degree of precision when performing a biopsy . Martin and Assistant Professor of Medicine Andrew Foderaro , MD , director of bronchoscopy for Rhode Island and The Miriam hospitals , perform three to four such procedures every Monday morning as part of the CALC ’ s Advanced Lung Nodule Program . When a mass is deemed malignant , the patient is referred to the Brown University Health Cancer Institute .
Martin also is part of the center ’ s Interstitial Lung Disease Program . ILD refers to a group of disorders that can cause scarring in the lungs , making it hard to breathe . The CALC is well suited to ILD patients , he says , many of whom require complex , long-term care . He and Caitlin Butler , MD , an assistant professor of medicine and an ILD specialist , evaluate patients at the center — taking a thorough history ( as some ILD can be caused by environmental exposure , inhalation , or autoimmune disease ), doing extensive blood work , sometimes even taking a lung biopsy — and then develop a multidimensional treatment plan . Such a plan can include medication , psychosocial support , oxygen therapy , and longitudinal monitoring , including for toxicity of the treatments themselves , Martin says .
STEADY GROWTH The Medical School ’ s strength in understanding , diagnosing , and caring for diseases of the lung isn ’ t new . Professor of Medicine James Klinger , MD , has been researching and treating pulmonary hypertension here since the late 1980s , before there were many treatment options . Most of his patients — most of them women — died .
In 1991 , Klinger helped establish the Pulmonary Hypertension Center at Rhode Island Hospital . The center appealed to area physicians to send patients with PH for treatment , and enrolled them in clinical trials . At the same time , more and more medications were being shown to be effective in managing the disease . In 2011 , Klinger recruited Ventetuolo from Columbia University , and hired nurse practitioner Mary Whittenhall . Two years later , the PHC received certification by the Pulmonary Hypertension Association as a center of excellence — the sixth in the country and the first in New England to do so . In 2017 , the PHC moved to a larger facility in East Providence , making it possible to take on more patients . When the CALC opened in August , it welcomed the PHC ’ s busy outpatient practice of 400 to 500 patients , and Klinger hopes to expand the practice further .
“ When you develop a center like this , you have to staff it not just with experts , but with experts who have access to a large number of patients . Because the more patients you treat ,” he says , “ the better the care .”
What ’ s more , the PH practitioners are all involved in robust bench-to-bedside research , so they can give patients access to the most novel medications being studied in clinical trials . For example , in March , to great fanfare , the FDA approved WINREVAIR , the brand name of the injectable drug in Jennifer ’ s trial , for adults with PAH ; because she was in the trial , she had access to this drug before it was approved and will continue to , during a time when access is still limited . The PH physicians are onboarding five new clinical trials in partnership with industry to test novel compounds in patients with PH and ILD . One such trial is testing a new , injectable medication that has never been used in PH .
“ When I started treating pulmonary hypertension , there were no medications ,” Klinger says . “ All of the meds patients are on now — we participated in the clinical trials that led to their approval .”
Still , most PH patients have to be on three to four medications , all of which carry high costs and significant side effects , according to Ventetuolo , and finding the right combination requires some trial and error . To bypass that , she and colleagues at Brown and the University of Maryland are pioneering a novel approach : following catheterization of the patient ’ s right heart ( part of the standard diagnostic workup ), they culture the diseased blood vessel cells that have adhered to the balloon to obtain their genetic signature . They hope to be able to use an innovative network medicine pipeline to inform treatment selection at the bedside . “ The dream is point-of-care testing , where we could precisely tell a patient which drugs , both approved and investigational ,” will be most effective for them , Ventetuolo says .
Like Klinger , Ventetuolo remembers a time when many patients died of PAH , and acknowledges that much progress has been made . “ A patient would walk in hopeless or bewildered about why they ’ re out of breath , unable to do their basic daily living activities ,” she says . Now , “ I ’ ve seen people return to work . I ’ ve seen people travel . I ’ ve seen people get their lives back .”
Recalling a recent visit by a patient he hadn ’ t seen in several years , Klinger notes something else that ’ s changed : “ The patient told me that when she was first diagnosed , she was told to go to Boston . Now , she said , that same organization told her to come to us .”
Klinger , who directs the CALC ’ s Pulmonary Hypertension Program , notes that consolidating testing , treatment , and
14 HEALTH DISCOVERIES @ BROWN l WINTER 2025