Dr Lara Dungan explains her immunology research and practice, and why our immune system is a ‘double-edged sword’.
Dr Lara Dungan thinks of immunology as “simply one of the most exciting and expanding fields you could possibly get into”.
She is currently a full-time doctor specialising in immunology, having qualified in medicine in 2017. This summer, she will start higher specialist training in immunology in St James’ Hospital, Dublin.
Dungan describes being accepted on this programme as the “proudest moment in my medical career to date”. It’s a five-year training scheme leading to a full qualification in clinical immunology and should enable Dungan to become a consultant in the field.
Dungan’s interest in immunology was sparked during her undergraduate days at University College Dublin (UCD) when she was studying for a degree in cell and molecular biology. She did a project on medications that use a patient’s own immune system to target diseases like cancer.
“I was so excited by the immune system and the amazingly extensive role it played in both health and disease,” Dungan said.
“It’s a double-edged sword – we need a robust immune response to help prevent things like infection, but an over-active immune response can be just as detrimental for a person in the form of autoimmune diseases for example.”
Her curiosity piqued, Dungan went on to study for a PhD in immunology in Prof Kingston Mills’ laboratory in Trinity College Dublin.
Her time in the lab wasn’t without obstacles. As Dungan explains, “like everyone else, I came up against roadblocks and failed experiments”.
“One experiment may seem to have incredibly exciting results but they weren’t reproducible, while another experiment that you’d worked on for months might end up leading to nothing.”
‘I was so excited by the immune system and the amazingly extensive role it played in both health and disease’
In spite of the challenges, Dungan persevered:
“If my research wasn’t going to plan, I just had to remind myself that all results can be potentially interesting, even negative results. It’s important to stay positive and keep on going.”
The move from lab to clinic
Dungan made the leap from lab-based research to clinical immunology and now most of her time is spent on patient care.
“We have busy clinics running numerous times a week where we see patients with a huge variety of immunological conditions; from those with immunodeficiency disease, through patients with allergies, all the way to patients suffering with chronic swellings and hives known as angioedema and urticaria.”
However, Dungan maintains that “even in the clinical arena, doing research remains extremely important”.
“As medical doctors, we have unique access to large cohorts of patients that many purely laboratory-based researchers may not.”
Her recent research has focused on “better characterising patients with the disease chronic spontaneous urticaria. These are patients that suffer with often debilitating hives and swellings”.
As Dungan explains, “there are currently quite poor biomarkers to help predict which patients will respond to which treatments”.
“I’m very interested in helping to discover and define biomarkers that will predict responses to treatment so that we might be able to decide much earlier in the disease course what drugs will work best to control different patients’ symptoms.”
Dungan gets very excited about the latest developments in her field.
“One thing that I’m incredibly excited by is the field of gene editing that is opening up and expanding rapidly.”
She explains that in simple terms, gene editing is “a technique where diseased immune cells can be removed from a patient and their genes can be edited to correct a disease-causing genetic mutation”.
“These cells can then be returned to the patient with the hope that they will correct the disease phenotype and the person will essentially be cured.”
This technique works for very few diseases currently, but Dungan hopes “this technology will greatly expand over the coming decade”.
‘A broad and sweeping field’
Dungan thinks of immunology as “a broad and sweeping field” with potentially endless “exciting and amazing discoveries and findings”.
Her desire to help patients is clear. As she puts it, “whether it’s laboratory or clinical immunology, the ultimate goal of all research is to help to treat and cure diseases and ease the symptom burden for patients”.
According to Dungan, Ireland is a world leader in lab-based immunology. However, she is concerned about the lack of funding for the clinical side of the discipline.
“When it comes to clinical immunology, I think that chronic underfunding of the service from the HSE is causing huge problems for the doctors working in the speciality and the patients who desperately need access.”
“Immunology is an ambulatory service which means we do everything we can to treat our patients in a day ward setting and help them to stay out of hospital. However, this type of service is underappreciated in the current healthcare system, and I fear this underfunding will only get worse and waiting lists will continue to grow.”
As well as chronic underfunding, another issue for immunologists is the amount of misinformation and misconceptions about the field.
“Many patients and even GPs and other doctors do not fully understand what the speciality involves and what kinds of people we treat,” Dungan says.
“Allergy especially can be a very difficult area as there are a lot of misconceptions around food and medication allergies.”
‘The ultimate goal of all research is to help to treat and cure diseases and ease the symptom burden for patients’
Dungan sees part of her role as involving outreach and education.
“Helping patients and referring doctors to understand more about immunological diseases, how to treat them and what to refer, hugely helps with general understanding,” she explains.
“Tools like webinars, podcasts and booklets can help to educate the wider community further on immunology and immunological disease.”
Dungan is clearly a person of action. Alongside her co-host and fellow immunologist, Dr Vyanka Redenbaugh, and with the help of their executive producer, Prof Niall Conlon, Dungan hosts a podcast called ImmunoTea.
Dungan describes the aim of the podcast as “highlighting the exciting work coming down the line from immunology labs and clinics all around the world”.
This podcast “by immunologists for immunologists and those interested in the speciality” gives listeners expert perspectives. This seems like a radical idea in the era of fake news.
As Dungan sees it, “there is a lot of misinformation out there. I think the best way for this to be tackled is to help educate people to be very critical of their sources.”
“If something seems very hard to believe, it probably is.”
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