51 minutes | Oct 14, 2021

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!

Highlights include:

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

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