Driven to Find Cure for PH, Brundage Leads New Quest for Breakthrough in Therapy

Bruce Brundage, MD, has seen it all, from the first anecdotal cases when no treatment for pulmonary hypertension was available, to the landmark National Institutes of Health (NIH) registry, to the large scale clinical trials of today involving hundreds of patients. For anyone seeking to chart progress in the field, his career serves as a bridge, spanning milestones in the treatment of the disease. He has been associated with virtually every key development in the progress toward a cure, beginning in the 1970s when he served as the director of the cardiac catheterization laboratory at the University of California, San Francisco.

It was during his study of those early cases, when he inserted catheters into the pulmonary artery to measure the effects of various vasodilating drugs, that he began focusing on pulmonary hypertension. During the last 25 years, research has been his passion—leading him to serve on the steering committee of the national registry and to play a key role in the growth of the 5,000-member Pulmonary Hypertension Association (PHA), of which he is now president. “It was in the late 1970s that I discovered the NIH was starting its patient registry in pulmonary hypertension so I applied to have our center enrolled as part of the registry,” he said. “Soon afterward, I was invited to be on the steering committee for the patient registry at a time when we began collecting data in an organized manner.” Joining the faculty at the University of Illinois at Chicago, Dr Brundage teamed with Stuart Rich, MD, and Paul Levy, PhD, two leading investigators, as they explored the effects of high-dose calcium channel blockers in treating pulmonary hypertension. “This was the first breakthrough in the treatment because we found there was a percentage of patients who were helped.”

In 1990 Dr Brundage was named chief of the Department of Cardiology at Harbor-UCLA Medical Center and became involved in the early studies of intravenous prostacyclin therapy. Enrolling 300 patients to receive what was a new infusion therapy at the time, he was a coauthor of a major paper published in the Journal of the American College of Cardiology demonstrating the long-term survival benefits of prostacyclin. At that point Dr Brundage's team at UCLA had enrolled more than 300 patients with pulmonary hypertension, one of the largest groups in the country at one center.

Following his departure from UCLA in 1998, Dr Brundage accepted the medical director's post at the Heart Institute of the Cascades in Bend, Oregon. At that point he began focusing more attention on the development and financial resources of PHA. He had already become chairman of the association's Scientific Advisory Board in 1996, a position he held until 2001. The Advisory Board has been renamed the Scientific Leadership Council. This year he agreed to become president of PHA and also serves as a member of the Board of Trustees. As a key figure in PHA's growth, Dr Brundage has seen the association's annual budget grow from about $100,000 to $1.8 million in only five years. Gifts from foundations, corporations, and individuals have spurred the group's efforts in research and have helped it award grants to young investigators seeking new therapies for PH as they pursue a career in this field.

“I think PHA will encourage the formation of another patient registry. Many things have changed since the formation of the first NIH registry. We might be able to collect data that will help us determine which patients are candidates for lung transplantation. We may also investigate the appropriate use of warfarin. The current recommendation is that all patients with pulmonary hypertension receive warfarin, but this practice has never been adequately evaluated in a randomized study. So we need to determine in a randomized, placebo-controlled study whether warfarin makes any difference in the long-term outcome of patients with pulmonary hypertension. It has been presumed that there is a thrombotic aspect of the disease but the long-term beneficial effect of anticoagulation has never been proven.

“This new registry will have thousands of patients in it throughout the country. Since we have representatives on the Scientific Leadership Council from Canada, Ireland, Germany, and Italy, it could be an international registry,” he added. “As president of PHA, my main focus will be to raise revenues in support of all of these projects. I am strongly committed to research to find a cure and raising millions of dollars in this effort. This is the best way to get to the cure. Pulmonary hypertension is multifactorial. The more we study this disease the more clear it becomes that it is a polyglot with many causes. Fortunately, many different kinds of therapies are being developed.”

In recognition of his achievements, PHA has given Dr Brundage its Physician of the Year Award. Widely respected in the medical community for his commitment to finding a cure for pulmonary hypertension, Dr Brundage has also earned the respect of colleagues and patients alike for his compassionate attitude and the quality of patient care he provides. PH