Introducing Ronald J. Sokol, M.D.—our 2018 AASLD president

Dear American Association for the Study of Liver Diseases (AASLD) community, it is my honor to introduce Ronald J. Sokol, M.D., as the 2018 AASLD president. Get ready for a fast-paced year of advances in hepatology under the guidance of our new leader!

Overview

Ron has made significant contributions to the field of hepatology through his clinical expertise, research, mentoring, advocacy, and service within national organizations. Ron is a professor of pediatrics with tenure and the section chief of Pediatric Gastroenterology, Hepatology and Nutrition at Children's Hospital Colorado and the University of Colorado School of Medicine. In addition, he is the Vice Chair of Clinical and Translational Research in the Department of Pediatrics and Director of the Colorado Clinical and Translational Sciences Institute at the University of Colorado Denver, Anschutz Medical Campus. Ron has been a National Institutes of Health (NIH)–funded investigator since 1986 and has received an astonishing $200 million in grant support to date. His major clinical interests are pediatric hepatology and liver transplantation. Ron's scientific interests include the mechanisms of vitamin E deficiency in cholestasis; the role of mitochondria and oxidative stress in liver injury; the mechanisms of liver cell injury in cholestasis, fatty liver, and parenteral nutrition–associated liver injury; the pathogenesis of biliary atresia; and the development of predictive models for rare childhood liver diseases. To that end, Ron has published 250 original articles pertaining to basic science, translational, and clinical research studies in pediatric hepatology.

Early Years and Education

Edith and Max Sokol welcomed Ron into the world on July 18, 1950. He grew up in Chicago, Illinois, and attended Von Steuben High School where, true to his nature, he was an active participant on not one but three varsity teams (basketball, track, and baseball)! Ron obtained a bachelor of science degree with high honors (Phi Beta Kappa) from the University of Illinois and his M.D. from the University of Chicago Pritzker School of Medicine (Alpha Omega Alpha member). He then left his home state for his pediatric residency and chief residency training at the University of Colorado Health Sciences Center, where he was influenced by Arnold Silverman, M.D., one of the first pediatric gastroenterologists in the nation. This was followed by fellowship training in pediatric gastroenterology and nutrition at Cincinnati Children's Hospital Medical Center and the University of Cincinnati. Here he met his first mentor, Dr. William Balistreri, who was instrumental to his early successes in pediatric hepatology clinical care and research. Dr. Balistreri once wrote that Ron was “an insightful clinician who was able to thoughtfully analyze bedside problems and doggedly pursue a solution (personal communication).” To this day he continues to be a master clinician, able to solve and treat the most difficult and perplexing cases of childhood liver diseases.

Research

Ron's research during fellowship training focused on the pathogenesis and treatment of vitamin E deficiency in chronic cholestasis. These investigations led to the discoveries that malabsorption of vitamin E was related to the intraluminal concentrations of bile acids, that the ratio of serum vitamin E to total serum lipids was the most accurate measure of vitamin E status during cholestasis, and that an oral water-soluble form of vitamin E was effective at correcting vitamin E deficiency and reversing the neurologic findings in patients with severe cholestasis. These landmark discoveries resulted in two New England Journal of Medicine articles within 2 years of completion of his fellowship. This work changed the way we diagnose and treat cholestasis-induced vitamin E deficiency in children and adults.

The enticement of the Rocky Mountains (i.e., hiking, skiing, and biking) and the opportunity to perform collaborative, cutting-edge research and to work with Arnold Silverman led Ron back to Colorado and the University of Colorado School of Medicine after fellowship. From the late 1980s through 2006, Ron's laboratory focused on the effects of oxidative stress that occurred in the setting of a variety of liver diseases. Specifically, Ron's group demonstrated the important role of oxidative stress in both hepatocyte necrosis and apoptosis during cholestasis. He discovered that mitochondrial respiratory dysfunction and cell death pathways were essential to this hepatocyte injury and that strategies to block the mitochondrial permeability transition and the use of antioxidants prevented this injury. These pathways were important to the liver injury found in many diseases, including various cholestatic diseases, hepatic copper overload, and hepatic steatosis. Ron had a decade of NIH R01 funding for his work on oxidant hepatic injury in cholestasis and has five patents related to the use of antioxidants in the treatment of cholestasis. In recent years, his laboratory has focused on pathogenic mechanisms of intestinal failure–associated liver disease in the setting of the use of parenteral nutrition. His group discovered gut-derived lipopolysaccharide-activated hepatic macrophages which release cytokines that decrease hepatocyte plant sterol (phytosterol) exporters. This leads to phytosterol accumulation in the hepatocyte, resulting in altered farnesoid X receptor signaling and bile transporter functions. This work was recently published in Science Translational Medicine and Nature Communications.

In addition to over 30 years of running a basic science laboratory, Ron has been a leader in clinical research pertaining to pediatric hepatology. In 1985 he and John Lilly, M.D., founded the Pediatric Liver Center at the University of Colorado, creating an avenue for integrating high-quality multidisciplinary pediatric hepatology care (with pediatric surgery and nutrition) with clinical and translational research. This was one of the first pediatric liver centers established in the United States. A major research focus of Ron's over the past decade has been defining the etiology, pathogenesis, best management strategies, and outcomes of childhood cholestatic liver diseases. Ron was instrumental in raising awareness at the NIH of the need for research in pediatric liver disorders. In this regard, he has chaired the National Institute of Diabetes and Digestive and Kidney Diseases/NIH–supported Childhood Liver Disease Research Network for the past 15 years and has been a major investigator in longitudinal studies of etiology, natural history, complications, and outcomes as well as clinical trials performed in eight rare cholestatic liver diseases, including biliary atresia. A born leader, Ron guides this network in a truly collaborative spirit—with compassion, efficiency, and high productivity (>70 publications to date have originated from the network). Moreover, in his past research collaborations he has made significant contributions to networks involved in pediatric acute liver failure (Pediatric Acute Liver Failure Study Group) and liver transplant (Studies of Pediatric Liver Transplantation). Based on his expansive expertise in pediatric hepatology and related research, Ron has been an invited national and international speaker 356 times!

Mentoring and Teaching

Without question, Ron should be proud of the impact he has had on nurturing the future of physician scientists and ensuring a pathway for success for trainees and junior investigators. In 2008 he was awarded the directorship and named the principal investigator of the NIH Clinical and Translations Science Award–funded Colorado Clinical and Translational Sciences Institute (refunded in 2013 and 2018). This encompasses developing and implementing training programs and funding mechanisms to promote and facilitate clinical and translational research and education at the University of Colorado Denver and affiliated organizations. His leadership in this institution has transformed the clinical and translational research environment and training programs at the University of Colorado, its six affiliated hospitals, and multiple statewide health care organizations.

In the pediatric hepatology arena, Ron has fostered the careers of countless transplant hepatologists through his educational and research collaborations. He is the strongest of advocates for the teaching and education of pediatric gastroenterology fellows. Within the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), Ron commissioned the preparation of the very first training guidelines in pediatric gastroenterology, published in the Journal of Pediatric Gastroenterology and Nutrition. Ron is an editor of the leading textbook in pediatric hepatology, Liver Disease in Children, and has published over 250 original papers, 121 chapters/review articles and 12 books/monographs that have educated thousands of clinicians and investigators worldwide.

In working with Ron for the past 15 years I have observed firsthand the critical role he plays in educating and mentoring trainees. He does not just teach the basic facts of pediatric liver disease but encourages one to critically evaluate the literature and manage patients centered on evidence-based medicine. Throughout his career Ron has taught medical students, residents, fellows, and junior attendings the fine intricacies of liver physiology and pathophysiology through formal lectures, participation in journal clubs, and inpatient and outpatient clinical experiences. Ron gives his research mentees, including myself, the courage to believe in their ideas and, as he once stated, “go out on a limb—let people know about the new ideas you have.” He encourages mentees to think outside the box and challenges us to pursue opportunities that, without his guidance, would have seemed unattainable. His excellence in teaching was recognized in 2015 with the Career Teaching Scholar Award from the Department of Pediatrics, University of Colorado School of Medicine.

Ron created the Pediatric Gastroenterology Fellowship Training Program at Children's Hospital Colorado in 1993 and was the director of this program until 2004. He has been the principal investigator of the NIH T32 Training Grant for Pediatric Gastroenterology at the University of Colorado since 2005 and has mentored 42 pediatric gastroenterology and hepatology fellows-in-training. Under his guidance, a remarkable 81% of T32 trainees have attained academic positions. Many of these fellows have gone on to have highly successful careers as physician scientists and leaders in the field of pediatric hepatology.

Service

Ron is a consummate leader within societies aimed at advancing the field of pediatric hepatology. He is a past president of NASPGHAN and has chaired numerous NASPGHAN committees and national and international educational conferences. During his NASPGHAN presidency he was instrumental in initiating the Children's Digestive Health and Nutrition Foundation, which provided research funding for young investigators. He led the negotiations that resulted in the creation of the first World Congress of Pediatric Gastroenterology, Hepatology and Nutrition in 2000, an international pediatric gastroenterology meeting bringing together societies from North America, Europe, Latin America, and Asia. Ron considers the AASLD his scientific home and has been actively involved with the AASLD since 1984. He has served as a member and/or chair of 18 AASLD committees throughout the years, organizing symposia, presenting research and invited talks at The Liver Meeting and other venues, as well as developing the Innovation Award program as councilor. He has participated in an extensive number of state and national committees, task forces, and commissions related to advancing the science and clinical care issues within pediatric gastroenterology and hepatology. This includes community service and activities related to public health within the American Liver Foundation, the Alpha One Foundation, and the Cystic Fibrosis Foundation, to name a few.

Family Life

Throughout his career Ron has been blessed with the everlasting support of his loving family, which includes his wife Lori and his sons Skylar and Jared. He takes great joy when describing what his boys are up to, whether it is their incredible skills in playing a musical instrument, performing magic tricks, or excelling in their education. “The apple doesn't fall far from the tree” as Skylar is now a software engineer and Jared is currently attending the University of Chicago Pritzker School of Medicine (his father's alma mater).

Summary

Ron is a one-of-a-kind individual who has endless energy and enthusiasm for all that life brings him. He is an incredibly accomplished clinician, researcher, mentor, administrator, advocate, and leader. He has received ∼40 honors and awards throughout his career, including the March of Dimes Basil O'Connor Award, the American Academy of Pediatrics Nutrition Award, and the NASPGHAN Harry Shwachman Award for major, lifelong scientific contributions to the field of pediatric gastroenterology, hepatology, and nutrition. In 2010 he received the Arnold Silverman, MD Endowed Chair in Digestive Health from the Department of Pediatrics, Children's Hospital Colorado. For those of us who have worked with Ron over the past few decades, we are convinced that he has actually cloned himself and that there are really approximately 10 “Rons” working at one time to accomplish all that he does for his family, his Pediatric Gastroenterology section, the Department of Pediatrics, the University of Colorado, the field of pediatric hepatology, and now as our AASLD president.