Bringing the case for ecological restoration home

Driving to visit relatives over the December winter break, Leighton Reid took a sip of seltzer water and discovered that he couldn’t burp.

A bite of turkey dinner a few days later required gulps of water to get the food down. And when he attempted a post-holiday run, Reid discovered that he couldn’t get enough air into his lungs. A red flag went up, and he sought medical help.

“My physician knew that I had been to Madagascar recently because he had prescribed me malaria prophylaxis medication,” said Reid, assistant professor in the College of Agriculture and Life Sciences. “When I told him my symptoms, he ordered a chest CT scan and then he couldn’t get out of the room fast enough. I realized later that he thought I had contracted tuberculosis, which is endemic there.”

That was the start of a medical odyssey that would see Reid go through multiple medical procedures and face diagnoses and treatments that had surprising correlations to his work in ecological restoration.

A threatened ecosystem

Protected by the Mozambique Channel on the west and the azure waters of the Indian Ocean on the east, Madagascar is a critically important — and critically threatened — biogeographical area. Sometimes called the “eighth continent” because of its isolated geography and unique flora and fauna, the island country sits at a critical intersection between conservation efforts and human activities.

“About 5 percent of all of the plant and animal species in the world live in Madagascar, and more than 80 percent of those species don’t live anywhere except the island,” said Reid, who teaches and conducts research in the School of Plant and Environmental Sciences. “Right now, 44 percent of the native forests in Madagascar have been cleared, and if deforestation rates don’t abate, Madagascar is projected to have no forests outside of protected areas by 2080.”

To mitigate that outcome, Reid has been collaborating with the nonprofit Green Again Madagascar as well as local farmers to explore strategies and techniques that will improve and restore the landscape of the country.

“We are working with local people to test restoration strategies based on traditional knowledge, include establishing small patches of trees to initiate natural regeneration processes and planting fire-retardant tree species to mitigate wildfire damage,” said Reid, who leads a Restoration Ecology Lab. “These are important because there is very little knowledge about how to restore Malagasy ecosystems, and that information can’t be borrowed from anywhere else in the world.”

Restoring native ecosystems like those in Madagascar has the potential to store vast amounts of atmospheric carbon while preventing the extinctions of thousands of species. Such spaces play a critical role in ensuring food security and economic opportunities for developing countries as well as providing the raw materials and bioactive compounds that can lead to breakthroughs in medical science.

An uncertain path to a diagnosis

Reid underwent a CT scan in early January and then started driving to Penn State to give a lecture to the biology department. He made it as far as Winchester before noticing the three calls from his doctor.

“I called back, and that’s when I found out I had a mass the size of a grapefruit in the middle of my chest,” Reid said. “My doctor told me to turn around and go straight to the hospital.”

That call was the first step that Reid — and College of Science research scientist Rachel Reid, Leighton’s partner — took toward months of medical uncertainty.

Placed in an isolation room in Roanoke, Leighton Reid quickly underwent a bronchoscopy, where doctors inserted a thin tube down his esophagus and into his lungs to collect tissue samples. That test ruled out the contagious outcome: He did not have tuberculosis.

Reid next underwent a mediastinoscopy, a more invasive sampling procedure that involved making an incision in his chest to collect tissue from the mediastinum, an area behind the breastbone that contains lymph nodes, the windpipe, and the heart.

“There was a lot of uncertainty for a couple months, and a lot of scary possibilities were being discussed,” he said. “There was fibrotic tissue in the sample they collected in the second procedure, so we started talking about mediastinal fibrosis. It’s a very rare condition caused by exposure to histoplasmosis, a soil-born pathogen that you’d especially find in the feces of birds or bats.”

Reid, whose fieldwork in tropical ecology has taken him to Madagascar, Costa Rica, and Ecuador, seemed a logical candidate: He has dug through numerous samples of bird and bat fecal matter to identify seeds that the animals were dispersing.

“Histoplasmosis exposure can go undiagnosed until you have a buildup of fibrous tissue, and then it’s very hard to deal with,” he said. “It is a little like having a woven Triscuit cracker in your chest. It kind of weaves around things like your aorta or mammary veins.”

The next step in his medical journey was a PET scan, which revealed bright patches of hungry cells around Reid’s chest. A lymphadenectomy surgery followed, with doctors removed an entire lymph node from Reid’s neck.

Those final two interventions provided a definitive diagnosis: mediastinal large B cell lymphoma.

Rachel Reid said having a diagnosis — one with an established treatment strategy and strong outcomes - was a surprisingly positive moment.

“It still feels strange to say that we were relieved by the diagnosis,” said Reid, who researches near-term ecosystem changes to landscapes in the Department of Geosciences. “The harder part by far was trying to sit with a lot of possibilities that were even worse than cancer.”

And while Leighton Reid’s illness turned out to have nothing to do with Madagascar, tuberculosis, or even exposure to tropical bats, it turned out that his cure has roots — literally — in some of the conservation and restoration work that he has spent a career pursuing.

From Mesopotamian stories to modern medicine

The Madagascar periwinkle is an evergreen herb that grows along the dry coasts of southern Madagascar, blossoming in a five-petaled flower of a deep pink that lends to its other name, rosy periwinkle.

It is also the rare plant that has a long history in pharmacology: Mesopotamian folklore mentions the plant and extracts have been used in both Ayurveda (Indian) and Chinese medicinal practices for centuries. More recently, alkaloids were isolated from the plant in the 1950s, triggering research into potential medical applications.

Today, the Madagascar periwinkle is utilized in the manufacturing of a drug called vincristine, a chemotherapy that treats certain types of leukemia. And, as it turns out, lymphoma.

“The rosy periwinkle is part of the unique Madagascar biodiversity that we’re trying to fix through ecological restoration,” Leighton Reid said. “It is more than a little ironic that a species that is part of the flora I’ve worked to conserve has been put into service to protect my own personal ecosystem.”

Not to be outdone, the ecological landscapes of Southwest Virginia that Reid works to conserve have made their own contribution to his treatment.

Mayapples — those early-blooming umbrellas of green that show up in the forests and hiking trails each spring — are cultivated as a source of podophyllotoxin, an active ingredient in the chemotherapy drug etoposide, which Reid received as part of his chemotherapy cocktail.

The medicines, cultivated in ecosystems as far away as Madagascar and as near as Reid’s yard, started to work almost immediately. After his first 96-hour drip of chemotherapy, Reid said he could feel the tumor that had been settled around his lungs and throat break apart.

“Having the tumor felt like having heavy Christmas ornaments hanging off the arteries and veins in my chest,” Reid said. “After the first round of chemotherapy, I could actually feel the tumor starting to break down.”

Today Reid is cancer free and will continue his work protecting the ecosystems that ended up protecting him. This fall, he is helping to lead ecological restoration projects on grassland and woodland ecosystems in Virginia. Later in the year, he will be visiting a long-term restoration project that he has been conducting in the Chocó ecoregion of northwestern Ecuador. And he is still keeping up with the ecological restoration efforts taking place in Madagascar.

“If anything, going through this experience has made me appreciate that I need to focus on the things that are important,” Reid said. “I think a lot of people have that realization, but for me it means that I want to spend more of my time focusing on research that is going to improve outcomes for biodiversity conservation.”