Please tell us about yourself

Dr Joveeta Joseph, PhD in medical microbiology, focuses her attention on ocular microbiology. She is a microbiologist at Jhaveri Microbiology Centre, L V Prasad Eye Institute (LVPEI), Hyderabad and is involved in diagnostic and research activities pertaining to ocular infections. She was the first one to describe the staining and electron microscopic features of ocular microsporidiosis. She has been honoured with various awards like G P Agarwal Young Scientist Award, DST Fast Track Scheme Grant, DST Women Scientist Scheme Grant, and recently the 2016 Young Scientist Award by Telangana Academy of Sciences. Being an active researcher in finding out ways to prevent avoidable blindness in India, she finds time out of her works to answer the questions posed to her from India Medical Times.

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Your background?

I started my research career in 2003 as a PhD student at the L V Prasad Eye Institute – BITS Pilani, soon after my Masters in General Microbiology from Osmania University. As often happens, the last few years of my graduate tenure were the most productive and yielded the most exciting discoveries of my thesis work, which focused on understanding microsporidia, an obligate intracellular parasite. I was able to demonstrate that different species of microsporidia possess a range of pathogenicity, tissue predilection and virulence to corneal tissue. In addition, I also worked on the significance of proteolytic enzymes in the pathogenesis of fungal keratitis. I later moved to the Indian Institute of Chemical Technology in 2008 wherein I was awarded the ‘Fast Track Scheme for Young Scientists’ by the Department of Science & Technology to work on investigation of microbial resistance among soil dwelling bacteria. It was a fantastic experience and provided a strong foundation for the span of my career. But I decided that I wanted to contribute to research in a field that would directly help people and thus when I was offered a faculty position as an ocular microbiologist at the L V Prasad Eye Institute, I immediately jumped ship.

In this journey, I realized the gravity of the problems associated with infections and diagnosis of infectious diseases as well as the role I could play as a professional microbiologist to directly combat these problems. Thus, where better than a centre of excellence in eye care services where basic and clinical research into eye diseases and vision-threatening conditions were being conducted for extending equitable and efficient eye care to underserved populations in the developing world. In addition, L V Prasad Eye Institute provides an academic environment wherein I have a chance to help educate the next generation on the facts and techniques in this fast changing field. In an attempt to move forward, I modelled my path after observing the passion for microbiology from Dr Savitri Sharma, who is currently Director of Laboratory Services of LVPEI network hospitals in India. With over 250 publications on ocular microbiology alone, along with several national and international grants, her diligence and professionalism have been my inspiration from the day I first stepped into this institute.

How did Ocular Microbiology specifically draw your attention and interests? How did you end up in an offbeat and unusual career such as this?

I came into the field of ocular microbiology twice. The first time, I had no other choices left to pursue my PhD, but the second time I found a purpose, having completed my PhD on understanding a pathogen that had been recently recognized as a causative agent of infective keratitis. It was then that we started publishing that microsporidia can cause ocular infections in immunocompetent individuals as well, a fact that was unheard of until then. My publications were among the first in the country and even today are the most cited. We have a global presence in this field. I realized that not only are we at a unique position to study these opportunistic pathogenic agents in ocular infections, the spectrum of infections in our country differ vastly than what is reported in western literature.

After joining back, along with infective keratitis, I started to focus on identification and characterization of mechanisms involved in vision loss and inflammation in endophthalmitis, an infection of the posterior segment of the eye. I noticed that out culture positivity in these cases have been between 30-40% but this did not correlate with the severity of infection and despite appropriate therapeutic and surgical intervention, there were cases of significant loss of vision (or the eye itself) within 1 to 2 days. This is an exciting field and there remains a lot to be studied. Ocular microbiology is one of the most under-recognized health professions but it remains an applied science wherein the advancements in molecular biology and the newer technologies pave the way for better understanding of ocular diseases.

Please tell us more about your research works.

Our laboratory is working on research projects related to investigating microbial pathogenesis and physiology, microbial susceptibility to drugs, immune defence system and the host-pathogen interface in a range of infectious diseases of the eye. The research activities are supported through research grants received from national agencies and industries, including the Council of Scientific and Industrial Research (CSIR), Department of Biotechnology (DBT), Department of Science & Technology (DST), Indian Council of Medical Research (ICMR) as well as international agencies such as Asia Cornea Society, Singapore; Bausch & Lomb International Research Programme; British Contact Lens Association etc. Some of them are outlined below:

Corneal diseases are a major cause of blindness worldwide and corneal infections are a substantial cause of blindness in Asia. We are one of the participating institutes in the Asia Cornea Society Infectious Keratitis Study (ACSIKS) study, conducted under the auspices of the Asia Cornea Society. ACSIKS is a supranational, three-year multi-centre study on infectious keratitis involving 11 clinical sites from major ophthalmic institutions in eight Asian countries with the aim to develop improved strategies for prevention and treatment, with the ultimate goal of reducing ocular morbidity and corneal blindness related to infectious keratitis in Asia.

One of the most challenging tasks faced by an ophthalmologist is to overcome antibiotic (antifungal) resistance in ocular pathogenic fungi, which are responsible for nearly half of the total corneal ulcers. Our laboratory is interested in characterizing Candida species (a common cause of fungal infections worldwide) isolated from ocular infections. This study aims to also investigate the virulence factors associated with these Candida strains. In addition, we are also interested in assessing the biofilm formation potential of ocular Candida albicans and to correlate the potential with antibiotic susceptibility by identifying the genes involved in biofilm formation in ocular Candida albicans. The results of this study would help understand the pathogenicity and clinical course of various Candida species associated with ocular infections, and would help us to achieve good treatment outcomes.

The human eye surface microbiome study aims at establishing both the gut and ocular surface microbiomes of normal individuals and individuals with keratitis using next-generation sequencing (NGS) as a foundation tool. The acquired knowledge would help to unravel and understand ocular health in the context of how gut microbiome changes could alter host–microbiome interactions to mitigate disease.

Using molecular methods we recently recognized a corneal pathogen Pythium insidiosum that was probably lurking around earlier unrecognized. Through our research we have now mastered a simple laboratory method to recognize this organism and the condition is increasingly being diagnosed in our laboratory. Our focus is now on studying the clinico-microbiological profile of patients with Pythium insidiosum keratitis. Resistance to treatment with antifungal drugs has made this condition of special concern to cornea specialists. Active research to address this issue is one of our recent engagements.

After eye surgery, trauma, or injury, there’s a potential that patients may develop nasty infections, either from the bugs that are present on the ocular surface, or from contamination, the environment, or pollution. When these bacteria get into the back of the eye, where the retina lies, they initiate an acute inflammatory response. The inflammation is good, as an early innate response to protect the host, but it must be resolved quickly or it will cause damage to the retina. What we are trying to understand is, what are these pathogens that get into the eye, and what kind of immune response they generate during endophthalmitis? We are also interested in looking at inflammatory mediators, like cytokines, as well as anti-inflammatory molecules. Our research programme provides insights and publications in the areas of ophthalmology, microbiology and immunology.

What’s your message for budding medical researchers in India?

As India is one of the fastest growing economies in the world, the global health sector industry is finding huge market in the Indian population. Better clinical trials conducted in India on Indian population can yield useful data pertinent to the country and will find application towards enhanced medical care and better health promotion. Medical research in collaboration with biomedical engineering will revolutionize various aspects of medical care, ranging from automated diagnostics, computer modelling of drug molecules and imaging technologies to minimal access and robotic surgeries. There are tons of data yet to be pulled out and a lot to be learnt. In addition, the country has long battled infectious diseases such as tuberculosis, malaria and dengue, but is now facing rising numbers of non-communicable illnesses, including diabetes and coronary heart disease. This puts further demand on applied research for developing new drugs, tests, imaging techniques, surgical modalities etc, especially because the increasing population burden and longer lifespan have generated novel health issues that were not so critical even a few decades ago. We need to initiate and establish a more stable and interactive dialogue between the clinical and basic scientists and also involve technological experts in translating basic bio-medical research into real applications. Medical research in general is in an exciting place. Technology is moving so fast, our understanding is moving so fast that I think the future holds a great promise.