Week 3: Ben

For my third week in NYC, I did a lot of wet lab research and clinical shadowing. To start off my week, I got to practice the islet extraction protocol that the Alonso lab performs routinely. I was given post mortem mice to practice the procedure, in which I cut open the abdomen of the mice, carefully remove the ribcage and remove the heart so I have easy access to the gallbladder. I then clamped the small intestine where it meets the bile duct, then through the gallbladder, I inject collagenase to disassociate the pancreas. I then excise the pancreas and further digest it, and centrifuge it to isolate the islets (Image 1). The following day, I picked out the intact islets that survived overnight incubation and further disassociated them onto a 24-well plate (Image 2). After, typically the lab performs different assays to assess its insulin and glucose responsiveness or treats them with an inhibitor, but the mice I performed the procedure on were practice mice with genomic defects in its insulin secreting gene INS. Thus, it was not worth the time and resources to perform further analysis, and I discarded them. However, this was valuable practice that I will keep doing throughout the summer so that I can master it. This will be an essential skill to take back with me to Ithaca.

Image 1: Islets after isolation from mice.

Image 2: Islets after disassociation and plating.

I also engaged in talks with a potential collaborator that can contribute a lot to the success of my project. I talked to Dr. Shahin Rafii, whose expertise is in organ-specific endothelial cells and their function. They recently published a paper in Cell about using an engineered adaptable endothelial cell line that vascularized and promoted the function of islets. Their work and ongoing efforts align with what I am trying to do, and working with them will definitely mutually benefit both of us. Dr. Rafii has invited me to present my research at their lab meeting, and I will get a more comprehensive view on how exactly we can help each other out, and what areas we can collaborate in.

Finally, I got the opportunity to shadow surgeries. Through my friends in my cohort, I was connected to Dr. Lisa Newman, who is a oncology surgeon specializing in breast cancer. During my time shadowing her clinic, I saw five surgeries. Two of them where mastectomies, which are full breast removal, and three of them were lumpectomies, which are partial breast removal. For the mastectomies, one procedure was a single breast removal, while the other was a double breast removal. For both procedures, the nipple was not preserved. For the lumpectomies, different strategies were used. One strategy used was a pellet-guided tumor extract, in which a radioactive pellet was injected near the site of the tumor pre-op. During the procedure, a probe that detects radioactive activity was used to detect the position of the pellet, and it was them excised. This strategy is used when the tumor is deep into the breast tissue and cannot be definitively felt by hand. Another strategy used was a guide free approach. In this case, the patient was able to feel the lump in her breast, and the tumor was located on the posterior of the areola and felt very defined. In this case, they simple added a metal clip which was inserted as part of a routine mammogram. Due to the easy access and physical identification of the tumor, no further guided strategy was needed. Finally, a wire-guided approach was used, where a metal wire is inserted into the site of the tumor pre-op using a mammogram as a visual guide. Similarly to the pellet-guided strategy, this was used for difficult to feel and access tumors, but it is typically offered as an alternative strategy if the patient is uncomfortable with radioactive material being inserted into their body. Also, the strategy depends on the radiologist on the case and which strategies they prefer. However, this strategy can be invasive, as needle will be sticking out of the breast. It was very cool to see clinical practice and the thought processes that go into the decision making on how to remove a breast tumor from a patient.

This week was very productive, and I not only made strives in getting resources that will directly help me drive my thesis back in Ithaca, but I also got valuable insight on clinical practice and the decision matrix that goes on there. Moving on to next week, I wish to learn more protocols related to islet biology, further establish potential collaborations, and continue to observe clinical practice in other surgery areas.