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S2-E51 – Precision medicine, Fibrosis, Liver Function and the Future: a Discussion With Scott Friedman

Scott Friedman, the "Father of Fibrosis", and Jörn Schattenberg join the Surfers to discuss Scott's recent Paris NASH and National Liver Congress talks on Precision Medicine, imaging and liver function.

Scott Friedman‘s Paris NASH talk on Precision Medicine made a strong impression on Stephen and Jörn, along with our listeners. The conversation summary of that talk and Lars Johansson‘s (S2 E46.2) is the largest conversation and third largest post in the history of the podcast.

Scott joined us to discuss precision medicine, imaging, stellate cells and an array of additional topics. Highlights include:

4:08 – Scott Friedman discusses his career in studying fibrosis, stellate cells and a range of other liver function issues
9:13 – Session icebreakers: Scott’s fun fact and everyone’s good thing from the past week
12:46 – Stephen Harrison introduces Scott by discussing what he learned at Paris NASH
16:00 – Scott begins his remarks and goes on to discuss Precision Medicine in the context of liver disease
19:02 – Why it means so much that precision medicine includes precision of therapies
19:39 – How the stellate cell got its name
21:04 –The power of technologies lies in single cell sequencing and analyses, and what it means for “us stellate cell geeks”
23:49 – The importance of senescent stellate cells
24:45 – An exciting future for CAR-T cells
25:40 – Jörn Schattenberg asks whether and how we can target drug therapies to specific patients
26:38 – Scott: Pharmacogenomics are the “known” part of how precision might affect prescribing and drug selection in the future
27:46 – The importance of endophenotypes: liver samples look the same under the microscope may reflect quite different causes of disease
28:50 – The ambitious effort to develop software that takes the mass of patient information and distills it into a clear picture and simple recommendation
30:02 – Stephen: do we know enough to target therapies to specific types of patients
31:14 – Scott: What we know about PNPLA3 cells, their variants and patient diagnosis and treatment is a good example of what we can learn over time
32:08 – Does part of the solution lie in pinpointing how a cell signals distress?
33:16 – The significant role imaging can play in improving precision
34:25 – Implications of precision medicine for drug development, and how being “yoked to biopsy” and the NAFLD Activity Score hold us back
38:18 – Should we focus our endpoints more on liver function?
39:38 – Is biopsy the “Premarin of diagnostics” – so highly and unreliably variable that we cannot replicate results?
41:04 – Getting beyond the biopsy: the imperative, the path and the two major challenges
44:02 – Putting existing tissue samples to better use: availability of sample, past discussions, potential solutions, practical considerations
48:06 – “Very cool” research “cooking” in Scott’s lab
49:02 – The importance of mentorship
49:24 – “Final question” to wrap up session
52:52 – Scott: there are good reasons for optimism in our history
55:21 – Business section

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