A career beyond expectations
Gianrico Farrugia, M.D., left his subtropical homeland of Malta in 1988, hoping to specialize in hematology — until a program at Mayo Clinic in Rochester, Minn., opened his eyes to other career options.
Twenty-five years later, he is a prominent gastroenterologist leading cutting-edge research that embraces enteric neuroscience and is helping to guide Mayo Clinic's advances in genome-driven individualized medicine.
"Honestly, my career has been way more than I ever expected," Dr. Farrugia says.
At the urging of the chair of medicine at the University of Malta Medical School, who had completed a Mayo fellowship, Dr. Farrugia came to Mayo for an internship and residency in internal medicine. He soon reached two conclusions:
- He was fascinated by gastroenterology. "When thinking about the science behind mechanically stimulated ion channels (proteins that act as pores in a cell's membrane and permit selective passage of ions and their electrical current in and out of cells), it seemed to me that the place to study is the gastrointestinal tract because it's constantly moving," Dr. Farrugia recalls.
- He wanted to do research. "I realized that I didn't know why certain conditions developed or why certain treatments were effective," he explains. "For me, it's always been the question, 'Why?' I had to do research."
Becoming a clinician-investigator
After his residency, Dr. Farrugia became a gastroenterologist through Mayo Clinic's Clinician-Investigator Program, which combines clinical specialty or subspecialty training with two years of research experience.
Despite no research background, he was mentored in the labs of physiologists James L. Rae, Ph.D., who was instrumental in developing the technique for measuring the flow of electrical current through ion channels, and Joseph H. Szurszewski, Ph.D., a pioneer in studying the role of enteric nerves in gastrointestinal function and disorders.
"This program was the only avenue I had for getting into research, and it fundamentally changed my career," Dr. Farrugia says. "Having those two years in the lab was transformational. And it was critical to getting my first funding from the National Institutes of Health (NIH)."
When Dr. Farrugia joined the gastroenterology practice at Mayo Clinic, a special Mayo program reserved 75 percent of his time for research in Dr. Szurszewski's lab for the next three years.
"To get NIH funding, you need to have a track record," Dr. Farrugia explains. "Because of the environment that Mayo provided, I was able to get NIH funding for my own research."
Dedicated to patient care
Today, Dr. Farrugia is a member of the largest gastroenterology and hepatology practice in the U.S., ranked No. 1 for digestive disorders in U.S. News & World Report Best Hospitals. He specializes in disorders of motility (how the gastrointestinal tract contracts and moves contents through it), especially gastroparesis (slow gastric emptying). Long associated with diabetes and other disorders, gastroparesis can cause nausea, vomiting, bloating, early fullness and abdominal pain.
As director of the Mayo Clinic Center for Individualized Medicine, Dr. Farrugia heads Mayo's adoption of genomics-based tests and treatments to personalize care for patients with diseases having genetic causes.
"The next transformation in medicine is coming from our ability to quickly decode every letter in a patient's genes and their whole genome," he says.
Obsessed about research
As director of Mayo's Enteric Neuroscience Program, Dr. Farrugia has helped Mayo garner NIH funding for studies on gastrointestinal motility and collaborate with researchers nationwide through the Gastroparesis Clinical Research Consortium.
His work in individualized medicine strives to identify genetic biomarkers that explain why some develop gastroparesis, for instance, and others don't. Meanwhile, he seeks to better understand the regulation of gastrointestinal motility and develop better treatment of gastroparesis.
Normal gut function requires coordination among nerves, interstitial cells of Cajal (ICC) and smooth muscle cells plus a balance between processes that injure ICC and processes that generate and maintain them. In people with diabetic gastroparesis, the balance shifts toward factors that damage ICC.
In mouse studies, Dr. Farrugia has shown that hemin, a biological product of red blood cells, boosts the production of an important ICC protector, allowing repair of the ICC network and normalizing gastric function. Now, he and his colleagues are recruiting patients for the first clinical trial to determine whether intravenous hemin therapy is equally beneficial for people with gastroparesis.
"The hope is that this clinical trial may lead to an effective medication for gastroparesis — one that actually targets the cause of the disease," Dr. Farrugia says.
Oct. 26, 2016