Allan S. Jaffe1, Jin Ye Yeo2
1Department of Cardiovascular Medicine and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; 2JLPM Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. JLPM Editorial Office, AME Publishing Company. Email: jlpm@amegroups.com
This interview can be cited as: Jaffe AS, Yeo JY. Meeting the Editorial Board Member of JLPM: Dr. Allan S. Jaffe. J Lab Precis Med. 2024. https://jlpm.amegroups.org/post/view/meeting-the-editorial-board-member-of-jlpm-dr-allan-s-jaffe.
Expert introduction
Dr. Allan S. Jaffe (Figure 1) is a graduate of the University of Maryland School of Medicine. He received his house staff and Cardiology training at Washington University and continued there for 24 years rising to the rank of Professor of Medicine and Director of the Coronary Care Unit. He then moved to the State University of New York where he was Chair of the Cardiovascular Division, Associate Chair of Medicine for Academic Affairs, and Professor of Medicine. After four years he moved to the Mayo Clinic where he is presently the Wayne and Kathryn Preisel Professor of Cardiovascular Disease Research in the Department of Cardiovascular Medicine and Professor of Laboratory Medicine and Pathology. He is a noted authority on biomarkers of cardiac injury, inflammation, hemodynamic disturbance, and coagulation and particularly their clinical utility. He has published a large number of original manuscripts, book chapters, reviews, and sits on most of the prestigious editorial boards and guideline committees in the Cardiology and Clinical Chemistry communities. He has been a principal for the Universal Definition of MI group. He has received numerous awards from both the Cardiovascular community and the Laboratory medicine community.
Figure 1 Dr. Allan S. Jaffe
Interview
JLPM: What drove you to pursue cardiology?
Dr. Jaffe: When I was an intern at Washington University, Barnes-Jewish Hospital, I was not quite sure what I was going to do. I had been exposed to infectious disease and hematology in medical school, so I was oriented towards those two fields. But I got to know a very engaging young Chief of Cardiology at Washington University who came a couple of months after I did so I always used to tease him that I had more seniority in this institution than he did. He thought I was an interesting and talented guy and wanted me to go into cardiology, and he gave me some opportunities. He was a great mentor and convinced me that cardiology would be a promising and fruitful career and he was right. He did me a great service by moving me into that area.
JLPM: Could you provide a brief overview of the recent significant findings regarding cardiac biomarkers? How will these findings change the way we assess and manage adverse cardiac events?
Dr. Jaffe: There is too much in regards to cardiac biomarkers. There are always new biomarkers coming into the market but there is not anything that is as revolutionary as troponin and natriuretic peptides just yet. There is a re-evaluation going on at present of how to use them optimally, now that 1) we have more sensitive probes for troponin, and 2) we are now appreciating the fact that lower levels of these markers might be used in the more overt clinical syndromes like heart attack and congestive heart failure, which can convey important prognostic and diagnostic information. Hence, we are starting to move towards using troponin and natriuretic peptides to risk-stratify patients and with that risk-stratification, we know given some of that information that suggest that these things are predictive, that there may be therapies that could be utilized to obviate some of the downstream consequences that we see in patients with lower levels of these biomarkers.
JLPM: Despite high-sensitivity cardiac troponin T and I assays being the preferred cardiac biomarkers to detect myocardial injury, certain caveats remain. In your opinion, do you think these caveats pose significant limitations in the assessment of myocardial injury?
Dr. Jaffe: One of the things that happen when you have new probes, such as the high-sensitivity troponin assay, is that you come to recognize that there are a variety of other disease entities that can affect the heart diseases and cause increases in the biomarkers. So the question is how do you sort and distinguish them? This is one of the difficult areas that people are now working on. If we can indeed add additional information with additional clinical and/or blood testing that will facilitate distinguishing, for example, the two types of myocardial infarction (MI), type I and II, which are very different and have different treatment consequences, that would be helpful. Many of us are involved in a variety of ways to figure out how to do that. One way is with artificial intelligence (AI), and there some really good suggestions that AI might be helpful. Another way is by looking at exosomes, which are little microvesicles that bud off from cells and if indeed they have proteins in them, they can provide mechanistic insights. And finally, troponin, like any other peptides, is really an agglomeration of a bunch of different proteins, depending upon how they are released, degraded, complexed etc. As a whole field, we are developing more sensitive probes to look at the fragments, in hopes that they can provide some mechanistic information as well.
JLPM: Looking back, what do you consider to be the most significant achievement/milestone in your career?
Dr. Jaffe: When I was at Washington University, I collaborated with a clinical chemist named Jack Ladenson. Jack made the antibodies originally to CK-MB and eventually developed the first troponin I assay. Jack did the analytic things while I did the clinical validation. The clinical validation turned out to be important. That is probably the thing that people might remember me for most, if they remember anything about me at all.
JLPM: As one of the guest editors for the special series “Cardiac Troponin” of JLPM, could you share what drove you to lead this special series?
Dr. Jaffe: We thought that there were many issues that could be elaborated on and in this issue, we got some of the people who were the most knowledgeable to write about those issues, and they expressed a variety of differing opinions. For example, we included clinical chemists, cardiologists, as well as emergency department physicians because they all look at the use of biomarkers in a different way. And one of the things we wanted to do was to try and make sure that the collaborative nature of what is necessary to use biomarkers in an efficient manner for all concerned was covered. What I think is the best thing about this series is that there are differing opinions, which gives us an opportunity to bring people together to find a better consensus.
JLPM: How has your experience been as an Editorial Board Member of JLPM?
Dr. Jaffe: No journal operates the way in which any given individual who have operated ideally. But the journal was helpful in getting the manuscripts processed and edited so I do not have any complaints either.
JLPM: As the Editorial Board Member, what are your expectations for JLPM?
Dr. Jaffe: I think there are a bunch of journals in this area and I think the best a journal can do is publish things that are accurate. I have real concerns that when we evaluate manuscripts, they should articulate not only the findings but what ancillary findings might be suggested of the data, and what gaps there were. Nowadays, authors often try to sell articles by saying something is totally correct and only include a small section on limitations even though the limitations are massive. I think that is not in the best interest of the academic and clinical communities, so I hope the journal will avoid that and push for manuscripts that are more balanced and then acknowledge them, for their positives but also their flaws.