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Lessons Learned from a Vascular Medicine Pioneer

When he was in fifth grade, Emile Mohler III built a wooden incubator with his father’s help, and picked up 25 fertilized chicken eggs at a Federal Poultry Research facility in Beltsville, Maryland. He wanted to see how the chick embryos progressed each day before hatching. Thus began a life of scientific experimentation and discovery.

So, too, begins Mohler’s 33-page A Medical Memoir, which moves from the fifth-grade embryology experiment to stories from a highly successful career in research and clinical medicine.

Emile Mohler, MD, a professor of Medicine and director of Vascular Medicine at Penn, wanted to write a memoir that would appeal to physicians and non-physicians alike, and he wanted to include lessons — both scientific and personal — that he learned along the way.

Earlier this year Mohler received the Society for Vascular Medicine’s highest honor: Master of the Society of Vascular Medicine — an honor awarded “in recognition of extraordinary service, selfless dedication and enlightened leadership to the SVM and the field of vascular medicine.”

As part of that award, of which Mohler is one of only 19 to have received, he wrote an editorial for the October issue of Vascular Medicine. During that process he mentioned his memoir to the journal’s editor-in-chief, Heather Gornik, MD, a vascular medicine specialist at Cleveland Clinic, who decided to publish it online, a first for the journal.

“I thought it was important try to find a way to get this into press and into our society’s journal, as Emile has been such a valued member of our community for many years,” Gornik said via email, noting that the journal has never published anything like it.

“There are tremendous lessons within for any early career investigator in the field of cardiovascular medicine, and I am eager to get Dr. Mohler’s ‘lessons learned’ disseminated as broadly as possible,” added Gornik, who is also president of the Society of Vascular Medicine.

Over the course of his career, Mohler has published more than 250 manuscripts, and is an editor of seven books. He also co-authored two editions of a textbook on peripheral artery disease (PAD), which occurs in the arteries of the neck, arms, and legs, can make walking painful and cause a limp. But his time, the writing was personal.

Mohler has Amyotrophic Lateral Sclerosis (ALS), a progressive neurodegenerative disease affecting the nerve cells in the brain and spinal cord. He decided to put pen to paper in hopes of passing along as much advice as he could to future generations of physicians, researchers, and those with an interest in health and science.

“For the young people who are training, I hope they take the ‘lessons learned’ and use those to advance their careers. We need to make medical advances as quickly as we can,” Mohler said in an interview. “To the non-physicians, maybe this will help them understand how complicated it is to do research and how it takes a team, and perhaps they will end up supporting that with donations and other things.”

In addition to the grade school experiment, Mohler covers his college and medical school experience, and his research career as he progressed from a junior investigator to leader in the field. Each chapter ending with a “lesson learned” which range from professional tips (“A mentor is essential for showing the way forward and providing inspiration”) to health advice (“Smoking anything is really bad for you”) to intellectual guidance (“Learn from experts in other areas of medicine to advance your ideas”).

And as one can imagine, as a pioneer in the understanding of peripheral artery disease, Mohler has a lot of insights to share. His research showing that inflammation but not calcification in the carotid atherosclerotic plaque posed a stroke risk to patients upset the conventional wisdom of the field. He also helped invent new ways to test how well blood vessels function and developed new treatments for patients with peripheral artery disease.

Throughout the memoir, Mohler stresses the importance for young researchers to seek out mentors, and the importance for established researchers to serve as mentors.

“They kind of become like your children, and you want them to be highly successful,” said Mohler, the son of a retired hematologist and PhD nurse.

He goes on to recount more research successes, but doesn’t shy away from experiments that failed. “Science is strange,” he said. “Even if our hypothesis turns out not to be true, we’ve learned something.”

But through it all, the successes and the failed experiments, the patient is never far away in Mohler’s mind. He was driven to find medicines that could improve the lives of his patients with peripheral artery disease. “That’s why I went to work,” he said. “That really challenged me and focused me and pushed me in the research area.”

As he describes his career, Mohler’s curiosity is a constant that guides his research.

In medical school, he approached one of his professors, the renowned cardiologist Proctor Harvey, with the idea that plaque on a heart valve could be related to the plaque that builds up in blood vessels. Harvey encouraged him to pursue the hypothesis, and Mohler and Dr. Bruce Waller from Indiana University found they were, in fact, related. Until then, rheumatic fever or old age were thought to be the cause of aortic valve calcification.

As a young fellow, he wondered if the way calcium accumulated on heart valves was related to how bone is produced. Through a series of experiments, Mohler showed bone-promoting proteins were present in the diseased aortic valves, which supported his initial thought. And as a principal investigator, when a drug trial failed to help patients who found walking painful because of a lack of blood flow in their legs, he wondered if exercise could help. As it turns out, he was right again: it did.

Mohler’s research led to a number of inventions, and he developed a pentane breath test that detected a carbon compound associated with a higher risk for heart attack and stroke — which one of his colleagues dubbed the “Mohler bad breath test,” an anecdote that was appreciated by Mohler’s dry sense of humor.

That same humor comes through as he describes a whale watching field trip for a college marine biology class: On a boat off the coast of Massachusetts, Mohler and his roommate were doused with a “whale shower” from the blowholes of two juvenile humpback whales. “It smelled of old fish, which explains why no one wanted to sit next to us on the trolley ride back to Boston College,” he writes.

Many years after the whale shower and the bad breath test, Mohler teamed up with Dr. Arjun Yodh and Dr. Britton Chance in the Penn Biophysics Department to create a near infrared spectroscopy device to look at tissue oxygenation and blood flow in patients with peripheral artery disease.

“I had no knowledge of biophysics,” Mohler said. “But some of the biggest findings have been in collaboration with people who are not cardiologists.”

As the work with Chance and Yodh showed, Mohler said, collaborations between disciplines can yield results, “the collaborative environment at Penn is very good as long as you’re willing to reach across lines and work together.”

Mohler concedes he worked hard and said he is grateful for the support he received from his wife, Bonnie, and their three sons. To compensate for his time away, Mohler would take a family member with him on his work trips. The trips rotated from one family member to the next. After presenting a poster at one meeting, Mohler asked if there were any questions. His son Riggs, then in grade school, said, “I have one.”

“It was a well thought out question,” Bonnie Mohler said in an interview, though neither she, nor her husband could remember the details. “He was curious, so Emile answered the question.” It was that same curiosity that his father had every day.

As a physician, Mohler liked to tell his patients “God made us to move around.” As a patient, he follows his own prescription, exercising three times a week, even as his ALS has progressed. Unable to walk now, he rides his scooter (dubbed the “Ferrari”) to a gym in his community in Newtown Square, Pennsylvania, where he works out with weights and clips into an exercise bike.

“He’s not one to sit,” Bonnie said. “It’s tough. It’s probably the biggest challenge.”

But always the fact finder, Mohler said there’s debate in the ALS community about whether exercise is beneficial or whether it saps too much energy. He points to a Johns Hopkins study showing exercise is beneficial, adding personally, that it also helps him emotionally and mentally.

Mohler’s lessons learned from that first experiment seem to carry through his career, and his life: “It takes several people to make science possible. Experiments do not always go the way you think. Life is beautiful.”

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