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#219 - 🔬 The Importance of Saliva (Ft Dr. Jill Maron)



Hello Friends 👋

In this episode of the Incubator "At the Bench," we talk with Dr. Jill Maron, a neonatologist and physician-scientist at Women and Infants Hospital of Rhode Island and Brown University. Join us as we hear Dr. Maron share her journey from medical school to becoming a leading researcher in neonatology. She discusses how her early drive to provide the best patient care evolved into a commitment to advancing bedside care through research. Inspired by Dr. Diana Bianchi, Dr. Maron pursued a career in salivary diagnostics, focusing on non-invasive prenatal testing and feeding tolerance in premature infants. She highlights the challenges and successes in her research journey, emphasizing the importance of finding the right mentorship and building a research career that addresses significant clinical questions that provide answers to patient care conundrums in the neonatal intensive care unit. Dr. Maron also talks about her experiences with giving a TED talk and the impact it had on her career. We are also fortunate to learn about how Dr. Maron decided to take on her current leadership role, when to say “yes,” and step out of your comfort zone in your personal and professional life. We are excited to have you join us for an insightful look into the life and career journey of an inspiring neonatologist-scientist!

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Some featured manuscripts highlighting work from Dr. Maron:

 

Maron JL, Kingsmore S, Gelb BD, Vockley J, Wigby K, Bragg J, Stroustrup A, Poindexter B, Suhrie K, Kim JH, Diacovo T, Powell CM, Trembath A, Guidugli L, Ellsworth KA, Reed D, Kurfiss A, Breeze JL, Trinquart L, Davis JM. Rapid Whole-Genomic Sequencing and a Targeted Neonatal Gene Panel in Infants With a Suspected Genetic Disorder. JAMA. 2023 Jul 11;330(2):161-169. doi: 10.1001/jama.2023.9350. PMID: 37432431.  

 

Maron JL, Hwang JS, Pathak S, Ruthazer R, Russell RL, Alterovitz G. Computational gene expression modeling identifies salivary biomarker analysis that predict oral feeding readiness in the newborn. J Pediatr. 2015 Feb;166(2):282-8.e5. doi: 10.1016/j.jpeds.2014.10.065. PMID: 25620512

 

Yen E, Kaneko-Tarui T, Ruthazer R, Harvey-Wilkes K, Hassaneen M, Maron JL. Sex-Dependent Gene Expression in Infants with Neonatal Opioid Withdrawal Syndrome. J Pediatr. 2019 Nov;214:60-65.e2. doi: 10.1016/j.jpeds.2019.07.032. Epub 2019 Aug 29. PMID: 31474426

 

Rao SL, Taymoori A, Wong DTW, Maron JL. Altered level of salivary placental growth factor is associated with preeclampsia. Placenta. 2020 Jan 15;90:118-120. doi: 10.1016/j.placenta.2019.12.016. Epub 2019 Dec 23. PMID: 32056542

 

Maron JL, Johnson KL, Dietz JA, Chen ML, Bianchi DW. Neuropeptide Y2 receptor (NPY2R) expression in saliva predicts feeding immaturity in the premature neonate. PLoS One. 2012;7(5):e37870. doi: 10.1371/journal.pone.0037870. Epub 2012 May 21. PMID: 22629465

 

 

 

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The transcript of today's episode can be found below 👇


Misty Good (00:50)

Hi, and welcome back to At the bench, the Neo-Phy-Sci podcast of the incubator. I’m Misty Good, a neonatologist-scientist and division chief of neonatology at UNC Chapel Hill, and I'm co-hosting today with Dr. Betsy Crouch. Dr. Crouch would you like to introduce yourself?

 

Betsy Crouch (01:05)

Thanks, Dr. Good. Yes, I'm Betsy Crouch. I'm a neuroscientist, a vascular biologist, and a neonatologist at UCSF at the University of California, San Francisco, and I'm thrilled to be here today. Thank you so much.

 

Misty Good (01:18)

Today, we're thrilled to host an incredible neonatologist-scientist, Dr. Jill Marin on our At The Bench podcast. Dr. Maron, would you like to introduce yourself?

 

Jill Maron (01:27)

Thanks, Dr. Good. And Dr. Crouch, it's really an honor to be here. I am Jill Maron, I am a neonatologist physician scientist, and the Pediatrician-in-Chief at Women and Infants Hospital of Rhode Island associated with Brown University.

 

Misty Good (01:41)

Awesome. Sounds like a big job, which I know we'll hear more about shortly. Can you tell us just a bit about your career path and your background? And what motivated you to pursue physician scientist career?

 

Jill Maron  (01:54)

Sure, I don't know; it was always clear to me; I think I went to med school, like so many, with the drive to be the best clinician possible. And I wanted to take care of patients. And along the way, I had the realization that how you take care of patients is advancing the care you can provide to them. And research really took a central role in what I wanted to do with my career. I really wanted to advance what we were doing at the bedside. And it was a journey. It was a winding road journey; not only did I want to a research career, but what were the type of patients I wanted to take care of? And how I got into neonatology and just followed, falling in love with those babies and thinking, this is it. This is what I want to do. And I think from a research standpoint, 24 years ago, the field was so wide open; there was so much we didn't know and so much we could do. And really when I entered my fellowship, I was very committed to that position scientist career. I will say I was always sort of off on the side a little bit. I was fortunate to train under Dr. Diana Bianchi for 13 years. And what made that relationship unique was she was both a neonatologist and a geneticist. And so, the foundation of so much of my work was based at a molecular genetic foundation of understanding really nucleic acids, how to investigate them, and how to utilize them to hopefully inform care.

 

Betsy Crouch  (03:26)

How did you find her? Like, how did you have that moment where you said, This is who I want to work with, because I think that's something that a lot of, physician scientists struggle with to make that choice about the sort of fellowship or postdoctoral mentor, because that launches them into the independent career.

 

Jill Maron  (03:42)

I actually read about her work. The lay press had just published one of her articles on microclimate tourism. So that phenomenon when fetal cells will establish residency in the mother for decades. And she published a seminal paper on this effect and how the fetal cells have actually rescued the thyroid gland of a mother who had cancer. And I just was blown away. And so, I realized she was in Boston at Tufts Medical Center. At that time, fellowship was an invite; it wasn't a match. So I went to meet with her, and basically said, Will you be my mentor? And she said, Yes. And she was. And I was just so fortunate that she took me on and mentored me in such an important way that she invoked my ability to be an independent scientist and think about who did I want to be? And how did I want to take this training and really make it into my own field that was independent of non-invasive prenatal testing or microchimerism, which launched my career into salivary diagnostics.

 

Misty Good  (05:03)

Can you talk a bit about because you talked about transitioning to independence? And sometimes people have a hard time along the way, thinking about that, especially with their mentor? Can you talk a little bit about I guess what that looked like for you and Dr. Bianchi?

 

Jill Maron  (05:19)

Sure. So you know, I think as a fellow, you really fall under the auspices of what your mentor is doing. And certainly, that was my case. What I'll never forget about Dr. Bianci in the beginning was she handed me a stack of papers said, these are the papers, these are my existing grants, come back and tell me what you want to do.

 

Betsy Crouch(05:43)

That's a good strategy. I have some meetings coming up anyway.

 

Jill Maron  (05:50)

And I studied and I really said, Well, let's see, we knew DNA was trafficking. We knew our we knew cells were trafficking, but we didn't know about RNA. And so, I was probably crazy and ambitious enough to tackle that. And I say that because it was so hard to stabilize RNA in plasma, especially when you're talking about the early 2000s. We just didn't have it. And I wanted to pull my hair out, trying to do this and so many failures at the bench. And I was doing it in plasma, I couldn't get it. And all of a sudden, PAX gene tubes came out and Pax gene takes whole blood, and they stabilize RNA, and that saved me. And then we converted to that technology. But what that laid the foundation for was Diane, I said you'd have to work in the auspices of my field, but you could be a little bit to the side. As I transitioned, I stayed with her. So I trained at Tufts Medical Center, and I made the conscious decision that I could not leave my mentor. And I really needed those formative years. And I stayed at Tufts, as I transitioned to a K. And we had our heart to heart. And I approached her and said, I need to branch off. Because I wanted to be me and really known for what I was doing. And not just someone in her lab who kept doing what she was doing and kept looking like the perpetual postdoc, I really wanted to be me. And, you know, PAX gene hit, but so did stabilization of saliva for RNA. And that was a game changer for the field because we couldn't do it. So now, all of a sudden, these kits were coming out. And in fact, it was a company that came to Diana, because what they were proposing to her was to use the mother's saliva to monitor the fetus. And I sat in the room and said, well, the mother I mean, it's blood, but they're big. And it's all right, you know, PAX gene is 0.5ccs. Everyone's gonna be okay. But babies don't have 2.5ccs. And I thought, will this work in a baby? And the precedent at this point was only really cortisol, there were lots of salivary cortisol tests. So we knew protein was there. And you could do that. But this was a whole new scope of work. I was asking, Can you pick up mRNA targets? How many? What will they tell you? And then in the back of my mind, I kept thinking and where are they coming from if I can do it, and so that really launched, that was the basis of my K. And it happened to be associated with feeding because in my head, I thought, well, if it's saliva, it must be related to the digestive track. And so, I thought perhaps we would be able to see how they were tolerating feeds. Were they going to develop NEC, and could I see that before it happened in saliva? And that's what we tried to do; the entire K was based on feeding tolerance and intolerance.

 

Misty Good  (09:01)

You know, NEC is my research focus and I can't say favorite disease because it's the disease that haunts us all so I appreciate you thinking about that. And just even the feeding intolerance like if we could tell the difference between feeding intolerance and NEC it would just be priceless for everyone taking care of babies at the bedside.

 

Jill Maron  (09:22)

It would except my career then took another turn.

 

Betsy Crouch  (09:26)

Yeah, but can you summarize because you know, you have made such contributions in that area but I was looking at your massive PubMed list of citations and trying to get a sense of kind of where exactly you feel like that field is at the moment. So do you mind just summarizing for you know us in the audience, what you feel like you were able to accomplish and you know, what, what questions still remain?

 

Jill Maron  (09:57)

Yeah, one of the biggest lessons I learned is, and Misty knows this as well, when you go after a relatively rare disease, it's really hard to establish informative biomarkers and account for the biological variability that we see in our patient population. So, there I was every day getting saliva on premature babies.

 

Misty Good  (10:21)

Every day, you're doing it every day?

 

Jill Maron  (10:24)

Every day. It’s easy. It doesn't hurt them, it takes a second, it doesn't hurt them, they always make more and parents as amazing. It's an amazing,

 

Betsy Crouch  (10:34)

No, it's good. It’s just, that is such a good paradigm.

 

Misty Good  (10:37)

Yeah, I just needed to hear it. Like, we get a lot of samples, but not daily samples.

 

Betsy Crouch  (10:43)

We do not get a lot of brain samples. So I'm trying to work with that.

 

Jill Maron  (10:49)

And what happened was in the first proof of principle, we found all these babies, but no one got NEC.

 

Misty Good (10:59)

Well, that's good.

 

Jill Maron  (11:00)

Of course, that’s good, but not if you want to study it. And so I had these samples, and at that time, you put them on microarrays, right? You are going to just extract your RNA and get them on a microarray and see what happened. Well, it worked. And then we saw all these gene transcripts sitting in their baby's mouse. And so that progressed to the bioinformatics analyses and what's happening. And the bioinformatics analyses came back. And it was all about feeding, as in the act of. And it was about hunger signaling and development of the digestive system. And I sat back, and I said, Oh, I know what I did. No one got NEC, but everyone learns to feed, and I just captured it. And that became a focus. Because you have to remember when you're trying to start something new, I can't have a baby get NEC every few months, I need every baby to be able to inform me about something. What does every baby in the NICU do? Feed? Right? It's almost 100%. And I want I cared if you knew how to feed it 35 weeks, and if you didn't know how to feed, I wanted to see the progression of how you were feeding and what was going on. And could we use that information in an informative way?

 

Betsy Crouch  (12:28)

I really had a visceral reaction to your TED talk, because we had this baby in the NICU recently, who is an ex twin, who it seems like, just for unclear reasons, has terrible, horrible aversion. And it became, and we think she just needs time, but you know, time is, time is hard, right now to get. I mean, that's the good news, sort of, but on the other hand, it's a huge burden for a family that has a twin who's at home, and also for a family that has some distrust of the medical system from personal experiences. And so the inability to be able to show them a test that says this is what's going on in your daughter's brain, you know, cranial nerves, or you know what I mean, or like oral motor system was really challenging, because, you know, there was a lot of good news that there was no pathology that we could figure out, but still, their baby wasn't home with them. And there were there were just a lot of challenges and a lot of things about it broke my heart. And so, that's the anecdote that came to mind as I was listening to your talk, just like the ability to give information, I think even when we can't say, oh, this is really bad oral aversion, and we don't have a small molecule inhibitor of oral version, which

 

Jill Maron  (13:57)

100%, I get asked that question all the time. Like, if you found out what would you do? Would you give them a drug and I'm not that brave yet. I just want to get to the point that this is what's going on with the baby. That's what I want to get to the point.

 

Misty Good  (14:12)

I think even that is helpful. So, I think as physicians, we always want to find the answer or the cure, but at the same time, like sometimes families just need to know, is this really happening? Or why is this happening? And then, yes, what can we do about it, but at least, you know, a diagnosis is sometimes what families are looking for.

 

Jill Maron  (14:33)

Yeah, they want the information. 100%. And I think, you know, one of the biggest challenges we have, is G tube or no, and we always want to wait, right? We always think tomorrow, maybe they'll do it. You saw a pattern that was globally delayed in multiple domains of development, that may, you just may say, let's get this baby home. Let's just take feeding out of the equation here and work on the other things that we can and we know babies do better at home compared to the NICU?

 

Misty Good  (15:03)

Yes, absolutely. I was going to circle back to your TED Talk and just ask you to tell us all, how did you get inspired to do that? And I don't know, did you train to put that out there? We'll certainly include it for our listeners, and we’ll include it as a link so they can all take a listen as well.

 

Jill Maron  (15:27)

Yeah, so that was totally random. This is what will happen when he is giving a talk. And there was someone in the audience who approached me after and said, oh, you should give a TED talk. And I said, Oh, thank you. And the next thing I knew, someone's emailing me that I hear you want to give a TED talk. And I was like, I do. I don't know, do I? One of the best experiences if you have an opportunity, because there's a lot of local ones. This was TEDx. I think Ted picked it up. But this was a TEDx. So it's local, you need to give a TED talk, it makes you so come out of your comfort zone, and really hone in on the messaging that you want about your science. So, they say I hear you want to do a TED Talk that led to a phone interview with the coordinators, and then it ended up with an audition. I didn't even realize how competitive TED talks were because honestly, it wasn't on my radar. So, I went to an audition. And I was really balancing what the message should be. I actually just taken on a leadership role. Dr. Bianchi had moved on to NICHD to be the director. I had taken, I was fortunate to be put in an interim position taking over the research institute there. So, I felt this burden to share the work that was going on at the Research Institute. And so that's what I should do. So I went and I auditioned with my pitch for the Research Institute. And they're brutal, but honest, they said that was sort of interesting, but what do you really like? And I said, and they're like, well, let's hear that. And then I had to go off the cuff. And they're like, that's the TED Talk. And you don't have a lot of time. That was November. We were live in January. Right? The whole thing! But they give you a coach. And you know, Misty, you and I offline have talked about coaching. And I've been fortunate, I got paired with an amazing woman who I'm still good friends with today, Gail O'Brien, and it's just, she just coached me through it. And I would write, and she would, she was brutally honest, That's good, that's not, you need to flush that out better. You're not gonna get him there. And then it's all memorized. If you wrote every word, it is all memorized. They give you one acting coach. So you work through it with your acting coach. And then you go to the venue, you have one practice one at the venue, just so the cameras are right. And they advise on what you should be wearing. And then you go out, and there was 1000 people that day. And it really was one of the best experiences. And this woman, she doesn't know she's my coach, but she totally is my coach. She helps me on so many levels, too. We meet regularly. And she said, What do you want to do now? And she advises me on how to do it. But just a great opportunity. I encourage anyone who wants to do it to go for it, but do it. It's great.

 

Betsy Crouch  (18:43)

What do you think it's what have been the I don't know, the challenges, challenges or benefits that came after that talk?

 

Jill Maron  (18:52)

What I didn't realize that when I go on to meet people, they've seen it. So I'll tell you just from a personal standpoint, one of the greatest things that ever happened to me from the TED Talk. Somehow, the high school got a hold of it. And I don't know why. So I had two high schoolers, you know, and I'm the mom, you know, as Neos. You know, you haven't been there. You were on call. You didn't show up and you don’t volunteer for anything. I'm like, the queen of not volunteering. But I got texted because the biology teacher got it and aired it in front of the class with my son. And all the kids turned to him and I was like your mom's cool. I was cool. And it was really nice. You know, not that my kids don't understand what it is I do. But with any working mother, I don't care what it is. There's always that balance and you've missed, but for a moment, I was cool in high school. And that was a real strength and a benefit of the Ted talk.

 

Misty Good (19:57)

That's good. You can keep that forever.

 

Betsy Crouch  (20:05)

I think that is true, though I don't know, just to talk a little bit about the personal aspect of being a physician, scientist, mother, partner, daughter, right, like whatever your personal obligations are. And I do think that there are ways that that doing this, it does bring benefits, right? You're not there for every thing, you're not the you're not the room mother. I'm not the room mother, either. But you have other ways that that bring, like deep connections with the people that you care about personally, because of your work. And I found that very meaningful to Yeah,

 

Jill Maron  (20:42)

it is. And then if you wait long enough, your kids go to college and all their friends want to be pre-med and want to shadow you.

 

Betsy Crouch  (20:52)

Know, there we go. Yeah. You know, at my stage, I have first graders twins. And for example, today, my daughter has to go to soccer practice, but I can't get to the school to pick her up. So the Au Pair drops her off outside of lab. I bring her in, she sits here in colors while I have various meetings or work on things. And then I'll take her to soccer around, you know, five, and people have told me it's like nice to see that a child here. And to have that be normal, acceptable. And she and her brother fight about who gets to come. That's good. There might be snacks here, too.

 

Misty Good  (21:30)

As long as you provide good snacks and entertainment with coloring, it should be fine; you'll have to get a little more creative as they get older, though. Yes, that's true. Well, good. Jill, do you want to tell us a little bit about what you're doing now, and potentially next steps or future directions?

 

Jill Maron  (21:52))

Sure. So, you know, saliva can span again, across many conditions. So, we have recently finished two R01 trials. One was on feeding, where we actually did an intervention during a developmental window, where we thought we could have an impact to improve feeding and we did salivary profiling. And we are getting ready to submit that manuscript, looking at the biomarkers, exciting findings there where we incorporated memory for the first time, which was really important. So it wasn't just the hunger signaling, but the constant reminder to these babies of this is how you do it, plus the sensory integration, as well as development of the facial structures. So, we will be submitting that shortly. And that's, that's exciting. And we'll see where that takes us in terms of a diagnostic. We also just finished salivary profiling for infants treated of suspected sepsis. That is the Spits trial, that funded trial. And that data analysis is completed. But what we showed there was, you know, the cytokines are all in these babies’ mouths, we could look at cytokine profiles, not only for infection, but hopefully a breath of disorders associated with inflammation, like PVL ROP, NEC, you do not need blood for salivary for cytokine profiling, it is right there, and it's in a drop. So that's really where I want to go next. We also just submitted an abstract, we have a preeclampsia screening assay. So, we have gone back to the mothers going back to the original population that I started with those moms, and we're working on submitting grants with engineers, to see if we can get an at home kit for those moms. So, at this stage, and I started in saliva in 2006, 2007. You know, we're well over a decade in approaching two decades in, I think it is not a question anymore of just what a wealth of information is sitting in babies’ mouths, and this is extended to microRNAs to exosomes, to the proteins, to the RNAs, across really all systems, from the brain, Dr. Crouch to the GI system, Dr. Good to inflammatory markers. I think I'll spend the last half of my research career working in a multidisciplinary fashion to see if we can bring these assays out, to see if it will be informative to clinicians, and that they can use them to help guide care. That is really what I want to do next. I don't need another clinical trial of 1000s of babies to show it's there. I just need to know if we can make it to the bedside at this point.

 

Betsy Crouch  (24:47)

So, you have a cytokine profile that's, you know, sensitive and specific for infection, or PVL, or NEC, you have all these things?

 

Jill Maron  (24:57)

So, we've looked at specifically at infection as the secondary analysis. Also, this will look at all morbidities associated. And that's the grant to give hope to all the listeners I had write three times, because I kept trying to tell NIH, I don't want to know if the baby's infected, I want to know that the baby isn't. We're good at infection, we are horrible at non-infected. We had 1400 babies in this trial, 70% of them were exposed, and were completely negative. And then, as Neos, we don't listen, so even in this in the setting of completely negative blood cultures, we just treated another 20%. And there were only about 8% that were really infected and needed those antibiotics, but we exposed all those other babies to them. And that's where I think our field needs help. And that's what I want to do. But I kept trying to tell NIH I don't really care if it's infected. Because 90/90+ percent of the time, we're exposing them, and they're not, and we don't know the difference. So, could we use cytokines to help guide the care?

 

Misty Good  (26:09)

I have so much saliva that I want to give you from our cohort of babies. I mean, I'm sitting here, just in awe of everything you've done, and I'm like, you know, we need to do the study. We need to like, write this grant, I'm like, writing the aims in my head right now. I am such a nerd, but I'm like, this is so cool. We have to do this for our field. Because we have a ton of babies and samples, and I think we could really make a difference. So, we will talk offline.

 

Betsy Crouch  (26:47)

Yeah, but I mean, how impactful you know. I think just on your major findings, you know, as is, as you talk about the number of babies that we exposed to antibiotics, and if you have to, if you have to make a choice about the risk-benefit profile of, you know, sepsis in a very small baby, then you're going to expose them to the antibiotics, you know, they should be stopped after the cultures are negative. But anyway, people people have room to grow. We all do. But you know, in our defense right there, like, there's nothing that can tell us if really, if a baby is septic, when they're really sick, and to miss that is, you know, to potentially cause a death, and also to deal with that burden for the rest of your career. So, you know, it's weighed that way. But if we had a test that could be informative, and we could count on. Well, thank you for working in that space.

 

Jill Maron (27:50)

So that's what we're going for.

 

Misty Good  (27:50)

So how are you going to facilitate that? So a bedside test is next? Have you or do you plan to partner with industry to make that a realization for our field?

 

Jill Maron  (28:04)

That is absolutely the goal. And I think, you know, one thing your audience should know is, and I alluded to this in the beginning, I've always sort of been a little bit to the side, even of my own field, and every single grant I've ever written has been multi-discipline. It has been with engineers, and chemists, and geneticists. It's always been this multi tiered approach to solve our problems. So, with the Spits study, I partnered with the man who invented the machine; with the feeding study, I partnered with a man who invented the machine. So, they already have passed forward with industry of how to bring things out. And so hopefully collaborating with them to see if we can do this and really get it to the bedside. And by bedside, I just mean, I wanted to go down to the central lab, you know, under CLIA. We will make it easy for the at home preeclampsia test that has to be at the bedside. But for the Spits trial or the feeding, I just needed to get to the lab and then know how to handle it and process it appropriately in a timely fashion to inform care.

 

Betsy Crouch  (29:15)

This is a little bit informed from recent experience, that I found challenging. Have you found any resistance from industry because you're not proposing something that's going to affect 60 million adults A year? And how have you overcome that?

 

Jill Maron  (29:34)

No, it's a great question. It's an absolute great question. And so, it's the same approach. You go after something that affects every baby. And I would say that's how I landed in infection, too. It wasn't that I was some immunologist, or I was fascinated by infection. But if you think about the two things that every baby in the NICU almost universally undergoes it's how to feed and are you infected? So, then when you do those numbers - and I've been asked to do those numbers - How many times can you test? Yeah, they love that one.

 

Betsy Crouch  (30:08)

Oh, I see.

 

Jill Maron (30:10)

How many babies can you test? Right? So, you could test the baby every day if you wanted to. No, I don't advise that, but you could do that. And then you also look at how much is it going to cost me to make. How much are we going to market it for? So, those are usually the three questions: How often can you test? How many? What is the cost markup? So, there are a lot of babies in our country that are premature, and in our NICUs, they all learn to feed, and almost all of them get ruled out at some point during their stay. And so, there was a method to my madness. Because if you look, as you said, Betsy, you look at my Pubmed and you say what’s going on here?

 

Misty Good (30:50)

That is not what she said.

 

Jill Maron (30:51)

 I hear you, I get it. But that was always the drive for me; bring a diagnostic out. Well, how are you going to do that? And it's all the things the concerns are, everything you're talking about, about getting those industry partners, what's in it for them? This is a rare subset. So, it was feeding and infection. And I think I'm more of an expert in feeding than infection at this point because that field is well represented, and I am sort of just on the sideline, trying to say, cytokines go up. Can we see them, and will they help? And what can we do with that information in spit, not blood?

 

Misty Good (31:33)

Well, besides all your expertise in salivary diagnostics, we'll transition a little bit. And I want to hear about, and I think our listeners would want to hear too about your leadership role. So you have an incredibly huge leadership role, and how did you decide to take that role, and then what do you like about it? And yeah, when to say yes, I guess, is also always on the forefront of our minds.

 

Jill Maron (31:59)

I swore for years that I wouldn't be a chief, and what happened to me was the Brown position became available, and I had trained in my residency at Brown. I really enjoyed all of that training in that environment, and it happens to be one of the very unique chief positions in neonatology, where I am separate. I'm at an entirely different hospital from the chair, and I work independently. I work in collaboration with my chair, but I'm not even in the same hospital system. So, control of money, control of hiring, control of so many things that you want as a chief. It's my domain, and I simply contract out with the Children's Hospital for the services, but I don't report to the chair for how the money is spent within my own group.

 

Betsy Crouch (33:01)

This is fascinating. You know, Satyan at UC Davis, who's the Chair of Pediatrics, thinks that this is the future of neonatology.  That we will be a separate department with MFM.

 

Jill Maron (33:14)

And it makes a lot of sense in so many ways. But of course, you know, we're all pediatricians at heart, and you cannot run a NICU without your pediatric subspecialists. It doesn't exist, so it has to be associated with a pediatric hospital. What's unique about the Brown system is it is the NICU that makes the pediatric hospital whole. So, Boston Children's is a whole Children's Hospital, but they provide services, for example, to the Brigham and Women's Hospital and Beth Israel Hospital, because they just have the nursery and NICUs, associated with the mothers. Hasbro doesn't have a NICU. We are it. So, their pediatric program, it's sort of a double way street in some ways, like they can't train without our hospital. They can't do a lot of things at some of the other freestanding, fully independent, I have all the subspecialty services can do. I enjoy that partnership. I really do. It's all about serving the families of Rhode Island, because we serve almost all of them in this small state. We are the only NICU in the state, and so that's really important to me, but that was really a driving factor. It was the uniqueness of this role, where I had so much more control than traditionally you would have in a chief position.

 

Misty (34:35)

That’s great. That's really nice perspective. 

 

Besty Crouch (34:38)

How is your lab running? Can I ask that question too? As like, as the assistant professor on the call, as the Assistant Professor Host?

 

Jill Maron (34:48)

No, it's a great question. And I think this has also been a journey. I do not have a huge lab. I've really gone into the clinical space. Because what I found was, for years, I did the lab work on spit. I did everything from what reference genes do you need to normalize in saliva? And what the different layers look like, and what if you put it on RNA Seq? What are you going to do with all those microbes in the mouth. I did so much of the technical work up front. But then, once we did that work, and we published that work. And I do encourage, I was at pas, and people were talking about reference genes in saliva, and I was like, look, guys, just go to the literature I've done it. Don't read 

 

Misty Good (35:29)

You're like, that's why we published this. So you didn't have to think about it.

 

Jill Maron (35:30)

It was such mundane but important work that I had to do. But once that was done, I just became really the clinical saliva collecting place. So my team is now collecting saliva every day, and then we either send it off. So for the Spit study, everything went to the central which was the heart, which was at Harvard, because he invented the machine, so we just sent it there, so I wasn't doing any of that work. And we did do all the pre eclampsia work there, but mostly we don't do it anymore. I really have just either sent out and now I just want to work with the engineers. So my footprint in lab lab is not huge anymore; It's just been a transition. My clinical trial footprint has gotten bigger and bigger and much more national. So, clinical trials is a new skill set. So, I continue to evolve as an investigator through the years.

 

Misty Good (36:30)

That’s incredible. I mean, what a journey. It's just, it's been, it's amazing. It's so inspiring. I mean, I’m just really inspired.

 

Jill Maron (36:41)

I'm with good company, though, and it’s been really good learning.

 

Misty Good (36:47)

I guess, as we near the end of the show, we would love to hear any advice or pearls of wisdom for early stage investigators, things to remember along the way, anything you'd like to share.

 

Jill Maron (37:01)

I really think the most important thing is not to fear failure. And, you know, when I started in saliva, I could have failed so miserably. I didn't even know if it was there. I don't think a lot of people even took what I was doing seriously, right? Like, it wasn't serious science. And I honestly believe this, just in my heart, that I had I been, you know, I was at Tufts Medical Center. I had Diana, but had I been at an institute that was a little bit more hardcore in what defined basic science, they wouldn't have even supported this. They would have said, we're not playing with that. We're not, we're not doing that. And so, you know, the adages are true. Trust your crazy ideas and I do. And I have that on my desk. It's a book. I have it on my desk. And the real failure is not trying at all. 

 

Misty Good (38:05)

That's true. That's awesome. We all have to have resilience in this job.

 

Jill Maron (38:12)

100% and I, and the other pearl of wisdom, when I go on my eRA Commons page, I have blocked out some of the grants I've written. I've looked and said, Oh no, when did I write this?  There's nothing worse than the yellow not discussed. It really is heartbreaking. The most successful people have received so many of those. You just keep trying. It doesn't define you. Your goal is to improve the care that we provide to these babies. And if you can look back on your career and just add one single layer that others can build off of, you won, you won, and that's good enough. I think someone told me this, and it is really resonated with me, is, know when it's good enough, right? Like, know when you don't have to keep going, going, going another award, award, Paper, paper, paper. Like, know when you've done enough, and pay it forward to the next generation. You know, you lay your foundation, you do your work, and then back away, let them be last author, let them get the accolades, because that's part of the joy of what you're doing. And I think that's really important to remember too.

 

Misty Good (38:05)

I agree. I think it's the most meaningful when you see like people you've mentored and just how they go out and do amazing things or give an amazing talk, or, you know, have an idea about a project that they want to get across the finish line. I mean, there's so many times that it's like those proud mentor moments I think are critical. A graduate student that does well, etc.

 

Jill Maron (39:50)

Yeah, they're the best. And it was sweet. One of my former grad, one of my PhD students, wish me every Mother's Day over the weekend, like you also form those bonds. It's just nice when you know you stay in touch and you watch them launch their careers and do well. It's a great feeling.

 

Betsy Crouch (40:10)

We like to end on something that's, you know, can you talk a little bit about your motto and how that's playing out in your personal life?

 

Jill Maron (40:13)

Sure, sure. I think people who know me, I think I was in college when I read a quote by Eleanor Roosevelt that I'm probably paraphrasing. It's probably not exactly right, but it was, you must do the thing you think you cannot do. And I have literally every year, come January 1, I say, alright, what is it you think you can't do this year? And it's also late, like the year I did the TED Talk in January, I was done. I was like, look, I think I was going to do that. And I did it. I had my first JAMA paper last year, first author. I didn't think I was ever getting there. That was last year. Then this year, I ran a half marathon at 50, and I have to tell you, no one thought I was going to do that, and I did it. And I think that's what you have to do. I think that to me, and I've seen different types of people. There are people that love to do the same thing over and over and over again, and that's never really driven me. It’s or well I’ve done that, could I do this? Could I do the next thing? And so each year, and it doesn't always have to be academic. It could be anything, anything that you think I don't know if I can do that, and maybe you can, maybe you can't, but the process of trying is what really invigorates me. It's not always just writing another grant. We all do that, but that's not what invigorates me. You know. It's really pushing myself out of my comfort zone, challenging myself in ways I didn't think I could be challenged. And the spectrum is broad as I said. It could be from your physical abilities, to your mental capacity to do something, to taking on a leadership position that you didn't know you could do. I think, all of those things. So each year I set out a goal. I'm done, now I gotta think about 2025.

 

Misty Good (42:13)

Well, that is incredible, and we will close on that note. But we're so grateful for the opportunity to host you, Dr. Maron, on our show, and thank you for all your inspiring words of wisdom, and we appreciate you and all that you do, and we will be talking offline soon to collaborate on a new adventure.

 

Jill Maron (42:36)

Thank you so much, both of you for having me. I really had a lot of fun. I appreciate it.

 

Betsy Crouch (42:40)

Thank you for being here. Thanks so much for joining us today. We hope you enjoyed this session, and are leaving as inspired as we are. Please look forward to new episodes. We now have a regular release schedule of once a month. Stay tuned for next time. Take care.

 

 

 

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