HemAware is conducting a series of interviews with researchers who have received awards from the National Hemophilia Foundation (NHF) to pursue their research interests. This interview was conducted with Mark T. Reding, MD, director of the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis. He is also assistant professor in the Division of Hematology, Oncology and Transplantation. Reding’s research interests include the immune response to factor VIII (FVIII), immunologic aspects of gene therapy and clinical management of patients with inhibitors.
What drew you to this field? What was your initial interest in this field of research?
Reding’s attraction to the field can be summed up in a name: Nigel Key, MB, ChB, now director of the Hemophilia and Thrombosis Center and a researcher at the University of North Carolina at Chapel Hill. “He was a great teacher, great clinician and wonderful with patients. And he had a keen interest in research. Being able to bring all that together—that was what I wanted to do.”
Where were you in your career when you were awarded the Judith Graham Pool (JGP) Postdoctoral Research Fellowship?
Reding received the JGP fellowship in 1999 for his project, “T Cell Epitopes on FVIII.” He had completed his three-year fellowship training and was beginning a position as a junior faculty member at the University of Minnesota.
What did you use the grant for?
The grant supported Reding’s salary during the two years he spent conducting research. Junior faculty members are pulled in so many directions that they rarely have enough financial or time support for lab work, Reding says. “If it hadn’t been for the grant, I probably wouldn’t be where I am today. It really shaped a lot of what happened after that.”
Did the research NHF funded through the JGP fellowship assist in advancing your own position at your research institution/hospital? Or did it serve as a building block to further your career or research in hemophilia?
For Reding, the grant served both purposes. At the time, few faculty members were being hired at his institution, and the department was being restructured, so the grant helped Reding get established. Plus, it helped him develop inroads into the research community. “The couple of years of protected research time allowed me to make a lot of contacts in the hemophilia world outside of my institution.” Attending meetings and conferences, meeting other researchers and collaborating with them rounded out the picture. “Many of those contacts are still active today.”
Are you still engaged in coagulation or bleeding disorders research specifically?
“I am, although our focus has shifted from the very basic science I was doing at the time of the award to more clinical research at the moment.” But that’s not by choice, Reding says. With shortages of trained hematologists nationwide, many hemophilia treatment centers (HTCs) like his must prioritize patient care over research.
“We have a variety of clinical trials that our center participates in, including looking at prophylaxis in adults and new factor products.” These are national trials conducted at multiple centers.
Gene therapy is another focus at Minnesota. “We are in the process of developing new gene therapies for hemophilia,” Reding says. Although his involvement is limited now, Reding anticipates that once clinical trials get under way in the next few years, he will be much more engaged.
How does/will your research have an impact on the clinical aspects of patient care?
As a hematologist at an HTC that serves adults, Reding is seeing the first generation of men with hemophilia living into their senior years, experiencing health issues of aging. “We’re starting to see a whole lot of things that we don’t have much experience with—degenerative joint disease, not just from hemophilia, but from age, and all the cardiovascular issues,” he says.
Clinical trials on younger subjects, especially involving prophylaxis, have limited application to the older generation. “Is it the right thing to do? Is it necessary? Is it as helpful as it is in kids? The research in terms of the clinical trials—looking at prophylaxis in adults, longer half-life drugs and gene therapy— those are going to help answer these questions.”
Orthopedic surgeries are a mainstay at Reding’s HTC. “We’ve done a number of major orthopedic procedures on inhibitor patients. That’s something in which there is very little clinical experience and not a lot of research going on.” As more men age, these procedures will be more common, and studies will be needed to verify best practices, he says.
What career goals do you have for the future?
Reding’s main career goal is to pass the baton. At meetings, he has noticed he is at least 10 years younger than many of his colleagues and wonders who will replace them in the future. “There’s a huge concern about this—are there enough people coming behind us?” Reding is determined to help. “If I can encourage and mentor other people who enter this field and be successful in it long-term, that would be a far greater achievement than any paper or clinical trial that I could do.”
Where do you see bleeding disorders research going?
“In terms of hemophilia, gene therapy is still something we’re going to see a lot of energy put into. I do think it will become a reality at some point,” Reding predicts. “There is a slowly building interest in the rare coagulation disorders,” he adds. “We don’t see a lot of those patients, but there are enough of them out there.”
When you’re not working, how do you “escape” from your work?
Reding enjoys being outdoors and spending time with his three children, ages 8, 12 and 15. “I don’t do enough of it, but I like to spend time at the lake, fishing, water skiing and boating,” he says. When asked about leisure reading, Reding laughs. “I don’t read much, partly because I think I read so much at work.” Travel is usually connected with meetings. Still, Reding makes time to scout around. “I always try to take an extra day and explore the place,” he says.