A Doctorate, Then Back to School
Medical school, graduate school, medical school. That's the course of study for students in the University of Toronto's MD/PhD program — a long but rewarding path that prepares students to tackle some of today's most pressing questions about health.
Robyn Elphinstone finished her PhD this June in the lab of Kevin Kain, a professor the Department of Laboratory Medicine and Pathobiology at U of T and scientist at Toronto General Research Institute. In September, she will start her second year of medical school, which she first entered in 2011.
Elphinstone spoke with Faculty of Medicine writer Jim Oldfield about her research on global health and malaria, the Kain lab and training to be both a doctor and scientist.
So what are you doing now?
I'm still wrapping up my PhD work, trying to get two manuscripts published. One has just been accepted and the other has been submitted. I also worked on a large biomarker study recently, unrelated to my thesis. It was a study of over 1,800 pregnant women in Malawi in which we analyzed blood samples longitudinally over pregnancy. We were looking for angiogenic and inflammatory biomarkers that can predict pre-term birth and small-for-gestational-age infants, which are both major problems here and in the developing world. We're now in the process of analyzing the data, but we hope this project will ultimately contribute to development of a rapid diagnostic test that can identify women early in pregnancy who have an increased risk of an adverse pregnancy outcome.
What was the focus of your PhD thesis?
I focused on cerebral malaria, which is a severe form of malaria that mainly affects children under the age of five in Africa. Even after treatment with anti-malarial drugs it can still be fatal, and many survivors experience long-term neurological disability. The pathogenesis of cerebral malaria is incompletely understood, so we're trying to get a better sense of what causes the disease and which adjunctive therapies might work together with anti-malarials. We recently found evidence that dysregulation of what's called the heme-hemopexin axis contributes to severe infections.
What's the role of this axis in cerebral malaria?
Malaria is a parasite that causes haemolysis, which is the rupturing of red blood cells. We found that severe malaria was associated with higher levels of free heme — a toxic molecule that causes leak and inflammation — and lower levels of hemopexin, a protein that protects against heme’s damaging effects. We looked at this axis first in clinical disease and then in a preclinical (mouse) model, which is how we tend to approach research questions in our lab. We found that knocking out hemopexin in mice made them more susceptible to disease, which suggests that hemopexin is playing a protective role during severe malaria and that giving exogenous hemopexin may be a promising intervention to improve outcomes.
What's it been like working in the Kain lab?
Fantastic. As a clinician scientist in training, I really appreciate Kevin's focus on translational research. He's just so intent on bringing advances to patients, and he really loves his work, which is inspiring. I've seen the whole range of research in his lab, from posing questions in patient populations to studying biological mechanisms in vitro and in vivo, then moving discoveries to patients through clinical trials. It's a really impactful way to do research.
Have you decided on a clinical focus for medical school and residency?
It's a bit early to say, although I'm very interested in infectious diseases. I'd like to go overseas for global health work at some point, maybe through an elective later in medical school. I did my undergraduate degree in Calgary in microbiology and ballet, and I'm still fascinated by host-pathogen interactions. Such tiny organisms have such a dramatic effect on our lives, whether it's making us acutely sick, changing our metabolism or driving the evolution of diseases like sickle cell. I look forward to continuing my research on malaria during medical school, but I’m open to seeing where my studies take me.
Do you still dance?
Yes, two or three times a week at Canada's National Ballet School. They offer really good adult recreational classes in the evenings. That's another great thing about Toronto.