‘Look for the Right Mentor’

‘Look for the Right Mentor’

Meet the Champions Pancreatology 2007;7:3–6 DOI: 10.1159/000101872 Published online: April 18, 2007 ‘Look for the Right Mentor’ An Interview with Pr...

123KB Sizes 0 Downloads 78 Views

Meet the Champions Pancreatology 2007;7:3–6 DOI: 10.1159/000101872

Published online: April 18, 2007

‘Look for the Right Mentor’ An Interview with Prof. Manfred V. Singer

Martin E. Fernandez-Zapico Gastroenterology Research Unit, Saint Mary’s Hospital, Mayo Clinic College of Medicine, Rochester, Minn., USA

Abstract Prof. Manfred V. Singer, a pioneer in the field of neuro-hormonal regulation of pancreatic exocrine secretion, is interviewed. He provided the first experimental proof of the existence of neural reflexes that control pancreatic functions. Here, Prof. Singer shares his life experience in pancreatic research and points out key aspects of a successful mentormentee relationship. Copyright © 2007 S. Karger AG, Basel and IAP

M.F.-Z.: What initiated you to work in pancreas re-

search in the first place? M.S.: At the beginning of my professional career, I was very lucky to meet three outstanding pancreatologists, clinicians and scientists: Dr. Harald Goebell, Chairman and Professor of Medicine at the University of Essen; Dr. Henri Sarles, Chairman and Professor of Medicine at the University Aix-Marseille and Director of the Unité 31 of the Institut National de la Santé et de la Recherche Médicale (INSERM) in Marseille (France); and Dr. Morton I. Grossman, Professor of Medicine and Physiology, University of California at Los Angeles School of Medicine, and Director of the Center for Ulcer Research and Education (CURE) at Wadsworth Hospital Center in Los Angeles, California. Harald Goebell, who later became my clinical mentor and supported me during my whole academic career, recommended to me in 1975 to join the group of Dr. Henri Sarles in Marseille. Henri Sarles was one of the first clini-

© 2007 S. Karger AG, Basel and IAP 1424–3903/07/0071–0003$23.50/0 Fax +41 61 306 12 34 E-Mail [email protected] www.karger.com

Accessible online at: www.karger.com/pan

cians and researchers who had focused their scientific interest on elucidating the clinical and pathophysiological aspects of alcoholic pancreatitis. Besides the Department of Gastroenterology, Henri Sarles had established the Unité 31 of the INSERM, which dealt with a broad spectrum of pancreatic physiology, pathophysiology, biochemistry and epidemiology. He had attracted many fel-

Martin E. Fernandez-Zapico, MD Gastroenterology Research Unit, 2-435 Alfred Building Saint Mary’s Hospital, Mayo Clinic College of Medicine Rochester, MN 55905 (USA) Tel. +1 507 255 6029, Fax +1 507 255 6318, E-Mail [email protected]

lows and scientists from Europe and South America. One of them was Dr. Osvaldo Tiscornia, Professor of Surgery and Anatomy in Buenos Aires (Argentina), who had profound insights into the duodenopancreatic innervation of the pancreas and who postulated the existence of the ‘pancreon’. Osvaldo Tiscornia was an excellent animal experimenter, who taught me how to perform pancreatic research on dogs in their fully awake states. Henri Sarles was not only a very energetic clinician and researcher who seemed to possess no limits to his mental and physical energy, but was also the most broadly educated French professor, capable of reading in Latin the Summa Theologiae by Thomas Aquinas. He and his wife Janine created the most wonderful atmosphere in their hospitable town and country houses, allowing fellows and their wives to enjoy the best of French cultural life. Henri Sarles’s belief in my research potential was therefore very crucial for my becoming a researcher. Another of my most eminent teachers was Dr. Morton I. Grossman in Los Angeles, California. Morton I. Grossman was a Homo scientificus par excellence. I think it was impossible for him to talk about any given subject, be it cultural, political, religious or even sports, without an intellectual scientific approach. When I started my work in Los Angeles on February 2, 1977 – early in the morning, since I knew that Mort came to the office already at 4 a.m. – M. Grossman welcomed me with these words: ‘Hi, Manfred, welcome to Los Angeles. What did you do in Marseille?’ Without delay he began discussing my physiological studies in Marseille and our common plans for the experiments in Los Angeles. Mort had a great impact on my scientific work, since he taught me to ask the right questions, to design the appropriate experiments and to base the conclusions on the results obtained. Thus, he stimulated me to do systematic studies and to provide as much experimental evidence as possible to answer some basic physiological questions. To be a part of the CURE and to work closely with Travis Solomon, who was my comentor, and John Walsh, who later became director of the CURE, as well as many visiting professors and fellows from all over the world, was one of the greatest experiences of my professional life. My wife Barbara and our little boys Christoph (7 years) and Oliver (4 years) very quickly overcame the cultural shock of the transfer from Southern France to Los Angeles and enjoyed ‘easygoing sunny California’. The three years of my research fellowships in Marseille and Los Angeles from October 1975 until June 1978 had a great impact on my professional and personal life and created the platform for my future research at the Univer4

Pancreatology 2007;7:3–6

sity of Essen in Germany. Fortunately, these fellowships and my research in Essen and later at the University of Heidelberg were supported by grants from the German Society of Research (Deutsche Forschungsgemeinschaft), to which I am most grateful. M.F.-Z.: You have pioneered pancreas research in so many directions. At the end of the day, what has given you the most personal satisfaction? M.S.: As far as science goes, my answer to your question is straightforward: the experimental proof of the existence of enteropancreatic vago-vagal reflexes mediating the early pancreatic enzyme response to intestinal stimulants is the most satisfying experience. My interest in the neurohormonal control of the exocrine pancreas was already stimulated in Marseille, but the studies in Los Angeles in dogs with pancreatic fistulas allowing us to directly measure the latency of pancreatic enzyme response to intestinal amino acids, fatty acids and HCl were the crucial experiments to prove the existence of enteropancreatic reflexes already put forward by the Russian physiologist Ivan Pavlov in the 19th century. After my return to Germany in 1978, in the following years my coworkers and I characterized these enteropancreatic reflexes as long vago-vagal, cholinergic reflexes involving acinar muscarinic receptors of the subtype M1. We also showed that these enteropancreatic reflexes are quantitatively significant mediators of the overall response of the pancreas to a meal [Singer MV, et al: Am J Physiol 1980;238:G23–G29 and Gastroenterology 1986; 90:355–361]. To differentiate between nervous and hormonal mediators of pancreatic exocrine secretion we performed a series of additional experiments in dogs in which either the pancreas itself or the small intestine were completely extrinsically denervated or autotransplanted in situ. These physiological studies together with electron microscopic examinations suggested that the pancreas has its own ‘little brain’ in a manner similar to the small intestine [Singer MV, et al: Gastroenterology 1989; 96: 925– 934; Hüchtebrock HJ, et al: Pancreas 1991;6:1–8; Niebergall-Roth E, et al: Am J Physiol 2000;279:G411–G416 and Int J Pancreatol: 2000; 28:83–90]. Thus, the pancreas is capable of controlling its exocrine secretion without a direct influence of either the brain or the extrinsic pancreatic innervations. As far as clinical pancreatology is concerned, I have been very much interested in the pathogenesis of chronic alcohol-induced pancreatitis. In 1979 I started a review on the effect of alcohol on the pancreas and other gastrointestinal organs. To my great astonishment I found only Meet the Champions

a few publications in which alcoholic beverages (which we usually drink) had been investigated in humans or animals. This stimulated a research area which I pursue even today with great enthusiasm and satisfaction. In a series of systematically performed studies in humans we characterized the dose-response relationship between ethanol and alcoholic beverages on the one hand and the gastric acid response and the release of gastrointestinal hormones on the other. We showed that only alcoholic beverages produced by alcoholic fermentation (e.g. wine) but not those produced by distillation (e.g. whiskey) are very strong stimulators of gastric acid secretion. Surprisingly, it is not the ethanol content in the alcoholic beverages produced by alcoholic fermentation which is responsible for their stimulatory actions on gastric acid secretion but two small dicarboxylic acids, succinyl acid and maleic acid. As far as the action on the pancreas is concerned, there is some evidence that both in humans and rats pancreatic enzyme output is stimulated by these two dicarboxylic acids [Singer MV, et al: Gastroenterology 1987;93:1247–1254; Teyssen S, et al: J Clin Invest 1999;103:707–713]. The finding that nonalcoholic ingredients in alcoholic beverages are important stimulants of the gastrointestinal organs has opened a new field of research with – most likely – great relevance for the pathophysiology of alcohol-associated gastrointestinal diseases. Meanwhile, at the University Hospital of Heidelberg in Mannheim, where I have been working since 1990, I have been trying to establish an Institute for Biomedical Alcohol Research, which will focus on alcohol-associated diseases of the pancreas and liver. Currently no such institute exists in Germany, in contrast to the USA and the Scandinavian countries. Fortunately, a private German foundation endowed us with a chair for research in alcohol-associated diseases. M.F.-Z.: Based on your experience as mentee and mentor, can you comment on the value of mentorship for the development of new investigators? M.S.: I think I have already given you the answer to this question with the description of my mentors at the beginning of this interview. Meeting these three outstanding scientists and clinicians was crucial for my whole academic career. It was not only the scientific qualities but also the whole personality of my mentors which strongly influenced me. In addition, it has been a great personal satisfaction to have worked in foreign countries and hence to have had the opportunity to meet so many wonderful investigators from different countries, make new friends and get a better understanding and apprecia-

tion of the different lifestyles. I enjoy very much being a part of the international medical and scientific society. M.F.-Z.: What is the best advice you have received during your career? What is your advice to the young investigators that are beginning in the field of pancreas research? M.S.: My advice to young investigators is (1) to look for the right mentor, (2) to go for quality, and (3) to focus on one scientific subject. Sometimes the search for the right mentor might turn out difficult, but the institution where the scientist is working and his/her publication record, as well as his/her reputation within the scientific community, are some of the helpful guides for such decisions. Once the young scientist has found his/her research subject, he/she should focus on the research topic and try to develop it over the years. It is my firm belief that this is the best way to answer some of the basic physiological and pathophysiological questions. On the other hand, don’t be too narrow-minded. Once you are quite firm in your subject, dare to look over ‘the garden fence’ and try to understand the questions and methods in another scientific field and even adopt and adapt some of the methods for your own research. M.F.-Z.: What do you think are the big questions to be answered in pancreatology? M.S.: There are many questions still waiting for adequate answers. I will stick to my research areas. Basic physiological questions of the neurohormonal regulation of pancreatic exocrine secretion both in the intact animal as well as on the cellular and intracellular level are still to be answered. The relative contribution of the different neuronal components and of hormones as well as of paracrine mediators to the pancreatic response to a meal are yet to be fully understood. The nature of the enteric stimuli that selectively activate either the excitatory or the inhibitory components of the enteropancreatic innervation is still unknown. Neurochemical investigations have revealed a number of peptides and other neuroactive substances in the nerve cell populations of the pancreas. However, we have yet to determine the physiological significance of these substances as neurotransmitters of these cells. Further investigation of the interaction pathways between these neurotransmitters could contribute to the understanding of the integration and/or summation of vagal, sympathetic, enteric and intrinsic pancreatic signals. In humans the role of the pancreatic innervation in pathophysiological processes such as acute and chronic pancreatitis and even pancreatic cancer remains to be elucidated.

Meet the Champions

Pancreatology 2007;7:3–6

5

As I have previously alluded to, another field which has not yet received the scientific interest it deserves is the study of the effect of nonalcoholic ingredients in alcoholic beverages on the pancreas. We need to know the physiological and the pathophysiological actions of different congeners in fermented and distilled alcoholic beverages on the pancreas (and on other gastrointestinal organs). Some nonalcoholic ingredients, e.g. polyphenols, have been shown to have some cardioprotective action. Xanthohumol, a constituent of hop extract, has been found to inhibit inflammation and tumor growth in vitro, and we have shown that maleic acid and succinic acid are potent stimulants of gastric acid secretion. Further studies might detect some nonalcoholic ingredients present in alcoholic beverages with a direct toxic effect on pancreatic cells. Removing these chemical agents from these beverages to protect the pancreas might be possible in the future. For the time being, however, this is mostly speculative.

M.F.-Z.: What do you think is the major need that a journal like Pancreatology should fill? M.S.: As you know, Clem Imrie and I were the last Editors of the International Journal of Pancreatology and the first Editors of Pancreatology from 2001 to 2004. In 2000 the International Association of Pancreatology decided to choose S. Karger as a new publisher for its journal. Clem Imrie and I were charged with managing the transfer of the journal and creating the new journal Pancreatology, which should attract many scientists and clinicians. The years from 2000 through 2004 were a very exciting period in my life. Together with the Editorial Board, Clem and I succeeded in creating a new exciting journal providing rapid publication of excellent scientific papers from basic and clinical research as well as presenting a platform for education in the whole field of pancreatology. I see with great satisfaction that our successor as Editor-in-Chief, Raul Urrutia, is pushing the journal in the right direction with new ideas.

Martin E. Fernandez-Zapico, MD Scientific Editorial Assistant

6

Pancreatology 2007;7:3–6

Meet the Champions