Andrew Crain (acrain@ucsd.edu)

Graduate Program:  Biomedical Sciences
Lab PI: Evan Snyder, M.D., Ph.D.
Undergraduate Education: San Francisco State University
Med-into-Grad clinical training area: Neurodegenerative Diseases
Main clinical mentors:
David Song (dsong@ucsd.edu)
Stephanie Lessig (slessig@ucsd.edu)

Quote:  “MIG had a significant impact on my life particularly due to witnessing the tragic impact that neurodegenerative diseases have on both the patient and loved ones. MIG has changed the urgency and reality of my work”.

Rationale for Med-into-Grad training:
Medical training and identification of medically-relevant research issues:
Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:
Diagnostic, therapeutic, and research collaborations:
Student-specific experiences:
Long term impact.:
Advice for new trainees--Autumn preparatory quarter:
Advice for new trainees--Winter clinical training quarter:
Take home perspective on Med-into-Grad at UCSD:

Rational for Med-into-Grad training:  The burden of Neurodegenerative diseases is immense and my thesis work aims to better understand the mechanisms of both degeneration and regeneration of neurons in the mammalian CNS. Neurodegenerative disease is a rather broad term and many diseases of the CNS fall into this category, however, the death of neurons in these patients is the common denominator. The clinical experience of MIG program presented me with the unique opportunity to observe and interact with Parkinson’s patients at various stages of disease.

Medical training and identification of medically-relevant research issues:  The majority of clinical training in the Neurodegenerative Disease program involved neurological exams, medication adjustments/decisions, neurology rounds, and post-visit discussions with the mentors. This training provided exposure to the disease progression on both the physiological and psychological aspects. Prolonging the survival of the affected neuronal populations is the most important research problem in neurodegenerative diseases. Identifying novel neuronal survival pathways and their pharmacologic manipulation is of great therapeutic value in the treatment of neurodegenerative diseases.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs: The major diagnostic tool is the neurological exam and evaluating symptoms in comparison to those of known diseases. Unfortunately, in the case of Parkinson’s there are variations of presentation and a diagnosis may take some time. Patient variability and a poor understanding of the requirements for survival of metabolically abnormal neurons hinder the advance of novel interventions in Parkinson’s and other neurodegenerative diseases. The development of treatments for neurodegenerative disorders must be both targeted and supplemental; specifically, a more developed understanding of neuronal survival pathways is needed for keeping at-risk neurons from dying.

Diagnostic & therapeutic collaborations:
The majority of my clinical experience was with Parkinson’s patients and it was readily apparent that the major issue in the treatment is the fine tuning of the drug regime. Unfortunately, the standard appears to be an empirical trial with a particular alternative dosage or replacement drug when a patient is not responding well to the current regime. This process can take months to achieve the correct medication for a given patient and thus a substantial gap exists in which the matching of a medication pattern to a patient tends to be a drawn out process. The use of patient data may shorten this time by creating an algorithm to give an overall prediction of the patients responsiveness to a revised therapeutic scheme.

Research collaborations:
No collaborations were established.  This was not a major intent of my training.

Student-specific experiences:
The med-into-grad experience had a significant impact on my life particularly due to witnessing the tragic impact that neurodegenerative diseases have on both the patient and loved ones. The clinical experience showed me that the personal psychosocial impact can vary tremendously among patients, especially across different stages of progression. In these cases I felt that knowing that there is nowhere to go but downhill is the most difficult part and further strengthened my scientific drive to investigate neuronal survival pathways.

Long term impact:  The Neurodegenerative Disease training program helped me realize that the course of disease progression is a critical window in which the opportunity to stop or reverse the effects of the disease exists. Neuronal survival and regeneration are linked and the stopping of the progression of disease can be achieved through a supplemental intervention in addition to directly addressing the cause of the degeneration.

Advice for new trainees--autumn preparatory quarter:
The best preparation outside of the prep course is to begin interacting with clinicians through seminars and particularly interactive sessions such as brain cutting and neuropathology.

Advice for new trainees—winter clinical training quarter:
The new trainees should wear short lab coats and expect to help the clinical mentors in whatever way they can. It is very important to maintain professionalism when seeing patients and be cognizant of the fact that they may be slightly uncomfortable with a new person in the room. The post-visit time is the best opportunity to discuss

Take home perspective on Med-into-Grad at UCSD:  The med-into-grad program is without question the most memorable experience of my graduate career. In the lab, at the bench, writing the introduction of a manuscript, we are still far from the center of what all our work is really focusing on, the patient. Any academic investigator would be a more well-rounded scientist through a clinical experience such as that of the med-into-grad program. The sum of the clinical experience has drawn my own research endeavors closer to the needs of the patient and thus, choosing models of neurodegeneration more closely resembling human disease.