Sonya Seif-Naraghi (sonya.seifnaraghi@gmail.com)

Graduate Program:  Bioengineering
Lab PI: Dr. Karen Christman
Undergraduate Institution: Arizona State University
Med-into-Grad Clinical training area: Cardiovascular Diseases
Main clinical mentors:
Dr. Kirk K. Knowlton kknowlton@ucsd.edu
Dr. Tsotorios (Sam) Tsimikas   stsimikas@ucsd.edu

Quote:   “As a member of a biomaterials and regenerative medicine lab, my research is focused on developing translatable therapies to treat someone who has had a heart attack to prevent them from developing heart failure. It is imperative that our work stays clinically informed and the HHMI Med-into-Grad training provided a great opportunity to receive first-hand clinical education."

Rational for Med-into-Grad training:
My graduate work is focused on designing and characterizing novel biomaterials for cardiac tissue engineering applications. I work with naturally-derived, injectable materials made from decellularized tissue – specifically myocardial and pericardial tissue. After processing, the extracellular matrix (ECM) from these tissue sources can be solubilized; this solubilized ECM remains a liquid at room temperature and forms a gel upon injection in vivo or incubation at 37 °C. This gel is a 3D fibrous scaffold that promotes cellular infiltration in vivo. Since the materials are injectable, they can be administered via minimally invasive methods directly into the left ventricular free wall for the treatment of ischemic injury.

With respect to my interest in the Med-into-Grad program, I have always known that both a clinical understanding and the ability to communicate with the medical community were important. I chose a graduate program at a university with a strong medical school for exactly this reason – I thought that the close relationship with the UCSD medical center would bring me closer to that clinical understanding. Recently, I have realized that it is going to take more than mere proximity to the medical school to develop the understanding and vocabulary that I know I lack. This point has been reinforced as I try to establish collaborations with cardiologists and cardio-thoracic surgeons in order to collect specimens and design a pre-clinical case study. Thus, the Med-into-Grad program – specifically the cardiovascular diseases track – appears to be the best way to accomplish this goal and truly gain some aspect of clinical understanding and an appropriate vocabulary.

Additionally, I hope to gain a new perspective that I can use to better guide my current and future research projects along a clinically relevant path, because ultimately, the goal of my work is to develop novel therapies that are implemented in the clinic. While I have received excellent training and continue to make progress in research, I have spoken with past Med-into-Grad students about their experiences and what I have noticed is that they seem to have acquired at least a rudimentary understanding and the basic vocabulary that I believe is so important. Also, the familiarity they develop assists them in maintaining relationships with the medical community and I strongly believe that it is that link that will result in the development of the best, most applicable therapies.

Medical training and identification of medically-relevant research issues: 
As a trainee in this program I spent the majority of my time in the cardiac catheterization lab, the echocardiography lab, the cardiology clinic at Thornton, and on various rounds with the residents and fellows at Hillcrest. Understanding how the medical community receives and interprets the clinical studies that are published was one of the most important learning experiences. It is an impressively difficult task to internalize the different results of the big clinical trials and then decide how to act on them in order to best treat the patients. I think my research was most influenced by gaining an understanding of the complex situation these patients are in – an array of medical therapies, previous surgical interventions, additional complications, etc. So much research is presented in an isolated manner, without acknowledging the reality of the clinical situation. As I continue to design injectable biomaterials as a treatment for patients who have suffered myocardial infarction, I will make sure to keep this in mind.

Potential Research collaborations:
Dr. Michael Madani is a cardiothoracic surgeon here at UCSD with whom we had discussed getting human tissue samples from in the past. We actually went forward with that project, got a few samples from him and published a paper. As a result of this program, however, I interacted with Dr. Madani a few more times and starting involving him in the design of the some of the studies as well. This really helped strengthen the impact of our work. Recently, we published a comparison study in the Journal of Cardiovascular Translational Research where Dr. Madani provided a clinical commentary on the work that will be published next to the original research article. I personally believe that this is the direction that all translational work should go and I am excited to have developed such a good working relationship with Dr. Madani this year.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:
I certainly feel like I acquired a solid understanding of the diagnostic and therapeutic techniques used in my clinical area. Watching a variety of percutaneous interventions as well as echocardiography really gave me an appreciation for the technologies available in this field. The field is advancing, too, with 3-D echocardiography and more sophisticated catheters for minimally invasive interventions. The surgical field is advancing, too, with more options for minimally invasive thoracic surgery being developed and used. There are, of course, plenty of ways in which these technologies can still be advanced – for example, heart valves still need a lot of work, especially to keep up with the advances in pharmaceuticals. Catheters for more specialized purposes also deserve some attention – for example, a non-occlusive balloon catheter, or catheters that prevent downstream embolization that are better than the current “butterfly net” catheters. With good communication between the research and development and the clinical realm, these advances will be possible.

Long term impact: 
As I mentioned previously, I will make sure that my future work will be applicable in the context of the current clinical reality. Actions already taken toward this end were to ask Dr. Knowlton and Dr. Madani (a cardiologist and cardio-thoracic surgeon respectively) to sit on my thesis committee.

Student-specific experiences:
Med-into-Grad is one of the best ways to spend a quarter of your graduate training. You do need a rather supportive advisor, since you do disappear from lab for a few months, but it’s definitely worth it. I would also strongly encourage you to supplement whatever schedule you are given with additional experiences. For example, I continued to add morning conferences and new clinics that I discovered as I spent time with the fellows. Spending time with the fellows is my other piece of advice – these people are amazing and they know a lot.

Advice for new trainees--Autumn preparatory quarter:
Definitely start going to the conferences, it will give everyone a chance to meet you and get comfortable with your presence. I think the Cardiology Fellows’ conference was really interesting and any chance you get to listen to Dr. DeMaria lecture is also worth it. Also, if you have any med student friends, start talking to them about what they know about your track area. Try to familiarize yourself with the vocabulary and any acronyms before you start your formal training.

Advice for new trainees—Winter clinical training quarter:
For the most part everyone is really nice and welcoming. Smile at people a lot, be early and dress nicely. Introduce yourself to all of the fellows, talk about your research/clinical interests. This may lead to you learning about opportunities from them that you wouldn’t otherwise have known about. The attending physicians are pretty used to having students around and do not mind being asked questions.

Take home perspective on Med-into-Grad at UCSD: 
I had a great experience with the Med-into-Grad program. I highly recommend it; it’s one of the only ways to get any clinical education as a graduate student. I only wish I could have spent more time as a participant.