STATEGIC VISION FOR THE BASIC SCIENCE AND ENGINEERING (BASE) INITIATIVE AND PROGRAM
AS DEVELOPED BY DR. FRANK HANLEY
BETTY IRENE MOORE CHILDREN’S HEART CENTER
LUCILE PACKARD CHILDREN’S HOSPITAL STANFORD
The Betty Irene Moore Children’s Heart Center at Lucile Packard Children’s Hospital Stanford announces the development of a basic science and engineering research initiative and program. The program will be directed by Dr. Marlene Rabinovitch and the leadership of the Children’s Heart Center, in close collaboration with the basic science and engineering communities at Stanford University School of Medicine and Stanford University. We anticipate recruiting up to 8 scientists, each of whom will be selected based on the quality of their existing work, as well as on the potential for synergy between their research and the work currently performed in the clinical setting within the Children’s Heart Center. The overarching goal is to leverage discoveries in basic science and engineering that will lead to improved outcomes in the clinical setting.
The Children’s Heart Center at Lucile Packard Children’s Hospital was formed in 2007 to address the rapid growth in both the volume and complexity of patients with congenital heart disease treated at the hospital. The Center has a formal structure, with individual leadership roles and standing committees. Frank L Hanley, MD serves as Executive Director. Stephen J Roth, MD, MPH serves as Medical Director, and Kathy Van Camp serves as Executive Administrative Director. The standing committees include Executive, Business Strategy, and Quality and Performance Improvement Committees. Membership in the Center is drawn from faculty in the Departments of Pediatrics, Medicine, Cardiothoracic Surgery, Anesthesia, and Radiology. We now add the new Program in Basic Science and Engineering (BASE) that will have scientists and engineers cross appointed to the appropriate departments at Stanford with its own administrative staff, steering committee, and external advisory board (see Org Chart below). The full scope of influence of the Heart Center, as initially envisioned, was to provide outstanding and innovative clinical care in a supportive and collaborative environment, and to contribute to the advancement of the field through both clinical and basic research.
Initial efforts were focused on development of the Heart Center’s clinical program. By 2012, the clinical program had evolved to one of the highest volume and highest complexity programs dedicated to congenital heart disease, with a faculty that had grown to 45 pediatric and adult congenital cardiologists, nine pediatric cardiac surgeons, ten pediatric cardiac anesthesiologists, and three pediatric radiologists. The clinical focus was all encompassing, caring for neonates to adults with the entire spectrum of heart disease. Once this strong and broad base was established, leadership made the decision to further focus on a core group of disease processes for which our faculty has particular clinical expertise. This focus has resulted in the development of several special programs, each of which has been provided with specific resources, organizational support, and a faculty director. These special programs include:
The Single Ventricle Program, under the direction of Gail Wright, MD https://profiles.stanford.edu/gail-wright : This program focuses on the short and long-term management of patients with single ventricle physiology, from fetal life to adulthood, and includes management of the effects of this physiology on other critical organ systems.
-The Pulmonary Artery Reconstruction Program, under the direction of Doff McElhinney, MD https://profiles.stanford.edu/doff-mcelhinney: This program focuses on management of patients with structural congenital and acquired pulmonary artery abnormalities, and on the effects on these abnormalities on the right ventricle.
-The Cardiovascular Connective Tissue Disorders Program, under the direction of Tom Collins, MD https://profiles.stanford.edu/ronnie-collins: This program focuses on management of the systemic effects of the genetic defects which effect connective tissue formation, with an emphasis on the cardiovascular abnormalities
-The Heart Failure and Transplant Program, under the direction of David Rosenthal, MD https://profiles.stanford.edu/david-rosenthal: This program focuses on the management of pediatric patients with heart failure, and includes medical therapy, ventricular assist devices, and transplantation.
-The Bloodless Surgery Program, under the direction of Katsuhide Maeda, MD https://profiles.stanford.edu/katsuhide-maeda: This program focuses on methodologies that minimize or eliminate the use of blood products during cardiopulmonary bypass and cardiac surgery, including technical, mechanical, and hematologic.
Clinical Outcomes and Translational Research Program:
In 2014, leadership developed the Clinical Outcomes and Translational Research Program within the Children’s Heart Center. The aim was to develop a resource within the Children’s Heart Center to support and promote clinically-based research. The Program is housed in dedicated contiguous space, under director Doff McElhinney, MD, https://profiles.stanford.edu/doff-mcelhinney. He oversees a core of biostatisticians, data managers, support staff, and dedicated research fellows. The program is supported by a $20M fund, which through an endowment structure supports the overall programmatic needs, as well as the salary and research expenses of the fellowship component of the program. The program retains up to four dedicated clinical research fellows at all times. The purpose of this program is to maximize both the productivity and quality of clinically-based research within the Children’s Heart Center, with broader goals of contributing to the advancement of the field, as well as acting as an instrument to allow self-assessment of clinical practice and direction internally. Since the inception of this program, the Children’s Heart Center has seen a significant increase in both the quality and volume of clinically-based research studies and grant submissions.
Basic Science and Engineering Program:
With the Clinical Program and Clinical Outcomes and Translational Research Program both fully established, the final step in development of the Children’s Heart Center is the buildout of the Basic Science and Engineering (BASE) Program. This step is viewed by leadership as the most critical one, because, when viewed in the historical context, the field of congenital cardiac care is currently at a critical juncture along its evolutionary path. Since the modern genesis of care for congenital heart disease in the 1940s, the driving force for advances in the field has been the development of increasingly complex and sophisticated operations and interventional procedures, and applying these procedures to younger and smaller patients. This approach to congenital heart disease has had a profoundly positive effect on survival and quality of life over the decades; however, in 2018, to a large degree, these well-proven techniques for moving the field forward are no longer the agents of major advance. Small increments in clinical improvement will still be possible in the future, but for the most part, the potential for major advancement using these techniques has been exhausted. Looking forward, the next major advances in survival, quality of life, and cure will not be achieved using these well-established techniques. New techniques, derived from discoveries in various basic science disciplines and engineering, will fuel the next wave of advances in the management of congenital heart disease. It is the goal of the leadership of the Children’s Heart Center to develop a Basic Science and Engineering Program that is designed to contribute to this new wave of advancement in the field over the next 10 years with the expectation that the field will be completely re-shaped in the next 20.
The challenges that we face will require innovation in computer science and bioinformatics, machine learning and engineering, interfacing with advances in genetics, developmental biology, chemical and structural biology, physiology and metabolism. Thus, we anticipate that our scientists will develop both independent and interdisciplinary approaches to solving the current challenges in regeneration of the heart lungs and blood vessels and in reversing existing damage to these tissues. We need to better understand and ultimately prevent and reverse failure and electrical-mechanical damage to the young and developing heart and to restore normal function and growth of blood vessels and heart valves.
BASIC SCIENCE AND ENGINEERING PROGRAM STRUCTURE
The Children’s Heart Center plans to recruit up to eight basic scientists and engineers into the program. This will be achieved in close collaboration with both the basic science and engineering departments at Stanford University and the Stanford University School of Medicine.
After careful deliberation, the Children’s Heart Center leadership has chosen Marlene Rabinovitch, MD, https://profiles.stanford.edu/marlene-rabinovitch, as the Director of the Basic Science and Engineering (BASE) Initiative and Program. Together, the Children’s Heart Center leadership and Dr. Rabinovitch have developed a Steering Committee that will be charged with overseeing the recruitment and development process for the program. The Steering Committee includes senior members of the Children’s Heart Center (Drs. Hanley, Roth, Rabinovitch and McElhinney) and leaders in the basic science and engineering communities at Stanford (Drs. Helen Blau, Brian Kobilka, Joseph Wu, Roel Nusse, Carlos Bustamante, Chaitan Khosla, Jennifer Cochran, and Alison Marsden). An External Advisory Board will help in guiding the implementation of the strategic vision of the BASE Initiative.
Official website: http://www.med.stanford.edu/base
The BASE scientists will be housed in contiguous, state-of-the-art laboratory facilities on campus within easy walking distance of the new hospital and clinical programs. This proximity was specifically built into the program design to promote communication, familiarity, collaboration, and synergy between the basic scientists, engineers, and clinicians. Basic scientists and engineers will be chosen primarily on the quality of their research work and future potential; however, significant importance will be placed on the specific nature of their research, with the overall goal to recruit individuals whose work shows the potential to advance knowledge and contribute to advances in areas linked to the highly-specialized clinical programs mentioned previously. Moreover, the newly recruited scientists will be able to leverage the rich and highly innovative environment that Stanford provides through existing programs such as BioDesign and BioX and new programs such as the Chan-Zuckerberg Bio-Hub, and the Chem-H interdisciplinary program. There is also the outstanding Silicon Valley environment that encourages and facilitates translation of fundamental discovery to the clinic.
SUPPORT AND COMMITMENT
The leadership of the Children’s Heart Center has worked closely with the greater Stanford community to obtain the resources, support, and commitments necessary to develop a successful basic science and engineering program.
The Dean of the School of Medicine, Lloyd Minor, MD, has committed 35 benches of wet laboratory and support space in the newly-constructed Biomedical Innovations Building (BMI), which will open in 2020 The committed space is contiguous and will be directly adjacent to the laboratory space committed to the Stanford Cardiovascular Institute (CVI): http://med.stanford.edu/cvi.html, under the direction of Joseph Wu, MD, PhD. The leadership of the Children’s Heart Center has worked closely with Dr. Wu, and the potential for collaboration with existing CVI investigators is excellent.
The leadership of Lucile Packard Children’s Hospital, and the leadership of Lucile Packard Foundation for Children’s Health (the hospital’s dedicated entity for philanthropic giving and program development) have committed to raising $110M over the next five years to support the BASE Program. This commitment was formally documented in writing in 2017. $50M of the total has already been raised in less than one year, leaving an additional $60M to be raised over the next four years to reach the target. Of the total $110M, $80M is earmarked as an endowment. The yearly payout from this endowment will be used for several purposes. The most important will be to support the scientists. It will support 40-60% of the salary and benefits of each scientist in the program, a fund for additional resources including core facilities, seed money for lab expenses, as well as administrative infrastructure. The remaining portion of the yearly payout will support the indirect costs related to the committed laboratory space in the BMI Building. The remaining $30M will be used for discretionary purposes, such as recruitment packages and endowed professorships, and one-time lab equipment purchases.
Leadership anticipates offering positions beginning in early 2020 when the BMI Building opens. Interested candidates will complete the online application on our website. After a pre-review by our Steering Committee, a Search Committee will review potential candidates and generate a short list to be offered the opportunity to interview at Stanford. The finalists selected will be offered a faculty position with appointment in the Children’s Heart Center and to a basic science or engineering department appropriate for their scientific discipline. We are recruiting at all academic levels and are encouraging applications from young investigators that have an exciting career trajectory.