Q&A: Barry London

This is a great time, in general, for cardiovascular research. The tools that are available for basic science research are unequaled and can be applied to both understand diseases and, ultimately, to identify new treatments for them.

This soup-to-nuts approach for research is the predominant approach—both in concept and reality. If you are funding research, you want to think that what you fund not only tells you how something works but tells you how to fix it. And that is what we want to do. Whether it's related to abnormal heart rhythms, heart failure, or things that cause high blood pressure or strokes, we want to develop programs that will go all the way to human treatments.

Yes. The hardest thing to build from scratch is basic research. If you don't have the infrastructure to do this, it's very hard to take nothing and create something. It takes time, and it takes funding.

Fortunately, we have this level of support, although some of the funding mechanisms have changed. Until relatively recently, we had a several large programmatic grants. We had three of these in the cardiovascular center when I arrived [in 2013], and each grant was several millions of dollars over several years. This level of support funded many people and projects. The NIH [National Institutes of Health] eventually “sunsetted” the ability for any single institution to have one of these grants for 30, 40, years or even 50 years, which we did have.

So, we've replaced them with smaller, collaborative grants. And we've added the translational and clinical application pieces to these, some directly related to the basic research we're doing. Steven Mickelson’s work is a great example. He basically created a new field in electrophysiology called pulse field ablation. This was done with the support of the ACRC. We had the ability to do that and the desire to do that—it became clear that pulse field ablation was something that could affect millions of lives across the country.

If you had asked Frank Abboud 40 years ago about the state of cardiovascular research in the United States, he would've told you that there were two places in the Midwest that did research of any significance—and the University of Iowa was one of those.

And he was correct. His work, which helped to define autonomic nervous system control of the heart, expanded into new directions—whether they be vascular, whether they be arrhythmias, whether they be heart failure—and led to natural extensions of the science that came out of Iowa. It was also about getting together a group of 10 to 20 top quality cardiovascular researchers and leaders within the center that then drive forward the next generation of the work that happens here.

It's a sign of success that many of our investigators through the years have left Iowa to run institutes and be division chiefs and department chairs elsewhere across the country. Their roots are here. And what they’re doing is a direct reflection of the ACRC. So, it's not just what we're doing here. It's also the people who've left and gone to Wash U. and Milwaukee and an assortment of other places and built their own outstanding programs.

That’s a great legacy, and it traces back to the work that Dr. Abboud and Dr. Allyn Mark and Dr. Don Heistad and others were doing back in the day.

So, I came here 13 years ago. I was recruited by Mark Anderson [London’s predecessor as director of the ACRC] to be co-director of the center with Mark. And then when he moved on, I became the sole director.

I came from the University of Pittsburgh. I trained in Boston, did my postgraduate medical training at Mass General as a resident and a fellow. I then joined as a junior faculty member. I stayed there as sort of a super postdoc, as many people in the Harvard system do for a year or two. Then I took a lab startup position as a young faculty member at the University of Pittsburgh before it was UPMC [University of Pittsburgh Medical Center]. Eight years later I became the division chief there and stayed there for eight years.

As I’d mentioned, Mark Anderson, who had been the cardiovascular division chief here and was promoted to chair of internal medicine, recruited me. It didn't hurt that my wife, who I met in Pittsburgh, had trained in Iowa. She came to Iowa initially to work with Frank Abboud in his lab, although she concentrated on heart failure and worked with [faculty member] Bob Weiss. She became a heart failure cardiologist and moved to Pittsburgh for her first real job. That’s where I met her, and we ended up getting married and coming back with kids.

I've always been interested in sudden death—the causes and how to prevent it. I started when I was an MD/PhD student many years ago in New York City. I started studying the connections between the electrical activity of the heart and the mechanical activity of the heart. It was physiology, electrophysiology, single-cell voltage control, that sort of thing.

And then, I went off to do residency and fellowship. When I was going back into the lab, I knew I needed to learn molecular biology. So, I joined a big molecular biology lab at Children's Hospital in Boston, and they were studying an inherited condition called Long QT syndrome. With this condition, some of the ion channels in the heart don't work well. This affects the heart’s electrical rhythm, and it can trigger sudden death.

When I first started, the genetics were not quite known yet, and the lab I joined was trying to figure it out. The lab that succeeded in figuring it out was a lab out in Utah, run by Mark Keating. His group identified genetic mistakes in sodium and potassium channels that cause Long QT syndrome. I had just gotten my first NIH training grant level, and I knew that trying to compete with a juggernaut lab with 25 people in it in Utah was probably dumb. Fortunately, nobody was doing basic mouse work on it. So, my lab made the first mouse models of Long QT syndrome.

In Pittsburgh, I started studying mouse models of genetic diseases. Then, a family with a recently described genetic cause of sudden death came to [the University of] Pittsburgh, but only one gene had been identified. So, I decided it was a good time to get into human genetic. Ultimately, we identified the second gene that caused this inherited syndrome. It was a sodium channel problem. And so, I’ve been studying sodium channels and potassium channels and other things that cause heart failure and sudden rhythm problems in heart failure through the years.

My own research has benefited greatly from being in Iowa. The quality of collaborators here is unequaled. I can go to people who can tell me how to do things and what I should be studying and vice versa. Others have come to me and said, "Can you join my project?" I mean, part of the reason I've been incredibly well-funded is because of the people who surround me here and the people in the ACRC who I can work with and get opinions and suggestions from.

Collaboration is as good here as any place I've ever been. At many institutions, there is a tension between researchers and clinicians and people who do both. Competition for resources, for example. Here, there is a more seamless integration of the missions than anywhere else I’ve been.

I am a reviewer for the NIH. I've served on three or more review panels per year for many years. I was recently asked to permanently join the mentored trainee study section, the one that gives awards to young physician-scientists. That’s so important, especially in the current environment, that we preserve mechanisms to help support the development of physician-scientists, which are a diminishing breed.

For eight years, I was editor-in-chief of the Journal of the American Heart Association. I joined as an associate editor when the journal was formed, was promoted to deputy editor, and eventually became the editor. It was a significant time commitment, but it was worth it. When I’d stepped down the journal was receiving around 4,000 manuscript submissions per year.

I’ve been a member of several honorary societies, and the one that you mentioned is the Association of University Cardiologists. It’s made up of leaders in cardiology across the United States and beyond. And it includes not just people who do mostly research; it also includes the education leaders in the country and some of the clinical leaders who define what the guidelines should be and how we should be doing it, and how we should be making cardiovascular care better.

I was honored to be nominated to the AUC council and then to the presidency. I became past president at the last AUC meeting. Now, I’m off the council but still a member. It's an organization that gathers a hundred or so leaders in cardiology together at the same place at the same time—to discuss the work and foster collaborations. It’s an invaluable thing for our field.

I think many of us want to give back. When I think back to why I did what I did, it's because of the people I worked with when I was a student.

When I was looking for a lab to work in as an MD/PhD student, I joined a young assistant professor who was a PhD, but he was part of a group of mostly physician-scientists—cardiologists who basically did two months a year in the hospital, had a half day a week in clinic, and the rest of the time was spent working in the lab. And so, between the first and second year of medical school, I spent the summer in that lab on basically a summer rotation. At the end of that summer I said, "This is what I'm going to do for the rest of my life." And it is, in fact, what I ended up doing.