Profile: Jack Remington, M.D.

Jack Remington, M.D., has spent the better part of his life studying infectious diseases. In the process, he has increased the public's understanding of infection and the body's resistance to it, developed diagnostic tests and treatment regimens used throughout the world, and mentored dozens of postdoctoral fellows who have become leaders in their field.

In nearly four decades as head of the Research Institute's Department of Immunology and Infectious Diseases, Dr. Remington has become world-renowned for his pioneering work as a clinician, researcher and teacher. The author or co-author of several books and more than 600 articles, he has won many prestigious national and international awards. He also has served as a medical consultant to governments throughout the world and headed numerous professional societies.

Dr. Remington has been described by colleagues at PAMF and Stanford University, where he serves as Professor of Medicine, as "one of the world's best infectious diseases researchers and clinicians."

The praise is well deserved. Dr. Remington is perhaps most well-known for his groundbreaking work with the microscopic parasite, Toxoplasma gondii, which can cause eye disease in children and adults, spontaneous abortion or severe disease in the fetus and newborn, and life-threatening disease in the brain, lungs and heart of immunosuppressed patients.

His research has led not only to major advances in the understanding, diagnosis and treatment of toxoplasmosis (an infection caused by T. gondii), but also the creation of the Toxoplasma Serology Laboratory at PAMF, the leading reference laboratory for the United States and much of the world. By using T. gondii as a scientific model, Dr. Remington and his colleagues have unlocked many secrets to the overall process of infection and the body's defenses against it.

Looking back on his career, Dr. Remington points to a number of highlights. "One of the things I am most proud of is that we were the first to demonstrate that one can diagnose an infection of the fetus and newborn if IgM (immunoglobulin M) antibodies are detected," he said. He developed what ultimately became the "TORCH" battery of tests for detecting IgM antibodies linked to several infectious agents -- T. gondii, rubella, cytomegalovirus and herpes. TORCH is used all over the world for diagnosis of these infections in newborns. In Europe, it is known as the "test du Remington."

"Our group was the first to demonstrate that activated macrophages (wandering cells that destroy infectious agents and other foreign bodies) can recognize and kill cancer cells," Dr. Remington said. "This opened up a whole area of research into resistance against cancer."

A major clinical focus of Dr. Remington's has been the study of infections in patients with suppressed immune systems, including those with cancer, organ transplants or AIDS.

"Early on, we studied and began to define the mechanisms underlying infection in the immunocompromised host, and also developed approaches for the diagnosis and management of these infections," he said. "We began doing this at Stanford with heart transplant patients, who receive immunosuppressive drugs to prevent rejection of their newly transplanted hearts. We then expanded our work to other patients who have diseases of the immune system, or who are receiving drugs that cause a defect in the immune system.

"After the outbreak of AIDS, we described toxoplasmic encephalitis (a life-threatening inflammation of the brain) in AIDS patients. Because we had done research on the mechanisms of resistance against toxoplasmosis for many years, we had the ideal models to study the pathogenesis and treatment of this disease in AIDS patients. I became extremely interested in the mechanisms in the brain that defend against infection. This led to a major research effort of our group and the co-editing of a book entitled 'In Defense of the Brain.'"

Virtually all of the drugs used today to treat AIDS patients with toxoplasmic encephalitis were first tested in Dr. Remington's laboratory at the Research Institute.

Other landmark studies by Dr. Remington and his colleagues have described the problem of fungal infections in hospitals in the United States, the importance of immune cells in defending against infections and brain tumors, and the diagnosis of infections in the mother to help prevent transmission of congenital infections to the newborn.

"Most of my laboratory work has been in basic science, but the plight of pregnant women and their babies has never been far from my mind," he said.

"A major factor that contributed to my research was that I served as consultant in infectious diseases at the Palo Alto Medical Clinic (PAMC) for most of my career. I saw PAMC patients with infectious diseases -- in the hospital, every day -- for more than 30 years. This was a tremendous experience, and also a major benefit for our postdoctoral fellows. It was a wealth of experience from which the fellows could learn and translate their research into clinical practice."

The training of postdoctoral fellows has been a highlight of Dr. Remington's career. "More than 60 fellows have been trained by our group. Many are now chairing departments of medicine or basic science in medical schools, or are heads of infectious disease divisions, throughout the country. Many others are leading researchers in other nations."

Many of Dr. Remington's former fellows, as well as other clinicians and scientists from the United States and Europe, came to Palo Alto in January 2001 to honor him on the occasion of his 70th birthday.

"I'm so very grateful to all my colleagues at PAMF, past and present, both at the Clinic and the Research Institute, for the tremendous camaraderie and assistance they have provided over the years. It has been a pleasure working with them. That, along with my work at Stanford, has made my life both as a clinician and as a researcher a meaningful and beautiful experience."
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