Investigator Spotlight: March 2016
Richard Oram, MD, PhD
Dr. Oram is a NIHR Clinical Lecturer at the University of Exeter Medical School, working in clinical nephrology and T1D research.
- Tell us about your education and background – where are you from, where did you go to school?
I’m originally from just south of London in the UK. I studied medicine at Oxford. I spent most of my postgraduate training in Exeter, where I trained in Internal medicine and nephrology. Then I gained an NIHR and Diabetes UK fellowship with Dr. Andrew Hattersley’s research team. During this fellowship I undertook a Ph.D. studying endogenous insulin in Type 1 diabetes. I finished my Ph.D. in 2014 and then took a visiting fellowship, funded by Alberta Health Services, at the Edmonton Islet Transplant Program for a year with Dr. Peter Senior and Dr. James Shapiro.
- Where do you currently work and what is your position? What does a “day in the life” look like for you?
I am currently an NIHR Clinical Lecturer at the University of Exeter Medical School and my time is split between clinical nephrology and my research, which is studying the biology of beta cell decline in type 1 diabetes. My clinical job includes looking after people with kidney failure, and people who have kidney and kidney/ pancreas transplants. My research work includes running two studies, funded by JDRF and Helmsley, looking at preserved C-peptide in type 1 diabetes, and studying people who are presented with type 1 diabetes very early in life. At the moment I am writing funding applications to allow me to dedicate almost all my time to the type 1 diabetes research.
- Why diabetes? How did you get involved in diabetes and/or what made you want to work in diabetes research?
As a kidney specialist, diabetes is by far the most common cause of kidney disease. In kidney and transplant clinics, we see some of the most unlucky patients who have severe kidney problems. They are faced with difficult choices about transplantation and dialysis. Like most clinicians, I have many patients whom I am very fond of, and who provide a very strong motivation for me to try and improve the care and prospects for people with T1D. I also have colleagues and friends with T1D who are a constant source of inspiration. I started my Ph.D. thinking about trying to understand Beta cell function after islet or pancreas transplant, but this has led me to believe that we still need to understand much more about the original disease process inT1D. During my Ph.D., I have become increasingly motivated to try and understand the disease process, with the long-term goal of this better understanding leading to new treatments to ultimately treat, prevent, or cure.
- Tell us about your research.
Type 1 diabetes (T1D) is classically thought to lead to autoimmune destruction of all insulin-producing Beta cells of the pancreas within the first few months or years after diagnosis. Increasingly, we now realize that not all the Beta cells are destroyed, and that many people go on making very tiny amounts of their own insulin even years after diagnosis. There are also some unusual patients who still make quite high levels of insulin despite many years of T1D. These findings suggest that there are key things to learn about why some Beta cells are not destroyed by the immune system. Another key question is: Can Beta cells regenerate? Understanding exactly why people with T1D carry on making tiny amounts of insulin may provide a crucial piece of the diabetes jigsaw puzzle. We—and several other teams around the world—are trying to address whether small amounts of persisting insulin production can make a difference to patients, by reducing the risk of kidney and eye complications, as well as hypoglycemia. We are also trying to understand the genetic and immune reasons that some people with T1D keep endogenous insulin and others don’t.
- What are your thoughts on the progress being made in T1D research as a whole?
There are many new and exciting avenues, but there is still much hard work to do. Look at the mission statement of JDRF, “To better treat, prevent, and cure type 1 diabetes.” Treatment is really improving all the time, through advancements in technology, such as closed loop systems, and better options for transplantation. However, we have not reached a point where we can prevent or cure T1D. This is the real challenge for researchers to tackle. I believe we need to better understand the biology of T1D and the underlying disease process before we will be able to do this. I also think that we have not been particularly good at realizing that there are many different variations of T1D that occur in different people, and I feel that if we understand this variation between patients better, it may bring a better understanding of the disease.
- Why is diabetes research so important?
It’s important because diabetes is such a common disease, and it affects people of all ages, from newborn babies to young children, teenagers, and adults. The impact of diabetes on individuals and their families is huge. It relates not just to the treatment needed, but also the chronic complications, such as eye and kidney problems. This impacts not just patients and their families but the whole of society.
- Do you have anything extra you would like to share? Is there anyone to thank or acknowledge?
I have a huge number of people to thank for the good fortune I have had with my work to date. My two mentors, Andrew Hattersely and Coralie Bingham, have taught me (and are still teaching me!) so much, from thinking critically and taking research from an idea to a study, to getting answers and telling people about it. There is a fantastic research team here at University of Exeter that includes excellent nurses, administrators, managers, clinicians and scientists. The whole team is much greater than the sum of its parts. It really feels like, given a challenge as a group, we can rise to it and make progress as a team. I am extremely grateful to all the patients in our studies. Without their dedication and willingness to take part in research, none of what we do would be possible. I am currently funded by a patient-focused charity and am humbled by the people who shake the tins and raise the money. Funding from JDRF is clearly making a huge difference to T1D research. They are in a great position to strategize and coordinate work on improved care for T1D patients, and to coordinate efforts to prevent or cure the disease. We are currently applying for JDRF funding to ask some of the questions I mentioned above. As someone who wants to have a career in T1D research, I have a personal goal of obtaining a JDRF Fellowship to make this happen.
- When you’re not working, what do you like to do for fun?
Spend time with my wife, Hannah, and our three children, Oscar (6), Matilda (4) and Rupert (1). I also have a passion for bike racing and riding my bike in the beautiful Devon countryside. I still just about manage to fit this in. I race for the Exeter University high-performance team when I can find the time…