by Kota Sueo
This summer, thanks to the generous support from Friends of UTokyo, Inc., I had the incredible opportunity to participate in a three-month elective clerkship program at Johns Hopkins University. My clerkship comprised two segments: a clinical rotation in the Department of Cardiology and a research rotation at the Schizophrenia Center. Both experiences profoundly shaped my understanding of what it takes to become an excellent doctor.
I. Department of Cardiology
I was assigned to the Progressive Cardiac Care Unit (PCCU), a transitional unit from the Cardiac Intensive Care Unit (CCU). While the CCU attends to patients in critical conditions, the PCCU is dedicated to those whose vitals have relatively stabilized. The PCCU is divided into two specialized teams: the General Cardiology (Gen Cards) team, which manages cases such as post-myocardial infarction patients, and the Cardiomyopathy (CM) team, which cares for post-heart transplant patients, for instance. My rotation encompassed three weeks with the Gen Cards team and two weeks with the CM team.
My principal responsibility entailed presenting the patients under my care during the morning rounds. This task, initially challenging, became progressively more manageable thanks to the precise and constructive feedback from the attending physicians, which fostered my consistent professional growth. Beyond the morning rounds, I had the chance to observe procedures such as catheterizations and echocardiograms and to help residents with their tasks. Additionally, I had the opportunity to deliver a presentation on “SAVR vs. TAVR Treatment Options” to the team. These experiences afforded me considerate insights into patient care and the nuanced practicalities of cardiology.
II. The Schizophrenia Center
The Schizophrenia Center is a comprehensive institution comprising clinical departments and multiple research teams, where Dr. Sawa, my mentor, serves as the director. During my time there, I participated in a research project and also attended the Schizophrenia Center Annual Symposium, where I learned about outreach methods for patients and their families.
Research Project
Given my interest in cardiology, I was assigned to a project on cardiomyocytes. Since the late 1980s, it has been recognized that some proteins have secondary roles beyond their primary functions, known as moonlighting proteins. Dr. Sawa has long focused on the protein GAPDH, collaborating with Dr. Takimoto’s team from the Cardiology Department of the University of Tokyo. GAPDH is typically known as a glycolytic enzyme localized in the cytoplasm, but under specific stress conditions, it undergoes post-translational modifications and translocates to the nucleus, inducing cell death. While many studies have addressed this cell death cascade, recent findings suggest the existence of GAPDH nuclear translocation that does not result in cell death, indicating further roles for GAPDH. This non-cell-death-related nuclear translocation of GAPDH has been linked to microglial dysfunction in Dr. Sawa’s team and cardiomyocyte hypertrophy in Dr. Takimoto’s team.
My task was to establish a similar cellular experimental system for the hypertrophy model at Johns Hopkins and to explore the mechanisms and concepts of cardiac hypertrophy through a literature review. Although I successfully confirmed nuclear translocation in the cell death model, I could not replicate it in the hypertrophy model, highlighting the complexities of cell biology. However, by extensively reviewing the literature, I identified other molecules potentially involved in this cascade and shared studies indicating that GAPDH translocates to the nucleus in a cell cycle-dependent manner with the team.
Presentations at the Weekly Meetings
Every week, a one-hour meeting is held where a few members present their research progress. I had the opportunity to present twice. The first presentation covered the historical context of the GAPDH project and my experimental results. The second presentation was a journal club on the relationship between the heart and brain. The paper I presented investigated whether mice experience anxiety when their heart rate is non-invasively increased using optogenetics, addressing the famous question, “Do people run because they are afraid of bears, or are they afraid because they run?” This paper used cutting-edge technology to explore the connection between mind and body. While it is well-known that stress can cause cardiac abnormalities, as seen in Takotsubo cardiomyopathy, appropriate experimental systems to study the reverse relationship were lacking, making this study particularly enlightening. Dr. Sawa emphasized that since humans function through the complex interactions of various organs, it is crucial not only to focus on one organ but also to consider how the same molecular mechanisms manifest in different organs and to think systemically about organ interactions. This experience truly brought his advice to life.
Schizophrenia Center Annual Symposium
The Schizophrenia Center has four main pillars, one of which is outreach to patients and their families. The Schizophrenia Center Annual Symposium is held for this purpose, bringing together researchers, clinicians, patients, and their families. The symposium is funded by donations, making participation free and accessible for patients. I was impressed by the inclusivity and the value of such a multi-stakeholder event in problem-solving. The symposium effectively connected clinicians and researchers with stakeholders, including patients and their families, who were also actively interacting with each other. Since psychiatric disorders often require long-term care involving families, this symposium provided a meaningful space for information gathering and support for them.
For aspiring physician-scientists, it is crucial to remember that there are always patients hoping for improvements in their conditions behind every experiment. Observing such an inclusive event reaffirmed this for me, making my participation highly rewarding. The symposium was a true embodiment of a win for all.
Acknowledgment
The experience of being educated within a different system has enriched my perspective and approach to medical practice. I extend my deepest gratitude to Friends of UTokyo, Inc., for their generous support. This invaluable opportunity would not have been possible without their assistance, and it has undoubtedly become a significant highlight of my academic journey.
