The 'Accidental Neuropathologist' - on 40 Years in Neuropathology
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Free Neuropathology 1:24 (2020) Harry V. Vinters
doi: https://doi.org/10.17879/freeneuropathology-2020-2956 page 1 of 21
Reflections
The ’Accidental Neuropathologist' – on 40 Years in Neuropathology
Harry V. Vinters1
1
Depts. of Pathology & Laboratory Medicine & Neurology, David Geffen School of Medicine at UCLA, Los Ange-
les, CA, USA
Address for correspondence:
Professor Harry V. Vinters · Laboratory Medicine & Pathology · University of Alberta · Faculty of Medicine & Dentistry · Edmonton,
Alberta · Canada
hvinters@mednet.ucla.edu
Additional resources and electronic supplementary material: supplementary material
Submitted: 14 August 2020 · Accepted: 16 August 2020 · Copyedited by: Christian Thomas · Published: 25 August 2020
Keywords: Neuropathology, UCLA, Personal reflections
ciless tyranny that would last until the early 1990s.
During that happy time in the early 1990s the USSR
thankfully collapsed under the weight of grotesque
This article is dedicated to the memory of my corruption and reliable, predictable, frequently
brother Raymond John Vinters (1952-2020). comical Soviet incompetence. Members of my
family lived in various refugee camps in Europe
between 1944 and 1949, at which time they were
sponsored by distant relatives to relocate to Cana-
da; some of their lasting and most intimate friend-
ships were made in the camps during those post-
Beginnings in Canada war years. My parents had wed in Lübeck, Germa-
ny.
My family were Latvians who, by the end of
World War II, had become refugees from the Soviet It was their (and my) good fortune that our
Union. For the repressive Communist regime that family ended up on the northwest shore of Lake
controlled the USSR, my family (on both sides) Superior, in the small city of Port Arthur (now inte-
were or would soon become ‘criminals’ who owned grated into a larger municipality, Thunder Bay),
land and were involved in commerce. They saw no where I was born. If one envisions Lake Superior as
future under a Communist regime, and the fate of having the shape of a wolf’s head, Thunder Bay is
relatives who remained in Latvia after World War II about where its eyes would be located. This beauti-
confirmed the wisdom of their decision and choice ful small city is situated on rolling hills overlooking
– some were exiled to Siberia for many years, oth- the lake, and is home to one of the harshest (win-
ers simply had their property confiscated. My fami- ter) climates of any metropolitan area in Canada. It
ly – grandparents, their two children (one my fa- provided me with an outstanding primary and high
ther) and assorted household staff who joined school education at the hands of, and with the
them – fled the country as the Red Army moved in mentorship of, dedicated and devoted teachers
to ‘liberate’ its people and begin a brutal and mer- who inspired a love of learning and a first-rate work
Copyright: © 2020 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the Creative Commons license is provided, and any changes
are indicated. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Free Neuropathology 1:24 (2020) Harry V. Vinters
doi: https://doi.org/10.17879/freeneuropathology-2020-2956 page 2 of 21
ethic, of which they themselves were emblematic. Latvia, lovingly cultivated their gardens of flowers,
Very lucky break for me! Winters were long and berries and vegetables on the two acres that
brutal in Port Arthur. I well remember sitting in my Eglaines occupied. I often wondered what it would
high school classes, looking out onto the harbor – be like to start one’s life over, at the age of 49 or
Port Arthur was a port city thanks to the St. Law- 50, in a foreign land and culture, as my resilient
rence Seaway (opened in the late 1950s, Queen grandparents had; the task was easier – though no
Elizabeth II herself came to our fair city for the offi- less challenging! – for my father and mother, who
cial opening), which allowed ocean-going vessels to later became a medical technologist. My father and
come into the Great Lakes. The harbor was still grandfather worked in the grain elevators that sur-
frozen in April and May, and I longed for warmer rounded the harbor (the grain coming from Cana-
days – never dreaming then that I would spend da’s prairie provinces and destined to be loaded
most of my working career in a climate that can onto seaway-bound ships) until my dad became a
safely be described as endless summer. real estate agent, then subsequently a real estate
broker. My paternal grandmother worked as a do-
I was also fortunate to have support and en- mestic. While I loved Port Arthur (that affection
couragement from a wonderful father [Figure 1] continues to this day) I yearned to pursue higher
who, as a single parent, raised me and my brother education in a larger center, and a variety of schol-
after our mother left in the early 1960s to begin a arships allowed me to do so at the University of
new life in the USA and my parents divorced. He Toronto (U of T), another lucky twist of fate. Being
died in 1980 but never a day goes by that I don’t a Toronto resident introduced me to the joys (and
think – with much love and gratitude – of him and challenges…) of big city metropolitan life, and I
his dedication to his sons and family, his generosity, have enjoyed urban living ever since. I adore the
support and kindness. Our loving and resourceful buzz of large cities, almost without exception. Idyl-
family included grandparents, aunts and uncles, lic country life, a dream for some, is not for me.
eventually cousins, all trying to find their way in the
brave new world into which they had been thrust
by World War II and its aftermath and sequelae. As
with many immigrant families trying to establish
life in a foreign land, barely speaking English and
with limited finances, extended family members
(usually from three generations) occupied small
apartments and houses, then eventually spread
their wings and left to make lives of their own in
their new homes, when they could finally afford
them. My favorite home in those early days was a
ramshackle house – little more than a cottage – just
outside the Port Arthur city limits, with two tiny
bedrooms and one miniscule bathroom (bath, no
shower), situated on the banks of a small meander-
ing river and on a gorgeous piece of land. The
property was also home to several massive pine
trees and came to be known (by the Latvian expat-
riate community) as Eglaines (loosely translated,
The Home of Tall Pine Trees). Seven of us called this
home for many years. It had an old coal furnace in
which fuel needed to be replenished during the icy
winter nights, a task shared by my father and
grandfather. My grandparents, who had been
‘saimnieks and saimniece’ (the master and mistress
of their household) and oversaw a large farm in Fig 1: My father Gunnar (Gunars) Vinters, 1925-1980
Free Neuropathology 1:24 (2020) Harry V. Vinters
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During the summer between my graduation required stamina and manual dexterity, both (in
from high school and the beginning of university addition to excellent clinical judgement) require-
(1968) I had the marvelous opportunity to work in ments of a first-rate Neurosurgeon. Fortunately,
the laboratory of a family friend (and my aunt’s throughout my career I have had the opportunity
godmother), Irene Grodums, who after immigrating to work with some of the very best in the latter
to Canada had completed her Ph.D. and become a field, in numerous productive collaborations and
Virologist at the University of Saskatchewan in Sas- diagnostic challenges (see below).
katoon. Prof. Grodums instilled in me a respect for
the importance of careful observation in tissue How Neuropathology chose me
studies, whether done by light or electron micros-
copy (she worked on Coxsackie virus effects on the Neuropathology was a largely invisible special-
heart) and respect for experimental animals used in ty while I was in Medical School. Admittedly, in the
biological research. early 1970s it was itself a fledgling discipline in the
In the 1970s medical school was increasingly Clinical Neuroscience firmament, certainly in Cana-
regarded as a place of graduate studies, following da. We received wonderful lectures from Neuropa-
upon an undergraduate experience. My first degree thologists – including Dr. Barry Rewcastle – but
was in Biology and most of my courses given in the were never really apprised of how a Neuropa-
Botany Department (these days, Plant Sciences). U thologist spends her/his time and contributes to
of T undergraduate instruction was loosely based in the diagnosis and understanding of neurologic dis-
one of the constituent colleges, and my academic ease. Indeed, we hardly knew that such individuals
(and residential) home was University College. I existed or how one went about becoming a Neuro-
thrived on living on an historic campus situated in pathologist, this despite several significant Neuro-
the middle of a world class city, one with a great pathologic discoveries having been made at U of T’s
sense of history. One of my first summer research Banting Institute on College Street, then home of
jobs was in the Botany Department, studying the the research components of the Pathology De-
kinetics of water movement into and out of giant partment. (Frederick Banting, the discoverer of
algae with Profs. Jack Dainty and Mel Tyree (both insulin, was the first and is still one of the few Ca-
accomplished Biophysicists); this resulted in my nadians to be awarded the Nobel Prize in Medicine
first publication [1]. While in medical school at the or Physiology). The initial report of progressive
University of Toronto (1972-76) I developed an supranuclear palsy [4] was co-authored by the
abiding affection for the Neurosciences, though I great Jerzy Olszewski, though he had unfortunately
realized I would never have the skill set, insights, passed on by the time I was in Medical School. I
patience or scientific acumen to be a solid basic spent my internship year at the University of Alber-
neuroscientist. Our inspiring Professors included ta Hospital in Edmonton, in retrospect a wise
the legendary Neuropharmacologists Phil Seeman choice because it introduced me to the beauty of
and Oleh Hornykiewicz; Dr. Seeman (probably one the rugged Canadian west (stunning prairie skies
of the best lecturers I have ever encountered) had and amazing geography) and facilitated my meeting
previously discovered how anesthetics and tran- people who remain steadfast friends to this day. Of
quilizers interact with cell membranes [2] and sub- course that year also provided a terrific opportunity
sequently contributed to the molecular under- to learn important fundamentals of Medicine from
standing of complex genes that control dopamine energetic and knowledgeable instructors. The Uni-
receptor function, while Dr. Hornykiewicz was the versity of Alberta Hospital would, many years later,
discoverer of the dopamine deficiency [3] that become a place where I would do an extended
leads to Parkinson disease. The other option was to locum.
choose a Clinical Neuroscience in which I would I began training in Neurology in London, On-
have both clinical responsibilities and an opportuni- tario in 1977 in the Department of Clinical Neuro-
ty to do research and teaching. I decided to pursue logical Sciences (CNS) at the University of Western
postgraduate training in Neurology, having elimi- Ontario / UWO (subsequently renamed Western
nated Neurosurgery as a career path – I lacked the University). This Department represented a logical
Free Neuropathology 1:24 (2020) Harry V. Vinters
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fusion of talent from Neurosurgery, Neurology, of the anatomic basis of neurologic diseases using a
Neuroradiology, and Neuropathology. Its leader- multitude of special stains, which in those days
ship included two legends of 20th century Neuro- (late 1970s) were, together with electron micros-
surgery (Charles G. Drake) and Neurology (Henry copy, the ‘gold standard’ for neuropathologic inves-
J.M. Barnett). London was also a major center for tigations. Oh yes, things have changed!
stroke research; the clinical specimens we were
shown in surgical pathology and at autopsy confer-
ences inspired an appreciation and respect for the
importance of cerebrovascular disease in Neurolo-
gy. The weekly 3-hour city-wide Clinical Neurosci-
ence rounds included presentations from all four of
the sub-disciplines, including a clinicopathologic
conference weekly or every two weeks. I was com-
ing to an important, somewhat uneasy career junc-
ture: Neurology felt like perhaps not quite the op-
timal choice of specialization for me. However…
An inspirational figure during that first year of
Neurology training came to be Dr. John C.E. Kauf-
mann, chief of Neuropathology at the (recently
built) University Hospital on the main UWO campus
in the north end of the city. Dr. Kaufmann (or JCEK,
as his trainees knew him, Figure 2) had been re-
cruited from South Africa to be the first Neuropa-
thologist at UWO, and one of only a handful in
Canada at the time. More than being a marvelous
diagnostician, JCEK was the essence of a ‘gentle-
man and scholar’, someone who took responsibility Fig 2: Dr. John C.E. Kaufmann, Chief of Neuropathology, Uni-
for the wellbeing and mental and physical health of versity Hospital, London, Ontario, Canada
his trainees. I daresay most of us lucky to be in that
multi-year cohort try to emulate JCEK in our own My other mentors in London were Dr. Melvyn
careers. He and his wife Suzanne Kaufmann loved J. Ball, who was already a prominent Alzheimer
art (they had an inspiring collection which included researcher, and Dr. Joseph Gilbert [Figure 3], who
an Andy Warhol), entertaining on a grand scale, had trained in Neurology and Neuropathology in
fine (exquisite) cuisine usually prepared in their Cleveland, though practiced the latter. Neuropa-
own kitchen, good and witty conversation and thology in Canada is configured as a specialty ra-
travel. The presentations JCEK oversaw at the ther than a ‘subspecialty’ requiring Fellowship
weekly Clinical Neuroscience rounds were marvels training. JCEK and Joe Gilbert were in charge of NP
of clarity and insights into neurologic disease. training at the two major UWO teaching hospitals,
Throughout that year of training in Neurology, I University and Victoria, and possessed complemen-
came to the conclusion that Neuropathology might tary, mutually reinforcing didactic skills. JCEK was
be a more appropriate career path for me. Fortu- an experienced, meticulous and insightful neuro-
nately, Dr. Barnett was very passionate about the histologist. Joe Gilbert was a master of providing
vital importance of Neuropathology in neurodiag- clinicopathologic insights based upon careful corre-
nostics. When I requested the possibility of doing a lation of neuropathologic findings with clinical signs
full year of Neuropathology training (then config- and symptoms (structural brain imaging in the late
ured as part of my Neurology residency) Dr. Barnett 1970s was still in its infancy). The experience of
was favorable to the idea, as was JCEK. I embarked working with them both and learning from them
on the road to my career as a Neuropathologist was exhilarating, humbling and yes – a little daunt-
with some trepidation, but a passion for the study ing.
Free Neuropathology 1:24 (2020) Harry V. Vinters
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to the journal Stroke as ‘back-to-back papers’, and
published in 1983 [5,6]. It is gratifying that the find-
ings we described using fairly primitive (by today’s
standards) technology have been replicated using
beta-amyloid immunohistochemistry in later stud-
ies; it is perhaps especially satisfying that the pa-
pers are still being cited 37 years after their publi-
cation (combined total citations of 500+ per the
Web of Science). Examining the pathogenesis and
consequences of CAA and other microangiopathies
in the brain would constitute a major theme of my
subsequent research endeavours.
My NP residency was spent feasting on the in-
struction and support of my mentors and the re-
markable and stimulating milieu created by the
clinical Neurologists, Neuroradiologists and Neuro-
surgeons at UWO. This showed and highlighted the
importance of collaborative activities in under-
standing complex neurologic diseases. Luminaries
in Neurology and Neurosurgery (Fred Plum, Ray-
mond Adams among them) were frequent visitors
to this small but ‘neurologically important’ city half
way between Toronto and Detroit. One of my in-
Fig 3: Dr. Joseph J. Gilbert, Neuropathology mentor, London, terests was in the effects on cerebral arteriovenous
Ontario
malformations (AVMs) of agents used in novel em-
bolization therapies that were just being devel-
Joe Gilbert also suggested to me a translation- oped, many of them at UWO. Two skilled endovas-
al research project that would determine and de- cular specialists (Drs. Fernando Vinuela and Allen
fine my research interest for the coming decades: Fox) were pioneering new agents and approaches
diseases of the cerebral microvasculature. As a to non-surgical therapies for vascular brain lesions,
stroke referral center, UWO was encountering and continued to do so throughout their careers.
many patients with lobar intracerebral hemorrhag- When these lesions (usually AVMs) were subse-
es caused by, or at least associated with, cerebral quently resected, they showed unique and some-
amyloid angiopathy (CAA). Joe suggested that we times dramatic reactive changes caused by the
collect our cases of (putative) CAA-related brain embolotherapy agents (about which more later…).
hemorrhage and write a descriptive paper on this Many of my research interests have been driven by
association; a companion study would assess the clinical or clinicopathologic questions. Here were
topography and severity of CAA in relation to brain two large and important ones: Why (and how) do
aging. In the late 1970s and early 1980s (well be- embolotherapy agents work through their interac-
fore the discovery of beta-amyloid protein in 1984, tions with vessel walls in vascular malformations?
see below) CAA was evaluated by the use of Congo What might be some neuropathologic clues to why
red staining and polarization microscopy (alterna- they sometimes fail? They were also questions that
tively using thioflavin stains and fluorescence mi- could be effectively addressed by simple observa-
croscopy). The ‘topography/severity of CAA with tion (using routine stains) of previously embolized
age’ study was performed simply by staining a large lesions when they made their way to the Surgical
number of brain sections, from uniformly sampled Neuropathology laboratory.
autopsy brains, with Congo red and evaluating CAA
in these. The two resultant manuscripts went There was discussion of my returning on facul-
through several drafts, were eventually submitted ty to UWO, but only after I had spent some time
Free Neuropathology 1:24 (2020) Harry V. Vinters
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developing basic research skills pertinent to the
study of cerebrovascular disease. The University
would provide or facilitate funding for my research
endeavours, but I had the freedom to choose a
laboratory in which I might develop appropriate
experimental techniques and skills that I could re-
patriate to UWO. At that time, some of the most
exciting work on cerebral microvascular biology
(especially the blood-brain barrier/ BBB) was being
done using cell biologic techniques in the laborato-
ries of Drs. Pasquale (Pat) Cancilla [Figure 4] and
Michael N. Hart [Figure 5] at the University of Iowa
(U of I) [7,8]. It was arranged that I would spend
two years working with them, after a 6-month pe-
riod refining my diagnostic skills in Pediatric Neuro-
pathology with Dr. Margaret Norman in Vancouver;
Marg became and remained a good friend for the
rest of her life.
Fig 5: Dr. Michael Noel Hart
came the bombshell: he had just accepted the
Chair of Pathology position at University of Califor-
nia Los Angeles (UCLA). He suggested that, since I
had independent funding that was not tied to a
specific institution, I might either stay at the U of I
and work with Michael Hart, or move with him to
UCLA. As I looked outside at the heavy snowfall and
felt the subzero temperature en route back to the
lab, I had essentially made my decision, and moved
Fig 4: Dr. Pasquale (Pat) and Enid Cancilla, undated photograph with Dr. Cancilla to UCLA that summer. During the
six months I resided and worked there, however, I
developed an affection for Iowa City, sometimes
described as the ‘Athens of the Midwest’—famous
Trying my hand at (basic) research for its world class medical center (including brilliant
translational neuroscience and behavioral neurolo-
I arrived in Iowa City (in which the University
gy) and the Iowa Writers Workshop. My colleagues
of Iowa is located) in January 1982, in the midst of
there included Drs. Jonathan Fratkin and David
a nasty midwestern blizzard. During a lonely week-
Beck, the latter an outstanding Neurosurgeon (then
end in a slightly seedy motel in Coralville (a suburb
still a resident) bursting with excellent research
of Iowa City) I frequently thought: ‘What on earth
ideas that might optimize the use of cultured cells
have I done?’ During my first day in the new labora-
in understanding BBB physiology and abnormalities
tory environment at the U of I, Pat Cancilla asked if
[9].
I could go with him for a cup of coffee. Then
Free Neuropathology 1:24 (2020) Harry V. Vinters
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UCLA, destined to become my academic home (this may be an erroneous recollection…), and
for most of the remainder of my career (though thinking that would probably apply quite accurately
that decision was still in the future), was research to L.A. in the late 20th and early 21st centuries.
heaven for a young scientist. It was fun helping to Though I at first lived near the UCLA campus, I
set up Pat Cancilla’s laboratory (our senior techni- found myself spending many weekends at Venice
cian at the time was Jim Bready) with top-of-the- Beach, where I have now had a home for the past
line equipment and facilities that were the perks of 30+ years. (Rationale: If you live near the Pacific
being a newly recruited Chair and entering the aca- Ocean, why not at one of the most famous beaches
demic milieu of a major research university. Our in the world?) As I was nearing the end of my post-
‘lab warming’ party was a smash hit throughout the doctoral fellowship, I was working in the lab on a
medical center. Pioneering studies of cerebral mi- Saturday morning. Pat Cancilla called me into his
crovessels (especially the BBB) were ongoing in the office (immediately adjacent to the laboratory) and
laboratories of two ‘Bills’ – William Pardridge and rather directly asked if I might be interested in a
William Oldendorf. Dr. Oldendorf had previously UCLA faculty position – one had just come open in
(1975) won the Lasker Award, and probably de- Neuropathology because of the retirement of Dr.
served the Nobel, for suggesting the principles that Jann Brown. We discussed the possibility briefly.
led to computerized tomographic (CT) scanning, This was the second time in my career that a casual
but was also an innovative and creative investigator chat with Pat Cancilla would alter the course of my
looking at the physiology of the BBB, especially career.
using isotope tracer techniques. He was also Bill
Pardridge’s mentor. Pat Cancilla’s lab became part Return to London, Ontario and UWO
of an informal consortium of investigators (also
including Drs. Judith A. Berliner, an experienced cell
(briefly)
biologist, and Eain Cornford at the West LA VA
Because of visa issues and funding, I was
Medical Center) interested in cerebral microvascu-
committed to return to London, Ontario, but my
lature (especially its endothelium) and optimal
faculty job there was a ‘soft money’ position, unlike
ways to study it. Our laboratory was mainly in-
the tenure track post for which I was being consid-
trigued by the potential use of tissue culture ap-
ered at UCLA. I had formally applied for the UCLA
proaches and had been able to isolate and culture
faculty position while still a postdoc there, inter-
endothelial and smooth muscle cells from brain
viewed for it, and eventually (a few weeks after
microvessels, initially from mouse brains but even-
returning to London, Ontario) was offered and de-
tually (some years later) even those derived from
cided to accept the job. It was a decision made over
human corticectomies for intractable epilepsy.
an agonizing weekend during which I weighed the
I was also smitten by the city of Angels, Los many pros and cons – the University of Western
Angeles. It represented a far different world from Ontario would have made a wonderful academic
the one in which I grew up. L.A. was (and is…) a city home for me, and London a welcoming and very
with a near perfect climate (summer and winter), livable city (I had already bought a home there).
far cleaner air than is widely believed, stunning John Kaufmann and Joe Gilbert were amazing men-
geography with canyons, hills and flatlands, a bril- tors and colleagues. Yet I had enjoyed my postdoc
liant seaside location on Santa Monica Bay, and at UCLA so much… that I felt I had to ‘give it [the
remarkable ethnic and cultural diversity. It reminds faculty position] a try’. Having heard that American
itself almost daily that it is the ‘world capital of the academic medicine could be rather brutal and
entertainment industry’, which is probably true, fiercely competitive (though I had seen little evi-
and ‘the creative center of the planet’ – the latter a dence of this during my postdoc), I began to won-
claim that London (England), Amsterdam, Tokyo, der whether I had the stomach for this. I rational-
Paris and a few other cities might dispute. I re- ized the decision by thinking I would remain at
member reading that the German novelist Gunther UCLA for 2-3 years, then return to London, Ontario
Grass had once described Berlin as representing a (assuming a position was still open there…). At the
city that ‘faced the realities of the 20th century’ appointed time, I considered this move back, and
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decided to remain at UCLA, where I am (part time, about how this polymer was interacting with ab-
semi-retired) today. normal vessel walls in AVMs. We put together a
significant (and rather unique) data set, which I
My 18 months in London (pending receipt of brought with me to UCLA when I returned there in
the green card / permanent resident status that July, 1985, hoping I would have the time to analyze
would allow me to take up life in the USA) were it in detail and prepare a manuscript.
delightful and rewarding both professionally and
personally – so much so that I began having some
doubts as to whether I had made the correct deci-
sion in accepting the UCLA job. (Timing is every-
thing. Were I making this same career-changing
deliberation in the current unwelcoming USA im-
migration climate, I would almost certainly have
stayed in London!) I managed to set up a small
tissue culture laboratory at University Hospital –
thanks to the fact that a fully equipped laboratory
with appropriate equipment had just been made
available by a departing or retiring faculty member.
We were able to successfully culture endothelial
and smooth muscle cells from human cerebral mi-
crovessels [10]. I continued to have an interest in
‘embolized AVMs’. As a result of the neurosurgical
skills and expertise of Drs. Charles Drake and Sid-
ney (‘Skip’) Peerless, brilliant endovascular therapy
experts Vinuela and Fox (see above) and their re-
spective teams, London and UWO attracted com-
plex AVM cases from around the world that might
be candidates for this unique therapy. If one is go-
ing to do translational research, it helps to have a
unique collection of abundant clinical and patho-
logic specimens to study – and our Neuropathology
laboratory had just such an array of treated AVMs,
Fig 6: Dr. Michael A. Farrell, friend, colleague and ‘partner in
an amazing experiment of nature, though one ad-
crime’
mittedly manipulated by physicians. With the help
of JCEK and a very industrious undergraduate stu-
dent (Mark Lundie) I set about a careful examina- I also had the good fortune to meet, during
tion of AVMs that had been treated by emboliza- that 1 ½ years back at UWO, Dr. Michael Farrell
tion with isobutyl cyanoacrylate, one of the widely [Figure 6], a newly arrived Neuropathology trainee
used embolotherapy agents at that time. (It is an from Dublin, Ireland. Michael became a great
agent that is injected through a catheter in liquid friend and colleague during that time and after he
form, but polymerizes at various rates depending returned to a consultant post in Dublin. Over the
upon how much contrast medium is in the mixture. years, we have written many papers (see below)
With this agent, timing of the polymerization pro- and co-authored a textbook, he has often visited
cess was of paramount importance – if it polymer- L.A. (even doing a mini-sabbatical in my laboratory
ized too quickly, the catheter could become stuck during the early 1990s), and I have gone to Dublin
to the intima of the AVM ‘feeding’ vessel; if too dozens of times; it is on my list of favorite cities
slowly, it would end up passing through the AVM around the globe. Great and generous friend.
and into a treated patient’s lungs.) We had vascular Through Michael I eventually came to know the
malformations with a wide range of post- small but vibrant Irish Neuropathology community,
embolization intervals that allowed for inferences including Drs. Katie Keohane and Francesca Brett.
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On faculty at UCLA In the meantime, I resumed my tissue culture
studies but decided to embark on other scientific
How does one summarize 35 years of academ- adventures. While I was impressed by the simple
ic and diagnostic work at one institution? There are questions that could be addressed (and answered)
many things I love about UCLA: the physical beauty using in vitro methods, I was (like many investiga-
and location of the campus in Westwood (the UCLA tors) concerned about how these phenomena
Medical Center, now Ronald Reagan UCLA Medical could be understood in the context of complex
Center, is at the southern edge of the main cam- multi-cellular tissues and organs, especially in the
pus), the collegial and collaborative nature of the brain. Being a junior faculty member at UCLA was
faculty, the wealth of expertise in all aspects of the academic equivalent of being a child at a candy
basic and clinical science, especially neuroscience, store. Colleagues were always approaching one
talented and intelligent students and trainees, and about working on any variety of projects, some
the cultural and ethnic diversity of both students utilizing human CNS specimens, others exploiting
and faculty who are committed to scholarly work. interesting animal models, transgenic and knockout
Yes, there are things not to like (but one endures mice, etc. Neuropathologists were and are in the
them…): the numbing, frequently obstructive bu- unique position of understanding the structure of
reaucracy, the ‘bend over backwards’ approach to the nervous system (normal and abnormal), and
being politically correct are among them. how best to study it. I re-established a close collab-
oration with William Pardridge (see above), an En-
I returned to L.A. and the UCLA family the first docrinologist in the Dept. of Medicine who was
week of July, 1985. I used the ‘down time’ in setting interested in the biochemistry (and eventually mo-
up a small research laboratory, to finesse two pro- lecular biology) of transport mechanisms through
jects. One was collating the embolized AVM data the BBB, but was now also looking for a way to
into a coherent story. As I wrote the manuscript study abnormalities (diseases?) of small blood ves-
and put the results into perspective, I thought the sels. We had many discussions about cerebral amy-
material was sufficiently novel that it might be wor- loid angiopathy (CAA), which of course affects arte-
thy of submission to the prestigious New England rioles and capillaries and, together with arteriolo-
Journal of Medicine, with the thought that ‘nothing sclerosis, is one of the two most common micro-
ventured, nothing gained’. As I put the manuscript vasculopathies found in the brain. In 1984, Glenner
in the mail (YES, what we now call snail mail...) I and Wong [15] had isolated the ‘A4’ protein from
was already reformatting the paper for a lower amyloid-laden meningeal vessels of an Alzheimer
level, less prestigious journal because of the cer- patient. Bill Pardridge was amazingly skilled at mak-
tainty of rejection. Then a few days later I received ing antibodies and proceeded to make a polyclonal
a surprising phone call from the NEJM telling me antibody to ‘A4’, using the partial sequence of the
the manuscript had been accepted, with minimal peptide provided by Glenner and Wong in their
revisions; they were calling me to verify that there paper. It worked magnificently in immunohisto-
was no overlap with a review article on cyanoacry- chemical protocols to demonstrate both senile
lates we had recently written – I assured them plaques and CAA, resulting in several publications
there was none [11]. The NEJM paper was pub- [16,17]. Bill Pardridge was also the best person in
lished in 1986 [12] and represents one of my two the School of Medicine to review the draft of a
appearances as an author of a paper in this high- grant proposal; I am eternally grateful for his merci-
profile venue, the second coming almost exactly 20 less critique of one of my first independent Nation-
years later as a co-authored contribution on a total- al Institutes of Health (NIH) proposals, which
ly different topic [13]. My other project was to through his intervention helped me transform an
write a review article on (what else?) CAA – I sug- unfocused and improbable set of studies into a
gested this to Henry Barnett, then executive editor fundable application.
of Stroke, and he liked the idea. That paper eventu-
ally appeared (after a few revisions) in 1987 [14] My Chief of Neuropathology was M. Anthony
and is still frequently quoted today. Verity, and we divided the service and diagnostic
commitments equally – each of us covered 6
Free Neuropathology 1:24 (2020) Harry V. Vinters
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months of the year. My interests were obviously in published earlier this year.) As Pathologists, we
cerebrovascular disease and dementia, Tony’s in were witnessing the evolution of a feared illness
neurotoxicology and neuromuscular diseases. that, at the time and for many years to come, had
When one of our outstanding Neurologists, Dr. no effective treatment and was almost uniformly
Jeffrey Cummings, decided to submit an NIH (Na- fatal. By the mid-1980s it was known to be caused
tional Institute on Aging) grant that, if successful, by the retrovirus HIV-1 (initially named HTLV-III). In
would fund an Alzheimer Disease Center (ADC) at that same time frame, thanks to the work of many
UCLA in the late 1980s/early 1990s, I seemed the investigators including George Shaw, Beatrice
logical choice to head the Neuropathology Core Hahn, Clayton Wiley, Leroy Sharer and others, it
and Brain Bank. We were funded on the first sub- became appreciated that HIV frequently infected
mission and I was thrilled to formally become part the brain in both children and adults, causing a
of the Alzheimer research enterprise at UCLA, even syndrome initially described as AIDS dementia
though my main academic focus (CAA and related complex (in adults) though later re-named several
microvascular diseases) was at the periphery of times. But I’m getting ahead of myself…
most debates on AD pathogenesis. This situation
has changed drastically in recent years. It is also Pathologists have now (and always have had)
worth noting that Glenner and Wong had isolated a key role in providing morphologic evidence for
A4 from amyloid-laden meningeal microvessels (‘a unique disease mechanisms – some of them based
novel cerebrovascular amyloid protein’) rather than simply upon careful observation of novel but con-
senile plaques (SPs); as is now well known, the anti- vincing histopathologic changes within tissues.
A4 antibody indeed labels SPs as well as CAA, but Consider, as one example outside the nervous sys-
not neurofibrillary tangles, despite initial claims tem, the astute observation by Robin Warren
that it might. (pathologist) and Barry Marshall (gastroenterolo-
gist) of ‘unidentified curved bacilli in the stomach of
Over the years until his departure from UCLA, patients with gastritis and peptic ulceration’. This
Jeff Cummings was an amazing leader: a superb description of Helicobacter pylori, initially published
diagnostician and organizer who supported basic in Lancet (in 1984) eventually led to their being
research efforts and consistently brought out the awarded the Nobel Prize in 2005 because the ob-
strengths in investigators and his staff. And oh yes, servation led to a complete re-examination of the
he was a masterful fund raiser, successful in obtain- rationale for ways to treat peptic ulcer disease, a
ing private donations that were crucial to support- major paradigm shift. Moving back into the CNS,
ing the ADC when NIH funding lapsed or became Neuropathologists have made countless key obser-
thin. He eventually secured an endowment that led vations (often in human biopsy or autopsy speci-
to re-naming of the ADC as the Mary Easton Alz- mens) pertinent to the pathogenesis of neuro-
heimer Center. I had obtained NIH and other fund- degenerative disease, intractable epilepsy, stroke,
ing for my own projects within 3-4 years of arriving developmental disorders, tumors, and the list goes
at UCLA, but have always felt most at home scien- on. With the beginning of the AIDS epidemic, here
tifically in the environment of a collaborative Cen- was another opportunity to see a new infectious
ter or Program Project Grant; pieces of these have disease evolving before our eyes. This might be
constituted most of my research efforts and fund- (often is…) called ‘opportunistic research’, with the
ing support while on faculty at UCLA. slight implication that it is not as challenging or
important as ‘basic research’. However, when
Of course, in the early to mid-1980s other unique opportunities to carefully study a human
events were taking center stage in the world of disease present themselves, one would be foolish
medicine: the disease that was eventually named not to take advantage. At UCLA Center for the
acquired immune deficiency syndrome (AIDS) pre- Health Sciences (CHS), one of the bright young res-
sented in a handful of gay men, initially studied in idents from Canada, Karl Anders [Figure 7], sug-
New York City and L.A. (Please also see Herbert gested we review the neuropathologic features of
Budka’s thorough and excellent description of the our large and growing autopsy collection of brains
beginnings of this epidemic in his Reflections piece from AIDS patients. Karl and I, both recent arrivalsFree Neuropathology 1:24 (2020) Harry V. Vinters
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from Canada, bonded as soon as I arrived at UCLA. Clinical Neuropathology. The manuscript had been
We had both grown up in two cities located about almost immediately accepted for publication in late
400 miles apart (Karl in Winnipeg), were raised in 1983 or early 1984. Then, to our amazement and
the households of immigrant families, and we both shock, Clinical Neuropathology ‘sat on’ this very
liked looking at slides – a lot of slides. topical manuscript for over 2 years before publish-
ing it – in the meantime printing (arguably) less
impactful and timely studies that had clearly been
accepted after our paper [18]. By 1986 we had
compiled data on almost 90 AIDS autopsy cases,
and submitted this updated report to the American
Journal of Pathology, where it was accepted with
minimal revisions, and published a few short
months after the much delayed Clinical Neuropa-
thology paper [19]. Karl and I wondered whether
someone reading both papers (published in 1986)
would question how we accumulated 60 new AIDS
cases in a few short months, which of course we
had not.
The neuro-AIDS work took some interesting
twists and turns, largely as the result of collabora-
tions with some of my formidably talented col-
leagues in Virology and Neurology interested in
viral neuropathogenesis. I co-authored two papers
together with David Ho and his research group
while he was briefly on staff at Cedars Sinai Medical
Center in Los Angeles [20,21]; these are the only
two publications I have written with a physician-
scientist who would eventually become Time mag-
azine’s Man/Person of the Year in 1996. (I very
much enjoyed basking in the reflected glow of Da-
vid’s richly deserved fame.) I was also approached
by a brilliant and productive retrovirologist, Dr.
Irvin S.Y. Chen, who had trained with one of the
discoverers of reverse transcriptase (Howard Temin
at the University of Wisconsin) before becoming a
Fig 7: Dr. Karl H. Anders, Pathologist and frequent collaborator faculty member at UCLA at about the same time as
on projects, currently in Calgary, Alberta, Canada me. Irvin was (and remains) keenly interested in
the molecular pathogenesis of interactions be-
We also engaged in this neuropathologic en- tween HIV and the brain. His laboratory used au-
terprise the collaboration of Dr. Uwamie Tomiyasu topsy brain and CSF specimens from neuro-AIDS
[Figure 8], an amazingly insightful, organized, help- subjects to characterize a neurotropic strain of HIV,
ful and collegial Neuropathologist at the West L.A. and exploited PCR to quantify HIV viral load in the
VA Medical Center (who over the years became a CNS of affected patients [22,23]. It seemed an ideal
close friend), and involved a promising young UCLA collaboration between a talented basic virologist
medical student Wayne Guerra in the project. Karl and someone (HVV) interested in morphologic
Anders had been the first author on the report of brain changes induced by HIV. At the same time,
our initial series of AIDS autopsy cases (less than my laboratory remained fascinated by the interest-
30) written while I was still a research fellow at ing opportunistic infections (OIs) – especially other
UCLA. We had submitted this detailed report to viral agents, that can cause puzzling varieties ofFree Neuropathology 1:24 (2020) Harry V. Vinters
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devastating neurologic diseases in immunosup- had a longstanding research effort on temporal
pressed AIDS patients. Cytomegalovirus was one of lobectomy for intractable temporal lobe seizures,
the viral OIs capable of producing variable CNS under the capable and inspiring direction of Jerome
disease in AIDS, including (at its worst extreme) (‘Pete’) Engel (Neurologist) and Paul Crandall (Neu-
severe encephalitis, ventriculitis and myeloradiculi- rosurgeon). Pete was, and continues to be, one of
tis, yet minimal abnormalities in others. Contribu- the great advocates for bringing the possibility of
tors to these studies included Karl Anders, a post- curative temporal lobe surgery or ‘neocorticecto-
doctoral fellow from Germany, Dr. Regina von Ein- my’ to epilepsy patients throughout the world. Paul
siedel and Marcia Cornford, who was one of our was a meticulous Neurosurgeon who provided us
first trainees in Neuropathology and is still a faculty with anatomically intact (including the hippocam-
member at Harbor-UCLA Medical Center in Tor- pus) temporal lobes. The arrival at UCLA of pediat-
rance, California [24,25]. I became the Pathologist ric Neurosurgeon Dr. Warwick Peacock from South
of record for the UCLA site of the Multi-Center AIDS Africa in the mid-1980s ushered in a new era of
Cohort Study (MACS, PI Dr. Roger Detels), one of pediatric epilepsy surgery. Using high resolution
the longest funded NIH projects in history. Karl neuroimaging (including structural and metabol-
Anders and I co-authored a monograph on the neu- ic/positron emission tomographic imaging) modali-
ropathologic features of AIDS [26]. ties linked with electrocorticography, Warwick and
the Pediatric Epilepsy group (under the visionary
leadership of Drs. Donald Shields and Raman
Sankar) developed the concept that generalized
epilepsies in infants and children (e.g. leading to
infantile spasms) might have a focal origin – a ‘zone
of cortical abnormality (ZCA)’ within the cerebral
cortex – and that removing such a focus might ef-
fectively treat the seizures. At the time, this was
considered a radical, almost heretical – possibly
even dangerous! – approach, but our clinicians
were certain they had convincing evidence for the
ZCA and proceeded with corticectomies for intrac-
table infantile and pediatric epilepsy, sometimes
removing a significant portion of one cerebral hem-
isphere in an infant. The challenge for Neuropa-
thologists was to identify what the underlying
structural abnormality (abnormalities) causing the
seizures might be. Again, we were handed the op-
portunity to study unique specimens that might
explain important clinical signs and symptoms.
By the late 1980s and early 1990s we had ac-
cumulated a significant experience with these spec-
imens. Fortuitously, my friend and colleague Dr.
Michael Farrell came over from Dublin in 1991 to
do a mini-sabbatical at UCLA, and set about collat-
ing the data on our collection of pediatric epilepsy
Fig 8: Dr. Uwamie Tomiyasu, (deceased 2004), former Neuro-
pathologist, West L.A. VA Medical Center and UCLA faculty
surgery cases. The most common neuropathologic
member, friend change (especially among the youngest sympto-
matic patients) was a malformation of cortical de-
By the mid- to late 1980s and into the 1990s velopment that had first been described by David
there were other interesting developments in Taylor and colleagues in the 1970s. It had a striking
UCLA’s active epilepsy surgery programs. It already resemblance to the tubers found within the brainsFree Neuropathology 1:24 (2020) Harry V. Vinters
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of patients with tuberous sclerosis complex (TSC) children with intractable seizures [31-33]. Dr. Nori-
even though affected individuals showed none of ko Salamon in Neuroradiology contributed her
the visceral or cutaneous stigmata of this neurocu- powerful diagnostic insights and observations
taneous disorder [27]. Ironically, ‘tuberectomy’ has [34,35]. In 2006, and based upon our morpho-
now become an accepted treatment for some TSC anatomical and electrophysiologic studies, we pro-
patients with intractable seizures. A much less posed the ‘Dysmature cerebral developmental hy-
common finding among corticectomies was an pothesis’ as a possible etiology for CD [32]. At the
inflammatory disorder first described in 1958, same time, we continued to explore the possible
Rasmussen encephalitis (RE). Dr. Farrell was first relationship of sporadic CD to TSC tubers.
author on our initial ‘pediatric corticectomy’ paper
[28] and we continued to collaborate on other pro- The genes that are mutated to cause TSC (first
jects, including one aimed at elucidating the de- TSC2, then TSC1) had been discovered in the 1990s;
tailed neuropathologic changes of RE [29]. Paul we made probes to the relevant gene transcripts
Mischel, then a Neuropathology Fellow and now a and eventually antibodies to the gene products
leading neuro-oncology researcher at UC San Die- (tuberin and hamartin), using these to study gene
go, was a lead author on a paper in which we pro- expression in normal brain, tubers of TSC and spo-
posed a ‘grading’ scheme for the (as yet poorly radic cortical dysplasia [36-39]. This led to a valua-
understood) condition of cortical dysplasia (CD) ble collaboration with leading TSC researcher Dr.
[30] – a scheme that served its purpose in the mid- David Kwiatkowski and his associates in Boston –
1990s and has been superseded by others, as it which included sophisticated molecular genetic
should be. analysis of many of our corticectomies and even
allowed us to examine a novel animal model of
The team of clinicians and basic researchers TSC, one of the first to be developed by his group
who collaborated in the Pediatric Epilepsy Surgery [40,41].
program was a pleasure to work with. This was
team science at its finest – everyone in the group I became UCLA’s Chief of Neuropathology in
respected (and utilized) the unique skills of all oth- 1993, when Tony Verity decided to take advantage
er basic and clinical neuroscientists, and the result- of the University’s ‘voluntary early retirement in-
ing multi-disciplinary studies benefited from this centive plan, VERIP’, though thankfully he re-
synergy. Experts in Linguistics, Neuropsychology, mained active as an Emeritus faculty for many
Neuroradiology, Neurophysiology and Psychiatry years, sharing his expertise in neuromuscular diag-
interacted productively with a simple Neuropa- nosis (Dr. Negar Khanlou became his protégé and
thologist. Our goal was not only to understand successor) and his passion for cricket. Tony was
what structural changes in the brain may have con- also an excellent artist and I am proud to have one
tributed to the catastrophic seizure disorder, but of his paintings on the wall of my living room in
how corticectomy might impact a child’s behavior Venice. I served in the Chief of Neuropathology
and language development. Dr. Gary Mathern, a post until I myself took ‘semi-retirement’ in 2016,
UCLA-trained Neurosurgeon and protégé of Paul and had the pleasure to mentor junior colleagues
Crandall and Warwick Peacock, eventually became who went on to highly successful careers: Cynthia
the surgeon-of-record for most of the pediatric Welsh, Dennis Chute, Jeff Twiss, Paul Mischel
epilepsy cases. Dr. Mathern also has the ‘soul of an among them. Dr. William Yong, my current Chief,
investigator’, is possessed of enviable organization- was a medical student who I tutored in the 1980s,
al skills and leadership qualities, and fostered new later a Neuropathology Fellow in our program, and
and exciting directions in which the UCLA Pediatric has been a marvelous colleague – alas, recently
Epilepsy Surgery Program might move, places departed for a position at University of California
where it might thrive. Dr. Carlos Cepeda, Michael Irvine Medical Center. For several years, I was hon-
Levine, (the late) Robin Fisher, Veronique Andre ored to hold the Sarkaria Chair in Diagnostic Medi-
and others became integral to the study of electro- cine.
physiological and morphological properties of the In the mid-1990s I was asked by University of
epileptogenic tissue originating from infants and Southern California (USC) Neurologist Dr. HelenaFree Neuropathology 1:24 (2020) Harry V. Vinters doi: https://doi.org/10.17879/freeneuropathology-2020-2956 page 14 of 21 Chui to become part of a California-wide study she entrepreneurial and creative Neuroscientist and was planning, examining the clinical, neuroimaging much fun to work with in joint projects. and neuropathologic substrates of individuals with documented (or at risk for) cerebrovascular dis- As the above summary indicates, much of my ease. The overarching (and perhaps overly ambi- research has been collaborative and translational. tious) theme and goal of the program project grant Grant reviewing agencies have, I am quite certain, was to highlight the neurobehavioral, imaging and considered it ‘scattershot’ and unfocused. ‘Can neuropathologic features of ischemic vascular de- Vinters not focus on a single topic?’ – the answer is mentia (IVD), on the assumption that such an entity clearly ‘no’. I’ve enjoyed all of the disparate re- exists. Helena was an inspiring and superbly orga- search endeavours in which I have been involved. nized leader, and an insightful judge of character, They have included interactions with investigators the consummate solver of problems. NIH Program possessed of unique talents and abilities, providing project grants (PPGs), including the one that fund- the possibility of forming irresistible, tantalizing ed this study, involve the interactions of widely scientific alliances. Table 1 summarizes the key differing personalities and the principal investigator individuals with whom I have worked and pub- of such an endeavor (i.e. Helena Chui) needs to lished most intensely over the years; it is by no manage those people and their disagreements as means a complete list. My advice to people enter- well as their productive interactions. Our group ing Neuropathology would be to choose your col- involved Neuropsychologists, Epidemiologists, Neu- laborators carefully, wisely. Consider individuals rologists, and experts in neuroimaging: Bruce Reed, who can bring projects to completion in a timely Dan Mungas, Mike Weiner, Bill Jagust, Ling Zheng, fashion and make effective use of a Neuropa- Wendy Mack and many others. My fellow investi- thologist’s unique skill set. Have I myself been suc- gators in the Neuropathology Core included Wil- cessful in following that mandate for timely com- liam Ellis (UC Davis), Ewa Borys (now in Chicago) pletion of projects? Well… not always… but often and Chris Zarow (then a talented neuroanatomist enough. Work with people who will criticize your at USC). Our studies, over the long duration of the work and writing, sometimes brutally. I’ve been IVD-PPG, showed that ‘pure’ IVD was a compara- fortunate to co-author a manuscript with a phar- tively rare phenomenon, but that risk factors for macologist, Dr. Louis Ignarro, destined to win the cerebrovascular disease probably contribute to 1998 Nobel Prize in Medicine/Physiology for his accelerated brain aging, and even some compo- discovery of nitric oxide [47]. (Disclosure: Dr. nents of Alzheimer disease (AD), a view that is gain- Ignarro did not win his Nobel on the basis of our ing traction in the neuroscientific community and a study!) My favorite projects and papers have been subject that has generated much research interest those that translated basic science observations to [42-44]. Two papers from the IVD group focused on address and inform important clinicopathologic the ‘neuropathologic substrates’ of cognitive im- issues – ones that might eventually be used to help pairment resulting from ischemic brain lesions patients avoid or recover from devastating neuro- [45,46], though crucial neuropathologic data were logic illnesses. In 2009, Dr. Michael Sofroniew in integrated into many other publications. For sever- UCLA’s Dept. of Neurobiology approached me with al years, I have had an enjoyable collaboration with the idea to write a review of basic astrocyte biology Dr. Wolff Kirsch, a Neurosurgeon at Loma Linda (his expertise), and how astrocytic dysfunction University Medical Center (approximately 100 miles might mediate neurologic disease (my interest) east of L.A.) who, rather than quietly retire after a [48]. It resulted in my most cited publication and stellar career in Neurosurgery, decided to become led to further productive collaborations that con- a researcher with an interest in, among other tinue now – studies of astrocyte derangement in things, brain aging and cerebral amyloid angiopathy certain seizure conditions. (see Table 1). Dr. Kirsch is devoted to the idea of eventually preventing or treating this microangiop- athy and has enlisted materials from the Easton Center Brain Bank in studies with that goal. Very
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I benefit daily from my colleagues (Drs. Wil- record that surpasses (in both quantity and quality)
liam Yong, Shino Magaki, Negar Khanlou), fellows those of some junior faculty. Sadly, one of the indi-
(currently Drs. Zesheng Chen and Josh Byers) and viduals on that list (Justine Pomakian) passed earli-
technically super-skilled histotechnologists and er this year after a long battle with leukemia. An-
staff research associates (e.g. Kazu Williams, cur- other (Spencer Tung) will graduate this year as a
rent laboratory manager of the Easton Center Brain physician.
Bank, Nelly Vehabedian, Jennifer Yi, Cecilia Choi).
Part of the group is shown in Figures 9 and 10, A huge bonus or perk of academic life is the
masked and ‘social distancing’ (at least in Figure 10) possibility to teach, train and influence others –
as appropriate for the pandemic. When one of the including medical students, basic science col-
technical staff contributes significantly to a re- leagues, graduate students, postdoctoral fellows,
search project and the resultant publication, I in- residents and clinical fellows. I am especially proud
clude her/him as a co-author on the manuscript. of the many Neuropathology fellows who have
Table 2 lists key senior research technicians and lab graduated from the UCLA training program and
managers who have each co-authored several pub- have gone out to initiate clinical and/or research
lications, many of which have been cited 100+ programs of their own. Our goal as teachers and
times (per the Web of Science). I take pride that mentors should be to foster the creation of
many of these skilled technicians have a publicationYou can also read
