Michael Woodworth, MD, MSc.
Assistant Professor, Division of Infectious Disease Infectious
Emory University

About my role in ARLG

I was awarded a two-year ARLG fellowship, which provides salary and tuition support for my research activities. My research primarily focuses on the use of microbiome therapeutics like fecal microbiota transplantation (FMT) for the eradication of intestinal multi-drug resistant organism (MDRO) colonization. My main efforts are concentrated on patient recruitment, and regulatory work related to a clinical trial of the safety of FMT for MDRO decolonization in renal transplant patients after infection.

With support from the ARLG, I have also been able to:

• Experience hands-on wet-lab training in next generation sequencing
• Better understand data science approaches to analyzing sequencing data
• Complete a retrospective clinical outcome project for a cohort of more than 250 patients treated with FMT for recurrent Clostridioides difficile infection at Emory

Why is this research important?

Many diseases, including intestinal colonization with multi-drug resistant bacteria, have been associated with the human intestinal microbiome. However, many regulatory and methodologic barriers hinder our understanding to what extent the microbiome plays a causal role in these disease states or are modifiable with treatments like FMT. Our FMT study in renal transplant patients expands the existing safety and efficacy data for FMT in immunocompromised patients. In addition, we hope that next-generation sequencing approaches will allow us to improve our understanding of the temporal dynamics of microbial community structure and gene-predicted functional capacity after FMT. We expect this will be a step forward in developing novel treatments to address reservoirs of MDROs in communities and healthcare systems.

How do these studies relate to the mission of ARLG and the global problem of antimicrobial resistance?
There is a great deal of work yet to be done in order to better understand the safety profiles and mechanisms of action of microbiome therapeutics like FMT. However, we think FMT and other microbial therapeutics may provide a potential alternative to the vicious cycle of antimicrobial use contributing to increasing antimicrobial resistance.

How did these projects progress?

My first ARLG fellowship year was mainly focused on training and finishing my thesis for a Master of Science in Clinical Research degree at Emory. In my second year, I have been able to focus more on our clinical study and have been ramping up our enrollment. We are seeing early signs of success and remain excited to see how the rest of the study pans out. It has been really encouraging to see the personal impact that a new treatment can have for individual patients.

How did funding and support from ARLG help propel your career?
It is hard to overstate the impact that the ARLG fellowship has had on my career. Pursuing a research career as a junior physician scientist takes time to build a publication record and develop skills to grow a high impact translational research program. I have been able to successfully compete for a NIH Mentored Patient-Oriented Research Career Development (K23) award, which will allow me to continue to develop my research skills and experience over the next five years. This simply would not have been possible without the ARLG fellowship.

How did mentoring support from ARLG influence the direction of your career?

When initially interviewing for infectious disease fellowship positions, I did not have an appreciation of the impact and importance of a mentorship program. I am constantly learning how important mentoring is in making important research career and project decisions. My mentors at Emory, Colleen Kraft and Chris Larsen have been instrumental in my success and have been inspiring models of productivity, accessibility, and responsiveness. Having additional guidance through the ARLG has been a major benefit of the fellowship, and instrumental in preparing my K23 application. In thinking about my transition to faculty, and in reflecting on mentoring practices that I have benefited from, mentoring will remain a central focus of the microbiome therapeutic program we build at Emory.

For individuals who are not familiar with ARLG, is there one piece of information that you would want them to know?
In a time of hyperintense postdoctoral fellowship funding and limited institutional training grants, the ARLG fellowship is a rare opportunity in infectious disease to protect research time and develop the necessary skills for trainees interested in a research career.