University of Colorado Hospital’s Comprehensive Lung and Breathing Program has added a top international asthma expert to its roster of specialists. For this, we can thank diversity and inclusion.

Diversity and inclusion, in this case, has nothing to do with the fact that Fernando Holguin, MD, MPH, is a dual U.S.-Mexican national. A man of his accomplishments would be a coveted hire regardless of census-form generalizations.  Rather, it’s that the University of Colorado School of Medicine was initially interested in hiring Holguin’s wife, Shanta Zimmer, MD, as associate dean for Diversity and Inclusion.

John J. Reilly, MD, dean of the School of Medicine and himself a lung specialist, knew them both from his previous job as chair of the University of Pittsburgh’s Department of Medicine, where they were all on the faculty. Reilly recognized a good thing when he saw it, and Holguin became a joint recruit.

Patients win, too, said Tim Wimbish, administrative director for the Center for Lungs and Breathing, where asthma patients have been a focus since the Center launched in October 2015. “I think between some of the research Dr. Holguin is going to bring in and a lot of other things he does, this is going to help us elevate our game,” Wimbish said.

Settling in

Three months into Holguin’s tenure, his Research Complex 2 office retains an ascetic feel, the walls and bookshelves mostly empty. Part of it has to do with his schedule: In addition to directing the Center for Lungs and Breathing’s asthma program, pushing ahead with his own asthma research and seeing UCHealth patients, he spends Fridays in downtown Denver, where he also serves as director of the CU School of Public Health’s Latino Research and Policy Center. The goal there, he says, is “to eliminate health disparities among Latinos in Denver and beyond.” On the home front, it’s not much quieter as he and Zimmer raise two boys, Mateo, 12, and Diego, 8.

The other part of it is, at age 49, Holguin says it’s time to “go lean” in the office.

“You accumulate a ton,” he said. “You never use it, and when you move, you have three dumpsters of trash.”

He’s in no hurry to move, but he’s had a lot of experience with it. Born and raised in Mexico City, Holguin graduated from his local La Salle University School of Medicine in 1991 and headed to Emory University for his residency and then a fellowship in pulmonary and critical care medicine, which he finished in 1999. In addition to spending a lot of time in intensive care units, he researched the link between acute respiratory distress syndrome and alcohol abuse in rats. It informed the first of his 83 publications to date. His boss at the time, Marc Moss, MD, was a co-author. They had adjacent offices back then – and again now. Moss is a UCH pulmonary and critical care medicine expert and the CU School of Medicine’s associate dean for Clinical Research.

Home again

When Holguin completed the fellowship he returned to Mexico and took a faculty position at La Salle University, his alma mater. In addition, through a connection he had made at Emory, he became a research associate with Mexico’s National Institute of Public Health. Holguin ran a project looking at the connection between air pollution and cardiovascular disease. It had nothing to do with his fellowship training, but it satisfied what he now recognized as a passion for medical research.

“I went from rat work to chasing particles in the air,” Holguin said, “and it was really interesting.”

The study linked PM 2.5 particulates from auto emissions to cardiac arrhythmias among the elderly. In 2001, that work helped get him a job at the Centers for Disease Control and Prevention (CDC) in Atlanta, with a joint appointment at Emory University. His research continued to chase particles in the air. His studies included the effect of air pollution on children with asthma in the basin that cradles both El Paso, Texas and Ciudad Juarez, Mexico.

The cities share the same air, so one might have expected similar impacts among the kids on either side of the border. Not the case, Holguin and colleagues found. Children on the Juarez side fared worse. The researchers linked it to living closer to major roads, which led to more inflammation and reduced lung function. Newly emitted road pollutants were more harmful than background pollutants, they realized.

At the same time, Holguin served as director of the Allergy/Asthma Clinic at Grady Memorial Hospital in Atlanta. He got interested in why people with obesity often have more extreme asthma – just as they have greater propensities for cardiovascular disease and cancer. That became a lasting research interest, one he continues to pursue.

His next move came in 2006, when he and Zimmer packed for Pitt. There, Holguin would become medical director of the Pediatric Environmental Medicine Center and, later, program director of the clinical and translational research center at UPMC Montefiore. As would be the case at CU, he held appointments in both medicine and pediatrics.

“I get frequently asked if I’m a pediatrician or not,” Holguin said. “I’m an honorary pediatrician,” he added with a smile.

Into the cell

At the Center for Lungs and Breathing, he sees patients on Tuesdays and Wednesdays. In addition, he’s establishing a research lab with Daniel Winnica, PhD, a CU School of Medicine assistant research professor and longtime collaborator who joined the faculty with Holguin. Their work focuses on the cellular mechanisms underlying asthma – which is in fact many conditions with many underlying causes and many potential treatments.

In particular, Winnica and Holguin are studying adult-onset asthma among people who are obese. They have found that these patients tend to have lower levels of nitric oxide, which relaxes smooth muscles and dilates airways. They’re studying whether L-citrulline, an amino acid, can help boost nitric oxide and alleviate asthma symptoms, Holguin said.

Finding solutions for these patients is important: More than one-third of the U.S. population is obese, and those with asthma are less likely to respond to medications such as steroids, Holguin said.

Holguin’s presence will bring other studies to CU, too, both ones he leads and other national trials through the National Heart Lung and Blood Institute’s AsthmaNet, in which Holguin is a principal investigator. Wimbish says Holguin’s presence – and his status as an “honorary pediatrician” – could help pave the way for increased collaboration with Children’s Hospital Colorado, in particular with patients who age out of pediatric asthma programs. To UCH patients, Holguin brings an expertise in clinical care that extends from steroid mainstays to emerging biologic therapies targeting allergy-driven inflammation triggers in the immune system, which are behind more than half of asthma cases.

The man with the lean office, in other words, has a full agenda, one that stands to benefit patients at UCH.