Newborn Brain Society

Steering Committee Interview: Dr. Pierre Gressens

The Steering Committee of the Newborn Brain Society plays the essential role of advising the society and helping it to maintain its mission, vision, and objectives. This advisory board consists of seven founding members of the society, one of whom being Dr. Pierre Gressens, the “Director of the INSERM U1141 –Université de Paris research laboratory, Consultant in the Department of Child Neurology at Robert Debré Hospital, Vice-dean for research at Université de Paris Medical School, and Professor of Foetal and Neonatal Neurology at King’s College in London.

Dr. Gressens received his education and training from the University of Louvain Medical School in Brussels, Belgium and went on to specialize in Neurology, and later in Child Neurology. He describes his transition into Neonatology, saying, “I’m a child neurologist by training, and I was interested in the developing brain. I started looking into the normal-looking brain, and then when I came back from my post-doc in the United States, I started to work with neonatologists in the lab and we decided to work on models of perinatal brain damage.” That was when Dr. Gressens began to work in the field of Neonatology. Since then, Dr. Gressens has taken on many roles ranging from senior research officer, to coordinator, to professor.

Dr. Gressens’ research has focused on exploring “the basic and applied aspects of research in diseases of the developing brain, with a special focus on neuroinflammation in the perinatal brain.” Throughout his research, Dr. Gressens has introduced various novel concepts aimed at understanding the pathophysiology of neurodevelopmental disorders. Currently, Dr. Gressens is most interested in “improving therapeutic strategies to treat these brain dysfunctions.” Of these strategies, Dr. Gressens describes the importance of personalized medicine in that there are many factors that need to be taken into account including pain, stress, nutrition, etc. and that a combination of these might result in better predictors, but also better ways of treating the patients.

Dr. Gressens has also put forth many publications including 280 original research papers and more than 180 review papers and book chapters. He mentions two of his favorites: the Lancet Neurology paper published in 2012 “where we came up with the late phase –  tertiary phase” which also opens up the option for intervention during a larger window to prevent long-term consequences. The paper did not focus on data, rather on the concept itself. The second one is more recent and focuses on wind pathway mechanisms. It includes a lot of different types of data including human data, rodent data, and transcriptomics data accumulated over 5 years in an attempt to make a strong case for the role of microglia.

Due to his countless achievements and contributions to the field, Dr. Gressens has received many awards including the Winter Neuropeptide Conference award, the FRM Foundation Guillaumat-Piel award, and The Elsie Widdowson Lecture from The Neonatal Society. He mentions specifically the Jean Hamburger’s award as one of his favorites, as it was the first prestigious award given at the national level he received, which meant a lot to him, especially receiving it so young. Though the Jean Hamburger’s award is definitely a favorite, the de Spoelberch award is more important because the monetary aspect of the award helped fuel more research and innovation in the field. Specifically, this money was not tied to any specific project that he had to accomplish – he was free to use the money in any project, which removed the limits to innovation that most grants set. He says, “it gave us the opportunity to do original science” as opposed to the mainstream where you must follow through on that specific project and then prove that you did so, which he attributes more so to industry versus science.

Dr. Gressens explains one of his biggest achievements in the field: “I think probably in terms of mechanisms I’ve contributed to validating the idea that microglia and neuroinflammation are very important for perinatal brain damage.” He also mentions that when he moved from his residency in Belgium to Paris, he almost had to start over because there was no neuroscience lab. It took some time to gather the resources and the people to build this from the ground up. It began with two people and has grown to 150, but it took 25 years to do so. When asked if he would go back and do anything differently, he said “probably not,” even though this path was hard and took a lot of time to be successful, because he was able to shape it in the way he wanted and create something new that would benefit many people in the future.

As a result of his innovative thinking, Dr. Gressens has put forth four patents ranging from the “Use of VIP analogues in the prevention and treatment of brain damage in the human fetus, newborn, and young infant” to “Novel applications of the HIP/PAP protein or derivatives of thereof.” He says the path to obtaining these patents is long and requires a lot of small steps to move from an idea to clinical trials, but it can be achieved if many different groups work together.  “For example, we just got an EU grant for stem cells for preterm infants and we have 7 preclinical groups and each has one or two models so the same cells will be tested in 7 different models with the same protocol to show if it is effective in certain models.” If you were to do this in isolation in a lab, it would take 20 years to do these kinds of tests and take the small steps from rodents to small and large animals, and then to humans.

Dr. Gressens has also worked to share his knowledge and skills with others through mentoring, including 60 research fellows, many of which have gone on to be very successful themselves. On mentoring, he says, “from my point of view, it is something very important.” He continues to mention how it is something that he enjoys doing and benefits not only the mentee but the mentor who ends up expanding his/her network and also has more opportunities to generate new ideas with new people. Dr. Gressens advises students and others new to the field to take part in clinical or prenatal research and also warns against disregarding the social aspect of research. Of course, the quality of the science conducted at a specific lab or institution is important, but so are the people who also work there and the environment that you will work in. He says that if you find yourself dreading going into the lab in the morning because of the social environment, then the research will become much harder. A balance needs to be struck between the two to have effective research while also enjoying it.

Dr. Gressens has also worked to share his knowledge and findings through over 340 invited conferences and seminars taking place in countries all over the world. He expresses the importance of these seminars that create a sort of network where you can show your findings and be exposed to the work and thoughts of your peers which is important for making progress. Another aspect of these seminars is teaching students and trainees and exposing them to the new concepts that are being worked on. A third aspect is to have an opportunity to talk to the parents of the children you are treating. “We need the patients and families” to move the field forward. “They are really key in helping us decide the best strategies.” He also emphasizes the importance of informing the parents and allowing them to have a say in the treatment of their child(ren). A last aspect is to bridge together different countries to make sure everyone is on the same page and is aware of new developments.

Dr. Gressens has lived and worked in multiple countries including Belgium, France, and the US, and has given lectures all over the world. He says that there are  differences even within a country in how different NICUs apply strategies. These differences are even more apparent and emphasized between countries, which makes it that much more important to share information, practices, and ideas between countries. It is also important to try to take into account the available resources and technologies in different countries which change the practicality of different practices. One of the goals of the NBS is to share the commonalities and to notice the differences which can help improve strategies for different countries. Another thing to keep in mind is differences of time zones, and although many of the NBS members and team come from North America, those living in other time zones should not be overlooked and should be accommodated.

Dr. Gressens has also learned many valuable lessons during his years including the importance of the novel idea. He says, “it’s easier for people to stick to a dogma because it makes them comfortable – seems to be totally accepted and understood. It’s much more complicated to come up with a new idea than to say ‘oh, what was said before is not completely correct…New ideas are more complicated and people don’t like that. They like comfort, easy, simple,” which can sometimes cause them to be shot down without being fully considered. Dr. Gressens gives the example of the topic of hypoxia ischemia. For a long time, the term used was HIE (hypoxic ischemic encephalopathy), but over the past 20 years there has been a push to move to NE (neonatal encephalopathy) because “HI may be one reason for NE but not the only one.” At the same time, Dr. Gressens realizes that one must first start with a simple hypothesis because it is impossible to integrate all factors right at the beginning, but also not to get stuck there and fail to consider other hypotheses once that has been set. Another lesson Dr. Gressens has learned is that “we have to be careful not to jump too quickly into something we see as a great idea.” He says that “We’ve been very lucky in a way with hypothermia,” meaning all the trials have shown the same thing – that it is protective, but jumping into human trials too quickly could result in a failure similar to that of the stroke industry. About 20 years ago a drug called TPA was shown to have some good effects in early trials and was moved into large trials too quickly, where they found no actual benefit to the drug. “And now the companies don’t want to invest anymore in stroke trials because they say it’s too much money we’ve lost over decades. So we have to be careful not to jump too quickly into something we see as a great idea.”

As an expert in the field of the Newborn Brain, Dr. Gressens shares his views on the field and where he hopes it will go. He says that one of the most important things the field has accomplished is showing that hypothermia is protective as that was the first neuroprotective treatment that is both doable and feasible. It also pushed members of the field to broaden their network and work with others they may not have considered before. He hopes that the field will also move into using biomarkers to identify high-risk babies at birth which would help to stratify data, as right now it is very hard to demonstrate the effectiveness of a drug with such a mixed testing group. This will help us to focus on treating pre-terms that need treatment as opposed to all preterm infants.

As a founding member of the Newborn Brain Society, Dr. Gressens shares his hopes for the future of the NBS. He mentioned an ongoing goal of the society, which is to link together different parts of the world through things like practices, reviews, and training programs. He wants to create “a larger community where people don’t feel like they’re competing with each other but rather to change and share.” He says that if the NBS is able to accomplish this, it will be a big success. If we reach that goal, then the next step is to look into international clinical trials and grants, but we first have to show that we are able to work together. A challenge Dr. Gressens foresees is the risk of losing the original philosophy of the society (which is to share and interact) to others who may be fighting for a leading role in the society, which is part of human nature.

As a co-director of the PremUP Foundation and a consultant for Service of Pediatric Neurology in the Robert-Debré Hospital, Dr. Gressens has been a leader in many different capacities and shares some characteristics he finds in good leaders. “One is of course knowledge. You need something to transmit.” Another is “You need to be open to new things. From my point of view, just because you are the leader of something doesn’t mean you cannot change or improve or change your concepts or your view of something.” The third characteristic he mentioned was being charismatic and having a good relationship with your team. You should not just be the boss telling them what to do, but also working with them and encouraging them. A very important one is also being able to train and teach others and helping them to develop themselves and become independent.

We are very fortunate to be able to have Dr. Gressens on the Newborn Brain Society team. His fruitful experience coupled with his leadership skills and innovative thinking has, and will continue to, help the NBS fulfill its goals.

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