The Division of Cardiology is one of the department's oldest, largest, and most complex units. A two-year search for a new head has resulted in recruitment of a superb physician, scientist, educator, and leader with a twenty-first century vision.
W. Robb MacLellan became the fifth division head on November 1, 2011, and was appointed to the Robert A. Bruce Endowed Chair in Cardiovascular Research. He succeeds Richard Page, who was division head for seven years and went on to become chair of medicine at the University of Wisconsin, and James Caldwell, who served as acting head for two years. A prominent investigator in cardiovascular regenerative medicine, MacLellan spent the past 13 years at UCLA where he directed the Cardiovascular Stem Cell Research Center along with many other roles. His research focuses on cardiac hypertrophy, cell cycle control, and stem cell biology. His clinical expertise is in heart failure, and he headed the left ventricular assist device program at UCLA.
Following medical school and medicine residency at the University of Toronto, MacLellan completed fellowships in cardiology and molecular cardiology at Baylor. He then moved to UCLA where he became professor of medicine and physiology and held the Maud Cady Guthman Chair in Cardiology. He was associate chief of the Division of Cardiology and director of its fellowship program, in addition to a busy clinical, teaching, and mentoring schedule. He also established a robust research program that continues at his new laboratory at South Lake Union.
At UCLA MacLellan was particularly successful in developing a powerhouse fellowship, doubling the size of the program and turning out advanced physician-scientists, most of whom remained in academic medicine, with an independent funding rate three times the national average. He credits the selection of fellows for that success but acknowledges that "there was some coaching involved." The new division head will be as busy at UW, if not more so. He enjoys teaching and hopes to have time for it at all levels. His clinical work will center on the CCU at UW Medical Center. Other than "being a cheerleader," he will not be directly involved in ventricular assist device (VAD) work.
From an early interest in heart failure ("a big enough problem to spend a lifetime on"), he became interested in regenerative therapies aimed at inducing cardiac myocytes to proliferate, something that has yet to be achieved. "The word regeneration has often been used inappropriately in the lay press," he said recently. "Cardiac cell transplantation almost certainly has not produced regeneration of heart muscle. Benefits can, however, derive from improved blood flow, reduced inflammation, and prevention of cell death. But to make new myocytes is a much trickier issue, so our research has focused on pluripotent stem cells which can differentiate into cardiac muscle."
There may be another approach. Mice can repair damaged heart muscle up to about a week after birth. "We have that capacity early in life, but we lose it," MacLellan explained. "We have identified stem cells and progenitor cells in fetal human hearts that make new cardiac muscle and endothelial cells, but in the first few weeks of life myocytes lose the ability to proliferate, and endogenous stem cells are lost. There are hints that some survive in the adult, and we are trying to find them and figure out how to stimulate them to grow. But that is a long way off."
As for the next big thing in cardiology, he predicts, "This is going to be the biomechanical decade. We are using an artificial heart, and that field is exploding like computer science did. VADs are getting better and smaller. In the next year we will be testing a tiny 'Heartware' device, and the next one will be wireless, with transdermal charging. It's going to be a bioengineer's dream. But that technology will reach a limit and then you will see true regenerative therapy, when cellular and molecular are ready for prime time."
"Cell therapy is happening now, but true regeneration is probably a decade away. We are already discussing whether VAD should replace heart transplant, and that will probably happen within a decade. When true regenerative therapy comes on board, the discussion will be whether to go for the biologic or mechanical approach. I'm betting that the biologic will ultimately win out."
MacLellan is deeply confident in the division he has inherited. "We have a lot of strength in clinical areas, outstanding groups in advanced heart failure/VAD/transplant, as well as electrophysiology. Our interventional program is the major center in the Pacific Northwest for percutaneous aortic valves, and we have been leaders in echocardiography for over a decade."
Basic and clinical research, likewise, is advanced on many fronts, with faculty collaborating in interdepartmental and multidisciplinary investigations. "We have many irons in the fire," he said, "and many will succeed."
With numerous faculty recruitments under way, MacLellan plans to dramatically expand research and clinical services, including the VAD program, cardiac cell transplantation study, percutaneous valve replacement, a new ablation program, and others. "We will be pushing translational research," he said. "We will probably see cardiology interact more with genomic sciences and medical genetics for both specialty care and research, including a cardiovascular genetics clinic. My role is that of a matchmaker. The infrastructure is here. My job is to make sure people who should be in a room together are there, talking about shared interests, forming successful partnerships. There's a cooperative spirit here that we will take full advantage of."
"We need to take the excellent basic research that we have and connect it with excellent clinicians, and that's where we will get the 'change-the-world' advances. I've had a pretty eclectic background, and I like building programs."