Massimo Pignatelli, MD, PhD, a distinguished pathologist and biomedical scientist, was recruited through an international search process to serve as founding dean of Nazarbayev University School of Medicine (NUSOM), which was formally established in January 2014 and will open with its first class of students in fall 2015. Before coming to NUSOM in November 2013, Dr. Pignatelli was at the University of Glasgow School of Medicine, where he served as international lead in the College of Medical, Veterinary, and Life Sciences and head of the School of Medicine, which includes the Schools of Medicine, Dentistry, and Nursing and Health Care. He also held the St. Mungo-Notman Chair as head of pathology. Dr. Pignatelli joined the University of Glasgow in 2011 following an academic career at Imperial College, London as senior lecturer/reader in pathology and at the University of Bristol, where he was professor of histopathology and head of clinical sciences. Dr. Pignatelli earned his MD summa cum laude from the University of Bologna, Italy, and his PhD from University College, London. He is a noted and well-published physician-scientist whose research focuses on epithelial adhesion molecules and particularly on their exploitation as biomarkers for tissue diagnosis, prognosis, and response to treatment.
Question: You are originally from Italy, but you’ve worked in the United Kingdom for many years. How did your career evolve?
Dr. Pignatelli: I earned my MD in Italy at the University of Bologna. After a one-year residency, I decided to go to the UK to do research. My plan was not to pursue a PhD, but to have some experience in research. Because I was interested in liver pathology, I decided to go to a very good academic hospital in London, which was one of the main centers of liver research at that time. I went to the Royal Free Hospital, where I worked with two very influential people in my career: Professor of Medicine Howard Thomas, who was a pioneer of antiviral therapy in hepatitis, and Peter Scheuer, who was a professor of liver pathology. After a couple of years, I had the opportunity to do a PhD in the laboratory of the director general of the Imperial Cancer Research Fund [now Cancer Research UK], where I developed my research interest in cancer biology. After my PhD, I had to decide whether to go back to Italy or to stay in the UK
Question: When you first left Italy, did you imagine you’d return soon?
Dr. Pignatelli: Yes. My plan wasn’t to stay in the UK. Many of my colleagues did similar things after medical school. It was common to go to the UK or the US for a couple of years of research and postgraduate clinical training, then move back. However, after two years you often find opportunities abroad.
Question: Did you experience culture shock when you first left Italy?
Dr. Pignatelli: Yes! But first, I should say that I recall my classmates saying, “You won’t have any problems because you are not a typical Italian.” It’s true. I am not, probably because my mother was from Northern Italy and my father from Southern Italy. And if you know Italy, there is a big difference. Southern is the stereotypical Italian—loud, chaotic, and passionate. People from Northern Italy are really more Northern European—very calm, organized, and perhaps less easily agitated. They are somewhat closer to Switzerland and Germany.
My friends said I would fit in, and they were right. I felt quite comfortable in my new environment. Of course, I did not speak English very well. And I remember when I arrived in London it was November, a very cold morning. First thing, I had to open a bank account. A simple thing, but it was so stressful because I couldn’t understand what they were saying to me. It was very stressful.
It got better, of course. The hospital was very international, with a large number of research fellows from all over the world. I spent 30 years of my life in the UK—more than half my life. Before coming to Kazakhstan I was head of the School of Medicine in Glasgow. Before that I was professor of pathology and head of clinical sciences in Bristol, so I was responsible for a significant portion of the medical curriculum in Bristol as well.
Question: How do you describe the plans for the first medical school in Kazakhstan?
Dr. Pignatelli: Our vision for Nazarbayev University School of Medicine is to establish a school based on international standards—modern medicine and modern educational methodologies based on a US graduate program. Obviously, the collaboration with the University of Pittsburgh School of Medicine is key to developing this program. It certainly was one of the main reasons I decided to accept this challenging job. It was an opportunity to work with a world-class institution. It’s an ambitious project for us and for the Republic of Kazakhstan. What we want to do is to train the future academic clinicians of Kazakhstan to ensure that, like many other nations, it will develop the world-class health care that the citizens of Kazakhstan deserve.
I also find the vision for the entire Nazarbayev University quite exciting. It is a very rich country in terms of natural resources; and it is trying to diversify the economy, invest in education, and invest in health care resources. At NU, what they are doing is quite different from what is happening in other developing countries, like in the Middle East, where international universities or medical schools are establishing campuses. Kazakhstan decided to try a different approach because they want to develop their own leaders based on their own expertise. So they have established a university based on international partnerships with established universities. Every school at NU is being developed with one of these partners: Medicine with the University of Pittsburgh, for example. Engineering is being developed with University College London. The School of Education is partnered with the University of Cambridge in the UK. When NU was established it was decided that all students would undergo a preparatory year, and this is being done with University College London. In every case, these are schools with expertise and very good international rankings. I don’t know of any other university being developed with this approach or model.
It’s a fantastic opportunity. There is a lot of support from the government of Kazakhstan and from President Nazarbayev. It is a challenge, especially in medicine, which is unique because of the complexity of the program, the number of stakeholders involved in the delivery of the program, and also in the expectations of the product of the program. The other part of this project is to reorganize the health care system in Kazakhstan and to develop an integrated academic health system so that the hospitals of National Medical Holding (NMH) will be integrated with the medical school.
Question: What are your personal research interests?
Dr. Pignatelli: Broadly, my area is histopathology. I’m interested in how cells communicate with other cells and with the extracellular environment. I spent quite a lot of time trying to understand the signaling molecules that regulate cell shape, movement, and phenotype—the differentiation of cells—particularly trying to understand the abnormalities that happen in cancer, because cancer is actually a disease in which there is a change in cell-cell communication. Cells do not respond to signals from other cells. The cell behavior is abnormal. This is what I did in my PhD work, discovering some key proteins on the membranes of cells that are abnormally regulated in tumors of the gastrointestinal tract. And these molecules could be used as a target for therapy. When I was doing this research in the mid-80s, we knew very little about these molecules. Now, there is extensive literature. They are called cell adhesion molecules. In pathology, I’ve actually used these molecules to predict the behavior of tumors. We are trying to predict whether some tumors will do well and others not so well and to understand why. There has been less success using them as targets for new therapy because cancer is a multifactorial disease. Even if you control a single pathway it may not be sufficient to reverse the phenotype and the abnormal growth.
Question: What are the rewards of a career that blends the lab and the clinic?
Dr. Pignatelli: One of the great advantages is that you can take a problem that you see in the clinic (or, in my case, a problem in a tissue section because as a pathologist I spend my time looking at histological slides), and from a morphological observation you can have some really fantastic ideas about what is really happening in that patient. Then, you use that knowledge to try to understand the mechanism and the progression of disease in that patient. Pathologists make morphological observations all the time. We observe patterns in the cells of a tumor, and we classify tumors based on appearance, cellular morphology, cellular shape, etc. We classify tumors as well differentiated or poorly differentiated based on that. My PhD was really trying to determine and understand the molecules that regulate cellular morphology. This is why I was able to discover these proteins, the adhesion molecules, which really seem to be key in the regulation of cell shape. This was a clinical, morphological observation. Then I went to the lab, and I designed a number of experiments. Based on my findings, I went back to the clinic—back to the tissue—to test my hypothesis that these molecules really were important in maintaining cell shape and influencing tumor behavior in patients.
Question: What are your long-term goals for the medical school?
Dr. Pignatelli: My hope is that it will become a model for every medical school in the nation. This is the goal of the project. NU will become the hub of medical education and biomedical research in Central Eurasia. The project has all the necessary components, including infrastructure, resources, and political stability.
Question: How would you describe the medical students you hope to enroll?
I look forward to interacting with the students. NU will have strict selection requirements, accepting only top students. All will be on scholarship, so they will receive free education. Students in medicine will do one year of university prepatory course, four years for the bachelor’s degree, and four of medicine.
These are students who are very committed to higher education. In medicine, they will be in the top 5-10 percent of all students. I think it will be enjoyable to teach these students, who will be as committed to the program as we are to them.
Question: How would you describe the faculty of the medical school?
Dr. Pignatelli: At the moment I’m the only faculty, which puts me in a unique position! I’ve got an ambitious recruitment plan for the school. The faculty will be a blended faculty, with local clinicians who are Kazakh, as well as international faculty. We will prepare local clinicians to teach and to engage students in the clinic, the operating theater, and so on. Then there will be international faculty from the US, from the UK, and from across Europe.
Medicine is different from any other program. In biology, you can have a few faculty members teaching a biology course. But in medicine, consider a cardiovascular course—I need a cardiologist, surgeon, radiologist, and pharmacologist, plus nurses, anatomists, and physiologists. We require quite a large number of people with varying expertise for a single course. We need a number of core faculty members plus a number of others who will contribute to teaching and research. By 2016, we will probably have 80 full-time faculty and a number of others contributing. Practicing clinicians in the hospitals will have day-jobs as physicians, and they will also contribute to med school teaching.
Question: What do you most look forward to?
Dr. Pignatelli: There are two important dates I look forward to. In August 2015 we will open the school and welcome the first students, and that will be a big day. And, of course, the graduation of the first class will be an extraordinary milestone. I think that will actually tell me that the school is a reality. We have a commitment now, and we have a great deal of work to do between now and August. When I think about the steps it is sometimes daunting, but also very exciting.
Question: How has your experience living in Kazakhstan been thus far?
Dr. Pignatelli: Living in Kazakhstan, I find the Kazakh people very friendly and welcoming. Perhaps this is a result of their history as a nomadic people. They are accustomed to travel and also to welcoming travelers. They have that mentality and personality. I look forward to feeling more integrated into Kazakhstan and to learning the language. Unfortunately, I don’t speak Russian, and that is a challenge for me.
Question: What do you enjoy most about working in the field of medical education?
Dr. Pignatelli: I like interacting with students a great deal. Medical students are a select group. They are motivated and committed. These are really the top students. They are stimulating, inquisitive and willing to challenge; that is certainly the case in the US and the UK. I hope the Kazakh students will develop those skills, as well. Culturally, I think they are different from Western students. I like the direct interaction with great students. I like to be challenged, to share my experience, and to perhaps serve as a role model. It’s an honor to have the opportunity to train Kazakhstan’s future doctors, researchers, and academic physicians.