Prof. Serpil Erzurum is Cleveland Clinic’s Chief Research and Academic Officer and Chair of the Lerner Research Institute. Dr. Erzurum has won numerous awards, has published more than 300 articles, and is among the top 1% cited researchers in the world. This interview was originally published in English on Nefes, the magazine of the Turkish Pulmonary Hypertension Association PAHSSc, on (date). Our sincerest thanks go to our friends and colleagues at the PAHSSc for graciously allowing us to republish this interview and share with the wider pulmonary hypertension community!
Interview
Prof. Erzurum, it is a pleasure to host you on this issue of our periodical “Nefes”. Thank you very much for your time. We feel honored.
* Dr. Erzurum, could you tell us about yourself please? Where you grew up? How you were drawn to medicine, if possible?
I was born in Cleveland and grew up in Ohio—not in Cleveland, but close to Cleveland—and my father and mother had come to the States for a job and then I was born here. My Dad is an engineer, and I really enjoyed Math and Science and I guess my teachers in school really encouraged me to think about medicine—there were no doctors in the family. My father really wanted me to be an engineer.
• How did you gravitate towards research in respiratory medicine?
There is a lot that we do not know in respiratory medicine. I asked my professors and my teachers so many questions that they did not seem to have the answers for I was just a very curious person, and so it seemed like the right way to get the answers was to try to investigate it.
* Which achievements have you been most proud of in your career?
We did quite a bit of early work on understanding how the lungs are able to match ventilation to perfusion: bloodflow matched to airflow so that the lungs can be efficient at gas transfer. I am really proud of that.
We also did some work that involved understanding the biological differences between the male and the female lung. There are quite significant differences.
And finally I think one of the areas I have been most proud to contribute to is understanding how populations of people adapt to their environment with their respiratory system, and most notably high altitude where there is a limitation on the amount of oxygen for breath of air that you take in, so there is no way to avoid hypoxia at high altitude. We worked through some of the mechanisms that your body physiologically does to adapt over thousands of years and we really had fun with this project. It is what led us to understand better perhaps those people at low altitude who do not have the appropriate adaptation to hypoxia from disease.
And which do you think is the most important for your field?
I am very proud of the contributions our group has made. I am very proud of it. If I had to say the most important thing that I feel has made a difference, is mentorship. For all the projects we worked on we had a team and young people and they learned a lot. I am really thrilled when somebody that is young decides they want to do research too. They want to continue and have their own research career and they see it as something possible for them and also an imperative to move the field forward. So I really am most proud of all the young people that have worked with me and they are fantastic, doing great stuff.
* Could you tell us about your immediate and long-term ambitions?
We are very close to using big data for drug discovery. Computation science regarding drug discovery. Ans using our understanding of the genome, the transciptome, the proteome, the metabolome, combining all those to look at how they interact, then to identify pathways that are altered in disease. From that we can use a computational approach from those we know to target those pathways. At least these are surprising suggestions for drugs you might try in different diseases. It also uncovers the mechanisms of disease and that leds us to understand better the origins of the disease. So this big data understanding of each individual and the disease they have I think is going to be transformative. I am so interested in pursuing that. We are all still learning how to do it. So it is not here yet. But we are trying.
* Practice, research and education all form a part of your work. How do these complement one another?
That is a question that I often get asked. I am a medical doctor. I do not have a PhD. and everything I have done in research has been to answer a question of a problem that a patient had but I did not understand and that I did not know how to take care of it and so my practice is a direct connect to the research. Many patients that I see often end up being in research studies. And then you develop a really close bond with that patient who feels like they are part of the team. They are helping us understand disease and perhaps new treatments for the future but they are also learning about themselves and what is wrong with them. So I think the medicine that I practice and the research I do makes me a different kind of doctor. I do not think I am better or worse. I think it is just different. That is how I practice. The education for the most part is through graduate students in my lab or young physicians working on projects so they are part of the team. I have graduate students regularly who get PhDs with me. Those graduate students get their PhD but they are very driven to help a patient. So usually the students that are working with me are interested in having an impact on patient care, and of course the physician scientists working with me are the same.
And which do you see as the most important?
Oh the mentorship, the education. It’s about the future because I am just one piece of a long line of people who should be doing this work. It’s going to take many people to find cures for pulmonary hypertension or asthma. I think the most important thing I do is mentorship for sure.
* You are being modest with yourself!
No, no I am always very happy when I see them achieving their goals.
* But still you are the leader!
I am trying.
• How does your working week look like? You were away last week. ( Do) you start working at 7 o’clock in the morning like this?
Yes, sometimes at 6:30 sometimes 7:00, I work till through 7:00 -8:00 late at night. It is true. Well, you know, it is because I love what I do. I love everything I do. It sounds unbelievable but I am so grateful that I have this ability and the opportunity. To be a physician is an honor. People come in, see you; they trust you; they tell you things. It is true.
* It is an honor for the world.
The other thing is that you know that being around young people is stimulating—it’s a joy. And to see their passion and ambition is very exciting and then the research itself is just fun. You are finding things that nobody has seen before. That is pretty amazing. It almost becomes more than a job. It is something that I love to do, it keeps me up at night. And I have raised my children, they’re grown and so you know I have time for this.
*. Your son is a doctor if I am not mistaken?
I have two daughters and one is a physician. She’s in Texas and the other is a lawyer. They are in Cleveland. I am very proud of them too. Hardworking.
* And plus all the hard work and three children. Quite a busy life.
2 children! It is a very full life. I am blessed.
*. What do you think are currentiy the most exciting or promising avenues of research into pulmonary hypertension?
The most exciting direction for research at the moment is computational analysis. We do not have enough skilled people and we do not have the tools. So the most exciting opportunity is in computational studies of human biology.
* In the past, if I am not mistaken it was easier to find people to do research on. Nowadays is it more difficult?
It is more difficult particularly since the pandemic of Covid. I do not know if that will turn around but there is definitely a shortage of people going into research. I think that is global.
* That was of course my question. How has Covid affected your life?
It has affected the whole world. The whole world. It has affected everything, every moment of your life is affected by it. So we are going to have to come through it somehow because we need to continue.
* We do not know the repercussions of the vaccinations we have had. I have had 6.
*. That is amazing.
I hope it will be amazing for my health in the future.
Right, a lot of vaccinations. My Goodness..
• Does your field currently receive enough investments for research or interest in your opinion? Is the amount of funding / investment increasing / decreasing?
Well, our research funding has been increasing steadily since 2017. We have almost tripled funding. We have been increasing every year. So I think the people that working in research are very dedicated and they are working harder and faster than ever. Some of this happened with the pandemic also.
*. The world, the people and the fund givers appreciate this. I hope you will find the best medication for us and we will live longer!
You are doing great. You are doing fabulously.
*. Professor Erzurum, should there be anything you would like to add please feel free to do so.
One thing that this pandemic showed us is that it is a small world. Something like this comes along and we are all affected. I think that one way we responded that was positive was that we collaborated scientifically across the world. Everybody saw that there was a reason to do research together, to understand the virus together and the data sharing was inspirational. There is not anyone who did not want to share their data, make it accessible and that accelerated the discoveries that we have made, the medications, the vaccines. You know, this is a good lesson, we should not wait for a pandemic to do it.
* In the past people used to sort of cling on to what they have found. That was the case if I am not mistaken.
Yes, it is correct. It is correct, to try to keep it in their hands and do not share, do not show, do not publish it and that slows us all down. If we could be more open and transparent in the research we are doing, we would all benefit. By the way, it would benefit each individual personally. Because you will be able to receive information, you will be able to do your own work faster.
I hope this has been a lesson and I hope we could move forward like this. That is my big thing: I watched what happened the past three years and I wonder why we do not focus all our efforts to cure other things like cancer for instance.
* May I ask something which came up while listening to you?
* You said we were working with the big data and you have the expectations about it. May we hear in five years years in two years, can you give us a term? That is my first question. My second question is, you said that patients learn about what is going on with themselves. This might sometimes be disturbing for the patient. We just do not want to hear about the disease and so on. How do you convince them? Can you share a brief memory that you have lived through with a patient of yours.
The first question is a good one. What do I see of the big data approach? Well, for example we have the capacity now to measure your whole genome and understand the entire sequence. All the genes that are transcribed that you are expressing in every one of your cells and what proteins are being made and what is the metabolism that is resulting from the enzymatic reactions. I also have the ability to image you, completely: CT scan, MRI, functional imaging. All that data could be placed into a computational algorithm to create a virtual Olcay, a digital twin. Someone like you in the virtual space, computationally, that has all the components that make you you. That digital twin can be experimented on. You could use that digital twin to know what is best for your health? What is worst for for health? What food should you eat? How often should you exercise? Can you smoke? Where and how would you be susceptible for disease? Would you do well at high altitude? All these things could be done hundreds of millions of times with that digital twin. It is you!
People are now thinking we will have cities of digital twins and you could follow yourself, your digital self, to understand what should I do? How should I work? What is best for my health? Who does not want to know that? Who does that want to know that!
Listen, when you go on Amazon or any other program where you order things you use this, right? Amazon has already created digital twins for me, the consumer. It knows what I like to buy. It knows when I should buy it. It knows which books I like to read and it makes recommendations for me. It will send me recommendations. It is time to buy more Clorox (bleach), you have probably run out—they are usually right! They will recommend books. I usually like them. How do you think they are making those recommendations? They have created a virtual you based upon your habits and what they know about you; your zip code, your age, your race, your demographic and it works pretty well. You probably enjoy that comfort. What if there was a digital twin for your life that you control, that made recommendations to you, what you should do this week, next week. I think that would be the next step for us. There is also the opportunity for people to have a combination of digital within themselves. The young generation now are never without their phone. They are open to having implantation of these devices. When that happens, then we are combining the digital virtual world with the human real world, and that will change the human race, and that will change how we go about our lives. It is coming, it will happen.
It is just something to look at and you have to embrace it and move forward with it. You can not say, I do not like it. I do not want want it because it is happening already. If you are on the internet, if you have a Facebook page, if you are on twitter if you have Amazon it is already happening commercially. I’m thinking it is useful for your health, for your life. People that do not want to know, that is ok. We do not push things on people. I think it would be rare for a person to not want to know, especially younger people.
Before we say goodbye to you may I ask a favor from you. We have a phrase, a motto which means, “Breath is priceless!” If I spell it in Turkish, would you say it in Turkish for our patients.
“ Nefese paha biçilmez.”
“ Nefese paha biçilmez”
Dear Dr. Erzurum, thank you ever so much for your time. You are helping the humanity. It is an honor to have had the opportunity to talk to you. You are a great model for the Turkish girls. We are extremely proud of you.