Bridging science discoveries with bedside clinical care
Janet S. Lee, MD, Chief, Division of Pulmonary and Critical Care Medicine, Selma and Herman Seldin Distinguished Professor in Medicine, Professor of Pathology and Immunology, a physician-scientist from the University of Pittsburgh, joined WashU in 2023 to develop innovative clinical programs aimed at addressing lung injury and host defense mechanisms. With over 18 years of experience and a notable tenure as the Director of the Acute Lung Injury Center of Excellence, Dr. Lee is set to bridge basic science discoveries with bedside clinical care.
“My focus has been on lung injury and host defense mechanisms,” said Dr. Lee, who is also an intensivist. “At WashU, we have a robust infrastructure of ICUs and critical care, coupled with strong basic science and translational components. My goal is to merge these strengths to create impactful clinical programs.” She is enthusiastic that the leadership of senior critical care investigators such as Dr. Kollef, Medical ICU director Dr. Kraft and other expert clinicians will expand translational research with physician-scientists Dr. Haspel and Dr. Kulkarni, who are also experts in lung injury.
Dr. Lee’s interest lies in the alveolar-capillary barrier, the vital structure responsible for gas exchange in the lungs. “We are very interested in how this barrier remains intact and healthy, and how it breaks during injury,” Dr. Lee explained. Severe pneumonia and sepsis are the most common causes of this barrier’s breakdown, leading to acute lung injury and acute respiratory distress syndrome (ARDS).
In ALI, there is disruption of the alveolar capillary barrier leading to extravasation of inflammatory cells, proteinaceous edema fluid, platelets and megakaryocytes into the interstitial space that contribute to dynamic matrix remodeling. Establishment of a provisional matrix is critical for optimal repair of the injured lung.
WashU’s extensive resources, including its renowned Siteman Cancer Center, provide unique opportunities for interdisciplinary research and clinical practice. The center’s oncologic ICUs, co-managed by the Division of Pulmonary and Critical Care and the Division of Oncology offer critical insights into the immune systems of cancer patients, especially those undergoing stem cell transplants. “Understanding why the immune system becomes dysregulated and how this leads to lung injury is crucial,” noted Dr. Lee. She is partnering with the ICU’s director Dr. McEvoy to initiate investigation to pinpoint the cause of lung injury in these patients. Her eye is also on the power of “big data”, harnessing the BJC network to identify immune and infectious diseases that impact patient’s illnesses. Physician-data scientist Dr. Michaelson has joined Dr. Lee’s mission to use artificial intelligence tools to improve patient outcomes.
Bridging Basic Science and Clinical Care
Dr. Lee’s journey to WashU is rooted in a profound commitment to addressing the significant health burden of lung diseases in Missouri and surrounding states. “Geographically, Missouri is central, with a huge health burden of lung diseases. We have the opportunity to build and expand programs for interstitial lung disease and lung fibrosis,” Dr. Lee emphasized.
The integration of clinical and research efforts is central to Dr. Lee’s vision. “We want to build clinical programs that help patients with interstitial lung disease and lung fibrosis. Sometimes, injuries don’t repair correctly, leading to fibrosis. Understanding these processes on a fundamental level is essential.” Dr. Lee notes that the Division’s clinicians that manage these patients on an everyday basis, led by Drs. Russell and Shifren, are building a larger team of new clinicians to care for patients across the region.
Dr. Lee’s research includes studying subclinical lung injuries, which may accumulate over time and progress to fibrosis. “We aim to provide early evaluation and detection, potentially leading to early lung transplant evaluations for those in need.” To expand research in lung fibrosis, she has recruited Dr. Choudhury to join physician-scientist Dr. Koenitzer in targeted translational efforts.
Addressing Health Disparities
Dr. Lee is also committed to addressing health disparities, particularly in urban populations affected by asthma and chronic obstructive pulmonary disease (COPD). “We want to provide more clinical services and build programs that serve the community,” Dr. Lee said. She has tapped Dr. Vazquez-Guillamet to help build this program in concert with the WU Program of Physical Therapy that can strengthen pulmonary rehabilitation programs for patients with COPD. Dr. Vazquez-Guillamet, along with Dr. Yusen, will provide a comprehensive COPD clinic to address acute exacerbations and reduce hospital readmission rates for these patients.
Lung tissue explant obtained courtesy of Dr. Derek Byers and Dr. Steve Brody.
The impact of socio-economic factors on health outcomes is a significant concern for Dr. Lee. “The Delmar Divide in St. Louis represents a socio-economic line with great health disparities. Diseases like asthma are prevalent in urban populations, and we aim to make a greater impact on these communities.” She notes that sarcoidosis is another lung disease that is commonly under diagnosed among the urban communities of concern. Dr. Anderson leads a strong clinical program that she expects will expand treatment options and outreach efforts.
Collaborative Efforts and Advanced Therapies
With a dedicated team of specialists, Dr. Lee is optimistic about the future. “We are leveraging our strengths in implementation and dissemination science, partnering with the Brown School of Social Work, and focusing on rare genetic diseases and innovative therapies.”
The Pulmonary and Critical Care Division has highly motivated investigators working in asthma care such Dr. James Krings and Dr. Kaharu Sumino, working to educate healthcare providers in federally funded clinics in the St. Louis area about the use of a new inhaler that combines a bronchodilator with steroids.
This inhaler, now part of the Missouri Medicaid, has been shown to reduce hospitalizations and complications in asthma patients
Janet S. Lee, MD
The Division also has a strong tradition in fundamental research of chronic lung diseases including asthma, COPD, and genetic lung diseases cystic fibrosis (CF) and primary ciliary dyskinesia with Drs. Holtzman, Alexander-Brett, Brett, and Brody. “We are partnering with fantastic clinicians in our division such as Dr. Shail Mehta and Dr. Andrew Roth who sees patients with bronchiectasis to leverage new therapies and improve patient outcomes,” Dr. Lee said. Similarly, those senior clinicians caring for patients with CF, Drs. Rosenbluth and Atkinson have been involved with long standing programs in CF clinical research that have brought life changing new therapies to these patients.
Dr. Lee inherits one of the nation’s top lung transplantation programs, led by Dr. Witt, which she hopes will continue to build both clinical and basic science research. Decades of close collaboration with the Thoracic Surgery group and a history of strong leadership has generated a team of top clinical investigators such as Drs. Byers. Dr. Lee is excited by the wealth of basic and translational research ongoing in this area by physician-scientists Bery, Tague, Cano, Kulkarni, and Alexander-Brett.
Expanding Lung Disease Programs
WashU is also making strides in pulmonary hypertension research and treatment. “Led by Dr. Murali Chakinala, we are recruiting researchers to bring basic and translational vascular biology research that complements the clinical program in pulmonary hypertension. Our goal is to build comprehensive programs in pulmonary vascular diseases such as pulmonary arterial hypertension, chronic thromboembolic pulmonary diseases, secondary pulmonary hypertension that affects patients with chronic lung diseases such as COPD and ILD, as well as more rare diseases such as hereditary hemorrhagic telangiectasia,” Dr. Lee stated. She has recently recruited Dr. Dai, who tackles the basic science side of these vexing problems.
The university is also enhancing its COPD program and diagnostic capabilities to improve care in cancer patients. “We aim to provide additional services and prevent hospital readmissions for COPD patients. Our partnership with the Siteman Cancer Center will ensure timely diagnosis and treatment of lung complications in cancer patients,” Dr. Lee added.
Dr. Chen’s Interventional Pulmonary group, including Dr. Chenna, is making significant advancements in lung cancer screening and treatment. “Using advanced robotics, we can offer diagnostics and special therapies for people with emphysema and other lung conditions,” Dr. Lee noted.
A Vision for the Future
Dr. Lee’s arrival at WashU marks a new chapter in the university’s mission to advance clinical care and research. “WashU’s tradition of excellence in science, discovery, and innovation is inspiring. We aim to make a significant impact on patient care and health outcomes,” Dr. Lee concluded.
WashU’s commitment to combining clinical excellence with cutting-edge research aligns perfectly with Dr. Lee’s vision.
“It’s about caring for patients, respecting the science, and being passionate about our work. Being part of a community that values both scientific discovery and clinical care is incredibly exciting”
Janet S. Lee, MD
Dr. Lee’s dedication to improving lung health through innovative clinical programs and translational research is set to transform the landscape of pulmonary medicine at WashU and beyond.