I was exposed to the research environment very early in my life. As mentioned above, my father is a professor of gastroenterology, and my mom is a professor of biology. I remember that at the age of 15 years I was already spending time in my mom's lab working with her plant specimens, helping with molecular analysis and reviewing her scientific papers. Then later in my career I met a lot of excellent international mentors, including Professor Peter Malfertheiner, Professor Stephen Schreiber and many others who gave me insights into the fascinating life of a clinician-scientist, which is not easy but at the same time is very rewarding. I am also grateful to ECCO and the European Helicobacter and Microbiota Study Group, which provided an excellent networking environment for me as a young researcher.
I think the beauty lies in the complexity of these diseases. Using advanced omics technologies and large patient cohorts, the IBD Research Community has identified many interesting signals. The next step now is to delineate their actual role. At our Institute of Digestive Research at the Lithuanian University of Health Sciences in Kaunas we are focusing on patient-derived IBD organoid technologies. This platform allows us to capitalise on different omics hits and bring them to personalised organoid testing platforms. These experiments currently include bacteria-derived metabolites, bacterial cell wall components, food metabolites, novel therapies and other substances that we are testing under the Horizon Europe MiGut-Health project as well as contracted research. We hope that these approaches can lead to certain translatable solutions for IBD patients in the longer run.
We have seen very rapid and enormous success of faecal microbiota transplantation for the management of patients with refractory Clostridioides difficile infection. Clinicians expected that we would immediately be able to transfer FMT to IBD and other complex disorders; however, this approach has largely failed. I think that the future of microbiome therapeutics is great, but we are at the very early phases of it. The major breakthroughs will come through targeted bacteria-derived metabolite therapies, phage therapies or predefined consortia of bacteria that are already in clinical trials in different clinical settings. We are trying to implement some of these approaches in another Horizon Europe-funded project, PerPrev-Cid, together with the University of Kiel and other international partners.
I am very happy that ECCO has decided to create a Working Group on Microscopic Colitis and I’m grateful that I had a chance to join it. I have been involved in Microscopic Colitis research for the last ten years, including clinical trials, clinical registries and basic research. I think that microscopic colitis clearly belongs to the spectrum of IBD. While classic IBD has received a lot of coverage in terms of basic/omics research, microscopic colitis needs much more of that in the future. We are currently running several wet lab studies looking at the microbiomes and immunity, trying to understand the underlying mechanisms in microscopic colitis.
It is a real challenge to combine research and administrative tasks but I'm very happy to have strong teams around me, which makes this combination possible. I think that the main conditions for which researchers should strive are collaboration, international exposure, less bureaucracy and flat leadership. This is what we're trying to implement at our institution now.
First, you need a strong and devoted mentor who is prepared to guide you during the early days of your research. I also think that you need to dive deeply into a specific area or research niche in order to be successful. Thirdly, I would strongly recommend international research exposure early in your career; this can be achieved through a PhD, internships or postdoc positions at excellence centres abroad, all of which help in creating networks and friendships. Lastly, I would strongly advise all clinicians who are considering a clinician-scientist research pathway to spend some time in the wet labs—this will enormously enhance your chances of doing impactful translational research.
Thank you, Juozas, for such a candid and energising conversation and for the reminder that behind every "unmet need" in IBD research is an opportunity waiting to be seized.
