This is the first in a series of stories about the Brigham Research Institute Centers. The BRI includes 10 disease-focused research centers that develop and support collaborative research initiatives. This infrastructure allows our diverse community of clinicians and scientists to communicate more effectively, providing numerous opportunities for them to collaborate on research aimed at curing, treating and preventing human diseases and conditions. The story below highlights some of the exciting work happening in the Lung Research Center and Lung Center of Excellence.
When someone receives a lung transplant, they get a second chance at life, says Raphael Bueno, MD, chief of Thoracic Surgery at BWH, co-director of the Lung Center and co-chair of the Lung Research Center. They’re able to get back to doing what they love—running a race, taking walks around a favorite park or blowing out candles on a birthday cake.
With last year’s formation of the Lung Center and Lung Research Center, BWH can advance the prevention, diagnosis and treatment of lung diseases through research while also expanding on its offerings of specialized and innovative care, such as lung transplantations.
“Our goal is to deliver extraordinary care for any lung condition—from asthma to cystic fibrosis to rare thoracic and lung cancers like mesothelioma,” says Bueno. “We’ve brought more than 30 clinical and research programs under our scope. Combined with our academic setting, the two centers are the most ambitious centers of their kind.”
Revolutionizing Patient Care With Help From Innovative Research
The Lung Center is a medical and surgical collaboration between the Division of Thoracic Surgery and the Division of Pulmonary and Critical Care Medicine, as well as other divisions and departments at BWH, including Anesthesia, Perioperative and Pain Medicine, and, at the Dana-Farber/Brigham and Women’s Cancer Center, Pathology, Radiation Oncology and Medical Oncology. Meanwhile, the Lung Research Center connects BWH’s researchers in lung health and disease to accelerate discoveries and quickly bring them to the bedside.
“When we’re thinking about growing a program or creating a program on the clinical side, we’re also doing it with a mindset that will also explore how we will advance care through research,” said Bruce Levy, MD, chief of the Division of Pulmonology and Critical Care Medicine, co-director of the Lung Center and co-chair of the Lung Research Center.
Since the early 1990s, BWH has been a leader in lung transplantation and just this year hit a major milestone: performing a record 51 lung transplants since Oct. 1, 2015—the highest number ever achieved in one year at BWH and in New England. The previous record was 36. Last year, the center performed 28 lung transplants.
“Typically, for every 10 donors, we only get one set of lungs that are actually suitable for transplantation, making lungs a particularly precious organ,” said Bueno. “We’ve realized that in order to better serve our patients, we need to seek out as many potential donors as possible, which in turn means patients on the wait list can get lungs transplanted sooner, thus reducing the mortality rate.”
The Lung Center has been able to increase the number of lung transplants performed annually based on several factors, including increased staffing, carefully evaluating every single lung offer and making new technologies available to patients, Bueno said.
The center now has four surgeons on staff whose main focus is performing lung transplants and caring for transplant recipients. The Lung Center has also identified additional faculty who are able to evaluate organs.
Advanced Technology Expands Organ Availability
Two technologies used in the Lung Center are also helping to expand the number of organs available for transplantation. Extracorporeal membrane oxygenation, or ECMO, is an intensive-care technology that takes over the work of the lungs temporarily for patients waiting for transplantations. It acts as a lung to deliver oxygen to a patient’s bloodstream, allowing damaged lungs or a stressed heart time to rest and recover. Ex-vivo lung perfusion (EVLP) is a procedure used to support donor lungs after recovery in an effort to make them suitable for transplantation. Research projects to refine and improve both ECMO and EVLP are underway.
One aspect about EVLP that Bueno said is exciting for both clinicians and researchers is the potential for it to perfuse lungs infected with hepatitis C or pneumonia, for example, with anti-viral medications that would essentially cure the lungs and subsequently make them suitable for transplantation. Thanks to EVLP, he expects there will be 10 to 20 additional transplants performed next year.
Bueno said the availability of the device raises the question of whether its uses extend beyond transplants. For example, could a lung that’s full of cancer be taken out of a living person, treated with extra-high doses of chemotherapy with EVLP and then be put back in the patient? Investigators in the Lung Research Center are exploring questions like this.
“This is a wonderful example of how unmet clinical care needs guide research directions,” Bueno said. “In turn, research results get rapidly translated to new, clinical opportunities for our patients.”
Connecting Clinical and Research Missions
In addition to research projects that may help expand the number of viable organ donations for lung transplantation, Lung Research Center investigators are also working on research efforts in many other areas related to lung diseases that have the potential to transform clinical care.
The BWH Interstitial Lung Disease Clinic team and the Pulmonary Genetics Center will soon conduct one of the first patient-focused studies of early pulmonary fibrosis detection in the country. Pulmonary fibrosis includes a number of lung diseases that result in lung scarring. Most cases are idiopathic, meaning their cause is unknown.
“Our hope is that this study will be a spark that ignites efforts in the pulmonary community to move beyond disease classification to disease prevention,” said pulmonologist Matt Hunninghake, MD, MPH.
Hunninghake and his team have been at the forefront of early pulmonary fibrosis detection. The team’s studies have demonstrated not only the physiologic and genetic connections between research subjects with early stages of pulmonary fibrosis and patients with late-stage pulmonary fibrosis, but also that early pulmonary fibrosis carries a high burden of morbidity and mortality despite its relatively common occurrence in the general population.
Elliot Israel, MD, director of Clinical Research in the Pulmonary and Critical Care Medicine Division, recently received a $14 million grant to lead a national study to evaluate methods to reduce the disproportionate burden of asthma in African American and Latino populations. The grant is based on Israel’s work showing that innovative, patient-friendly approaches for use of asthma medications may be more effective than current ways of treating asthma.
Finally, through the Vitamin D Antenatal Asthma Reduction Trial, Scott Weiss, MD, MS, co-director of Systems Genetics and Genomics in the Channing Division of Network Medicine (CDNM), and Augusto Litonjua, MD, MPH, also of the CDNM, are testing the concept that vitamin D supplementation to pregnant mothers may reduce the development of asthma in their children.
Last month, the Lung Research Center hosted its Heart and Lung Research Symposium, featuring researchers from BWH and the University of Cambridge in England. The symposium included a poster session open to lung and heart researchers. The goal of the event was to bring together heart and lung clinicians and researchers, highlight ongoing research activities and encourage cross-collaborative research efforts, Levy said.
Edwin Silverman, MD, PhD, chief of the CDNM, who co-directs the Lung Research Center with Bueno and Levy, sees ongoing opportunities to increase the volume, quality and depth of collaborative efforts throughout CDNM, Pulmonary and Critical Care Medicine and the Division of Thoracic Surgery over the next year.
“But it’s not only within these three divisions that we are collaborating,” Silverman explained. “We’re working with Radiology, Pathology, Anesthesiology and others. We are certainly very open to new ways of interacting with each other. The potential is limitless.”
Added Levy: “We are always thinking about ways in which we can connect the clinical and research missions of the two centers. We wanted to build a clinical operation that was cognizant of the needs of our clinical translational researchers. When we’re collecting samples from a patient for a bronchoscopy or biopsy, for example, we want to do it as a shared resource to enable investigators to perform translational research as well.”
Want to learn more about the ongoing work of the Lung Research Center? Join us for Discover Brigham 2016 on Thursday, Nov. 10 and catch the Lung/Pulmonary session at 1 p.m. Register for Discover Brigham here.