Interview with John Kurhanewicz by Alexa Rocourt
Q: In a couple sentences, tell me about what you do in your work.
A: I’ve been here for thirty years, and the focus of my work has been developing MRI in order to personalize medicine for patients. In patients, we want to better characterize the disease for improved treatment selection, and to better monitor the effects of the subsequent treatments. I also oversee all of preclinical imaging in the department of radiology. In that setting, I oversee a lot of work in other cancers and diseases.
Another focus of my work is to develop unique techniques to develop these imaging exams. The area that I’ve been very interested in is being able to image living metabolism. Metabolism changes with the development of cancer, it’s progression and its response to therapy. We use that information to better characterize the cancers in individual patients, which leads to the improved selection of what to do.
A perfect example is in the setting of prostate cancer. About 230,000 men a year get newly diagnosed in the United States alone with prostate cancer. Only a very small percentage (about 25,000, 10% or less) of those men will develop lethal disease. So you have this enormous population of men being diagnosed with cancer, but many of these men probably have what we call non aggressive disease. Recently, people have acknowledged this and a lot of these patients can avoid doing aggressive therapy for a period of time.
So I’ve developed exams which involve metabolism in order to combine it with other kinds of imaging, like structural imaging. What we developed with about 25 years of NIH funding is multi-parametric staging exams. When men get biopsy proven prostate cancer, they get this exam in order to better characterize their cancer and help them and their doctors answer the question “Should I do aggressive therapy or can I wait and follow my disease?”
We worked with big and small companies, (like GE Healthcare being big) in order to develop this exam and clinically translate it. Right now this exam has been fully clinically translated here at UCSF, and we scan around 1,400 men a year.
Most imaging is based on water, because we are 90 percent water. So, our anatomic imaging basically looks at water and how the properties of water change in different structures so we can get structural information ready. When we go to metabolism, we actually want to look at intermediate metabolites. So we take up sugars, like glucose, when we eat our food, and glucose goes in the cell and gets converted to all the nutrients that we need to create energy and building blocks that make up cells. The concentration for those things are at a much much lower level than water. With proton imaging, we run it through a sensitivity problem. At the moment, we’re working with GE Healthcare on a brand new technology in which we use carbon protons. We use radio waves, which go right through us. They don’t change anything, and we can use them to excite our spins so we can excite the system without changing it. That’s the beauty of it. The bad side of it is that the sensitivity when we want to look at metabolism is very low. So we take this new technique, take a probe and label it with carbon 13 and we go through a pre-polarization step which increases our signal to noise hundreds of thousands a fold, so the low concentration metabolites have the same signal as water. We inject this probe (a simple endogenous sugar) and watch it go through the body. We can watch and image it being taken up by the cancer and watch wherever that carbon goes.
So we take what we have and see how much we can improve over what we are already doing in measuring the presence and aggressiveness of the cancer and its response to therapy. One side of the point is helping men who are already diagnosed to decide what or whether they need to do therapy. The other side of the point is monitoring men who have undergone treatment and have developed resistant disease. So we would love to be able to figure out whether a cancer is moving towards being resistant to treatment before it actually happens so that we can treat it with other new drugs and extent the patient’s life.
Q:What’s your favorite part about being a scientist?
A:What’s so exciting about being here at UCSF is being able to take something from the bench-top to a patient. Another part is of course the students; the people who make this happen. I’ve been very fortunate to have many students go through my lab who have been both a pleasure having them work in the lab to help achieve these accomplishments, but also to go off and do great things later on. The students here are amazing. Teaching is something that really makes me want to go to work in the morning. It’s a great thing to be able to see how things translate into patient studies, but then also having the students as great people to work with.
Q:What have you created or discovered that you are most proud of?
A: I’m very proud of the multiparametric proton, but I’m very very proud of this new hyperpolarized studies going on right now. We did the first clinical trial in prostate cancer patients of this new hyperpolarized probes C13 pyruvate. Currently, we have 9 ongoing patient trials looking at a variety of diseases (prostate cancer, brain tumors, metastatic disease, breast cancer. So we’re developing probes of all kinds of processes in the body and clinically translating them.
Q:At the end of the day, why does your work matter?
A:It matters because it helps patients. We don’t hypothesize that it helps patients; we’ve seen it help patients. When I first started the imaging prostate cancer patients, most prostate cancer patients didn’t get imaging done. About 30 years ago we used to do maybe five a month. Now we’re doing hundreds a month. We’re helping them answer a very very difficult question; a question of “what do I do next?” Their problem is that if they go to five different doctors they are going to get five different answers. What they need is quantitative data that helps them and their doctors make the right decision. We’ve seen this and now we’re trying to make it better. We’re on the cusp of seeing how much better we’re going to make it.
Q:Outside of work, what do you do to relax?
A:Work does consume me. Family is always important, of course. I have a big family with five children. They are all off on their own now having kids of their own, which is a beautiful thing as well. I like swimming, biking and things of that sort. I like being outside. California is a beautiful place to live for sure.
I try to take time off, but it’s hard to get that balance. The reason is in this line of work, you’re your own boss, and the hardest boss you have is yourself. In order to do big picture stuff, you have to have big groups, a lot of collaboration and a lot of money. So you spend a big chunk of your life begging for money, and you wind up basically running a business. I’m responsible for my group and for the livelihood, so that weighs heavily.
For the last decade I’ve been saying “well I’m slowing down now,” but it’s so hard to do that because in order to slow down you have to give up some of what you’re doing and it’s hard. Right now the way I’m approaching it is passing it on. So I mentor a lot of junior faculty. Parts of what I’ve put together in my program, my people, my staff I’m beginning to share with other faculty that I work with so that eventually they’ll be able to take over. That will open the door for me to do things like golf, sail and things like that, which I haven’t had the chance to do.
Q:What situation do you think you’d feel the most out-of-place in? What is something that makes you uncomfortable?
A:Not being in control, so being in that position of helplessness is something I despise. It just drives me nuts. I like to be able to address things and move forward. I’m so used to figuring out how to approach a problem vs having to turn it over to somebody else and say “fix me.” Being in a hospital myself would probably be pretty miserable. Doctors make the worst patients in the world. Medical scientists are similar in that scenario.
Q:In 100 years, what do you want to be remembered for?
A:That’s a question I think about a lot now, because I am phasing out. I think I’d like to see the techniques that I helped develop continue to help people grow. I think my true legacy in the world are the students I leave behind and what they do for medicine and patients. I'm in the process of passing the systems that I set up here at UCSF and the core imaging facilities to other people. I would love to see those things expand and continue to be used by people outside of imaging so they can use imaging to help them answer basic biology questions or medical questions.
