Discovery Forum 2017: An Interview with Dr. Ian Lipkin

Discovery Forum 2017: An Interview with Dr. Ian Lipkin


hello it’s a special treat to be sitting
here with Dr. Ian Lipkin professor at Columbia University and lead of the new
Center the NIH funded Center for Solution for ME/CFS thank you for being
here my pleasure so this is a rare opportunity
because you are a hard person to find you are very busy you travel all over
the world you are involved in Zika work you are involved in any health crises
around the world set the stage up for us with respect to you I’ve been doing this
for a long time really when I decided to leave clinical medicine in 1985 and
begin to work in basic science which are really not done I had only taken the
requirements to get into medical school and I finished these residences I found
myself interested in trying to understand how people became ill not
just what I could do about it initially with the current armamentarium but
trying to find real solutions like you’re trying to do with Solve
ME/CFS I had to go back to the lab so I spent six years learning learning the
tools of the trade pipetting mm-hmm early days the quake
acid hybridization caesium chloride lovely as a dad the whole thing before I
didn’t lots and lots of radioactivity remember those days? totally I do. that was
what we did we all radiated ourselves it was the only way that’s the only way to
get you to imaging anything image anything this way so and then I and then
I found myself sort of moving directly into the use of genetic methods for
detection of infectious agents and that’s what really led to my first
exposure to to mecfs and and which was then CFS
it wasn’t even CFS in those days and then the XMRV experiments and
ultimately where we are here today and the focus of our Center is on discovery
as we think at this stage this is what we need to focus on yeah so this guy so
our so our centers really focused on discovery we’ve collected samples over a
period of several years with the support of the NIH and the Hudsons family
foundation and the microbe discovery project which was kicked off by the late
Vanessa Lee a wonderful young woman who was dedicated to trying to find
solutions and she took her own life as you know in February of 2015 because she
was despondent about about her condition and we’ve gathered you know great people
to work with us Oliver Fein at UC Davis and John Greeley who was located at
Albert Einstein and this terrific clinician group that’s really been with
us since the earliest days of xmrv you’ve interviewed all of them here I
think with the exception probably of Jose Montoya who I haven’t seen yeah at
this meeting and we’re gonna be mining these specimens as rigorously as we can
looking for signatures of viral bacterial yeast exposures doing
metabolomic proteomic analyses and and moving into epigenetic and functional
genomic studies that’s wonderful yeah so it’s we’re very excited well we us too
and we we will circle back to the to the collaborative research centers I always
find that very admirable about you in that you deal with big-ticket items you
deal with national crises right on Zika on Ebola and things of at that level at
that nature of the same time you do the mecfs so I I watching right now yeah the
thing that we’re doing right now right is absolutely devastating as we’re
working with the Indian government the Indian Council on medical research with
the most disenfranchised people I have ever seen these are the most are these
are lowest-level socioeconomically of the
the doll eats in in Uttar Pradesh just south of the Nepalese border and their
children are dying of encephalitis thousands of them are Donovan South the
lightest and so we’ve been going back and forth there and trying to figure out
why these kids are ill on their whole range of viruses and bacteria that are
implicated in what we need to do is to identify not only how these children are
getting sick what are the pathogens but how they’re being coming exposed so we
do many things in in our Center ranging from acute diseases like the
encephalitis I’m talking about as well as you know more chronic conditions
which are which are equally equally challenging more so in fact because
sometimes the trigger is remote it might have happened years earlier mm-hmm the
thing that attracted me to this field initially was in addition to meeting Dan
Peterson and having him send patients to me really in 1984 Leon but that’s a long
time ago was that so many patients will relate to you that at some point they
had an infectious disease of what sounded like an infectious disease and
that then resulted in an fatigue that just didn’t dissipate it continued and
it continues for years so the question is how do we find those fossil you know
imprints that allow us to ideas that might have occurred remotely so it’s
more challenging but I think I think we can get there I really do so we’ve done
this recently with autism where we found that triggers of innate immunity during
pregnancy place children at greater risk for autism and I’m sure we can do it
here it’s a question of bringing all these new techniques to bear now what
we’re trying to do is to exploit and I think that’s the correct term mm-hmm the
various platform technologies and insights that have come about through
emerging infectious diseases and bio defense research
now to bear on these other problems so it’s a it’s a peace dividend if you will
from some of these other programs that with which we’ve been involved after
bite on by defend after 9/11 you developed a national consortium of sorts
put together a group of leading centers how does that technology is that
technology helping in mecfs is that interdisciplinary work even an insult my
life this work now in India it has that been applied in the knowledge at least
so sort of the I think the pivotal moments were initially of course HIV
because everybody became aware that an infectious agent could spread and that
we had to find more rapid ways to identify these agents but then there was
West now and what West Nile did for us in 99 was demonstrate that there were
agents that existed in ma’am and animals that that could move into humans and
that we needed to pay more attention to what we think of the zoonotic diseases
that was certainly not the first zoonotic disease but that’s the one that
captured the attention of the Senate and the Congress and push that forward and
then why was that in life it because there was a senator in Connecticut named
Joe Lieberman know who was concerned that had taken so long to figure out
what was going on there was no conversation between the veterinarians
and the human side and so so they didn’t realize that did the two were linked hmm
so that was 99 and that’s been I’ve written about that other people have
written about that so I won’t dwell on it much but after 9/11 when there was a
recognition that that that there was you know more than just you know the
mechanical risk associated with these horrific you know explosions and more
the anticipation of really what we’ve seen in terms of the breakdown of social
order no over the past few years hmm it was also the anthrax attacks in the
anthrax attacks while you know shut down you know the Senate office building and
just NASA 911 like it just after 9/11 right and so so the the government
decided to invest in bio defense because really didn’t have a strong bio defense
platform at all so you know there was a point of which the United States like
everyone else was engaged in a biological warfare research mm-hmm now
during Richard Nixon’s administration and people find this hard to believe he
decided to unilaterally declare a moratorium on offensive biological
research hmm and he was a Quaker so it was like the last sort of vestiges of
his Quakerism that’s already came forward suddenly this was inappropriate
so we didn’t have a lot of work on the offensive or the defensive sight so from
a standing start the decision was made and the leader really for much of this
really was was the director of NIAID anthony foutch II who persuaded then
President Bush that the money should not be allocated to this new Department of
Homeland Security to do this research but the US scientific research community
should be engaged to do this and that they would do it better the scientists
should heed this and as a result funds were allocated to create centers now the
center I directed which was in Health and Human Services region 2 included all
the institutions in New York and New Jersey and the Virgin Islands in
Connecticut and Puerto Rico principal Rico but Yale decided to go with us to
rather than stay with HHS region 1 Harvard which I know is sort of your
affinity but what can I say ain’t that they because they got a better deal New
York lives you with the New Yorkers anyway we had a roundtable everybody
participated and we went as a country in a period of five years from having
nobody doing this kind of having spectacular work and it was all
in diagnostics and vaccines and therapeutics and all of these tools
right which accumulated over the period of about 15 years now are being brought
to bear on mecfs so if there is an infectious agent you know people are
gonna find in fact they’ll find it yeah and if they’re there they’re there
imprints somewhere in the experience immunological experience we will find
that – I think that mecfs is not a single disease they’re going to be
subtypes within it and there will be a subtype who will respond to drugs that
are directed against viruses they’re gonna be microbiome focused you know
efforts they’re gonna be things in effect neurotransmitters I mean it’s you
know we’re looking at you know it’s the old story about the elephant you know
one person touches it this part and says it’s you know it’s a tree and something
else touches this and says it’s a rope it’s all of those things we need to
understand the syndrome and of all of its complexity if we’re gonna bring
solutions to bear but you think that even in all these subgroups there is a
pathogenic construct to them I think there’s a pathogenic construct to them
and I think there are obviously key features that allow us to lump so it’s
very useful for certain purposes to lump and others it’s more useful to split the
whole point of precision medicine yeah you know which is a huge effort right
now globally is a recognition of the fact that we are that we are all
different in some way that doesn’t mean that you know that something that people
are inferior or superior it’s not that at all it simply means that certain
genetic programs differ certain proteomic programs differ and if we can
dissect those specifically then we can identify the appropriate therapeutic
intervention and the appropriate preventive measures and
that’s really where the research needs to go you know this I I have been
thinking about this set of disorders since IRA saw my first patients in 1984
and I knew then and I knew and I know now that you know they that they have
been neglected and this is something that I think is finally starting to
change yeah because of you and and and others in the fear coz of others as well
there’s a few solve any CFS is at a huge role in promoting awareness and without
awareness we don’t email investment with and without investment there are no
solutions that’s right that’s right and thank you thank you for your kindness
now these viruses you know let’s explain to folks who are not scientists out
there these viruses work with cellular counterparts with human cellular
counterparts so they they need they need two to tango right they either hijack
our replication machinery or they they do they do they internalize themselves
into our cells we lost a microphone but that’s fine
so so they always you know when we say viral infection or there is a cellular
human cellular component to this as well so and many viruses sometimes target the
same replication machinery for their own the same factors in the cell so because
of the many viruses that have been associated with mecfs does that tell you
that there is a singular cellular counterpart there are many cellular is
that some avenue that we should be looking at more in terms of the classic
replication machinery that is the bread and butter of viral propagation so so
far first of all what are viruses viruses are not alive in the way we
think of organisms as B less bacteria for example could move
outside of a cell they just need nutrients they need the
right conditions and they can grow viruses as you say our obligate
parasites inside of cells they must live inside ourselves if they’re not inside
of cells they can’t reproduce themselves they can exist outside obviously because
I have to transfer like from from host to host person-to-person animal to
animal or plant the plant but they can’t reproduce themselves unless inside of
cells there are many different lifestyles for viruses some viruses go
inside of cells and take over all the cellular machinery make millions of
copies of themselves and blow the cells apart and then they look for the next
victim and they move on it other viruses are more subtle they move inside of a
cell they take a little bit of this and a little bit of that and they just sort
of poke along those viruses can actually be as damaging as the ones that explode
cells why because what they do is they interfere with your ability to function
so you can envision a situation like with a herpes virus and there are many
different types of herpes viruses where it simply goes inside of a cell and as a
result of its life cycle it reduces the amount of energy that you have it
interferes with your ability to think it may have some sort of an impact on the
immune system resulting in an autoimmune disease it can induce cancer mm-hmm
there are all sorts of all sorts of a scenarios that can emerge from these
types of infections and bacteria and viruses can act in concert like to cause
disease as well which is so the only so the only way to get at this problem is
to use a multi-pronged approach one effort is to try should focus on trying
to identify the infectious agent at the time you may be able to find
genetic material proteins you may even be able to recover infectious fire sort
of excess bacteria the other is to look at the host response because everything
that you’ve seen over the course of your life is recorded in immunological memory
an immunological memory can be measured by the cells that make these little
proteins called antibodies that attach to targets or in the form of T cells and
T cells our cells that actually recognize other cells has infected
attack the following innovators in that fashion so we need to be able to track
not only immediate infection which is present at the time you look them but
the history of infection the history of infection if you use the appropriate
sorts of mathematical tools will allow you to make links between exposures
appendixes and then and then the other aspect is you try to link all of these
effects in some way many ways in some instances to effects on metabolism so
energy production cognition effect or emotion all of these things can be
linked and you do these using sophisticated epidemiological tools so
as we are in a School of Public Health we have people who are used to doing
this kind of work so it really is I think it’s it’s an ideal marriage of you
know public health clinical medicine basic science research and of course
everything at the end of the day focuses on the patient’s because the patients
are the ones who explained to you how they became ill but you know what
factors aggravate their illness what regiments appear to help them in some
way that’s not to say that we rely on anecdotal evidence to make a definitive
link between either a causative agent like a
mold or a bacterium or a virus and the disease we still have to do rigorous
objective research but their clues and the stories that you hear from people
that allow you to say I’m going to generate a hypothesis that I can test in
a rigorous scientific way but that is based on the kinds of conversations with
patients and and natural history of the disease in this space has been lacking
yeah so another focus of this group and I’m really privileged to work with these
brilliant clinicians so we have you know as part of our team now for five years
we that’s an abatement and sue Levine and Dan Peterson and Jose Montoya nancy
clymas is not part of our group but she was very helpful early on and of course
we have you know they’re the the maestro himself Tony Comoros of course right who
was directing our clinical project with Anna March and Anna March is an
epidemiologist who has been doing very nice work with the Hutchins isolation
and so she and Tony Howard have created an app which is gonna be useful in
tracking how people feel on one day or another this can actually guide us for
sampling so that perhaps we’ll be lucky and will actually catch outage the thing
about this at the moment and and I will say again that your letter for us was
was sincere and inspirational and it’s ordinarily helpful and we deeply
appreciate thank you the opportunity to work with you and you thank you thank
you I this means a lot to us thank you so much for all the work you do and
thank you for being in this field much gratitude to you thank you

10 thoughts on “Discovery Forum 2017: An Interview with Dr. Ian Lipkin

  1. These videos are a remarkable accomplishment, providing direct access to candid conversations with the leaders in the field, offering the most current and critical information for an under-served community.

  2. Vanessa Li was NOT despondent about her condition as Dr Lipkin says.
    She was about to be moved into the neuropsychiatric hospital in London, and chose not to be placed at the mercy of British psychiatrists.

  3. I wonder why Dr Lipkin says he saw his first patients in 1984?
    Dr Peterson didn't even know there was a problem until November, and only read about the EBV syndrome in the Jan 85 Annals Journal.
     As I remember it,  Dr Peterson sent blood to Dr Lipkin for Borna virus testing in January of 1986.  I have a newspaper which testifies to this effect.

  4. I know "beggars can't be choosers" all too well from my many years being disabled from severe ME and seeing the shameful neglect of this tortuous condition, so I am, truly, THANKFUL for ANY-and-all legitimate scientific research!!! – – – but – – – how I WISH that this team would be working WITH the Ron Davis/Stanford/OMF team and WITH the Nancy Klimas team, and any other major group of doctors and scientific researchers – – – putting aside ANY "our group" or "our organization" ego, wanting to be the ones credited with "solving" ME! We severe ME patients are DYING (and not just from suicide, and even then, NOT because we are "despondent"!!!), and, while we are living, we are enduring a suffering level of someone in the last days-to-hours of their life with cancer or organ failure – – – PLEASE please plase SHARE ANY/ALL INFORMATION WITH EACH OTHER!!!

  5. I don't understand how and why medical research/science is done the way it is. Why are there so many disparate groups researching ME/CFS? Why is research not done in a more collaborative manner? It just seems like you have these different groups of scientists, these different centers, all doing their own research and not bouncing ideas of each other. I find this confusing because I know they must be reading the prior research. For example, you have Nancy Klimas in south Florida researching it from an immunological perspective, Ron Davis at Stanford focusing on metabolism and genetics, not on viruses, collaborating with the folks at the University of Utah and the University of Melbourne, among many others. How much are they taking into consideration what Nancy Klimas is doing, or John Chia in LA who has spent his career studying ME/CFS and enteroviruses? How much is this guy above collaborating with the above mentioned people? I just don't understand. If everyone is looking for answers so hard why aren't they collaborating more? TBH, I really don't understand why Ron Davis isn't looking more at viruses. I know I wouldn't be so sick if I didn't have a massive viral infection, and I am grateful for the work of Nancy Klimas and John Chia that is helping me. I just want to understand better why people are working as independently as they are. I don't mean to be critical. I am very grateful to everyone who cares and who are trying. I just want to understand better how research is done in America.

  6. PLEASE let us know what the APP is that allows us to track our condition (and give the data to you to study?) Thank you!!

  7. Dr. Salahi out of Univ of Albany (in combo w/ Dr. Peterson and probably some other clinical sites) are doing thorough family illness and health histories. It will be wonderful to have a better illness picture and can tie in w/ genetics.

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