Stem cell scientist, pediatric thoracic specialist, and associate chief for strategy and integration discusses the newly established esophageal center at Johns Hopkins and research initiatives.
In addition to pursuing his own research, Shaun Kunisaki is forming a multicenter pediatric research consortium aimed at studying and improving surgical treatment of esophageal problems, among other rare conditions, in children.
What steered you toward medicine?
My father, who was an African-American obstetrician, died when I was only 6 weeks old. With a promising career ahead of him, his life was cut short. Since I had no other male role models until I was older, it seemed natural to want to be like him and study medicine. I have always felt that one of my purposes in life was to pursue his unfinished business of helping others and to carry on his legacy.
Why pediatric surgery?
I love taking care of all children, no matter how big or how small the problem. As a father of six, I never forget that developing the trust of parents during a stressful time is powerful. It is an absolute privilege to be a part of this.
What is your niche as a surgeon?
Pediatric surgery is an incredibly broad field, arguably the broadest of all the surgical disciplines in terms of the range of the anatomy. Although I enjoy the full breadth of the specialty, my niche as a surgeon is in the treatment of fetuses and infants with non-cardiac thoracic surgical problems, which typically affect the esophagus or lungs. I became interested in this area as a resident at the Massachusetts General Hospital and Boston Children’s Hospital. Chest surgery in kids is quite interesting but a bit of a neglected field.
Pediatric cardiac surgeons focus on fixing the heart, and there really are very few dedicated pediatric general thoracic surgeons like there are in the adult world. Congenital anomalies of the lungs and esophagus often require highly complex operations, and there continues to be debate in our field about how to best manage them. For example, in some babies born with esophageal atresia, do we stretch the esophagus or replace it with another organ? In babies with lung malformations, does it make sense to remove the lung mass even if it may never cause a problem? Should we have dedicated subspecialty surgeons do the more complicated thoracic procedures, or should general pediatric surgeons, most of whom perform these procedures only two or three times per year, do these cases? There is still work to be done to maximize outcomes in these children.
What are your goals at Johns Hopkins Children’s Center?
One of the main reasons I came here is to help establish a formal esophageal center, very few of which exist in this country. Because esophageal problems in children are so rare and are often difficult to treat, families are willing to travel across the country and even the globe for the best care. I have been fortunate to treat children from all over the country and from Europe. However, you need a truly multidisciplinary effort with pediatric surgery, gastroenterology, otolaryngology, anesthesia and speech pathology, to create a center of excellence to manage the most complex esophageal disorders. You need the collective experience of the whole group to figure out whether medicines, endoscopic techniques, minimally invasive surgery, or open surgery can fix the problem. Sometimes, a combination of different approaches is required. Here at Johns Hopkins, we recently established a pediatric esophageal center with specialists including Margaret Skinner in otolaryngology and Ken Ng in gastroenterology, among others.
We understand you are also reaching outside Johns Hopkins to tackle these problems.
Yes, over the past decade, there has been this growing realization that no individual children’s hospital can really study in a rigorous fashion many of the disorders we take care of as pediatric surgeons. Most hospitals simply do not have enough of these patients, and national administrative databases have their limitations. Consequently, many pediatric surgeons from children’s hospitals located in other parts of the country have formed regional research consortiums in the past several years. Thanks to the vision of my boss (David Hackam), I am working on forming a multi-center pediatric surgery research consortium based at Johns Hopkins. It is time to put egos and rivalries aside and collaborate for the sake of improving children’s surgical care.
What is the status of that group?
Johns Hopkins and about a dozen other large children’s hospitals on the East Coast have agreed to form. We will officially launch in late 2019.
Your other research interests?
As a pediatric surgeon who does prenatal counseling and treats newborns with birth defects, I am continually fascinated with fetal organ development and how that goes awry. About 10 years ago, when I finished training, I was given the fantastic opportunity to start a basic and translational science laboratory looking at perinatal stem cell reprogramming using induced pluripotent stem cell technologies. In the lab, I learned how to transform skin, placenta and amniotic fluid cells into stem cells that behave almost identically to embryonic stem cells. With this technology as well as funding from the National Institutes of Health, our lab has been studying how to better regenerate the spinal cord in spina bifida patients. We are also working with engineers to learn how to grow lung tissue for patients with congenital diaphragmatic hernia. The Holy Grail would be to use a child’s own fetal stem cells to improve outcomes at the time of surgery.
Why Johns Hopkins?
As the associate chief for strategy and integration for our division, I get the chance to market the Johns Hopkins brand to all of the hospitals that we cover in Maryland and Pennsylvania. In Baltimore, I also get the opportunity to work with some amazing people who are all striving to deliver the best treatments for children. My hope, as both a clinician and as a scientist, is to contribute to that enterprise in some meaningful way. David Hackam is a phenomenal leader and one of the premier surgeon-scientists in the country. Johns Hopkins is already pushing the envelope of pediatric care in many areas, such as in fetal therapy under the leadership of Ahmet Baschat and Eric Jelin, among others. The crab in Maryland isn’t too bad, either.