Funds at Work

Joren C. Madsen, M.D.
Massachusetts General Hospital

Funding provided by TSFRE played a critical role in advancing my research career. I became an attending cardiac surgeon at Massachusetts General Hospital in 1993. In 1995, I was awarded a TSFRE grant for a project entitled, Cardiac Allograft Vasculopathy in MHE Inbred Miniature Swine. This TSFRE funding allowed me to establish the first large animal model of chronic heart rejection. In doing so, I was able to generate enough preliminary data to successfully apply for my first RO1 grant from the NHLBI. Since then, I have dedicated 50% of my time to research and now run an internationally recognized transplantation laboratory called the Cardiothoracic Transplantation Laboratory in the Transplantation Biology Research Center at the Massachusetts General Hospital. My laboratory is currently funded by six RO1-equivalents from the NIH and is run by seven post-doctoral research fellows from around the world (one of whom, Dr. Sahara, was just awarded a 2005 TSFRE grant). Furthermore, Dr. James Allan, another TSFRE recipient and now a TSFRE committee member, is Co-Director of the laboratory. Our fellow’s projects range from molecular biological studies in mice to pre-clinical tolerance induction trials in swine, to pig-to-non-human primate xenotransplantation experiments using cloned pigs.

My goals are to extrapolate tolerance induction protocols that have proven successful in the laboratory to human heart transplant recipients and to bring xenotransplantation to the clinic. I believe that both these goals are attainable in the near future.

I perform about 150 adult cardiac surgery cases and heart transplant procedures a year. My research activity does not affect my care of cardiac surgery patients. However, it does limit the number of cases I can do a year.

The two major barriers to cardiac surgeons conducting research and obtaining funding are the precipitous drop in reimbursement rates leading to an overriding concern for the “bottom line” and the recent drop in federal funding to the NIH. That is why the TSFRE is more important than ever. The TSFRE grant reviewers understand the problems facing young cardiothoracic surgeons trying to write grants and perform research. There is no doubt that TSFRE will become the cornerstone for the future funding of young cardiothoracic surgeons interested in research. It is critical that the TSFRE remains strong and well supported by the members of our specialty.

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Elaine Tseng, M.D.
University of California, San Francisco

TSFRE was very helpful with my research endeavors by providing funding support for two years in the laboratory at John’s Hopkins Hospital.

My project involved investigating the mechanism of neurologic injury after hypothermic circulatory arrest. We discovered that neuronal apoptosis in addition to necrosis was involved in the neurologic injury of HCA. We also determined that inhibition of neuronal nitric oxide synthase reduced both neuronal apoptosis and necrosis after HCA.

Research funding was critical in order to perform the experiments as large animal work, tissue processing, immunohisto-chemical staining, TUNEL, EM, are costly endeavors.

Future research plans involve investigating the biomechanics and flow dynamics of percutaneous aortic stent valves. The neurologic injury work is crucial to the eventual development of strategies to reduce cerebrovascular complications after open heart surgery.

The biomechanics and CFD work on percutaneous stent valves will be essential to determine the feasibility and safety of such endovascular approaches to valvular disease in the future.

Barriers in research funding are to find sources of funding that understand the translational nature of such research and thus understand the importance of such work.

TSFRE has advantages since it is for thoracic surgeons to make advances within our field as opposed to government agencies or industry that may or may not understand the need for such work. Industry will not necessarily be interested in work that potentially may reflect poorly on the outcomes of the new innovative products. Government agencies may not value such translational/developmental efforts.