Oscar Alcoreza is getting used to being the “first” to do something.

He is a first-generation American. “My parents were the first ones to come to the U.S. from their families. My mom is from Puerto Rico and my dad is from Bolivia.”

He was the first in his family to pursue a doctorate, starting with a master’s degree to position himself as a more competitive applicant for medical school.

Alcoreza became the first in his family to attend medical school after being accepted to the Virginia Tech Carilion School of Medicine (VTCSOM).

And to top off the growing list of “firsts,” he became the first VTCSOM student to pursue both a medical degree (M.D.) and a doctorate of philosophy (Ph.D.) through Virginia Tech’s Translational Biology, Medicine, and Health Graduate Program. “I knew no one at VTCSOM had done it yet, but that it was a possibility,” Alcoreza said. “It stuck in the back of my mind.”

Research had been part of Alcoreza’s path to medical school. He earned a Howard Hughes Medical Institute undergraduate research fellowship while studying biology at William & Mary. He continued research in his master’s degree program at Boston University. The research-intensive curriculum at VTCSOM was a draw for him to attend.

“When I first met Oscar and discussed his interest in further pursuing research opportunities, I realized that he was one of those special students who was not only committed to delivering health care to his patients but also had an inner fire to make advances that could help other patients now and into the future. He certainly has followed the path to accomplish those goals and is well on his way to becoming a contributor to science and medicine. His accomplishments represent a significant milestone for both the school of medicine and the TBMH graduate program as the health sciences and technology campus continues its advance to becoming a full academic health center,” said Michael Friedlander, vice president for health sciences and technology, executive director of the Fralin Biomedical Research Institute at VTC, and VTCSOM’s senior dean for research.

During his first year at VTCSOM, Alcoreza joined the lab of Harry Sontheimer, a former professor at the Fralin Biomedical Research Institute at VTC who is now on the faculty at the University of Virginia School of Medicine. Alcoreza worked under the mentorship of Sontheimer and Susan Campbell, who is now assistant professor in Virginia Tech’s College of Agriculture and Life Sciences.

Sontheimer’s lab researched glioblastoma, which is an aggressive form of brain cancer. They found that the tumors’ presence upregulates a protein, system xc, which causes the release of a molecule called glutamate, an excitatory chemical neurotransmitter, and if there is too much in the brain, it can cause seizures. The lab found that an FDA-approved drug, sulfasalazine, was also capable of inhibiting the upregulated protein and reducing the release of glutamate to help prevent seizures in patients with brain cancer.

Alcoreza sought to build on what the lab had discovered to see if the drug sulfasalazine had promise to help other forms of epilepsy. After two years of juggling medical school plus working in the lab, Alcoreza was named a fellow in the Howard Hughes Medical Institute’s Medical Research Fellows program. The funding allowed him a year-long break from medical school to commit to his research. “At the end of that year, I needed more. I wanted to see it through.” He committed to adding a full Ph.D. to his studies.

With one year in the HHMI fellowship and another three years of dedicated research time, Alcoreza completed his Ph.D. in the TBMH program, successfully defending his dissertation this May. The extra time allowed Alcoreza to hone his expertise and make some significant findings.

The laboratory had previously discovered that patients with brain tumors present with epileptic seizures that are the result of too much of the neurotransmitter glutamate because of an enrichment of a transport protein that releases glutamate. They also discovered that a drug used to treat Crohn’s disease can normalize this and effectively treat such seizures.

“The question that I asked was, can this approach work in other types of epilepsy, where there's not mutated cancer cells expressing such high levels of the protein?” He used multiple animal models and discovered that the drug has potential for other forms of epilepsy beyond brain cancer. “As someone who came into this from the medical side, it would be hard to find a project more translatable than research to potentially repurpose an FDA-approved drug to treat epilepsy.”

“Oscar, being destined to become a physician, was laser focused on how his research may benefit patients,” said his mentor, Sontheimer. “It showed in every aspect of his work, and importantly in the urgency he brought to it. He worked tirelessly, long days, often seven days a week.”

Campbell added that beyond Alcoreza’s research talents, he also brought a new perspective to the lab. “His medical training made him think a little bit deeper into the questions or think about it from the patient’s viewpoint,” Campbell said. “Beyond that he is personable. Having both types of training, he won’t be able to look at the patient, the treatment options, and the medications he is prescribing in the same way. He will have a multi-modal viewpoint which makes a well-rounded physician who will also help scientific advancement.”

Now, Alcoreza finds himself shifting from the bench to the bedside. He has jumped back into the final two years of study to complete his M.D., with the third year of study being clinical rotations in the major medical specialties.

“The mindset of my Ph.D. was super focused at the molecular level. There are a handful of people who have the expertise that I do, not because I'm smarter than anyone, but because it was highly specialized work,” Alcoreza said. “That's so different from the mindset of a clinician. By the end of my Ph.D., I kind of got that itch. I wanted to go back to medicine.”

While the time commitment to earn both an M.D. and Ph.D. is lengthy – about eight years total – Alcoreza said the hardest part was being out of sync with his fiancé, who he met in his class at VTCSOM and is already in residency. But, it has been worth it. “Being a physician is non-stop learning. I don’t want a physician that’s not going to keep on updating their knowledge, so in a sense, my life was already going to be full of studying and learning new things,” Alcoreza said. “So, pausing for a few years to really dive deep into a subject that is interesting to me and something I’m passionate about, that was a no brainer.”

“Oscar may be the first VTCSOM student to carry out the M.D. and Ph.D. path, but I see him in his future being the first at a lot of great things. He has that in him,” Campbell said.

For now, Alcoreza will focus on his last two years of medical school. While he wants to keep his mind open during clinical rotations, he believes he will pursue a residency in a specialty related to the brain. No matter the specialty, he hopes to find a residency with dedicated time for research.

“We are proud of Oscar and this 'first' for him and the school,” said Lee Learman, dean of the Virginia Tech Carilion School of Medicine. “Our intensive research curriculum gives all of our graduates the strong foundation they need to develop habits of scientific thought in their practice of medicine Those who choose this dual path of an M.D./Ph.D are preparing to become physician scientists who spend a substantial part of their careers advancing knowledge in a quest to contribute to medicine at a higher level and ultimately prevent and cure diseases, optimize health, and improve patient care and outcomes.”

A second VTCSOM student, Kenneth Young, recently decided to pursue this dual M.D./Ph.D. path as well. He recently completed his first two years of medical school and is starting on his Ph.D. work. Read his story.

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