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Prof Adrian S Woolf
Professor of Nephrology and Head of the Nephro-Urology Unit Institute of Child Health University College London London, United Kingdom |
Dr Goldsmith: Why did you go into medicine?
Prof Woolf: I don't know - perhaps a psychologist can work
it out. My father began to train as a rabbi but switched to art school and
became a hairdresser; my mother was a nurse. As a boy, I liked the Volvo
driven by our family doctor but now I have no interest in make of cars.
Dr Goldsmith: Why into Nephrology?
Prof Woolf: At Westminster Hospital Medical School, London,
there was an inspiring Nephrology team with Malcolm Milne (who had a great
interest in tubule metabolic disease), Lavinia Loughridge (an intriguing
person) and Mike Bending (the Senior Registrar who 'knew everything'). After
qualifying, at first I wanted to do Psychiatry but, in the end, Nephrology
won. As a medical Registrar, I worked with Jeffrey O'Riordan and Willie Slater
at the Middlesex Hospital, London, they taught me about calcium and
sodium metabolism at the interface of Endocrinology and Nephrology; I subsequently
did my first research with Peter Moult, another Endocronologist, on atrial
natiuretic peptide. From circulating hormones acting on the adult kidney,
it is a short conceptual step to paracrine and autocrine factors which control
embryonic kidney growth.
Dr Goldsmith: What area interests you most in your research
career?
Prof Woolf: Working out why children are born with malformations
of the urinary tract, the commonest cause of chronic renal failure in early
life. In most cases it is still a mystery two of our favourite theories
include de novo mutations of nephrogenesis genes and subtle alterations
of environmental factors such as maternal diet.
Dr Goldsmith: You work with paediatric patients of course
- how can we best support Paediatric Nephrology?
Prof Woolf: I think that Paediatric and Adult Nephrology
should interact more. There is room for a new sub-specialty, in the form
of Adolescent Nephrology. There would be the challenge of giving best care
to teenagers with renal disease and, moreover, little is known about long
term (i.e. many decades) follow-up of common Paediatric Nephrology disorders
such as reflux nephropathy, posterior urethral valves, Henoch Schonlein purpura,
congenital solitary kidney etc. In addition, advances in dialysis and transplantation
technology mean that a 'new' group of children, born with severe kidney malformations
and renal failure, is surviving into adulthood what will happen to
them and will they give rise to a further generation with kidney malformations?
Dr Goldsmith: How can we best promote "Academic Medicine"?
Prof Woolf: I don't really know. With regard to research,
in the 90's, we hosted a series of young Paediatric medics who did laboratory
research and PhD theses. More recently, perhaps driven by political, management,
service delivery and formal training pressures, I perceive that risk-taking
and career flexibility are less encouraged both, however, are needed
for a research pathway in 'Academic Medicine'. By contrast, we continue to
host a stream of excellent Paediatric Urology clinical fellows who are keen
to do both basic and translational laboratory research; that is good because,
in Paediatric practice, kidney and lower tract disease often coexist.
Dr Goldsmith: How would you persuade a junior doctor to
embark upon Nephrology as a career (or would you)?
Prof Woolf: I would not attempt to persuade anybody. I would
say "look around, talk to people, read the best journals and then make
up your own mind".
Dr Goldsmith: Did you have, or do you have,
a role model, mentor or significant influence in medicine?
Prof Woolf: Brian Gazzard, who taught me Gastroenterology
when I was a medical student, said something along the lines "Medicine
does not become interesting until you know a lot" - I agree with
that. Leon Fine was my mentor at University of California, Los Angeles when
I was a Travelling Research Fellow 1989-1991; Leon is a great lateral thinker
and had sent several of his US Nephrology Research Fellows to work in basic
science units, everything from cell biology to fruit flies. It was a
very different attitude from anything I had yet to experience in my UK Nephrology
training. Martin Barratt, the Emeritus Professor of Paediatric Nephrology
at the Institute of Child Health, London, has a crystal-clear logical mind
and (nearly) always catches me out when I lecture. I have learnt a lot about
human genetics from Sue Malcolm, another Emeritus Professor at the Institute
of Child Health.
Dr Goldsmith: What piece of research, or publication, are
you proudest of?
Prof Woolf: I am always thinking about the next publication.
Working with Simon Welham, a junior scientist, we recently showed that rather
modest alterations of diet ingested by pregnant animals cause major alterations
of cell turnover and gene expression on the first day when the embryonic
kidney forms, correlating with subsequent renal growth. The human implication
would be that whatever our mothers ate in the first two months of our own
gestations determined how many glomeruli we have in our kidneys.
Dr Goldsmith: How do you relax in your time away from your
work?
Prof Woolf: By counting my Nature research papers
(it is not a very strenuous activity) and reading books belonging to my two
daughters (Martha, 3 years old, and Lily, two years old).
Dr Goldsmith: Where do you see yourself in 5 years time
from now?
Prof Woolf: If I knew where I would be in 5 years, life
would be too boring. In the end, I would like to live in a cliff-top house
overlooking the ocean and write a novel, with my wife (Kate Hillman, an Adult
Nephrologist), earning the cash for unlimited wine and gin Martinis. Before
that, I want to go deeper into kidney Developmental Biology, working with
model systems like fish and flies, as well as continuing to study human disease.
