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R. James White, M.D., Ph.D.

Pulmonary

Contact Information

Phone Numbers

Appointment: (585) 486-0869

Administrative: (585) 275-4861

Fax: (585) 486-0947

URMFGA member of the University of Rochester Medical Faculty Group

groupAn Accountable Health Partner

assignmentAccepting New Patients

Research Labs

Biography

The overall goal of my clinical research and bench laboratory is to provide better care to patients with a rare disease of the lung blood vessels, pulmonary arterial hypertension (PAH). Our nationally accredited PHA Comprehensive Care Center provides evaluation and therapy for patients from all over New York and central PA, and we use the full complement of approved PAH therapies. We also contribute actively to clinical research in hopes of better therapies with drugs that are already available and those yet to be approved. I serve as leadership on steering committees and DSMB for global clinical trials in this deadly disease.

In my laboratory, we do experiments in animals and cells in an attempt to discover entirely new ways to treat this deadly disease.

Because echocardiograms often estimate pulmonary hypertension in patients with obstructive sleep apnea and heart failure, much of my clinical practice and expertise is focused in these two common problems.

The URMC Pulmonary Hypertension group also includes my partner Dan Lachant, MD; three full time RN's, Karen Frutiger, Ali Theuer and new comer Cyndi MacDonald; a full time administrator, Jocelyn Dixon; two research technicians, Deb Haight and Jackie Bruno; and a post-doctoral research associate, Allison Light.

Professional Background

I am a scarlet and grey bleeding Ohio State Buckeye who still has a special drawer for OSU sweatshirts and the like. I earned my MD and PhD degrees while in an NIH funded Medical Scientist Training Program at the University of Pittsburgh under the expert mentorship of Ian Reynolds. My thesis studies demonstrated that mitochondria were critical buffers of glutamate stimulated calcium loads and further that mitochondrial depolarization was an important consequence after pathologic neuronal stimulation.

I moved to Rochester in 1997 to begin residency training in internal medicine and stayed to complete training in pulmonary and critical care. Mark Taubman mentored my early scientific career in the lab studying rat models of pulmonary hypertension and a potential pathogenic role for tissue factor, the protease which initiates blood coagulation. I still have a strong interest in bench studies of the pulmonary vasculature, but more recently I have enjoyed leadership roles in phase 2 and 3 clinical trials for PAH drug development.

Research

The University of Rochester is a nationally accredited PHA Comprehensive Care Center, and we provide evaluations for patients with echo estimated pulmonary hypertension. We take care of ~300 patients with WHO Group 1 classified Pulmonary Arterial Hypertension. I was a lead enroller and study author in the labeling trials for tadalafil (PHIRST), oral treprostinil (Freedom-M), and the initial combination Ambition study. I chair the Freedom-EV steering committee and am leading the ongoing global development efforts for oral treprostinil in WHO Group 1. We participated actively in the Reveal registry, and I am associate medical director for Bill Nichols' NIH funded PAH Biobank. We are the lead nationwide enrollers for the NIH funded study of rituxan in scleroderma PAH, and we are making active contributions to Reata's studies of bardoxolone. We use subcutaneous treprostinil (Remodulin, more than 150 patients over the years), inhaled Tyvaso, ambrisentan, tadalafil, macitentan, selexipag, and riociguat in combinations best tailored to a particular patient's needs. We provide a strong link to surgical centers at Massachusetts General and Allegheny General for our patients with chronic thromboembolic pulmonary hypertension.

I am grateful for the opportunity to serve as steering committee leadership in drug development projects with United Therapeutics (oral treprostinil) and PhaseBio (VIP analogue PB1046). I also serve as a consultant providing development advice to Reata, Gilead, Bayer, and Celtaxsys. I chair the DSMB for the first randomized, placebo-controlled trial of genetically-modified, endothelial progenitor cells led by colleagues in Canada (sponsor, Northern Therapeutics).

The overall goal of my bench laboratory is to do better preclinical testing of potential novel treatment options for pulmonary arterial hypertension. Our current approach is with a rat model that recapitulates the histopathology, severe hemodynamic alterations, and right ventricular heart failure seen in advanced human disease. This rat model employs pneumonectomy (promotes contralateral lung growth) and endothelial injury (low dose monocrotaline) to cause lethal pulmonary hypertension in about 4 weeks. Our animals die earlier with a more severe phenotype, and we presented the first report of proliferative, plexiform-like lesions in 2004. We have developed a novel CT angiography to assess for vascular pruning during disease progression, and we have become expert at evaluating RV size and function with echo. We have also utilized telemetry techniques to measure pressure in awake, behaving animals. Our main recent contribution has been to establish a model severe enough that we can test new therapy approaches in animals treated with today's FDA approved agents. We believe that this sort of preclinical testing will provide the best evidence to move compounds into the clinic. Deb Haight, LVT, leads the lab work.

We hypothesize that tissue factor (the membrane bound glycoprotein which initiates coagulation) is an important contributor to disease progression, and we are actively testing small molecule inhibitors of tissue factor and thrombin as novel therapies in this devastating disease.

Credentials

Faculty Appointments

Specialties

  • Critical Care Medicine
  • Internal Medicine
  • Pulmonary Disease - American Board of Internal Medicine

Education

1990
BS | Ohio State University
Arts & Sciences

1996
PhD | Univ Pittsburgh Sch Medicine
Neuroscience

1997
MD | Univ Pittsburgh Sch Medicine
Medicine

Post-doctoral Training & Residency

06/24/1997 - 06/23/1998
Internship in Internal Medicine at University of Rochester Medical Center

06/24/1998 - 06/23/2000
Residency in Internal Medicine at University of Rochester Medical Center

07/01/2000 - 06/30/2003
Fellowship in Internal Medicine: Pulmonary Disease and Critical Care Medicine at University of Rochester Medical Center

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Awards

2005 - 2007
Parker B. Francis Fellowship in Pulmonary Biology, Francis Family Foundation

2003 - 2005
Buswell Fellowship, Department of Medicine, University of Rochester SMD

2001 - 2004
NIH Training Grant Multi-Disciplinary Training & Pulmonary Research, University of Rochester SMD

1996
Alpha Omega Alpha, University of Pittsburgh

1990 - 1997
NIH Medical Scientist Training Program, University of Pittsburgh

1990
Phi Beta Kappa, Ohio State University

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Patents

Title: Treatment of Pulmonary Hylertension uisng An Agent that Inhibits a Tissue Factor Pathway
U.S. Serial #: 11/576,773
Filed: Oct 07, 2005
Invented By: MarkTaubman, R. JamesWhite

Publications

Journal Articles

5/25/2017
Light A, Heininger A, Wessman K, Frutiger K, White RJ. "8% Capsaicin Patch as Analgesia for Severe Treprostinil Infusion Site Pain." Pain medicine : the official journal of the American Academy of Pain Medicine.. 2017 May 25; Epub 2017 May 25.

3/2017
Rahaghi FF, Feldman JP, Allen RP, Tapson V, Safdar Z, Balasubramanian VP, Shapiro S, Mathier MA, Elwing JM, Chakinala MM, White RJ. "Recommendations for the use of oral treprostinil in clinical practice: a Delphi consensus project pulmonary circulation." Pulmonary circulation.. 2017 Mar 0; 7(1):167-174. Epub 2017 Mar 21.

2/2017
Chakinala MM, Feldman JP, Rischard F, Mathier M, Broderick M, Leedom N, Laliberte K, White RJ. "Transition from parenteral to oral treprostinil in pulmonary arterial hypertension." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.. 2017 Feb 0; 36(2):193-201. Epub 2016 Jun 24.

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Videos

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New guidelines set for treating clots