Chairman James Crawford sets tall goals for pathology — in research, teaching and lab science

Discoveries with obvious potential for controlling, reversing or preventing several devastating diseases have brought world recognition to the UF College of Medicine’s department of pathology, immunology and laboratory medicine.

Department Chairman James M. Crawford, M.D., Ph.D., said his department’s reputation is due to faculty members renowned for determining the origins of various diseases and/or finding potentially effective treatments or preventative strategies.

“The track record established by our scientists in Gainesville and Jacksonville, the successful outcomes of our residency and fellowship programs, and first-rate laboratories leave us poised to become one of the nation’s best academic programs in pathology,” said Crawford, who was recruited to UF from Yale four years ago. “We’re aiming to rank among the top 20 percent nationally within the next five years.”

Crawford noted that among the 64 pathology faculty members in Gainesville, “We have individuals who are tracking the earliest indicators of emerging diabetes and are developing innovative ways to treat diabetes and other autoimmune diseases. We have others who have developed the first effective way to induce insulin production by pancreatic, hepatic or bone marrow stem cells cultured in the laboratory. Our faculty have identified key factors that lead to kidney stone formation and have developed a preventative therapy soon to be tested in people.

“We have leaders in pediatric immunodeficiency disease and in viral hepatitis,” Crawford added. “We also have researchers who have figured out how to better track the development of cancers of the breast, liver, prostate and genitourinary tract.”

While Crawford praises his colleagues’ accomplishments, the pathology department also is strengthened by his own significant expansion of knowledge regarding liver pathobiology, both in original scientific work and in published textbooks and chapters. This month he becomes editor-in-chief of Laboratory Investigation, an official journal of the United States and Canadian Academy of Pathology. The journal will be managed in the department with Associate Professor Anthony Yachnis, M.D., as senior associate editor.

Crawford is recognized for two discoveries of lasting importance — one that took 12 years of dedicated effort and substantial grant support and another that yielded key findings after only two months of work and required no funding.

First, stemming from his earlier studies of hepatic bile formation, he collaborated in the 1990s with Ronald Oude Elferink, Ph.D., of Amsterdam and Henkjan Verkade, M.D., Ph.D., of Groningnen, Netherlands, to define the structural mechanism by which the liver secretes phospholipids into bile. Phospholipids are the major form of fatty substances in all cell membranes, and their secretion into bile is critical for the elimination of excess cholesterol from the body. Together, they answered the century-old question of “the source of the bile.”

Second, Crawford credits his wife Aleta, a bench scientist and medical illustrator, for recent clarification of normal liver anatomy that has gained appreciation by pathologists worldwide. Vexed by the continued international argument of what constitutes “normal liver histology,” Crawford collaborated with Aleta to rigorously describe the normal adult human liver biopsy.

Aleta’s report of what she observed contradicted decades-old dogma about liver structure. She detected a highly preserved paired relationship between liver arteries and bile ducts, such that any breaking of this relationship would signify the onset of significant liver disease.

“Aleta’s discovery of an important aspect of normal liver anatomy put an end to arguments I’d been hearing among pathologists at their meetings year after year,” Crawford said. “She also identified the probable place where stem cells reside in the liver, a timely observation since investigations of liver stem cell biology were just taking off. Within a year after publication of our 1998 paper, the information was so widely disseminated that our names were forgotten in the dust of common knowledge. I consider this a high compliment for work of lasting value.”

In the two decades since he earned his M.D. and Ph.D. at Duke University, Crawford has gained a national reputation that often calls him to professional leadership. Currently he serves on the liver disease site committee for the American College of Surgeons, the education committee for the American Society of Investigative Pathology, and the National Institutes of Health study section for liver and pancreatic disease.

New Directions on an Urgent Topic

Bioterrorism is probably the last topic Crawford might have predicted would find its way into his professional agenda, but it’s now a major assignment. As part of a seven-university Florida alliance led by UF emergency medical physician David Seaberg, M.D., Crawford is working to develop a system for response to any potential attack involving weapons of mass destruction. He is directing the alliance program that is coordinating the deployment of bioterrorism training courses for hospital-based health-care providers throughout Florida. “Our effort is moving forward with the support of a $1.6 million state contract,” Crawford said. “This is part of a larger allocation from the Centers for Disease Control and Prevention being used to contract with Florida universities to oversee training across all groups of disaster responders and medical personnel.

“Our alliance is working with a sense of urgency to ensure that emergency responders, community leaders, physicians, nurses, hospital staff and managers are educated in how to deal with a bioterrorist attack,” Crawford said. “I see this as more than an important assignment; I believe it’s my turn to do something of critical value to our country.”

Commitment to Clinical Service

The pathology department’s clinical laboratories are responsible for half the billing events of the UF Faculty Group Practice.

“Given the fact laboratory tests of some form are obtained for all of our hospital patients and about 70 percent of outpatients, our department has to maintain a high-volume laboratory ‘business.’ We provide experts in pathology to assist every medical specialty in diagnosing diseases from the tip of the scalp to the tip of the toes,” Crawford said.

To prepare the pathology laboratories to support continued institutional growth, Crawford has led the way in upgrading the work environment. With the exception of the blood bank, every square foot of pathology’s clinical laboratory space and faculty offices has recently been renovated or built new, resulting in 20,000 square feet of renovated space in Shands at UF and a new 40,000-square-foot building on Southwest 34th Street.

“We’re well positioned for clinical business growth,” Crawford said.

Outside work, Crawford awakens well before dawn most workdays to run, take an extended spin on his bicycle or rollerblade through the Haile Plantation neighborhood. On Thursday evenings, he joins Aleta for church choir practice, and other evenings he practices playing his bagpipes. His plaintive piping of “Amazing Grace” provided a moving closure to a memorial program held in the Shands at UF atrium shortly after Sept. 11, 2001. He again donned his Scottish kilt and shouldered his bagpipes to lead this year’s UF medical commencement procession.

Crawford said family time, music and exercise take up the hours remaining after typical 12-hour workdays. To balance many priorities, he lives by a certain philosophy: “You need to keep your family relationships strong, stay physically fit and be spiritually whole to make it all work.”