Each of us takes a different road to their final professional destination. Some make a deliberate choice, some follow in their parents footsteps or obey their parents’ will; some are driven by circumstances. My choice was based on a combination of many reasons.
My mother was a doctor by vocation. She devoted 40 years of her life to medicine. Being an obstetrician-gynecologist and a surgeon, she saved numerous lives, cured infertility in many women and brought joy to those families who had long hoped for a child. My elder sister went to a medical university and so when I finished school, I knew I was going to be a doctor.
Although I graduated with honors from high school, I had to take exams just like other applicants. At that time those high school graduates who held diplomas with honors had a privilege of taking only one entrance exam (in chemistry). Chemistry was my favorite subject at school and I was absolutely sure I was going to get an excellent mark. But although all my answers during the exam were correct, I got a good mark. The examiners told me that if I really was an excellent student, I would not have any problems passing other exams successfully. This was the beginning of my long and challenging road to medicine. I was a diligent and curious student but when finally it was time to decide on a specialty, I realized I needed a moment to deliberate. We did not study allergies and immunology at that time — there was no such department or specialty in our university. I was thinking about going into plastic surgery but again there was no such faculty, and cosmetology was not considered a medical specialty. It was much later in life that I studied dermatology and sexually transmitted infections, cosmetology and clinical laboratory diagnostic techniques. For now, I was just trying to find my way in life.
I completed my postgraduate training course at the Department of Microbiology where anti-infective vaccines were developed at that time. We studied secretion of specific antibodies and non-specific immunity factors to evaluate the efficacy of those vaccines, and my work very much resembled a true research in immunology. Later, when I was working in some research institute, I was appointed head of the Department of Hybridoma Technologies. In the late 1970s and early 1980s almost noone knew anything about such technologies in our country. We had virtually nothing to start with: no training in cell technologies, no experience, just foreign academic articles describing methods for obtaining monoclonal antibodies which we were supposed to reproduce. I spent so many sleepless nights translating foreign works; I was often upset that my own work was not going as planned. But we managed. We managed to develop a cell technology for obtaining monoclonal antibodies and devised a testing system; we also received 2 invention certificates. The hybridoma lines were shipped to the Research Institute of Cytology of the Russian Academy of Sciences in St. Petersburg.
There was another thing that significantly influenced my career choice. My baby daughter developed sepsis several months after birth. As I found out later, the maternity hospital where my daughter had been born was to be closed shortly after, and the hospital staff did not care much about sterility any longer. When my daughter got sick and was admitted to another hospital, it was decided to test her blood for bacterial infection. But sterility testing normally took from 10 to 14 days, and my daughter’s condition was deteriorating in spite of the treatment she was receiving. I was distressed, but not desperate. Before it all happened to my child, my colleagues and I developed an express diagnostic technique that could detect a number of infections, including those caused by staphylococci. I begged the nurse to take another blood sample from my daughter and performed a test. In a couple of minutes I knew that she had a staph infection in her blood. That first blood sterility test came positive two weeks later. I dare not imagine what could have happened to my child within those two weeks. The express test (that I also patented, by the way) was based on a simple agglutination reaction, but the diagnostic agent was unique. In that hospital there were many children with suspected staph infection waiting for the blood test results. The head of the pediatric department asked me to run my express test on their samples. Half of the tests came out positive, and luckily, the children received timely treatment.
But I was still fighting for my child’s life. I insisted that my daughter receive the antistaphylococcal immunoglobulin, all to no avail. The baby was getting worse. The doctors told me I had to accept the inevitable. And then I decided to try the experimental drug Thymalin, the first immunomodulatory agent developed in the USSR (in St. Petersburg in the mid 1970s). This drug was undergoing the final phase of its clinical trial. I had nothing to lose. I contacted all of my friends, colleagues, the people I knew and asked them to help me get the drug as soon as possible. I was lucky. I had the drug in two days. My daughter received it according to the regimen proposed by the developers. As her immune system was recovering, the antistaphylococcal immunoglobulin started to have its effect. The baby responded to treatment, and her condition improved. I realized that immunity issues are crucial and demand a serious research work. The blood sterility test I mentioned before came out positive for Staphylococcus aureus right at the time when my daughter had almost recovered. Through this bitter experience with a happy ending, my belief in the crucial role of the immune system in fighting infections has grown stronger.
I always aspired to new knowledge. Soon, life gave me another chance to learn. Immunorehabilitation was a brand new branch of immunology that later evolved into an independent medical science. It was founded by my friend and teacher, a scientific advisor on my doctoral dissertation, an academician of the Academy of Sciences of Georgia, a corresponding member of the Russian Academy of Sciences, Doctor of Medicine, Professor Revaz Sepiashvili, who I have been working with for almost 25 years by now. I was convinced that the immune system plays an important role in the development and outcome of some diseases, and decided to conduct research aimed at developing strategies and tactics for a complex immunorehabilitation of patients with impaired immune function, which I later used as a basis for my dissertation. Immunorehabilitology is a very interesting science that is widely acknowledged not only in Russia, but also abroad.
A great interest in the basic and clinical immunology drove me to realize that many pathogenic mechanisms underlying a number of diseases, including primary and secondary immunodeficiencies, allergies and autoimmune disorders, could be explained only from the perspective of immunology. Researchers finally understood that the immune system is a separate system of the organism just like the respiratory, nervous, endocrine and others, but it is far more complex. Physiology of the immune system became a common term. Allergists and immunologists now had a list of parameters with reference values they could rely on when making a diagnosis. Currently, physiology of the immune system is a kind of introductory chapter to allergology or clinical immunology that medical students have to start with if they plan to be allergists or immunologists.
I am deeply convinced that the normal performance of the immune system is critical because the latter controls the work of all other systems. Recently I have developed an interest in the interdisciplinary approach to the treatment of various pathologies, such as physical, surgical, gynecological or skin conditions, cancers, etc. In this approach, medical advice of a clinical immunologist is essential and must be considered when deciding on a therapy. It has already yielded very good results helping to reduce disease duration and ensuring sustained remission and low relapse rates. A number of new specialties, such as immunodermatology, neuroimmunology and immunooncology, have emerged at the interface of several medical sciences. Novel treatment approaches based on the assessment of the immune system dynamics have been studied in surgery, pulmonology, gynecology, and pediatrics. Immunomodulating agents have found their application in target therapy aimed to restore damaged components of the immune system. Research on pathogenic immune mechanisms and compromised immune competence in cancer patients, attempts to discover diagnostic and prognostic immune markers that could be used in oncology are still in their prenatal stage, so to say. However, since immunology was first introduced to oncology, we have learnt a lot.
We work hard to make our own contribution to this medical field. We are currently conducting interesting research on the development of a personalized vaccine against bladder cancer and have already made some advances. Our research on atopic dermatitis is almost complete: we have developed an algorithm for diagnostic and treatment procedures and identified the criteria for predicting infectious complications. Psychosomatic disorders, including atopic dermatitis and bronchial asthma, are of great interest to us. Plastic surgeons and cosmetologists must consider psychosomatic aspects of the problem they deal with. Everything is connected. Although my major specialty is allergy and immunology, I am very interested in cell technologies, immunodermatology, psychiatric aspects of socially significant diseases, cosmetology, etc.
My education, research work and clinical experience allowed me to expand my areas of expertise. I am convinced that a modern doctor should strive to attain profound knowledge of allergies and immunology (it is a good idea to join a continuing education program or to go back to university to major in immunology if you are a family doctor, pediatrician or general practitioner). There are situations when a doctor must refer a patient to a clinical immunologist or follow recommendations of the latter. The immune system is a shelter that protects other systems and organs from negative environmental factors, infections, stress, surgical interventions, bad ecology or the like.
Molecular allergology is an important and innovative branch of allergology. I believe that it will yield significant breakthroughs in science in the nearest future. It holds promise for individual allergy passports for every child that will help us to predict and prevent adverse allergic reactions or conditions. The first brief textbook on molecular allergology was published in 2016 and announced at the European Congress on Allergy, Asthma and Immunology in Vienna. Molecular allergology elucidates the reasons underlying a different response to the same allergen-specific therapies demonstrated by patients with the same pathology.
I wish preventive medicine would totally prevail over treatments. The number of patients who suffer from allergies is increasing to pandemic proportions. A lot of people have cancer. I wish we could develop vaccines against cancer and allergies that could be used to prevent these diseases in the future. World-leading research groups are working on this problem, we are also trying to make our little contribution to this work, so I hope such vaccines will be possible in the nearest future.
When I was a child, I often heard the phrase “You’ve got to study, study and always study”. Regardless of your life circumstances, age, social position or job, you have to keep studying. It must become your inner instinct, just like drinking a glass of water when you are thirsty. World science does not stand still; it is evolving rapidly. There is another saying rooted deep inside me: “If I know that I know little, I will do my best to know more”. Do not be scared to ask. Do not feel embarrassed if you do not know something — it is embarrassing not to want to learn.
Always do what you enjoy most. Do not let those who impose their ambitions on your lead you. Know your goal and go for it. Once you have reached it, you will see other goals ahead. Never miss a good opportunity. We all have our chance in life but not all of us can recognize it. There are no trivial things in science, be attentive, responsible and devoted to what you do. Care for people. Have the courage to face defeat. Life does not favor the week, so be strong. Hardships are there to be overcome. Never be sorry for yourself but look after yourself, love yourself the way you would like other people to love you. Always look for a solution. Do not look for excuses. Do not get stuck trying to find an explanation for not doing what you can do. Let your choice be your vocation. There is still a whole lot of advice I could give to young scientists, but I normally do it right before my students sail off on their journey along the river of knowledge and research.
I think that the most important personal qualities of a true scientist are curiosity, persistence, responsibility, scrupulousness, enthusiasm, aspiration to self-perfection, ability to work with scientific literature, knowledge of languages. Be a workaholic; do not yearn for the end of your working day — creative work does not know time boundaries.
If you think about going abroad, go, but come back. Working abroad will allow you to gain new experience, learn to use new techniques or devices, prepare grounds for scientific arguments, establish international contacts and conduct research together with your foreign colleagues. You cannot work or live in isolation now. You have to communicate, meet new people, argue and be creative. However, I am confident that Russian scientists can make “big” science without having the facilities normally available abroad. And if so, then with the state-of-art equipment and adequate funding, Russian researchers have good chances to become world leaders in science. We just need to set priorities properly.