“My interest in ILD began during my respirology elective, when I cared for a 30-year-old man with PPFE (Pleuro Parenchymal Fibro Elastosis, a rare ILD).” This is how Dr. Bohyung Min, began her application for a CPFF Robert Davidson Fellowship.
She describes how she journeyed with the patient through his acute deterioration, ECMO surgery, lung transplant, and eventually saw him walk through the door on his own two feet in the post-transplant clinic, while completing her residency in internal medicine in Edmonton.
“I was intrigued by the complexity of ILDs, the diagnostic challenges, and the opportunity to care for a wide range of patients, during my respiratory rotation,” says Dr. Min. “I wanted to know: How did this previously healthy, young man, end up in intensive care?”
This month she will complete her one-year CPFF fellowship in Calgary and is now well on her way to achieving her career goal of becoming an ILD expert and leader in the field, by striving for clinical excellence in caring for patients and conducting research.
Like other CPFF fellows, she spent 75 percent of her time pursuing research under the guidance of Dr. Kerri Johannson and the rest of her time caring for patients under the supervision of Dr. Charlene Fell at the South Health Campus ILD clinic in Calgary.
On the research front, Dr. Min was successful in having her “poster” (a summary of her study) presented for discussion at the meeting of the American Thoracic Society held last month.
Her study “Monocyte Count and Transplant-Free Survival in Patients with Fibrotic Interstitial Lung Disease,” is also being drafted for publication. Her aim was to investigate a way to use a common blood test as a potential biomarker for progression in fibrotic ILD (fILD). More specifically, the objective of the study was to characterize the associations between blood monocyte counts with transplant-free survival in patients with fibrotic ILD in a multi-center registry.
Circulating monocytes mediate functions in the immune systems and may contribute to fibrosis through the release of pro-inflammatory cytokines and other mediators. Blood monocyte counts have been associated with disease progression and risk of death in patients with various ILDs.
Analyzing data from 2,464 patient files in the Canadian Registry of Pulmonary Fibrosis (CARE-PF), who had a complete blood count (CBC) drawn within one year of diagnosis, Dr. Min studied the associations between blood monocyte counts with transplant-free survival in specific ILD patients.
What she found is that elevated monocyte counts were associated with reduced transplant-free survival in unadjusted models, but this association was lost in models adjusted for other relevant factors including age, sex, and treatment.
What does this mean? Several things according to Dr. Min. It means that there may be a more complex relationship between monocyte counts and fibrotic progression. It also means that treatments may be a factor in this association, by reducing the rate of fibrotic progression. Further investigation is warranted into studying other blood components or more relevant specific monocyte subsets, which could be used as biomarkers of potential survival.
“Even when a direct association is not upheld, as in this case, the information we gather is still helpful,” says Dr. Min. “It may indicate a different fork along a pathway, but it is still another step forward.”
For patients, clinicians, researchers and health care systems, continued research to find simple, effective, and cost-effective biomarkers to identify patients at higher risk of disease progression, continues to be a worthy goal. The ability to identify these patients, means they can benefit from early interventions and/or intensified monitoring. It can also prepare patients for the possibilities ahead.
As Dr. Min looks to the future, she sees incredible opportunities to contribute to advancing our knowledge of pulmonary fibrosis and providing excellent patient care.
“I am grateful to my mentors Drs. Johannson and Fell. They have been wonderful to work with and I look forward to spending another year in Calgary continuing to learn,” says Dr. Min. “I am also very grateful to CPFF for giving me this outstanding opportunity to be a CPFF Robert Davidson Fellow.”
And what about that young man she cared for years ago? “I don’t know where he is now, but for me, he will always be an inspiration, and I hope he is doing well.”