Expert Breakfast Report for March 6th 2024: Assoc. Prof. Rajesh Katare, Dept of Physiology

Assoc. Prof. Katare outlined his early years in India, Japan, the UK and now New Zealand, then gave inciteful insight into the process of research with great tips on a wide variety of associated issues.

Head of Physiology, Associate Professor Rajesh Katare, is from Chennai, the capital city of Tamil Nadu in Southern India, famous for a great many things, including being known as ‘India’s Health Capital, and being the home of the Chennai Super Kings. For those few who are not aware, the Super Kings are a very successful cricket team in the Indian Premier League, captained by the giant of cricket, M.S.Dhoni, and coached by New Zealand’s former cricket captain Stephen Fleming.

However, and perhaps more importantly, Rajesh studied Medicine there, the beginning of a quite diverse and impressive career. After qualifying in India, he went to Japan - at least in part because is brother was already there - to a town of 150,000 people called Kochi on the island of Shikoku about one hour west of Osaka. Although his original thinking was to gain a little research experience, then go into clinical work, he was so enthused by the research he did that he embarked on a Ph.D. on the topic of ischemic heart disease. [Basically, this is reduced oxygen supply to the heart muscle, resulting in damage to that muscle. - Ed.] The issue is that a patient may suffer a major, possibly fatal, heart attack with relatively few signs and symptoms preceding it, mainly chest pain on exertion. This research focussed on what might be causing the injury to the heart, and developing some form of therapy to apply before the problem becomes major. The fact that this research went very well reinforced Rajesh’s passion toward the whole idea of research.

At the same time, his increasing facility with the Japanese language led to his being offered a lecturer position, so for a while he was teaching cardiovascular and renal physiology in Japanese. Rajesh also had a son born in Kochi, who is now studying for a Bachelor in Oral Health at Otago.  Although Rajesh had become fluent in Japanese, his family as a whole had not, and for this and other reasons, he made the move to the University of Bristol in the UK, where he began to concentrate on how diabetes affects the heart. After 5 years there, he started to look at more permanent academic positions, and was successful in applying for the post of Senior Lecturer in Physiology at Otago.

Value of Student Evaluations

“I have to say my first student evaluation was terrible . . . 60% didn’t think I was an effective lecturer!” Rajesh went on to explain how different University study had been for him.

In India you would be given a book on general physiology. There were no guidelines about what to read, and in fact you could be tested on anything from the book. “I learned that this was not the case here. We needed to provide a lecture slide and we needed to test only from those lectures. So I adapted to that. Then went on and the students started liking me. Those student evaluations genuinely help - although we bombard you guys with so many evaluations, we do take those evaluations seriously, especially the comments. It helps us to develop.”

One-Year Honours Degree and “Doctor-Doctor” Options for Medical Students

Rajesh also teaches second, third year and 400 level physiology. One of the second year papers, 232, is more about cardiovascular and respiratory, while third year is more focussed on research topics. He started forming his own research group, focussing on diabetes and the heart. In addition to teaching at the levels listed above, he supervises several students in their second and third years who spend some time with his research group in the Summer to get a hands-on experience of research. Once they start developing an interest, some Medical students take a break in Medicine after the third year and then do a one-year honours degree. Sometimes people go on from there to a Ph.D., graduating as MB, ChB, Ph.D. This is achieved by carrying out two years of research, then writing up over the following 3 years as they also complete MB ChB studies. [More on this later.]

HUBS Connections

Assoc. Prof. Katare has been first a deputy convener for HUBS, then convenor for HUBS 190 for two years, 2021 and 2022. However, he then became Head of the Health Department of Physiology, plus his son was doing HUBS, so he decided not to teach HUBS. However, he has maintained contact as the Chair of HUBS, which generally is held by the Head of Physiology - although he did step down last year. “I loved to teach HUBS” but that is currently being done by Jeff Erickson in Rajesh’s Department, so the latter continues to oversee the HUBS curriculum.

Don’t Stress! - And other Advice on Studying First Year HS

Shelby asked Rajesh if he had any advice to give members doing what is “a very stressful course”, and Rajesh commented that he had spoken to several first year students, and “pretty much everyone wants to do one of the professional courses . . .  which is good! If that is your aim, do work towards it, but don’t stress yourself. Do enjoy - you need to start understanding the subject rather than regurgitate . . .  If you speak to students who have got into Medicine, they tell me that they started to understand the subject once they got into second year.” Shelby noted at this point that this was due to the lack of competition in second year compared to the first, with which Rajesh agreed. Again commenting on the need not to stress, he added that there was more to be gained by going to lectures than just listening to the podcasts, using the podcast as a backup as required. Apparently attendance at lectures last year and this has been good. “I know some students try to listen to the podcasts by fast-forwarding . . .“ But he warned against this. He did encourage use of the Blackboard session board for the posting of questions, sometimes answered by other students.

If, at first, you don’t succeed . . .

If a student does not answer one paper well, for example, all is not lost, because there are plenty of opportunities still to reach your goal. The Medical course here has “ a lot of students who are ex-graduates.” In other words, if you do not get into your chosen profession at this first attempt, go for a different degree, and aim to enter your chosen path that way. Instances of this included an architect and an engineer as examples of people who pursued a different degree then entered Medicine as graduates, though Biochemistry, Physiology, Anatomy or Microbiology might be more common. Such entrants would generally begin at second year.

Research Interests.

Asked by Shelby to elaborate on his research work, Rajesh noted that the main interest of his group was on how diabetes affects the heart. He told us that, at the present time, around 10% of New Zealanders currently have diabetes, and that it is increasing rapidly in incidence around the world.

When someone develops a heart problem, there are some warning signs, such as chest pain on exercise, which generally cause them to seek medical help. However, in diabetes, there is damage to peripheral nerves such that sufferers do not get those warning signs, even to the extent of a minor cardiac infarction. So most diabetics admitted with major heart attacks, are much more difficult to treat. Rajesh went on to explain that his father had been a diabetic, appeared to be completely healthy, then woke up one night with a massive heart attack, acute heart failure and passed away.

Early Diagnosis of Diabetics at Risk of Heart Attack.

That triggered Rajesh’s desire to work on the problem of what diabetes actually does. His team has the aim of identifying those at risk much earlier than at present by focussing on damage at the cellular level. A molecule of interest is microRNA (not to be confused with messenger RNA, (mRNA)). Among other things, microRNA affects the translation of amino-acids into protein, but the most interesting thing about them in the current context is that they are released into the blood circulation. They can therefore be measured in blood samples. Not only that, microRNA molecules specific to heart tissue are released in quantity if there is any damage to the heart.

The measurement system is PCR (Polymerase Chain Reaction) which you may have heard about in connection with Covid testing. This works by expanding the concentration of target molecules making their measurement more sensitive. MicroRNA cannot be measured directly with PCR, but is first converted to a product that can be so measured.

In summary:

Early diabetes-induced heart damage

- more heart-specific microRNA released

- converted to product on which PCR can act

- PCR measurement detects the increase.

Experiments at present involve taking blood specimens from diabetic and non-diabetic people. By following these results from individuals over a period, inviting them back each 6 months for a general assessment of heart health plus cardiac-related microRNA measurement, the group hopes to achieve early detection of cardiac damage, and so institute early treatment. Such treatment may simply involve exercise and/or other lifestyle changes.”So right now we're doing a clinical trial where we have seven years of work on these individuals.”

The group is also trying to understand what microRNA-stem cell interactions there might be. Stem cells, particularly embryonic stem cells, are, of course, a highly controversial topic because they can be used in bad as well as good ways. They can be used to cure diabetes, but the supply is very limited.

[To find out more about stem cells, just type ‘Stem Cells’ into the YouTube search box].

Basically, stem cells can divide and differentiate into specific types of cell, so the group is also trying to use stem cells to treat damaged heart tissue. Isolating and culturing stem cells is a well-established but long procedure, and to bypass this step their idea is to try to use microRNA to activate stem cells within the body.

Summarising again, the two aims are:

1. To use microRNA as a biomarker aiming at much earlier diagnosis of cardiac problems in diabetics.

2. Using microRNA as a therapy, to increase the number of cardiac stem cells to repair the heart damaged in diabetes.

Research on What, Where? - Follow Your Passion!

There was a short discussion concerning areas of research and research in a University versus research as a practising physician. On the first point, Rajesh urged people to keep their options open. On the second point, it depends to a very large extent where one is working in the world. While practising physicians also doing research is relatively common in the USA, in many other countries the work-load makes doing research virtually impossible. Rajesh himself was persuaded by his Ph.D. studies - publishing 5 papers in the course of that work - that research in a University was what he wanted most. "I'm not saying being a physician is bad. To be honest, I still miss talking to the patients directly every day. But on the other hand, I'm also very passionate that I can develop something new which actually can help the future generation. . . While I don't interact directly with the patients, I still collaborate with clinicians to keep myself up to date . . . And the clinicians work here . . . do discuss research with me. They're very happy to listen to my research, happy to collect samples, happy to help with analysis, everything else, but they just don't get time to do research.”

How to be Involved in Research.

There were a number of questions from members on this topic, and I will attempt to summarise them here.

Asked about the ‘upsides and downsides’ of having a career as a Researcher, Rajesh stressed the importance of motivation, “It's more of a passion, right?

1."You are working on developing something new, which is going to help a lot (of people) and which is going to educate the clinicians on what they would do."

2. "When you have published your research work, and others repeat it successfully, that is a good feeling."

3. “If you discover something novel, you don't want to reveal too much. You can apply for a patent - every university has an innovation centre who will help with this, and the University will pay for the patent. Potentially your discovery becomes a commercial proposition."

4. "There is a time, when a piece of research is completed successfully, when you know something no-one else in the World knows!"

5. "Good research is rewarded because one can obtain more, and greater, research funding. We usually have around 8 to 10% success in applying for big grants. When I say big grants, that’s around 1.2 to 1.3 million a year.” This was not the case when he first came to Otago, and was virtually unknown, of course, but is the result of building a reputation for effective research. Before that, there are quite a number of small grants to get people started.

To get into an academic position, you need to go through the appropriate pathway. "I'm just being honest here. It's not quick. So compared to being a clinician, let's say you qualify in Medicine, become a Registrar, then in 10 years, you will be a consultant, most likely, if you work hard."

"The research pathway takes time. But if you have passion, keep working for it. But after, you need to do your PhD, which takes three years, at least. And then you start doing your postdoctoral fellowship, which is another three years. You look for an academic position, and in New Zealand, that might be tough. Not many positions come up, but in other countries, so many options."

"If you don't want to be an academic, which requires you to teach, but just be a research scientist, there is industry, which is quite good. There are a lot of options in industry, and I feel it comes with a good package, and more flexibility as well."

"Or you can apply for funding agencies and become an independent research scientist, which means you apply for your own grant, including your salary. So being an academic is good. So they teach you, you learn, you also mentor students. But being a research scientist, you work for your team."

In a University, there are also Research Fellows, who only do research - but generally on a 3-year contract basis, as well as the previously mentioned post-doctoral positions.

The Process

First, see if research is really what you want to do. If you are aware of an area you would like to try, talk to the staff concerned - including junior staff working in that group. Having a good supervisor is very important. Often it is possible to spend a few weeks helping in their laboratory during the summer, which will give you a pretty good idea of what it is like. Opportunity for this is available at Assoc. Prof. Katare’s lab and many others. There are also Summer Scholarships which you can apply for. These give you 10 weeks in a research laboratory. “I think it's $6,000 now. So $6,000 to do research, enjoy the lab work, but at the same time, learn something new.

If research seems to be your thing and you are doing a science degree, the Honours year should give you further experience of doing research. Rajesh has several students doing their Honours year in his lab, including students from overseas.

From there you progress to a Ph.D. then post-doc as outlined above, becoming part of a group somewhere along the line, then maybe striking out and setting up a research group of your own.

Some people doing Medicine incorporate a Ph.D. into the process, spending two years doing research in a lab. then returning to Medical studies and also writing up their Ph.D. thesis. “It is challenging to do them together, but if you are able to do it, it is perfect.”

Interview for Entry to Medicine, Increased Places, and Will Graduates Stay in New Zealand?

Apparently in the future interviews are probably going to be held for places on the Medical course, as has been the case at the University of Auckland. These will apparently be similar to MMIs (Multiple Mini Interviews). As the previous Government announced, there will be a total of 50 more places added over two years. This year, there are around 335 students in Medicine. Since NZ need more doctors, there is a possibility that this number will keep increasing, This includes - as now - graduate entries, etc.

Many people qualify in New Zealand then go to practise overseas, because salaries are so much better, while there is a need for more doctors, dentists and pharmacists (and researchers) here.

And a Little More on Research

The standard of research in New Zealand is equal to anywhere. Our research is small scale compared to the US, UK or Australia, but there is nothing different about the quality of the published papers. “As long as your research is well-designed and tested well and the quality is good, it's not a problem to publish it.”

Asked about outstanding research or findings, Rajesh said,”I'm very proud to say we are the first ones to understand microRNA could be a biomarker for long-term heart diseases.

We have been doing this study with different ethnic populations within New Zealand, but also I have some collaborations in India, the UK and Japan. And what we have found here is consistent with other countries. That actually is very exciting for me personally, but also that's a big thing. What it says is that what you're doing is not specific to our lab or our country. And the other thing in my lab, we are just very friendly. Enjoy research.” He encourages this, and it is definitely one of the things to look for when seeking any kind of research position. 

Enjoy the work. Be honest. Be friendly.

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Posted: Monday March 18, 2024