An exciting time for Hepatology


The Way to Predict the Future is to Invent It Alan Kay

It is with great pride, privilege and humility that I take on the task as EIC of Liver International, which is a truly International journal and also the official journal of the International Association for the Study of the Liver (IASL), the first truly International Liver Association. Sam Lee and his editorial team have done a sterling job over these past years of bringing the journal to becoming one of the very best in the field. The articles cover the length and breadth of hepatology with readership from all over the world, which continues to grow with increasing downloads. This growth of Liver International, which acquired its new name in 2003 when it became officially affiliated with IASL, has paralleled the amazing progress Hepatology has made during this time. I am hopeful that the new editorial team led by Geoff Dusheiko as a co-editor and myself will continue to improve the impact and the influence of the journal. Raj Reddy will provide leadership to organizing and planning the Reviews section of the journal, which will also deal with Controversies and Consensus statements. The Associate Editors are all leaders in their own field, some established and others emerging and are drawn from all over the world. They provide enormous expertise in all aspects of liver disease. The new Editorial Board is comprised primarily of young investigators who are likely to become leaders in their own fields in the next years. Liver International, therefore, has the infrastructure and is ready to take the next step. To quote, Sam lee, the outgoing Editor, ‘Liver International is the velociraptor of journals: small, clever, fast and definitely a force to be reckoned with’ [1].

Liver disease is truly global and has a great deal of differences in terms of aetiology, clinical presentation and management as it has implications on life-style, economic conditions, availability of organs for transplantation and genetic diversity. For example, non-alcoholic and alcoholic liver diseases predominate in the western world whereas viral hepatitis has reached epidemic proportions in the Far East and North Africa. The predominant type of transplantation performed in the west is ‘cadaveric’, whereas it is mainly ‘living-donor’ transplantation in the east. Then, there is the huge issue of public/private funding routes for provision of healthcare which no doubt impacts on the kind of research emerging from these widely different areas around the world. It is not surprising therefore, that consensus statements about management of disease, indications for transplantation, short and long-term follow-up of patients will vary widely. Then, there is a new and emerging field of ‘Primary Care Hepatology’, which will be necessary to further develop if we are to have a true impact on reducing the morbidity and mortality from liver diseases. Liver International is well placed to address these global issues in Hepatology, and in recognition of the unmet need in this area, Arun Sanyal, the past President of AASLD, has kindly agreed to lead on this subject for the journal in future.

It is becoming clear that we may be near to conquering the scourge of hepatitis C, having already had a major impact on deaths from hepatitis B. Those of us who practice hepatology are already starting to see a different spectrum of patients. Looking into the crystal bowl, I think that hepatitis C will have a cure in the next 5 years, but how we will deliver these treatments to the huge number of patients around the world will be the issue. In recognition of the avalanche of new drugs and their potential uses, selection of patients most appropriate for individual drugs and strategies for implementation of guidelines around the world, Geoff Dusheiko will provide leadership to this area supported by George Papatheodoridis, Robert Flisiak, Ji Jia Dong and Mario Pessoa. The main problem that is emerging as the major cause of death is complications of cirrhosis and the associated liver failure that ensues. In recognition that a huge amount of new research and treatment strategies are ongoing and urgently required to try and reduce deaths from cirrhosis, the associate editors who will run this section are Juan Cordoba, Subrat Acharya, Juan-Carlos Garcia Pagan, Ran Oren and Han-Chieh Lin who has kindly agreed to stay on after a previous stint. Non-alcoholic steatohepatitis is fast emerging as the most important cause of liver disease around the world and Paul Angulo will address this area for the journal. Liver cancer, I think, will emerge as one of the major problems for which huge research effort is required in order to address methods of early diagnosis, tissue characterization and prevention. Kwang-Hyub Han will lead for this subject. In recognition of the importance of liver surgery and liver transplantation and, issues with respect to the growing diversity in its delivery, Chung Mau Lo will help the journal. Most importantly, the basic science and translational issues are critical for the future of hepatology and in this area Philip Newsome, Chun Hong Ma, Fabio Marra and Karolin Lackner will guide the journal. Looking at the list, one notices the amazing talent and the wide geographical reach the journal has access to. I welcome them to the journal.

In order to improve the outcome of patients, research has to, at some point, move from the bench to the bedside, which raises a number of issues. By its nature, translational research crosses boundaries between basic science and clinical application. However, crossing these boundaries also gives rise to new and often conflicting obligations between researchers, the University, industry sponsors and publication of articles. The lay public is obviously concerned that the financial interests of researchers, their institutions and their corporate sponsors may bias research and its ultimate publication. Yet, it is also clear that industry collaboration is essential in realizing the promise of translational research and generating funds, which allow publication of journals. At first glance, the bond between universities and industry seems reasonable. Academic physicians and the pharmaceutical and biotechnology industries have a shared interest in the advancement of medical knowledge to conquer disease. The raw intellectual talent of academics can quite naturally link to the strong commercial skills of industry to lead to successful product development. There are, of course, numerous examples of success within this paradigm, which are well described. Ideally, these partnerships between academics and industry benefit all parties. However, whichever way one looks at this issue, there is likely to be significant conflicts of interest [2, 3]. The only way to ensure clarity is the full and uninhibited disclosure of either known or potential conflict of interest by all individuals involved including the Editors, reviewers and also the investigators wishing to publish their results in Liver International. In starting this process, the Editors' conflicts of interest will be available to all concerned.

In performing clinical studies, one must ask who is the research for and whether there has been enough thought and patient engagement in the design and delivery of such studies as it may allow development of suitable end-points [4]. From the point of view of Liver International, we are in the process of developing a platform, which will allow patient engagement through online discussion using twitter (@liverinternational), introducing open access to lay summaries of papers and a ‘news’ sections. These may well culminate in a Liver International mobile app. Gautam Mehta will be heading up the IT interface for the journal.

Finally, I would like to take this opportunity to thank a number of people who have provided me the inspiration and mentorship, which has given me the confidence to take on this important post. Peter Hayes is an extraordinary clinician scientist who taught me about importance of creating a happy working environment, particularly if one wants to do good quality clinical research. I must thank Roger Williams who I worked with for nearly 10 years as a clinician scientist. He is truly a giant and a visionary with an enormous amount of energy. Most of all, I would like to thank three people with whom I did not work directly but have influenced my thinking and my career enormously. The first is the late Andy Blei who had infectious enthusiasm and the uncanny ability to come straight to the point. During his time as Editor, Hepatology made huge progress, which is attributable only to his dedication and passion. Patrick Kamath has been an incredible role model, demonstrating extraordinary clarity of thought and clear expression both of ideas and advice. More recently, I have had the honour and privilege of working with Vicente Arroyo in organizing the EASL CLIF-Consortium. He is another colossus with a worldwide view of hepatology, and a tremendous researcher. His leadership has allowed to bring together over 70 units in Europe and now strong links with researchers in the United States and Asia have been developed to try and reduce deaths from chronic liver failure. There are far too many colleagues to thank for their friendship and unflinching help and advice over the years but I would like to single out Juan Cordoba, Steven Olde Damink and Raj Mookerjee, all of who have provided huge support and close scientific collaboration. Finally, I must thank Sam Lee who has organized the journal extremely passionately and diligently and first introduced me to the idea of taking on this post. Over the past months he has provided guidance in learning the ropes.

To conclude, hepatology is at an exciting phase where scientific enterprise has led to the emergence of true solutions for the prevention and treatment of this dreaded disease. I am proud to be leading Liver International for the next years to help grow that success and take the journal forward.