Making His Mark

By Eric Rangus erangus@emory.edu

Kenneth Kokko was named an assistant professor in the Department of Medicine last July. But this is not his first affiliation with Emory. Far from it.

After graduating from Dartmouth College in 1988 with his bachelor’s degree, Kokko entered the School of Medicine that fall. He graduated with an M.D./Ph.D degree four years later (one of only five students to do so that year), completed his residency here, then earned a three-year fellowship in Emory’s nephrology division (nephrology is the study of kidney disease).

Kokko spent the second of those three years as Emory’s chief medical resident. Following the completion of his fellowship, Kokko ascended in 2001 to his current position in the renal division, which stations him primarily at the VA Medical Center, although he spends time at Emory Hospital as well.

Kokko isn’t the first member of his family to make his mark at Emory. His father, Hauha, was chair of the Department of Medicine for 13 years. Hauha Kokko was, in fact, the first person to graduate from Emory with an M.D./Ph.D. degree. The elder Kokko’s presence made for an interesting situation when his son became a student here.

“It was a little awkward the first year, but then, once people realized I wasn’t running off crying to daddy every time things didn’t go my way, they realized we were two separate entities,” said the younger Kokko. “We made an agreement that we wouldn’t talk business at home.”

“I think, if anything, you’re probably treated a little more stringently that everyone else because people don’t want to show favoritism,” he continued. “So instead of doing that, they actually go the other way.”

Kokko didn’t coast on Dad’s coattails then, and he isn’t doing it now. His area of expertise is kidney transplantation, and he already has earned two research grants: a three-year VA Research Career Development Award and a two-year grant from the National Kidney Foundation called the Robert Schrier Young Investigator Grant.

The focus of his current research is on improved drug therapy for kidney transplant patients.

“The problem with the medicines we have today is that they have very bad side effects,” Kokko said. They could bring on diabetes and even thin the skin, and they often result in weight gain. Among the most serious side effects, Kokko said, is a thinning of the bone, something that adversely affects older transplant recipients.

“We are keeping people alive for 10 or 15 years with transplants, and some of them are experiencing bone fractures and other problems [because of the drugs],” Kokko said.

Kokko’s goal is to develop drugs so that the body can accept transplanted organs without causing dangerous side effects. While he focuses on the kidney, Kokko’s work can be applied to other organs. He currently is testing a compound in mice that have received a transplanted heart (a transplanted kidney would be too small to study satisfactorily). This compound is an antibody that eliminates cells that attack transplanted organs.

“The heart makes a good model of kidney transplantation because the problem with transplanting kidneys into mice is that you can’t tell when the kidney is rejected,” Kokko said.

In only a few months, Kokko has made significant progress. Without the experimental drug therapy, hearts transplanted into genetically mismatched mice (many human organ transplant recipients do not match genetically with donors) are rejected in about seven days. With the drug therapy, these hearts last up to three months.

Despite the fact that his father was a doctor and he knew many doctors growing up, medicine was not Kokko’s first area of study; his early college career was spent studying astrophysics. As part of Dartmouth’s program, he logged six months research time at the MDM Observatory, which is located 50 miles west of Tucson, Ariz. Beautiful country, but not an atmosphere that offers much of a social life.

“Astronomy sounds very glamorous, but you never actually look through a telescope,” Kokko said. “You spend all your time sitting in a red room at night looking at computer screens and typing in coordinates of objects that you can’t visualize. The telescope tracks them through the night and collects data. It’s not until about a month later that you start downloading images onto the computer and start seeing what you’re looking at. It was a lot different than I thought it was going to be.”

After testing a bit of astronomy on the front line, Kokko decided it wasn’t for him. “I realized I needed more interaction with humans,” he concluded.

So Kokko began exploring other career choices. His junior year in college, he sought
out M.D./Ph.D programs and was accepted at Emory’s.

Each summer, Emory medical students rotate among the school’s different laboratories. At a Christmas party for the renal division, Kokko met Doug Eaton, then a professor in the division. Eaton invited Kokko to spend a summer in his lab, which he did.

It was in Eaton’s lab where Kokko completed his dissertation, which involved investigating how certain hormones regulate the transport of sodium and chloride across the kidney. Kokko’s early work is related to his current research, in that hormones can affect the growth and differentiation of white-blood cells. Those white-blood cells modulate the immune system and play a major role in whether transplanted kidneys are accepted.

“The care of transplant patients is relatively complicated, and it is still a very specialized area,” Kokko said. Emory’s transplant center follows about 2,000 kidney-transplant patients, Kokko added, making it the eighth largest in the country.

Kidney transplants are one of the most commonly transplanted organs and one of the most successful. There is a 92-percent one-year survival rate, and kidneys—depending on whether they have been taken from cadavers or living donors—can have half-lives ranging from eight to 15 years.

Still, Kokko said, there is room for improvement—improvement he hopes to find through his drug therapy.

“With some of the newer medicines, we don’t know if those numbers are going to improve, but they certainly should,” he said.