Louis Vincent Avioli, M.D., F.A.C.E.: April 13, 1931-November 21, 1999

Today the Journal pays tribute to Louis V. Avioli, who recently passed away. In previous years and undoubtedly in the future, similar tributes have appeared or will appear. However, no single individual deserves tribute more or has given so much of him/herself to the Journal, the ASBMR and the collective field of bone and mineral research. In Louis Avioli we have encountered someone whose impact will live far into the future. As you will realize after reading the accompanying articles about his accomplishments, Louis played an undeniably large role in crafting the ASBMR and has trained an enormous number of outstanding scientists, who continue to put Louis' mark on the bone and mineral field.

Each of us has favorite stories or memories about interactions with Louis and I am no different. But the one that I wish to share with you relates to a visit that Louis made to Duke University to present at Medical Grand Rounds. Of course I took the responsibility of introducing him to the audience. Little did I realize how formidable this task could be. After all, how do you introduce a man who had accomplished as much as he had. I wondered if I should tell about the scientific advances he had pioneered or the people he had trained or the impact he had on our field. I decided that there was no win-win position. Nothing I could say would appropriately introduce Louis. However, I recognized that verbal communication is but one method of conveying ideas. Indeed, in many cases the impact of other forms of communication can provide a far broader message than a reasonable number of words. Thus, I stood before the audience and indicated that we had a visiting lecturer for this day, one Louis Avioli, who had long contributed to the bone and mineral field. At that point the lights dimmed and the beginning scenes from Godfather began showing at the front of the room and the well-known music from the movie blared throughout the room. Instantly, as Louis walked to the front of the room, everybody recognized that we were privileged to have amongst us a giant in the academic world.

Today, I face the same problem, to introduce a tribute to a giant in the academic world. Nothing that I can say can adequately convey my personal feelings or the deserved accolades due him. However, I can request that each of you begin to hear the music and turn to your private thoughts about him. I know that as he looks upon us from the world beyond, he too will hear the music and continue to care for us and the academic community in which he towered. To his family, to his friends and to his associates, the Journal and its staff offer condolences and this tribute to the memory of Louis V. Avioli.

Marc K. Drezner, M.D.

Editor-in-Chief

We can only speculate as to the motives that led Lou Avioli to bring a small group of us together and propose the founding of a new society devoted to fostering bone and mineral research 25 years ago. My belief is Lou recognized better than any of us that the field needed a broad-based, active and identifiable society if we were to compete successfully in attracting the best and brightest. The planning meeting was in the Drake Hotel in Chicago. Claude Arnaud, Norm Bell, Bill Peck, John Potts, Larry Riggs and I joined Lou to talk about how to start ASBMR. I think we picked the name at that meeting. The initial idea was to add a day or two to the Endocrine Society meeting, because we did not think people would put out travel money for an extra meeting. We could not have done it without Shirley Hohl. She organized the first meeting of the ASBMR with the same aplomb that she ran Lou Avioli's bone group.

Almost 200 people signed up for the first meeting at the Disneyland Hotel and we had to make a special appeal to the management to get a larger room. The room had a low ceiling; the screen was small; people in the back could hardly tell what was going on, but everyone seemed to enjoy it. People talked to each other, made new acquaintances and everybody agreed that we were onto something that should work. The dues were not large and the financial situation never better than desperate. The second meeting was held at the Sheraton in Washington, which was undergoing extensive reconstruction. During the meeting the hard hats were hammering and sawing and making an outlandish racket which made it difficult to hear the speakers. Despite this, the meeting was a scientific success and everybody had a great time, but we were still short of money. The following summer I had to borrow from my mother who ran “Marika's Antique Shop” to set up the third meeting in Cincinnati. By this time, we had more than doubled the attendance and the number of abstracts and had trouble finding room for all the posters.

I think the key to the early success of ASBMR was that it was a truly open meeting, in which there were no invited speakers and everyone could present their research. The only distinction was between oral and poster presentations and it quickly became a mark of distinction to “get an oral” at ASBMR. Another critical feature of the meeting was audience participation. During those early years, Lou and Shirley watched over us like fond parents. Lou was not only our leader in ASBMR, but also our leader in a variety of adventures, about which I can only say that an evening with Lou was always memorable and occasionally censorable.

Lou made an enormous effort to bring young people into ASBMR and provide them a platform for presentation and an opportunity to play a role in running the society. The terms for president and council were short enough to provide turnover and opportunity for more and more people to participate. We were all proud to share the experience and watch ASBMR establish itself as the preeminent scientific organization in our field, thanks to the vision, energy and charisma of Lou Avioli.

Lawrence G. Raisz, M.D.

University of Connecticut

Dr. Louis Avioli was born in Newark, New Jersey on April 13, 1931 and died in Clayton, Missouri just before Thanksgiving on November 21, 1999. His influence on our field over the past four decades resulted from his extraordinary intelligence, intuition, vision, energy, fearlessness and understanding of human interactions.

Lou was graduated from Princeton magna cum laude in 1953 and then entered Medical School at Yale. He considered interrupting his medical education to work towards a Ph.D. in biochemistry, but reluctantly changed his mind and graduated with his entering class in 1957. Lou entered the residency program at the University of North Carolina at Chapel Hill and was mentored by Dr. Louis Welt. Lou Avioli's interest in fluid and electrolyte metabolism and in parathyroid disease was kindled in part by Dr. Welt and by Charles Burnett, Chair of Medicine at Chapel Hill, and a former colleague of Fuller Albright's. After completing his residency, Lou migrated to the NIH, and after two years there, was recruited by Phil Henneman to join the faculty of the New Jersey College of Medicine. There Lou initiated research in bone and mineral ion metabolism.

It was during this period that I first met Lou in Davos, Switzerland at a 1965 European Calcified Tissues Meeting. There he presented the results of his studies on inorganic pyrophosphate excretion in metabolic bone diseases. Lou stood out in crowds, certainly in the staid crowd typical of the time. We began a close, albeit occasionally stormy, relationship that grew over the next 35 years. Lou inserted an intense passion into all of his activities, not only his research but also into his interactions with family, friends, patients, colleagues, students or total strangers.

In 1966, Lou moved with his wife Joan and five children to St. Louis to become Chief of the Division of Endocrinology at Jewish Hospital and a member of the faculty at Washington University School of Medicine. Eight years later, he was given an endowed chair in the Department of Medicine at Washington University. Over the years he turned down many other job offers. Why should he have left a land of plenty? He was highly respected; he had good space, and support sufficient to maintain large academic and clinical operations. As a prolific writer, as editor of Calcified Tissues International, and an indefatigable speaker he attracted fellows from all over the world. He maintained a major interest in nephrology, contributing to understanding abnormal vitamin D metabolism and parathyroid gland function in chronic renal failure, and collaborated with scientists such as Eduardo Slatopolsky, Hector Deluca, Neal Bricker, and Saulo Klahr. He encouraged and supported Steven Teitelbaum, Roberto Pacifici, Roberto Civitelli and many others who went on to develop independent programs.

Lou was an avaricious reader, quick to absorb new ideas. He was in demand as a speaker at institutions in Japan, Italy, Spain, Germany and countless other venues. In Italy he received an honorary doctorate from the University of Siena, of which he was very proud. His accomplishments included election to the American Society for Clinical Investigation, the Association of American Physicians and appointment to chair NIH study sections and advisory panels. He played a vital role in identifying osteoporosis as a major medical and public health problem and helped stimulate pharmaceutical corporations to develop new effective drugs now in current use for treatment of bone disease.

Most impressive, though, was the effect Lou had on people. His style was unique, enabling him to accomplish so much, in part because Lou engendered such loyalty from staff, colleagues and students. At St. Louis, Lou moved all over the place, demanding, cajoling, flattering, occasionally screaming but usually making his point and emerging the victor. There were probably a few who couldn't take it but the vast majority adored him. He was great with his students and they in turn tried hard to please him. He had created one of the most outstanding centers in the world for the study of bone biology and the care of patients and he reveled in the success of the people whose careers he nurtured.

Lou, with his passionate interest in human bone diseases and the attendant research, was always pushing for better communication. In the 1970's, he talked about starting a new organization that would focus on bone research. He kept pushing, networking, calling in chips until the ASBMR Council had its first meeting in St. Louis. At that first meeting of the Society, fewer than 250 abstracts were submitted, and nearly everyone who attended either presented something or commented on what someone else said. Lou loved it all, knew everyone there and was very much a driving force. Not everyone approved of the breakaway society, but after several years it was clear that the ASBMR was here to stay. He influenced all of our lives with his passion and neither the ASBMR nor the Journal of Bone and Mineral Research would exist had he not mobilized the forces to create and sustain the Society and the Journal.

Stephen Krane, M.D.

Harvard Medical School

On November 21, 1999, we lost Lou Avioli, founder of the ASBMR. Eleven years ago Lou developed prostate cancer. He confronted his disease with characteristic fortitude and optimism, being more concerned about the anxieties of those near to him, than his own comfort. His passing was as courageous as his life.

Lou came to Washington University as Chief of Endocrinology at Jewish Hospital of St. Louis, charged with developing a program in metabolic diseases of bone. Lou's approach was ecumenical. Department affiliation was irrelevant to Lou who recognized enthusiasm as the most important characteristic of a colleague. Lou's efforts at Washington University came to fruition rapidly and within a short time he was awarded the Sidney M. Shoenberg Chair in Medicine and named Director of the Division of Bone and Mineral Diseases, the first of its kind and the paradigm for similar efforts at other institutions. Lou published over 300 scientific papers and was a superb clinical teacher of residents and medical students. His research was recognized internationally with many awards and honorary degrees; he and Stephen Krane published three editions of the text, Metabolic Bone Disease and Clinically Related Disorders and he served as Editor-in-Chief of Calcified Tissue International since 1979. In 1998 Washington University established the Annual Louis V. Avioli Endowed Lecture.

Lou's dynamic nature attracted many trainees and young colleagues whom he molded into successful scientists. He considered the welfare of his fellows more important than his own and made great sacrifices for their careers. When my time came for candidacy for honorific societies, Lou insisted on removing his name from manuscripts to which he had contributed so as to establish my self-sufficiency. He encouraged rapid independence of his trainees and reveled in their accomplishments. Fellows joining the faculty of Washington University were immediately considered peers and given a voice in the direction of our program. Lou trained more than 120 fellows, most of whom have committed to academic medicine at institutions throughout the world. He influenced them all and each holds him in great affection.

Lou and Joan had five children and many grandchildren, but Lou's concept of family extended far beyond the nuclear. Our group at Washington University is an Avioli family, concerned about each other's professional and personal lives. His trainees were his lineage and many of us in the ASBMR had important doors opened by this caring man.

I was fortunate to have been one of Lou Avioli's trainees and he was responsible for any success I may have enjoyed. He was a selfless mentor and knew how to be a devoted friend. Lou leaves a unique legacy and his absence creates an unfillable void.

Steven Teitelbaum, M.D.

Barnes-Jewish Hospital

Louis Vincent Avioli, M.D., F.A.C.E. Curriculum Vitae

Princeton University, B.A., magna cum laude, 1953

Yale University, M.D., 1957

University of North Carolina at Chapel Hill, Internship and Residency 1957–1959

National Institutes of Health, Clinical Associate 1959–1961

New Jersey College of Medicine Instructor in Medicine, Assistant Professor of Medicine, 1961–1966

Washington University School of Medicine, St. Louis, Missouri

Assistant Professor of Medicine 1966–1968

Associate Professor of Medicine 1968–1970

Professor of Medicine and Oral Biology 1970–1972

Sydney and Stella Shoenberg Professor of Medicine and Oral Biology 1972–1999

Director, Division of Bone and Mineral Metabolism, 1975–1999

Professor of Orthopedic Surgery, 1995–1999

Jewish Hospital of St. Louis, Director, Division of Endocrinology 1966–1999

Shriner's Hospital for Crippled Children, Director, Metabolic Unit 1971–1980, Co-Director 1980–1999

Andre Lichwitz International Prize for Research in Bone and Mineral Metabolism, 1979

American Association for the Advancement of Science, 1982

Selected One of the 120 Best Doctors in America, 1984

Physician-Teacher-Investigator Award, American College of Nutrition, 1987

Neuman Award for Outstanding Leadership and Research in Bone and Mineral Metabolism (ASBMR), 1988

Robert H. Williams Distinguished Leadership Award (Endocrine Society) 1990

Golden Hippocrates Award (Italian Health Council) 1990

Ann D. Vaughn Kappa Delta Award for Research in Bone Cell Biology, 1992

John M. Kinney International Award for Nutrition & Metabolism 1993

St. Louis “Good Guy” Award for Tangible Efforts in Improving the Lives Of Women 1993

Fellow, American College of Endocrinology, 1995

Pioneer Award, U.S. National Osteoporosis Foundation, 1996

Peter H. Raven Lifetime Award, Academy of Science, St. Louis, 1998

National Academy of Sciences Space Science Board 1972–84

FDA Administration Panel on Review of Vitamins, Minerals and Hematinic Drug Products 1973–1978

National Academy of Sciences National Research Council 1974–80

NIH General Medicine B Study Section 1973–1975, Chairman 1975–1977

American Society for Bone and Mineral Research, President 1977–79

Gordon Conference on Bones and Teeth, Vice Chairman 1981

International Conferences on Calcium Regulating Hormones Board 1981–84 and 1994–99

Gordon Conference on Bones and Teeth, Chairman 1982

NASA Advisory Panel for the Space Station, 1983–87

Endocrine Society Council 1984–88

Sclerodoma Foundation Advisory Board 1988–99

National Institutes of Health Special Grant Review Committee 1988–91

The Paget Foundation for Paget's Disease and Related Disorders Board 1990–99

National Institutes of Health Reviewers Reserve Board 1994–99

Association of Osteobiology, President 1995–99

U.S. Army Orthopedics Review Panel, Chairman 1995–99

Therapeutic Grand Rounds, JAMA and Archives of Internal Medicine, Editor 1968–1970

Journal of Laboratory and Clinical Medicine Editorial Board, 1970–1975 and 1990–1999

Kidney International Editorial Board, 1970–1975

Journal of Clinical Endocrinology and Metabolism Co-Editor 1973–1977, Editor 1977–1978

American Medical Association Editorial Board 1976–1987

Journal of Mineral and Electrolyte Metabolism, Associate Editor 1977–1985

Metabolic Bone Disease and Related Research 1977–1985

Calcified Tissue International, Editor-in-Chief 1978–1999

American Journal of Medicine Editorial Board 1978–1982

Journal of Bone and Mineral Research Editorial Board 1986–1999

Italian Journal of Mineral and Electrolyte Metabolism Editorial Board 1989–1999

Osteoporosis International Editorial Board 1990–1999

European Journal of Experimental Musculoskeletal Research Editorial Board 1990–1999

Journal of Endocrinological Investigation Editorial Advisory Council 1990–1999

Spanish Journal of Metabolic Bone Diseases 1996-present

Representative Publications:

Avioli LV, McDonald JE, Singer RA, Henneman PH 1965 A new oral isotopic test of calcium absorption, J Clin Invest 44:128–139.

Passannante Aj, Avioli LV 1966 Studies of the ultrviolet fluorescence of vitamin D and related compounds in acid alcohol solutions Anal Biochem 15:287–295.

Avioli LV, Berman M 1966 Mg28 kinetics in man. J Appl Physiol 21:1688–1694.

Avioli LV, Birge SJ, Lee SW, Slatopolsky E: The metabolic fate of vitamin D3–3H in chronic renal failure. J Clin Invest 47:2239–2252.

Bricker NS, Avioli LV, Birge SJ 1968 On an in vitro assay for a humoral substance present during volume expansion and uremia. Nature 219:1058–1059.

Bricker NS, Slatopolsky E, Riess E, Avioli LV 1969 Calcium, phosphorus and bone in renal disease and transplantation. Arch Intern Med 123:543–553.

Avioli LV, Scott S, Lee SW 1969 Intestinal calcium absorption: Nature of defect in chronic renal disease. Science 166:1154–1156.

Haddad JG, Birge SJ, Avioli LV 1970 Effects of prolonged thyrocalcitonin administration on Paget's disease of bone. N Engl J Med 1970; 283:549–555

Avioli LV 1972 Intestinal absorption of calcium Arch Intern Med 129:345–355.

Birge SJ, Avioli LV 1972 Intestinal calcium transport: The role of sodium. Science 176:168–170.

Avioli LV 1973 Collagen metabolism, uremia and bone. Kidney Int 4:105–115.

Avioli LV, Haddad JG 1977 Vitamin D's: More and more measured better and better (editorial). N Engl J Med 297:1006.

Avioli LV 1978 Controversies regarding uremia and acquired defects in vitamin D3 metabolism. Kidney Int 13:S36–S38

Avioli LV 1978 Childhood renal osteodystrophy Kidney International 14:355–360.

Avioli LV 1978 What to do with “postmenopausal osteoporosis” (editorial). Am J Med 65:881–884.

Perry HM III, Fallon MD, Bergfeld M, Teitelbaum SL, Avioli LV 1982 Osteoporosis in young men: A syndrome of hypercalciuria and accelerated bone turnover. Arch Intern Med 142:1295–1298

Seino Y, Sierra RI, Ichikawa M and Avioli LV 1982 1,25 dihydroxyvitamin D3 receptor in the X-linked hypophosphatemic mouse. Endocrinology 111:329–331.

Fisher LW, Whitson SW, Avioli LV, Termine JD 1983 Matrix sialoprotein of developing protein. J Biol Chem 258:12723–12727.

Cunningham J, Bikle D, Avioli LV 1983 Acute, but not chronic, metabolic acidosis disturbs 25-hydroxyvitamin D3–1 metabolism. Kidney Int 25;47–52.

Avioli LV, Haddad JG 1984 The vitamin D family revisited. N Engl J Med 311;47–49.

Avioli LV 1984 disorders of calcium homeostasis Clin Chem 1984; 3:1–11.

Morimoto S, Birge SJ, Shen V, Avioli LV 1985 (Ca2⁺⁺ Mg2⁺)-ATPase activity in plasma membrane of circulating monomuclear cells. Lack of a direct effect of vitamin D J Biol Chem 260;14953–14957.

Pacifici R, Avioli LV 1987 Calcium supplementation and postmenopausal bone loss N Engl J Med 317;1025–1026.

Heaney RP, Avioli LV, Chesnut III CH, Lappe J, Recker RR, Brandenburger GH 1989 Osteoporotic bone fragility: Detection by ultrasound transmission velocity JAMA 261:2986

Pacifici R, Carano A, Santoro A, Rifas L, Jeffrey JJ, Malone D, McCracken R, Avioli LV 1991 Bone matrix constituents stimulate interleukin-1 release from human blood mononuclear cells. J Clin Invest 87;221–229.

Chaudhary LR, Avioli LV 1996 Regulation of interleukin-8 gene expression by interleukin-1, osteotropic hormones and protein kinase inhibitors in normal human bone marrow stromal cells. J Biol Chem 271;16591–16596.

Chaudhary LR, Avioli LV 1998 Activation of c-Jun NH2-terminal kinases by interleukin-1 β in normal human osteoblastic and rat UMR-106 cells. J Cellular Biochem 69:87–93.

Rifas L, Avioli LV 1999 A novel T cell cytokine stimulates IL-6 in human osteoblastic cells. J Bone Miner Res 14:1096–1103.

Avioli LV 1983 Aging, bone and osteoporosis. In: Steinberg FU (ed) Care of the Geriatric Patient, in the Tradition of E.V. Cowdey. The CV Mosby Company, St. Louis, pp 143–153.

Hahn TJ, Avioli LV 1984. Anticonvulsant drug-induced mineral disorder. In: Roe DA and Cambell TC (ed) Drugs and Nutrients: The Interactive Effects. Marcel Dekker, Inc., New York, pp. 409–427.

Avioli LV 1984 Hypocalcemia. In: Bayless TM, Brain MC and Cherniack RM (eds) Current Therapy in Internal Medicine 1984–1985, CV Mosby Co, St. Louis, pp 510–513.

Avioli LV 1984 Calcium supplementation and osteoporosis. In: Armbrecht HJ, Prendergast JM and Coe RM (eds) Nutritional Intervention in the Aging Process, Springer Verlag, New York, pp 183–189.

Hahn TJ, Avioli LV 1989 Acquired (non-inherited) disorders of vitamin D function. In: DeGroot LJ (ed) Endocrinology, 2d ed, WB Saunders, Philadelphia, pp 1095–1110.

Chesney RW, Avioli LV 1992 Childhood renal osteodystrophy. In: Edelmann CM, Bernstein J, Meadow SR, Spitzer A, Travis LB (eds) Pediatric Kidney Disease, Vol. II., Little, Brown & Co., Boston, pp. 647–684.

Avioli LV 1992 Therapy with bisphosphonates, sodium fluoride, thiazides and vitamin D metabolites. In: Avioli LV (ed) The Osteoporotic Syndrome, 3^rd ed, John Wiley & Sons, Inc., New York, pp 155–169.

Goldring Sr, Krane SM, Avioli LV. 1995 Disorders of calcification: Osteomalacia and rickets. In: DeGroot LJ (ed) Endocrinology, 3^rd ed, WB Saunders Co, Philadelphia, pp 1204–1227.

Azria M, Avioli LV 1996 Calcitonin. In: Bilezikian JP, Raisz LG, Rodan GA (eds) Principles of Bone Biology, Academic Press, pp 1083–1097.

Louis V. Avioli's Past Trainees

(A Representative List)

Daniel T. Baran, M.D.

S. Beeki, M.D.

Josep Blanch, M.D.

M. Elizabeth Bruns, Ph.D.

Arkadi Chines, M.D.

Roberto Civitelli, M.D.

Nancy E. Cooke, M.D.

John Cunningham, D.M., FRCP

Samuel Dagogo-Jack, M.D.

Larry Fisher, Ph.D.

Nuria Guanabens, M.D.

Stephen Hough, M.D.

H. Ibrahim, M.D.

Ryuichi Kasai, M.D.

Robert Kimble, Ph.D.

Riko Kitazawa, M.D.

Michael Kleerekoper, M.D.

Robert Knabb, M.D.

Hitoshi Kurose, M.D.

C.-F. Lai-Huang, Ph.D.

R. Leelawatana, M.D.

Joseph Levy, M.D.

Angel Lopez-Candales, M.D.

D. Maggio, M.D.

Chet S. Monder, M.D.

Shigeto Morimoto, M.D.

Roberto Pacifici, M.D.

H. Mitchell Perry III, M.D.

Deborah Joy S. Riley, M.D.

T. Saleh, M.D.

Yoshiki Seino, M.D., Ph.D.

Stephen M. Spaethe, Ph.D.

Sunil Srivastava, Ph.D.

Steven L. Teitelbaum, M.D.

Michael P. Whyte, M.D.

Neill Wright, M.D.

R.A. Wolf, M.D.

Shu-Fang Zhang, M.D.

Konstantinos Ziambaras, M.D.