Introducing the AASLD President: Adrian Di Bisceglie
Authors: Jay H. Hoofnagle
Journal: Hepatology (2013)

On January 1, 2014, Adrian M. Di Bisceglie (Fig. 1) became the 65th president of the American Association for the Study of Liver Diseases (AASLD) and takes on leadership of a 3,700-member academic society with a yearly operating budget in excess of $12 million and a long tradition of excellence in promoting liver disease research, training, and education. Few individuals are as qualified, committed, or enthusiastic about taking on this daunting task as Adrian Di Bisceglie. Currently, Adrian is professor and chairman of internal medicine as well as chief of hepatology at the Saint Louis University School of Medicine (St. Louis, MO). He is the author of more than 300 original articles and scholarly reviews in liver disease and is coeditor with Bruce Bacon, John Lake, and John O'Grady of the well-received textbook Clinical Hepatology, now in its second edition. He has been a member of the AASLD for more than 25 years and has served on seven of its committees (chairman of two), many abstract review groups, and, since 2010, its governing board. He has also served on multiple National Institutes of Health (NIH) and U.S. Food and Drug Administration scientific review groups (study sections) and is the principal or coprincipal investigator on three NIH grants. Most recently, Adrian (with Paul Martin) organized and oversaw the 2013 AASLD Postgraduate Course ("New Treatments in Liver Disease"), which drew 3,291 registrants, making it the one of the largest and most successful courses in the AASLD's long tradition of excellent yearly scientific educational presentations. Adrian was born in Germiston, South Africa, a small mining town and suburb of Johannesburg, its largest city. His father was born in Italy, but taken to South Africa after being captured by the British army in North Africa during World War II. After his internment, he stayed on in South Africa to work in the gold mines and, more important, to marry a young South African woman and start a family. Adrian was the first person on either side of his family to graduate from high school. Not stopping there, he went on to gain entrance to the prestigious University of Witerwatersrand (Johannesburg, South Africa). Six years later, he graduated with a bachelor of medicine and surgery (M.B.B.Ch.), the equivalent of an M.D. in the United States. The following year, he did a general medical internship at the Coronation Hospital in Johannesburg. After compulsory military training, where he spent several months in Namibia providing care for troops and locals, Adrian became a registrar (similar to a resident in medicine and later gastroenterology fellow) at the famous Baragwanath Hospital just outside the sprawling community of Soweto. This 3,000-bed hospital has provided outstanding care to the citizens of Soweto and extensive clinical experience to generations of South Africa physicians. As a registrar on call, Adrian regularly supervised a team of interns that might admit more than 100 patients each day. It was there that Adrian became interested in liver disease, falling under the mentorship of Professor Michael Kew. There also, Adrian first dealt with the disease that would become the focus for his career, hepatocellular carcinoma (HCC), the single, major cause of cancer death at Baragwanath Hospital. On weekly rounds, patients with liver disease would be presented to Professor Kew. Those with HCC would get a special visit from the professor to obtain a clinical history, demographic information, and a serum sample—data that would ultimately help define the role and burden of hepatitis B as a cause of HCC in Africa. Unlike in Asia, HCC in South Africa was a disease of young, otherwise healthy men (average age: late 20s), was rapidly progressive, and occurred in persons with low levels of virus and inactive disease. With Professor Kew and Geoffrey Dusheiko (then having recently returned from a medical staff fellowship at the NIH), Adrian began clinical and laboratory investigations of chronic hepatitis B, its epidemiology, modes of transmission, natural history, therapy, and relationship to HCC. An early project was to assess the prevalence of hepatitis B among school children in Soweto, the large city adjoining Johannesburg in apartheid South Africa. Among 2,000 children, the rate of hepatitis B was less than 1%, far below the rates reported in rural areas and among migrant workers from southern Africa in the gold mines—a mystery in the epidemiology of hepatitis B that remains unexplained today. In 4 years of training and attending service at Baragwanath Hospital, Adrian published more than two dozen original articles and began to establish his reputation as a clinical investigator in liver disease. In 1986, Adrian, like many promising young South African physician investigators, came to the United States. He joined the Liver Diseases Section at the Clinical Center of the NIH under the directorship of E. Anthony (Tony) Jones (chief) and Jay Hoofnagle (senior investigator). When asked what he would like to make the focus of his research, he replied "hepatocellular carcinoma." "Very admirable", he was told, "but we don't see a lot of it here." The statement was true at the time, but, sadly, has changed since. Adrian came to the Clinical Center of the NIH at a propitious time, and he thrived in the face of its challenges and opportunities. Within 2 years of joining the Liver Diseases Section, he had authored or coauthored important initial descriptions on the use of interferon-alpha (IFN-α) in chronic hepatitis C (CHC) and D, the natural history of hepatitis C, the replicative status and concentration of hepatitis B virus in hepatic and nonhepatic tissues, and pilot studies of other antivirals in chronic viral hepatitis. Adrian was made a senior staff physician in the Liver Diseases Section in 1989 and, 3 years later, became its director. He initiated and was the first author on controlled trials of IFN-α in hepatitis B and C, which were instrumental in its ultimate approval as therapy of these diseases. He demonstrated the effects of IFN therapy on the newly described hepatitis C virus (HCV) and showed that long-term remissions in CHC were attributable to long-term clearance of HCV. He initiated and was responsible for multiple pilot studies of other antiviral agents in hepatitis B, C, and D (including ribavirin [RBV], didanosine, and IFN-γ). Adrian was a close collaborator with Stephen Feinstone, discoverer of the hepatitis A virus and a skilled molecular virologist. Together with Drs. Michiko Shindo and Shuichi Kaneko, both visiting scientists at the NIH, they developed and refined the first assays for hepatitis B viral DNA and hepatitis C viral RNA, utilizing them to assess the effects of these novel therapies. These tools allowed them to show that levels of HCV RNA declined and could become negative in patients on IFN therapy, that relapse was associated with return of the viral RNA, and that long-term clinical remission was associated with viral eradication—the first demonstration that a human, chronic viral infection could be cured by antiviral therapy. From early on, Adrian was privileged to interact and collaborate with some of the giants in the field of viral hepatitis, including Harvey Alter, Robert Purcell, John Gerin, and Leonard Seeff. He was a regular attendee and participant in the famous weekly liver pathology conferences at the Armed Forces Institute of Pathology with the giants in the field of hepatic pathology, inclulding Kamal Ishak, Hans Popper, Hyman J. Zimmerman, Lionel Rabin, and Zachary Goodman. His medical staff fellows in the Liver Diseases Section that he helped supervise included many who now hold prominent positions in hepatology, including Paul Martin, Mauricio Lisker, Nora Bergasa, Tse-Ling Fong, Mark Swain, Antonia Mangia, Michiko Shindo, Manuel Battegay, Hari Conjeevaram Obaid Shakil, David Herion, Paul Hayashi, and Michael Fried. In 1994, Adrian left the NIH to become professor of internal medicine and associate chairman at Saint Louis University School of Medicine, joining Bruce Bacon, who was division chief of gastroenterology and hepatology. Together, they formed the Saint Louis University Liver Center, ultimately to become one of the most prominent units devoted to research and care of patients with liver disease in the Midwest. Their superb clinical and basic research team grew to include Brent Tetri, Elizabeth (Beth) Brunt, Bruce Luxon, John Tavis, and Jeffrey Teckman, among others. With local start-up funds, Adrian created a hepatitis research laboratory and was successful in receiving NIH funding for support of basic and clinical investigation. Adrian's laboratory focused on aspects of the molecular virology of HCV, the quasispecies diversity of the virus in serum and liver, and the development of a technique for near full-length amplification of the HCV genome. Clinical research of the Saint Louis University liver group focused on iron status and hepatitis C and attracted industry support for clinical trials. A defining moment in Adrian's career came in 1999, when he became a principal investigator in the NIH-funded Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial and was chosen as the chairman of its steering committee. This U.S. multicenter trial enrolled more than 1,000 patients with CHC and advanced fibrosis or cirrhosis and assessed the long-term benefits and safety of IFN-α therapy in patients who were nonresponders or only partial responders to optimal pegylated IFN/RBV–based therapy. His chairmanship of the HALT-C Trial demonstrated his best qualities: persistence; attention to detail; scientific rigor; medical judgment; personal leadership; and major organization abilities. Ultimately, long-term, low-dose IFN therapy was found to be ineffective in improving important clinical outcomes of CHC (cirrhosis, clinical decompensation, HCC, or death)1 and indeed was associated with an excess in all-cause mortality.2 But, at the same time, the HALT-C Trial fostered an enormous amount of clinically useful information and new hypotheses regarding the natural history and complications of CHC, generating more than 75 publications, establishing a standard of excellence in clinical investigation and training a cadre of clinical investigators in liver disease research. The success of the HALT-C Trial was the result of many people, but was, in great part, a result of the persistence, commitment, and organizational talents of Adrian Di Bisceglie. As a member of the AASLD, Adrian has been particularly active in public policy, having been a long-term member and, eventually, chair of the AASLD Public Policy Committee (now called the Public and Clinical Policy Committee). He served as the first medical director of the American Liver Foundation under then-president and CEO Alan Brownstein and made multiple visits to Washington, DC, to the NIH and Capitol Hill, testifying on behalf of liver disease research before Congress and speaking directly to legislators and patient advocates regarding policy and the importance of federal support of liver-disease–related research. Adrian Di Bisceglie becomes the president of the AASLD at a critical time, as rapid changes are about to occur in the U.S. medical care system, policies on screening for liver disease, management and therapy of hepatitis C and B, the level of biomedical research funding, and as fundamental breakthroughs in the understanding of the liver and its diseases are beginning to be translated into effective interventions to prevent or reverse the major causes of liver injury. As a seasoned clinician with experience in both clinical and laboratory research, Adrian is well positioned to appreciate and promote the needs of AASLD members. He understands the critical need to preserve the roots of the association in basic and applied research, but equally understands the need to accommodate a newer generation of members, clinicians who are in the front lines of managing patients with liver disease. As with past challenges, Adrian has the experience, talents, and commitment to take on these tasks and succeed.