Growing up, Dr. Fernando Martinez saw healthcare from both the patient and the healer perspective. He would hear his mother wake up in the middle of the night, crippled by severe asthma. He watched his father, a pediatrician, devotedly work to help children.
Later, inspired by both his mother and his father, he chose his career path: a pediatrician and researcher specializing in asthma research. It was a fortuitous decision to merge the two; Martinez and his colleagues at the Arizona Respiratory Center would go on to discover that asthma is a developmental disease that begins in the first few years of a child’s life.
“It is in childhood that we find the roots of the disease,” he said. “And it will be addressing these roots that we will be able to understand what causes the disease.”
Uncovering the roots of asthma is just one of the many achievements in respiratory illness research that has emerged from the work being done by the Center’s almost 100 person staff in Tucson.
The Arizona Respiratory Center, led by Martinez, is one of the leading centers for respiratory illness research in the world. Every year, the center receives $8 million in funding from the National Institutes of Health, close to 15 percent of the total funding UA’s College of Medicine receives from the NIH.
“It’s rare for a center that studies a specific disease to receive such a large amount of money,” he said.
Arizona has long been thought of as a place with a climate suited for those suffering from respiratory illnesses. When UA’s College of Medicine was founded, it received a special grant from the NIH to establish the respiratory center, committed to studying the illnesses plaguing those who moved to Arizona for respite.
Less than a decade later, Martinez arrived at the center and began to climb the ranks. In large part because of the work he and his colleagues in Tucson have done, asthma has been listed by Arizona’s Bioscience Roadmap as a strength that could help the state leapfrog on to the international bioscience stage.
“The Arizona Respiratory Center offers a growing platform, with existing capabilities for supporting population genetics analysis and other research endeavors,” the Roadmap reports. “A key resource strength in Arizona is its access to population groups affected by asthma and other related respiratory diseases, including Hispanics, elderly, and American Indians.”
To build on these strengths, an asthma platform committee has been formed. It held its first meeting this past month to begin identifying how to turn Arizona into a destination for asthma research, treatment, and prevention studies.
That committee, comprised of scientists from institutions across the state, is co-chaired by Martinez.
It has been more than 20 years since Martinez, the Swift-McNear Professor of Pediatrics at UA, came to Arizona and decided to stay put. Now this Chilean-born asthma researcher who helped the Arizona Respiratory Center achieve international acclaim, has begun to play a key role in doing the same for statewide asthma research.
After a long trip to Israel and then Ontario, Martinez sat down with us to tell us more about his inspirations, his vision for Arizona asthma research, and the science behind it all.
You were born in Chile and later moved to Italy to receive your medical degree. What then brought you here to Arizona?
I arrived in Italy in 1973 and there I had done some work on the epidemiology of respiratory diseases that had been published in international journals. Through this interest, I came into contact with people from the University of Arizona interested in this same area of research, looking at what factors are associated with childhood asthma. They invited me to spend one year with them. I came and stayed for twenty. Once I arrived in Tucson and discovered we could all do important things together, I stayed on.
What sparked your interest in asthma?
One of the things that I remember best from my youth, my earliest youth, was my mother who had severe asthma. I remember vividly, I must have been 3 or 4, my mother waking up in the middle of the night with an asthma attack and having to treat herself with one of those handheld plastic nebulizers. I was too young to understand what was going on; I just saw my mother struggle to breathe. I was told by my father that there was really no solution to this problem. And so as child, I thought I would dedicate my personal efforts to finding a cure for this disease that was so anguishing for my mother.
Why did you decide to focus on children?
My father was a pediatrician. And one of the things I learned later, when I became older, was how interesting my father’s work was—to take care of children and alleviate their suffering. He inculcated the importance of that in me. And I merged these two sources of inspiration—my mother having severe asthma attacks, and my father dedicating his life to the health of children—into the work I do today.%pagebreak%
Looking back on your history in asthma research, what are you most proud of?
I feel most proud of developing a team of researchers here at the University of Arizona that has been dedicated to understanding what causes asthma and what we can do to find a cure of this disease. No researcher works in a vacuum, and I’m proud a team has been established here that was able to do that. We have made some big, important contributions to understanding the causes of asthma, contributions that are now adopted by the scientific community.
Can you talk about some of those contributions?
Our center discovered that most people have symptoms of asthma in the first years of their life—it is a developmental disease. This is now accepted by asthma researchers around the world. And what that finding has indicated is that if we will ever be able to prevent the disease, we will have to concentrate our efforts in the first years of a child’s health. Our center first described how persons who will go on to develop the severe form of asthma, develop allergies very early, sometimes even before the time they develop their first asthma symptoms. From our point of view, what is happening is that there is an abnormal response of the immune system. Meaning, from the very early stages of life, a child’s immune system matured abnormally.
The second contribution our center has made to asthma research is we have discovered that these very young children who will go on to develop asthma have a genetic predisposition, or susceptibility, to the disease. However, it’s not the genes themselves that cause the disease, so what is it that happens? These people have this genetic heritage and background that makes them susceptible to exposures that they either receive or do not receive in the first years of their life. Depending on what their susceptibilities are, certain exposures may either lead to asthma or prevent it.
Can you give an example of what an exposure might be?
For example, we now know that if you take your child to a daycare during the first months of his or her life, that child may be less likely to have asthma later in life. During the beginning of life, that child will have more respiratory illnesses, but it is that same exposure that trains their immune systems what to react against and what not to react against. They react to diseases but not to allergens. But not all children are equally protected by daycare. You need to have the right genetic background so you respond the right way when you go to daycare.
So what are the implications of these findings for the future of asthma research?
What we are trying to do in the future is find, if you get exposed to something, which are the genes that will increase the likelihood of developing a disease like asthma, or vice versa. Then we can give the right exposure to the right person, and the right medicine to the right person. That’s personalized medicine.
It is perfectly possible, I would say plausible, that people come to us when a child is three days of age and ask, can I take my child to day care, of course we won’t ever be able to say anything with absolute certainty, but we will be able to tell people they have a probability of getting pneumonia from daycare, or they’ll be able to prevent asthma by going to daycare. On the other hand, we could be able to tell people yes, in your case, there’s a high probability, taking your child to daycare will help build defenses to asthma.
People need to understand that this increases our freedom because it will allow us to make more informed decisions. What’s important is that our destiny is not written in our genes, what is written in our genes is our potential, given what we expose ourselves to. We’re not genetic machines; we’re not even machines at all. We are biological entities with a genetic background that allows us to adapt to different environments. For some people an environment is good, for others an environment is bad. To be able to have better information to select the right exposure for our genes, will give us the opportunity to realize our full potential.
As co-chair of the asthma platform committee, what do you think makes asthma research in Arizona so strong and what do you hope to see happen over the next few years?
The Arizona Respiratory Center at the University of Arizona is one of the best known in the US if not the world in respiratory studies and asthma research. And that’s certainly one of the strengths. Also, in Arizona we have a large population of people with asthma or people with respiratory diseases who come in the winter to snowbird here. Because of that, we also have a large number of nurses and physicians who take care of these individuals, giving us a large cadre of experts in the field. Then we have scientists at other institutions such as Arizona State University, Northern Arizona University, the BIO5 Institute at the University of Arizona, and the Translational Genomics Research Institute doing leading research in bioinformatics, vaccines, and genetics. If we put all these together and apply them to asthma, we will be able to make Arizona one of the major integrated centers in the world that finds the causes of asthma and new treatments. If we can put all these strengths together, we can become one of the drivers in the US. That’s the role of the committee.
The Arizona Respiratory Center was established as Arizona’s first Center of Excellence, and has since become internationally recognized for its work. How do Arizonans benefit from your center’s clinics?
We’re not only a research institute although we’re mainly a research institution. We have physicians interested in the respiratory health, and we consider ourselves part of the state of Arizona. We are here, and we are committed to the well being of the citizens who contribute part of their tax dollars to support the university. To that end, the center has a clinical presence in the state, providing services to smaller communities in the state that do not have specialists in respiratory illnesses. For example, we have pediatric pulmonary doctors who treat respiratory diseases in children. They go to outpatient clinics four to five times a year, one of them in the extreme northeast part of the state. The second thing that is important to understand is that we have a national presence. I am a member of one of the Food and Drug Administration advisory committees that makes decisions on medicines in the respiratory and allergy field. Members of our center are involved similarly in other national organizations.
Is there anything else you feel people should know about asthma research in Arizona?
What people need to know is that we have an opportunity in our state to make a very significant contribution in the asthma field. We could integrate all the work that has been done with the new Roadmap initiatives to become leaders nationally and internationally. That could significantly contribute to the economic prosperity of the state and alleviate suffering for those with respiratory illnesses. We need the community’s support, but they will get a return with improved quality of life, improved health, and economic prosperity.