Dr. Khachadurian, emeritus professor of medicine, who established the division of endocrinology, metabolism and nutrition at Rutgers Medical School in 1973, has had a career filled with life-defining moments. Journeying to the United States and Rutgers Medical School D Beginnings in Beirut M edicine wasn’t his first career choice. At age 16, Dr. Khachadurian began working as an accountant in Aleppo after his father had a stroke; he had to earn enough to support his family. “It was a very important job,” says Dr. Khachadurian. “The government had nationalized all wheat production, and I was actually controlling the distribution.” When he went back to school at 18, it wasn’t until the last moment that he made the decision to choose medicine to study. “Biochemistry was a new science. It was just starting to influence medicine. People were beginning to describe pathways,” says Dr. Khachadurian. “Medicine was less sophisticated then.” He adds, “Lebanon and Syria had a lot of intermarriage, cousins marrying cousins, that created inborn errors of metabolism.” The lure of biochemistry’s role in understanding those errors reeled him in. He served his residency at American University of Beirut. “Then I went to Harvard for two years, studying biochemistry and diabetes, and later returned to Beirut, where I had a joint appointment in biochemistry and medicine,” says Dr. Khachadurian. He was teaching and working in a clinic, seeing mostly diabetics and patients with other metabolic disorders. One day, he was sent a 16-year-old girl whose cholesterol was between 700 and 800. The condition was causing lifethreatening atherosclerosis in young adulthood. A professor suggested to Dr. Khachadurian that he study such cases. That moment signaled the beginning of Dr. Khachadurian’s odyssey to investigate familial hypercholesterolemias (FH). He reviewed the literature. At the time, there was no agreement about how the disease was inherited. Once people knew about the work he was doing, he began to get more patients. “In 1964, I published about ten families, all showing this form of FH where children had cholesterol in the 700 range when both parents were around 350—a significant deviation from the normal population’s range, which was around 170,” he says. The evidence was clear-cut: if a mother and father both had the heterozygous mutation, one-fourth of their children would have the homozygous form of the disease. Dr. Khachadurian had demonstrated that there was a metabolic defect present in patients with FH. The study, entitled “The Inheritance of Essential Familial Hypercholesterolemia,” was published in 1964 in the American Journal of Medicine. r. Khachadurian was recruited by Northwestern University in Chicago. After spending a year there on sabbatical, he was invited to become a professor of pediatrics and director of a clinical research center. Meanwhile, political unrest in Beirut was taking hold. The Northwestern offer was one he couldn’t refuse. It was at Northwestern that Dr. Khachadurian used fibroblasts to detect metabolic disorders. In 1965, he biopsied the skin of one patient; after returning to Beirut, he studied many more—including liver biopsies in patients that showed the same defect. Michael S. Brown, MD, and Joseph L. Goldstein, MD, later used this work as the foundation for studies that led to the development of statins— for which they received Nobel Prize recognition. Dr. Khachadurian was recruited by many medical schools. Hadley Conn, MD—who was then the chair of the Department of Medicine at Rutgers Medical School—lobbied for him to come to the school. Dr. Conn knew of Dr. Khachadurian since he had spent a year at the American University of Beirut as a visiting professor of medicine. An Honored Scientist S everal investigators feel that Dr. Khachadurian deserved a piece of the Nobel Prize. He humbly disagrees, believing that as scientists, “we all stand on each other’s shoulders.” But Dr. Khachadurian has significant awards of his own. In 2012, the National Lipid Association honored him with a Distinguished Achievement Award in recognition of his scientific contributions. At Robert Wood Johnson Medical School, the division of endocrinology, metabolism and nutrition has named its research laboratories the Avedis and Laura Khachadurian Laboratory of Metabolic Research. And in 2015, the Familial Hypercholesterolemia Foundation Global Summit recognized him for his seminal contribution to metabolic research. Dr. Khachadurian believes he owes a great deal to the support he had at Rutgers Medical School. “I couldn’t have done the things I did alone,” he says. “Looking at antioxidants, the 40-plus publications on cholesterol, and collaborations with anatomy, biochemistry, and pharmacy—these things happened because I saw a lot of my colleagues in the dining room. We were like a family in my division. To this day, we are so close to each other.” According to Dr. Amorosa, Dr. Khachadurian’s need for answers hasn’t abated: “At 90 years of age, he still asks the smartest questions in the room.” M 28 Robert Wood Johnson I MEDICINE