Jeremiah Alt, M.D., Ph.D., a CCTS KL2 scholar and physician-scientist of Native American heritage talks about his perspectives on health care and research.
Has your Native American heritage shaped your professional career in any way?
This is an interesting question that I commonly think about. Early in life, I was exposed to the realities of healthcare access and disparities. Family Native American heritage and membership in the Spokane Indian Tribe granted our family access to free healthcare through Indian Health Services that we would otherwise not have had. This exposure to such a valuable service for my family generated my early interest in health care and my initial motivation to pursue a medical education to contribute to the well-being of others.
What drew you to your field of research?
During my PhD in neuroscience I was interested in understanding how the immune system “talked” to the brain. Specifically, I was interested in why we feel sleepy when we get sick. I discovered that immune signaling molecules signal through sleep promoting areas in the brain that are crucial for recovering from an infectious insult. I was intrigued by the scientific method and the realization that my discoveries in the laboratory had the potential to translate into clinical treatments for patients. After getting my PhD I felt that a medical education would not only afford me the ability to continue discovery, but also grant me a unique skill set to apply my scientific training to the treatment of human disease - the rest is history.
What are you investigating?
Patients with chronic rhinosinusitis have tremendous deficits in overall quality of life that are as severe or more severe than many well-known diseases. In many instances, patients report lower quality of life scores than those with widespread conditions, such as coronary artery disease and congestive heart failure. Furthermore, chronic rhinosinusitis is the most common etiology of olfactory dysfunction (50-69% prevalence) and is used as a criterion for the diagnosis of chronic rhinosinusitis. Despite the wide occurrence of chronic rhinosinusitis and its associated olfactory dysfunction, health risks, and effects on reduced quality of life, its etiopathogenesis is unknown.
It is particularly problematic that no effective therapies for chronic rhinosinusitis associated olfactory dysfunction exist. CRS-associated olfactory dysfunction is likely multifactorial, and growing evidence suggests that it may be secondary to the underlying inflammation present in the olfactory epithelium. Increased inflammatory cell activation and cytokine secretion within the sinuses have been associated with a reduction in neuronal signaling, degeneration of olfactory sensory neurons, and inhibition of neuronal regeneration. From a therapeutic standpoint, our group developed novel anti-inflammatory compounds known as semi-synthetic glycosaminoglycan ethers (SAGEs). These molecules inhibit innate immune signaling, mast cell activation, and pro-inflammatory cytokine expression. Preliminary data shows that SAGE attenuates sinus inflammation and preserves olfactory function. The mechanisms by which SAGE inhibits epithelial inflammation and olfactory dysfunction is currently under investigation.
Have you faced any challenges working both as a scientist and a physician?
I often get asked the question – is the challenge and effort worth it and would you do it again? I commonly start with: I spent 4 years as an undergraduate to get a BS in Neuroscience, 5 years in my postdoctoral work to get a PhD in Neuroscience, I then spent 4 years getting my MD, followed by 5 years of residency training in Otolaryngology, and another 1 year in a Sinus Skull Base fellowship spending 19 years in higher education. My resounding response is YES – I would do it all again just to have the opportunity to take care of one more person suffering and to have the ability to discover a new treatment or cure to affect 1000’s of patients. There are many challenges along the way to become a surgeon scientist with many more in the future. However, the awards of being an academic surgeon scientist far outweigh all of these challenges.