EASL International Recognition Awardee 2014
Authors: Reiner Wiest
Journal: Journal of Hepatology (2014)

It is both an honour and a privilege to introduce Prof. Dr. Guadalupe Garcia-Tsao on the occasion of the 2014 EASL International Recognition Award 2014. "Lupe" or "Lupita" as the large group of friends and family call her is Professor of Medicine at the Yale University School of Medicine, where she is Director of the Clinical and Translational Core at the NIH-funded Yale Liver Center and Program Director of the Hepatitis C Resource Center. In addition, she is Chief of Digestive Disease Section at the Veterans Administration (VA) – Connecticut Healthcare System, West Haven, Connecticut. Lupe is a longstanding member of EASL. Her record of service to the organization and to the field of Hepatology is extraordinary. The International Recognition Award is a special honour, awarded for distinguishing features as well as excellence of character and academic performance. Lupe stands out in all of these parameters, thus making her a natural choice for recognition by one of the highest EASL honours. Lupe was born and grew up in Mexico City. Her mother was Chinese and her father Mexican. He actually wanted her to pursue a career in advertising (as he did) because a career in Medicine was "not easy for a woman". However, already then she did it "her way" and proceeded to Medical School in Mexico at the renowned Universidad Nacional Autonoma de Mexico. During her last year in medical school she became involved in liver research with Dr. Marcos Rojkind. He and a young Dr. David Kershenobich, who had just returned from a fellowship with Professor Sheila Sherlock, had started a placebo-controlled randomized trial of colchicine for the treatment of cirrhosis. Lupe was highly active in randomizing patients, supplying medications, collecting data and, thereby, got hooked on to clinical research – a sustained passion since then. The study was published in the New England Journal of Medicine. After graduating from medical school she competed for a Internal Medicine residency slot at the Instituto Nacional de la Nutricion, the premier and most coveted postgraduate medical institution in Mexico with an acceptance rate in the single digits. She was accepted and spent 3 years with a punishing schedule of 120 working hours per week and 4-month rotations. At that time more than 80% of her colleagues were male. Lupe excelled in this competitive environment because she did it "her way" without having to fight or complain, but solely based on her performance. In her quest to pursue a career in clinical research and hepatology, and following the steps of her mentors, she sought a fellowship position abroad. Among different possibilities, she finally chose a position at the West Haven Veterans Administration (VA) and Yale University with Dr. Harold Conn. During these 3 years she established herself as a principal investigator despite the fact that Harold Conn left for a one-year sabbatical shortly after her arrival. She single-handedly completed the first comparative diagnostic study of spontaneous bacterial peritonitis. In fact, this was the basis for her continued interest in other complications of cirrhosis such as ascites and hepatorenal syndrome. Roberto Groszmann, then acting chief of the Liver Unit at the VA, early on realized the academic potential of Lupe's intellect, personality and craving for research. Indeed, her pioneer-mentor was extremely influential as a role model for Lupe's future scientific career. This serendipitous juncture did start a highly prosperous partnership which has been ongoing for almost 30 years and led to more than 30 publications that have changed the knowledge and practice of cirrhosis and portal hypertension. Despite having completed two clinical studies on pharmacological modulation of portal pressure during her fellowship, she decided to return to her alma mater in Mexico, the Instituto Nacional de la Nutricion. She felt it to be her duty to pass on what she had learned to young medical students, residents and fellows in Mexico, in the same way she had been mentored. However, Roberto Groszmann, foreseeing Lupe's potential, enabled her to return to Yale some years later. Struggling with the idea of leaving Mexico, she accepted to return to Yale as an Assistant Professor of Medicine in 1989 only on the premise of taking a "leave of absence" rather than relinquishing her position in Mexico. This was 25 years ago and she still is at Yale. Clinical translational research with clear endpoints based on a sharp sense of the pathophysiology of disease has always been the focus and backbone of her scientific work. The area in which Lupe has provided major contributions over the last 25 years is the area of complications of cirrhosis. She was part of the research team that established the threshold portal pressure level for the development of varices and that performed the only placebo-controlled studies of non-selective beta-blockers in the prevention of first variceal haemorrhage and in the prevention of the development of varices. Moreover, her studies on spontaneous bacterial peritonitis helped establish diagnostic standards such as inoculation of at least 10 ml of ascites into blood culture bottles at the patient's bedside and define cut-off levels of ascites polymorphonuclear cell count to establish the diagnosis of spontaneous bacterial peritonitis. Her keen clinical observations and thorough pathophysiological understanding allowed Lupe to characterize the liver involvement in hereditary hemorrhagic telangiectasia – a study that has been likewise been published in the New England Journal of Medicine. Most of these trials were supported by peer-reviewed funds provided by the NIH or the VA Healthcare System, among them a K-24 mentoring award from the NIH in 1999; several Merit Review awards on studies on refractory ascites and a VA central office grant in 2001 to establish one of four Hepatitis C Resource Centres across the country. This grant has been ongoing for more than 10 years and has clearly helped to improve the care for veterans with hepatitis C and associated complications, including, of course, cirrhosis. It is important to note that it has become extraordinarily challenging to receive funding for translational human research with focus on pathophysiological aspects. Despite this Lupe has insistently continued performing such research. Knowledge derived from such "practical" issues has helped define the natural history and course of cirrhosis and thus, is fundamental to centre the focus of future research. Lupe prides herself of being a consummate clinician and one of her joys is to share clinical pearls with students, residents and fellows, particularly those that link pathophysiology with a clinical presentation and/or a given therapy. Many students and residents have chosen a career in hepatology based on their interactions with her in the wards or in the classroom. A key personality trait is her enthusiasm that captivates her audience when lecturing or rounding or discussing a project, enthusiasm that infects anybody interacting with her. This energy and determination are easily reflected in her name. "Guadalupe" which in native American Aztecan (Nahuatl) language translates into "the one that crushes the serpent's head". Moreover, taking her nickname, Lupita, as an acronym: L: for lively, vivacious and witty mind by which her students, fellows, patients and colleagues get carried away. U: for unstoppable or utterly honest and clear-cut transparent communication whether related to scientific discussions, academic decisions or mentorship. P: for powerful, forward-moving leader determined and focused on key questions that are of practical daily relevance. I: for intelligent and irrepressible, brilliant creative thinker driven by immense curiosity. T: for "tough as nails" when it comes to solving clinical problems for her patients or when taking on scientific challenges. A: active, adventurous and amazing person and excellent team worker being an asset in any endeavour that she is involved in. Finally no description of Lupe Garcia-Tsao could be complete without mention of her love for cinema, rock-and-roll and cats. Lupita's personality and "her way of" knowing how to make complex multifactorial clinical problems and entities appear easy and logical makes her an outstanding lecturer. Thus, she is invited frequently to speak at national and international meetings. In fact, teaching is one of Lupe's passions and has led to multiple named lectureships such as prominently the Telfer Reynolds USC lectureship. She has received several prestigious awards such as the Yale Humanism in Medicine Award and the Hugh Butt award at the Mayo Clinic. She is an elected member of the Mexican Academy of Sciences and is fellow of the Royal College of Physicians. Lupe has established long-standing professional and personal relationships with others who would, like her, become prominent physician-scientist members of the EASL, including Jaime Bosch (former recipient of the first EASL recognition award) and Andrew Burroughs (former Secretary General of the EASL and last year's recipient of an EASL recognition award). Her inspiring character and verve for mentoring junior researchers has likewise drawn a number of individuals to perform research under her direction, including Puneeta Tandon, Annalisa Berzigotti and Salvador Augustin. While working in the laboratory of Roberto Groszmann interaction with Cristina Ripoll and Alexander Zipprich got them hooked on to her spirit of research and they developed a scientific relationship that has led to various studies and publications. In fact, the same has happened to me from the first day when I met Lupe after having arrived to Yale University as a young postdoctoral Research Fellow in 1997. She introduced me to the concept and importance of bacterial translocation which like a seeding jab since then accompanies me. Not only this, any further input from her or others boost this inoculation and her continued mentorship resembles the archetype of academic and scientific life for me. Lupe was proud to become a member of the EASL in 1997 when she attended her first EASL meeting precisely in London. She has attended this meeting regularly since 2002. She served as associate editor of the Journal of Hepatology and collaborated closely with EASL leadership during her tenure as president-elect and then as president of the AASLD in 2012. For Lupe, the presidency of the AASLD represented a culminating event in her career in that it allowed her to contribute to move forward the science and practice of hepatology, focusing on mentoring and education. EASL salutes Lupe Garcia-Tsao with one of its highest honours. Lupe has made a clear difference in the lives of all of us that have had the privilege to work with her. This includes but is not limited to "her way" of succeeding, mentoring, investigating, teaching, taking care of patients and living. Since, modesty is her middle name I know that the decoration provided by this award goes beyond her expectations. I wish to express my gratitude to many colleagues, companions and friends of Lupe Garcia-Tsao for their help in obtaining additional insight into the professional and personal life of our awardee.