As the son of a father with a serious chronic illness, Eric
Schmidt came to understand the power of a good bedside manner at an early age.
“Dad was sick. Mom was worried. And somehow, these doctors
made us feel better,” recalls Schmidt, who grew up in the steel town of Bethlehem,
PA and spent many anxious nights in the hospital cafeteria. It was there,
around age 10, that he spotted those same doctors eating dinner next to him“just
like regular people.”
“I realized that I could be a doctor too someday, and I was
drawn to critical care medicine because of its power to take people who are
scared and provide them with clarity and peace of mind.”
Today, Schmidt - an Assistant Professor in the DOM’ Division
of Pulmonary Sciences and Critical Care Medicine – practices that empathetic
ethos with his patients and their families and passes it on to future doctors
he trains. Meanwhile, his cutting-edge research on a perplexing condition
called Acute Respiratory Distress Syndrome (ARDS) is paving the way toward improving
outcomes for some of the hardest-to-treat patients.
First described in 1967 by the late CU pulmonologist Tom
Petty, the life-threatening syndrome prompts the blood vessels within the lungs
to leak, filling the lung air spaces with fluid. It often occurs spontaneously following
severe infection, like sepsis, or trauma. But despite decades of research,
little is known about why ARDS happens or how to treat it. And the best Intensive
Care Unit clinicians can do is put the patient on a ventilator, “watch and
wait” and try not to make things worse, says Schmidt.
Of the 190,000 people who suffer ARDS each year, one third
die, and many suffer long-term complications.
As a young physician-scientist wrapping up his fellowship in
pulmonary medicine at Johns Hopkins in 2008, Schmidt saw this as a challenge. “I
thought ‘we can do better for these people.’ I wanted to look at something
completely different that no one had ever looked at.”
Schmidt arrived at CU in 2009 and – with the help of a
half-million-dollar federal grant from the American Recovery and Reinvestment
Act – has spent four years exploring the possible mechanisms of action behind ARDS.
His research has centered on the glycocalyx, a thin film of sugar molecules which coats the inside
of vessels and protrudes out into the blood flowing through them, “much like
seaweed sticks out into the ocean water.” Schmidt hypothesized that somehow
infection could cause the protective glycocalyx to erode. But to test his
theory, he had to observe it in a living lung. To do this, he helped establish
a first-of-its kind Medical Physiology and Imaging Core – a suite of
high-powered microscopes and cameras that allowed him to document in real-time
what happens to the glycocalyx inside a mouse’s pulmonary vessels after it has developed
The results, published in the July issue of Nature Medicine,
have been lauded as an important step forward in understanding ARDS, says
Michael Matthay, MD, a University of California San Francisco researcher who
specializes in lung injury.
“The focus on this lining layer is novel, and potentially
uncovers an important step in the injury that has not been appreciated before,”
Schmidt found that sepsis activates an enzyme called
endothelial heparanase, which seems to “chew up’ the protective glycocalyx, prompting
the blood vessels to leak. He also found, via samples taken from human plasma,
that the enzyme is abundant in people with sepsis. And he notes that the
prescription drug heparin seems to de-activate the lining-destroying enzyme.
Could giving heparin-like drugs to ICU patients with sepsis prevent
the onset of ARDS, or stop it in its tracks before it progresses?
Schmidt says it is way too early to tell and much more
research must be done first.
“This is just one piece of the puzzle,” he says. “But if we can protect the lung a little bit,
maybe we can minimize the short-term mortality of sepsis and the long term problems
that come with lung injury.”
For now, he says he is just thrilled to be in a place that
not only allows him to be both a passionate physician and a dedicated
scientist, but expects it.
find satisfaction in doing a lot of things – being a teacher, a leader, a
clinician, and a researcher, and I can do that here. That’s exciting.”