Johnnie Aycock:
Every breakthrough, every innovation, every bold idea shaping our future begins with curiosity and the people willing to follow it.
Lisa Jones:
From research labs to manufacturing, from discarded materials to the next generation of design, this is BrightPath...
Johnnie Aycock:
Where science meets creativity and ideas come to life.
Lisa Jones:
The old idea that the brain, immune system, and aging process operate separately is completely wrong.
Johnnie Aycock:
Researchers are increasingly looking at chronic inflammation, immune memory, and cellular behavior to understand what may be happening silently inside the body long before disease is ever diagnosed.
Lisa Jones:
Hey, everybody, I'm Lisa Jones.
Johnnie Aycock:
And I'm Johnnie Aycock. And this is BrightPath.
Lisa Jones:
Today, we're joined by Dr. David Figge, Director of Clinical Immunology at UAB, the University of Alabama at Birmingham, and assistant professor in the Department of Pathology.
Johnnie Aycock:
Dr. Figge studies one of the most fascinating frontiers in modern medicine: how memory works inside both the brain and the immune system.
Lisa Jones:
His research bridges neuroscience, immunology, aging, epigenetics, and cellular behavior.
Johnnie Aycock:
Dr. Figge earned his M.D. and Ph.D. from the UAB School of Medicine and completed his residency training in clinical pathology at UAB as well.
Lisa Jones:
Dr. Figge, welcome to the BrightPath studio.
Dr. David Figge:
Thank you so much for having me, you guys.
Johnnie Aycock:
It's good to see you.
Lisa Jones:
Yes, great to see you again. Okay, so let's just dive right in, if that's okay with you.
Dr. David Figge:
Please do.
Lisa Jones:
All right, so, Figge, are scientists beginning to discover that the brain, immune system, and aging process may be far more connected than we once believed?
Dr. David Figge:
Absolutely, Lisa. They totally are. And actually, that's kind of why I went to medical school to begin with.
For the last 50 or 60 years, the way we've always been studying things has been kind of in a silo. The brain people studied the brain.
Lisa Jones:
Right.
Dr. David Figge:
Immune system people studied the immune system. But now, as we kind of get into the 21st century and start exploring, I feel like some of the hottest, most interesting questions in science today—and it's also why I went to medical school—are about the interactions between all these organs and all these systems. Trying to understand how they work together is a big thing because they are connected.
The nice part about medicine is that people always think something like blood pressure is just about your heart. "Oh, that's your heart."
But actually, when you look at it, it's your heart, your lungs, and your kidneys all working together to regulate your blood pressure. It's not just one of them.
And that's really why I went to medical school, because doctors learn what we refer to as organ-systems-level physiology and think about how your entire body works together versus just looking at one thing in a silo.
Johnnie Aycock: You know, it makes sense.
Lisa Jones:
It does make a lot of sense.
Johnnie Aycock:
And I'm wondering right now, because I deal with high blood pressure, they never check my lungs.
Dr. David Figge:
Your lungs are so important for oxygen, and they help control oxygen levels. They kind of help control how much vasoconstriction you have, or how high your blood pressure is, because your body wants to make sure the blood gets everywhere.
Lisa Jones:
So I love the way you put all of that together and describe that for our audience. This may be an old-fashioned notion. If it is, please tell me. But I've heard this for years. People would say, you know, you really need to get to the root of the problem. Would that apply here?
Dr. David Figge:
I mean, absolutely. A lot of times, that is exactly what I try to figure out. And that's kind of some of the strengths and weaknesses of our scientific process, where we obviously really want to make any investigation or discoveries very, what we refer to as, translational—or very clear and apparent in how they're going to have an impact.
Sometimes, and this happens with a lot of things, just trying to figure out how things work could eventually, while maybe not directly tangible, lead to some of our most monumental discoveries down the line. And honestly, that really has been the case over the years.
Sometimes you kind of have to just ask the question for the sake of knowledge and maybe not necessarily know why you want to know it quite yet.
Lisa Jones:
Wow.
Johnnie Aycock:
And that kind of leads to another question. A lot of us deal with chronic inflammation, different types. What are we learning about how that affects the overall immune system, how our body works, and those neurodegenerative types of diseases? Where is the connection?
Dr. David Figge:
That's a great question, Johnnie. So the fancy phrase that we use in my world is we call it inflammaging.
Johnnie Aycock: Inflammaging?
Lisa Jones:
Wow.
Dr. David Figge:
That's what we call it. And essentially, it's kind of the way that I sold myself on how a neuroscientist wound up in immunology.
I was really interested in understanding Parkinson's disease and trying to figure out how it happens. And what really makes a lot of the neurodegenerative diseases so unique from a diagnostic point of view, as far as I'm concerned, is that they're one of the only diseases that have age built into the diagnosis.
You have to have sporadic Parkinson's or Alzheimer's, and you have to be over the age of 50. Otherwise, we assume you have a genetic condition. We may not know what that is, but we just assume it has to be.
Lisa Jones:
And that is a safe assumption?
Dr. David Figge:
Exactly.
Johnnie Aycock:
Well, I mean the observation. You don't see any young folks with those diseases.
Dr. David Figge:
That's exactly my point. Because if it were truly random, with seven or eight billion people in the world, some poor, unlucky person—some 18-year-old kid—should have accidentally gotten Parkinson's or Alzheimer's. If it were truly random, that would happen. That's really what got me interested. What is so required with age?
Lisa Jones:
The memory—is that it?
Dr. David Figge:
Yeah, that's eventually where we're going. And, yeah, so that was kind of what got me interested. The only thing I've ever found that also correlated with age, besides the incidence of these chronic diseases, was that as you age, you just kind of generically become chronically low-grade inflamed. And they've actually connected that to the incidence of cardiovascular disease, hypertension, and all that kind of stuff. Because inflammation is actually what's going on when you have atherosclerosis and blockages in your arteries.
The fat is actually causing an inflammatory response in your vessels. The next one is cancer. Inflammation is a huge source of the cause of cancer. And so that's why I always say that your 50s and 60s are a lot of times when heart disease starts to pop up. Your 60s and 70s are classically when cancer appears, and our scientific and medical community in America has done a great job of turning that into a chronic condition.
Now we're figuring out that neurodegenerative diseases, which tend to hit you more in your 70s or 80s, are also inflammation-related.
So it just kind of seems like all of the big groups of diseases that get you in your 50s, 60s, and 70s are all kind of related to chronic levels of inflammation.
Johnnie Aycock:
Would it be fair to say that our immune system is remembering all of this? I mean, how is all that related? Because I'm thinking, as we age, I didn't know I had any cardiovascular disease, but as I got older, all of a sudden I started having heart issues. I guess there's genetics involved with those who have it at a younger age. We understand that, but it's so consistent with aging.
Dr. David Figge:
So actually, Johnnie, it's the other way around. Really, it's not forming memories; it's forgetting. The whole point when you're young is that your immune system has, as all young people do, very defined ideas of what is good and what is bad.
Lisa Jones:
Okay
Dr. David Figge:
Right, they know. And unlike in reality, actually, it does kind of know. Sorry, sorry, college kids. But as you age, what happens is your immune system becomes kind of brittle, just because as you age, you kind of start forgetting things. A prime example is clearing out infections. I got chickenpox.
Lisa Jones:
Okay. Yes. Yes.
Dr. David Figge:
I was one of the last people to get it because the vaccine came out when I turned about eight or nine. And so because of that, I'm going to kind of be part of the last group of people that ever get shingles. Because shingles, which is the disease that pops up when you're around 65, is literally because what happens is your body kind of forgets that it already fought the chickenpox.
Lisa Jones:
Stop it right now. Are you serious?
Dr. David Figge:
The virus gets reactivated, and then you get shingles.
Lisa Jones:
I did not know that was the explanation.
Dr. David Figge:
And so my sister, who is 10 years younger than me, got the chickenpox vaccine. She didn't have to sit in sweatpants and have her mom tell her not to scratch things.
So she's never going to get shingles. She never has to deal with that. And that's why, because the vaccine came out, I'm kind of part of the last generation that's going to have that problem.
Lisa Jones:
So what is the actual focus of your research as it pertains to inflammation and memory in the brain and immune system? What is your approach?
Dr. David Figge:
Great question. So right now, I'm still young, and I'm kind of growing as we go. I know where I want to wind up, and we're all going to take little paths to get there.
But right now, what I'm really focused on is trying to understand how T cells work. T cells are really the most important parts of the immune system that remember things. They're the kind of cells that we're trying to get to form when we give you a vaccine.
Essentially, I'm trying to understand: How do T cells remember things? How do we choose which ones should be remembered and stay there long-term, and how do we choose which ones don't?
And so that's like half of my lab.
Lisa Jones:
Okay.
Dr. David Figge:
The other half of my lab is actually a little more oriented toward Parkinson's disease, and it's trying to understand how inflammatory mechanisms exacerbate or help in Parkinson's disease.
Lisa Jones:
Wait, you're saying they could help?
Dr. David Figge:
In fact, I'm telling you that they do. And actually, the reason that you have Parkinson's disease is because the immune system stops working as well. That's actually the problem.
And the prime example of this is kind of twofold: one, you guys may not know it, but actually, all of us have cancer in us right now, at all times. We just have cells that don't divide right. But normally, what happens is your immune system comes in and eats those cells and gets rid of them before they can really become a problem.
When you've seen loved ones with cancer, that's because the immune system has kind of already lost the battle, and the cancer is overwhelming it so much that now I can see it.
But you can see that a lot of our most modern therapies for cancer are what we call immunotherapeutics. They're actually trying to stimulate the immune system to fight the cancer.
Same exact thing for neurodegeneration. If you're going to have Parkinson's or Alzheimer's, for most of us, it's going to start already in your late 30s or early 40s. If I have it, I probably already have it. And the problem is, we just don't see it until you're in your 60s because it takes so long. Your brain has so much reserve and resilience that it takes that long to show up.
But in reality, the processes that are likely precipitating Parkinson's and Alzheimer's are happening in your 30s. That's because my immune system isn't clearing things out normally like it should, and it's just kind of losing that battle.
Johnnie Aycock:
What are we learning about a process to shortcut it, to kind of address it before it begins to develop? Whether it's a cancer cell or a Parkinson's cell, what are we learning about prevention methods, preventive processes that we all need to be paying attention to? Are we at that point yet?
Dr. David Figge:
Absolutely, we are. It's just that we may not have made the connection as well as we could. My prime example for this is—I know it's a little taboo right now because scientists kind of flip-flop on things a little bit—but the prime example is baby aspirin. I imagine you were asked to take a baby aspirin when you started being worried about your heart.
Johnnie Aycock: About 20 years worth.
Dr. David Figge:
Yeah, but you notice that it's always a baby aspirin. It's always the little one. And you're like, "Why are we getting the little one instead of the big one?"
Literally, it's because a lot of times when we take aspirin, it's because there's a lot of inflammation, and that's what's causing us to have pain. So we take it.
But baby aspirin is actually meant to address exactly what we're talking about.
Lisa Jones:
It addresses inflammation.
Dr. David Figge:
You give a little bit just to kind of tamp down that inflammation. The reason we flip-flopped on those guidelines is because, as you may be aware, Johnnie, if you take a baby aspirin, it does kind of thin your blood out a little bit. People get annoyed when they knock into things and get little bruises and stuff. And so that kind of became the risk.
The guidelines switched because if you come into the hospital after a car accident and you're bleeding, taking baby aspirin makes your blood thinner, and it makes it a lot harder for me to try to address that. So essentially, it became a risk-benefit ratio. They made the decision that if you're worried the patient is not going to live for, I believe the number was about 10 more years, then it probably isn't worth it because the risk of them needing to be cared for in a hospital outweighs the benefit.
But if you think they're going to last for over 10 years, then actually, just hindering that little bit of low-grade inflammation is more health-positive than anything else.
Lisa Jones:
Is there any kind of dosage compromise there, Figgie? Are we doing that even below baby aspirin?
Dr. David Figge:
That's a great question, and probably there is. But the way the medical world works, our number one concern whenever we do anything with people is, in my ethos, do no harm.
And what matters is that we ran our clinical trials on 81 milligrams. We know that works. If I suddenly start switching it, well, now you've got so much data—
Lisa Jones:
Exactly. You've got the hard data. Theoretically, the peer-reviewed science is what it's all about. I get you.
Dr. David Figge:
So maybe if someone did it again, they could find the same effect with 40 milligrams instead of 80. But then you're going to have to go through all the clinical studies on that.
I have them on 81, so I know that's good. I'm going to use that, and maybe a different number is better. But because I know 81 is good, I'm not going to just start cowboying because that could be how you accidentally hurt people. You know what I mean?
Johnnie Aycock:
We'll stay on this trail for just a minute. I literally have been taking baby aspirin for almost 20 years.
Dr. David Figge:
I believe it.
Johnnie Aycock:
But guess what? I just had something added to my dosage. Now I'm taking Eliquis.
Dr. David Figge:
Ah, yes, exactly.
Johnnie Aycock:
And so I'm thinking, okay, I've been on this one thing that's supposed to be evaluated for protecting my heart, and then all of a sudden it's not working anymore. They've got to add something else.
The inflammation thing has got my attention, what you're talking about. So I go back to an earlier part of the conversation. Are there steps or processes that we as individuals, as we age, should be implementing? Do we know what those are yet?
Lisa Jones:
And the second part of that question is: Shouldn't Johnny Rocket get back into the gym?
Johnnie Aycock:
She got me on that one.
Dr. David Figge:
Guess what? Those two things are connected.
Johnnie Aycock:
Yeah, they are. They are. I know that.
Dr. David Figge:
So a big thing with it is lifestyle modifications. We don't necessarily always understand why, but certain things have been shown to help. A big one is what you eat. I'm not going to lie. I know this is a hot topic, but plants are good in general. We need a little bit of meat, but in general, you don't need maybe as much as we consume. I forget the name of it. He's written several books on food. He's a scientist at Stanford who's very interested in the way humans and plants have evolved. He had a really great quote related to diet that I think is: Eat primarily plants in smaller portions.
I think that's really good advice.
Johnnie Aycock:
Well, we had a nutritionist friend on our noon show recently, and she reminded us to just go to the outside aisles of the grocery store. Don't go inside. Go outside.
Lisa Jones:
Yes. And I've got a further comment. So I know you've heard, Figgie, about the Blue Zones of the world. That really hits home when you say the diet matters.
So tell us a little bit about what you know about the Blue Zones and how diet affects those Blue Zones.
Dr. David Figge:
So the two big Blue Zones that I'm aware of—there's an area of Japan that has people who are—
Lisa Jones:
Okinawa.
Dr. David Figge:
I'm not sure exactly.
Lisa Jones:
There's Okinawa and then some others. There are several.
Dr. David Figge:
I just know it's a very high concentration of centenarians, people over 100. And then the other one that is very notorious is the Mediterranean.
Johnnie Aycock:
Yes.
Dr. David Figge:
And effectively, a lot of people have looked into that. The big things they talk about are, again, a very plant-based diet, lots of fish.
A big reason for that is—I know this isn't popular—but a lot of the fats specifically in red meat have been shown to exacerbate inflammation. And so we think that probably the differences in the fats that are in fish are important. The other thing that's very popular with the Mediterranean diet is olive oil. That type of fat is supposedly much less inflammatory than others, and that's thought to—
Johnnie Aycock:
Yeah, the Mediterranean diet is often prescribed, and I think it's a good diet, actually.
Lisa Jones:
Yeah, I think so too. But you're talking a lot about inflammation. Would you say that these Mediterranean diets, the diets that are prevalent in the Blue Zones, help to actually fight inflammation without having to take, say, a baby aspirin?
Dr. David Figge:
That is absolutely correct. That's exactly what I'm trying to imply. I can't tell you guys exactly why that is.
Lisa Jones:
It's not peer-reviewed, so you can't say—
Dr. David Figge:
Oh, no, no, it is peer-reviewed.
Lisa Jones:
It is peer-reviewed.
Dr. David Figge:
We don't know why. We just know they're correlated.
Lisa Jones:
Okay.
Johnnie Aycock:
How do things like stress and anxiety affect inflammation?
Lisa Jones:
What a great question!
Dr. David Figge:
They do a lot. The best example of this is actually when you get scared or nervous, you get a rise in a very special hormone called cortisol. Do you know what one of the most important roles of cortisol is?
Lisa Jones:
What's that?
Dr. David Figge:
To turn off inflammation. So, right, all of the people with autoimmune diseases— yeah, yeah. You know as well as I do. Anyone who has autoimmune diseases, we give them steroids. That's what cortisol is. We give steroids to turn off inflammation.
Lisa Jones:
Interesting.
Dr. David Figge:
So cortisol is very interesting. My wife's an endocrinologist, as you guys may remember, and cortisol is one of those compounds that has huge effects and affects all the cells across your whole body. But that's why, when you have a really stressful experience, like taking finals or whatever, you get sick for a reason.
All that stress is kind of messing with your regulation of your immune system. It's kind of exactly like aging. It doesn't know which way to shoot and who's good and who's bad.
Lisa Jones:
So the thing about stress is, and I know Johnnie's a big Mel Robbins fan. I am too, but I'm the world's worst, too.
We'll just say when it comes to stress, probably my reaction to it is not always golden. And I would like to think that if I could really turn that mindset around full-time, I do have the awareness, which is a giant first step.
Wouldn't you say that meeting that stress with a different mindset, one where you try to remain calm and maybe take some deep breaths—which is, in reality, very difficult—what is your opinion on that?
Dr. David Figge:
I couldn't agree more with you. Unfortunately, I don't know if I'm quite as far down the line as you are. I've actually never been one of those people. It's why I'm a good scientist. You don't want me to be your ER doctor because I get a little overwhelmed when stressful things start happening. I'm a thinker. I'm a scientist. It's like, three years—I'm going to think about the same problem every day. I want a long runway that I can perseverate on.
Johnnie Aycock:
But again, going back to stress and anxiety and that type of mental pressure on ourselves, is that turning off the cortisol, basically?
Dr. David Figge:
No, it's causing it to go up. And because of that, your body is in a really fine balance. The moment you start doing that kind of stuff, the body gets confused.
Like, well, do I want to turn this inflammation off? Do I want to do this? Is this real? And you kind of start getting confused.
Johnnie Aycock:
So it fights that management of inflammation, basically.
Dr. David Figge:
Because you've got to remember, the body's number one thing at the end of the day is to keep you alive in the moment, right.
We've got to be ready sometimes when a lion's chasing me, you know? So the cortisol rush, although it's going to kind of suppress my immune system, your body is kind of saying, "Yeah, I don't need that right now. We need to run from a lion. We've got to run. Run from the lion." I don't care about that. And so that cortisol might make you mobilize your sugar so that you can run really fast and go really hard, and your heart will start beating. But exactly like what we kind of think is how PTSD works, your body never learns how to turn that system off again because of the memory.
Lisa Jones:
Yeah, we're learning in here today, y'all.
Johnnie Aycock:
This memory-based, but it doesn't mean just the brain.
Dr. David Figge:
Correct. It's your whole body. Your whole body has memory.
Johnnie Aycock:
Wow, this is just fascinating. I want to go back one more time before we get through here today. In describing once again for our listeners, how do we change or create that lifestyle to help us manage the inflammation that seems to be at the heart of all of this?
Dr. David Figge:
It's a great question, Johnnie. Unfortunately, I'm going to sound like every other doctor. It's lifestyle management, which is one of the hardest parts. It's about doing little things that will not only help your stress but also help your health.
Walks after eating. Fifteen minutes before you go out, just to do that. Not only is that exercise helping you digest and everything, it's known to reduce stress. Also, the diet changes. I am as guilty as anyone. I just ate a bunch of Dreamland. I feel like McDonald's later.
Lisa Jones:
Confessional time.
Dr. David Figge:
I will be honest. I am not—
Lisa Jones:
You're just human.
Dr. David Figge:
I live in glass houses. I'm not throwing stones. Look, my job is to provide the best advice.
Lisa Jones:
We're going to give you a pass on that. You're in Tuscaloosa. It is allowed.
Dr. David Figge:
Okay. Just those kinds of things: eat smart and be pretty active. Those are the keys. And although I can't guarantee anything, I can't guarantee that the sun will come up tomorrow. But I know that, in general, those things will help you. They work.
Johnnie Aycock:
They work.
Lisa Jones:
And I like that you said "in general." I would like to make a comment about what you just said about eating Dreamland. In general, you are eating healthy, but when you come to Tuscaloosa and want Dreamland, you best allow yourself to do it because you don't want to completely deprive yourself.
Dr. David Figge:
You've got to enjoy life, enjoy life...
Johnnie Aycock:
And you've got to address the stress. And barbecue ribs? Treat yourself sometimes.
Dr. David Figge:
Maybe go get a Rama Jama's and Gallēttes afterward.
Johnnie Aycock:
There you go.
Lisa Jones:
We totally support that.
Johnnie Aycock:
I have to ask one more question before we get through here, and it's just a real brief one. I know you do a lot of work and research related to Parkinson's. How far away do you think we are from finding solutions to diseases like Parkinson's? Are we far away, or is it something that looks promising?
Dr. David Figge:
It looks promising. The problem is how long the disease takes. By the time you find it, by the time you have symptoms— as we kind of were referencing, it takes 20 years for you.
Johnnie Aycock:
That's what you said.
Dr. David Figge:
And everyone will tell you it's always way easier to prevent something than it is to fix it. So really, what I think my goal is, to be honest with you, I'm not trying to cure Parkinson's and Alzheimer's. I want to do what they did with cancer. I want to turn it into a chronic condition.
Because, as I kind of mentioned, your 50s and 60s are when heart disease is a problem. We've got blood pressure pills and all these things. People still pass away from heart attacks and strokes, but we kind of kick the can down the road.
Then cancer is the problem in your 60s and 70s. And then we kick the can down the road, and now neurodegeneration is really a problem in your 70s and 80s.
I don't want to cure it. I want to kick the can down another decade, and maybe something else will be a problem.
Maybe I'll get hit by a truck when I walk across the street. I don't know, but I just want to give people that extra time.
Johnnie Aycock:
So maybe early diagnosis types of approaches...
Dr. David Figge:
And just kind of stall it. Really, what I'm trying to do is stall the progression of it. Just slow everything down.
One of my own father figures got a neurodegenerative disease. I'd gladly take five more years. Who knows what's going to happen in those five years? A pandemic might happen in those five years.
Johnnie Aycock:
Is there any progress on creating earlier diagnosis, back in the 20s and 30s? It seems like that would be a huge step.
Dr. David Figge:
Absolutely. So the biggest one that's really developing that is my competitor, Alzheimer's. They have really developed a lot of things. They've even started immune therapies for Alzheimer's that just went through the FDA recently, and we're doing them at UAB.
But they've also really gotten oriented, because of that whole prevention thing, toward trying earlier biomarkers to figure out who's going to get it as early as possible so we can intervene as early as possible. And that is a huge amount of the work of the Michael J. Fox Foundation, which you guys may have heard of, and also a lot of the Alzheimer's research.
It's all about trying to figure things out because we're just so much more effective at preventing things than fixing them on the back end.
Johnnie Aycock:
That's an encouraging word that we're going to have to—
Lisa Jones:
Yeah, kind of close it. I'm really enjoying this conversation.
But, you know, Johnnie Rocket, I am a big fan of old sayings, and I'm going to say one: An ounce of prevention is worth a pound of cure. And that's great to live by.
And on that note, I'm just going to go ahead and close this out, y'all. What a great, great, great conversation.
Thank you so much to Dr. David Figge for driving over from UAB to join us here on campus at the beautiful University of Alabama Digital Media Center.
For Johnnie Aycock, my name is Lisa Jones, and this has been BrightPath.
Johnnie Aycock:
BrightPath is made possible in part by our partners at Alabama Public Radio and by the music of Matt Jones, whose song "This Place" sets the tone for our journey.
Thank You.
