A conversation with Dr. Jaroslaw Aronowski, Professor, University of Texas HSC at Houston, McGovern Medical School, Department of Neurology, Vice Chair for Research, Roy M. and Phyllis Gough Huffington Chair in Neurology, and 2017 recipient of the Thomas Willis Award for his work on acute cerebral ischemia, intracerebral hemorrhage, and neuroinflammation, in recognition of National Stroke Awareness Month.
Interviewed by Dr. Alexis N. Simpkins, Assistant Professor of Neurology, University of Florida School of Medicine.
They will be discussing Dr. Aronowski’s career path and research, including his advice to young researchers and clinicians working in the field of stroke.
Dr. Simpkins: What drew you to the field of stroke and research early in your career?
Dr. Aronowski: Since my childhood, I was fascinated by the brain and by the complexity involved in how it works. My first steps with neuroscience were to work on opioids and mechanisms associated with opioid dependence. On this topic, over 30 years ago, we demonstrated that there could be a cross talk between the immune system and CNS that drives opioid dependency. It was rather unorthodox to connect CNS with the immune system these days. Looking back, it was an amazing environment at the University of Texas in Houston that triggered my interest and curiosity about stroke. This is primarily because of Jim Grotta, who just started developing his Stroke Program at UT. Together, with Grotta, about 30 years ago, I started to build my journey and adventure with translational stroke. All this happened during exciting days when we (the stroke community) have just started to investigate ideas that rt-PA could be used to treat stroke. Another important stimulus for me was daily interactions with many bright stroke fellows who rotated in the basic research lab and who brought great amount of energy, curiosity and translational value to the animal research as a model to test novel treatments for stroke. Lewis Morgenstern (later faculty in the department) was particularly an important contributor to my future interest in the pathogenesis of ICH.
Dr. Simpkins: The depth and breadth of your contributions to research in cerebrovascular disease is extraordinary. What do you feel are your most important discoveries?
Dr. Aronowski: I believe that we were one of the first in the field of stroke who tried to pose a rather obvious question: Could the recovery after stroke (and primary ICH) be improved by the enhancement of the endogenous cleanup process that is normally conducted by the phagocytic cells, such as macrophages and microglia? Can we modulate microglia in the brain to promote better outcome? In addition, I believe that our studies with transcription factors in stroke helped to bring closer realization to the fact that in order to effectively protect the brain, a therapeutic approach should demonstrate pleiotropic effect and benefit all the cells within the neurovascular unit.
Dr. Simpkins: What do you see as the most important barriers to overcome now in translating research to the bedside?
Dr. Aronowski: We need to focus on developing better animal models that could more accurately model stroke. From the biochemical pathways point of view, we should more frequently use humanized mouse models and pay closer attention to the long-term outcome (recovery) including effect on the cognitive functions. The next important task is to improve our understanding of how peripheral organs such as guts, heart, spleen, muscles, or lungs (often constituting various comorbidities) interact with the brain after stroke. Sex differences need to be better outlined.
Dr. Simpkins: Where do you feel will be the future direction of stroke research?
Dr. Aronowski: There is no dispute that the most important task of ischemic stroke is to achieve full recanalization of the occluded vessel, as well as to effectively support reperfusion at the microvascular level. Thus, more research should be devoted to better understanding of the reperfusion (e.g., prevention of the secondary occlusion) and collateral flow. In case of ICH, more effort should be devoted to studies on how to clear blood from the affected brain. We now already appreciate the important role immune responses play after stroke; however, much more needs to be established to understand this complex system. Especially regarding how peripheral immune responses (e.g., bone marrow, lymph nodes, and guts) affect responses within the brain.
Dr. Simpkins: You have mentored many successful researchers and clinicians. What advice would you have for yourself now if you were a starting in academia as a clinician or as a researcher?
Dr. Aronowski: We all are getting too busy day after day in our professional lives. This makes it very difficult to find time for carrying multiple assignments. Thus, first we should start from focusing on one or two tasks and execute them to the perfection. One of the main predictors of success is to stay focused and be fascinated with the topic of your research. Try to participate in activities that allow you to be the judge of research done by others. Help your senior colleagues to review papers. Stay proactive. Many journals, including Stroke, are now engaged in educational missions by recruiting into the review process so-called “trainee reviewers.” Ask your senior colleague to nominate you for this position, or ask the editorial office directly. If possible, ask your mentor if you could help in writing his/her grants. This helps in becoming more critical toward your own work and self-demanding. Work hard and have fun. Being a researcher is a lifestyle, not a job.
Dr. Simpkins: What do you feel were your most consequential decisions in your career?
Dr. Aronowski: I believe that the most important decision for me was to stay in Houston with a UT Stroke group of some most dedicated clinical and basic science researchers. It is almost impossible to do translational research without having daily interaction with the clinical group, fellows and the other research crew. On a more specific note, I think that focusing on pathobiology of ICH was a very important and rewarding step in my career.
Dr. Simpkins: What advice do you have for new investigators on conducting impactful research?
Dr. Aronowski: Make sure that your research explains the mechanisms. Descriptive research only adds to the complexity. Your goal is to make things simpler and to link pieces together. When trying to find explanation, assume that in most situations the response directed by our body is to make things better. Try to take advantage of that.
Dr. Simpkins: Thank you for sharing your journey, giving your advice, and participating in the Blogging Stroke interview.