Interview with Dr. Kleinman and Dr. Vacanti, co-chiefs of MGHfC

As co-chiefs of MassGeneral Hospital for Children, Ronald E. Kleinman, MD, and Joseph P. Vacanti, MD, together run a hospital-within-a-hospital that serves 170,000 children every year at the Boston campus and in 15 community locations throughout the area. Its 375 clinical staff work in 60 subspecialties.

Dr. Kleinman, who is physician-in-chief of MGHfC, is also unit chief for Pediatric Gastroenterology and Nutrition and chief of Partners Pediatrics. Dr. Vacanti, who is MGHfC surgeon-in-chief, is also deputy director of the Center for Regenerative Medicine, where he is principal investigator at its Tissue Engineering and Organ Fabrication Lab.

Mass General Magazine sat down with the co-chiefs to hear what makes MGHfC so unique — and increasingly, the choice destination for pediatric patients across the region and beyond

Q: What’s the advantage of a children’s hospital that is part of a larger academic medical center rather than as a dedicated stand-alone institution?

A: Dr. Kleinman: Mass General is one of the largest and most successful patient-care and biomedical research enterprises in the world. So with MGHfC as a hospital-within-a-hospital, we leverage this position by providing our pediatric patients with exceptional access. That has meaning when it comes to patient care — because our pediatricians, who are top-flight in their own right, work side-by-side with their adult care counterparts and share ideas. So our pediatric neurologists share information with the realm of neurologists throughout the hospital, and so on.

Moreover, we offer comprehensive care over a lifetime. When pediatric patients reach adulthood, they have a smooth transition to their new physicians. When pregnant mothers are seen for obstetrics services, we can diagnose problems with the fetus in utero, then treat that infant once it is born.

Dr. Vacanti: Also, as part of a major academic medical center that receives funding from a variety of sources, MGHfC benefits from expensive technologies that only the biggest such centers can afford. Take the Francis H. Burr Proton Therapy Center. It’s one of less than a handful of proton beam centers in the country because it is so costly. But children with cancer are major beneficiaries, because the proton beams are able to target tumors with great precision, sparing neighboring tissue. That’s especially valuable for children because their bodies are still growing. Traditional radiation often stunts growth in children with cancer.

The hospital also has some of the most advanced imaging tools anywhere — massive functional MRI machines, CT scanners and other 3-D imaging techniques that are rarely found in clinical settings because they are incredibly expensive. These tools have enabled MGH to become a leader in diagnosing and researching brain injury, tumors, epilepsy, motor and language disorders and other neurological diseases.

Q: How does the research enterprise translate, as well, to rewards for MGHfC?

A: Dr. Kleinman: In countless ways. Hundreds of clinical trials are going on at any given time here, and our patients have the ability to enroll in them and thus benefit from new treatments. Another way is when researchers investigating genetic links to cancers and other diseases are able to identify pediatric-specific cancers — like in the case of Daniel Haber [MD, PhD, director of the Mass General Cancer Center] who discovered a link between inactivation of the WT1 gene to Wilms’ Tumor, a pediatric kidney cancer. And there are many other examples.

Q: Scientific research is in a new era of broad interdisciplinary coordination. What will be the effect on pediatrics at MGHfC?

A: Dr. Vacanti: Advances in stem cell science hold promise for finding cures for a spectrum of diseases, many of which rear their heads in childhood. Likewise in genetics and in molecular biology. In my field of tissue engineering, we have found methods to produce more than two dozen tissues in the body, some of which are in human use. Our ultimate goal is to fabricate entire organs, which would save the lives of many children and adults who die for lack of an appropriate donated organ. One of the exciting projects in my lab right now is the development of an artificial, silicon-based lung for premature infants that will function like a baby’s lungs.

Q: Do pediatric care and research at MGHfC inform adult medicine as well?

A: Dr. Kleinman: There is an ongoing dialogue between physicians dedicated to adult and pediatric practice, so in innumerable ways that dialogue builds knowledge in both child and adult medicine. In my specialty, gastrointestinal (GI) disorders, I am sharing information with adult GI specialists all the time. One of my GI colleagues, Dr. Garrett Zella, for instance, is working hand-in-hand with MGH adult GI specialists to identify the bacteria that may influence the course of patients with inflammatory bowel disease. This has implications for children as well as adults and may even offer opportunities to identify patients with early symptoms of inflammatory bowel disease and treat them before it progresses.

Ronald E. Kleinman, MD

Massachusetts General Hospital for Children
Chair of the Department of Pediatrics
Chief of the Pediatric Gastroenterology and Nutrition Unit
Charles Wilder Professor of Pediatrics at Harvard Medical School

Joseph Philip Vacanti, MD

Massachusetts General Hospital for Children
Surgeon-in-Chief, Massgeneral Hospital for Children
Chief, Pediatric Surgery
Director, Pediatric Transplantation Program