Driving the Discussion in Fatty Liver Disease. Join hepatology researcher and Key Opinion Leader Stephen Harrison, Liver Wellness Advocate Louise Campbell, and Forecasting and Pricing Guru Roger Green as they discuss the issues affecting the evolving NASH market from their own unique perspectives on the Surfing the NASH Tsunami podcast. #NASH #NAFLD #FattyLiver
S2-E50.3 - "Dare to Dream" - How New Imaging Methods Can Change Our Future
Antaros Medical's Chief Scientific Officer Lars Johansson joins Stephen Harrison, Louise Campbell, and Roger Green to reprise the key points of his recent Paris NASH talk. In this section, panel members speculate on the largest, most important conceptual changes that the new imaging approaches can drive in disease knowledge and research.
This session begins with Lars discussing the value of 3-D MRI, a technique he discussed in Paris, as well as work he did not mention in Paris that looks at spleen volume. The conversation ends with each panelist answering two questions from Roger. First, he asks the panelists to "Dare to Dream" the one most significant advance each one hopes will ensue from these imaging advances. After this, he asks two final wrap-up questions. To Lars, he asks the most important messages listeners should take from this episode. To the others, he asks the most "mind-blowing" thing they heard.
S2-E50.2 - "Seeing What Should Be" - Imaging the Liver To Assess Functioning Hepatocytes
Antaros Medical's Chief Scientific Officer Lars Johansson joins Stephen Harrison, Louise Campbell, and Roger Green to reprise the key points of his recent Paris NASH talk. This conversation revolves around the implications of Lars's comment that we should track and analyze functioning hepatocyte cells as an excellent marker for liver function.
This conversation starts with a comment from Louise Campbell that this entire approach might play a significant role in moving us beyond the biopsy. Lars agrees, noting that studying fibrosis and fat reduction places too much emphasis on "what shouldn't be" in the liver instead of focusing on "what should be," which are high functioning hepatocytes. To explore hepatocyte function, he discusses use of gadolinium contrast agents, more than 50% of which are taken up by hepatocytes. This provides a setting to combine dynamic functional inputs based on hepatocyte function with static measures based on stiffness and PDFF. This provides a truly dynamic look at liver disease, which is particularly important given the liver's ability to regenerate. Stephen spends the last few minutes of the conversation by discussing the results this approach can yield and contrasting it favorably to the techniques we use today, some of which are difficult to implement and none of which provide the richness of information achievable with the imaging techniques Lars describes.
S2-E50.1 - "Potential Game Changer" - Imaging Can Provide a Dynamic View of NASH Evolution
Antaros Medical's Chief Scientific Officer Lars Johansson joins Stephen Harrison, Louise Campbell, and Roger Green to reprise the key points of his recent Paris NASH talk. In this conversation, Lars and Stephen discuss the value of assessing the balance of fibrogenesis and fibrosis in healthy and unhealthy livers.
Introducing our guest surfer, Stephen Harrison describes Lars Johansson's Paris NASH talk as "remarkable and intriguing." Lars begins his comments by discussing the use of PET tracers to target fibrosis through Collagen Type I cells as well as hepatic stellate cell activation through PDGFR beta. He and Stephen go on to discuss two critical ways the resulting insights can change drug development: first by identifying the correct circulating blood biomarkers to include in different trials or pieces of research, and second by optimizing combination therapies based on the specific effects each agent has on the fibrosis and fibrogenesis processes. On the latter issue, Stephen suggests this approach might have benefit not only in NASH but also a broader range of metabolic diseases Lars concurs.
S2-E50 - "Dare to Dream" - the Exciting, Evolving World of Organ Imaging
Antaros Medical's Chief Scientific Officer Lars Johansson joins Stephen Harrison, Louise Campbell, and Roger Green to reprise the key points of his recent Paris NASH talk and comment on several other topics.
Lars Johansson's Paris NASH presentation, "Innovations in Imaging Assessment of Fibrosis"," introduced his audience to a dynamic, multidimensional view of tools that can show us how the liver works. Rather than focusing on static measurements of "what shouldn't be there," Lars discusses the measurement of "what should" - for example, the interplay of fibrosis and fibrogenesis. Most striking, he describes an array of leading edge and state of the art imaging techniques that shift focus from today's "what shouldn't" targets (fat and fibrosis) to "what should" (functioning hepatocytes, to give one example.) This different viewpoint combines with the novel imaging tools and approaches to create an episode that might leave you repeatedly thinking "Oh, Wow!" Expected to be challenged and exhilarated!
12:27 - Stephen Harrison introduces Lars Johansson by discussing the Paris NASH meeting and the session Stephen chaired
14:29 - Lars begins his discussion of the Paris NASH paper
15:35 - The role of PET tracers in assessing disruptions in liver homeostasis through assessment of hepatic stellate cells and imaging collagen Type I
17:58 - Why Stephen sees the kinds of imaging Lars describes as "potentially a game changer" and his "next step": to associate these results with blood-based biomarkers
20:59 - Lars discusses the best interplay of circulating blood biomarkers and PET tracers, and highlights combination therapy development as an area for development
22:29 - Stephen suggests that this approach can provide more holistic solutions than histopathology, particularly for metabolic disease and specific sub-types
25:04 - Louise discusses the benefit to the patient of using these kinds of technique to move beyond much current biopsy
26:25 - Lars's "second piece from Paris" is the use of a gadolinium contrast agent due to its high level of hepatic uptake
27:41 - Roger observes that these tools allow us to study the liver as a dynamic system
28:24 - Lars discusses why to him, hepatocyte function is a robust dynamic measure
29:38 - Stephen speculates that these techniques can create knowledge more efficiently than our best measures today and suggests that they will provide greatest value in cirrhosis and advanced fibrosis
34:32 - Lars suggests these kinds of techniques might replace for augment HVPG over time and goes on to share an integrated version of how much data these approaches can produce in a single drug trial
36:22 - Louise's "Dare to Dream:" replace biopsy with an easier way to assess path of disease which will allow more efficient screening of more patients
37:12 - Roger's "Dare to Dream:" visualize the liver in the context of the whole patient
39:23 - Stephen's "Dare to Dream:" to become cognizant of how the range of noninvasive tests can help us mold drug development for different phenotypes of patients and separately, to speed drug development
41:09 - Lars's "Dare to Dream:" Bring these techniques to early drug development, which will streamline investment of time and money by improving focus
42:52 - Roger's final question - "The one thing that 'blew everyone's minds' the most."
46:40 - Business Section - A listener record; for the first time, a conversation gets more downloads than its episode, update on CME, requests for conferences you would like us to attend
S2-E49.3 - Clinical Care Pathway: What Can Be Done Today?
Last author and leading endocrinology Fatty Liver Opinion Leader Ken Cusi joins co-author Stephen Harrison, Louise Campbell and Roger Green to discuss the recent Clinical Care Pathway published in Gastroenterology. This conversation answers the question "What Can Be Done Today?" in terms of screening and patient management without approved drugs.
The paper "Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease" is a clarion call to action, but what exactly should clinicians do? This conversation addresses that issue. Louise Campbell starts by stating that the World Health Organization should incorporate Fatty Liver disease into their diabetes initiative. Next, she leads the group into a discussion of the merits of transient elastography, which leads Ken Cusi and Stephen Harrison to discuss blood-based and imaging options clinicians can deploy when they lack access to a FibroScan or similar device. Finally, Roger asks the most important step stakeholders should take now, which provide an array of different actions.
S2-E49.2 - Clinical Care Pathway: Behavior Change and Prevalence Data
Last author and leading endocrinology Fatty Liver Opinion Leader Ken Cusi joins co-author Stephen Harrison, Louise Campbell and Roger Green to discuss the recent Clinical Care Pathway published in Gastroenterology. This conversation centers on two issues: driving behavior change and recognizing the scope of the need.
For "Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease" to achieve its goals, clinicians need to be motivated to action and then understand what to do and why. This conversation discusses different philosophical and behavior economics motivators. Ken Cusi stated his excitement based on the belief that once a clinician starts to screen and sees one seemingly healthy patient with cirrhosis, he will treat differently. Roger Green pointed out three small items in the first paragraph of the paper that seem designed to say, "This is serious. Pay attention!" Finally, Ken and Stephen Harrison discuss their previous work in assessing prevalence, which demonstrated that disease is far more widespread than most people (clinicians and patients alike) believe and over the past 10 years, we may be seeing a dramatic increase in the number of seemingly healthy people with severe NASH.
Insightful and diverse perspectives
I find this podcast easy to listen to and insightful, covering interesting topics and diverse perspectives in NASH!
At long last!
We have sorely needed a podcast that allows clinicians and academics to focus on major issues in NASH and NAFLD. Their recent coverage of ILC was timely and incisive. I find myself discussing the episodes with colleagues and Twitter buddies.
A podcast for the NASH community! So many relevant topics. There are guest speakers almost every week who contribute a new energy to each episode. Keep the good work coming