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

Pulmonary

Contact Information

Phone Numbers

Fax: (585) 486-0947

Office: (585) 486-0147

URMFGA member of the University of Rochester Medical Faculty Group

groupAn Accountable Health Partner

assignmentAccepting New Patients

Biography

Dr. White's focus is to understand the vascular biology of pulmonary arterial hypertension (PAH) and to apply the best science in the care of patients. His lab uses a rat model of severe PAH (pneumonectomy and monocrotaline) and they measure the effects of PAH on exercise tolerance, hemodynamics, and angiography. They are testing novel small molecules that might be useful in treating patients with this devastating disease. Dr. White is currently treating ~130 patients for PAH with 30 patients on Remodulin or Flolan. We are actively enrolling in national clinical trials for PAH.

Professional Background

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

Research

The University of Rochester is the regional referral center for patients with echo estimated pulmonary hypertension. We take care of ~170 patients with WHO Group 1 classified Pulmonary Arterial Hypertension. I was a lead enroller and study author in the Phase III pivotal trial for tadalafil, and we continue to make significant contributions to the development of oral treprostinil (Remodulin). We are actively participating in the Reveal registry. We use subcutaneous treprostinil (about 50 patients), inhaled iloprost, bosentan, ambrisentan, tadalafil and sildenafil in combinations best tailored to a particular patients needs. We provide a strong link to San Diego for our patients with chronic thromboembolic pulmonary hypertension. The overall goal of my bench laboratory is to understand the vascular biology which causes severe pulmonary arterial hypertension. Our main 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 (monocrotaline) to cause lethal pulmonary hypertension in about 4 weeks. Our animals die earlier with a more severe phenotype, and we have presented the first report of plexiform lesions. We have developed a novel CT angiography to assess for vascular pruning during disease progression, and we are also utilizing invasive techniques to measure pressure and cardiac output in awake, behaving animals. 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. A second line of investigation seeks to define the role of thrombin and the PAR1 receptor in PH. In endothelial cells isolated from the rat pulmonary microvasculature, PAR1 activation promotes migration, wound closure, and tube formation in in vitro angiogenesis assays. The migratory activity is dependent on the matrix (fibronectin or collagen) and the microvascular endothelial cells behave differently than those derived from the proximal pulmonary artery. We hypothesize that plexiform lesions result from exuberant proliferation after these cells migrate to sites of injury rich in a fibronectin matrix. This is the work of the recently graduated M.D. Ph.D. student in my laboratory, David Meoli.

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

Title: Treatment of Pulmonary Hylertension uisng An Agent that Inhibits a Tissue Factor Pathway
U.S. Serial #: FR05813918.9
Filed: Oct 06, 2005
Invented By: MarkTaubman, R. JamesWhite

Title: Treatment of Pulmonary Hylertension uisng An Agent that Inhibits a Tissue Factor Pathway
U.S. Serial #: DE05813918.9
Filed: Oct 06, 2005
Invented By: MarkTaubman, R. JamesWhite

Title: Treatment of Pulmonary Hylertension uisng An Agent that Inhibits a Tissue Factor Pathway
U.S. Serial #: GB05813918.9
Filed: Oct 06, 2005
Invented By: MarkTaubman, R. JamesWhite

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Publications

Journal Articles

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.

11/2016
Hoeper MM, McLaughlin VV, Barberá JA, Frost AE, Ghofrani HA, Peacock AJ, Simonneau G, Rosenkranz S, Oudiz RJ, White RJ, Miller KL, Langley J, Harris JH, Blair C, Rubin LJ, Vachiery JL. "Initial combination therapy with ambrisentan and tadalafil and mortality in patients with pulmonary arterial hypertension: a secondary analysis of the results from the randomised, controlled AMBITION study." The Lancet. Respiratory medicine.. 2016 Nov 0; 4(11):894-901. Epub 2016 Oct 11.

6/15/2016
White RJ, Rao Y. "Novel Analysis of the Oral Treprostinil Combination Therapy Trial Data." American journal of respiratory and critical care medicine.. 2016 Jun 15; 193(12):1434-6.

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Videos

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