Building Doors to Opportunity: Spotlight on Cesar Arias
“Destroying is easy. Building is complicated,” says Dr. Cesar A. Arias, who, as Chief of the Division of Infectious Diseases at Houston Methodist Hospital and Co-Director for the Center for Infectious Diseases Research at Houston Methodist Research Institute and Weill Cornell Medical College, builds programs that support international and national antimicrobial resistance (AMR) research by training scientists and physicians to conduct AMR bench research and clinical trials.
It also speaks to his background. Arias grew up in Colombia in the 1980s, during a period that was particularly rife with social unrest, mainly due to violence generated by drug traffic wars and civil conflict.
Though it was a humble beginning, he acknowledged that he wouldn’t be where he is today if it weren’t for poignant lived experiences, ingenuity and perseverance in the face of self-doubt and adversity. These are traits he said he learned from his mother. Growing up, disparities were less about race than about class and economics, and it was a single mother's resilience and hard work that secured the loan from the government that allowed her sons to pursue an education.
Driven by a desire to get ahead in a difficult environment, and save lives instead of destroying them, Arias entered medical school in Colombia at the age of 17. “We had to witness horrific things in Colombia during that time—war, deaths of children, bombs going off. Life was just a commodity,” he recounted. He believes it is important to share difficult memories. “Your experience, that is who you are. You can’t get away from that; it shapes your future, your behavior, etc.” he said.
During the last 3 months of medical school, Arias was selected for an exchange program between his Medical School and two Harvard-associated hospitals in Boston, an experience that he says changed his life. It was his first time out of Colombia, and although the language barrier and unfamiliar experiences (like snow) were isolating, it was an exciting time, professionally. Colombian medical schools placed a strong emphasis on clinical training and patient interactions, but research opportunities were limited. During this experience studying abroad “I saw how medicine is integrated with science,” he recalled. Arias was top of his class and was introduced to new contacts, ideas and opportunities that helped him chart a course to integrate his passions for medicine and research.
Arias graduated medical school knowing that he was interested in infectious diseases and wanted to pursue a science degree. He earned an MSc in Clinical Microbiology at the University of London. Then, with the financial backing of scholarships from the Colombian and U.K governments, Arias went on to pursue a PhD at the University of Cambridge, where he studied how enterococci make peptidoglycan precursors that are resistant to the action of vancomycin, an antibiotic that blocks the construction of the cell wall in gram-positive bacteria.
“That was a wonderful time for me,” Arias shared. “I knew the language better, understood the culture better and it was a time of great scientific discovery.” In collaboration with scientists at Cambridge and the Pasteur Institute in Paris, Arias illuminated the metabolic pathway for the synthesis of D-serine-ending peptidoglycan precursors that confer vancomycin resistance in enterococci. The work led to the discovery of a novel racemase enzyme responsible for synthesizing D-serine and highlighted the major role of the stereochemistry of biological molecules. This was important because it defined another route by which bacteria can develop resistance to antibiotics that target the cell wall, which in turn suggested additional targets for new and developing antimicrobials.
Money was tight, but after 2.5 years, Arias managed to save enough to return to Colombia to visit his mother. The night before he was scheduled to return to Cambridge, she had a heart attack. Arias performed CPR and helped secure her transportation to the hospital. Fortunately, she survived, but Arias recounted the experience as an enlightening one. “It reminded me that this is who I am,” he shared. “I am a doctor, and I missed caring for patients.”
Before returning to medicine, Arias wanted to ensure that the research he was deeply invested in at Cambridge would continue to grow and thrive, and he wanted to find a way to give back to his home country. After obtaining a grant from the Wellcome Trust, Arias accepted a faculty position at the University of Cambridge and started a center to study antibiotic resistance at his alma mater (Universidad El Bosque) in Colombia. The Molecular Genetics and Antimicrobial Resistance Unit at Universidad El Bosque in Bogota, Colombia celebrated its 20th anniversary last year.
Drawn by the work of Dr. Barbara Murray, at the University of Texas Health Science Center at Houston (UTHealth), who he calls the “U.S. queen of vancomycin resistance,” Arias then moved to Houston, Texas to complete a medical residency/fellowship in internal medicine and infectious diseases. At the end of his training, Arias was offered a full-time position, but he had no funding, and his visa did not allow him to work in the United States. Two weeks before he was scheduled to leave the country, he was awarded the National Institutes of Health’s (NIH) K99/R00, Pathway to Independence award, which paved the way for him to remain in the U.S. and build the autonomy to conduct independent research. At the time, this was the only career development NIH grant that international applicants could apply for.
Since then, Arias founded the Center of Antimicrobial Resistance and Microbial Genomics (CARMiG) at McGovern Medical School and, building on his work in Colombia, launched a training program with the Universidad El Bosque to facilitate expansion of AMR research and surveillance of resistant pathogens in South America. Working together, these labs have continued to identify novel mechanisms by which bacteria become resistant to antibiotics and understand the molecular epidemiology of such organisms through the use of microbial genomics. This knowledge has led to the growth of clinical studies to test novel diagnostic and therapeutic approaches for even the most vulnerable patients. “We have sort of built a program that goes from the molecule to the patient and then back to the molecule and that's what I always wanted to do,” Arias explained.
He recognizes that funding may be a significant barrier for many young scientists, like it was for himself, and advises that having a good idea, talking to the right people and being persistent are the keys to success in this arena. “Unleash the power of collaboration,” he said. “Get somebody interested that will have the resources to do it.”
Today, Arias is Editor in Chief of ASM’s Antimicrobial Agents and Chemotherapy journal and hosts the Editors in Conversation podcast. He also recently transitioned to become Chief of Infectious Diseases at Houston Methodist Hospital and co-director of the Center for Infectious Diseases Research at Houston Methodist Research Institute and Weill Cornell Medical College. But he still asks, “How long am I going to have to prove [to] myself that I’m worth it?” He explained that these questions linger not only because he is an immigrant, but also because he didn't grow up with a father. “You grew up with a vacuum of insecurity that is very marked.” He added that although he has tried to seize opportunities to advance whenever he could, “there’s always this insecurity that you don’t belong.”
His advice to future scientists from underrepresented communities: keep knocking on opportunity’s door. “There will be many, many times during the journey that you get into a hole and think ‘This is the end. Why should I continue?’” If there is one message that he could share with people who are at that point, it’s to hang on. “The light will come. The word resilience is my main message–something I get from my mother.” It might take some creativity. “There will always be doors that will not open; keep knocking anyway and go through another door if you have to.”