Cohn performed his internship and residency at Massachusetts General Hospital, then entered the
Army Medical Corps as a captain, working in the laboratory of virologist
Joseph Smadel at the
Walter Reed Army Institute of Research. For two years Cohn "explored respiratory enzymes and the cell wall of the intracellular parasite Rickettsia tsutsugamushi."
Rockefeller Institute for Medical Research In October 1957 Cohn was appointed assistant physician and research associate at the Rockefeller Hospital and what was then called the Rockefeller Institute for Medical Research (later
Rockefeller University) in New York, where he worked in the laboratory of
René Dubos, whose 1954 monograph Biochemical Determinants of Microbial Diseases he considered "visionary and provocative" and "always kept within reach." Dubos's studies in microbiology had played a key role in the development of antibiotics. Yet there was little understanding of how these "wonder drugs" worked. Cohn's first project in Dubos' lab, which he conducted with Steven Morse, was to confirm that it is polymorph leukocytes that kill the bacteria that cause staph infections. Moberg and Steinman describe the situation in the Dubos Laboratory of Bacteriology and Pathology, as follows: "Dubos fostered investigators, not mere problem solvers, thus allowing newcomers independence to plan experiments and progress at their own pace. As [Cohn] said in a 1983 interview, Dubos had a habit of talking to newcomers 'for the first two days, and if he thought they could get along on their own he would not talk to them again for another year. I was terribly upset, I must say.'" Cohn worked at Rockefeller for the next 35 years, "most of them on the fourth floor of Bronk Laboratory." When Cohn began working under Dubos, as Moberg and Steinman explain, "the study of leukocytes was still in its infancy....It was also the time when the new science of cell biology was emerging at Rockefeller....This was making it possible to explore the world inside cells: electron microscopy for showing cell structures never before observed and centrifugation methods for separating and analyzing cellular constituents." Cohn and his colleague
James G. Hirsch "used these new tools to address the question of whether phagocytes contained preformed bactericidal substances or whether these substances developed after foreign particles were engulfed. They isolated granules from the rest of the cell contents, used phase and electron microscopy to visualize them, and determined chemically that they were lysosomes, the cell organelles recently identified by Belgian biochemist Christian de Duve. These discoveries, which traced the phagocytic digestive system to the fusion of phagocytic vacuoles and lysosomes, became widely available to the community after Jim and Zan made a remarkable series of films showing living phagocytes discharging their abundant lysosomes to kill bacteria." In 1966 Cohn was made full professor at Rockefeller, which had just changed its name from the Rockefeller Institute for Medical Research to the Rockefeller University, and, with Hirsch, formed a Laboratory of Cellular Physiology and Immunology. There they explored macrophages, about which little was known. Cohn's "adroit tissue culturing of macrophages made it possible to observe, challenge, and manipulate them to figure out how they worked." He showed how "the cell's outer membrane folds around the captured material, forms a sac or vacuole that is pinched off from the cell surface and enclosed within the cell, and fuses with the lysosome where the contents are then digested." The result, as Moberg and Steinman put it, was the transformation of endocytosis into "a central field of cell biology, because it is pertinent to all cells for extracting from their surrounding environment the nutrients needed for survival as well as for capturing and destroying toxins and pathogens." A Rockefeller University source puts it this way: "Cohn's discoveries on endocytosis in macrophages have proved fundamental to cell biology, since endocytosis is a process universal to all cells, and is the mechanism by which cells digest materials from their surroundings, ranging from microbes to proteins carrying nutrients." Cohn's team discovered other key functions of macrophages, moving beyond endocytosis to study macrophages' secretions and identifying more than 50 products of macrophages that play "active roles in inflammation and immunity." The team found that "activated macrophages release active oxygen intermediates, such as superoxide and hydrogen peroxide, to destroy bacteria and tumor cells. A further demonstration that macrophages could be activated by lymphokines in vivo was important in the laboratory's subsequent clinical efforts to treat diseases in which macrophages achieve both intracellular and extracellular killing." Cohn called macrophages the "versatile element of inflammation," with some of their secretions resulting in the healing of wounds, the repair of tissues, or the destruction of microbes and tumors, while excessive amounts of secretions from overstimulated microphages can intensify various diseases, including rheumatoid arthritis and atherosclerosis. An interview with Cohn described the discovery of the secretory role of macrophages as follows: "A major immunological finding, which has come primarily from work in Dr. Cohn's laboratory, is that macrophages are not just eaters. In addition to the chemicals they make to kill and degrade the cells they ingest, they also secrete many molecules into their surrounding environment, affecting the activity of other cells. 'This is an important part of the inflammatory process, which may lead either to wound healing and tissue repair or to destruction of tissues,' says Dr. Cohn. 'Among the secreted chemicals are those that stimulate the formation of blood cells and blood vessels; pyrogens, the fever-producing substances; and enzymes involved in lipoprotein metabolism. A delicate balance exists in the amount and nature of the secretory products. When present in excessive amounts disease states such as rheumatoid arthritis, glomerulonephritis, and even atherosclerosis may be potentiated.'" Looking into the genesis of macrophages, Cohn and his colleague
Ralph van Furth "used a radiolabeled isotope to label blood monocytes and trace their production and development. They identified the blood monocyte as the precursor for tissue macrophages and the bone marrow as the source of monocytes." At the same time, electron microscope studies he performed with Hirsch and Martha Fedorko provided further insight into macrophage formation and differentiation. This work, according to Moberg and Steinman, "illuminated a pivotal pathway to host defense and captivated the minds and spirits of innumerable scientists," resulting in five international conferences on mononuclear phagocytes held at Leiden between 1969 and 1991.
Ralph Steinman joined the Cohn-Hirsch laboratory in 1970, and eventually it became the Cohn-Steinman laboratory. In 1973, in the course of studying macrophages, Steinman and Cohn discovered "an entirely distinct class of immune cells" which differed "in structure, appearance, and function from macrophages" and which would come to be recognized as "powerful initiators of the immune response and major controllers of both innate and adaptive immunity." As one source puts it, this cell, which Steinman named the dendritic cell, would later be found "to be the sentinel cells of the immune system." In the early 1980s, wanting to discover "why in certain diseases the macrophages, after ingesting pathogens, not only fail to kill them but instead provide a hospitable environment for them to thrive, multiply, and reactivate disease," and thus develop therapies, Cohn and other members of his team began visiting hospitals in Brazil, and later in Colombia, Ethiopia, India, Nepal, and the Philippines, to study patients with leprosy and various other diseases, including tuberculosis and AIDS. "For some reason," Cohn said in a 1983 interview, "no one had ever really looked very hard at the local skin lesions of leprosy patients. Diagnosis has usually been based on analysis of cells in the blood stream. So when we first went to Brazil, we decided that we would examine the cells in the skin. In the virulent lepromatous lesions we found bacteria-filled macrophages together with a large number of suppressor T cells. As we studied patients in the intermediate stages of the disease and on to the tuberculoid form, we found that the number of so-called helper cells began to increase relative to the number of suppressor T cells." This, Cohn said, suggested "that the suppressor cells produce a factor which, in effect, turns off the macrophage. Or else, the macrophages don't work because of the absence of helper cells. The question is, Can you suppress the suppressors or help the helpers? Some experiments we've been doing in the lab with cells of other diseases indicate that either or both may be possible, but we need to know a lot more about the bacteria and the immune cells before we can manipulate them clinically....What we can learn about these suppressor cells...is also of great interest because there's a fair amount of evidence in many animal models that suppressor cells modify the ability of a host to fight off tumors, and that if you can destroy the suppressor cells, you'll allow normal body defenses to come back and destroy the tumor." The examination of T cells in leprosy patients led Cohn and his team to develop treatments that "restored some of the patients' immune function at both the local and systemic level, although they did not cure the disease." Cohn developed "high expectations that lymphokines and other agents interacting with macrophages would someday enter the physician's armamentarium to fight disease." At the time of his death, Cohn was arranging "an expanded program to enhance the immune system of immune-compromised individuals with
AIDS and tuberculosis." Cohn was appointed Rockefeller University's vice president for medical affairs by President Torsten Wiesel in 1992. During the last seven years of his life, Cohn was also the Henry G. Kunkel Professor at the university. In addition, he held the title of senior physician at Rockefeller University Hospital. For a long period, ending only two years before his death, moreover, he was principal investigator at the Irvington Institute for Medical Research. ==Other professional activities==