In the mid-’80s, a young family practitioner began his medical career in a small Mediterranean town of Gazipasa in his native Turkey. Simply employing a stethoscope and relying on the occasional medical textbook, he cared for patients from some 15 neighboring villages. From treating the common cold to drilling holes in the skull to relieve the pressure of an epidural hematoma, this son of a Turkish doctor honed his clinical skills in every way possible. Little did he know at the time that 26 years later he would have gone from his two-room clinical practice to a corner office in the state-of-the-art Prentice Women’s Hospital of Northwestern Memorial as new chair of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.
What Serdar Bulun, MD, George H. Gardner Professor of Clinical Gynecology, did know, though, was that the intersection of clinical medicine with biomedical research could lead to better patient care. His aspiration to combine the two as a physician-scientist—a passion instilled in him by his late father, a general internist—brought him to the United States in 1986 for residency and fellowship training.
“My father went to medical school at Istanbul University in the ’30s, when many international stars and pioneers in medicine were coming to Turkey. Many of them were Jewish doctors who were forced to leave Nazi Germany, including the likes of Rudolph Nissen, who was then the chair of surgery at Istanbul and inventor of the famed Nissen fundoplication procedure still used now for reflux disease,” shares Dr. Bulun, who also earned his MD degree from his father’s alma mater. “He always spoke highly of their dedication to medicine and science. His experience meeting these individuals really inspired him—and me.”
Pioneering in his own way
Obstetrics and gynecology had special appeal to Dr. Bulun, who had decided to pursue the specialty long before he left Turkey. When he got to the U.S., he completed a pathology residency at the University of Arizona College of Medicine and an internship in obstetrics and gynecology with the Columbia University College of Physicians and Surgeons. He rounded out his training with a three-year obstetrics and gynecology residency at State University of New York at Buffalo and a sub-speciality fellowship in reproductive endocrinology and infertility at the University of Texas Southwestern Medical Center at Dallas.
“OB-GYN doctors have tremendous advantages for understanding all aspects of women’s health,” he explains. In the case of Dr. Bulun, his fascination with steroid hormones has led to key research discoveries that are improving the health of literally millions of women today.
A renowned investigator in his field, Dr. Bulun has spent his academic career studying naturally occurring ovarian steroids and their influence on female-specific diseases. In particular, he zeroed in on aromatase, an enzyme essential for the production of estrogen. Thanks to his research and that of others, aromatase inhibitors became an effective and preferred endocrine treatment for hormone-dependent breast cancer. By the mid-’90s, Dr. Bulun had expanded his aromatase work. He decided to tackle two of the most common women’s health problems: endometriosis and, then later, uterine fibroids. In 2003 he joined Northwestern to create the new Division of Reproductive Biology Research in the Department of Obstetrics and Gynecology, where studies center on better understanding how steroid hormones affect women’s health via complex and diverse mechanisms.
“As a gynecologist, I treated many patients with endometriosis—a condition that continues to have few treatment options,” explains Dr. Bulun. Abnormal cell growth outside of the uterus is the hallmark of endometriosis—a disorder that affects more than 5 million women in the U.S. “So I said, ‘OK, what can we do to understand the role of aromatase in endometriosis?’” His team’s preliminary studies on aromatase led to a greater discovery that distinct epigenetic defects acquired before the menarche, the first period of a young woman, are responsible for triggering abnormal signaling mechanisms and causing severe inflammation, pelvic pain, and infertility.
These laboratory-based studies eventually paved the way for new therapeutic agents. In 1998 Dr. Bulun and his research team were the first to introduce the novel use of aromatase inhibitors to alleviate the inflammation and discomfort of the disorder. Aromatase inhibitors, currently used as an off-label drug, have made a difference for women seeking relief from unresolved endometriosis-related pain. For his contributions to the understanding and treatment of the disease, Dr. Bulun received a National Institutes of Health (NIH) MERIT Award in 2010.
The development of non-cancerous uterine fibroids (leiomyomas) will occur in as many as three out of four women at some point in their lives. Sometimes causing anemia due to heavy and irregular uterine bleeding, fibroids also may lead to recurrent pregnancy loss and potentially grow into extremely large masses, causing significant pelvic discomfort. Women often face the choice of surgery—including total hysterectomy—to remove the fibroids or the use of high-intensity ultrasound technology to destroy them. No effective drug treatment presently exists.
Heading the only NIH-funded comprehensive uterine fibroid research center in the nation, Dr. Bulun is focusing on another ovarian steroid that may hold the answers to new fibroid treatments. “We found that the real enemy stimulating fibroid growth is progesterone,” he explains. Dr. Bulun’s recent work has looked at the use of anti-progesterone drugs to shrink fibroids, which would then eliminate or decrease associated symptoms. A year ago, Dr. Bulun and researchers at the Uterine Leiomyoma Research Center at Northwestern received a $5.7 million NIH grant to further fund their studies in this area.
Some nine years ago, Feinberg School Assistant Professor J. Julie Kim, PhD, was one of the original four independent investigators hired by Dr. Bulun to get the new division of reproductive biology research off and running. She credits his ability to combine clinical insight with a passion for scientific discovery for creating a world-class research program uniquely focused on some of the most prevalent women’s health issues. “He is a leader in the field, and his research in endometriosis and leiomyoma is at the forefront,” she says. “A stellar researcher and caring physician, he understands how important research is to moving medicine forward.”
Dr. Bulun is clear that steroid hormones play a pivotal role in women’s health and is determined to learn more. “What we are working on is making a huge impact on the health of women in general. From a biological viewpoint, estrogen and progesterone are broad master-regulators that play major roles in cell function across the genome, and there is still a lot to be done to understand how they make diseases better or worse. From an epidemiological perspective, both endometriosis and fibroids affect millions of women and are very important public health problems to overcome.”
Deeply committed to advancing clinical medicine, Dr. Bulun appreciates the role clinicians play in raising important research questions as they work to find solutions to patient health and wellness concerns. In his new position, he hopes to capitalize and expand upon the clinical as well as the research strengths of the whole department—just as he has done in his own career as a physician-scientist.
“As the Department of Obstetrics and Gynecology at the state-of-the-art Prentice Women’s Hospital of Northwestern Memorial Hospital and Feinberg School of Medicine at Northwestern University, we are uniquely positioned to become the best department in the U.S. We seek to be at the forefront in setting standards of care, providing outstanding training for medical students, residents, and fellows, and conducting innovative research on reproductive health, linking it to emerging areas of modern medicine. My goal is to attract the best and brightest in the world to our department.”