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John Emerson, MD, is an enthusiastic and passionate family medicine physician educator with a goal of inspiring the next generation of medical students and family medicine residents. Aspirations and areas of interest include leadership development, innovative healthcare delivery models, residency and medical student education, and care of vulnerable and at risk populations. Provider Gender
Male Language English Age Groups Seen Infants and Toddlers Children 2-4 Children 5 and up Teens Adults Adults 65 and up A physician, or doctor, is extensively trained to diagnose and
treat complex medical problems. Often, physicians focus their practice on certain disease categories, treatment methods or patient types. Physicians can diagnose and treat illness, prescribe medication, offer medical consultation and advice, perform surgery and more. Clinical Assistant Professor of Emergency Medicine Insurances We Accept About MeAs a physician, I specialize in emergency medicine. I earned my bachelor's degree in biochemistry with a minor in anthropology from Kenyon College. Following that, I returned to Cincinnati, Ohio, where I was born and raised. I graduated AOA from the University of Cincinnati College of Medicine. I received my residency training at Vanderbilt University, where I served as a chief resident. My academic interests include resident education and development. In my free time, I enjoy spending time with my wife Angela, weight lifting, reading nonfiction, and watching ice hockey. Education and TrainingEducation HistoryMedical School University of Cincinnati College of Medicine, Cincinnati, OH Vanderbilt University Medical Center, Nashville, TN 7/1/2012 - 6/30/2015 Board Certification American Board of Emergency Medicine Academic InformationMy DepartmentEmergency Medicine Consulting and Related RelationshipsAt The Ohio State University Wexner Medical Center, we support a faculty member’s research and consulting in collaboration with medical device, research and/or drug companies because a faculty member’s expertise can guide important advancements in the practice of medicine and improve patient care. In order to provide effective management of these relationships, the University requires annual disclosures from all faculty members with external interests related to their University responsibilities. As of 09/30/2022, Dr. Emerson has reported no relationships with companies or entities. How can we utilize the regenerative stem cells already found in the human adult body to combat the effects of heart failure? Dr. Alain Bouchard discusses this cutting edge realm of medicine with Dr. Emerson Perin, director of the Center for Clinical Research at the Texas Heart Institute. TranscriptAnnouncer Dr. Alain Bouchard Dr. Emerson Perin Dr. Alain Bouchard Let’s talk about heart failure a little bit. We know that heart failure patients can be doing well for many, many years, 10, 20 years, but when they start decompensating, and require hospitals, hospitalization, require hospital admission, usually it really affects their prognosis and increases their mortality within the first year at about 20%. Five year mortalities is like 50%. So it’s a really big change. Tell us a little bit what happens when the heart start failing and decompensate. Dr. Emerson Perin And it’s interesting because over the years, really, the medical community has developed an incredible number of treatments for heart failure. And we have a lot of medicines that actually avoid death and help prolong life. But up until now, we weren’t able to sort of address the more fundamental issue behind heart failure, which is inflammation. So I think we’ll talk about that, and how cell therapy really opens a new door on being able to treat heart failure from a completely different perspective than all the medicines that we have available today. Dr. Alain Bouchard Dr. Emerson Perin And so, I always say that everybody on this planet is made of two cells, you know, so if you can make a person, you can certainly heal the tissue and do other things. It’s just a matter of, which is tricky, figuring out how we’re going to do this, but it’s not a question of will this work. It works. The question is, how do we make it work? And so that takes a while and we keep working at it. Dr. Alain Bouchard Dr. Emerson Perin Dr. Alain Bouchard Dr. Emerson Perin And we’ve kind of come from an initial, more naive notion that we just kind of threw the cells at the problem, and maybe some magic happen, to a much better understanding of the mechanisms at play, and I would say that today, the best cell that we have against—to treat heart failure is an anti-inflammatory cell, and that the mesenchymal cells are fantastically anti-inflammatory, and, very importantly, they can read their environment. So they have those receptors on these cells that detect the environment they’re in, and if they see, for example, they’re in the middle of a tissue that has a lot of inflammation, will they immediately send out signals and proteins and different things to affect and change that inflammation. And we think that that is what is really helping in the clinical trial, when we put these cells in an inflamed heart, and we see that most of the benefit is in the patients that have inflammation, that they can turn that around. Dr. Alain Bouchard Dr. Emerson Perin Dr. Alain
Bouchard Dr. Emerson Perin Probably one of the most dramatic findings, when we looked at the results was that there was a very significant difference in events, such as heart attacks and strokes. So if you had gotten the stem cell treatment, you had a 65% reduction in the occurrence of heart attacks and strokes. 30 months out from this single treatment in which we injected these mesenchymal cells into the heart muscle. We also looked at composites which are commonly looked at for heart failure, including cardiac death, and MI and stroke. And that was significantly reduced as well. So then we tried to think about, well, we know that these cells are anti-inflammatory. And so knowing that we had, in the beginning of the trial, dosed CRP, which is a common blood test, and it’s a biomarker of inflammation, and we then looked at the population of the patients that had elevated CRP, or that had ongoing inflammation in their bodies, and people that had low CRP, and lo and behold, that really has shown us the mechanism of how cells work, because all of the benefit was in the patients that had an elevated CRP that received stem cells. So, that’s just…sort of for the first time, really confirmed to us that in heart failure, if you select patients that have inflammation, with these cells, you can improve their outcomes. And I’m talking cardiac death, stroke, and heart attack. Dr.
Alain Bouchard Dr. Emerson Perin And we hypothesize that, really, there is more viable tissue, those patients are earlier on in their course, and the cells, when you put them there, can interact with the environment and still perform better than if you put them in sort of the end stage of heart failure, where there’s less fertile ground, if you will, for the cells to have an action. So we think that optimally, if we can, and this makes a lot of sense, and is kind of like what we want to do, and what our patients would want also to happen, is to be able to treat people early on. Well, so we select the inflamed patients, we treat them early on, we’ve seen enormous benefit as we go forward. Dr. Alain Bouchard Dr. Emerson Perin And now we’ve really hit on something that…this is what is very interesting, is it treats the inflammation, it does not treat the volume overload. So you talked about, the body compensates, but the heart gets bigger, and you try to do all these things, to make it—the heart failure better. And so all the medicines that we have address, try to block these bad things that the body does to the heart, and actually improves heart failure. But it doesn’t address the primary problem. So we know that Entresto and all these newer drugs that we use, ACE inhibitors, beta blockers, they’re very successful in dealing with that volume overload, and they’re successful in dealing with recurrent hospitalizations for heart failure, but they’re less successful in dealing with mortality and subsequent cardiac events. And there’s a big difference there. And I think, for the first time, we’re seeing…”Wait a minute, let’s not mix up recurrent hospitalizations, repeat visits to the emergency room with sort of interrupting that what is maintaining the heart failure fire burning in the heart,” and that we can do with cells. Dr. Alain Bouchard Dr. Emerson Perin Dr. Alain Bouchard Dr. Emerson Perin In terms of the future, well, we are definitely slated to do a confirmatory trial. So now, we have the elements with—this is, we’ve been, you know, for the last 20 years really searching for a path into treating heart failure. We have found it. And I have the perfect roadmap for a next trial in which—would be very similar to DREAM-HF, that’s fine-tuned a little bit to really highlight and confirm what we’ve seen, that really doing what we think we’re doing that we’re going to improve these endpoints again. And if we can do that, well, then the FDA is going to say, “Okay, well, then this is obviously a very good treatment. And it’s something that can be approved.” So that’s number one on my list is to get a mainstream cell therapy approved for heart failure, and I think these mesenchymal cells definitely are on the shortlist. As we go to the future, we can think about things that you mentioned, let’s say, more potent cells, and also gene therapy, the combination of cell and gene, the combination of different cells, and we’re really in the very, very beginning of a long, long process of discovery. I’m sure you know, 100 years from now, they’ll look back and say, “Oh, man, those guys, they tried really hard. And now they understand how things work.” But you know, you do what you can with the knowledge that we have, but I think that the future is very bright, I think these cells and other cells, and in combination with gene therapy, really hold a lot of good things to come as we gain knowledge from the things that we do, so… The future’s good. Dr. Alain Bouchard Dr. Emerson Perin Dr. Alain Bouchard Announcer Subscribe to the MyHeart.net Podcast on Apple Podcasts, Spotify, or Google Podcasts. Our Most Recent Podcast Episodes5/5 (3) |