Meet the researcher: Vance Fowler, MD

Tuesday, January 24, 2012

A lot of what Vance Fowler, MD, associate professor of medicine (Division of Infectious Diseases), needed to learn about running a lab, managing several NIH grants and developing the standardized protocol for the management of a bacterial infection that affects thousands of people each year, he learned from managing the family farm.

“It’s 250 years old, and about 650 acres, outside of Fayetteville” said Fowler. “Running it helped me learn to ask myself, ‘What have you got in your hand, and how can you make it work for you?’ Then, if there isn’t a previous example for your work, you just have to will it into existence.”

For the past 17 years, Fowler has investigated why some people recover easily from staph infection and others don’t. It’s a basic question, but to begin to answer it, Fowler had to move from the clinic to the lab, forgo sleep for a decade, and build a research database of thousands of bacterial isolates and blood samples, one keystroke at a time.

[quote style="boxed" float="left"]Start early, and stay late.[/quote] “My whole career has been surprising,” said Fowler. “I’ve basically learned new approaches as I go along to address the same question. While this makes for fun science, my learning curve has been nose-bleed steep for the past decade.”

After medical school at the University of North Carolina-Chapel Hill, Fowler came to Duke as an internal medicine resident in 1993. In September of 1994, he began cataloguing every adult patient at Duke Hospital with a Staph aureus bacteremia. Enlisting the aid of the Micro Lab was essential in creating his repository.

“We knew we had to win over the technicians,” Fowler said. A pizza party cemented the relationship.

Fowler then began collecting clinical data, bacterial isolates, and eventually, patient DNA.

Eureka!

In the mid-1990s, he had two “Eureka!” moments that defined his career: The first came in 1995, when he read a New England Journal of Medicine article about staph virulence factors. He realized if he gathered enough clinically well-characterized Staph aureus, he could evaluate how these factors influenced patient outcome.

The second Eureka moment came a year later, late at night, while entering patient data into the database.

“I thought to myself, ‘One day they’re going to sequence the human genome’ – “well, I’m not a geneticist, but I can start getting ready by saving patient DNA from patients with Staph aureus bacteremia.”

DNA samples began to accumulate with the blood bacteria isolates. Fowler still didn’t have a lab and soon saw that the clinician’s toolbox was a bit limited to meet his research interests. “Clinical descriptive research was a blast, but in the end I just wasn’t able to really dig into the determinants of patient outcome like I wanted to without going to the lab.”

Gordon Archer, MD, from VCU and one of Fowlers most influential mentors, told Fowler that he needed to go into the lab. A number of Duke researchers, including Ralph Corey, MD, Barth Reller, MD, and Doug Marchuk, PhD helped Fowler take his research to the bench, introducing him to PCR, mouse models, and rapid diagnostics.

Pathways to funding

In 1999 Fowler got an NIH K23 starter grant, which allowed him to hire a part-time study nurse. Since then, he has been awarded four RO1s, a K24 Mid-Career Mentoring Award, an R21, NIH contracts, and funding for a multi-million-dollar, multi-site NIH-funded DCRI clinical trial investigating treatment strategies for staph blood infection.

“We try to see if we can do the same with less antibiotic therapy, be more prudent,” said Fowler. “We’re looking for ways to reduce antimicrobial resistance.”

Currently, Fowler has one of the larger mouse colonies at Duke, and he uses animal models, human DNA and bacteria samples to understand which genetic characteristics contribute to negative outcomes in S. aureus infections.

“The clinician scientist is like one of those short-beaked birds in the Galapagos Islands that needs a long beak to crack open nuts,” said Fowler. “We’ve been selected against, especially in these economic times.”

But Fowler has successfully secured several NIH K awards and R01 grants. He said anyone who aspired to do the same needs to start early, and stay late.

“The sooner you can identify a problem to study and a mentor to clue you in, the better.”