Jeffrey Towbin, heart, Heart Clinic, Juan Reyes
Memphis is evolving as a major center of medical research and education, although not so long ago there were gaps in patient care — particularly in the pediatric area. It’s common knowledge that St. Jude Children’s Research Hospital is on the cutting edge of cancer treatment and Le Bonheur Children’s Hospital has been making strides in other kinds of care.
But a few years ago, Le Bonheur, even with solid clinical and surgical programs, wanted to do better. Making its heart institute world-class required improving some areas and reinstituting its transplant program, which hadn’t done such an operation since 1998.
Enter Dr. Jeffrey A. Towbin, who was hired in 2014 to be a co-leader with Dr. Christopher Knott-Craig of Le Bonheur’s Heart Institute. Towbin specializes in diagnostic and therapeutic advances for cardiomyopathies (heart muscle disease), heart failure, heart transplantation, and cardiovascular genetics. His research work and clinical expertise in pediatric heart failure is internationally known and he has an impressive string of achievements.
Dr. Jon McCullers, pediatrician-in-chief at Le Bonheur and chair of the Department of Pediatrics at the University of Tennessee Health Science Center, contacted Towbin saying he wanted to build a better program and had some ideas. In recent years, Towbin had been improving and refining heart programs at children’s hospitals in Houston and then Cincinnati, boosting their rankings in the annual U.S. News & World Report’s Best Children’s Hospitals survey (both are in the top four this year).
Towbin agreed to come to Le Bonheur with the idea of improving a good program. “I want to create the best program,” he says. “I want to be able to be cutting edge. I want to create new knowledge. I want to change the field to be better.”
His plan was to not only build programs but also change the culture “from a general orientation where everybody does everything to an expertise-oriented scenario where people do what they’re best at.” That required recruitment, so he’s brought in people from around the country, including Denver, New York, Boston, Washington, and Cincinnati.
Towbin says Le Bonheur’s heart transplant program started about a year ago and has done nine transplants in that time, a large program in pediatrics. The survival rate is 100 percent so far. Not only is he redefining Le Bonheur’s heart program, he’s also chief of cardiology at St. Jude Children’s Research Hospital and chief of pediatric cardiology at UTHSC, allowing him to get his heart muscle disease program into other institutions.
“Cancer, chemotherapy, and some of the other things that happen to the kids who are being treated for cancer at St. Jude affect the heart,” he says. “And it’s usually heart muscle related problems and you’re best off having experts. So I started going there pretty much every day, seven days a week, and developing a large presence so they felt that they could rely on us, that we were part of their team.”
That collaboration has led to other efforts where Le Bonheur programs for kidneys and lungs are now integrated with St. Jude. “Now it’s a large multidisciplinary approach to the care of these kids, which is better for them,” Towbin says. “They get great cancer care, lots of great research going on, but now the things that are the negative effects of cancer and cancer therapy are being handled by experts, and I think that really helps St. Jude.”
He wants to have the Le Bonheur name be as well regarded as that of St. Jude. “And I think partnering is the best way to do it because we get the best of both worlds and that’s occurring at this point.”
Meanwhile, the UTHSC connection further strengthens Towbin’s mission. “There’s a linkage now that’s somewhat tighter than it has been before,” he says. “I’m a professor at UTHSC and I do committee work with them and help in other ways. But I spend all of my time clinically here at Le Bonheur and over at St. Jude. It’s really three linked organizations instead of one organization that has umbrellas out there, which some medical school oriented places across the country have. So it’s a slightly different makeup and one I think is twenty-first century.”
The research Towbin is doing springs from the notion that while medicine largely focuses on treating symptoms, there needs to be more attention paid to pursuing the causes of disease. Necessary to that is identifying genes that cause a variety of heart problems, including cardiomyopathies, rhythm abnormalities that cause sudden cardiac death, and viruses that infect the heart causing myocarditis.
Over the years, Towbin has published numerous papers and received several NIH grants supporting the research and has moved his lab here from Cincinnati. “It’s a combination of gene discovery,” he says, “trying to identify the actual mechanisms causing the clinical features so that we can develop new diagnostic approaches, whether it’s a blood test or something else, and targeted therapy.”
He’s much like the relentless investigator who won’t rest until he finds the answer. “We’d rather get rid of the problem instead of having to deal with the symptoms all the time,” Towbin says. “The only way you’ll know how to deal with the original problem is to know everything there is about the original problem. And if it’s genetic-based, you clearly need to know the gene, you need to know the proteins that the gene makes. You have to understand what the problem is with the protein and why it gives a certain set of clinical features. Why does it progress or not progress? Why do some people have a severe problem while someone else with the same gene has a very mild problem? Why do some people die? Why do some people live until they’re 90 with the same problem?”
The answers to those questions will enable therapies to directly deal with the problem rather than the aftereffects. It’s further important to be able to identify potential problems in family members. If one member of the family has an issue, it should be possible to apply preventive medicine to another member who might have the same condition. But it requires understanding the genetics.
“It’s a stair-step approach to growth and it’s not growth necessarily in bigness,” Towbin says. “It’s growth in knowledge and in cutting-edge ideas and outcomes.”
Looking to the near future, he sees promise in gene editing. “You have an abnormal gene that has one mistake in it and you can edit that mistake out and sort of change it back to what it’s supposed to be, which then takes you from that genetic disease to a non-disease.”
It’s an approach that holds the possibility of working for a lot of diseases, heart or otherwise. “We’re moving into that arena ourselves,” Towbin says. “I’m hopeful in five years we’ll have a clue whether or not this idea, which already has proof of concept, could work.”
