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Dr. Phedias Diamandis is one of 330 medical residents who recently finished training at the University of Toronto (U of T). He specializes in neuropathology, a five-year residency program in the Department of Laboratory Medicine and Pathobiology, and is in a new position as a neuropathologist at UHN, where he'll help diagnose and treat diseases of the central nervous system.
Dr. Diamandis spoke with U of T Faculty of Medicine writer Jim Oldfield about his training, his new role and what he hopes to achieve in the fields of molecular diagnostics and precision medicine.
How does it feel to be done your residency?
It feels like finishing a marathon. For a long time it felt like it would never end. The final year was pretty gruelling but I just tried to stay positive and keep moving forward and before I knew it, I crossed the finish line! It's a great feeling of accomplishment when I look back. My wife just booked a week-long trip for us to Portugal to celebrate, and I'm very much looking forward to joining the pathology department at UHN as a neuropathologist when I return.
What will you do in that position?
I'll join two other neuropathologists at UHN, making us the largest neuropathology service in Toronto. As a team, we'll be in charge of the diagnostic work-up of brain, spinal cord, muscle and peripheral nerve specimens sent from our neurology and neurosurgery colleagues at UHN and other institutes. We'll perform brain autopsies to accurately characterize neurodegenerative and medical disorders that affect the brain and which may have contributed to mortality. Given UHN's ties with U of T, there will also be an expectation to teach and do research, which are both passions of mine. It's a juggling act, but I look forward to the challenge.
The final year of your residency allowed for electives and research. How did you divide your time?
It's a hectic year because even though you've developed the skills to work efficiently, you're starting to build the next chapter of your career. I was lucky to be in a supportive program that gave me protected time for a three-month elective at Harvard Medical School's Brigham and Women's Hospital. That was a very valuable experience. It helped shaped my academic aspirations and allowed me to see how neuropathologists at other institutions practice our specialty. I gained some unique and emerging skills, and I'm very grateful for that opportunity.
When did you get interested in pathology?
I was a member of U of T's MD/PhD program prior to residency, and in my doctoral studies my supervisor was Professor Peter Dirks, whose lab focuses on brain cancer stem cells; rare cells with stem-cell-like properties thought to be the origin of cancer, and which may propagate malignancy. Before the cancer stem cell hypothesis was introduced, scientists mostly saw cancer as a homogenous mass of cells. Since then, many people have shown that these rare cells are more resistant than most tumour cells to traditional chemotherapy and radiation therapy, and that may explain some treatment failures. I realized that pathologists who studied tumours under the microscope had appreciated this cellular heterogeneity of cancer for decades. At that point I began to appreciate the power of neuropathology and how I could contribute clinically by becoming proficient in microscopic analysis of brain tumours. I thought I could conduct research with the potential to change the way we understand and treat neurological disorders.
Has cancer stem cell theory changed treatment?
I haven't encountered treatment changes based on the cancer stem cell theory yet. But molecular medicine has changed how we look at cancer and made therapy more individualized. Through genome sequencing, we can characterize each cancer more comprehensively and tease out molecular differences between tumours to tailor treatments for each patient. This is the present and future of medicine. My research interests are in adding proteomic, or protein-level data to the mix. Genomics is a powerful tool, but we're learning that the protein make-up of a tumour does not always mirror its genetic signature. Proteins are the ultimate executors of biological function, so proteomic data can add an important layer of biological complexity in characterizing cancer. I think we need to explore cancer in as many ways as possible and ultimately, the most effective therapy will borrow from cancer stem cell theory, genomics, transcriptomics and proteomics, among others. Pathologists will be well-suited to put it all together and provide unified recommendations on how to treat tumours.
Your father, Professor Eleftherios Diamandis, is a high-profile researcher. What's it been like as his son?
I've been fortunate to have not one but two tremendous scientific role models — my mother and father. When we immigrated from Greece, I was thankfully old enough to watch my father build his career here. I saw first-hand what it takes to succeed — relentless hard work, talent, building strong bonds with the people around you, and making the best use of your time and opportunities. His achievements motivated me to reach for his level and attempt to build on it; to try make the lives of others better through research. That may sound daunting, but I never felt pressure from him or my mother to achieve anything beyond trying my best. There was always a feeling of unconditional pride that I'm his son and vice versa. I guess you can say it's been great having him as a mentor, and even better having him as a father and life-long tennis partner.
Reprinted courtesy U of T Faculty of Medicine