It is extraordinarily fitting that Vivianne Tawfik, M.D., Ph.D., is a 2022 recipient of the James E. Cottrell, M.D., Presidential Scholar Award. Dr. Tawfik is a consummate physician–scientist, being an outstanding clinician, a rigorous researcher, and a dedicated mentor. She is passionate about our specialty and is committed to leading by example the next generation of academic anesthesiologists. She has already made major contributions to our fundamental understanding of pain mechanisms and has emerged as a national leader who promotes clinician–scientists in our specialty. As the current (B.T.B.) and former (R.G.P.) chairs of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University (Stanford, California), we have observed and take great pride in Dr. Tawfik’s extraordinary accomplishments and contributions.
Dr. Tawfik received her B.Sc. with First Class Honors from McGill University (Montréal, Canada) in 2002, where she first became interested in neuroscience and the potential to combine a career in research and medicine. As part of the M.D./Ph.D. program at Dartmouth Medical School (Hanover, New Hampshire), she sought to answer questions related to basic pain mechanisms and joined the laboratory of Dr. Joyce DeLeo. She graduated in just 7 yr with five first-authored publications and several awards recognizing her research, clinical, and community service achievements. After medical school, Dr. Tawfik completed her internship in general surgery at Dartmouth-Hitchcock Medical Center (Lebanon, New Hampshire). She was recruited and mentored by Dr. Rona Giffard for residency training in anesthesiology at Stanford University in the Fellowship in Anesthesia Research and Medicine residency research track, of which she now serves as the director. To fully integrate her research and clinical interests, after residency she completed her subspecialty clinical fellowship in pain medicine under the supervision of Dr. Sean Mackey. After being chosen as the top candidate in a competitive national search, in July 2017 she joined the faculty at Stanford in the physician–scientist faculty line (University Medical Line).
Dr. Tawfik’s work to understand how peripheral and central immune cells contribute to persistent pain has spanned almost two decades. During her Ph.D. studies, she discovered that two types of glial cells in the spinal cord (microglia and astrocytes) were important for postinjury pain responses and opioid tolerance.1–4 These findings laid the groundwork for subsequent investigations during her postdoctoral fellowships investigating the identity of sensory and spinal neurons involved in pain perception and analgesia.5,6 She previously demonstrated that spinal cord microglial cells were activated after chronic morphine administration; however, whether this occurred through glial mu opioid receptors remained a matter of debate. Using novel techniques during her postdoctoral training with Dr. Gregory Scherrer, she and her colleagues demonstrated that mu opioid receptors are not expressed by microglia in vivo,7 a finding with widespread implications for the study of opioid tolerance that has already been cited in the literature more than 200 times.
Since starting her own independent research group in 2017, Dr. Tawfik has taken advantage of her years of training in cutting-edge techniques in neuroscience to focus on the contribution of peripheral immune cells and spinal cord glia to chronic pain conditions, including complex regional pain syndrome and peripheral nerve injury.
Recovery from surgery relies on a multicellular interplay between pro- and anti-inflammatory processes. Whether these processes exhibit sexual dimorphism has been largely underexplored but obviously would influence treatment paradigms. In a recent publication,8 Dr. Tawfik utilized high-dimensional mass cytometry to perform a comprehensive analysis of phenotypic and functional immune system differences between male and female mice after orthopedic injury. Multivariate modeling of innate and adaptive immune cell responses after injury revealed sex-specific divergence after injury with a stronger immune response to injury in females. Using the tibial fracture model of complex regional pain syndrome, which she learned during her postdoctoral training with Dr. David Clark, she further explored the myeloid cell contribution to the acute-to-chronic pain transition common to most pain conditions. She and her team performed positron emission tomography using a myeloid lineage activation marker to identify the unique spatiotemporal dynamics of the innate immune response in complex regional pain syndrome.9 She found early and persistent involvement of peripheral myeloid cells at the site of injury, and early and transient activation of central nervous system microglia distant from the injury site.
More recently, Dr. Tawfik published an exciting article detailing how activation of microglia through the pattern recognition receptor TLR4 promotes chronic pain specifically in males.10 In contrast to published dogma, she found that microglia themselves contribute to female chronic pain, but not via TLR4 activation. Related translational work from her group reported clinical use of the antimalarial drug hydroxychloroquine in the treatment of refractory complex regional pain syndrome and a potential microglial modulatory mechanism for this effect in an accompanying mouse model study.11
Dr. Tawfik is leading several additional initiatives with collaborators at Stanford including projects to understand how targeted immune modulation to improve bone healing can decrease pain and improve recovery, to distinguish the contributions of astrocytes to persistent pain, and the use of targeted ultrasound to direct pain therapeutics to peripheral sites of action.
Dr. Tawfik has had impressive success with competing for independent funding, obtaining a 5-yr National Institute of General Medical Sciences R35 Maximizing Investigators’ Research Award grant that funds investigators to “go where the science takes them,” and a collaborative 3-yr Defense Advanced Research Projects Agency grant with Stanford Nobel Laureate Dr. Brian Kobilka. She was also recently awarded an National Institute of Neurological Disorders and Stroke R21 focused on the highly innovative concept of peripheral neuronal senescence as a target for the treatment of pain. Her work has been recognized with several prestigious awards. She is one of few practicing physician–scientists to have received the basic science–targeted Rita Allen Foundation Award in Pain since 2009. She received the McCormick and Gabilan Faculty Award in 2019 from Stanford University, a grant focused on supporting women researchers and leaders.
Dr. Tawfik is a highly effective mentor. She is the primary thesis advisor to two graduate students, both women from underrepresented backgrounds in the Stanford Ph.D. Neurosciences program, as well as three postdoctoral scholars and many undergraduate students. In 2018, Dr. Tawfik was appointed as Director of the Fellowship in Anesthesia Research and Medicine program, the residency physician–scientist training program. In this role, she recruits medical students to the Fellowship in Anesthesia Research and Medicine track, serves on the residency admissions committee, and mentors residents and fellows in the program, providing career development advice. She also directs the research track for the Stanford Anesthesia Summer Institute, a program that provides the opportunity for high school and college students interested in science, technology, engineering, and mathematics (STEM), especially those from underrepresented minorities, to gain exposure to the field of anesthesiology.
During the past 5 yr, Dr. Tawfik has continued to expand her involvement in the academic future of anesthesiology at the local, national, and international levels. She has served on multiple review panels at the National Institutes of Health (Bethesda, Maryland), is an Associate Editor for the British Journal of Anesthesia, and recently began in a new leadership role leading basic science efforts in our department as an Associate Vice-Chair. In 2016, she became the first Co-President of Early-stage Anesthesiology Scholars, an organization formed to represent and foster early career anesthesiologist–scientists. She is also a member of the first working group of the Anesthesia Research Council, a group formed with support from the American Society of Anesthesiologists (Schaumburg, Illinois), the Foundation for Anesthesia Education and Research (Schaumburg, Illinois), and the International Anesthesia Research Society (San Francisco, California), to address critical questions and challenges in research relevant to advancing science and patient care in anesthesiology. In recognition of her contributions to academic anesthesiology, she was recently appointed to the Board of Trustees of the International Anesthesia Research Society. Finally, Dr. Tawfik was also recently asked to take on the role of Vice-Chair of the American Society of Anesthesiologists Scientific Advisory Committee, a role she will begin in fall 2022.
She brings the same level of thoughtful attention to the care of her patients in the Pain Management Clinic at Stanford as she does to her research program. She leads an active outpatient clinical practice focused on persistent pain after limb injury, complex regional pain syndrome, and chronic postsurgical pain. The clear alignment between her research and clinical duties provides added value to both domains of her work. To best care for patients with complex nerve pathology, she is involved in the development and implementation of an interdisciplinary “Nerve Team” consisting of pain physicians, radiologists, and three peripheral nerve surgeons.12
Dr. Tawfik is focused on making an impact on anesthesiology research and practice. She is scholarly, collaborative, skillful, and committed. She is also generous in giving her time to mentor others and takes great pride in fostering their success. Our specialty is fortunate to have someone with her talent and drive leading us into the future.
Competing Interests
The authors declare no competing interests.