Thoracic Surgery Labs

There are two active basic/translational research laboratories within the Division of Thoracic Surgery.  These are:

This laboratory has interests in the biology of non-small cell lung cancer and mesothelioma (an aggressive malignancy of the pleura, or chest lining). We are a fully equipped, state-of-the-art molecular biology laboratory that has multi-disciplinary relationships with other basic science labs within the university, spanning diverse departments such as Anesthesia, Radiology, Systems Biology, Computer Science, and Radiation Oncology. We are actively investigating complementary aspects of lung cancer biology at the single-cell level, including cancer stem cells, metabolomics, and tumor microenvironment interactions. Another active area of investigation is centered on analysis of critical cell signaling networks contributing to the development of mesothelioma. Overall, we seek to discover novel molecular targets in these devastating tumors and thus develop more effective patient-specific therapies.

Directed by Dr. Joseph Shrager in collaboration with Dr. Huibin Tang, PhD,  this laboratory is focused upon the responses of the respiratory muscles, in particular the diaphragm, to various disease states and interventions.  Most recently, this laboratory published the seminal paper establishing that even brief periods of mechanical ventilation cause marked atrophy of the diaphragm muscle fibers — presumably a major cause of "failure to wean" from the ventilator.  The lab is currently focused on elucidating the molecular mechanisms of this diaphragm atrophy with the intention of designing interventions that might be brought through animal models to the clinic.  This lab's work has been published in important journals, such as The New England Journal of Medicine, The Journal of Thoracic and Cardiovascular Surgery, and The American Journal of Respiratory and Critical Care Medicine. The lab has garnered continuous support for over 10 years from the VA Merit Review Board as well as support from the NIH and the American Association for Thoracic Surgery.

The Division is also actively engaged in a variety of clinical trials that provide patients access to new and promising therapies while simultaneously contributing to important advances in the field.  Some of our currently active trials include:

• Several trials of stereotactic body radiation (SBRT — commonly called "cyberknife") for the treatment of stage I NSCLC in both patients who are felt not to be candidates for surgery and in certain operable patients.
• A trial of stereotactic body radiation (SBRT) to try to create a non-invasive form of lung volume reduction surgery (LVRS) to treat emphysema, in patients who are not good candidates for the well-established and highly effective surgical form of LVRS.
• Randomized PleurX catheter trial – A study randomizing patients with malignant pleural effusions to the "standard" PleurX catheter versus a newly developed catheter that is designed to achieve a faster pleurodesis, and thus a shorter time with the catheter in place.  Dr. Shrager in the national PI for this study.
• Myriad lung cancer genomic prognostics study – In this study, patients' tumors are submitted for genomic analysis in order to determine if a molecular prognostic signature that has been developed results in changes in the use of adjuvant therapies and alters outcomes.