Pulling Back the Curtain: Carlo Brugnara, MD

Carlo Brugnara, MD
Director of the Hematology Lab at Boston Children’s Hospital and professor of pathology at Harvard Medical School.

In this edition, Carlo Brugnara, MD, talks about working in his parents’ bakery and pasta factory during childhood and his first role in academic publishing – as editor-in-chief of the American Journal of Hematology.

Where did you grow up? What was your childhood like?

I grew up in Pergine Valsugana, a small town in the Italian Alps, near the provincial capital of Trento. My parents owned a bakery and eventually expanded and opened a factory where they made fresh pasta and tortellini. We lived upstairs from the factory, so I remember waking up in the morning to the smell of freshly baked bread or pastries.

The fleet of delivery trucks for the Brugnara family’s pasta factory.

My parents worked hard to give my younger brother and me a privileged childhood in which we had everything we ever needed. In return, we helped in the factory. By the time I was 7 or 8 years old, I was riding my bicycle around town with a huge basket on my shoulders, delivering bread to our customers. When we got older, my brother and I would help manage the bake shop, package pastries, and make deliveries during the summer.

Seeing my parents work hard left a deep impression on me. It instilled in me a sense of responsibility and pride in doing your work well. We had a fleet of trucks with the Brugnara logo on them, so we wanted our work to meet people’s expectations. I had a very fortunate childhood, with so many happy memories, but my parents also taught me the importance of hard work. That work ethic stayed with me throughout high school and medical school.

Was there ever another career you could see yourself in?

I’ve always enjoyed challenging myself intellectually. When I was growing up in Italy, there were two types of high schools in the education system: One that offered a more scientific and mathematic curriculum and one that focused on the study of ancient Greek, Latin, philosophy, and literature. I chose the latter track, which I thought would me more challenging.

Eventually, I was drawn to the challenge of learning the enormous amount of information in the field of medicine. I have never regretted going into medicine, but if I had to choose an alternative, I would love to be in the foreign service as a diplomat.

Walk us through your career. When did you come to Boston?

I attended medical school at the University of Padua in Verona, Italy, where a group in the lab studying human red cells caught my interest. I set out to study ion transport abnormalities in red cells of patients with essential hypertension, prompted by a paper published in the New England Journal of Medicine  by a Boston group in the early 1980s. Dr. Roberto Corrocher, my supervisor in Verona, arranged for me to visit the lab in Boston, where the work originated, and show them our data. Dr. Mitzy Canessa and I had a great discussion and Daniel Tosteson, MD, PhD, who was the dean of Harvard Medical School at that time, invited me to study there for the summer. I accepted his invitation and, basically, I never left. In June 2022, I will have been in Boston for 40 years.

During my first year doing basic red cell research, our lab did not have funding, but fortunately, my family helped and supported me. At the end of the first year, Frank Bunn, MD, a well-known hematologist at the Brigham and Women’s Hospital, suggested I work with him on a funded research project that was seeking to understand why red cells in patients with homozygous hemoglobin C disease were abnormally dehydrated.

Dr. Brugnara at the Ball of Industry and Technology in Vienna in 2007, with his wife Csilla von Csiky (far right), and friends Anita and Peter Gerner, MD.

That experience, and Dr. Bunn’s influence and support, really launched my career of looking at ion transport in human red cells. In 1986, I received my first grant and this type of research received National Institutes of Health (NIH) funding for almost 25 years. The research also led to an association with the Boston Sickle Cell Center, which was based at Boston University and Brigham and Women’s, which was instrumental in transitioning my work to sickle cell disease.

While I was running my own R01 grant, I realized that I also wanted to work as a physician. So, at the same time, I trained in clinical pathology and transfusion medicine at Brigham and Women’s. This was only possible because of the advice and encouragement I received from Ramzi Cotran, MD, who was Chair of Pathology at that time and one of the most famous pathologists in the United States. At that time, clinical pathologists trained at the West Roxbury VA Medical Center, which I felt was too far away. When I told Dr. Cotran this, he said simply, “Okay, so why don’t you do it here?” He suggested I set up my own training at Brigham and Women’s, which had no formal clinical pathology training program then.

For a few years, I helped train all residents who wanted to train in clinical pathology, and the program was then taken over by David Sacks, MD, PhD. Today, it is now one of the most successful clinical pathology trainings program in the country. I only played a small role in getting the program started but I would not have been able to accomplish it  without the mentorship from Dr. Cotran.

In 1992, Orah Platt, MD, the chair of Laboratory Medicine at Boston Children’s Hospital, asked me to come over from Brigham and Women’s to take care of the hematology and coagulation laboratory. I have been here for 29 years now.

I don’t know what Dr. Canessa  saw in me in 1982 – this guy from Italy who didn’t speak English very well – but she offered me the opportunity to stay here for the summer and begin my career in the US. The same was true with Dr. Bunn, Dr. Tosteson, and Dr. Cotran. They each saw my potential – which I wasn’t able to see in myself – and offered me opportunities that shaped my career. I feel fortunate to have had the best possible mentors in my career.

What drew you to clinical pathology specifically?

Clinical pathology is a great way to combine research efforts with clinical medicine. While we do not directly take care of patients, we help physicians interpret tests, select tests, and provide feedback on challenging cases. In my opinion, the beauty of clinical pathology is that it allows you to be involved in clinical medicine without the heavy burden of caring for patients and all the other things that our clinical colleagues do – and that we all greatly appreciate.

Dr. Brugnara (at left) at the Giza Necropolis with his daughter Alessia and family friends in 2001.
Dr. Brugnara and his daughter Camille skiing in the Dolomites in Italy.

Looking back on your career so far, what is your greatest accomplishment?

When I’m giving a talk, the person who introduces me might mention how I have published more than 200 papers, and I cringe because that is not how I define accomplishment. Above all, I value the people whom I work closely with in research and the bonds that we have formed throughout the years. For instance Alan Kopin MD, whom I met in Dr. Tosteson’s lab in 1982, is one of my best friends. I remember driving to a gas station with him and drawing blood from a morbidly obese patient who was kind enough to give us red cells for our research, which we turned into a beautiful paper in the Journal of Clinical Investigation.

The people with whom you work closely in the lab become friends. We have shared both research interests and our lives, in a way. In the clinical setting, as well, personal bonds form with colleagues who seek your advice   on interpretation or selection of laboratory tests. It also helps to have a good espresso maker in your office, an additional incentive for them to come and chat with you.

My greatest accomplishment is being able to help trainees as they launch their careers. It’s so rewarding to see them publishing a paper or giving a talk and feel that I played a small role in their success. At the end of the day, that’s what matters to me. Science is always changing and what’s new today is old tomorrow. The relationships we form last longer.

What advice would you pass on to early-career hematologists?

Given my experiences, I always try to encourage early-career hematologists to look for mentors who really care about them, the way mine did for me. Find a mentor who knows your strength and weaknesses and can gently guide you down the best path for you. Your area of research may shift and change over time – you may start working in one area and then change direction – and a good mentor can help guide you through that process. They can see your potential, even when you can’t, and help you to realize it. A second advice is to try to connect with as many colleagues as possible, scientifically, clinically and personally.  This network is key to support your career, start new scientific projects, give you visibility and support your academic progress.

How did you become editor-in-chief of the American Journal of Hematology? Had you held previous roles in academic publishing?

It’s a funny story. When the journal was looking for a new editor-in-chief in 2007, one of my very good friends and colleagues, Martin Steinberg, MD, was on the selection committee. He told me that I should apply, and I initially declined because, at the time, the journal had seen better days, to put it politely. I also had no prior experience running a journal – even as an associate editor or member of an editorial board. Martin convinced me to apply anyway, and I must have written a convincing plan to get the journal back in shape in my application because I was selected. Becoming editor-in-chief of the American Journal of Hematology in 2007 was my first role in academic publishing.

Improving the journal was a team effort and a long process. As we started being more selective in the papers we published, the journal grew. Academic journal editors live and die by the impact factor, and in our case, we raised the impact factor over 15 years from 1.5 to more than 10. I attribute this to selecting high-quality people who care about the journalfor your  editorial board, such as Ayalew Tefferi, MD, and David Porter,  MD who were my first selections as associate editors. I cannot overemphasize the value of a good team of editors. I’ve enjoyed my time as editor-in-chief and have learned a tremendous amount about hematology and oncology – that is what I really enjoy.

Tell us about your life outside of medicine. What do you enjoy doing in your off-hours?

Prior to the COVID-19 pandemic, I used to go to the gym every day for fitness classes, such as yoga, spinning, and powerlifting. I was sometimes the oldest guy in the class by about 20 years, but I was always able to keep up! Now, my exercise routine consists of solitary biking on the stationary bike at home. I used to ski often but do it less now. Two to three years ago, I discovered audiobooks, and now listen to books in Italian, French, and English during my walks or my commute to work. My favorite activity now is to walk, especially when I am visiting cities like New York, Vienna and Paris.  Let me just walk without a destination and I’m perfectly happy.