Member Spotlight: Kevin Messacar

Kevin Messacar, MD, PhD, is associate professor of pediatrics, section of infectious diseases at the University of Colorado School of Medicine in Aurora. He earned his medical degree from the University of Michigan Medical School and did his pediatric residency and pediatric infectious diseases fellowship training at the University of Colorado School of Medicine. He completed a PhD in Clinical Investigations at the University of Colorado Graduate School.

Dr. Messacar was the 2021 recipient of the PIDS Young Investigator Award. He is currently a member of the PIDS Advocacy Task Force where he leads the initiative on NIH funding.

Why pediatric ID? I spent summers in undergrad with St. Jude Children’s Research Hospital as part of their Pediatric Oncology Education (POE) program which first sparked my interest in pediatrics. Then in medical school, I took a year off to work with the St. Jude International Outreach Program working in Guatemala and Kenya where I realized my true passions lie with infectious diseases. When I did my pediatric residency in Colorado I had the good fortune to be trained and mentored by some of the giants in the field, Mimi Glode and Jim Todd, and was just blown away by their teaching skills, their clinical acumen, their research breakthroughs, and sought to follow in their footsteps.

Where have you taken your ID focus? The thing I love most about ID is that it is constantly changing and you can pursue so many interesting paths at the same time.  Out of fellowship, I recognized that newly emerging diagnostic technologies, like rapid multiplex PCR panels and next-generation sequencing, were progressing at a pace that exceeded our knowledge of how to use them. My PhD thesis and K23 award focused on using dissemination and implementation science to develop concepts of diagnostic stewardship, optimizing implementation strategies for diagnostic technologies emerging from research labs for clinical care at the bedside. As clinical researchers in peds ID, we are uniquely positioned to help design diagnostic and antimicrobial stewardship systems to guide the use of the right test for the right patient at the right time and to ensure that right interpretation leads to the right medication at the right time.

Due to my interest in improving diagnostics for central nervous system infections, I had an ongoing clinical research study coming out of fellowship collecting spinal fluid from children. In 2014, I began to enroll a group of children without the typical signs of meningitis or encephalitis, but instead who couldn’t move an arm or a leg, very similar to polio. Fortunately, due to this open research protocol we were able to collect well-characterized samples and data from these paralyzed children enabling us to describe what is now known as enterovirus D68 acute flaccid myelitis, or AFM.  I’ve spent the past 10 years trying to better understand this new disease and develop better ways to diagnose, treat and prevent it.

What is a recent development in peds ID you are working on? Through my work on enterovirus D68, I was connected with intramural scientists at the NIAID Vaccine Research Center, who were interested in launching a new project to conduct immunologic surveillance to better track and respond to emerging infections, and sought to pilot this with enterovirus D68. I became principal investigator of the PREMISE(Pandemic REsponse REpository through Microbial and Immune Surveillance and Epidemiology) pilot project, which has become a highly successful core component of the NIAID pandemic preparedness plan. We have now enrolled four cohorts of children <10 years old at sites throughout the country and are following them over the course of a year looking at their immunologic response before and after infections to identify targets for monoclonal antibodies and vaccine candidates. 

Due to the timing of this project starting during the pandemic, we captured a unique period of epidemiology during and following non-pharmaceutical interventions targeting COVID-19 but impacting most endemic respiratory viruses. We have some really fascinating and unique data to show what was happening on a population immunity level in young children that drove the unusual patterns of endemic virus re-emergence we all have experienced for the past several years. The novel immunologic surveillance data can be fed into existing epi models relying on pathogen surveillance data to drastically improve our ability to explain circulation patterns and predict future outbreaks. I think it’s such a cool project because it involves everything from basic science of T and B cell immunology, to clinical research with pediatric human subjects, to population-level mathematical modeling of infectious disease epidemiology. To me, PREMISE is a perfect example what can be accomplished through successful partnership between government scientists within the National Institutes of Health with cutting edge lab technology and expertise, and academic clinical researchers with access to research subjects and pediatric ID expertise.

Another project I’m excited about that is running parallel to PREMISE and was just launched, is ReVAMPP (Research and Development of Vaccines and Monoclonal Antibodies for Pandemic Preparedness). It is a pandemic preparedness project involving many of our pediatric ID colleagues throughout the country seeking to learn more about understudied viral families with pandemic potential. These projects will help ensure we are more prepared with on-the-shelf countermeasures the next time a new disease emerges and don’t have to start from scratch.

What do you enjoy most about being a PIDS member? What keeps you renewing your membership? I enjoy most the ability to work collectively with my peds ID colleagues in PIDS on advocacy work to stress the importance of the work we do at the federal, state, and local levels with lawmakers and funders to ensure continued support. During these challenging times, we really need to be able to get our stories out about the impacts of our work, and the PIDS Advocacy Task Force is working to do that.

One of my biggest concerns with the current uncertainty and unpredictability surrounding medical research funding is the potential of losing a generation of pediatric ID researchers. With this would come the loss of the next generation of research advances, whether that is the next vaccine for an emerging illness or the next breakthrough treatment for resistant bacteria. Through PIDS mentorship and advocacy efforts, we have to continue to mentor and support those interested in joining our field to ensure they can visualize and realize a career path in pediatric ID that is exciting, financially viable and stably supported.