Dermatology's Role in Closing the Bench-to-Bedside Gap

By bringing dermatology researchers together with researchers of other specialties, Dr. Anna Lien-Lun Chien 01C is helping to uncover surprising links between skin conditions and neurological conditions.

By Jarret Cassaniti 08PH

Dr. Anna Lien-Lun Chien 01C

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By bringing dermatology researchers together with researchers of other specialties like neurology, Dr. Anna Lien-Lun Chien 01C is helping to uncover surprising links between skin conditions like rosacea and neurological conditions. Across America, scientists and clinicians often work in different ways, foreign to each other. Hospitals are divided into departments and the system rewards health professionals for achieving goals individually, not collectively. But the 38-year-old Emory alumna is working to break down these walls.

Chien is seated in her eighth-floor office in the Department of Dermatology’s Outpatient Center at Johns Hopkins Hospital. With a view of Baltimore City behind her, she describes her collaborations with ophthalmologists as an assistant professor and Co-Director of the Cutaneous Translational Research Program.

“On the skin we found there were some immune markers that were elevated or changed in people with rosacea and we wanted to see whether or not that happens in eye rosacea as well,” Chien says. Since the department does not see a lot of eye patients and lacks the resources or know-how to take the samples from the eye, they rely on colleagues from the Wilmer Eye Institute for help. “Similarly, they don’t have the resources or experience of taking skin samples and comparing them,” explains Chien. Realities like these that lead to the pooling of skills and resources are what translational science is all about.

Despite progress in making these types of connections, there is a long way to go in addressing the popular perception that rosacea is just adult acne. Chien explains that there are many different pathways that cause the redness and burning on people’s faces. Researchers have speculated that activated nerve receptors cause these symptoms and noted that similar nerve receptors are found in the gastrointestinal track, leading to the belief that there could be a link between the two.

The demand for translational research is greater than ever. The public increasingly expects the health and medical community to develop treatments for over a thousand known diseases, but the process of developing them is lengthy and expensive. The field gained prominence in the 1990s and earned the nickname bench-to-bedside for shepherding lab research into clinical practice. Since then, the concept has broadened to include a focus on public health. According to the National Institutes of Health (NIH), translation is “the process of turning observations in the laboratory, clinic, and community into interventions that improve the health of individuals and the public—from diagnostics and therapeutics to medical procedures and behavioral changes.” It is a perfect fit for Chien, who enjoys working with people and views dermatology through a wide lens.  

The daughter of an engineer and science teacher, Chien was born in Taiwan but spent most of her childhood in Miami where she graduated from high school. She arrived at Emory University in 1997 as a biology major and spent time volunteering with a student EMT group. She also advised fellow students in the Emory Career Center.  

“She enjoyed helping others directly and wondered if medicine would be the best way to accomplish that,” says Carter Weeber, assistant director of the Center. Weeber said Chien developed an interest in counseling and advising, which was somewhat unusual for an undergrad. Weeber also noticed qualities that would serve Chien well as a translational researcher: being approachable, methodical, and willing to wrestle with hard questions.

During her sophomore year Chien gained a greater depth of exposure into medicine while working with ophthalmologists at Yerkes National Primate Research Center. The same year she also met her future husband, Timothy Hwu 99C through the Taiwanese American Student Association. After graduation she left the warmth of the southeast and headed to the University of Chicago for medical school and then to the University of Michigan for residency. In Michigan, Chien met Dr. Sewon Kang, who would become the Chairman of the Department of Dermatology at Johns Hopkins Hospital. In 2009 she joined him in Baltimore to revitalize the department. What started with one project blossomed into over 40 projects today, ranging from photobiology research to skin regeneration, 10 of which Chien leads. During her eight years at Johns Hopkins, Chien has collaborated with ophthalmologists, oncologists, neurologists, rheumatologists, and epigeneticists. She tested topical treatments for cancer and looked at how genes impact skin health.

Although the costs of developing new treatments can reach $2 billion and take 14 years or more, improving care delivery can be done more cost-effectively and in shorter time by using existing treatments in new ways. Chein explained that a dermatologist in the Research Program was interested in addressing itch among patients with end stage renal disease on dialysis. Since the skin is not able to clear toxins, the toxins stay in the system causing great discomfort. The researcher connected with a kidney specialist at the hospital to explore intervention for providing relief. As a result, the two researchers are now writing grants together to examine if a light treatment used to treat eczema and rashes could be repurposed.

In addition to reaching out to, and fielding requests from researchers in other disciplines, Chien mentors between three and five researchers each year: medical students, residents, and fellows. Noori Kim is a medical resident that collaborated with Chien on several studies. She reflected on the four years that Chien has mentored her. “Chien is a great listener,” Kim says. “As a mentee, it makes discussing our interests and exercising our creativity to come up with new study ideas easy. She is always supportive and provides insightful comments about all the nuances of pursuing clinical research, from study design to research funding to data analysis.”

With the host of counseling and advising skills she was first exposed to as an undergraduate, Chien is quietly helping medical and health professionals break down the divisions between disciplines, so together they can make new discoveries.

“There’s a lot of preparation and kinks to work out,” Chien says. “But to see the end product, or to find data that is interesting that could change clinical practice, or change how we approach patients, that’s very rewarding.”