Two recent faculty additions at the University of Arizona College of Medicine – Tucson’s newest department, Otolaryngology – Head and Neck Surgery, have teamed up to pursue innovative research to treat airway disorders like cystic fibrosis (CF) and allow patients – often children – a chance at a better life.
Eugene H. Chang, MD, FACS, has been appointed director of Rhinology and Skull Base Surgery and an associate professor of otolaryngology, while Kwang Chul Kim, PhD, has been appointed director of the Respiratory Mucus Research Program and a professor of otolaryngology research in the UA Department of Otolaryngology – Head and Neck Surgery, which became a department at the college in October 2014.
"The recruitment of Drs. Kim and Chang is another step toward building a world class sinonasal and airway program here,” said former interim head of the UA Department of Surgery, Alex Chiu, MD, now chairman of the new department. “Sinusitis affects nearly 15 per cent of the country's population and we’ve already developed a clinical program that draws patients from all over the state as well as Colorado, Texas and California.
“In addition to the basic science and translational research in Dr. Kim’s and Chang's labs, we’ve begun clinical trials looking at outcomes of sinusitis treatment, use of novel topical therapeutics in its management and the effects of early intervention for population health management. It’s our goal to become a national destination for clinical care and an international thought leader in sinusitis research."
Attacking Chronic Sinusitis, Cystic Fibrosis
Dr. Chang, a surgeon, is an up-and-coming National Institutes of Health (NIH)-funded physician-scientist specializing in sinonasal and upper airway disorders, such as chronic sinus disease and cystic fibrosis, and remedies to ease their symptoms. He comes to the UA from the University of Iowa Carver School of Medicine where he was an assistant professor and practiced in clinics in otolaryngology at the University of Iowa Hospitals & Clinics. While there, the UI Cystic Fibrosis Center developed the first transgenic animal model to study cystic fibrosis – a major milestone in its treatment.
“It was the first animal model to replicate human airway disease and we were able to characterize this animal model for CF sinus disease,” said Dr. Chang, who earned his medical degree from Brown University before conducting research funded by the Doris Duke Charitable Foundation and through an NIH Sinonasal Research Fellowship at Iowa. He also receives funding from the Cystic Fibrosis Foundation.
“We revealed a potential mechanism for CF sinusitis as well and applied a novel therapy that could essentially cure CF sinus disease for a small population of patients with a specific genetic CF mutation called G551D, which represents only 4 percent of people with CF but really transformed the way we treat CF airway disease.”
Cystic fibrosis is the most common autosomal recessive fatal genetic disorder for humans in the United States, affecting about 30,000 people – largely Caucasians. The most common mutation, present in about 80 percent of those with cystic fibrosis, is a Delta F508 mutation. People with two copies of this mutation are likely to suffer from severe pulmonary and pancreatic disease and have a shortened lifespan. One in 30 U.S. Caucasians carry one copy of the mutation. These people have a three times higher chance of developing chronic sinus disease, or sinusitis – nasal and sinus airway inflammation and infection that lasts greater than 12 weeks. Almost all people with cystic fibrosis develop chronic sinusitis. One of the most chronic U.S. medical conditions, sinusitis accounts for about $10 billion in direct health costs and two to three times that in indirect health costs, including time lost from work, decreased productivity, the cost of antibiotics and other medications and treatment.
“If we can figure out why people with CF develop chronic sinus disease,” Dr. Chang said, “then we can broaden our understanding of non-CF related chronic sinusitis, one of the most common chronic medical conditions in adults. Our goal is to provide the best surgical care for people with chronic sinusitis, and use animal and human research models to lead the way for innovative therapies to treat chronic sinusitis in generations to come.”
Among the reasons he joined the UA was the opportunity for a “fresh start,” Dr. Chang said.
“Dr. Chiu just started the new Department of Otolaryngology last fall with a young group that’s very hungry, very talented and very collegial. Using some techniques I had been involved with at the University of Iowa, I thought it would be a nice opportunity to build something from the ground up in sinonasal and upper airway research, which includes cystic fibrosis.”
Translational Research Shows Promise
With a long, successful research career himself that includes 25 years of NIH funding, Dr. Kim said he understood the feeling. He joins the UA faculty from Temple University in Philadelphia, where he recently retired as a tenured professor of physiology and the lung mucus research director at the Center for Inflammation, Translational and Clinical Lung Research – his area of strength being chiefly the study of lower airway infections and inflammation.
A native of South Korea, Dr. Kim has spent more than 30 years trying to understand the role and regulation of lung mucus in an attempt to control excessive mucus secretion as seen in patients with cystic fibrosis, asthma, and chronic obstructive pulmonary disease (COPD). COPD is the fourth-leading cause of death in the United States, affecting more than 15 million Americans. In 2008, he wrote the first translational review article on the anti-inflammatory role of MUC1 mucin, a protein he discovered during the early days of his lung mucus research. His current research on a MUC1 mimetic peptide offers promise in preventing development of chronic inflammatory diseases such as COPD.
His interest began during his post-doctoral fellowship he completed in the 1980s on molecular and lung cell biology at the NIH National Institute of Environmental Health Sciences in Research Triangle Park, N.C. He did his earlier undergraduate and graduate work at Seoul National University and earned a doctorate in pharmacology from The Ohio State University. In addition to Temple, Dr. Kim also held faculty positions at Boston University, the University of Maryland and Lovelace Respiratory Research Institute in Albuquerque, N.M. He now is engaged in research to translate his findings into drug therapies for clinical treatment of chronic inflammatory diseases, including COPD and cystic fibrosis.
Dr. Kim said he was asked to come to Tucson after retirement to help young physician scientists by UA Senior Vice President for Health Sciences Joe G.N. “Skip” Garcia, MD, whom he befriended while both were in Maryland. Dr. Garcia, who also is interim dean of the UA College of Medicine – Tucson, was then at Baltimore’s Johns Hopkins University as director of pulmonary and critical care, expanding research there from $2 million to $30 million in NIH-funding and earning the program a top national ranking. The new UA otolaryngology department, chaired by Dr. Chiu, already is in the top 40 for NIH funding among similar departments. The program also has been ranked among the top 30 nationally for Ear, Nose and Throat (ENT) programs by U.S. News & World Report.
“I felt, rather than just hit golf balls, let’s start a new life in this beautiful desert,” Dr. Kim said. “Dr. Chiu is an excellent leader. Skip is going to build a greater scientific community here to raise the UA’s national and international ranking. He has a lot of experience. I’m sure he can do it. Building such a medical enterprise here will make it much more attractive. I would like to contribute by helping young physician-scientists while actively launching a new anti-inflammatory drug – that’s why I decided to come here.”
A Host of Mentors for Young Physician-Scientists
Dr. Kim is impressed by Dr. Chang’s work, and the two plan to collaborate on their research.
“Dr. Kim has been a phenomenal resource,” said Dr. Chang. “He’s been kind of like a father figure in the amount he’s been able to accomplish in the lower airway. Having him will be huge from a mentor aspect and also translating some of the really critical findings he’s found related to the upper airway.”
Dr. Chang is also learning how to successfully wed research and clinical work thanks to Abraham Jacob, MD, otolaryngology department vice chair, director of the UA Ear Institute and an associate professor. Dr. Jacob’s neurotology work focuses on chronic ear diseases, particularly acoustic neuromas or benign tumors of the nervous system related to hearing and facial nerves.
“He was really one of the first physician-scientists in the UA Department of Otolaryngology and he’s been showing me the ropes in terms of how to have a successful surgical and research practice. That’s very rare in our field and so having him to look up to in that fashion has been very inspiring and serves as a model for what I’d like my practice to be in the next several years.”
Lastly, Dr. Chang looks to the UA’s Fernando Martinez, MD, director of the BIO5 Institute and the Arizona Respiratory Center. Dr. Martinez is his primary mentor on his KO8 NIH grant, a special clinical investigator award for promising medical scientists to pursue research.
“He’s been instrumental in helping me make these connections in the research environment at the University of Arizona,” Dr. Chang said. “And he’s encouraged me to think about novel roles of the upper airway, particularly the nose and sinuses, in asthma pathogenesis and research. This adds to the phenomenal strength and foundation that he and Donata Vercelli, MD (associate director, Arizona Respiratory Center), have produced in the world of asthma research. I’m excited to join their team.”
Dr. Chang sees patients at the University of Arizona Medical Center – University Campus — soon to be Banner – University Medical Center Tucson, following the closing of Banner Health’s merger with the University of Arizona Health Network this month. To make an appointment, please call (520) 694-8888. Learn more at uahealth.com.