Dr Darshi Ramanathan is a researcher and neurologist at Kids Neuroscience Centre, where she specialises in diagnosing and treating demyelinating disorders with the Brain Autoimmunity Group.
Last year she was awarded a prestigious and highly competitive Early Career Researcher overseas fellowship from the National Health and Medical Research Council and has now spent four months of her two year stay at Oxford University working with the Oxford Autoimmune Neuroimmunology Group.
We checked in with her to see how she was finding it and how she got there (beyond the flight details).
How did you come to do a PhD – was it during your medical studies that you became interested in research or did you always want to do research?
My father is an academic. I used to sneak into the back of the lecture theatres and watch him lecturing, and I was impressed by all the journal articles and books he authored. He is a role model for me, and loves his work, which inspired me to consider research.
I was fortunate to have Professor Russell Dale and A/Professor Fabienne Brilot as my PhD supervisors, and my PhD was a very enjoyable and career defining experience which cemented my desire to be involved in research in the long-term.
How did you become interested in neurology and neuroimmunology?
I was given the book “The man who mistook his wife for a hat” by Oliver Sacks when I was about 11 or 12. I was fascinated, read all of his other books, and decided I wanted to become a neurologist!
As an intern I was on neurology rotation with the team looking after the first patient in Australia diagnosed with NMDA receptor encephalitis, a condition that was only described that year.
This was the first time previously undiagnosed patients with disabling encephalitis were found to have specific antibodies causing their condition, which, if treated appropriately could allow them to return to a normal life. There was an explosion of international interest and discovery on this and similar conditions in the years that followed, and I knew I wanted to work in this field in my own career.
How does what you see in your patients influence your research?
There are patients who are diagnosed with “probably multiple sclerosis” or “probably Parkinson disease”, who have features which don’t quite sit right with that diagnosis if you look closer. I am interested in differentiating these atypical patients, studying them as a group both clinically and from a basic science perspective, and identifying what sets them apart and how best to manage them.
I love working in neuroimmunology because the patients affected are often fairly disabled by their presentations, but with accurate and early diagnosis and appropriate treatment you can improve their outcomes and allow them to return in many cases, to a normal life. This is a huge motivator for me to pursue translational research in this field.
You won an NHMRC ECR fellowship that involved moving to Oxford for 2 years for a kind of “knowledge exchange” - what new skills have you learnt over there and vice versa?
I am evaluating a cohort of patients I identified over the last five years, who behave like they have antibody-associated demyelination, but who do not have an identified antibody. We are screening for novel antibodies, which is an exciting area.
This involves learning to culture primary neuronal, astrocyte, oligodendrocyte, and microglial cell lines; and advanced microscopy and molecular biology, which I am learning here at Oxford. I am also learning new techniques in prolonged single cell cultures and trying to make monoclonal antibodies from patients with antibody-mediated neurological diseases.
I have been able to assist in existing projects with my clinical experience in phenotyping patients, and my laboratory experience in flow cytometry. I have not had a chance to explore punting yet, but it is on our bucket list during the Oxford summer!
Is your work in Oxford very different to what you were doing here?
It is similar to my PhD in that my research has both a laboratory and clinical component to it and is hence translational. However the projects are different, and the techniques and skills I am learning are very different. From a clinical point of view, I participate in the autoimmune encephalitis and neuromyelitis optica clinics. The Oxford Autoimmune Neuroimmunology Group is a quaternary referral facility for patients from all over the UK.
The patients have conditions that are uncommon, and to have the opportunity to be involved in the care of so many of these patients provides me with a wealth of experience which I hope will help me in my future clinical practice when I return to Sydney.
How do you manage being a clinician, scientist and family life?
Life used to be fairly organised before we threw the twins into the mix, but now I think we are just keeping our heads above water! But they are such fun. I try to prioritise my time. As my kids are still little, for the last few years I have been prioritising my family and my research roles, and my clinical roles have taken a bit of a backseat, limited mainly to neuroimmunology clinics and the occasional on-call.
I assume as they become a bit older, I will be able to take on more clinical work. We had great help with the kids from my parents in Sydney, which we are certainly missing in Oxford. My biggest support is my husband, who is a true partner in all that we do, encourages me to pursue my goals, and helps me make things happen.