As a father of six, Donald Torry, Ph.D., has some experience with pregnancy. Helping women who develop preeclampsia has become his life’s work. Preeclampsia is a pregnancy condition in which high blood pressure and protein in the urine develop after the 20th week (late second or third trimester). Preeclampsia develops in 5-10 percent of pregnancies and, aside from anti-hypertensives to try to control spiraling blood pressure, the only “cure” is delivery.
“Preeclampsia is one of the most common obstetrical complications,” Dr. Torry explains. “We could have a big impact if we could prevent it.” The exact cause of preeclampsia is not known, but auto-immune disorders and blood vessel problems may play a role, as well as genetic predispositions and diet.
In his SIU lab, Dr. Torry, professor in the Department of Medical Microbiology, Immunology and Cell Biology, has been working for 20 years to more accurately predict which women are at risk for developing preeclampsia. He also is a clinical professor of obstetrics and gynecology. His research shifted from immunological aspects of pregnancy to the role of angiogenesis and blood vessel formation. “Only in the female reproductive tract does new blood vessel growth occur normally. Any other time in an adult, it is usually associated with pathology.”
For successful pregnancies, a tremendous amount of blood vessel growth has to occur (angiogenesis) to support the embryo as it implants in the uterus. “What’s governing that during pregnancy?” Dr. Torry ponders. “What are the mechanisms and growth factors that regulate that growth?” In preeclampsia, blood vessel function is compromised, and the embryos tend to be smaller, due in part to the lack of a good blood supply.
His team has studied angiogenic growth factors produced by trophoblasts (cells from the placenta that play an important role in embryo implantation) during gestation. His team has focused on placenta growth factor (PLGF), which regulates blood vessel function and is produced in placenta. This may be one key to predict which women will develop preeclampsia.
“Within some moms’ circulation, there’s almost no PLGF for her blood vessels.” Without PLGF, her blood vessels remain closed and tight, rather than being dilated. This causes the mom’s blood pressure to rise — and preeclampsia develops. “The lack of PLGF keeps those vessels closed. We think that is one of the contributing factors to preeclampsia, and we have focused on trying to understand why this happens,” Dr. Torry explains.
Looking at PLGF expression, his team was the first to publish that levels of PLGF are much lower in women with preeclampsia than those with normal pregnancy. Subsequently, they found that this defect is evident even before preeclampsia is diagnosed. “After the 16th week, PLGF levels started to climb in women destined to have normal pregnancies while levels remained low in those who later developed preeclampsia. That means we may be able to predict who will develop preeclampsia. Why this happens is something we need to determine on a molecular level. By identifying a high-risk population, we can work in a systematic way to look at preventive aspects of preeclampsia.”
A key element of his research is securing placenta cells. Dr. Torry and his team work with the SIU Division of Maternal Fetal Medicine to acquire clinical samples of placentas to study. Typically, less than an hour after the placenta is delivered, Dr. Torry and his staff have begun isolating trophoblast cells from the placenta. Trophoblast cells form the interface between fetus and mother. “Those are the cells that produce PLGF and the soluble form of its receptor. We can collect the placenta, isolate those cells and study them in vitro under different conditions. Also, we collect biopsy samples as quickly as we can to see what was happening in utero.”
Dr. Torry is focused on not just understanding how it works, but looking at preventive measures and treatments at the molecular level. “We are trying now to lessen the impact of preeclampsia in the high-risk population, but the ultimate goal is prevention.” Tests are being developed to help predict which pregnant women may be at risk for developing preeclampsia. “If we can predict, we can open the door to do things we never thought about trying before.”
While placenta growth factor is low in preeclamptic patients, the preeclamptic placenta produces a soluble form of its receptor that has a very high rate of production. Dr. Torry’s lab is studying how to regulate production of angiogenic factors in human trophoblast with the hopes to increase the production of PLGF and decrease the soluble form of the receptor. “PLGF and its receptor seem to be the molecules that need to be targeted,” he explains. “We have to understand how to regulate expression of these genes.” His ongoing studies include investigating the role of nitric oxide and immune cytokines in regulating the production of the soluble form of the receptor. “Regulating PLGF and the soluble form of the receptor being produced by the placenta is key,” he says. “It’s a potential treatment we wouldn’t have thought about five or ten years ago.”
This research may help lead to treatments and ultimately prevention of preeclampsia, but they are still years away.
“Pregnant women are a special population,” he adds. “Any potential treatment for preeclampsia will require that it is safe for both the mother and the fetus.”
After spending more than two decades researching preeclampsia, Dr. Torry was honored in 2011 with a lifetime achievement award for reproductive immunology research from the American Society for Reproductive Immunology. “It’s truly humbling to receive this honor,” Dr. Torry says. “Any recognition certainly reflects a group effort with my researchers and students.”
THE ART OF TEACHING
Dr. Torry says the supportive environment at SIU School of Medicine has helped foster his research. “We are at the best and worst possible scenario here at SIU,” he says. “Teaching is highly valued, and research is highly valued. It’s a constant struggle to maintain high quality in both areas. But I think our faculty do both well.”
Dr. Torry began his education career as a high school science teacher in Carbondale. “I wanted to teach at a higher level, so that meant getting a Ph.D.” He received his advanced degree from SIU Carbondale. “My mindset was being a teacher first, not doing research.” But a lecture on reproductive immunology changed his professional course. “Dr. John McIntyre spoke about how the maternal immune system impacts pregnancy. It was fascinating and got me hooked on doing research in reproductive immunology.”
He gained experience in the molecular aspects of gene regulation while doing his fellowship at Harvard Medical School.
At the University of Tennessee, he combined his interest in reproductive immunology with his experience in molecular genetics to research pregnancy at the molecular level, using what goes on in the placenta during a normal pregnancy to understand what goes wrong in obstetrical complications.
SIU School of Medicine is where he found the perfect combination of teaching and research. He is co-director of the Hematology, Infection and Immunology Unit and director of the Year 2 curriculum for the School of Medicine.
The second-year curriculum demands that students learn a large amount of basic science information. At SIU, this knowledge is taught with clinical scenarios and integrated case sessions with clinicians and basic scientists, a structure that intrigued Dr. Torry. “Most of us learned to teach by lecturing,” he notes. “Blending the clinical and basic sciences provides a context for all the information and is one of the hallmarks of medical education at SIU. That’s our strength. I’ll continue the outstanding collaboration we have with our clinical colleagues to ensure we’re robust in our teaching effectiveness.”
“It’s easy to get in front of students and dump factoids. But the art of teaching is being able to explain things so they can understand the big picture. That way of learning is so much more valuable than memorizing large lists of facts.”
Outside the laboratory and classroom, you’ll find Dr. Torry — likely with some combination of his six children — with a sports ball. “I never go home; I go to a field or gym somewhere in central Illinois,” he jokes. A former baseball and basketball player, he now coaches competitive basketball teams in Chatham. His wife, Lisa, a former collegiate soccer player, coaches at the Springfield Area Soccer Association. She is a nurse at Memorial Medical Center. Their children share their love of sports. “Anything with a ball,” is how Dr. Torry puts it.
Dr. Torry has found the perfect melding of two areas of the medical school mission. “I don’t know of two jobs where we can touch the future more than teaching and research,” he says. “Every day we’re able to touch the future a little bit with research and mold the future a little bit by our education efforts.”