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Neuropathy expert receives AACE Distinction in Endocrinology Award
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ORLANDO, Fla. — Aaron I. Vinik, MD, PhD, FCP, MACP, FACE, professor of medicine, pathology and neurobiology and director of the research and neuroendocrine unit at Eastern Virginia Medical School, received the 2016 American College of Endocrinology Distinction in Endocrinology Award during the American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress.
The Distinction in Endocrinology Award is given to an AACE member in recognition of advancing the understanding of endocrinology through research and education. Vinik, a recognized global leader in basic and clinical neuropathy, has defined the heterogeneity of neuropathy, established a need for a modular approach depending on the particular nerve fiber damaged, and pioneered immunotherapy for autoimmune neuropathies.
Aaron I. Vinik
Endocrine Today spoke with Vinik about his groundbreaking work in the regeneration of islets and nerve cells, his collaborative work to better manage diabetic neuropathy, his fondness for the Argentine tango and hope for a world free of diabetes and its complications.
What area of research in endocrinology most interests you right now and why?
My major focus has been on curing diabetes and the translation of basic science in neuropathy to clinical care.
I grew up in a house in which there was no television, iPhones, iPads or even laptop computers. So, we became storytellers and listeners, and this has served me well. Listening to patients telling their stories allowed me to work with my wife, Etta Vinik, to develop a Quality of Life tool for Diabetic Neuropathy (Norfolk QOLDN), which has now been translated into 56 different languages and has become the universal endpoint for studies on diabetic and transthyretin neuropathies. It has also become a screening tool for detecting occult neuropathy and facilitated earlier and more aggressive management in 26,000 Romanians. The tool only took 10 years to develop to be able to ask the questions in the context of the country, the ethnicity, the languages spoken and the nuances of the meaning of words. It was first translated into four different English dialects. As Winston Churchill said, “We are countries separated by a common language.”
I have also received considerable recognition for diagnosis and management of complex patients with neuroendocrine tumors and pioneered the use of somatostatin analogues and, more recently, the use of tyrosine kinase inhibitors and MTOR inhibitors. These tumors and their syndromes are enough to challenge even the most insightful mind.
What do you think will have the greatest influence on your field in the next 10 years?
My focus has been on regeneration of the pancreatic islet as a cure for diabetes and on slowing the progression, reducing the severity and reversing the neuropathic complications of diabetes. Within the context of islet replacement as a cure, I have no doubt that we have identified one of the most potent candidates for the stimulation of islet neogenesis from proto-differentiated stem cells with the greatest likelihood of curing some people with diabetes. The great barriers to achieving this goal are the apoptosis and inflammatory destruction of these neoislets. We have to stop the killing, and we are in the infancy of identifying appropriate anti-inflammatory agents that have the ability to abrogate the process. When this is achieved, I think we truly will have the facility to promote endogenous stem cell therapy and be able to offer this form of intervention to a larger cadre of people. I think that other molecules have shown promise in stimulating islet cell growth and proliferation, and these in combination with INGAP may well carry an advantage in certain instances.
Similarly, we now have conceded that it is no longer heretical to believe that nerves can be regenerated. We now have potential candidates just entering phase 2 trials examining the feasibility of utilizing the ability of growth-promoting molecules to regenerate small nerve fibers. The approach to reversing small fiber neuropathy is now within our grasp. What eludes us is the large myelinated fiber, and [we have] yet to stumble across agents with this potential. As long as we believe that it is possible, it will be so, hopefully in the next decade. We have now been able to inject naked DNA into the SC tissue or muscle with relief of pain, and there are a number of potential nerve growth factors and anti- inflammatory and immune modulators suggesting that, as is the case with islets, this dual approach is likely to reward us in the next decade.
What are some of the most exciting advances in diabetes treatment that you have been a part of?
The focus of my research endeavor has been regeneration of islets and nerve cells. The islet regenerative work has been translated from wrapping pancreases in [plastic] to having a new molecule in clinical trials in neuropathy, the identification of molecules that can cause nerve regeneration has translated into clinical care and restored people’s sensory perception, enhanced their quality of life and reduced the rate of foot ulcers and amputation [as well as] falls and fracture rates. It does not get more exciting than that, but, as Woody Allen said, “I do not want to become famous for anything I have discovered, I only want to live long enough to enjoy it!”
You have spent decades researching and treating diabetes. What is next for you?
I would love to live in a world free of diabetes and its complications, but I recognize that that may be a little too ambitious. I would be comfortable if we reduced the cardiovascular disease death rate by 50%, eliminated strokes, gangrene and foot amputations, and put a stop to the dialysis and transplant programs. I used to have a foot clinic, but no longer see amputations, simply by implementing behavioral changes. I would hope that it would be enough to lead the horse to the water and we would not have to make it drink!
What are your hobbies/interests outside of work?
My wife and I love music, art, theater, movies and dancing the Argentinian Tango. We, with our sons, are sailing enthusiasts and enjoy windsurfing and kayaking, and have just embarked on kiteboarding. I asked the instructor how old was the oldest person he had taught to kiteboard. He thought for a moment and said, “He was very old ... about 60 years.” I responded, “Get me flying that kite and speeding across the water, and you certainly will break that record.”
For more information:
Aaron I. Vinik , MD, PhD, FCP, MACP, FACE , can be reached at the Eastern Virginia Medical School, 855 W Brambleton Ave., Room 2018, Norfolk, VA, 23510; email: vinikai@evms.edu
Disclosures: Vinik reports no relevant financial disclosures.