From Patient To Dedicated Advocate
Allan Klein, MD, had no inkling when he began his training in cardiology that he would eventually become an international leader in diagnosing and treating pericarditis. He arrived at the field while mastering advanced imaging techniques to diagnose and treat various forms of heart disease, including a form of pericarditis called constrictive pericarditis, where the lining of the heart becomes thickened. Along the way, it became clear that there was a long line of pericardial patients around the country searching for better care.
“Recurrent pericarditis is a debilitating condition, but there are major gaps in education and treatment for the condition,” says Dr. Klein.
About 40,000 people in the U.S. experience recurrent pericarditis, battling chest pain, fatigue and shortness of breath. For many, an acute case becomes recurrent before they are diagnosed and treated with NSAIDs and colchicine, a drug that has been used to treat gout. And, while using steroids as a second-line therapy offers the most powerful relief, these drugs come with a long list of side effects, including weight gain, ulcers, sugar diabetes and mood swings.
Dr. Klein came to Cleveland Clinic in 1989 with a research echocardiography fellowship and clinical cardiology training under his belt. With deep expertise in imaging constrictive pericarditis, he was well-positioned to create a center of clinical and research innovation that offers fresh hope to pericardial patients from all around the world. Today, the Center for the Diagnosis and Treatment of Pericardial Diseases is everything he envisioned and more. Dr. Klein and his colleagues treat more than 3,000 cases of pericarditis every year. They are leading the charge in using cardiac MRI for scans and developing biologic drugs that will likely supplant steroids in the near future.
Lending Support
Dennis Feinberg, a retired veterinarian who practiced in Charleston, South Carolina, first arrived at Cleveland Clinic in 2009 with a dilated anterior aorta. Dr. Klein, an expert in echocardiography and advanced imaging, was an ideal fit for his case. From the first visit, Feinberg appreciated Dr. Klein’s friendly demeanor and deep well of knowledge.
“He is an excellent listener, always quick to respond when I reach out,” Feinberg remembers. “Over time, he has advocated for me whenever I need to see another specialist."
Feinberg is a medical advocate in his own right. He serves on the advisory board of the Medical University of South Carolina Heart and Vascular Center and leverages his resources to champion physicians who stand apart in their field. After meeting Dr. Klein for the first time, Feinberg began to research his background and learn about his leadership in diagnosing and treating pericarditis.
Using cardiac MRI, Dr. Klein can not only diagnose pericarditis but stage it like a cancer, determine a prognosis (e.g., three to five years on anti-inflammatory medications), predict the likelihood of recurrence and devise an optimal treatment plan. He has also conducted clinical trials for new therapeutic agents such as interleukin-1 blockers. One phase 3 randomized trial, termed RHAPSODY, evaluated an interleukin 1-blocker called rilonacept that provides immediate relief to patients and reduces the risk of recurrence of pericarditis by 96%. Other than redness in the injection site and a slightly higher risk of upper respiratory infection, rilonacept comes with none of the major side effects of steroids. The FDA approved the drug in March 2021.
“It quickly became clear that Dr. Klein was leading a renaissance in his field,” Feinberg reflects. “I realized that supporting his efforts as a researcher would make an impact on countless patients.”
Over the past decade, Feinberg and his wife, Sharon, have made numerous gifts to support Dr. Klein’s efforts. Buoyed by ongoing philanthropic support, Dr. Klein is building on the success of the RHAPSODY trial. Recently, a long-term extension study showed that at 18 months, only 3% of patients who continued on rilonacept experienced another recurrence of pericarditis, compared to 75% of patients who stopped. These findings indicate that recurrent pericarditis is a chronic disease that requires long-term therapy. Other ongoing research focuses on the role of genetics in recurrent pericarditis, new inflammatory markers in diagnosis, the role of MRI in tracking the disease and the role of exercise restriction in patients with recurrent pericarditis.
A decade from now, Dr. Klein envisions smaller, more portable MRI scanners and echo machines guided by AI and improved biomarkers to better diagnose patients with pericarditis. As research progresses, he also hopes to be better positioned to choose different anti-inflammatory drugs based on patients’ genetic makeup.
“We are living in an exciting time for the treatment of pericarditis,” says Dr. Klein. “But there is still work to be done in terms of funding, specialized training, development of pericardial centers of excellence across the nation and public awareness.”
He credits philanthropic support from donors like Feinberg, whom he calls “a very accomplished gentleman, friend and loyal advocate of the Clinic,” for propelling innovation forward from the sidelines.
Feinberg travels to Cleveland twice a year to see Dr. Klein, who is still his primary cardiologist. Given their shared science background, the two also exchange articles and information about breakthroughs in treatment.
“Dr. Klein is a model physician-researcher and a true pioneer in discovery,” says Feinberg. “It’s exciting to be part of something that is improving the quality of life for today’s and tomorrow’s patients.”
Straight Talk from the Doc: A Q&A with Breast Oncologist Zeina A. Nahleh, MD
Zeina Nahleh, MD, is Regional Vice Chief and Chair of the Department of Hematology-Oncology at Cleveland Clinic in Florida, and Director of the Maroone Cancer Center at Cleveland Clinic Weston Hospital. A breast oncologist, Dr. Nahleh has received numerous awards and distinctions and authored more than 50 articles and book chapters in the field of cancer and breast cancer research.
Born and raised in Beirut, Lebanon, amidst civil war, she knew early on that she wanted to be a physician. In training, she realized her life experiences gave her great sensitivity and empathy which suited her interest in caring for patients with cancer. Dr. Nahleh recently received a VeloSano pilot grant for her research involving the exploration of immersive virtual reality as a therapeutic tool. Her award marks the first time that VeloSano research dollars will be applied directly to patient care practices in Florida. Dr. Nahleh recently shared her thoughts on breast cancer research and the importance of philanthropic funding.
Q. What most excites you about current breast cancer research?
A. Current breast cancer research is leading to new more personalized ways to treat breast cancer that are often milder and gentler with less side effects than historical treatment.
This is very exciting and provides more hope for a cure and improving survival rates while maintaining a good quality of life.
Q. How do support services and adjunct therapies support a patient's course of treatment?
A. Support services are a vital part of cancer care at Cleveland Clinic. These are proven therapies that are evidence-based and provided by licensed therapists to address symptoms caused by cancer and cancer treatment, such as fatigue, pain and anxiety.
These services aim to improve the quality of life for those navigating cancer by giving them safe tools to support the physical and emotional well-being, such as nutrition, psychotherapy and fitness therapy to name a few. They complement the cancer treatment and are provided along with, not instead of, standard cancer treatment.
Q. How does philanthropic support impact your work?
A. Scientific research has clearly advanced cancer care and provided hope to many through the development of innovative treatments and ways to improve cancer outcomes. However, cancer remains a deadly diagnosis for many patients, unfortunately, and more research needs to be done. Cancer research can move faster and reach many more patients with close partnerships between medical specialists and philanthropy.
Also, despite the great advances in treating the disease, cancer is still a devastating diagnosis, and patients are challenged during and after treatment. Therefore, support services are needed to help support the patient's mind and body. Many of the needed support services are not covered by insurance and can only be provided with support from philanthropy.
Q. Why is it important to fund medical research, and how does it act as a catalyst for innovation?
A. Medical research is the proven way to make progress toward saving lives and diminishing the tremendous burden of cancer in our society.
Scientific research allows physicians and scientists to better understand the biological processes involved in cancer, leading to better prevention, detection and treatment of many cancers. The current improved cancer survival rates are due to more effective and targeted treatments and prevention strategies discovered through research and innovation.
Your support of breast cancer research at Cleveland Clinic in Florida begins here. Thank you for making a gift.
