Bridging Two Worlds
In the world of research, questions are the crux. What questions should scientists ask and which are the most pertinent?Nowhere is this more crucial than in medical research. While lab-based scientists will find many questions intrinsically interesting, a sense of what is most important can only come from interacting with people who deal with medical conditions. Doctors, for instance.
It's in the clinician's world that the immediacy of the need for scientists to come up with specific solutions is usually first felt. The questions that confront doctors can often direct scientists to examine those aspects of a disease that need urgent attention. And doctors can benefit from research too, particularly when diagnosis requires more than the simple examinations of cell morphology and pathology that are routinely used in the clinic. At such times, a scientist with a background in medical research and the cellular, molecular and genetic components of disease can provide critical insights.
It's obvious then, that dialogues between scientists and clinicians must be of mutual benefit. But adequate communication between the groups has not been the norm. Bridging that gap is exactly what scientists at NCBS and doctors at the St.John's Medical College and Hospital at Bangalore are attempting to do.
Sudhir Krishna and his team of cancer researchers at NCBS have been working with practising clinicians at the St. John'sMedical College and Hospital ("St. John's" from now) for the past five years. It all began in August 2005 when scientists including Krishna, Vishva Dixit (vice president of molecular oncology, Genentech, San Francisco) and Inder Verma (professor, Salk Institute for Biological Studies, California) among many others met at the NCBS-DBT Cancer Meet. Apart from discussions on how to take Indian cancer research forward, they talked about linking with hospitals and having a separate translational research component, where researchers take their results to medical practice so that people can benefit quickly from it.
This plan paved the way for formalized collaborations between the two disciplines: and NCBS and St. John's in particular. Conferences, training workshops, talks, informal brainstorming sessions - the ways that NCBS and St. John's have worked together now are many and varied.
Krishna, Cecil Ross (professor of Medicine and Hematology, St. John's) and mathematician Seema Nanda (Reader, Centrefor Applicable Mathematics, TIFR) initiated a series of courses on leukemia (Leukemia as a Disease Paradigm) in early 2009. The project involved tapping into the expertise of experimental and theoretical scientists. Participants attended lessons on mathematical modeling, an important component of cancer research. Discussion topics included the basics of leukemias, their biology and the molecular mechanisms driving them. Lessons were not restricted to the four walls of laboratories or classrooms - participating researchers even visited hematology wards, where they learnt pathology and diagnosis. Conversations and interactions again led to the next set of meetings that looked at hematological malignancies:cancers that affect blood, bone marrow and lymph nodes.
By early August 2010, the first meetings to discuss hematological malignancies were already underway. This time organisers included Elizabeth Vallikkad (professor and Head of Gynaecologic Oncology, St. John's). At St. John's, they also facilitated workshops on clinical cytometry, a method that helps analyse cell parameters that are of utmost importance in cancer detection and treatment.
With the success of these programs, Krishna, Vallikkad, Ross and Nanda initiated a series of meetings to continue discussing hematological malignancies from September 2011. More experts from varied fields are now part of the program, including Ravi C. Nayar (professor and head of the ENT Department, St. John's Medical College), R. Sowdhamini (NCBS), Amit Kumar Mandal (associate professor, St. John's Research Insitutute), Das (inStem), H. Krishnamurthy (NCBS) and Karuna Ramesh (professor and head of clinical pathology, St. John's Medical College and Hospital). They initiated the establishment of a laboratory at St. John's, the facilities of which will be open for people from St. John's to use. The idea is that doctors and NCBS researchers working there will interact and learn from each other. "I was very keen that whatever research activity we set up, is set up in the hospital and the college so that we can integrate pathology, microbiology, clinical medicine, on a daily basis with research," says Krishna. With the Department of Biotechnology now backing the project, five positions are available under this project where researchers can join and take the project forward.
Organisers conducted the recent Hematological Research Meeting from 20th October to 8th November 2011 as part of this program. The 19-day-long program included training modules, workshops and research meetings held across NCBS, St.John's Medical College and Hospital, C-CAMP and the Institute of Bioinformatics. Researchers and interested clinicians were taught some basic methods of cancer research and diagnosis (such as hematology, bioinformatics, isolation and data analysis of microRNA) by both established scientists and practising doctors.
These conferences, research meetings and workshops incorporating hands-on-training with medical procedures have been immensely popular. The multidiscipinary approach has broadened the perspectives of students and researchers working at NCBS. "The group of people participating in the workshop consists of both researchers and doctors. The clinicians ask us questions that we don't even think about, so it is really very interesting to interact with each other," says Shankar Rao Patil, a junior research fellow in Sudhir Krishna's NCBS lab, who also took part in the workshop. He currently works from the new lab at St. John's as well.
The program is not merely restricted to researchers at NCBS - it has attracted participation from researchers across the country. "I found it very useful. I got to clarify all my doubts through one-on-one interactions with experts," says Deepshikha Mishra from the Banaras Hindu University, who attended the recent workshop. She is a first year doctorate student in G. Narayan's Cancer Genetics Lab of the Molecular and Human Genetics Department there. "In the lab, what we do is immediately extract DNA or RNA from the patient samples. We don't look at cell morphology at different stages -which I did during this training module," she says. Cell morphology also plays an important role in cancer prognosis.
While this concept of Indian universities tying up with clinicians is catching on across the country, it is not new to Krishna and his team. His team of cervical cancer researchers have been working closely with doctors from the Kidwai Memorial Institute of Technology for nearly twenty years now. But with his collaborations with clinicans at St. John's, this is the first time that these interdisciplinary interactions have been formalised between institutions.
Today, the idea that germinated in a small discussion has come a long way. A huge number of individuals and organisations have been involved with this program so far. Facilitating talks between clinicians and other fields of research, like stem cell biology is also something that has come out of this interaction. ENT surgeons at St.John's, for example, are now interested in stem cell biology and its uses in ear and trachea regeneration. The program has also led to international interactions, with experts like Frederique Madignier (Lyon, France), Francesco Blasi (IEO-IFOM Campus, Milan) and William Vainchenker (Institute of Gustave-Roussy, Villejuif, France) speaking and interacting with participants across the many workshops, seminars and conferences that have been hosted over the last five years. Organisations that have been involved in this program include the collaborators' institutes: NCBS, St. John's Medical College and Hospital and the Centre for Applicable Mathematics, TIFR. Along the way, parts of the program have been funded by the Department of Biotechnology's GLUE grant, the International Centre for Theoretical Studies (TIFR) and NCBS-TIFR. Others like the Institute of Bioinformatics and the Kidwai Memorial Institute of Oncology have provided crucial conceptual and infrastructural aid. "Akhilesh Pandey and Harsha Gowda from the Institute of Bioinformatics have been hugely helpful in conceptualising the program," says Sudhir Krishna.
Getting people from two different yet interlinked fields to interact, and to incorporate the ensuing knowledge into their current work, is not an easy feat. "Challenging, but doable," says Krishna. "It requires a long innings. We have to do this for a long time," he says. "You have to communicate. And you have to communicate at several levels - at the level of people that you're working with, their teams, your teams, and it's an ongoing process." Ultimately, Krishna hopes to see these interactions formalized as courses that will help researchers learn about more aspects of the diseases they are working on.
So what would you call such an interdisciplinary collaboration? Many would say it's translational research. Says Krishna,"People often ask me what is it that you're doing there (St. John's) and I tell them that we do curiosity-driven science, in a different context. And that holds." Whatever it is, this work aims at bringing together two disciplines that would otherwise have worked in isolation, and it's doing exactly that. The aim of research, ultimately, is to make life better. "Even though we do research, we must in the process of doing that research and teaching, also enable better service because that is a feed back loop," says Krishna.
Selected images for the graphic borrowed from Wikimedia Commons (http://en.wikipedia.org/wiki/File:SEM_Lymphocyte.jpg , http://en.wikipedia.org/wiki/File:Surgeon_operating,_Fitzsimons_Army_Med... and http://en.wikipedia.org/wiki/File:Hodgkin_lymphoma_cytology_large.jpg).