A passion to advance individualized care for kidney patients
Doctors who treat patients affected by kidney disease or injury face a challenge that physicians in some fields don't: There is no method to individualize patient care.
Dr. Bruce A. Molitoris is a distinguished professor of medicine and the director of the Indiana Center for Biological Microscopy. He said nephrologists are unable to quantify the best measure of a patient's overall kidney function, the glomerular filtration rate.
"Cardiology, pulmonary critical care, and GI have techniques and tools to individualize therapies and quantify the progression of a disease," he said. "Nephrologists do not have a suitable, rapid, and reproducible way to do that. It limits us in making a diagnosis of kidney injury and quantifying the severity. It limits us in knowing how much kidney function has been lost. It limits us in conducting clinical studies because we can't quantify the effect of a drug."
Molitoris has developed a technique that quantifies both the glomerular filtration rate and plasma volume at the bedside. The work has been licensed to FAST BioMedical through the Indiana University Research and Technology Corporation. Molitoris serves as FAST BioMedical's medical director.
"The end result is that we can more accurately care for individual patients," he said. "We no longer have to estimate kidney function using equations that are plus or minus 30 percent about the mean."
Molitoris realized his passion for basic science after earning his undergraduate degree. "I had begun Ph.D. work in nutrition at Cornell when I decided I wanted to be in medical school," he said. "I entered Washington University in St. Louis, but after my first year I decided to return to the laboratory to do basic science work while I finished my M.D. I realized that I wanted to do basic science that was applicable to human disease directly."
Molitoris believes translating research from the bench to commercial products and processes is the basis of medical advancement.
"You need commercialization in order to benefit patients," he said. "It does very little good to find something interesting and publish it, and then it just sits there and doesn't mature into something commercially viable that businesses will take up and make available for health care professionals to advance patient care."
His own experiences in translating research into commercial applications involve working with IURTC officials.
"Bob McDonald immediately understood the potential value of being able to quantify kidney function," Molitoris said. "He was a huge help to me and Jim Strickland, the business person who took up the license. IURTC not only understood the importance but also helped identify someone who could carry forward with the business end."
Obstacles from the business end were the biggest surprises that Molitoris faced. He said there were scientific and production obstacles, but the most unusual one had to do with venture capitalists and industry.
"It took a while to convince them that this was a worthwhile undertaking," he said. "There was no pathway for them to see how it would directly generate a profit. It hadn't yet been used to affect clinical outcomes. Venture capitalists said, 'Show us the evidence that this will affect outcomes so we know hospitals will buy it and physicians will use it.' We said, 'We can't show evidence until we develop the tech, and we can't do that without money.' The venture capital world has become much more conservative, I'm told, within the last 10 to 15 years. They want research that's farther down the road and a more guaranteed endpoint."
These obstacles have led Molitoris to tell colleagues who ask for advice on commercializing their work to be certain they are passionate about it.
"This is too tough a road to get to the end of," he explained. "They have to be convinced that the work will benefit patients. This has to be exactly why they went into medicine and are at an academic center: to further patient care. And the business world is different from academics, science, and medicine. They will need help along the way, and they need to find outstanding business people to work with."
Molitoris has seen attitudes toward commercialization shift during his 20-plus years at the School of Medicine.
"In the last 10 years, institutions across the U.S. have realized that a good portion of their future will depend upon patents and spinout companies," he said. "As federal research dollars are shrinking, they have to turn someplace else. And why shouldn't they become more like a commercial entity: patent, develop, license, and spin off companies? I think it's a universal change. IU went through it and is still going through it. It's a never-ending process of change."
Molitoris said he admires anyone who will start with an idea and develop it.
"Some people are dealing with paradigm shifts, which are very difficult to get accepted," he said. "They keep plowing ahead, creating new data to support where they're going, and finally it's accepted and they move forward. Then technology can adapt and bring something to life that no one else had ever thought about."