by Sipan Haikazian
Graphic design by Anais Lupu
Marfan Syndrome (MFS) and Loeys-Dietz Syndrome (LDS) are rare, genetically distinct Connective Tissue Disorders (CTD). The primary contributor of morbidity and mortality is dilation of the aorta, the largest blood vessel in the body, leading to rupture and subsequent death if timely intervention is not administered. A few decades ago, the life expectancy of patients with these disorders was around 30-40 years. However, with the appropriate clinical management, driven by ground-breaking research, individuals with MFS and LDS can have life expectancies similar to that of the general population.
Nairy Khodabakhshian, a second-year PhD student in the Institute of Medical Science (IMS) program studies the cardiac response to exercise in pediatric patients with MFS and LDS. She works at the Hospital for Sick Children (SickKids) under the supervision of Dr. Luc Mertens. By studying differences in exercise responses in children with MFS and LDS compared to healthy volunteers, Nairy’s research hopes to better identify high-risk patients and reduce the risk of adverse aortic events.
Nairy’s journey into IMS has been a unique one. She graduated from the Biomedical Sciences program at Toronto Metropolitan University where she made her time count. Nairy worked in two labs over the course of her undergraduate studies, culminating in the completion of a fourth year wet-lab based thesis project. This experience led her to appreciate the fundamentals of research methodology. Nairy also volunteered at SickKids and the affiliated Ronald McDonald House Charities throughout her undergraduate studies. After graduating, Nairy landed an administrative position in the cardiology unit at SickKids. Here, she received an opportunity to experience a side to science and medicine that was very different from wet-lab research. “Although this job was an administrative role, I got a lot of clinical exposure: learning about the patient journey from admission to discharge, observing the day-to-day flow of the clinical setting, and seeing how multidisciplinary teams manage high acuity patients.”
To Nairy, the world of pediatric cardiology was super interesting. “I would hear diagnoses and I would ask the nurses to explain the concepts to me during downtime, as well as look it up in my own time.” This experience had a strong influence on her chosen field of graduate study. “I made a pact to myself that if I was going to do a graduate project, it would 1) be in the field of pediatric cardiology and 2) be clinical research focused”. Nairy got to know several physicians and researchers at SickKids during her administrative role, including her future supervisor Dr. Luc Mertens. Being drawn towards the research he conducted, Nairy eventually applied to IMS and secured a position in his lab as an MSc student. “Having a bit of a rapport with him from my time at SickKids propelled the student-supervisor dynamic. He’s been incredibly supportive throughout my degree”.
While talking to Nairy, I got the sense that she has a very mature perspective about her research. Being surrounded by clinician-researchers in her lab, she gets to directly observe the transition of research from the bench to the bedside. “The Mertens lab is fortunate to have direct access to the Connective Tissue Disorders Clinic at SickKids, which is managed by my co-supervisor, Dr. Vitor Guerra. Through my interactions with clinicians, I always keep the question of ‘Is this clinically relevant?’ when I make decisions related to my research.” Although intimidating and challenging at times to be surrounded by clinician-researchers with a vast knowledge base, Nairy feels this allows her to excel in her research.
After 18 months into the MSc program, Nairy successfully completed her PhD transfer exam. The decision to transfer was a very calculated one. “If you asked me at the beginning of my Master’s whether I would ever do a PhD, I would have sworn ‘No’”, said Nairy looking back on her decision. Never say never though! Nairy had a fantastic opportunity to transition, as her program advisor committee members unanimously agreed that her project could obtain sufficient data to qualify for a PhD degree. But what made her decide to transfer? “There were many factors. I looked at my own career aspirations—I wanted to be a clinician-scientist myself. I didn’t want to give up the clinical exposure or the research. I enjoyed everything about my research project, and really wanted to see my project through to the end. I asked other people who had obtained PhD degrees at different points in their careers. I learned about the pros and cons of each journey. Ultimately, I felt the best time for me to get the degree would be now.”
And what advice did she have for MSc students in IMS considering transferring into the PhD program? “It’s a massive commitment.” She stresses the importance of not doing a PhD degree just for the sake of doing it. “Think about your career aspirations, consider your own life and personal circumstances when deciding the best time to do the degree. Ask the various PhD candidates and graduates for their advice.”
Apart from her research, Nairy is heavily involved in extracurriculars within the IMS. She joined the Institute of Medical Science Student Association (IMSAA), where she held executive roles for two years. Once she successfully transferred into the PhD program, she became the Program Lead of the Peer-2-Peer Mentorship program, aiming to assist incoming IMS students with navigating through various responsibilities during graduate school.
Furthermore, Nairy continues to spearhead a Clinical Research Skills course to be available to IMS students, where basic clinical skills is taught to graduate students in the early phases of their graduate work. The goal of this course is to enable the integration of graduate students into the clinical setting. Together with a team of IMS students and faculty, including one in the Biomedical Communications (BMC) program within the IMS, they are hoping to launch the course with a virtual reality (VR) component. “We didn’t want to task an already overburdened healthcare system with equipping our graduate students with clinical research skills, but we also knew that this course could not be taught in the traditional lecture format, so VR was a solution that addressed both those challenges. As a bonus, this project gets to be the MSc project of a BMC student.” Nairy has allowed me to share that their group is currently in the process of receiving approval to formally offer the modular course to IMS students in Fall 2023.
One piece of advice for the incoming IMS student? “Be stubborn with your long-term goals, but flexible in your journey to them. If there’s anything I’ve learned from grad school, it is that things don’t always unravel as planned, but they always end up working out.”
Upon graduation, Nairy plans to continue her journey of becoming a clinician-scientist, perhaps within the field of pediatric cardiology. “That’s the ideal route for me. But as I learned, I am leaving the door open for other opportunities”. One thing is certain; the work during her PhD will not only help children with MFS and LDS, but will also help set up future generations of IMS graduate students for success.
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