Introducing Dr. Eric Hoy

Introducing Dr. Eric Hoy

Introducing Dr. Eric Hoy

Neonates.  Phagocytosis. Myeloperoxidase.

Ask Dr. Eric Hoy the meaning of these terms and you may be amazed that when he’s done explaining them you actually understand. At least he hopes so—especially if you were one of his students wanting to pass his course in basic immunology.

Dr. Hoy might also display a sense of humor rarely found in serious scientists when he tells you that Phagocytosis is actually a new Indie rock band out of Seattle. This isn’t surprising coming from an immunologist whose Yahoo ID is “Ottoantibody”.

Over the last 19 years, Dr. Eric Hoy has been applying his extensive knowledge of immunology with a wry sense of humor as a professor at the University of Texas (UT) Southwestern in Dallas, Texas. He has taught clinical immunology and clinical chemistry in the UT School of Health Professions, as well as conducting active research into the area of autoimmunity diseases.

Dr. Hoy travels throughout the world giving presentations to international audiences about new diagnostic laboratory tests, the proper way to run these tests, the proper interpretation of the tests, and advantages of one test system over another test system.

He not only shares his expertise with doctors and technicians, but he serves as the medical consultant for the PAN Support Network helping patients get a lay person’s understanding of the complexities of vasculitic diseases. Since 2003, Dr. Hoy has lead several panel discussions about vasculitis at the Vasculitis Foundation symposiums.

In a wide ranging interview with the Vasculitis Foundation, Dr. Hoy talks about his creating improved diagnostic tests for autoimmune patients and some of the cutting edge research currently being done concerning all autoimmune diseases.

Q:  Please share with us some of your backstory. Talk about your career path that led you into the field of autoimmunity, immunology, and studying rare diseases.

A.  I kind of backed into studying autoimmunity. There were no big moments when the heavens opened up and a booming voice told me to study autoimmunity. Autoimmunity was simply the most fascinating field that I could find within clinical pathology. The fact that I could do research in the field of autoimmunity, and teach at the same time was like frosting on the cake.

My PhD. is in clinical pathology, and I am specifically interested in the mechanisms of disease: what triggers diseases, how the disease damages normal tissues in the patient, and methods for stopping the disease and repairing the damage. When I started looking at immunological diseases, the autoimmune diseases stood out because so little was known about their mechanisms. Teaching is a passion of mine that I have pursued for a long time.

Q.  Fill in some background about your time at UT Southwestern.   When did you begin there?   Talk about the various roles and positions that you’ve held in your time there?   

A.  I moved to Dallas in 1986 to become head of a Research & Development laboratory for a company in the diagnostic immunology field. I knew some people at UT Southwestern, and they invited me from time to time to come in and give lectures. In August 1990, the Dean of the School of Health Professions called me and asked me if I could teach a class that fall semester.

When I met with the dean, I discovered that the chairman of the Medical Laboratory Sciences department had suddenly decided to retire. This left the university without someone to teach a class in infectious diseases that would be starting in three weeks. I agreed to teach the class even though I didn’t even have an outline prepared of what we needed to cover in the class.

The class was very popular with the students, and I was invited to teach microbiology the next semester. I taught microbiology for the next two semesters, and then a new department chairman was hired for Medical Laboratory Sciences. He needed someone to teach immunology, and since that is one of my stronger areas he asked me to join the faculty.

My teaching duties were only part-time so I was able to continue my work with the R&D lab off-campus. This relationship continued for the next 19 years. For the past three years, in addition to teaching clinical immunology, I have also taught clinical chemistry in the School of Health Professions. Throughout this time I have continued doing research in the field of autoimmune diseases.

Q.  In terms of technology what do you wish existed back when you first started that would have made your work easier, or more effective?

A.  Technology has changed the way I teach in many ways. Clinical Laboratory Science is largely a visual field. We spend a lot of time looking through microscopes. We have some tests in which color change indicates the presence or absence of a substance in the patient sample.

In teaching the interpretation of these tests it is necessary to have photomicrographs (photographs taken through the microscope) or photographs of the actual color reactions and the appearance of a positive and a negative test.

In the first few years that I was teaching, I used a 35mm film camera to take pictures for my classes, and I had a special set up on the microscope that would adapt a 35mm film camera to the microscope. There were many occasions when I would shoot an entire roll of film looking at microscopic images, take it to the processing lab, wait several days, and end up with photos that were not suitable for my classes.

Nowadays with digital photography and digital imaging through the microscope I can shoot literally hundreds of pictures and select those that show the points that I want to make within a matter of a few hours.

Q.  Specifically in terms of immunology/autoimmunity talk about the current state of these fields of study.   How does this particular discipline stack up against other disciplines as far as attracting students who are deciding on a medical career path?

A.  Immunology and autoimmunity are fields that are growing extremely rapidly and a lot of research is being done in these areas. A lot of research dollars are being spent in these areas, so they attract students and researchers who are interested in advancing the knowledge of the immunologic mechanisms and autoimmune mechanisms.

Depending on the medical center and medical school, some fields are more popular than others. UT Southwestern is known for its internal medicine programs, and it attracts the cream of the crop of students who want to do a residency in internal medicine. Many of these students want to go on further into a fellowship in rheumatology and we see some of the finest internists moving into the field of rheumatology at UT Southwestern.

I see the field of immunology and the subfield of autoimmunity as a large growth area over the next couple of decades. We’ll see more research and I hope we will see breakthrough research that leads to cures or at the very least more effective treatments.

Q.  In your biography,  you mention that you worked in a lab that was doing some of the first ANCA testing for vasculitis.  Tell us about that experience.

A.  The laboratory where I worked in Chicago when I was a graduate student became one of the
first to do anti-nuclear antibody testing for systemic rheumatic diseases. When the ANCA test
was discovered in the early 1980s, our laboratory brought it on board and started offering it
even before the large reference laboratories in the area were offering the test.

The ANCA test led to my interest in autoimmune vasculitis. Vasculitis was a tiny part of diagnostic autoimmunity at that time. Like many parts of autoimmunity studying the diseases was very frustrating. There were no good diagnostic tests and the clinical syndromes overlapped quite a bit. There was even controversy as to whether some of the diseases existed, or were psychosomatic syndromes in the patients.

Q.  In terms of diagnostic testing for vasculitis where do we stand today in terms of evolution from say a decade or more ago?

A.  We have progressed quite a bit from there even though the tests that we use are somewhat primitive and Sed Rate and CRP are still not specific for any given disease. Even the ANCA test doesn’t differentiate between microscopic polyangiitis, Wegener’s granulomatosis, and Churg-Strauss syndrome.

The diseases are still defined by a variety of tests, clinical impressions of the physician, and complaints from the patient. The importance of accurate, reproducible, properly interpreted laboratory tests cannot be over emphasized.

The ANCA test is technically demanding and requires a very skilled individual to read the microscopic results. There are intra-laboratory proficiency testing programs that help to standardize the testing from one laboratory to another, but these are not fool proof.  I am aware of some laboratories that do an excellent job and other laboratories that consistently do a poor job of running and interpreting these tests.

Q.  And what about biopsies and their interpretation by a lab.

A.  The situation is similar with biopsies. A pathologist who sees a lot of biopsies from vasculitis patients is obviously going to be more skilled in recognizing the features when he or she looks at the microscopic tissue slides.

Q.  Where a patient goes for testing or where the lab results are interpreted are important, right?

A.  Yes. It is for this reason that I recommend patients go to a vasculitis center such as the Cleveland Clinic, the Mayo Clinic, Johns Hopkins, or the other vasculitis centers throughout the US,  Canada and worldwide for a definitive diagnosis. If the patient is unable to travel, the patient’s hometown physician can consult with experts at a vasculitis center, including having laboratory testing and biopsy interpretations done by the experts at those centers.

Q.  In your career, what do you think have been the major advances in testing for autoimmune/vasculitis diseases. Technological milestones or benchmarks that have been key.

A: One of the first advances for autoimmune testing in the clinical laboratory was the development of the anti-nuclear antibody test, which has a very high association with systemic lupus erythematosus, Sjögren’s syndrome, scleroderma, and other systemic rheumatic diseases. Using this test as a screening test has made the diagnosis of the systemic rheumatic diseases much easier than it was before we had good laboratory testing.

In a similar fashion, the discovery of the antibodies that give positive ANCA tests has made diagnosis of the ANCA-associated autoimmune vasculitides more accurate and definitive. However, we still have a long way to go in understanding the role of antibodies in autoimmune diseases. Like everything in the immune system, autoimmune disease is probably a complex interaction of cells, proteins, and genes.

Q.  You are retiring from teaching, but still plan on being active in helping industry develop new labs tests. What’s next in your career plan?

A:  I’m taking retirement at this time because the Medical Laboratory Sciences program at UT Southwestern was closed on February 28, 2013. I am going to remain with the University and the School of Health Professions, but I will no longer be teaching on a regular basis.

I will continue to work with industry in developing new laboratory tests and devices for running those laboratory tests. My retirement does not mean I’m going to slow down at all and I assure everyone that I will not just be sitting on the porch yelling at the neighborhood children as they pass by.

I still may come to the PAN Sunday evening chats and yell at the people as they pass by.

Q:  What personal goals/bucket list items do you plan on pursuing now that you’ve have retired. Travelling (for fun instead of business), catching up with family, etc.?

A:  Things aren’t going to change a lot. I’m going to have a little bit more free time, but other activities will use that up fairly quickly. I’m already travelling around the world, so travel isn’t a big deal. I consider cruise ships to be large floating incubators full of infectious diseases, so that isn’t in the future. Staying at home, working in my garden, and spending time with my wife and (grown up) children are the biggest priorities.

by Ed Becker, Director, PAN Support Network