Dr. Abdul Razzaque Ahmed: The Physician Scientist who revolutionized the Cure of Blistering diseases

Every time he travels abroad to deliver his lecture on his specialization or to see his patients, he pays a visit to Makkah to express his gratitude to God Almighty. He has performed more than 100 umras.

He is one of those unique individuals who has scores of pieces of the curtain of Kaaba. Abandoning financial goals and pursuits, this humble, soft-spoken, cultured man, enriched with family traditions and upbringing, has taken a long and challenging road from an unknown town in Central India to the Ivory Towers of Harvard University and beyond.

Silently but persistently, his clinical expertise and creative streak have brought lifelong relief and good health to some of the sickest patients in the world. His humanitarian spirit and concern for the less fortunate have transformed the lives of individual families and societies.

Few people, in one lifetime, can positively impact the world in which they are born and make it a better place to live. Few can build the roads he constructed or make the journeys he made, no matter what the terrain or the weather.

He has touched many lives. Without meeting him, seeing him or knowing him, across the US, India, and many countries on this earth, people thank him for what he did for them, thank Noor Jahan Begum for giving birth to him, and the Creator for inspiring him to make it a little better and bearable for all of us.

He is currently the Ibn Sina Professor at Tufts University School of Medicine in Boston, MA. He is Dr. Abdul Razzaque Ahmad.

He spent his early childhood in the small town of Vani, in central India, in a house built by his great-grandfather in approximately 1875. He studied in a convent run by French nuns until the age of 7. He went to a Jesuit Catholic Boarding School in Nagpur.

Upon completing high school at the age of 15, he received an American Field Service International Scholarship to come to the US. He spent one year in Le Mars, Iowa, where he lived with the Thompson family. He attended the local high school part-time and Westmar College the rest of the time. This one year in a small rural town in the Midwest changed his view of the world, his vision of the future, and laid the foundations for what he would become in the years ahead. Deep in his mind and psyche, the US will always be the LeMars, Iowa, he knew and loved.

Upon returning to India, he studied pre-medical courses at Nagpur University and subsequently got admission to the All-India Institute of Medical Sciences (AIIMS).

At the AIIMS, he stood first in most of his classes and received a Gold Medal for being the best graduate of his class. Immediately after receiving his MBBS Degree, he came to the United States to begin his specialty training. He trained in Internal Medicine at the University of Pittsburgh, Dermatology at the University of Buffalo, and Clinical Immunology at the University of California at Los Angeles (UCLA). He joined the Faculty of Medicine at UCLA. His love and passion for science led him to Harvard University, Medical Campus in Boston. He began to work on a Doctor of Science Degree, which he received from the Faculty of Medicine at Harvard. While conducting research in Molecular Immunology, he generated data that resulted in two NIH grants with a return on investment (ROI). This led to the establishment of the Ahmed Lab, which remained funded by the NIH for over 20 years.

When he decided that Boston would be his home, Dr. Ahmed created the first Center for Blistering Diseases in the US, and perhaps the world, for these rare, orphan diseases that are potentially fatal and had not received much attention at the time. Dr. Ahmed decided that if there were to be meaningful advances and progress, it was essential to stay focused and committed. The Center for Blistering Diseases was a one-stop Center for all the needs of the patients. He assembled experts in other fields and disciplines of medicine that his patients needed, thereby forming a "team".

This combination of an extensive clinical practice with a well-funded research lab provided the strength and stimulation for creative thinking and the development of new ideas, both in clinical practice and in basic bench research.

Dr. Ahmed's training background and experience in Medical Dermatology helped him acquire new knowledge and skills in Oral Medicine. Physicians and Dentists came to his Center and learned how to manage complex, difficult patients. Doctoral students conducted research on clinical material from their patients, and critical discoveries emerged as a result.

Dr. Ahmed's basic research focused on fundamental questions, such as why only some people develop these diseases. What initiates or starts these diseases? The clinical questions were equally basic. Are there better treatments than those currently available that do not produce catastrophic side effects? Could some treatments enable patients to experience long-term, sustained periods of disease freedom and drug-free status? The self-created challenges were neither easy nor straightforward. Dr. Ahmed utilized all available resources and personnel. He gathered Physicians, Dentists, Scientists, and Health Care Providers who shared his mission and vision, and this cohesive team worked tirelessly.

Dr. Ahmed's research team collaborated with some of the world's leading immunogeneticists and identified MHC class II genes that contribute to enhanced susceptibility to these diseases. Besides patients, he studied families. He was the first to demonstrate that family members who shared the same genes with the patients produced the same autoantibodies as the patient, albeit in small quantities, and never developed the disease. He described pathogenic (disease-causing) and non-pathogenic (non-disease-causing) autoantibodies.

In his efforts to understand what initiates the disease, Dr. Ahmed's laboratory identified molecules in the skin, mouth, conjunctiva, and other tissues that undergo molecular changes and become key factors in initiating the processes that ultimately lead to disease. Since these are autoimmune diseases, the root problem was that the immune system had lost its balance and regulation.

While most serious investigators follow a narrow road and thus become world authorities on their limited area of interest, some enthusiasts are willing to take some tangential turns. One such opportunity arose in Dr. Ahmed's life as a researcher. The Health Authorities in Iran were puzzled by a large number of Pemphigus patients in North-Western Iran (Gilan). The Dermatologists in the country felt that this could be the beginning of a serious epidemic, and many people would die. Their consensus was that Dr. Ahmed was the only person to guide them.

Despite the perceived difficulties, Dr. Ahmed traveled to Gilan in northwest Iran. He realized that there was no epidemic. A brilliant, young, well-trained dermatologist was diagnosing the patients. Dr. Ahmed, like any analytical physician scientist, did not stop there. He returned with his research team, collected blood, extracted DNA, and brought it to his laboratory in Boston, MA, to conduct immunogenetic studies. His discoveries initially troubled him. The genes of concern in these Muslim Iranian patients were 100% identical to those of Jewish patients in Boston (US), Europe, and Israel. He consulted with Jewish historians, but none had clear explanations. Finally, in a library in Berlin, Germany, he found a book with a map published in the Thirteenth Century. This describes Khazaristan. The Khazars were a Jewish people who lived in modern-day Northern Iran. Due to three decades of famine and drought, they migrated to what is Europe today. They spoke a Turkish language called Ashkenazim. When they arrived in Europe, they were referred to as Ashkenazim.

After much digging and perseverance, Dr. Ahmed finally found the reason(s) for his observations and discoveries in northwest Iran.

 These understandings of the immune system formed the foundation for Dr. Ahmed's discovery of revolutionary therapies. Treatments that have saved thousands of lives worldwide and prevented blindness.

Dr. Ahmed saw the long-term and short-term damage that steroids did to patients referred to him. The "cure" was as bad as the disease. While at UCLA, he did experiments in which he took cells from the blood of patients and observed that they could reproduce autoantibodies in an incubator. He did this experiment again. This time, he added a biologic agent, used in the treatment of other autoimmune and immunodeficiency diseases, called intravenous immunoglobulin (IVIg). The patient's cells no longer produce autoantibodies in the incubator.

Dr. Ahmed began to treat his patients with IVIg. The results were terrific. Patients recovered from their diseases, discontinued steroids, and all other drugs. Their recovery lasted for years. While many researchers would have jumped to a patent, Dr. Ahmed did the opposite. He spoke at seminars, conferences, nationally and internationally, spreading his message to help as many patients as possible. Since IVIg is very expensive, Dr. Ahmed took data on 160 patients to the Center for

Medicare and Medicaid, and convinced them on a clinical and pharmacoeconomic basis to authorize IVIg use in blistering disease. A special panel heard his presentation and voted to allow Medicare coverage for IVIg for blistering diseases. Private insurance companies followed Medicare's policies.

Dr. Ahmed was aware of a drug trial using a biologic agent to treat cancer that was working well in patients with rheumatoid arthritis. With the help, guidance, and collaboration of two Harvard Oncologists, they collectively developed a unique novel protocol using a combination of Rituximab and IVIg. It was based on science and the pathobiology of B cells in autoimmune diseases.

The protocol was highly effective and published in the New England Journal of Medicine. Those patients were carefully monitored for 15 years. They did not require any additional maintenance treatment and remained disease-free for 15 years. This was also published in the New England Journal of Medicine.

One notable feature of Dr. Ahmed's most recent research is particularly noteworthy. In 2001, he published a study on 21 patients with Pemphigus treated with only IVIg. He followed them for 25 years after completing the protocol. They had reversed the damage to their immune system and regained their normal physiological state. Their landmark and milestone paper was published in 2024 in the Proceedings of the National Academy of Sciences (PNAC) of the US.

An aspect of Dr. Ahmed's clinical practice and research that distinguishes him from many of his colleagues is his groundbreaking, enduring, and pioneering work on a rare eye disease called Ocular Cicatricial Pemphigoid. Despite the most aggressive systemic therapy, at least 25% of the patients become blind.

Dr. Ahmed first studied the mechanism that causes scarring in the eye. In collaboration with his Ophthalmology colleagues, he then treated patients initially with IVIg and later with Rituximab and IVIg. This protocol prevented blindness in millions of patients globally. Patients recovered completely and retained their normal vision. It is now the standard of care for treating these patients.

Dr. Ahmed was concerned about his patient's coping with dreadful, potentially fatal diseases and handling monthly intravenous drug infusions. He initiated a "Boston Blistering Disease Support Group". Once a year, as many patients as could come got together, had lunch, and discussed their illnesses and response to treatment. For more than 25+ years, the group met at a public high school. COVID-19 forced its temporary suspension. In 2025, it will meet again.

With his discovery and design of effective protocols that required intravenous therapy on multiple occasions, Dr. Ahmed established an in-office, ambulatory, non-hospital-based infusion suite. Patients were referred from all New England states, throughout the US, and from several countries.

His model is being replicated in practices in many cities in the US and overseas. Since many dermatologists are not familiar with administering intravenous drugs, they refer their patients to Rheumatologists or Hematologists. Dr. Ahmed set up a model to prevent that. The model is effective and successful.

Dr. Ahmed has been and continues to remain an impressive, concerned, and caring mentor and role model to medical and dental students and residents. Many of his former students are Professors and some are Heads of Departments in the US and their native lands.

 Dr. Ahmed is an excellent speaker. He has lectured at conferences in the US for over 35 years and has been a Visiting Professor at numerous universities. During his professional career, he has lectured in 37 countries on all the continents except Australia. Few Dermatologists in the US have such a global presence and impact. With his extensive knowledge, Dr. Ahmed brings a wealth of clinical experience. Making his lectures relevant and valuable to the audience.

Any physician anywhere in the world knows that if they have a difficult-to-manage patient with a blistering disease, they can call Dr. Ahmed, and help will be on the way.

Dr. Ahmed is a modest man who quietly does this work without social media or news media presence. Nonetheless, his contributions are recognized by his peers, professional societies, and the general public.

In the US, he has received awards for "Best Doctor of the Year". William Gies Award by the International Association for Dental Research, American Society for Dermatology, and Walter F. Lever Award by Tufts University, which is given once every 25 years. He has received Lifetime Achievement Awards from the International Congress on Autoimmunity, the American Academy of Dermatology, the Portuguese Society for Dermatology, the Arab League of Dermatology, and Dermatology Societies in Italy, Tunisia, Turkey, and India. Since the novelty of his research parallels the works of Charaka, who originated Ayurveda—the ancient Indian art and science of herbal medicine—India bestowed upon him the "Charaka Award."

Less known but critically important is the fact that at the end of the last century, in 1999, both the Governor of Massachusetts and the House of Representatives of the Commonwealth of Massachusetts separately gave him the "Citizen of the Year Award" for his contribution to the citizens of Massachusetts and for reflecting the spirit of Massachusetts.

While his work as a physician, scientist, scholar, writer, investigator, and teacher is nationally and globally recognized, appreciated, and honored, something equally significant remains unknown and unmentioned. Approximately 23 years ago, Dr. Ahmed established the Noor Jahan Begum Charitable Trust. The Trust's primary focus is the education of impoverished young men and women residing in ghettos, slums, and beggar colonies. While the Trust's primary interest is in young women, men are included. The Trust operates an undergraduate college that awards bachelor's degrees and a law college that trains attorneys. The entire education is entirely free. All students are provided with computers, books, and all necessary learning materials. Dr. Ahmed has built all the buildings, and all students get free transport in buses owned by the college. Students are taught public speaking, life skills, financial management, survival, and, most importantly, leadership skills. The medium of instruction is English. Thus far, 9789 students have completed their education. Thirty-one young women serve as judges in State Courts, some as public prosecutors, and others in Law Practices. Their worlds have changed completely and forever.

This was Dr. Ahmed's design to solve generational poverty. The entire fundraising for the Trust is single-handedly Dr. Ahmed's effort through global and US connections.