Author: Ioana Nicorescu
On March 25th, 2023, the Immunotherapy group I am part of hosted a patient engagement session, showcasing how we use the samples donated for research. The session was designed to educate and inform the public on the potential of immunotherapy to treat autoimmune diseases, and to touch upon different research techniques.
To begin with, I would like to mention the obstacles as a foreign student I have had to deal with. Certainly, it is my firm belief that people pave their way toward their goals by working hard as things do not come in easily. Accordingly, when I started the application to pursue a Ph.D. during the Covid-19 outbreak, with all the mess of that difficult times, I found myself frustrated by receiving many rejections and shortlist interviews that turned out soaring my desperation. Afterward, I finally got an opportunity as an ESR with a fellowship within INsTRuCT Consortium. I could not believe it. It came across like the light at the end of the tunnel. However, the story had only begun. You see, I faced another issue with my visa which resulted in a time-consuming process. As such, it represented the second big cumbersome as a foreigner. Despite everything, I could finally travel and join the lab thanks to my beloved ones and the supportive team of INsTRuCT who encouraged me to not give up along the wait.
The not-so-lazy Saturday morning kicked off with a reception in the meeting room, where patients got an introduction on how the session would develop. Tea, coffee and cookies made the start of a cold and rainy day more appealing. Patients and researchers were now ready to get into the art making rooms. In the first part there was a thorough explanation on how blood samples are processed and how to work in a clean environment. As a mimic of real blood we used starch and red food colouring, to demonstrate how immune cells are isolated from whole blood. Patients also observed cells in a dish under the microscope and learned these can either live in suspension and travel across the human body, like lymphocytes, or be resident in a certain area of the body and stick to it, like fibroblasts.
Next, the visitors received an overview of the journey biopsies go through from the patient to the research labs. Patients often donate tissue (be it blood sample, skin, or tissue from other areas) for research, but not often do they get the chance to see what it is used for in practice. Once a biopsy is obtained from the patient, it’s only a matter of minutes before it starts degrading, thus hampering the downstream applications and quality of data that can result. A saline solution is normally used in which the tissue is conserved for temporary storage. From there, the biopsy can either be fixed in a formalin solution and embedded in wax for storage, or snap frozen. Our colleague showed the patients the latter process, and used a piece of ham instead of an actual biopsy, as a prop. After carefully dissecting the ham with a scalpel, she took a section and immerged it into a bucket with dry ice to get some lovely frozen ham. Her demonstration made the patients appreciate and wonder how long a tissue can be stored with this procedure. If processed correctly, frozen or wax embedded tissue can be preserved for years, if not decades. This raised a very timely and important discussion on ethical matters and having the right approval in place for long term storage of human tissue.
We then proceeded to showing the patients different tissue sections under the microscope, ranging from tonsil, synovial tissue from the knee, and skin. Visitors also learned about how tissue morphology and the multitude of cellular identities within it can inform on various inflammation states. Our group focuses on rheumatoid arthritis as an autoimmune disease, where joint inflammation is one of the weighing factors. Often joint biopsies offer important insights on the level of inflammation in a joint, and whether a certain treatment has worked. I added an example below to facilitate the reader’s imagination on what our patients saw that day!
Figure 1. Two images showing how tissue (non inflamed and inflamed) from synovial joints can look under the microscope. Once a biopsy is obtained, it is processed for long term storage. The block is then cut into very thin slices and dyed with specific substances that will colour cells in dark purple, and the rest of the tissue structures in red. This way, researchers can identify how severely inflamed a joint is, by looking at factors such as the infiltration of immune cells within it. In the example in A, the tissue presents with normal content of cells. In B, a densely packed cell aggregate can be seen, often structured radially around what we call a germinal centre. These cells cause inflammation and contribute to disease severity.
The morning concluded with project presentations from two of our PhD colleagues. I feel I gained a lot from this experience. We as researchers got to know the patients on a personal level, and it was rewarding to let them into our world for a bit. The patients got to see how we operate in the lab, and they learned more about how we use the samples we take from them. Moreover, learning to use lay terminology enhanced our communication skills and made us realise how often science overcomplicates language, resulting in wider gaps when trying to connect with the general public.Public engagement events are an opportunity that every researcher should take. This way we are increasing awareness on the importance of research and how crucial patients are in clinical research for the advancement of novel therapies.