Mary Pacold (mpacold@ucsd.edu)

Graduate Program:  Biomedical Sciences
Lab PI: Doug Richman
Undergraduate Institution: University of Illinois at Urbana-Champaign
Med-into-Grad clinical training area : Infectious Disease (Viral)
Main clinical mentors:  Doug Richman, drichman@ucsd.edu
 

Quote:  “This training influenced me to continue choosing research projects that have direct relevance to clinical medicine.  I also feel more obligated to focus on projects for resource-limited settings, because of the remarkable contrast between the care HIV patients are receiving here and the care lacking in third-world countries.  New methods must be developed for diagnostics and therapeutics in those places.”

Rational for Med-into-Grad training:  My thesis project is about detecting and characterizing HIV dual infection, which occurs when the same host is infected by two different strains of HIV.  The two infections can happen simultaneously (coinfection) or the sequentially (superinfection), in which the host has a chance to mount an immune response to the first strain before the second appears.  My project involves determining how frequently coinfection and superinfection occur within a high-risk, high-exposure cohort and then comparing the people who were superinfected to the people who resisted superinfection.  If a protective mechanism against superinfection can be identified, it may be possible to duplicate it in the form of a protective vaccine.  I am also interested in the clinical consequences of HIV coinfection and superinfection—whether they cause significantly faster progression to AIDS if left untreated.
            I was interested in Med-into-Grad because I felt somewhat disconnected from the clinical side of my thesis project.  I hoped to see firsthand the potential impact my laboratory work could have in a clinical setting.

Medical training and identification of medically-relevant research issues: I attended micro lab, infectious disease rounds and research conferences, the retrovirus seminar series, medicine grand rounds, and clinical rounds in which I shadowed my advisor while he was attending patients.  In micro lab, I learned more about bacterial conditions than I had ever known before.  It was eye-opening to see the variety of cultures and techniques that the micro lab attending and fellows discussed.  Even though the infectious disease rounds and research conferences were within my clinical training area, they exposed me to aspects of infectious disease that I had not previously encountered, since I was focused entirely on viruses (and really, only on HIV).  For instance, one of the case studies was about West Nile virus, which I knew very little about.

Potential Research collaborations: One research project that would be useful is a urinary proteomic analysis for assessment of HIV clinical status.  Urine is an ideal biological sample for the discovery of new biomarkers due to the ease and noninvasive nature of collection.  The open research question I would be interested in answering is whether a urinary proteomic profile can be used as a predictor of the clinical status of an HIV-infected person.  Unfortunately, I will not be able to pursue a collaboration to address this question, mostly because it is not very compatible with my existing thesis project.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs: The diagnostics for HIV are numerous and varied in their methods and efficacy.  HIV tests exist in many forms, such as testing of saliva (e.g. OraQuick) and blood (both antibody and nucleic acid tests).  Antibody tests are not reliable for recent infections, because the host does not develop antibodies against HIV for about a month after infection.  Therefore, an antibody test taken during this window period will produce a false negative.  Western blots that look for the proteins of HIV itself and nucleic acid tests that look for HIV genetic sequences are more accurate but also more elaborate.
            Therapeutics for HIV are quite sophisticated and effective at suppressing the viral load, though they cannot completely eradicate it.  HAART (Highly Active AntiRetroviral Therapy) is a combination therapy that attacks HIV from multiple points along its life cycle.  This multi-pronged approach is necessary in order to account for the virus’s exceptional ability to mutate in response to immune pressure.  Overall, customizable therapeutics for HIV are highly effective in the first world, but they are very expensive and impractical for the third-world countries that need them most.  The major problems are that the therapeutics are expensive and not single or short-term dose, but must be taken daily for the rest of the infected person’s life.

Diagnostic & Therapeutic collaborations:  The urinary proteomic screen, if developed successfully, would be a useful tool for monitoring the clinical status of HIV-infected people in both first-world and third-world settings.  However, the HIV superinfection investigations I am currently undertaking could potentially have an even more direct impact on prevention of HIV transmission.

Long term impact: This training influenced me to continue choosing research projects that have direct relevance to clinical medicine.  I also feel more obligated to focus on projects for resource-limited settings, because of the remarkable contrast between the care HIV patients are receiving here and the care lacking in third-world countries.  New methods must be developed for diagnostics and therapeutics in those places.

Student-specific experiences:  Med-into-Grad made me grateful to have chosen a thesis project in the life sciences and with clinical relevance.  Among other things, it was a great reminder of why I was initially excited about this field and how interesting its applications can be.

Advice for new trainees--Autumn preparatory quarter:  I very much enjoyed the course “Science Meets the Medical Patient.”  The patient interviews were extremely interesting, and there was such a variety of cases presented.  The interviewees were very open and willing to share the details of their experiences, so their perspectives were quite valuable.  I would recommend reading some basic introductory articles or even wikipedia entries about each disease before the class on that particular topic.  It’s very helpful to have for each disease an idea of its causes, symptoms, diagnostics, and therapeutics before attending the lecture by the expert speaker.
            As time permits, I would also recommend reading as much as possible about the basics of your clinical training area.  This will give you a jump start on your winter clinical activities.  It doesn’t hurt to start early on the various labs, grand rounds, and seminars as well.  As with many aspects of this program, you get out of it what you put into it.

Advice for new trainees—Winter clinical training quarter:  It’s very important to have a good relationship with your clinical mentor.  He or she and the rest of the group will be happy to help if they see you are genuinely interested in the field and respectful to the patients and overall environment.  Asking questions is key, even if you feel embarrassed.  You can also take notes about items to look up later.  It’s easy to get overwhelmed, but be patient and take it one step at a time.

Take home perspective on Med-into-Grad at UCSD:  I would highly recommend the Med-into-Grad training opportunity to other students.  It is a unique experience that will impact your current and future projects and even your whole approach to science and medicine.