About 15 years ago, during the early part of her academic career, biophysicist Koel Chaudhury, bumped into a gynecologist at a conference who found her work interesting.
Chaudhury was then involved in the development of a non-hormonal injectable male contraceptive, that has recently completed the phase III clinical trial.
“The gynaecologist (Chaitali Dutta Ray) was, however, curious to learn why research on women’s health, a matter of great concern from an Indian perspective, was missing,” recalled Chaudhury, who heads the Clinical Biomarkers Discovery Laboratory at IIT Kharagpur.
Her interactions with Dutta Ray spurred her to learn more about the issues of women’s health and eventually motivated Chaudhury to kick-off research on various aspects of women’s health taking the metabolomics approach.
“She introduced me to issues such as malnutrition, lack of basic sanitation, maternal mortality, etc. The more I read about the issues that need to be addressed, the more I was motivated and soon initiated work in various aspects of women’s health,” Chaudhury said, adding that she and Dutta Ray are now best friends.
Metabolomics Way to Health
Chaudhury and her group have extensively used the metabolomics approach to investigate women’s health with an emphasis on pregnancy-related complications.
Metabolomics is the study of the entire set of small-molecule metabolites (products of metabolic reactions) that are produced by the cells during metabolism and required for the maintenance, growth, and normal functioning of the cell.
Collectively, these small molecules and their interactions within a biological system are known as the metabolome and it directly reflects the underlying biochemical activity and state of cells/tissues. Less-invasive nature of sampling and more sensitivity of the metabolome to changes in environment and external perturbations associated with diseases are some of the approach’s advantages.
Chaudhury and her group have tapped into metabolomics to identify disease biomarkers (for example, indicators for early diagnosis of stage 1 endometriosis). They are also working towards unraveling the biological mechanism underlying complex human diseases (such as unexplained recurrent miscarriage and its early prediction).
According to estimates, of the 176 million women all over the world who suffer from endometriosis, 26 million are from India. Recurrent miscarriage refers to the spontaneous loss of two or more consecutive pregnancies before twenty weeks of gestation. The data on the prevalence of recurrent spontaneous miscarriage (RSM) in India are scarce but a 2015 study revealed a higher prevalence of RSM among Indian women as compared to western data.
In an interview with FIT, Chaudhury, who has been honoured for her contribution to reproductive health, talks about her core research areas, the challenges, and the updates on her research. She also emphasises on public engagement with women such as through the use of pamphlets in vernacular to generate awareness.
Q) How is metabolomics shaping medical research?
Metabolomics has the potential to be valuable in a clinical setting where it could be used for early diagnosis of a disease and as a predictor of treatment response and survival. Also, the metabolic status of an individual could be monitored during drug treatment and used to indicate possible toxic effects.
Most of the medical treatments today are designed for the average patient using the “one-size-fits-all” approach. Unfortunately, this type of treatment is seen to be very successful for some patients but not for others.
In the future, medicine is to be practiced according to algorithms that will take into consideration the patient's characteristics, e.g. their genome, microbiomes, metabolomes, the environment they are exposed to and their lifestyle to make diagnostic and therapeutic strategies precisely tailored to individual patients. This is what we call ‘precision medicine’.
Q) What are the core areas of study in your research on women’s health?
Some of the core areas and the questions that we are trying to answer are:
Can Stage I endometriosis (usually exists without signs and symptoms), a common gynecological disorder, be diagnosed early? What is the underlying cause of unexplained recurrent miscarriage and can it be predicted early?
Can metabolomics help test the effectiveness of the drug dydrogesterone (a synthetic form of progesterone) in women with recurrent miscarriage?
Can a set of biomarkers be developed for pregnancy-induced hypertension and preeclampsia during the first trimester of pregnancy (i.e. less than 12 weeks of gestation) which is expected to benefit at-risk pregnant women and assist clinicians in taking adequate measures to prevent future maternal and fetal complications?
Q) How is your research progressing?
Compared to international research, where real-time dynamic changes in the metabolome of patients are often being monitored in clinical settings, research in this field in India is still in its infancy with a considerable scope of development.
With reference to our research team, we have successfully identified robust serum biomarkers in early-stage endometriosis; fabrication of a minimally invasive multiplexed point-of-care diagnostic device for detection of these markers is underway.
Also, potential markers have been identified for polycystic ovary syndrome, preeclampsia; validation of these promising markers is ongoing.
One of the research areas (not related to metabolomics) which has had a good impact on maternal health deserves a special mention. Pictorial-based information pamphlets with simple text (Hindi and Bengali) were made available for free to all women attending antenatal OPD of the Department of Obstetrics and Gynecology at IPGMER and SSKM Hospital, Kolkata.
The need for a nutritious diet, physical activity, check on maternal obesity, and immunization was emphasized. Our team’s special emphasis on the importance of regular check-ups helped the pregnant women to understand its necessity proved to be highly beneficial as most of the women were from rural backgrounds. Nearly 1000 women reporting for antenatal checkups were counseled and made aware of gestational hypertension and other pregnancy risk factors-associated signs and symptoms. They benefited from the advice related to diet and lifestyle to be followed during the gestation period.
Q) What are the challenges in your research and how are you addressing them?
Reproducibility of measurements, high-throughput state-of-the-art equipment necessary for biomarker identification, a large sample size needed to establish reproducible, robust markers are some of the challenges we are trying to address.
Because metabolomics in women’s health is a multi-disciplinary research area, it requires input from different types of experts including clinicians, analytical chemists, statisticians, data scientists among others.
Since a large patient cohort is needed to generate error-free data for biomarker discovery studies, we are in the process of signing MoUs with more number of hospitals. The upcoming superspecialty hospital at IIT Kharagpur will provide the ideal set-up for such high-throughput data generation.
(Sahana Ghosh is a microbiologist-turned-journalist. She writes on science and environment and is interested in science in remote areas.)
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