Endocrine autoimmunity expert recognized for international impact
Endocrinology is a field that spans the globe. Leaders in the discipline advance research and clinical practice for their own communities as well as those of their colleagues across countries and seas. This year, the American Association of Clinical Endocrinologists will acknowledge one such leader by naming George J. Kahaly, MD, PhD, recipient of the ACE International Endocrinology Award.
Kahaly serves as the chief physician of the endocrine outpatient clinic of Johannes Gutenberg University Medical Center in Germany and director of the Molecular Thyroid Research Laboratory and is a prolific author and an active participant in thyroid organizations in multiple countries. He spoke with Endocrine Today about his early career, the importance of choosing a medical path and his affinity for classical music.
What was the defining moment that led you to your field?
Kahaly: It was during the time when I was a resident. I was interested in the research pertaining to the thyroid gland. I had been working in a department of nuclear medicine investigating many patients with thyroid disorders. I was offered a 3-year PhD program for translational thyroid research doing cell and molecular biology in the lab as well as developing assays for biomarkers. After the completion of the PhD thesis, I finished my fellowship in endocrinology, diabetes and metabolism. For more than 30 years, my lab has been financially supported without interruption by national and international grants.
My main interest now is both experimental and translational work in the field of endocrine autoimmunity. I direct the thyroid lab and chair the endocrine outpatient clinic and the orphan multidisciplinary expert center for autoimmune polyendocrinopathy and Graves’ orbitopathy.
What advice would you offer a student in medical school today?
Kahaly: The best advice for a student in medical school is to timely choose an academic career either focused on research and teaching or a clinically oriented one as a general practitioner or clinically based internist. An early decision will facilitate future steps either way. For research, choosing and applying for a PhD program in a successful and productive lab, as well as being lucky to be mentored by an acknowledged researcher, is a crucial milestone. Differentiation between both careers is warranted and will save time and energy.
Have you ever been fortunate enough to witness or to be part of medical history in the making?
Kahaly: I was fortunate to witness relevant progress in the basic science, pathophysiology and immunogenetics of autoimmune endocrine diseases, such as autoimmune polyendocrinopathy. As an example, there are currently immunogenic and serological data allowing the differentiation of patients at risk for developing multiple autoimmune disorders. Clinically, novel treatment strategies encompassing monoclonal antibodies and/or small molecules targeting specific receptors on endocrine cells and target cells — orbital fibroblasts and adipocytes — have been introduced and were both clinically effective as well as well-tolerated.
Another “revolution” is the novel immunotherapy of various forms of cancer, such as melanoma or lung cancer. Immune checkpoint inhibitors unleash the immune system on cancer to great effect and increase survival rates. However, switched-on immune cells set their sights on other targets, many times the endocrine system. Indeed, when immunotherapy takes aim at various forms of cancer, endocrinopathies (such as autoimmune thyroiditis, hypophysitis, thyroid dysfunction, type 1 diabetes, etc) are often in the line of fire. While most endocrinologists are familiar with how to treat this “collateral damage,” new treatment protocols will likely evolve with experience.
What do you think will have the greatest influence on your field in the next 10 years?
Kahaly: In general, and in basic research, the ultimate goal is to desensitize the immune system against autoantigens and, therefore, restore the early loss of tolerance already observed in the thymus of patients with autoimmune diseases. Clinically and specifically in patients with autoimmune-induced endocrine diseases, such as Graves’ hyperthyroidism and associated orbitopathy, novel immunomodulatory strategies targeting the thyrotropin receptor and/or the IGF-I receptor as well as the co-stimulatory pathway within the immunologic synapse will offer causal, specific and, hopefully, clinically highly effective and well-tolerated treatments.
Whom do you most admire and what would you ask that person if you had 5 minutes together ?
Kahaly: Sir Simon Rattle has been for years (2002-2018) the highly successful and acknowledged director of the Berlin Philharmonic. Originally from Liverpool, U.K., he now directs the London Symphony Orchestra. I also appreciate the qualitative work and biography of the Israeli-Argentine Daniel Barenboim as leading pianist and director. Further, the concerts of Mrs. Anne-Sophie Mutter, an exceptional German violin player, are always a highlight. Finally, I enjoy listening to opera, particularly Puccini, Verdi, Mozart, etc.
Mrs. Angela Merkel, the German chancellor is a highly and globally respected person. I appreciate her discipline, her hard work and her rational thinking. She is never aggressive nor does she lose control, always focused and trying to find satisfying solutions for all parties. If I have the chance to talk to these great musicians or to Chancellor Merkel I would be much honored.