Hello Friends đ
In this episode of the Incubator, Dr. Paul Rozance discusses his research on fetal metabolism and growth regulation, emphasizing the role of insulin, glucagon, and placental function in development. He shares insights on how metabolic signals influence fetal growth and how complications like placental insufficiency impact long-term health. The conversation also highlights the challenges of translating research from animal models to clinical applications and the importance of collaboration in advancing neonatal science. Get your popcorn! There are some suspenseful stories #getyourpopcorn. #barker hypothesis #neuroendocrinology
----
The articles covered on todayâs episode of the podcast can be found here đ
Amelia R. Tanner, Sarah N. Cilvik, Marjorie A. Nguyen, Evgenia Dobrinskikh, Russell V. Anthony, Stephanie R. Wesolowski, Paul J. Rozance Int J Mol Sci. 2025 Mar; 26(5): 1904.  Published online 2025 Feb 22. doi: 10.3390/ijms26051904 PMCID: PMC11900341
White A, Stremming J, Wesolowski SR, Al-Juboori SI, Dobrinskikh E, Limesand SW, Brown LD, Rozance PJ.Am J Physiol Endocrinol Metab. 2025 Jan 1;328(1):E116-E125. doi: 10.1152/ajpendo.00259.2024. Epub 2024 Dec 16.PMID:Â 39679943
Cilvik SN, Boehmer B, Wesolowski SR, Brown LD, Rozance PJ.J Physiol. 2024 Nov;602(22):6329-6345. doi: 10.1113/JP286974. Epub 2024 Oct 9.PMID:Â 39383208
----
The transcript of today's episode can be found below đ
Betsy Crouch (00:02)
Hi everyone, welcome to this at the bench segment of the Incubator podcast. I'm one of your co-hosts, Dr. Betsy Crouch. I'm thrilled to be here today with my co-host, Dr. Misty Good and our esteemed guest, Dr. Paul Rozance. Dr. David McCully is taking care of experiments in the lab today. Misty, would you like to introduce yourself and our guest?
Misty Good (00:27)
Sure. Hi everyone. Glad to be back. I'm Misty Good. I'm the division chief of neonatology at UNC Chapel Hill. And I'm thrilled to co-host this podcast with Dr. Crouch today and really excited about our guest speaker, Dr. Paul Rozance who's the Frederick C. Battaglia Chair of Neonatology Research at the Children's Hospital of Colorado. He's also a professor of pediatrics and neonatal medicine at the University of Colorado and is in charge of their perinatal research center. He's going to tell us all about his work and I'm really excited. This brings me back to the days when I visited Colorado and you showed me around the perinatal research center and all the amazing work that you all are doing there. But Paul, would you like to introduce yourself a bit
Paul Rozance (01:18)
Thank you. So, yeah, my name's Paul Rose-Anse. I really appreciate the invitation to be on the incubator podcast. It's quite exciting. Yeah, my work, think if I were to sum it up in one phrase, it would be the study of the regulation of fetal growth. you know, I'll follow that line of work wherever it takes me. Initially, I...
Misty Good (01:27)
Thanks.
Paul Rozance (01:44)
started out really focusing in on the fetal pancreatic beta cell because insulin is a, you know, one of the dominant anabolic growth factors for the fetus. More recently, it's brought me into the world of placental biology, which has been a wonderful addition to the work that we do in the lab.
Misty Good (02:05)
That's great. How did you initially decide that you wanted to pursue a career as a neonatal physician scientist? Take us all the way back.
Paul Rozance (02:13)
Well, I guess all the way back. mean,
for me, the, the goal of, you know, pursuing a career related to science. mean, it dates back, probably even to when I was an undergraduate, not, not earlier. I never really was in a lab before that, but the sort of interesting or maybe sad thing about that goal is that I never really acted upon it as an undergraduate. So.
You know, I took great classes and when we got into our upper division, you know, molecular biology classes, we had those that were based on, you know, reviewing experiments and going over articles and publications. But I never took that leap to perform research as an undergraduate. So when I went to medical school, that's when I did my first, you know, lab-based research.
It was a project related to Lyme disease and neurobereliosis. And, you know, from there, you finished medical school, went to residency and ended up at Colorado. But what's interesting is you asked about how I decided to become a neonatologist as well. So I think what I ended up studying in the lab relates to, you know, both the decision to be in a lab, but also what I wanted to do clinically.
Can I go ahead and gonna really appreciate that when I was an undergraduate, my emphasis in molecular and cell biology was in neurobiology, not but neurobiology. And I would say during my time at my undergraduate institution at Cal Berkeley, I was destined to become
Well, either a neurologist or a psychiatrist. mean, that's what really fascinated me. And to be honest, back in whenever that was in the 1990s and late 80s, you know, I think, I think the idea of like a molecular basis of psychiatric disorders was sort of becoming better known maybe for the first time. And the idea that all these illnesses, which were distinct from neurological disorders could be, could be based in something molecular.
I just found that really fascinating. I, you know, that's what I gravitated to as an undergraduate. And when I went to medical school, that was what I was going to be. It was probably going to be a neurologist or a psychiatrist in order to study the problems in that field, especially psychiatry. However, during my medical school, a couple things, a couple things, well, yeah, a couple of things became really clear.
Misty Good (04:54)
You saw the lights.
Paul Rozance (04:59)
The first was that the field of psychiatry really mandated, if you're in clinical practice, it mandated talking to your patients. And that wasn't something that absolutely excited me. And so I started looking around more around hospital medicine, neurology, but even that had a bit too much.
bit too much, let's say, outpatient clinical work for me. And what I really found exciting was everything we were doing as medical students on the inpatient side of things. And so why did I end up in pediatrics and neonatology? I think I don't have a great answer, but I will say this. Pediatrics was my first clinical rotation in medical school. This is back when you did two years of preclinical work, all classroom basically, and then you went for your first rotation that
that summer of your third year and pediatrics was my first rotation and I probably came home and told my wife that I wanted to be a pediatrician because it seemed so much fun and everybody was so nice and you know, it was a little different than like the courses we were getting and the intimidation factor around some of the other clinical courses that my colleagues were talking about. So that was medical school.
And then I just, and I stuck through it, right? I flirted with surgery. I think for anyone interested in inpatient medicine surgery, you know, it was a very attractive option. And, but I ended up sticking with pediatrics. And then I didn't really know what I would specialize within pediatrics, but I will say my very first rotation as a pediatric intern was in the NICU, right? So, so here I am.
Misty Good (06:47)
It's so interesting
how many people say that it's so interesting. It's like Neonatology got you right off the bat. Yeah
Paul Rozance (06:53)
I know!
right away. mean, I
do worry about, you know, what if like, what if surgery had been my first rotation? Or what if, you know, what if like, you know, I don't know what a family medicine had been my first rotation, would I have been in family medicine? I think I do gravitate to the hospital more though. So that first, my first call night was at our county hospital. It wasn't at the main children's hospital where I was a resident. And again, back then, you know,
Attendings didn't stay in-house. It was pretty much the house staff down where we were and you know, we had two babies born that were under 500 grams and it was a big deal and you know, we were doing procedures back then as interns as you guys probably can appreciate and Yeah
Misty Good (07:38)
yes.
Betsy Crouch (07:42)
So wait, set the scene. So it's like you're an R1 and
Paul Rozance (07:46)
you would go with a respiratory therapist, a NICU nurse, and the R2 and R1.
Betsy Crouch (07:50)
Yeah, I was gonna say, and an
absolutely amazing nurse, right? Like a triage, you can basically do resuscitation with one hand tied behind your back.
Paul Rozance (07:55)
Yeah, yeah, they were great. Absolutely, yeah, yeah.
Misty Good (08:01)
But wait, wait, okay, so you said the scene, like, who else can intubate there besides you two? Can the RT intubate? Because they could when I was a resident, actually. They would come with us. But was there a nurse practitioner?
Paul Rozance (08:03)
Ha!
yeah.
There was a, not a nurse practitioner.
We, you were there, there was an R2 in the hospital assigned to the NICU, me as the intern, the R1. There was an R3 in the hospital who would be called in sort of for extra emergencies, extra help. But it was mostly us. And there was a lot of intubations back then. And so I don't know if you guys predate or post-date the article, the really seminal article that showed intubating all babies with meconium.
Misty Good (08:38)
Yes.
Paul Rozance (08:48)
was not beneficial, you know, but that came out while I was a resident, which meant, and we weren't part of that trial. So that meant that we were still intubating all babies with meconium. So every night we would intubate five or six or 10 babies it felt like. And so it was a skill we all picked up pretty quick. And of course I didn't have that skill as an R1 on my first week of rotation, but I think that by the time you were a second year, it was a a pretty,
Misty Good (09:11)
No.
Paul Rozance (09:18)
routine procedure for us.
Betsy Crouch (09:20)
Yeah, I mean,
I think this is so exciting. was listening to to give a little bit of a shout out. I was listening to Jonathan Klein's ONTPD lecture on High Frequency Jet Ventilation for first intention for our, you know, for the babies that you're talking about, less than 500 grams. And it made me feel really intrigued, but also pretty proud of us, you know, as a field that like we're now using cutting edge technology, which is something I love about being a neonatologist.
Paul Rozance (09:31)
Mm-hmm.
Yeah.
Betsy Crouch (09:49)
in
ways that are evolving based on the pathophysiology of what stage of lung development are we in the cannalicular stage, are we stage, and thinking about our modalities of ventilation and how that ties together. So yeah, I mean, think it's been a really cool story, like many stories in neonatology. But that's a nice personal anecdote on those lines.
Paul Rozance (10:08)
Absolutely. Yeah,
absolutely. I remember, you know, also when I was a resident, the sort of the pendulum of giving steroids to all those preterm swung the other way. you know, meaning when I was a resident, we were, I don't know if we were still giving sort of 42 days of dexamethasone to every preterm baby, but you know, that idea that it was beneficial had really.
started to wane and yeah, I just like the continual changing nature of our field. From a research standpoint, I think our field could do a little better in terms of recruiting patients. I don't know what it's like at your centers and centers around the country, and maybe this is specific to the University of Colorado, but you know, really enrolling patients, getting parents to agree to consent to enroll their little babies in new studies is sort of the key to
know, ensuring that the innovation we do at the bench makes it into the bedside.
Misty Good (11:11)
I do think it's hard when you're trying to consent families for research. think one is you want to make them feel a part of the process, right? But then also, they have a new baby and they don't want them experimented on. And so it is tough. I I lead the NEC biorepository and it's all observational and it's just really collecting samples.
Paul Rozance (11:25)
I know.
Mm-hmm.
Misty Good (11:36)
And sometimes even that is just a little bit hard to convey, like why we need these samples so much. And like a lot of the samples were throwing away anyways, you know, but I think for a clinical trial in particular, that research is hard, but.
Paul Rozance (11:41)
Yeah.
It's hard.
mean, they do it well in, you know, at least when I was a resident, it seemed that they do it quite well in pediatric oncology, which is another critical point in a person and a parent's life. And I don't know if they phrase it better or talk about, you know, talk about, you know, I like the phrase random versus randomized care. mean, you know, but, but again, it is such a hard time to, approach a family and most, you know, just can't make any.
Betsy Crouch (12:02)
Hmm.
That's interesting.
Paul Rozance (12:25)
any decisions around that, but thankfully, you know, many do and we're able to again make that good translation that we need.
Misty Good (12:32)
So did you save the baby? What happened?
Paul Rozance (12:34)
Well, one of the babies
made it to discharge and I'm getting fuzzy on the exact birth weight, but I sort of kid you not that I think this baby was in the 300 gram range, but was 27 weeks gestation and the mother had these terrible uterine fibroids and so big head obviously and teeny little baby and that baby made it to discharge. And then the next baby that was born that night,
was probably what was a severely IUGR 20, 24 week baby and that baby did not survive to discharge.
Misty Good (13:11)
Sorry.
Paul Rozance (13:13)
But the process that evening made a strong impression in me. And I remember the R2, my supervising resident, I think by the end of the morning, she just looked at me and said, this is your job. I can tell you're gonna be a neonatology resident. And I said, no way, like, let me experience oncology. Let me experience the PICU. Let me experience these other more hospital-based specialties. But I guess she was right.
Misty Good (13:30)
That's awesome.
Betsy Crouch (13:41)
you describe what it was about you in that environment that just seemed to click?
Paul Rozance (13:45)
Well, I mean, I don't know. No, she didn't. I mean, I was happy to be in the hospital. I mean, I don't think it's possible. You're in your element, right? Like you can't be an intensivist and be sad that you're in the hospital. We all have our personal lives that, you know, we need to balance and we need to acknowledge the importance of those things. But there's sometimes you just can't leave the hospital. And if you're not happy about that, it's going to be a tough, tough position to be an intensivist.
Misty Good (13:52)
You're in your element.
Paul Rozance (14:15)
obviously the same way. you know, everybody ultimately has to feel that way about their job, that there are emergencies they just can't avoid. So I think it was something about being extraordinarily positive and the other, mean, yeah, that was it. I loved, we got to moonlight a lot too. This was prior to duty hour restrictions, so we could, we did a lot of moonlighting and there were definitely a cohort of my fellow residents.
program that we took every opportunity we could get to Moonlight in the NICU, mostly because it was fun and it was like being paid extra to do something that was fun.
Misty Good (14:51)
Yeah,
and it's great learning, I felt like, you know, when we were allowed to light back in the days, free work hours.
Paul Rozance (14:53)
Absolutely, yeah.
in the days.
Betsy Crouch (14:57)
Well,
I some of the other things that I really appreciate about the NICU and talking about being an inpatient hospitalist is just that the collaboration, working with these days, I mean, working with the RTs and the nurses and the dieticians, not to mention different providers coming from different perspectives like the nurse practitioners or the residents and kind of working.
you know, with all these different levels of people with different perspectives, it's really fun to come together and think about like, what is the best way to move forward in this particular like clinical situation? It's the best care, right? When you can take all of those experts together and like pinpoint them on one particular baby, feels really, it feels really right to like spend that time, you know, working on one patient. And we can because we're inpatients, like because we're inpatient doctors, because
Paul Rozance (15:30)
It's great.
Absolutely.
Absolutely.
Betsy Crouch (15:54)
we're there. We're not going to get to the next patient. And I love that luxury of time. I do think as inpatient doctors, we have more time to think of our patients. And it helps me, I think, provide better care. But that's because I'm an inpatient doctor. I'm sure folks who do outpatient do good care in that setting. Yeah.
Paul Rozance (15:55)
Absolutely. Yeah.
Yeah.
I think you're absolutely right. And
yeah, the multidisciplinary nature is awesome. And, know, I was fortunate we, and this may be a lot of programs were like this back when I was a resident, but we had that dichotomy of, you know, the county hospital versus the hospital at the big children's hospital, the Quaternary hospital. There we did have our, you know, our awesome group of neonatal nurse practitioners who
were the resource. Obviously the kids were more complex, the patients were more complex. So we needed that, and we needed our fellows were there and all the nutritionists, respiratory therapists, pharmacists, absolutely.
Betsy Crouch (16:54)
Yeah, so there's one thing I wanted to get back to, which is talking to our families about research, because I agree strongly with both of you that I think this is an area of improvement, but it's also a solvable problem. So I have a medical student who's working on a project that Dr. Mercedes Paredes and I, she's a neurologist actually here at UCSF, but my counterpart in a lot of kind of.
Paul Rozance (17:19)
Mm-hmm.
Betsy Crouch (17:23)
human brain development studies. And she and I did want to know why some families were excited about research and for other families it seemed foreign or even something that they, that it was bothering them to talk to them about these opportunities. And so we were fortunate to work with three different studies that were recruiting in the NICU and go back to those families and ask why did they participate? What were the positives and negatives that they found out and kind of get the
get the perspective from, from in their own words. So we're, sending them a new script out right now, but, but it does have like a lot of basically there. can, I can give you the, the take-homes, but they're motivated strongly by, altruism, you know, by, wanting something to come from their experience to help other babies. But Misty, like you were saying, the timing is so important. And there was one participant who said it so well that her baby went for an MRI.
Paul Rozance (17:57)
Mm-hmm.
Misty Good (18:00)
So.
Paul Rozance (18:05)
Please.
Betsy Crouch (18:22)
and came back and had a tough time at the MRI and came back and that's when she got approached to And she was like, no way, like, how dare you, you know, ask me to do something else in this stressful setting. And I think that was so important and I'm really grateful to her that she could articulate that. So I do think we need to be cautious about approaching families when the baby's having a good day, right? Which is intuitive, but how brilliant.
Misty Good (18:45)
Right.
Betsy Crouch (18:47)
You know, and this is like increasingly how research is moving, right? All of our funding agencies are telling us to do not like, not research where we have like a couple of parents who like give us the thumbs up, but more, you know, to really design the research strategy with a parent advisory board. It's so humbling when we did this. was like,
Paul Rozance (18:48)
Yeah.
Yeah.
Misty Good (19:09)
Absolutely.
Betsy Crouch (19:12)
is really important. So you know it's how I've started to think about all of my basic science and my cellular studies now going forward. So yeah so we're making progress, we personally, but also I think as a field we're making progress on this point.
Paul Rozance (19:18)
Yeah.
Thanks.
Yeah.
Misty Good (19:28)
I think in the next space, like what you bring up, Betsy, is very important because like those babies may be having a good day or a bad day, right? And for when we approach the families, like I'm really fortunate to have amazing research coordinators that check in, like it happened today. Should we approach this family? You know, and...
Betsy Crouch (19:38)
Yeah.
Misty Good (19:48)
you know, their baby recently had surgery. And so, you know, I said, make sure you check in with me that way we can see if the baby is having a good day because I do think it's important to not, you know, like add any additional stressors when the family is down. I think it's really important.
Paul Rozance (19:56)
Yeah.
stuff.
Betsy Crouch (20:07)
Yeah. Yeah, I mean,
Paul Rozance (20:07)
Yeah.
Betsy Crouch (20:09)
I guess I would probably take it one step further, which is that I think this should be a standard part of consent in the children's hospital, at least an academic one, where a patient is admitted. And part of the onboarding is, hey, we're doing research here to try to push the field forward, to try to push medical care, to push discovery forward for children who are, in my mind, like,
Misty Good (20:18)
Mm-hmm.
Betsy Crouch (20:36)
the most deserving population. If you're eligible for any studies, would you be interested? Just ask them off the bat as a part of the admissions process. That's how I'm trying to get our children's hospital to move, because I do think that it's important, number one, that parents are empowered, that they know their options, that they can participate in things, or they can choose not to, either way, but that there's a uniformity about who's approached. So this has become a recent hot topic amongst my research.
Paul Rozance (20:43)
Yeah.
Misty Good (20:57)
Right.
Paul Rozance (21:05)
I think
that's how, mean, when, back again, back when I was a resident and I watched people get consented for the oncology trials, that approach seems to be what they would take where, you know, something, whether it was a new diagnosis or a relapse or a complication, I mean, just as part of the process, was, this is how, I mean, this is what, I mean, one is, they would, you know, it could be the only way you had access maybe to a...
Betsy Crouch (21:12)
Yeah.
Paul Rozance (21:32)
drug that was better but not proven better yet or something like that or but really a lot of it was appealing to the altruism that you talk about and making sure that every family feels empowered to be able to contribute to that.
Misty Good (21:47)
Yeah, agree.
Betsy Crouch (21:50)
We're going a little off track from your.
Paul Rozance (21:51)
little off
track for sure because since I didn't almost no clinical research so yeah pretty relevant yeah
Misty Good (21:51)
Hahaha!
Betsy Crouch (21:55)
But very relevant, I mean, I would say. Quite translational
Misty Good (21:56)
We want to hear about your...
Paul Rozance (22:02)
want me to keep going? mean, yeah, we got to the R1. then, so then I wanted to be a neonatologist. And, you know, obviously, like, there's times I'm sitting there thinking, I wish I had pursued neuroscience, right? Kind of like you, Betsy, you know, I would get to stutter. Instead of these complex psychiatric illnesses, I could actually study development, which is, you know, just as exciting and as important if probably
you know, we will argue as neonatologists more important to study development.
Betsy Crouch (22:34)
Yeah, mean, there
is an intersection also between our interests as a neuroscientist and a regulation of fetal growth Yes, there's probably a cool acronym there. We can ask that, GPT But, know, I also thought about neuroendocrinology, you know, like just kind of as the as the obvious connection between our interests. but I also think I don't know what you do and thinking about how growth regulates neurodevelopment, think is also
Misty Good (22:37)
Mm-hmm.
Paul Rozance (22:38)
Yeah.
Regulation of fetal growth. Yeah
Misty Good (22:42)
Mm-hmm, mm-hmm.
Paul Rozance (22:45)
No.
Mm-hmm.
Betsy Crouch (23:04)
So, you know, I just wanted to reassure you that you are not. There's a Venn diagram here that overlaps.
Paul Rozance (23:05)
Yeah. Yeah. Thanks.
absolutely. mean, I, you know, I could talk to you guys for hours about, you know, fetal oxygen and oxygen delivery and blood flow patterns in the fetus and how that, you know, relates to brain development. I guess when I, but when I finished, so when I was finishing my residency and looking for a place to do fellowship, I like to, you know, how I got into this field of, of research again, I think it's.
think it's okay to acknowledge to our, to your audience that people get excited and into certain places and research in different ways. Like, like I was conversing with, your cohost, David McCauley, you know, and, I look at him and, know, he's probably somebody that, you know, saw congenital heart disease or saw congenital diaphragmatic hernia and just felt like, you know, from the very beginning, he needed to know exactly why.
Misty Good (23:55)
Mm-hmm.
Betsy Crouch (24:09)
Mm-hmm.
Paul Rozance (24:09)
you know, that baby had that problem. Whereas for me, you know, I knew I wanted to do research, but I didn't know in what. And we got to a point, this is now my wife and I got to a point in our lives towards the end of my residency where, you know, we were looking for a kind of a place for me to do my fellowship and a place for us to live. And we sort of created this list of cities that we would like to live in. And, you know, they are
Misty Good (24:36)
Nice.
Paul Rozance (24:39)
obvious, not obviously for us, they were on the East and West coast. And that was it. They were by the ocean. That was a big part of our, what we did and recreationally. And we just enjoyed being near the ocean, but we had met somebody from Denver and they had loved it. And they told us, you know, how much Denver was awesome. And we do love the mountains and we looked at the map and noticed that it's right by the, the mountain. in this list of East coast and West coast cities, you know, Denver popped up.
And I went to one of my mentors at Stanford and showed him this list. And I think the only, he just said, well, if you really would move to Denver, that's an amazing place. And there's amazing opportunities there for training and research. essentially he said, I mean, what he said was, if you move to Denver, you should do research and.
pulmonary development and injury and pulmonary hypertension with Dr. Steve Abman, or you should study the regulation of fetal growth with Dr. Bill Hay. And so I kind of looked at both of them and looked at their publications and chose to work with Bill Hay and study the regulation of fetal growth. And that's what I did. And then I got here and kind of refined it a bit with Bill. But again, wasn't just, unfortunately, I wish I could tell you it was that.
you know, some 400 gram IUGR baby as an intern that inspired me to study. In fact, I probably should. Can we go back and edit it all? I'll just, present a much better story for you guys. But the reality is it just wasn't that way. And I think the, mean, one of, yeah, well, cause one of the things is, you know, you do have to be cognizant of your environment as your training and, and, or junior faculty member. You have to make sure that you could have.
Betsy Crouch (26:07)
You probably should, yeah.
Misty Good (26:12)
It's important, yeah, it doesn't have to be.
Paul Rozance (26:27)
these great ideas about what you want to study, but the environment has to be supportive. And that's the institutional resources that are available, the people especially that you'd be working with. And sometimes, I don't know, well, not everything can be studied at every institution. And for us, for Brenda and I, the geography was important, and that was that.
Misty Good (26:50)
Can I dig in a little bit? Because you had said institutional resources. And I think that's something that our listeners, especially if we have fellow listeners, for example, as they think about their transition to a faculty position, you all have amazing resources at Colorado.
And specifically, you know, there are some places that, you know, don't do large animal models, for example. So could you share with us a little bit about your experience? Like, when did you start doing large animal and was it when you were a fellow or how did that process go? Because I just I'm so intrigued by it, because I think I had shared this with you, you know, several years ago, maybe a decade ago. But but.
Paul Rozance (27:32)
Mm-hmm.
Misty Good (27:35)
you know, we had done some premature piglet nec models. And for me, it was just so exciting, right, to be doing that in the lab. And although very tiring and like running the Piglet ICU or PIGU as we called it was really intense. And so maybe you could share some of that large animal experience and how you got involved in that and what your...
Paul Rozance (27:41)
Yeah.
Yeah.
Yeah.
Misty Good (28:05)
That's where it went.
Paul Rozance (28:06)
Yeah,
it was, I mean, at the time it was the only, well, so if to follow then working, you know, with Bill Hay, it was really the kind of research that was offered. I think at the time he had three different NIH grants about different fetal organs and the regulation of growth in different areas, but they were all focused on that large animal. And for us, it's the sheep, it's a pregnant sheep. And just so the...
everyone's aware the reason why pregnant sheep have been used since the 1930s maybe to study pregnancy and placental and fetal physiology is because of their size. They're about the same size as a little human baby when they're born, about three or four.
four and a half kilograms. But pretty quickly it was realized you could catheterize both sides of the placenta and then allow this pregnant you to recover. So you put catheters in the fetal and umbilical circulation, maternal placental circulation, and then you allow them to recover and you tunnel those catheters to the flank pouch and you can draw blood. You can infuse anything you want and maintain them for weeks. So this is kind of
you know, I guess to answer your question about, you know, it really, was the research that was presented to me at the very beginning of my fellowship. And I think it becomes quite accessible to new, to ex pediatric residents who are starting a neonatology fellow, especially to someone like me who did not spend time as an undergraduate in a laboratory and who did not do much work in a laboratory as a medical student and not as a Peds resident. So what everybody studies, I think from medical school on is
is pathophysiology. It's a massive part of what we study and it's a massive part of your clinical rotations and your residency. So using a large animal where you can measure things like glucose concentrations and blood gases and it's not that hard of a concept to think about.
know, umbilical blood flow or blood flow in general, like we're all familiar with those as we move through our training. likewise, at the same time, Dr. Abman was running in the same facility using sheep to, you know, talk about the, you know, what maintains high pulmonary vascular resistance and what's responsible for the drop after the lambs are born. And so,
you know, these concepts are all familiar to people that aren't, you know, hardcore molecular biologists who don't have that training. So our lab, and this was really started, you know, by Dr. Battaglia back in the sixties. He started this, this facility that we're, that I'm still working in. And, you know, it was always geared towards training medical doctor, physician, scientist, I guess is, is the way to say it. And I think it's just such an accessible.
area to study for people that, again, don't have that hardcore training in molecular biology. So it was pretty much from the outset. And we kind of talked about the resources. So clearly, takes and was took back then institutional resources to maintain this. And I think as part of our obligation as trainees and then as early career faculty to that.
to those resources was the idea of collaboration. there's nothing makes you want to collaborate more with people when you look at the budget, the animal budget for a set of experiments like this. And so there were, when I first started, there was...
Betsy Crouch (31:46)
You
Paul Rozance (31:54)
Dr. Jim Berry, Dr. Danielle Smith, and Dr. Laura Brown and myself, and then Dr. Sean Lemelson is not a neonatologist, but the first set of individuals I named, we were all neonatal fellows together. We were all working on different aspects of, say, the regulation of fetal growth and metabolism. And it didn't, you know, I think we each had our own individual project to start out with first, you know, with, Bell as our mentor, but it didn't take long before we realized we would all do much better.
Misty Good (32:05)
Hmm.
Paul Rozance (32:22)
if we started sharing resources or what that really meant was utilizing the same animal and the same experimental paradigm to look at things like the pancreas and the skeletal muscle and the heart and the liver and the placenta. And of course, Jim and Danielle went on to become, they're our current medical directors of our two big hospitals. And so people don't always stay in science, but they stayed in academics and are wonderful medical directors.
Sean Lemelson moved to Arizona where we still collaborate and we've now added Dr. Wes Slawski, Dr. Clyde Wright, and there's a whole host of others that are now our early career faculty that are doing great work. But the themes remain. certainly share, when it comes to the large animal models, we share this resource when it comes to working with Clyde.
on sort small animal models and models of intruder and growth restriction in mice. We work with a team there of four or five faculty there. So these themes were set up, I think, by Dr. Battaglia way back when, and we've just carried them forward.
Misty Good (33:33)
That's great. So awesome. I love all the stories of collaboration and how you can share resources and you know that way you don't have to feel like you're out there alone doing science and it can be so fun you know to have your friends doing the same thing with the twist you know.
Paul Rozance (33:39)
Yeah.
Yeah, absolutely.
The other
thing for us is since we're at our heart, a physiology lab studying, you know, the physiology of fetal growth, you we, it is, you can, of course, one must be reductionist in their approach to biology that's necessary. And, but it's also important for us to share our results with each other to make sure we're not, well, really to make sure we're understanding them fully. You know, we wouldn't want to say something about insulin secretion in the fetus.
And then it might relate to insulin action if, say, my colleague is going to publish a paper next month about insulin action and they completely are opposite to each other. some of that is necessity. it's mostly fun. It's just awesome to be able to talk about your work with people that care.
Betsy Crouch (34:30)
Mm-hmm.
Misty Good (34:42)
Yeah, not so true.
Paul Rozance (34:45)
Yeah.
Betsy Crouch (34:45)
Yeah. Paul, I'd love to know, you know, about some of, as I was mentioning, in the lead up to our discussion that you're so productive, and I having a lot of fun thinking about all of the different ways that you're envisioning the neuroendocrine axis. We could go there again. And its effect on the...
Paul Rozance (35:05)
Uh-huh.
Betsy Crouch (35:11)
growing baby fetus embryo, depending on which animal model you're using. But I don't know, I'd love to have you walk us through a little bit, like, you know, what you thought of as your, you know, your early research studies, and now you were telling us that you're growing into kind of the influence of maternal factors on fetal growth. you know, I and our listeners would love to take the opportunity to learn from you about some of these topics.
Paul Rozance (35:15)
huh. Yeah.
Yeah.
Okay, so you're asking, if you could just repeat the question maybe, Betsy, you're not asking me specifically about my thoughts on neuroendocrinology necessarily, correct? Yeah, which I'll try to get back to.
Betsy Crouch (35:49)
No, I was just throwing that in there for fun.
Yeah, we can get back there if you want. But I think also, I don't know, give us some highlights. What are your favorite days from your career, from your earlier work looking more at the placenta and its impact, now thinking about maternal.
Paul Rozance (36:00)
Yeah.
Yep.
Yeah, that's great. And so, you know, I mean, I don't, I mentioned why I came to Colorado and why I chose the laboratory in the field I did. And, you know, but the, but the reality is I, you know, once I made those choices, I really wanted to understand everything I could understand about that field. So my initial studies were on the fetal pancreatic beta cell and in sheep and how it
at the, the end of gestation, acts as a nutrient sensor. You know, it can sense oxygen and amino acids and glucose and insulin secretion by that beta cell is regulated by those different nutrients. Different fetal hormones play into that. So we have this, this regulation of the beta cell. It's kind of the sensor, you know, at the time I, I, I considered it to be the absolute, you know, most important cell in the fetus for regulating growth. Cause it would sense all these different inputs and then secrete insulin, which, you know,
my belief is that's the dominant fetal growth factor over the latter half of gestation. So I got to spend my entire first year or two of fellowship and I continue to do it and invested in learning about the field of diabetes. Nobody really studies the beta cell because it's a fetal nutrient regulator. Everybody studies it because it would be key for curing diabetes if we could make them work better or create...
Misty Good (37:22)
You
Paul Rozance (37:31)
beta cell replacement therapies. So, you know, this was fantastic. And as part of trying to learn everything I could, the clinical problem that we were studying was fetal growth restriction and placental insufficiency. And, you know, at the time that was the one, we had a great model that we still use established at Colorado. We were using it, we were doing our studies in this model of growth restriction and placental insufficiency. And so part of our work was to understand some of the basic
know, physiological pathways or pathophysiological pathways that led to features of growth restricted newborn or fetus, so early complications, hypoglycemia, especially in my case, poor long-term growth. And then we certainly got into things like the Barker hypothesis where that was just becoming, you know, better accepted when I was starting my fellowship. And so this gave our...
work, know, justification to a broader audience, you know, maybe more important to understand the fetal origins of adult disease. And if we could understand why beta cells were restricted in their growth early on, maybe that would help, you know, diabetologists and figure out why they didn't work well when these people grew up. So studying everything, but, really it was that clinical problem of fetal growth restriction in utero. was sort of how do we
How do we make fetuses grow better safely in utero? And, you know, I had this study that it was published in 1980 and it is like really driven me ever since I read about it. So obviously published in 1980, I was not, I was not contemporary with the publication of that, but it came out in pediatrics. It was by Rush and they took a group of
Misty Good (39:17)
You
Paul Rozance (39:24)
by that study as women who were high risk for having a growth restricted pregnancy. And they put them all on, you know, there were three groups. One got a high protein dietary supplementation to take daily for the second half of pregnancy. Another group got a dietary supplement that had the same calories but less protein. And I'm talking 40 grams in the high group and six grams in the kind of low group. And then there was a control group.
And, you know, as I read the articles in the 70s, there was a really good rationale for why giving women or a pregnant person protein during pregnancy should improve fetal growth or prevent entry during growth restriction or ameliorate placental insufficiency. Like the rationale was there from animal studies, it was there from, you know, people's review articles and commentaries about those studies. But when they did this study, what they found was that the
group that got the high protein daily supplementation had an increased risk of perinatal mortality, whether that was throughout pregnancy, as they were in the study, around the time of birth, or even right after birth. And this was unexpected, and there were some follow-up commentaries on this that pointed to the fact that this probably wasn't just a one-off problem in the study, that it may truly be dangerous.
And that study sort of stopped research from what I could read in the field for how you might treat placental insufficiency. moved towards much better fetal monitoring of those pregnancies and Doppler flows and early indicated preterm delivery when the Doppler flows and the biophysical profiles looked bad, but no real fundamental.
changes and how we manage those pregnancies from a treatment standpoint. And you know, this should be, well, I don't want to say it should be, this may be familiar to some listeners because we just went through the same thing with the trials of sildenafil to treat and treat placental insufficiency and improve fetal growth in cases of placental insufficiency. And just like amino acids back in the 70s, there were lots of good animal data.
to say that treating fetal growth restriction with sildenafil should have improved growth. that trial, the Strider trial was divided into sort of five related multicenter trials, each a little bit different. One of them showed worse neonatal outcomes following the administration of sildenafil. And again, there was great animal data to say it should have worked.
I think in hindsight, people are designing studies to try to determine why it didn't work and what sort of caused the pulmonary problems in the subjects that got sildenafil. So I guess to go kind of back to your question, that trial really motivated me a lot. we first studying the regulation of the beta cell by glucose, then by amino acids.
in trying to sort of, you know, cure growth restriction or figure out why that rush trial from 1980 did not work. And so that was a seminal paper that drove me. But the one thing that always bothered me about that paper that I couldn't figure out until maybe four or five years ago, I had no idea why those babies should have done worse. I mean, yes, I wanted to come up with a different strategy.
But what really bothered me was why did the babies do worse, right? Like if our thinking around the regulation of fetal growth is that maternal nutrients and the maternal hormonal environment kind of are sensed by the placenta and the nutrients are taken up by the placenta and then transferred to the fetus and these nutrients stimulate the beta cell to make insulin, which along with nutrients stimulates the liver to make insulin-like growth factors. I didn't understand why the baby should have been worse.
it was like maybe the placenta didn't work and didn't transfer the amino acids effectively. So it maybe wouldn't have had an effect, but what really bothered me was why they were worse. Yeah, so that got me, I mean, I wish I could have just studied that. I know, I couldn't just write grants for that, but that got me to this other area that I've been.
Betsy Crouch (43:53)
Yeah, yeah, I'm on the edge of my seat. Yes, Paul, come on.
Misty Good (43:55)
Ha ha ha.
Betsy Crouch (44:03)
Well.
Paul Rozance (44:09)
thinking about a lot more in the last 10 years, and that's the area of placental physiology. And glucagon physiology in the fetus, which now dominates half of my laboratory efforts are around glucagon's role in the fetus.
Misty Good (44:20)
You
Betsy Crouch (44:28)
Yeah, I was looking through
your papers and had to sort of go glucagon anemia, right?
Paul Rozance (44:33)
Yeah,
glucogonemia, experimental hyperglucagonemia. So we set this study up. This is with Dr. Silvik, who was a fellow here and as an assistant professor at Wake Forest. you know, so we worked together to set this study up where we were going to create experimental hyperglucagonemia in late gestation fetal sheep. And our goal wasn't really to link it at all to that RUSH study. It was really
Betsy Crouch (44:35)
This is on evening, yeah.
Paul Rozance (45:02)
It was really because every time we thought we saw amino acids doing something positive to beta cells, glucagon was always elevated. And so we know from work in diabetes that glucagon stimulates beta cells to replicate. It potentiates glucose-stimulated insulin secretion. So that was going to be the study. But what we found was that glucagon actually led to a reduction in uterine blood flow. So we infused this glucagon into the fetus.
It doesn't cross the placenta into the maternal circulation. And yet it caused this reduction in uterine blood flow from the mother to the placenta. It caused this reduction in placental uptake of nutrients, glucose, oxygen, amino acids. It caused a reduction in the transfer of those nutrients into the fetal circulation. And what we ended up with were, you know, these essentially they were like growth, they were smaller fetuses. It wasn't from
classic placental insufficiency, but it was from an inhibition we think of amino acid transfer by the placenta. And that then got me back to that rush trial, which was, if you recall, that was giving high doses of amino acids to the pregnant parent causing worse outcomes, perinatal death. And what I didn't tell you was that a lot of our work had been showing that amino acids stimulate glucagon concentrations in the fetus. We did that.
We've done that experiment in a lot of different ways over a lot of different time courses. if these people, my theory is if these people were taking high doses of amino acid protein and converting them to free amino acids, those were getting into the fetal circulation from the placenta. Now these fetuses are going to be, you know, having these really high amino acid concentrations that will stimulate glucagon. The person kept taking the dietary supplements. So no matter what the glucagon did to uterine blood flow,
or anything else, they still get these high doses of amino acids. if you then imagine that these pregnancies that were already at risk for growth restriction, if you do something that's going to then impair uterine blood flow, that might just be enough to impair oxygen uptake and delivery to the fetus in a way that would be that detrimental. And so it was great that I now have a...
hypothesis to explain the Rush trial and a lot of the work we're doing now is, you know, showing whether that is indeed true or not and obviously looking at the pathophysiological pathways that might be responsible. So getting to placental lactogen, which is a whole other story that I at some point should tell you because it's just great.
Betsy Crouch (47:51)
Yeah.
Paul Rozance (47:55)
Is
Misty Good (47:55)
I
Paul Rozance (47:55)
this a good time? You're so funny. All right. Well, let's see if we can get this podcast on the trailer of the new Captain America movie being released on Thursday and see if everyone shares our enthusiasm. I got an even where I really got interested. Yeah, exactly. That's right. It's like the hormonal captain.
Misty Good (47:55)
mean, I feel like I need popcorn actually. I'm ready. I'm ready for it. I'm here for it.
Ha
Betsy Crouch (48:08)
There we go.
Misty Good (48:12)
awesome.
Betsy Crouch (48:14)
Lactogen and glucagon and insulin, my, there we go.
Paul Rozance (48:23)
hormonal Avengers or something.
Betsy Crouch (48:26)
Wow.
Paul Rozance (48:27)
Yeah.
Misty Good (48:28)
I love
Paul Rozance (48:29)
So, okay. So now this predates the study that Sarah Silvik and I did together with the experimental hyperglucogonemia. But another really close and really important colleague, mentor of mine, is Dr. Russ Anthony, who works at Colorado State University. And Dr. Anthony's spent decades and studying placental actogen, is one of the world's experts in
placental lactogen, he happens to use sheep mostly to study placental lactogen. And when I started as a fellow, he was kind of half time at our campus and half time at Colorado State. So two or three days a week, he would drive down from his home in Fort Collins to our campus in Denver and now Aurora. And we had some projects, some joint projects together, but nothing terribly intense.
He started manipulating the placental gene expression in sheep pregnancies. This is a technique that people have also used in mice and rats, but you essentially remove the embryo from a donor animal. You incubate it with some vector that then becomes integrated so that, and then it expresses something. And in this case, kind of an interfering RNA.
Misty Good (49:32)
Mm.
Paul Rozance (49:52)
that then you can take that blastocyst and put it back, put it into a recipient and the pregnancy, if you know, will go to term, or at least if you don't interfere with the wrong things, it'll go towards term. And he did this with placental actogen in sheep and found these animals to be small and growth restricted. And so he approached me about writing a joint grant where we would,
take those animals that he had shown were small at the end of gestation. But instead of letting them go to the end of gestation, we would do what we do at our center, which is put catheters in both sides of the placenta and use tracers to kind of determine placental blood flows and nutrient uptakes. so this is one of those points where I'm glad I made the choice I made in my career because Russ, well, one is I made it because Russ Anthony is brilliant.
fun to talk to, fun to work with. And so I thought it would be great to collaborate with them, but I really didn't feel like I was a placental physiologist or a placental biologist. Some ways it felt like I have no business sort of spending my time with this project. Like, you know, it was a little off track from what I was interested in, but it was just so compelling. I think I had also, at the time I had also been on some NIH study sections where placental biology became sort of the
big theme around these study sections. So without being a placental biologist, I'd been learning more and more about placentas. So we did that. We got the grant funded and have published several studies from that. But what was really interesting is when Sarah, Sylvik, and I were going over our results with that glucagon experiment, I would say some of the tools to characterize at a molecular level
Sheep placentas, sheep tissues are difficult, antibodies, that sort of thing, as well as the ability to isolate cells from the placenta and study, trophoblasts in vitro. We decided we would do a whole panel of mRNA with real-time PCR. And whereas I think we would all kind of do RNA-seq now, we just picked 50 different genes to look at, mRNA to look at, transporters of glucose.
amino acids and all sorts of things. And because of this relationship with Russ, we just decided to look at placental lactogen mRNA. I mean, we'd had the tools, he had the tools, he had the primers, I guess. So we had the primers and we did it and there was a 50 % reduction in these animals that had got glucagon. And if it hasn't been clear yet, I'm not really a molecular biologist. never, I don't have that background, but.
You know, I looked at that mRNA with Sarah and it was one of, you know, of all the 30 or 40 that we measured, there were only two that were down and it was one of them. The only two that were changed up or down. And, but I didn't really worry about it too much because to me, didn't, I didn't think much of the mRNA changing, but I talked to Russ and I don't think Russ thought too much of the mRNA changing either, but what we decided to do was measure the placental actogen concentrations in
the maternal and fetal plasma to see if there was a functional consequence or a functional consequence of this mRNA change. And so we sent him the samples because he had the RIA lab up at Colorado State University. And I can't remember how much time went by, but it was, I don't think I'll forget the one day period where this happened. And what happened is I sort of didn't worry about it. I wasn't keeping track of.
how long it was going to take to get the lactogen results back from the plasma. But eventually he emailed me back and maybe called me or emailed, but I think we talked and he said that there was probably a problem with the RIA lab and you know, he couldn't figure out what it was. He had them do all sorts of different quality checks. And the problem he said is that, you know, half your samples are like, you know, they're not, they're not picking up there. They're too low.
they're not detectable. I've done everything I can to troubleshoot it with the RIA lab, but at this point I have no idea what's going on. And so I'm going to just give you the data. He didn't, you he was blinded as was the RIA lab. So he didn't know. So then I spent that afternoon and evening decoding those data and un- blinding them for myself, so to speak. And, you know, it was incredible because all the, all the samples that were undetectable were in that glucagon group. And,
Misty Good (54:38)
I
Paul Rozance (54:39)
and all the ones that were normal were in the normal group. I don't know if you guys have had this experience. I don't know if that's gonna be an important finding ever. Chances are, none of what I do will ever be important, but for like a little bit of time, for a little bit of time, okay, we don't know, nobody knows the impact, right? Nobody knows the impact of what they're gonna publish, right? It's important to publish things, but it could be in the form of a case report and it may take,
Misty Good (54:53)
That's not true. We can't let you keep going right there. That's not true.
Betsy Crouch (54:57)
and I'll
Paul Rozance (55:09)
10 years or 20 years before somebody actually builds on that. And so I don't know what will be built upon my work. How about that? But it felt like for that night between that evening and when I ended up calling rest the next day, I felt like the only person in the world that knows that maybe experimental fetal hyperglucagonemia leads to this profound reduction in placental actogen. And like I said, whether that's gonna...
be built upon or not, know, whether I can keep building on it or anybody else will. Right, right, right, right. So this is now linking fetal metabolism to maternal metabolism and maternal both cardiovascular adaptations to pregnancy, but because of what lactogen does in the pregnant person, metabolic adaptations and eventually
Betsy Crouch (55:44)
Where could it go?
Mm-hmm.
Paul Rozance (56:06)
as well as sort of lactogenic adaptations or the preparation for breastfeeding. So placental lactogen is, you know, it's secreted, it's one of several peptide hormones secreted by the placenta, but it's secreted at super high quantities. And classically, it is something that will turn the pregnant person's metabolism into more of an insulin resistant state. So I think, you know, there's gestational diabetes, which is the pathological insulin resistant state, but there's
you know, sort of physiological insulin resistance of pregnancy that a lot of people talk about. And along with another couple of hormones, placental actigen is one of the ones that maybe does this experimentally. So that typically frees up things like glucose and amino acids and probably lipids to a large extent, frees that up from maternal tissue use to then be directed to the placenta and taken up by the placenta to promote fetal growth. And, you know, we...
This is now a way, instead of that top-down approach to the regulation of fetal growth that I talked about, where it's sort of maternal adaptations to pregnancy, nutrients, hormones, then getting across the placenta, this is now a way that a fetal metabolism is compromised, or fetal metabolism is in such a state as to result in high amino acids, as well as the other things that might stimulate glucagon secretion are low oxygen, high catecholamines, like these sort of
markers of stress or an inability to use amino acids. If that is going on in the fetus, glucagon concentrations go up and now we have a way that the metabolism of the fetus impacts not only placental function, but maybe even the maternal or parental adaptations to pregnancy. So both cardiovascular, but even more classically metabolic and breastfeeding, really lactogenic adaptation. I think
I'm unfortunately not a milk biologist. I'm not a nutritionist, but there are people that do talk a lot about how pregnancy is complicated by a growth restriction. You know, the quality of milk or the ability to produce milk is different in those pregnancies. know, twins are different than singletons in terms of milk production. And, you know, this is one potential way that, that what's going on inside, you know, on the other side of the placenta, on the fetal side of the placenta can impact maternal metabolism.
And then I think the other place this is going to be really important is, and this is where I'm working with another colleague of mine, Terry Hernandez, and she does do clinical studies all the time. It's what she's always done. And she studies the regulation of, well, she studies maternal metabolic adaptations to pregnancy and obesity, gestational diabetes, as well as the impact then on placental function and fetal growth.
our field of obstetrics, another big problem in addition to placental insufficiency is gestational diabetes. you know, while we can give insulin to control blood sugars, we can certainly do dietary interventions. There are cases where, you know, there's things about it that we don't understand. So people that have great control of their blood sugars still have a LGA baby that has all the complications that you think about for an infant of a diabetic person or a person with diabetes.
You know, and so what I, what we're trying to study, Terry and I is sort of how does oxygen play into that? And, know, there are cases of intrauterine fetal demise, unfortunately, before we were such so good at monitoring these pregnancies. So some of those babies are hypoxic. Some have high catecholamines based on amniotic fluid and urine studies and kind of tease that into, you know, these, these, you know, how does the placenta function? Why do some babies grow big and do great? Why do some
Pregnancies that are complicated by diabetes not have any complications. So we're trying to develop clinical studies to study that. And the other person I should really give a major thank you to publicly is Dr. Teresa Powell. She's in our section and like Russ, she's a 100 % placental biologist, has been studying placental biology her whole career.
And what she's allowed me to do, what our collaboration, our work together has allowed me to do is move some of these ideas from just animals like sheep into human tissue. So Terry and I are working on sort of collecting human clinical samples and relating that to clinical outcomes. But with Teresa, her lab forever has been able, I don't know about forever, but for a long time has established the technique of isolating primary human.
trophoblasts, which are the cells of the placenta, the fetal cells of the placenta that regulate nutrient transport and secretion of lactogen and other hormones. you know, this is one case where I think it's, well, at least on our campus, it's easier to get human trophoblast cells isolated for functional studies than it is to get, an animal model like sheep. So we've been doing some of these experiments now where we're
incubating those cells with glucagon, trying to show that placental actigen secretion is down. And then we're going to go on and on to look at some of the other actions of glucagon on those trophoblast cells. That would be, that'd be work that I'm, I'm confident Dr. Amelia Tanner will be able to move forward with. She's a postdoc. She was initially a grad student with Russ Anthony, was fundamental in some of the studies I've described with Russ. And now is a postdoc down in our lab looking for a.
faculty position if anybody wants to contact her. So but you know trying to switch some of what we do from the animal models into humans to obviously make it to translate it to human biology.
Misty Good (1:01:50)
Okay.
I think it's so important to translate all that. Sorry, Betsy, here we go. Yeah, it's so important. mean, we deal with a lot of mice in our lab, but we're constantly talking about how can we go from the bedside to the bench and back. And I think that's ultimately, as physician scientists, what it's all about. And how can we make an impact?
Betsy Crouch (1:01:59)
Yeah.
Paul Rozance (1:02:01)
Yep. Yeah.
Betsy Crouch (1:02:02)
We had the same
idea.
Misty Good (1:02:24)
to the care that we're providing at the bedside or novel treatments or really getting in there and improving the outcomes for our babies and obviously impacting their whole lifetime moving forward.
Paul Rozance (1:02:33)
Yeah.
Yeah.
So we have like,
you know, I have some ideas where, you know, could placental lactogen has been looked at in cases of growth restriction and placental insufficiency, and it's, you know, generally down. It's been looked at in cases of kind of insulin resistance and diabetes, and, you know, maybe it's generally up. But I think there's a ton of space there where, you know, we could refine the clinical outcomes that we're relating that to, like,
Are they the cases of placental insufficiency that would have, hopefully not an IUFD, but would need indicated preterm delivery? Same with diabetes. So yeah, there's a lot of ways to translate this for sure.
Misty Good (1:03:21)
Yeah, definitely.
Betsy Crouch (1:03:23)
that's a perfect spot to start to wrap up. We usually like to close on something fun about our guest research team. Do you have a favorite music you like to listen to while writing? Something your team does together? A little tradition.
Paul Rozance (1:03:38)
Of all the questions you could ask me, this is one that probably induces the most anxiety. Because I realized maybe I'm not a fun person, you know? Maybe I'm an introvert or maybe, I don't know what it is, the favorite music. I know, well, I have fun, but you know, do I organize?
Misty Good (1:03:47)
It's supposed to be fun.
That's okay. You... Yeah, that's exactly...
Betsy Crouch (1:03:56)
Introvert does not exclude fun.
Yeah. I mean, you can tell
me that you enjoy a fantasy novel, and that would be interesting.
Paul Rozance (1:04:08)
That would be interesting. used to listen to, you know, I used to work in a trailer. I didn't have an office. I just had a kind of a room that we stored a bunch of stuff that was like trash. And that's where my first office was. And I used to, you know, when I was working on a computer, I like listening to Grateful Dead concerts. So I would listen to Grateful Dead concerts. And then my colleague, Dr. Brown was looking, you know, she finished her fellowship a year later and was looking for space and that was the only space available. So.
Misty Good (1:04:18)
no.
Paul Rozance (1:04:38)
I can't remember if I had to stop listening to those concerts or make her promise that if she shared that, like to put a desk on the other side of the room, if I could still listen to those concerts. So that's my favorite kind of music to listen to. But I don't know, what's that?
Misty Good (1:04:40)
You
Betsy Crouch (1:04:54)
That's a great tip. That's a great tip. You know, the great tip on their front
Misty Good (1:04:57)
Yeah.
Betsy Crouch (1:04:58)
here in the Bay Area, and they're all these like fun as you probably, you know.
Paul Rozance (1:05:02)
Yeah,
absolutely. Well, that's where I first, yeah, I got, remember, I remember spending, hours like countless hours. Now to be fair to me, my wife, Brenda, she, you know, loved the Grateful Dead before I did. She went to Grateful Dead concerts and I never went to a concert before there, before Jerry Garcia passed away. But, but, so she is the one that's sort of responsible for what I'm about to say. And that is I found a person who was my clinic preceptor at Stanford, who was a big deadhead who
had all their tapes, like hundreds of them. And this was when CDRs were big, like you could record a tape to a CD. So we had a deal. He would lend me a tape, I would record it, and I would give him a copy of the CD and I would take a copy of the CD. So I spent definitely a few hours doing this over the course of my residency. Brenda got so mad, or I think she became tired of listening to the dead, so I might have turned her off.
And then now for those that know, I mean, you can pull up any Grateful Dead concert online for free in a way that's totally legit, because they just put it out there. So I kind of wasted all these hours. So anyway, that's my favorite. Well, at the time for sure, it was my favorite music to listen to. And then fun things that our lab does. I mean, as I've been rambling, I've been thinking about that. Our lab staff is, I mean, we're a lab staff that is...
for the sheep work, we value stability, we value people who are long-term committed and professional staff. So we don't have a lot of turnover. Most of the people, if you compare it in terms of age, are probably my age or older. And so the idea of, you know, before the pandemic, we would do lab, you know, we'd go to lab happy hour, lab lunches.
pandemic sort of slowed that down. But I don't know, I've always felt like I kind of respect their time, like a lot. you know, when they're not working, I assume they want to be home with their families. Maybe that's maybe that's bad. I don't know. Certainly, when we go to, you know, big conferences, like we used to go to, well, I used to go to PIS, our, you know, neonatology group still does when we go to SRI, Society for Reproductive Investigation, or the Western Society for Pediatric Research, we always
have a big, you know, maybe not just lab specific, but Colorado neonatology specific dinner. And now we do have a lot more, a lot more youth in our group, people that are, you know, destined for graduate school of different types. So it's probably time to start doing some, fun things. Sure.
Misty Good (1:07:33)
Mm-hmm.
Since you mentioned that, we'll end on one thing, but you mentioned
some early career folks. I was wondering if you had any pearls of wisdom or something inspiring for our early career investigators.
Paul Rozance (1:07:58)
I wish it was inspiring. And I don't know if it's a pearl or not, but the one piece of advice that I think holds for everybody looking for, especially as you look for a faculty position, just like when you're setting that, when you're getting that position, make sure the expectations are really set. And, you know, that has a lot to do with meeting your division head, meeting your chair, whoever's sort of in charge of whether you're
meeting those expectations or not. And, you know, because when you start on faculty as a clinician scientist, you can be pulled in a ton of different directions immediately. And chances are you're being hired because you are great and you probably can do anything you want really effectively. And so there'll be people who are not your division head or department chair that are gonna ask you to contribute in a ton of different ways. You're gonna have so many opportunities.
And those ways can be taking on extra clinical work. can be taking on like actual work in the hospital. They can be taking on, you know, really important clinical projects. They can be taking on research projects that are not your primary, you know, primary area of interest. But, you know, just articulating why you were hired isn't just critical, I think. I mean, if you're, and so for me, most people ask me advice around the physician scientist track. So if you're hired to get a K award.
you know, it's probably going to take most of us a few years on faculty, but that's why you were hired. And so anything you do that's not in that service may not be the best use of your time. And I actually flip like it's really hard because, you know, somebody can say, well, we have a, we have a need for people to, you know, be on service, you know, to cover this emergency or that emergency. And you have to balance being a team player and a, and a part of a group.
But you also have to balance, you know, what you were hired for. So if there's lots of people in your group that could cover that, it almost feels selfish to me to agree to cover it just because you want to be in the hospital more. Like if you're being protected to 12 weeks or eight weeks and you then go and volunteer at the first drop of a hat for two extra weeks, well, what does that say about your commitment to that protected time? And so it turns that selfish argument a little bit on its head. It's actually selfish of
Misty Good (1:10:19)
Mm-hmm.
Paul Rozance (1:10:24)
want to go into the hospital where every I think most of us love working in the hospital you know that would be it would be great to be able to work in the hospital you know the full sort of however many weeks we could potentially do it but if your goal is to if your goal laid out by your division chief or your chair was to get a K you have to be careful so that's that's a piece of advice I give I give lots
Misty Good (1:10:47)
it's good. think it's important as you go along in your career, and certainly I am not that great at this, but learning how to
Betsy Crouch (1:10:54)
Both
Misty Good (1:10:55)
No, think it's important to learn how to say no, though, as you go along and really figure out what is important to you. And if that K and continuing your research career is important, I do think you need to say no to ensure that you're able to protect your time, because you do need time and space to think and dig deep on the science and be able to build your career.
and your scientific portfolio in such a way that you're able then to transition to get the R, right? Which is like the next big hurdle of the career. But if you do say yes to a lot of clinical obligations, you know, and I'm saying this as a chief, but it is hard to watch and then you can only do so many things at once.
Paul Rozance (1:11:28)
Absolutely. Yeah, absolutely.
Yeah, mean,
yeah. I mean, sometimes we have to do those things. We have to take care of patients for sure. But just making sure you're doing it for the right reason to be a great team player and not for a selfish reason, I would say.
Betsy Crouch (1:11:58)
Yeah, there's a balance.
Misty Good (1:12:00)
Betsy
can close us off today.
Betsy Crouch (1:12:03)
Yeah. Well, I'm very grateful to our guest today, Paul Rozance for walking us through. I learned so much about regulation of fetal growth. I'm really excited to see what you have coming in the near future, because I think this is such an area of need. You know, I'm thinking recently about the baby that we had who had terrible sacral agenesis and, you know, just, you know, the importance of maternal health, you know, on the developing baby. And thank you for your work and for sharing it with us today. Misty, thank you for being my fabulous co-host. And to all of you who are listening, we hope you also found this talk really encouraging and inspiring and we'll look forward to catching you the next time.
Misty Good (1:12:51)
Take care.
Paul Rozance (1:12:53)
Thank you.
Comments