When Alberto Pugliese, M.D., was a teenager in his hometown of Trapani, Sicily, he was overweight and quite fond of sweets. Especially doughnuts. “I’d get them every day!” he recalled.
A routine examination threw a scare into the teen and his family.
“They found sugar in my urine,” he said, “and they thought I might have type 1 diabetes. My mother and father were terrified, and I realized how scary this disease could be.”
The episode made an impact, and so did the diabetes specialist (“very charismatic,” recalled Pugliese) who ultimately determined that young Alberto did not have type 1 after all and could avoid type 2 by changing his diet and losing weight. “I remember how inspirational he was.”
Pugliese, the Samuel Rahbar Endowed Chair in Diabetes & Drug Discovery, is the newest and most prominent addition to City of Hope’s growing commitment to stamp out type 1 diabetes, taking over the Wanek Family Project for Type 1 Diabetes and chairing the Department of Diabetes Immunology. He is an internationally known researcher who amassed a formidable record in a 35-year career, the last 28 at the University of Miami.
“He was known best as the go-to guy for mentorship and collaboration, especially with young people,” said Jay S. Skyler, M.D., a longtime Miami colleague. “We were all in love with him.”
Pugliese says he made the move to California because he needed to do more.
“I like the idea of starting something new, building a new program. It’s exciting,” he said. He wants to make City of Hope the premier place for type 1 diabetes research and clinical trials, adding that the resources and support provided by the Wanek family and others provide an ideal foundation on which to build and grow. “It’s a fantastic opportunity,” he said.
Fantastic on both sides, according to his new colleagues.
“We got lucky,” said Debbie C. Thurmond, Ph.D., director of the Arthur Riggs Diabetes & Metabolism Research Institute and the Ruth B. & Robert K. Lanman Chair in Gene Regulation & Drug Discovery Research. “We were looking for a renowned leader, we had what he was looking for, and we caught him at just the right time.”
What they found, adds John S. Kaddis, Ph.D., was a world-class networker with an uncanny ability to bring experts together from far and wide — even those in competition with each other — to advance the science and work toward a cure.
“In science, many people will say, ‘I bring people together,’ but few are willing to put in the hard work to actually do it,” said Kaddis, associate professor in the Department of Diabetes & Cancer Discovery Science. “Alberto is a master at it. Finding common ground is his major strength. I’ve seen it for years. He knows so many people, knows the work they’re doing, and he’s always trying to help everyone move forward.”
“He has this superpower,” agreed Thurmond. “He brings people together in such a good manner that you really want to work with him, and you learn so much.”
Finding His Passion
Since early childhood, Pugliese knew he wanted to be a doctor, emulating his uncle — a local gynecologist and hospital director. But in medical school, Pugliese found the classroom boring. “I wanted to learn from the patients, not the instructors,” he recalled. So, he ditched class and followed doctors on their rounds, learning and listening. He even arranged to shadow that same charismatic diabetes specialist who had so impressed him years earlier.
The pivot to research came a couple of years later.
As a young intern in Palermo, Pugliese was assigned to a unit treating children with type 1 diabetes. “Some had arrived in a coma. They needed immediate IV treatment,” he remembered. “Then, I could educate the families, monitor the kids’ condition, do follow-up ... but I couldn’t make it go away. Sometimes families would return later because another kid had come down with type 1 diabetes. It was incredibly frustrating.
“I realized it wasn’t enough for me to be just a clinician. I wanted to do research, so I moved to the U.S. I left my family, my country… so I could do my best.”
His “best” has been impressive, increasing our understanding of type 1 diabetes on many levels. His key contributions include the discovery that the thymus plays a role in the production of insulin and the development of type 1 diabetes. He has demonstrated that certain genetic variants afford protection from type 1 diabetes, even among people who show evidence of autoimmune response against their body’s insulin-producing beta cells. He has also shown that patients who’ve undergone pancreas transplants can eventually develop diabetes again, even if they are taking immunosuppressants.
Pugliese and his co-investigators have also examined how a protein molecule called interleukin-2 may be used to regulate the immune system and alleviate type 1 diabetes. This is a critical part of Pugliese’s view of type 1 diabetes as a chronic disease in which the immune system must be regulated, not simply suppressed, and that finding ways to do that is part of the combination for success toward protecting, preserving and reviving a patient’s remaining beta cells. He hopes to test this approach in a new clinical trial.
Bringing People Together
Typically, Pugliese gives credit for these and other revelations to everyone but himself. He insists his goal is always patient-centered: to advance toward a cure, not to see his name at the top of a list of journal article authors. He does, however, marvel at the progress that’s been made.
“If you look at the past 35 years,” he said, “it’s mind-boggling. Our understanding, the tools we have. It’s unbelievable. Now, it takes a long time for all of this to reach the patient. But we’re getting closer every day.”
He’s bringing that day closer with his work as a “master collaborator” at two research organizations especially dear to him. One, TrialNet, facilitates a host of type 1 diabetes clinical trials. Playing to his strength, Pugliese led committees that brought researchers together, especially those who study how a therapy might work and what might predict disease risk.
Then there’s nPOD, the Network for Pancreatic Organ donors with Diabetes. This organization fills a critical research gap. It can be difficult to near impossible to accurately examine beta cells inside a patient’s pancreas. Conventional scanning and imaging tools are inadequate. (“We’re blind,” lamented Pugliese, when it comes to understanding what is happening in the pancreas when a person is developing type 1 diabetes). nPOD enables researchers around the world to receive pancreatic tissue from organ donors who’ve passed away and had type 1 diabetes. Creating such a network required painstaking work reaching out to hundreds of medical and scientific professionals. Pugliese did it, often casting his recruitment net around the world and across multiple institutions.
“He’s a connector,” said Helena Reijonen, Ph.D., associate professor in the Department of Immunology & Theranostics. Reijonen has known Pugliese since the mid-2000s and was involved in the recruitment process that brought him to City of Hope. “He brings teams together. He’s what we need to establish City of Hope’s type 1 diabetes research program nationally and internationally.”
Friends don’t exactly call him a workaholic, but they do note his calm-yet-intense demeanor, his tendency to lose track of time when engrossed in a project and his sneaky, dry sense of humor. Pugliese and wife Clara have a 19-year-old daughter, Valentina, who wants to be a veterinarian “and save all the animals” he says with a smile.
He takes few vacations, but does indulge in a couple of diversions: He’s a talented, meticulous photographer (“In a park, he’ll photograph every single flower,” one friend observed) and a fan of fast cars and motorcycles — a hobby he’s excited about enjoying on more than a few California roads.
Cars aside, it’s his work that drives him.
“This is my mission in life,” he said. “I don’t even think about it as work.
“It’s my reason for being.”