Yale celebrated 75 years of Hepatology with a Diamond Jubilee on February 25, 2022.
Originally established as the Liver Study Unit in 1947, what is now the Yale Liver Center has evolved into one of the premier research centers for hepatology in the country, one of only three that is sponsored by the National Institutes of Health (NIH). Ninety members from 24 departments at Yale University participate, and together they have published nearly 400 papers in high-impact journals in the past five years alone.
“The goal of the liver center has always been to bring together investigators doing liver-related research at Yale, and to provide resources to help them be more productive in their research, but also to help them integrate and collaborate with other center investigators,” said Michael H. Nathanson, MD, PhD, director of the Liver Center and the Gladys Phillips Crofoot Professor of Medicine (digestive diseases) and professor of Cell Biology.
Among its many significant accomplishments over the years, said Nathanson, the Center has supported the development of a more effective technique for diagnosing spontaneous bacterial peritonitis, an infection of the abdominal fluid that affects many patients with cirrhosis; the discovery that the microbiome can affect the progression of fatty liver disease to non-alcoholic steatohepatitis; and devised a method for measuring the amount of pressure build-up in the liver due to portal hypertension that is now considered the gold standard.
The Jubilee celebration included a day-long program of seminars and lectures on the current state of hepatology from specialists in the field and ended with a panel of speakers discussing what the future looks like for patients with liver disease.
“It is reasonable to expect a number of advances in several areas,” said Mario Strazzabosco, MD, PhD, co-director of the Liver Center and professor of medicine (digestive diseases).
To name a few: Xenotransplantation—the possibility of transplanting a liver from pigs after genetic modifications to make the organ more tolerable—will likely become a reality and improve organ availability. Protocols to treat genetic disease with gene therapy, or by transplanting healthy cells (cell therapy) will see major advances. Improvements in so-called “artificial livers” will help sustain liver function during acute decompensation. Artificial intelligence (AI) will allow doctors to manage large amount of data and use sophisticated computer algorithms to improve diagnosis of liver diseases, personalize treatment, and discover new diseases.
To make these breakthroughs a reality, Strazzabosco says he sees a need for the Center to become more interdisciplinary and calls the relationship between clinical care and research a “yin yang in the sense that both are required. “There is research in clinical care and clinical care in research.”
“Modern medicine is divided into specialties and subspecialities,” he said. “This is very important because the amount of specialized knowledge that you need to advance treatments and technologies in specific areas is such that a more generalist approach would not be as successful.
“However, patients with liver disease have needs that transcend the boundary of these specialties and subspecialties. Each liver disease requires a multidisciplinary approach. All these changes will require a flexible organization able to capture the opportunities as they present. So, while we bring home the future scientific advances, it is mandatory to understand how to best deliver care to all patients in an equitable way.”
Overall, Nathanson said the thing that puts all of it in perspective is how common liver disease is around the world.
“There's probably over a billion people that have some form of chronic liver disease,” he said. “We don't appreciate in this country that liver cancer is the second highest cause of cancer deaths worldwide. That's why I think the presence of resources like the Yale Liver Center to understand the basis for liver disease and to figure out better ways to diagnose and treat it is so important.”