St John’s Medical College, Bangalore
St John’s Medical College, Bangalore
Since my under graduation medical studies, I was always drawn towards scientific discoveries. This led me to select Physiology as my post graduation specialization. Nutrition and Physiology have been my focus of research from post graduation days. The right mentoring and timely exposure to research methodology moulded me into an independent researcher. At times one might feel the process of research is long and tiring, but eventually when you reach your goal, all hard work seems like a distant past. As a junior faculty, St John’s National Academy of Health Sciences awarded me among the junior faculty in the area of biomedical research. Even though these studies were simple, performed with basic facilities, their good quality led to publications in reputed journals. This further convinced me of the fact that good quality work always gets acknowledged. Meanwhile, I received the ICMR International Fellowship for Indian Biomedical Scientists to work at National Hospital For Neurology and Neurosurgery and Imperial College London. During this fellowship, I learnt a lot as a clinician and researcher. Upon my return, I felt there was a need to initiate clinical service to patients as a positive outcome of research work that one carriers out. With strong desire, motivation, and help from my senior faculty, the Clinical Physiology Unit was setup. Currently, this unit under my supervision is running successfully and is providing service to patients, including evaluation of autonomic nervous function, skeletal muscle functionality to name few. Meanwhile, I enrolled for PhD, which I felt at that point was necessary to help me comprehend and widen my skills in research. My PhD thesis dealt with micronutrient deficiency in particular vitamin B12 deficiency and neural function across life cycle. We demonstrated that subclinical vitamin B12 deficiency was associated with autonomic neural dysfunction across life cycle.
My parallel area of research focus has always been to study individuals with varied nutritional status in particular-low body mass index. I was involved in studies, which assessed insulin sensitivity using hyperinslinemic euglycemic clamps and body composition (fat/muscle) in individuals with low body mass index. As part of these studies, we developed measures of forearm skeletal muscle strength assessment. This body of work allowed me to obtain the International Senior Research Grant from The Physiological Society to assess the Skeletal muscle functionality in type 2 diabetics using better and more sensitive techniques. I worked at King’s College London for a brief period and developed skills to assess muscle functionality using isokinetic dynamometry. Collaboration with King’s College and my body of work at St John’s has lead into to the current proposal.
Muscle mass and muscle function could be considered as two integral parts of skeletal muscle system driving insulin sensitivity. Muscle quality (muscle function/muscle mass) is a dynamic process and depends on optimal and well-regulated signaling pathways (eg:Akt-mTOR, AMPK/PGC-1a) operating in skeletal muscle. This could translate into greater energy production by skeletal muscle mitochondria, protein synthesis than breakdown and increased oxidative fibre type representation in skeletal muscle, all leading into better muscle contractility. Higher muscle contractility translates into up-regulation of glucose transporter (GLUT 4) and better glucose disposal/insulin sensitivity. Improvement in glucose disposal levels on a single bout of exercise could help explain the above mechanisms. Skeletal muscle mass determined by intra and intermyocellular fat, mitochondrial content and cytoskeletal proteins are suggested to be regulated by muscle functionality, which in turn could influence muscle quality. Therefore, it is crucial to understand the importance of skeletal muscle quantity vs quality in regulating glucose disposal, especially in populations who are considered to have low muscle mass to begin with. These factors could play a key role in explaining the mechanisms leading to the development of type 2 diabetes in Indians. Moving in this path exploring changes in prediabetics could help us unravel changes at very early stages, which would go a long way in planning preventive strategies.