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Presentation of the Julius M. Friedenwald Medal to Anil K. Rustgi

2017; Elsevier BV; Volume: 152; Issue: 8 Linguagem: Inglês

10.1053/j.gastro.2017.04.039

1528-0012

Gary W. Falk, Gregory G. Ginsberg, David A. Katzka, Rotonya M. Carr, Kathryn E. Hamilton, Gary D. Wu,

Gastric Cancer Management and Outcomes

Established in 1941, the Julius M. Friedenwald Medal honors an individual who has contributed significantly to the American Gastroenterological Association (AGA) and has made lifelong contributions to the field of gastroenterology. This is the highest honor bestowed upon an AGA member. As members of the Division of Gastroenterology at the Perelman School of Medicine at the University of Pennsylvania, it is our distinct honor to provide this perspective on Anil K. Rustgi, in celebration, as he becomes the recipient of the AGA’s highest honor, the Julius M. Friedenwald Medal. To each of us, Anil is much more than our division chief; he is a colleague, mentor, and friend whom we have known for many years. Herein, we provide a brief glimpse into his upbringing and early career and how this led Anil to become a physician–scientist in gastroenterology who has made enormous contributions to the field through his leadership at Penn and the AGA, his scientific and clinical contributions to the field of GI oncology, and most important, his role as a mentor to many destined to shape the future of gastroenterology. In the end, we believe that you will all agree that Anil K. Rustgi is the epitome of the principals embodied in the Julius M. Friedenwald Medal. Anil was born in New Haven, Connecticut, where his father, Dr Moti Lal Rustgi, was a research associate in physics at Yale. At the age of 2, Anil and his family moved to India. Although he moved back to the United States at age 6, these years had a strong influence on Anil. Their entertainment was spending time with Anil’s large extended family in Delhi. When Anil came back to the United States, he spoke Hindi but he did not speak English. With a hint of things to come, Anil greatly enjoyed baseball statistics and pouring over the newspaper sports sections. He listened to rock n’ roll, with a particular fondness for the Beatles and the Bee Gees but he never forgot the roots of education, inquisitiveness, and hard work taught by his father, mother, and now his brother, Vinod. Dr M. Rustgi held different faculty positions at Yale University, Harvard University, Ottawa, and University of Southern California. He spent much of his career as a professor of physics at the University of Buffalo (1966–1992) where Anil grew up. Dr Rustgi was a world authority on the photodisintegration of the deuteron and other nuclei. Anil’s mother Kamla also held the family to high standards with older brother Vinod who attended Yale University and the Johns Hopkins University School of Medicine on his way to becoming a national leader in hepatology. Vinod also assumed the role of becoming another guiding force in the ascent of Anil’s career. Vinod would grade Anil's book reports mercilessly until he achieved an appropriate grade. By the time Anil went to class, he had already endured the hardest part of his day. Anil attended Yale College. He met and befriended others and thrived in his major of molecular biophysics and biochemistry with a minor in history. After graduating summa cum laude, he matriculated to Duke University Medical School in 1984 where he was elected to the AOA Honor Medical Society and won the Trent Prize in the History of Medicine. It was during a GI fellowship at Massachusetts General Hospital, while in the laboratory of Dr René Bernards, that Anil met Poonam Sehgal. After completing her residency in anesthesiology in New York at Albert Einstein, Poonam and Anil married and she moved to Boston where she joined the faculty at Beth Israel Hospital. Their son Naryan was born in 1996 (at Beth Israel Hospital) and Anil passed on his love for the Boston sports teams, the Celtics and Patriots, to his son. Anil and Poonam moved to Philadelphia in 1998 where they settled in Villanova, Pennsylvania, and their daughter Sabrina was born in 2000. Anil completed his internal medicine residency and chief residency at Beth Israel Hospital (1984-1987), gastroenterology fellowship from MGH (1987-1990), followed by an Instructorship of Medicine (1990-1992) and his first faculty position at Harvard Medical School/MGH (1992-1998). Experiences and mentors who played an important role in Anil’s early career development include Dr Gerhard Giebisch (with whom Anil spent a summer research fellowship at Yale College), Dr Joseph Greenfield (former chair of medicine at Duke University), Dr Eugene Braunwald (former Chair of Medicine at Brigham and Women’s Hospital and Beth Israel Hospital), Dr Lewis Landsberg, Firm Chief at Beth Israel Hospital (before becoming Chair of Medicine then Dean at Northwestern University); Dr Kurt Isselbacher (former Chief of GI and Director of the Cancer Center at MGH), and finally, Dr Daniel Podolsky, then Chief of GI and Vice-Chair of Research in the Department of Medicine and later, also Head of Academic Affairs at Partners, and now President/CEO of UT Southwestern). It was the Yale-Duke-Beth Israel-MGH trajectory that propelled Anil to his current position at the University of Pennsylvania as Chief of the Division of Gastroenterology. Anil has made enormous contributions to the field of digestive disease research based on his own work in the area of GI oncology and for the entire community through his leadership of numerous initiatives at Penn, the AGA, nationally, and internationally. As a leader in the field of GI cancer research, Anil’s group has made seminal contributions to understanding the mechanisms underlying the pathogenesis of several major GI cancers, notably esophageal, pancreatic, and colorectal cancers. Anil’s research is supported by several organizations, but primarily by the NIH, including the NIDDK and National Cancer Institute (NCI). His NIH support comes in the form of R01, P01, P30, T32, U01, and U54, which represent a broad spectrum of funding that are designed for individual projects, collaborative projects, research centers, and training. Importantly, his scientific accomplishments have garnered him numerous awards and recognition, among which are the prestigious American Cancer Society Research Professorships and memberships in the prestigious American Society for Clinical investigation (ASCI) and Association of American Physicians (AAP), to name a few. I (GDW) vividly remember meeting Anil for the first time in my office at Penn in 1998 during his visit as a candidate for division chief. His excitement for this work was clearly evident as he drew diagrams on my blackboard to explain his vision from both a technical and mechanistic standpoint. From Anil’s clarity of thought, his vision of how a complex set of mechanisms could be systematically addressed, his passion and dedication to this project, and his ability to communicate these complex concepts in a lucid manner, it was clear to me that Penn would be very lucky to recruit him as the GI division chief. Two decades later, with more than 200 primary publications and nearly 100 reviews/editorials/commentaries and editorship of 2 textbooks, many in premier journals such as Gastroenterology, Nature, Nature Genetics, Cancer Cell, Genes & Development, Journal of Clinical Investigation, PNAS, Molecular and Cellular Biology, and the Journal of Biological Chemistry, Anil has established himself as an iconic physician–scientist in the field of GI oncology, where he leads interdisciplinary, collaborative research programs in GI cancer biology and genetics related to esophageal cancer, pancreatic cancer, colon cancer, using 3-dimensional organotypic culture models and genetically engineered mouse models. A particular interest is in the tumor microenvironment. His group has developed organotypic cultures that represent significant technical advances in the field that he has shared with the scientific community in 2 publications in Nature Protocols, one entitled, “Isolation and characterization of mouse and human esophageal epithelial cells in 3D organotypic culture” and the other, “Isolation, culture and genetic manipulation of mouse pancreatic ductal cells.” No doubt, Anil’s sharing of these technologies has played an important role in helping to propel the field forward.The mentor: “Tell me and I forget, teach me and I may remember, involve me and I learn.”— Benjamin Franklin Anil leads a division of 65 faculty gastroenterologists, 20 GI fellows, multiple research associates, and more than 200 staff at the University of Pennsylvania and both directly and indirectly supports the research efforts of numerous medical and graduate students and postdoctoral fellows. He is the PI or co-PI of several NIH training grants and Penn educational programs. Without hesitation and from a place of deep humility, Anil states that he sees his own success through the successes of those whom he has mentored. In the spirit of his institution’s founder, Benjamin Franklin, he views effective mentorship as immersing mentees in experiences that cultivate growth. Like a marionette puppeteer, Anil has mastered the art of unleashing the full potential of all of his mentees by providing a timely nudge, individualized opportunities, and words of encouragement. This approach has led to the receipt of numerous NIH-K awards and career development awards for his GI and post-doctoral fellows and young faculty; career independence of mid-level faculty (Figure 1); and countless national and international leadership opportunities for his senior faculty. Anil’s successes have been honored with several mentorship awards including the University of Pennsylvania’s highest mentorship honor, the Arthur K. Asbury Outstanding Faculty Mentor Award, and Penn’s biomedical postdoctoral program Distinguished Mentor Award. In the AGA, he received the AGA Institute Council Gastrointestinal Oncology Section Research Mentor Award in 2013 and the AGA’s Distinguished Mentorship award in 2016. These awards were the results of efforts by his mentees to give a little back to someone held in the highest esteem. Dr Kate Hamilton (Research Associate at the University of Pennsylvania Division of GI) is one such mentee who writes that, “Anil fully embodies the role of the altruistic mentor. He is consistently motivated to improve himself and his trainees and evolves in his thinking when necessary, which is a truly rare quality for someone holding such positions of power.” Another mentee and founding member of the Rustgi lab Dr Hiroshi (Hiro) Nakagawa, MD, PhD (Research Associate Professor of Medicine at the University of Pennsylvania Division of GI), has reflected on his interaction with Anil during the past two decades and testifies that “Anil’s mentorship is truly extraordinary” and that Anil has “set a high standard for him to follow with his own research team.” Among his many talents and strengths, Anil has been a transformative division leader at Penn. During his time as chief, the Penn GI Division (Figure 2) has grown from 15 to 65 full-time physician faculty members at 5 hospitals and an additional 5 satellite centers with substantial growth in clinical and procedural volumes and trainees. The clinical focus of the Division is on the following programmatic areas: inflammatory bowel disease (IBD), hepatology and liver transplantation, advanced/interventional endoscopy, gastrointestinal oncology, esophagology/swallowing, neurogastroenterology/GI motility, celiac sprue/nutrition/obesity, small bowel imaging, and general gastroenterology. Since Anil assumed leadership of the Division in 1998, where he is the T. Grier Miller Professor of Medicine and Genetics, there has been robust growth in the number of patients awaiting liver transplantations and obtaining liver transplants (the program is the seventh largest in the country); improved quality and quantity of endoscopic procedures; and an increasingly complex nature of GI subspecialty consultations in the areas of hepatology, oncology, IBD, esophageal diseases and motility/physiology from local, regional and national referral bases. In 2016, there were more than 40,000 office visits and nearly 40,000 endoscopic procedures of all types. In total, under Anil’s leadership, Penn’s GI division has grown to be one of the largest and most comprehensive programs in the country with preeminence spanning clinical, basic science, and translational domains. Anil is an outstanding clinician who has remained immersed in clinical activity taking regular turns as inpatient consult attending (including call!!), outpatient fellows and GI Genetics Clinic (which he founded), and a routine endoscopy schedule. He is a role model to all in treating patients, trainees, and staff and colleagues at all levels with patience, courtesy, and respect. In addition to leading the GI Division, Anil is also the Director of two Centers at Penn—the NIH/NIDDK Center for Molecular Studies in Digestive and Liver Diseases and Joint Center for Digestive, Liver and Pancreatic Medicine between Penn and Children’s Hospital of Philadelphia. He is also a Co-Program Leader for the Tumor Biology Program at the University of Pennsylvania Abramson Cancer Center. Among dozens of other important administrative roles that Anil has at Penn, he was the Director of 3 programs that play an important role in mentoring the next generation of physician scientists: Physician-Scientist Pathway for Penn Medical Residents, the Doris Duke Student Scholars Program, and the NIDDK year out program for medical students at Penn. Anil has been a long-time member and active contributor to the AGA. His activities are too numerous to catalog, but important contributions are illustrated. Anil has taken a long-term leadership role in AGA meetings having chaired or co-chaired various conferences. He served as Chair of the GI Oncology section, Chair of the Education Committee and was Councilor on the Governing Board. In addition to these activities, Anil was Editor-in-Chief of Gastroenterology from 2006 to 2011. All these contributions culminated in his selection as AGA President from 2013 to 2014. During his time at the AGA, Anil has touched countless individuals around the world. His approach is best captured by the current AGA Executive Vice President, Tom Serena who says the following:Anil exhibited the best characteristics of the servant-leader illustrated clearly by his insistence on including a diversity of perspectives from all stakeholders. He was expansive in his vision, reaching out to non-GI medical specialty organizations in recognition of the growing importance of interdisciplinary health care. Anil emphasized transparency and the need to inform the members about the board's activities through a presidential column in eDigest and communicating AGA's strategic priorities through the journals. He showed his dedication to AGA's mission in a tangible way as a leader and fundraiser in our research endowment campaign. On a personal note, I appreciated the way that Anil connected to others in very personal way, showing interest in their lives and accomplishments. His compassion, dedication and inclusiveness were hallmarks of his service on behalf of AGA and the foundation. These sentiments are shared by former Executive Vice President, Lynn Robinson:Anil’s passion for gastroenterology was a hallmark of his term as President. I cannot think of any other leader who devoted himself so completely to building collaborations among and between gastroenterologists, hepatologists, industry, government, and all related healthcare providers who could or did have an impact on medicine and science. He understood that AGA needed to lead the field, and was an ardent advocate for advancing the role of young GI researchers and clinicians, women in GI, underrepresented minorities, and international members, who were at the early stages of their career. His tireless efforts on behalf of the AGA Foundation, and his own commitment to fundraising, helped secure numerous research grants and programs. He always brought a global perspective to the Board room, and earned the unwavering respect of his peers and the staff. In addition to his outstanding contributions to the AGA, Anil has made substantial contributions to numerous other professional organizations. For example, he is currently a member of the Scientific or Medical Advisory Board of many GI disease-centered organizations including the Pancreatic Cancer Action Network, National Pancreas Foundation, National Colorectal Cancer Research Alliance, and Neuroendocrine Tumor Research Foundation. Mirroring his service to the AGA, Anil’s service to the American Association for Cancer Research (AACR) has been exemplary. He either serves or has served on numerous AACR committees in the last 2 decades. An equally important and major service contribution by Anil is one he renders to the National Institutes of Health (NIH) through study sections, advisory panels and ad hoc task forces. A notable example is his past membership on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Advisory Council, a position appointed by the Secretary of Health and Human Services (HHS). He is past member of the Scientific Advisory Boards for several centers, including those based in Mayo Clinic-Rochester, University of Chicago, Stanford University and Baylor College of Medicine, helping each in their own NIDDK-funded Digestive Diseases Centers. Anil is the epitome of the “quadruple threat” in academic medicine—a preeminent scientist, a compassionate and highly skilled clinician, an educator who has personally trained scores of scientists and clinicians, and a visionary leader who has helped to shape the landscape of gastroenterology at the University of Pennsylvania and across the country through his leadership at the AGA and other organizations. As the recipient of multiple mentorship awards, one of Anil’s greatest legacies will be the profound impact on the next generation of gastroenterologists at Penn, nationally, and internationally where he works with tremendous passion and vision to support the careers of trainees with a special emphasis on women and underrepresented minorities. He is an inspiration and role model to all in the field of gastroenterology as the recipient of the 2017 Julius Friedenwald Medal.