Hepatotoxicity SIG: Herbal and Dietary Supplement Induced Liver Injury: Defining the Future

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Recorded On: 11/09/2018

This program will focus on liver injury due to herbal and dietary supplements. The program will begin with a description of a realworld case of liver injury due to OxyElite Pro, which highlights the challenges faced by diagnosticians and researchers in establishing causation for hepatotoxicity due to herbal and dietary supplements. The program will also review the role of the FDA, CDC and chemists, including scientists with the National Center for Natural Products Research, at the University of Mississippi, who perform product chemical analyses.

Victor J. Navarro

Victor J. Navarro, MD, MHCM, FAASLD earned his Doctor of Medicine degree from the Pennsylvania State College of Medicine and completed medical residency followed by chief residency in Internal Medicine at Temple University.  Thereafter, he obtained fellowship training in Gastroenterology, Hepatology, and Hepatobiliary Endoscopy at Yale University.  In 1994, Dr. Navarro joined the faculty of the Yale University School of Medicine as an Assistant Professor of Medicine and Epidemiology and the Director of its Liver Failure and Transplantation service. He was also the Director of the State of Connecticut Emerging Infections Program Liver Study Unit.  His scholarly work while at Yale focused on the population-based epidemiology of chronic liver disease. In 2019, Dr. Navarro earned his Masters in Healthcare Management from Harvard University.

As a mentor, Dr. Navarro has been directly responsible for the scholarly and clinical training of many young and mid-career health professionals and academicians.  Dr. Navarro’s chief sources of research funding are the National Institutes of Health as an investigator for the U.S. Drug Induced Liver Injury Network (DILIN), and the Patient Centered Outcomes Research Institute for his study of Palliative Care in Patients with End Stage Liver Disease.

Raul Andrade

James L. Boyer

James L. Boyer, MD, FAASLD is the Ensign Professor of Medicine and Emeritus Director of the Liver Center at Yale University School of Medicine.  He is a graduate of Haverford College (1958) and the Johns Hopkins University School of Medicine (1962). From 1982 until 1996 he directed a combined Digestive Disease Section in the Department of Medicine at Yale.  He was the founding Director of the NIDDK funded Liver Center at Yale since 1984 and former Director of the NIEHS Center for Membrane Toxicity Studies at the Mt Desert Island Biological Laboratory in Salsbury Cove, ME where he was also Chairman of their Board of Trustees from 1995 to 2003 and 2011-2013.  He is past Chair, Board of Directors of the American Liver Foundation and a current member of Board of Mangers of Haverford College and Honorary Board member of the Mt Desert Island Biological Laboratory.  Dr. Boyer has a broad interest in all aspects of basic and clinical hepatology.  His laboratory has pioneered in understanding the cellular and molecular basis of bile formation and cholestasis and was supported by NIH for more than 40 years including two MERIT awards from NIDDK.  He is a member of the AASLD, ASCI, AAP, APS and ACCA and past president of both the American and the International Association for the Study of Liver Disease.  He is the recipient of Distinguished Achievement Awards from the AGA, AASLD and American Liver Foundation and the EASL International Recognition Award in 2020. 

Ikhlas Khan

Melissa Viray

Monique Salter

Adrian Reuben

Dr. Reuben is Professor of Medicine Emeritus (January 2015) at the Medical University of South Carolina, in Charleston SC, where he directed the Liver Program that he created there in 1993. Dr. Reuben was born, raised and educated in London, UK, where he obtained his medical degree, completed his Residency and Fellowship in Gastroenterology (Guys Hospital, London) before completing a scholarship in the Liver Study Unit at Yale School of Medicine. He was appointed to the faculty at Yale (1981-1993) before moving to MUSC to establish a Liver Service and enhance the then fledgling Liver Transplant program.

His continuing research interests focus on Acute Liver Failure, Coagulopathy in Liver Disease, Complications of Cirrhosis, and Drug Hepatotoxicity - in which he has co-authored many original articles.

In addition to all aspects of clinical hepatology, he has considerable experience in liver transplantation, portal hypertension and hepatocellular carcinoma - about which he edited two issue in Clinics in Liver Disease. Until 2006 he also had a laboratory-based career that focused initially on biliary lipid secretion, and later on hepatic fibrogenesis. He has published over 100 peer-reviewed articles, editorials, case reports, book chapters and 44 essays on Hepatology history in the successful Landmarks in Hepatology series. Currently he is editing a new series of more than 50 essays on the History of Hepatology by renowned experts worldwide, to be published in the AASLD online journal Clinical Liver Disease (Editor: Nancy Reau, Rush Medical Center, Chicago IL).

Reuben has presented original research papers at national and international meetings as well as teaching in postgraduate courses and workshops, and presenting invited lectures in the United States, Europe, the UK, and Asia. He served on several committees of the American Association for the Study of Liver Disease, including the Ethics Committee of which he was the Chair three years ago, and now he is the Chair-elect of the AASLD Hepatotoxicity Special Interest Group (SIG). Despite retirement from clinical practice, Adrian Reuben remains active in lecturing, collaborating in research projects, reviewing manuscripts, writing chapters and reviews as well as publishing original research articles. His interest in drug hepatotoxicity stems from his medical student days, when he obtained a bachelor degree in Pharmacology, and is exemplified by the publication of an original article in Hepatology, on Acute Liver Failure due to Drug-Induced Liver Injury, on behalf of the United States Acute Liver Failure Study Group (ALFSG), for which he was also the first author of an overview of 16 years’ experience in Acute Liver Failure.

Finally, Reuben is to be the recipient of the 2019 AASLD Distinguished Service Award.

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Introduction
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Open to view video.
Liver Injury from Herbal and Dietary Supplements: Introduction
Open to view video.
Open to view video. Presenter: Victor Navarro
The Landscape of Liver Injury from Herbal and Dietary Supplements in Europe, Latin America, and Asia
Open to view video.
Open to view video. Presenter: Raul Andrade
Case Presentation
Open to view video.
Open to view video. Presenter: Robert Fontana
Chemical Analysis As a Tool for Causality Assessment
Open to view video.
Open to view video. Presenter: Ikhlas Khan
Dietary Supplement Adverse Event Detection and Surveillance
Open to view video.
Open to view video. Presenter: Melissa Viray
Regulatory Response to Adverse Events from Dietary Supplements
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Open to view video. Presenter: Monique Salter
Panel Discussion/Q&A
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Open to view video.
Final Evaluation
Final Evaluation
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