Meet Our First Year Residents: Nico Gomez, MD, PhD

“…the neuropathologists at Michigan are deeply curious people who are eager to teach and start new projects. Their training backgrounds and scientific interests are impressively complimentary such that no topic, niche, or clinical entity felt unfamiliar to the team.“

Tell us about your background so we can get to know you.
I grew up in Minnesota and spent my high school years in Chicago’s Hyde Park. After graduation, I attended Tufts University in Boston, studying biology and music. Ultimately, I spent more time doing music – mostly vocal performance and Ghanaian drumming – than biology. As an undergrad, I worked in the lab of Dr. Joanne Berger-Sweeney, studying a mouse behavioral model of Rett Syndrome. I learned how to design and execute experiments, read and write scientific literature, and care for mice.

After graduation, I stayed in Boston working as a lab manager in the lab of Dr. Corey Harwell at Harvard Medical School. There I focused on cortical development – particularly neurogenesis, migration, and circuit integration. We used intersectional mouse genetics, sparse cell labeling, and histology to investigate surprising new functions of developmental regulators (i.e. the morphogen Sonic Hedgehog and the brown adipocyte transcription factor PRDM16) in the perinatal mouse neocortex. This experience was foundational to my fascination with brain tissue architecture and the wide range of tools used to study it.

What motivated you to pursue a medical career?
I applied to medical school while working in the Harwell lab. I was accepted at the University of Michigan but deferred for a year to spend more time on research. I began as an MD candidate in 2015, and after my first year, I began working in the lab of Dr. Sami Barmada, focusing on the neurodegenerative diseases amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD).

That summer, I worked on a machine-learning–based tool to classify microscopy images of fluorescently labeled rat brain cells as either neurons or contaminating glial cells. I was able to achieve a nearly 90% discrimination accuracy using morphology alone – a promising first step.

At the end of summer, I applied to the MD–PhD program internally, and by winter I was admitted.

I finished my pre-clinical studies then left medical school to pursue my PhD in the Barmada Lab. For my doctoral work I focused on potential ALS/FTD therapeutics. I studied the gene UPF1, a canonical member of the nonsense mediated decay (NMD) pathway, which had been found by us and others to be neuroprotective in a broad spectrum of cell- and animal-based model systems of ALS and FTD. In fact, one pharmaceutical company was so convinced of its efficacy they began studying its safety in humans.

At the time, however, there was no proposed mechanism for its neuroprotective effect, so, using a blend of wet and dry techniques, I spent my PhD trying to come up with some answers.

I developed analytical pipelines to study NMD impairment in publicly available ALS and FTD patient datasets then used genetically induced neurons derived from patient fibroblast to characterize the specific transcriptomic changes associated with UPF1 treatment.

At the end of my PhD, I published my thesis “Investigating the mechanism of UPF1-mediated rescue of TDP-43–based models of ALS and FTD.”

How did you decide on Pathology?
For the longest time, I thought I would do neurology. Age-related cognitive disorders have always interested me. When I returned to medical school, however, my rotations in neurology didn’t feel quite right.

Although I greatly value learning directly from the experiences of my patients, there are still no disease-modifying therapies available to folks with neurodegenerative disease. I was afraid of spending my career breaking tragic diagnoses without the ability to provide treatment options.

I realized I wanted broad expertise in the material nature of diseases – knowledge that might put me in a better position to help treat patient down the line. During a month-long neuropathology rotation at Michigan, everything clicked. Systematically drilling down from tissue architecture to cellular and subcellular morphology, and then to the molecular events underpinning disease, just felt natural to me.

What’s more is that the neuropathologists at Michigan are deeply curious people who are eager to teach and start new projects. Their training backgrounds and scientific interests are impressively complementary such that no topic, niche, or clinical entity felt unfamiliar to the team.

I began to think this could be the specialty for me. To be sure, I did a general pathology elective which showed me I wasn’t the “neuro-purist” I once thought I was. Histology is cool—full stop. It all came together quickly and convincingly, and in my second-to-last semester of medical school I decided to apply to Anatomical and Neuropathology.

You ranked Michigan highly for the Match. What attracted you to our program?
Over the years I’ve learned that the people you surround yourself with and relationships you have with them are the strongest determinants of success in training. Although I considered leaving Michigan to gain new institutional exposure, I was a little worried about going to a new place and not having the same connection with mentors elsewhere.

It really came down to the people and the environment of constant development they foster. Whereas at other institutions I might have hesitated to ask some questions, at Michigan I never felt that way. Nobody’s too advanced to revisit the fundamentals!

Ann Arbor has also treated me very well, opening doors to new communities each year. Michigan is good people. That’s why I’m here.

Tell us about your time as a resident so far. Is there anything you would like to highlight?
I’ve been here about six weeks, and the chief residents have done an excellent job of easing us into things. I started on molecular pathology, which I loved, and then I did a month of autopsy. The breadth represented by those two contrasting services was illuminating and underscored just how multifaceted pathology at Michigan is.

On autopsy, I saw gross anatomy in a way I never had before. In fact, if I could go back, I would have liked to do autopsy more frequently throughout my medical school career – perhaps in lieu of cadaveric dissection. Compared to anatomy lab, at autopsy you get to see both normative anatomy as well as the diverse and integrated consequences of disease in situ. It is a very holistic approach to understanding clinicopathologic relationships which is one of the fundamental goals of medical education.

What brings you the most joy in your work?
I love thinking about the complexity of cellular identity—the genetically and spatially defined functional niche of a cell in tissue.

Cellular identity is critical to understanding the origins and prognostic implications of cancers. Interestingly, cellular identity is also of growing importance in neurodegeneration, where neurons, a predominantly non-dividing cell type, die, typically in an age-related fashion.

What’s fascinating is that vulnerability to age-related stressors is not uniform across all neurons.

For any given disease process—whether the ALS/FTD spectrum I studied in graduate school or isolated mild cognitive impairment—most of an individual’s neurons are still doing just fine. This phenomenon, called selective vulnerability, may hold the key to unlocking the next generation of neurotherapeutics.

To think that, even in the most debilitating examples of neurodegeneration, most of our brain cells are still simply biding their time, ready to celebrate the next birthday—that’s pretty rad.

What do the resilient million neurons know that the vulnerable few don’t?

Were there any mentors you would like to mention? If so, how did they impact your life?

Yes. First and foremost, I’d mention my PhD mentor, Dr. Sami Barmada, whose childlike enthusiasm for science was as motivating in year five as it was on day one. He somehow balanced this energy with prodigious focus and often hilariously pithy nuggets of wisdom (e.g., “Always design the tool around the question, never the question around the tool”). I can’t thank him enough for showing me how to strike the balance between curiosity and rigor.

I’d also like to mention Michigan neuropathologist Dr. Sriram Venneti, who has been an outstanding mentor to me as an early-career physician–scientist. He’s been very generous with his time, talking me through the step-by-step process of becoming an independent principal investigator. Only about an hour after I got my Match results, he reached out to tell me how excited he was to get to work together. The feeling is mutual.

What is your strategy for finding balance between training and your other interests?
I prioritize a little time for hobbies and exercise everyday - usually in the evening. These days it’s mostly pickleball and swimming at Fuller pool for exercise and a spot of garden time to close out my day. Certainly, no day is complete without grossing some fresh produce. I’ve also learned that the secret to surviving midwestern winters is indoor sports. Fortunately, between Ann Arbor and the U-M facilities, there is no shortage of indoor pickleball courts, pools, and rock-climbing gyms.

What advice would you give medical students considering a career in pathology?

Find an authentic shadowing experience as soon as you can. Get to know the bread and butter of the workday. It is one thing to be interested in pathological entities, and it is another thing to thrive in an environment where you are doing the grossing, previewing, and researching of said entities. If you cannot tolerate either grossing or staring at slides all day, you’ll want to know that before you apply. As I am on the neuropathology track, I really needed to confirm that I wasn’t exclusively interested in cutting brains and looking at brain cells. Only after my general pathology elective where I worked with a broad range of soft tissue entities did I feel pathology was a good fit for me. That said, I think more people would take an interest in pathology if medical schools were better at incorporating it into curricula. So, if you’re really interested in pathology, tell a friend!

What are some fun facts about you that we could share?
During my PhD – and, crucially, before the pandemic – I got really into homesteading hobbies such as sourdough baking, cold-process soap making, crochet, and gardening. I always have a crafty project cooking at home, which gives me something to actively unwind with at the end of a busy day.

Welcome to the Department of Pathology, Nico! We are looking forward to following your career as you grow as both a neuropathologist and a research scientist.