Faculty Spotlight: Daniel Laskowitz, MD, MHS

Daniel Laskowtiz, MD, MHS, was the subject of one of our first Faculty Spotlight interviews in 2015, in which he shared his loves of education, translational research, and providing neurocritical care. More than seven years later, we revisited Laskowitz for a follow-up interview. Now, he talks to us about his three decade journey to develop treatments for traumatic brain injury from the lab bench to the patient’s bedside. Laskowitz also shares his top priorities as  Vice Chair for Academic Affairsand therapeutic lead for Duke Clinical Research Institute’s Neuroscience Medicine. He also updates us on his 2015 hopes for learning to ride a motorcycle and play the guitar.

What are your responsibilities within the Department? What does a typical day for you look like?
It is hard to describe a typical day, because I have several different roles that are so varied. On the research side, I help to lead the Neuroscience Medicine team at the Duke Clinical Research Institute, where we have been involved in studies designed to improve patient care. I also lead a translational laboratory that tests new therapies in animal models of stroke, acute brain injury, and cerebrovascular disease. 

We have a number of translational projects; for example, evaluating systemic delivery of neurotrophic growth factors to improve functional recovery after acute brain injury; using novel microglial inhibitors to reduce vasospasm and delayed cerebral ischemia following subarachnoid hemorrhage, developing an apoE based peptide-mimetic to improve outcomes in models of Alzheimer’s disease and acute brain injury. A significant part of my typical week is also involved in undergraduate medical education where I help lead the Duke medical school curriculum immersive research experience during their third year. 

I have a fractional appointment at the Duke-Singapore medical school where I also help guide this research program and promote translational collaboration. On the clinical side, I spend most of my time in the neurointensive care unit, and during these weeks I don’t have much time for anything else. So, my days are variable, but it keeps things interesting, if somewhat disjointed.

In our 2015 interview, you discussed your work in the Brain Injury Translational Research Center. What have been some of the Center’s main accomplishments since then?
Clinical neurology can be frustrating at times because we have imperfect therapies, and we see on a daily basis the personal toll of neurological disease. To me, one of the most compelling aspects of academic neurology is the opportunity to translate ideas from the lab to clinical practice. Translational research is a slow and high-risk endeavor, and we have been fortunate to have some successes along the way. For example, CN-105 is an apoE base drug that reduces glial activation and secondary injury in animal models of acute brain injury and AD. 

Almost thirty years ago, we began studying this type of molecule using cell culture and basic signaling experiments. Today, we have a drug that has made it through the FDA and orphan drug process, and we have recently completed multiple successful clinical trials in the US, Singapore, and China. In collaboration with other academic investigators, our laboratory has also performed the animal modeling for several first in class drugs that have novel mechanisms of action, and it has been exciting watching these develop from preclinical work through FDA evaluation, and ultimately helping to guide these compounds through early first to man (Phase 1) trials. 

The important thing about translational research is that it is not about any one individual; it is an integration of skill sets. All of these successes were made possible by extraordinarily talented and committed clinicians, laboratory-based and clinical researchers, statisticians, and regulatory experts. Frankly, one of the most satisfying aspects of translational research is the ability to work with and learn from these exceptional teams who are committed towards a common goal.

What are your top priorities as Vice Chair for Academic Affairs for 2023?

I think that one of the perspectives that change when you are at an institution for a long time is that personal ambitions become somewhat less important, and what becomes more meaningful is the ability to positively impact those around you. 

Our faculty are tremendously talented, but have varied career paths and skill sets, and with all the many changes implemented at the institutional level, the road to academic advancement can be at times confusing. This may contribute to burnout and feeling under-appreciated. 

So, one of my top priorities is to try to work directly with faculty and Division chiefs to clarify the promotion process. This involves creating policies for the Promotions and Tenure Committee, interfacing at the institutional level, and providing mentorship when appropriate. I also consider it a priority to reach out to other Departments to establish collaborations and joint initiatives, as this also increases opportunities for our faculty.

What do you see as your top priorities and challenges as the therapeutic lead for Duke Clinical Research Institute’s Neuroscience Medicine?
I think that a lot of our faculty may primarily associate the DCRI with cardiology megatrials, and don’t realize the opportunities to work with the DCRI in neuroscience medicine. It is a priority for me to help interested faculty understand the opportunities and advantages to working with the DCRI. Being involved in a trial at the coordinating center level often gives our faculty the opportunity to impact their field at a national level, in a way that traditional site-based research may not. 

There is a range of research at the DCRI from innovative Phase 1, proof of concept and pivotal trials, registry, and even post-marketing trials. I am personally most interested in evaluating innovative new therapies that can fundamentally change how we practice neurology. For example, we are currently involved with an NIH initiative to help evaluate new therapies for patients with cognitive issues associated with long COVID; trials to evaluate first in class therapies for neurodegenerative and AD; and developing and implementing protocols to evaluate cell based and pharmacological interventions to improve outcomes in patients with chronic deficits after stroke.

What do you enjoy most about your work?
I am excited by the prospect of taking an idea from the lab and potentially impacting the care of our patients. But this is a slow process, and as time goes on, I realize that ultimately, what makes it all worthwhile are the people that I work with. 

In the ICU there are some of the most committed, thoughtful, and clinically superb clinicians that I am always learning from. Similarly, I have had the honor to work with unbelievably dedicated and talented laboratory based, clinical, statistical, and regulatory teams that have helped make many of our translational projects successful. 

Hopefully, I have also had the opportunity to have some positive impact on our graduate and postgraduate medical trainees. For example, I was the Neurocritical Care fellowship director for about a decade, and it was enormously gratifying to see many of our fellows advance through their careers. Many of these relationships have lasted my entire career, and several are now tenured Professors at Duke. 

The educational, research, and clinical aspects of what I do are quite varied in many respects, but the common theme is that I work with exceptional interdisciplinary teams in all of these areas on a daily basis, and that is what keeps me coming on every day.

What’s the hardest part of your job?
The ICU can be physically, and sometimes emotionally demanding, and it is often frustrating that we do not have more to offer patients. Research progress, on the other hand, progress can feel excruciatingly slow, and there is constant pressure to remain funded.

Before joining Duke as a faculty member, you were a Duke medical student and fellow. What’s one memory or lesson from each of those experiences that was especially memorable or helpful to you?
When I first came to Duke as a medical student in 1987, I knew that I was interested in clinical neurology, but I had no particular interest in laboratory-based research or academics. Frankly, when I chose to work in a basic research laboratory evaluating strategies to overcome chemotherapeutic resistance in medulloblastoma, it was well outside of my comfort zone.

 I left that experience with the recognition that, although I might not have any particular aptitude for the technical aspects of laboratory research, it was possible for a clinically oriented person to integrate new ideas from across disciplines, test them in a lab, and have the opportunity to fundamentally improve what we have to offer patients. 

It was almost a visceral sense of empowerment to realize that, as a clinician scientist, you can have that kind of impact on medicine. This is in a large part why I agreed to lead the SOM 3rd year research program.

As a fellow, on the research side, I had the opportunity to work with a number of senior faculty across Departments (several of whom were chairs), who welcomed me, as an unfunded fellow, into their labs and helped me to explore my ideas. I was blown away by their graciousness and generosity. We hear a lot about corporate Duke, but this was really Duke at its best, and something that I always try to keep in mind and emulate. 

I vowed to pay that forward, and I hope that I have, in some small part. My clinical fellowship director was Cecil Borel, who came from Johns Hopkins to set up the Duke NeuroICU. He was just an exceptional and authentic person, who taught me the importance of multidisciplinary collaboration, and how it is possible to lead with humility rather than with swagger.

In our 2015 interview you also discussed wanting to practice the guitar and ride a motorcycle. Have you found the time to do either of these activities, and what else do you like to do when you’re not at Duke?

I did, in fact, pick up the guitar, and even took regular lessons for several years. I am embarrassed to say that I let this drop during Covid, but I have started staring at the guitar again with guilt and am committed to picking it up again at some point in the near future. Soon after our original interview, I did buy an old 600 cc Honda Shadow. That did not end well and there was, shall we say, a mishap during the first few months. 

Fortunately, there were no significant injuries (besides the bike, and perhaps my pride). It has been collecting dust for the past 4 or 5 years in our garage but, like the guitar, I am committed to trying again. Duke has taught me nothing if not perseverance.