them have gone on to
• 22:16full-time academic careers,
• 22:17including three of whom have gone
• 22:19on to become department chairs,
• 22:21ten of whom have gone on to become
• 22:23section chiefs or other program
• 22:25leaders and 10 individuals on this
• 22:26training grant are people that
• 22:28currently are on our full-time faculty,
• 22:30so I think it's been quite
• 22:32successful in that regard.
• 22:34But actually,
• 22:36perhaps more importantly,
• 22:38over 250 other postdoctoral fellows have come
• 22:41to our institution to train liver research,
• 22:44and they've come from over
• 22:4720 other countries.
• 22:49And these non T 32 trainees also have gone
• 22:51on to become quite influential investigators,
• 22:54including professors,
• 22:55section Chiefs,
• 22:56Department chairs and Deans.
• 22:58And you'll hear from a group of them
• 23:01during the panel discussion on the impact
• 23:03of Yale around the world later today.
• 23:06Next slide, please.
• 23:09Now I'd like to say a few more words about
• 23:11the Klatzkin liver service that the doctor,
• 23:14actually the Dean and then Doctor Boyer.
• 23:16And now I have brought up.
• 23:17It's named as,
• 23:17you know,
• 23:18after Gerald Klatskin who founded
• 23:20our Liver unit 75 years ago.
• 23:22It's reserved for patients who
• 23:24are admitted to the hospital
• 23:26primarily for a liver problem,
• 23:28which often, but not always,
• 23:30is complications of end stage liver disease.
• 23:32But people also can be admitted to
• 23:34that service with acute liver problems
• 23:36in the setting of either preexisting
• 23:39or no preexisting liver disease.
• 23:41It's a dedicated.
• 23:44Unit localized to 9 W and
• 23:47Yona Haven Hospital.
• 23:49It's alongside the transplant
• 23:51service and it's a conveniently
• 23:53located adjacent that is just
• 23:54across the bridge to the Miku.
• 23:58It's staffed by Hepatologist
• 23:59from our faculty,
• 24:00plus a dedicated apparen Miss McDonough,
• 24:03who I mentioned a GI Fellow
• 24:053 medical residents,
• 24:06one of whom rotates here from our
• 24:09affiliated hospital in Bridgeport,
• 24:102 interns and two medical students,
• 24:12and I would say there's really
• 24:15intensive teaching on this unit of and,
• 24:18and the patients tend to be
• 24:20quite ill and either Despite
• 24:22that or perhaps because of that,
• 24:24it's consistently ranked with
• 24:26one of the two most.
• 24:29One of the two favorite rotations
• 24:30among the Yale House staff,
• 24:32and interestingly,
• 24:33it's the most highly ranked rotation
• 24:35among the Bridgeport residents,
• 24:37even though it's a rotation
• 24:38that's not even at their hospital,
• 24:40and so I think it's been
• 24:42quite a successful service,
• 24:44both in terms of patient care
• 24:47and training of residents,
• 24:49medical students, residents, and fellows.
• 24:52In fact, residents frequently
• 24:53comment on how they have always
• 24:55been terrified of liver patients.
• 24:57Until they rotate on the classical
• 24:59service and then they feel quite
• 25:01comfortable managing these patients.
• 25:02Next slide please.
• 25:05So there's some recurring educational
• 25:06events to mention as well.
• 25:08We have a monthly research
• 25:10liver center research seminar.
• 25:12We have an annual klatskin lecture now
• 25:15to become rededicated as the Klatskin
• 25:17Boyer Lecture that's in its 35th year.
• 25:19Joe Lim hosts an annual liver
• 25:22update now in its 12th year,
• 25:24and it routinely attracts 100
• 25:26participants and something that
• 25:28we are instituting and this got
• 25:30delayed because of the pandemic.
• 25:33But we're going to start it.
• 25:34Now is a what we're calling
• 25:35a reverse mini sabbatical.
• 25:36Program and it will be to
• 25:39attract innovative or established
• 25:40investigators for extended visits
• 25:42to Yale in order to share their
• 25:44expertise and to cultivate new
• 25:46collaborations with folks here at Yale.
• 25:51Next slide, please. So to summarize,
• 25:55I would say what is Yale liver in the
• 25:59new Millennium in terms of research,
• 26:01I hope I've shown you that we have
• 26:04investigators from across the university
• 26:06involved in liver research in an
• 26:08environment that's highly collaborative
• 26:10and provides liver specific core facilities
• 26:13that facilitate ongoing high impact
• 26:15discoveries in terms of clinical practice.
• 26:18We have hepatologists and other
• 26:20types of clinicians providing highly
• 26:22specialized levels of care to a large.
• 26:24Volume of inpatients and outpatients across
• 26:26the entire spectrum of liver diseases
• 26:29and in terms of education and training.
• 26:31We've been fortunate to train literally
• 26:34hundreds of postdoctoral fellows in
• 26:36liver research here over the years,
• 26:38and they in turn have gone on to
• 26:41become established investigators and
• 26:42to train others and liver research
• 26:44both across the US and worldwide.
• 26:46So thank you for your attention,
• 26:48and if there's any questions
• 26:49I'd be happy to to answer them.
• 26:57Michael, thanks very much for very.
• 27:00Extensive summary and and
• 27:03it's really been a very very
• 27:05successful liver Center for sure.
• 27:07Congratulations to you and all
• 27:08the people who contributed to it.
• 27:12Thank you. You you mentioned as
• 27:15we're waiting for questions.
• 27:16We you mentioned the
• 27:18undiagnosed liver clinic.
• 27:19It's an unusual clinic and are
• 27:21there any specific cases you you
• 27:24might mention through the group?
• 27:27I don't know if I if Sylvia Vilarinho
• 27:30is is here, and if so she would
• 27:33be the one who addressed that.
• 27:34I know that she has published several
• 27:37papers reporting new liver diseases,
• 27:39and some of these people.
• 27:42I'm sure she's drawn from her clinic.
• 27:45If she's on, I don't know
• 27:47if she's even eight.
• 27:48I don't know if we can call on someone
• 27:50who's in the audience to to speak or not,
• 27:52but I would I,
• 27:53I guess I would just refer you to
• 27:55to some of those publications.
• 27:58Yeah.
• 28:01Reminder to the audience.
• 28:02If you want to ask questions,
• 28:04you can use the Q&A function in zoom.
• 28:14So there's a question,
• 28:17can you share your thoughts on the
• 28:19current challenges and opportunities
• 28:21and what you see or hope for the
• 28:23future direction of the unit will be.
• 28:27Well.
• 28:32So I guess I would have to break that
• 28:34down into all three categories that
• 28:36I that that I used to give this talk
• 28:38and in terms of research I think it's
• 28:40going to be quite important to continue
• 28:44to attract basic investigators and to
• 28:48facilitate their collaboration with
• 28:50clinicians and translational investigators.
• 28:54You know, I think that. It's. I you know,
• 29:02I think a great example of that is.
• 29:05Jerry Schulman and Rachel Perry's
• 29:08observation that that I highlighted
• 29:11that that there's a non toxic protona
• 29:14for they've developed that can
• 29:16essentially help burn up liver fat.
• 29:18And you know that has the potential.
• 29:22Through collaborating with all of
• 29:23the fatty liver clinics and the huge
• 29:26number of fatty liver patients we
• 29:28here have here to do some impressive
• 29:30clinical trials to establish how well
• 29:32a technique like that would work.
• 29:34So I think you know, an effort.
• 29:36To continue to engage and collaborate
• 29:38with the basic science investigators is
• 29:41going to be very important to move our
• 29:44field forward in terms of clinical practice.
• 29:46It's I mean it.
• 29:47When I was reviewing the numbers,
• 29:49it's really amazing the the volume of
• 29:51liver patients that we see in the number
• 29:54of liver related procedures that we do,
• 29:56and I think that it will be important
• 29:59to continue to make sure there is
• 30:02communication among our clinicians and
• 30:04integration of our efforts at every level.
• 30:07And and then,
• 30:08in terms of education and training,
• 30:09I think that it's it will just be a
• 30:11matter of continuing to make sure that
• 30:13there's adequate support so that we
• 30:15can continue to train people in this
• 30:17really unique and exciting environment.
• 30:19OK,
• 30:20one last question and quick answer.
• 30:24Over to 75 years of history in
• 30:26Hepatology, ill. What do you think?
• 30:29Is the most important achievement.
• 30:37You know, This is why.
• 30:38This is why I gave three slides
• 30:40instead of one or one line.
• 30:41I mean, the very first slide was every
• 30:43single thing is something people learn
• 30:45in medical school now around the world.
• 30:47I, I don't think I can say there's anyone.
• 30:50Probably the I take that back.
• 30:53The probably the biggest achievement
• 30:55would be helping establish
• 30:56hepatology as an independent field.
• 31:00Alright thanks, thanks very much
• 31:02Michael. Wonderful look thanks.
• 31:19This session will be ending and
• 31:21you can access the next session by
• 31:22clicking the All sessions tab at the
• 31:24top banner of the screen. Thank you.