Hector D. Molina, M.D.,
seeks links between miscarriages, the immune system
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Hector D. Molina, M.D., seeks links between miscarriages, the immune system |
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Unshrouding the mysteries
of miscarriages Hector D. Molina thinks a percentage of them may happen because of an abnormaility in the mother's immune system By Darrell E. Ward Hector D. Molina, M.D., assistant professor of medicine and of pathology and immunology, was 18 and an undergraduate at the University of Puerto Rico when his grandfather died.
The event solidified his decision to enter medicine. Today, Molina is a physician and researcher and has done groundbreaking work on the possible role of the immune system as a cause of some miscarriages. Molina graduated magna cum laude from the University of Puerto Rico in 1981. He also attended medical school there, graduating in the top 10 percent of his class. In 1988, he came to Washington University for a fellowship in rheumatology, the branch of medicine that treats a range of diseases that affect the joints. His interest in science and the workings of the human body began as a young boy, and when not playing baseball or basketball, he read from the family's encyclopedia. He read biographies, too, and especially enjoyed those of scientists like Edward Jenner and Louis Pasteur, who eased fear and suffering through research. "I dreamed of helping humanity in the same way," he recalls. His mother, a housewife, and his father, an administrator with the Puerto Rico Department of Health, encouraged him and his younger sister, Irma Molina, to attend college and medical school. She now is a physician in Puerto Rico.
Molina wanted to learn how the complement system was regulated and what role it played in inflammation and in autoimmune diseases such as lupus and rheumatoid arthritis. To explore these questions, he engineered a strain of mice missing one copy of the gene for a protein known as Crry, which helps regulate the complement system. His research took an unexpected turn when he bred the mice: Those offspring that completely lacked the Crry protein were lost through miscarriage. This stunning discovery provided new insight into an old question: Since half the genes in a fetus come from the father, why doesn't the mother's immune system recognize the fetus as foreign and reject it? In mice, Molina hypothesized, the Crry protein protects the fetus from the mother's immune system. "When that protein was completely missing," he says, "the mother's complement system recognized those fetuses as foreign and destroyed them." To confirm his hypothesis, Molina engineered mice whose complement system did not work and who lacked one copy of the Crry gene. When these mice reproduced, all of their offspring had a deficient complement system and some also had no Crry whatsoever. The mice without Crry survived, showing that it was in fact the presence of a healthy complement system that led to miscarriages in the first strain of mice. These findings made national news and, this year, Molina received a prestigious Burroughs Wellcome Clinical Scientist Award in Translational Research, which provides $150,000 per year for five years for continuation of his work. "We now want to relate what we saw in mice to women who have recurring miscarriages without an identifiable cause," he explains. "We think that a percentage of human miscarriages may happen because of an abnormality in the mother's immune system."
"Hector doesn't cut corners or go for the fast advance," says John P. Atkinson, M.D., the Samuel B. Grant Professor of Medicine and professor of molecular microbiology. Atkinson was head of the Division of Rheumatology in 1988 when he recruited Molina for the clinical fellowship program. "He's careful, methodical and asks important questions," Atkinson continues. "His work represents some of the most important studies in the field of fetal-maternal tolerance in the last decade. In addition, he collaborates with many other investigators, and he's always fair in his dealings with others. He treats people like you yourself would want to be treated." Molina spends about 80 percent of his time doing research, with the remaining time spent seeing patients. "Making a diagnosis and providing treatment is always refreshing and rewarding," Molina says. But, he adds, those two activities require different skills: Making a correct diagnosis requires broad knowledge of medicine, but successfully treating the disease also requires a strong bond of trust between physician and patient. "Making that relationship happen is kind of an art, and that can be very rewarding," he says. "Patients have to trust that I am advising them for their best interest, and I have to trust patients to tell me when they don't take medications as prescribed." Molina credits much of his success in medicine to the caring mentors he had along the way, including here at the University. They include people such as Atkinson and Wayne M. Yokoyama, M.D., the Sam J. Levin and Audrey Loew Levin Professor of Research in Arthritis and professor of pathology and immunology. "Mentors," Molina says, "help you see what is important in what you are doing. They teach you how to do science, and they teach you the moral and ethical aspects of science. They also serve as people you can look up to." Molina himself mentors students through his research and as co-director of the Lucille P. Markey Special Emphasis Pathway in Human Pathobiology, a two-year program offered by the Division of Biology and Biomedical Sciences to provide graduate students and postdoctoral fellows with a deeper understanding of the nature of disease. "We all think very highly of Hector," Yokoyama says. "He's heavily involved in the Markey program. As a physician, he understands clinical medicine, so he can help expose Ph.D. scientists to problems seen in the clinic. In addition, his research involves taking clinical issues back to the laboratory, which again enhances his work in the Markey pathway." According to Molina, "My most important mentor is my wife, Irma. All that I do now is because of her support and encouragement." The couple met in medical school and married in December 1984. She now is a pediatrician in private practice in St. Louis. The couple has two sons, Alex, 11, and Kevin, 8, with whom Molina enjoys playing baseball and basketball. Ask Molina what he does to relax and he replies without hesitation and with a wide smile: "Play music, Latin jazz." He is the keyboardist for the band "Latin Touch," which performs for weddings, nightclubs and charity fund-raisers. These diverse opportunities, both academically and socially, are why Molina is happy to call St. Louis "home." "Washington University is a wonderful place to work," he says. "I have great colleagues and mentors, and the fact that I am here at one of the best universities in the nation really helps develop collaborations with colleagues at other universities." Molina still hasn't forgotten his grandfather, though. "When confronted with a particularly challenging or difficult case," he says, "I think of my grandfather and tell myself that I couldn't help him, but I can help this person."
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