A Director of The Regenerative Medicine Institute with the National University of Ireland (REMEDI), Galway he has received funding in excess of €14.9 million by Science Foundation Ireland (SFI) to conduct basic and applied research in regenerative medicine, an emerging field that combines the technologies of gene therapy and adult stem cell therapy. The goal is to use cells and genes to regenerate healthy tissues that can be used to repair or replace other tissues and organs with a minimally invasive approach.

Professor O'Brien graduated from University College Cork with MB, B Ch BAO (Honours) and PhD. He is a Fellow of the Royal College of Physicians of Ireland and a Fellow of the American College of Endocrinology.

He returned to Ireland from the United States in 2000 where he held positions at University of California-San Francisco and in Endocrinology at the Mayo Clinic. He now focuses his research on cardiovascular disease and has a special interest in diabetic vascular disorders. As a Fellow of the College ‘RCPI Today’ spoke with Prof. O’Brien to find out more.
 

Professor O’Brien you decided to return to Ireland after building a very successful career over a number of years in the U.S.  What was your motivation in making this move?

I moved to the U.S. in 1988.  At that point there were no structured training programmes in postgraduate medicine in Ireland.  I spent thirteen years in the US completing training in General Internal Medicine and Endocrinology & Metabolism.  I did a postdoctoral Research Fellowship at the University of California, San Francisco and then returned to the Mayo Clinic as a Consultant Endocrinologist and Associate Professor of Medicine for six years before returning to Ireland. In my position at Mayo Clinic I had 75% of my time protected for research and academic activities and 25% for clinical practice.  I was motivated to return to Ireland by the incredible changes that had occurred in the Country between 1988 when I left and 2001 when I was about to return.  This included a massive increase in funding and the establishment of Science Foundation Ireland.  There was also substantial investment in infrastructure by the Higher Education Authority allowing ‘state of the art’ research facilities to be constructed.  At the point I returned to Ireland it was equally feasible to engage in academic medical practice in Ireland, as it was in the USA.

Can you tell us about your role and activities in Galway since your return?

In the year before I returned to Galway I participated in the University’s HEA bid under the programme for Research in Third Level Institution Programme.  We were awarded funding and built a National Gene Vector Laboratory incorporating a GMP Facility for vector and stem cell production.  I returned as Professor of Medicine at NUI, Galway and Consultant Endocrinologist in Galway University Hospital.  My activities can be divided into clinical practice, education, research and administration.  In 2004, I led a bid with Professor Frank Barry to establish a Regenerative Medicine Institute under the Science Foundation Ireland, CSET programme, I now direct that programme, which has 75 researchers in Galway in addition to my activities in education, clinical practice and administration.  There has been a significant increase in the number of consultant and academic clinicians in Galway since my return and therefore this has resulted in a substantial sharing of the academic load. 

What are the major goals for your unit in Galway for the next few years?

We have established in Galway the complete translational infrastructure necessary for biomedical research.  This includes basic research labs, animal research facilities, a GMP grade vector and stem cell facility, and we recently received funding from the Health Research Board to build a Clinical Research Facility, which will have substantial emphasis on clinical cancer research and regenerative medicine.  Major goals for the Department of Medicine in Galway in the coming years is to participate in the introduction of a new integrated five-year medical undergraduate curriculum and the introduction of graduate entry medicine to NUI,Galway.  This will also involve close interaction with affiliated hospitals in Letterkenny, Sligo, Castlebar, Roscommon and Ballinasloe.  We have established a Western Region Education Network and this will provide the foundation for an integrated network of medical education at undergraduate and postgraduate levels in the HSE West Region.  On the research front, the immediate goal is to apply for extension of the funding for REMEDI.  It was initially funded for a five-year programme from 2004 to 2008.  Next year, we will have a four-year review and will apply for funding for years six through ten.  We will establish basic research programmes in stem cell and gene therapy with translational studies in cardiovascular disease, orthopaedics and spinal cord injury with a specific target of participating in phase one clinical trials over the next five years.  On the clinical service front, we have been developing diabetes care with Dr. Sean Dinneen, Dr Marcia Bell and Dr. Fidelma Dunne over the past few years.  We now have a large number of focused subspecialty clinics within diabetes and strong links with the community.  Dr. Marcia Bell is focusing on the development of endocrinology and in particular endocrine malignancy.  On the administrative front, the University has undergone restructuring and the Department of Medicine will play a major role in the development of the School of Medicine and the College of Medicine Nursing & Midwifery & Health Sciences.  There will also be major changes in the governance structure within the Health Service and the Academic Department of Medicine will participate fully in that process.

How well do you think the increased investment in medical research has been conceived and implemented in Ireland?

The investment in medical research has changed dramatically in Ireland.  There has been a substantial increase in the level of funding.  It is hard to imagine now the difference between 1988, when I left Ireland, and 2001 when I returned.  There is a large increase in funding available through Science Foundation Ireland, Higher Education Authority, the Health Research Board, Enterprise Ireland and other agencies.  I chaired the Health Research Task Force of the Advisory Science Council, which has made recommendations for ensuring that the clinical and translational research infrastructure be markedly enhanced in Ireland in order to benefit from the major investment in basic and fundamental biomedical research.  Ireland is well positioned to establish a network of clinical research facilities with the country as a whole serving as the translational unit.  This will be aided by the evolution of the Dublin Molecular Medical Centre into Molecular Medicine Ireland under the direction of Dr. Ruth Barrington.  NUI,Galway and Galway University Hospital will play a very enthusiastic role in ensuring that these goals are met. 

The symbiotic relationships between clinical care, education and research are often commented on.  What is your view of these relationships and how they can be strengthened?

Having spent a large amount of my postgraduate training and early consultant years in the Mayo Clinic I have a very strong belief in the inter relationship between clinical care, education and research.  The Mayo Clinic logo of three shields represent the connection between these three activities.  It would be my view that clinical care and clinical practice should be the major driving force for academic medical centres and that education and research serve the clinical care mission.  Thus, the provision of ‘state of the art’ clinical care to todays’ patients must be complemented by systems whereby the education of the carers of tomorrow is pursued and also the new treatments of tomorrow are developed through research.  At the end of the day, however, it is my view that the academic medical centre must be patient centred and that education and research are critical factors in enhancing clinical care.

Many young doctors currently in training will aspire to contribute significantly to research – what advice can you give them?

I am very anxious to see medical research play a large role in the training of all physicians.  HRB is increasing its commitment to training clinicians in research and this is also a policy of the Higher Education Authority.  It is important that doctors in training from the undergraduate years forward are exposed to research.  Special study modules in research, summer electives and research projects should be encouraged and the latter also pursued in intern and SHO years.  I would encourage people who are serious about pursuing an academic medical career should pursue a substantive period of time in research during the training period.  This could be for three years to PhD level during the specialty registrar scheme which might also be complemented by additional experience overseas preferably linked to Irish Clinical Research Centres.  In addition to careers with substantive protected time for research, however, it is important that all clinicians have had exposure to research during their subspecialty training. 

As a senior Fellow of the RCPI, what advice would you give the College as to how it should develop over the coming years?