On 29th September 2014, Prof. Dr. Hristina Grupcheva, DSc, Head of the Department of Eye Diseases and Visual Sciences, was elected to take the position of Vice Rector for Innovations and Translational Medicine by the Academic Council of MU-Varna.
Prof. Grupcheva graduated from MU - Varna in 1992, and since 1996 she has been working as a specialist in Eye Diseases. She has accomplished plenty of specializations at Moorfields Eye Hospital, London, and at Dundee University, the UK. In 2000 she won a grant from Maurice and Phyllis Paykel Trust and launched a 3-year academic and clinical specialization in cornea at Auckland University, New Zealand. Besides the position of a Senior Assistant Professor she also occupied a clinical position at the Department of Eye Diseases at the National Hospital in Auckland. At that time she completed a doctoral thesis, entitled "Microstructure Analysis of the Cornea in Health and Disease."
PhD in New Zealand
"In Bulgaria in 1999, there were no available doctoral positions, at that time this was the greatest crisis. In 1998 I went to Scotland for the first time. There I launched a project with a Scottish Professor, with whom I did my dissertation later on in New Zealand. In 1998 we published the first and the only one of its kind Bulgarian book-atlas about the cornea - the Professor provided the photographs, and I wrote the text. Then he received a job offer in New Zealand, and I decided to go there in order to write my academic work in cooperation with him.
Before going to New Zealand, a person cannot realize what step they are about to make. This place is situated within a distance of two twelve-hour plane flights. When I landed there, the first thing I felt was my overwhelming desire to return immediately. However, what really motivated me to stay was the technology I had access to."
During her stay in New Zealand Prof. Grupcheva had the opportunity to work with a confocal microscope for the first time – a technological revolution in the diagnostics of cornea and the anterior segment of the eye. "I had the full support of the University. I was with a grant from Maurice and Phyllis Paykel. Maurice Paykal himself supported me personally. He came with his entire family to take part in the recruitment of patients for the basic research with confocal microscopy. All people related to him somehow, came to support the project. A very serious PR campaign was conducted in order make the population aware that such a technology and new diagnostic possibilities existed. Thanks to all that I was able to collect so many interesting patients and cases. The dissertation I wrote won the Rector's Award at Auckland University for 2002, and the publications I did were published in some of the most prestigious scientific journals worldwide such as Investigative Ophthalmogogy Visual Science. To be honest, I immediately received a job offer to start working there. But I decided I wanted to go back to Bulgaria."
An ophthalmologist with nearly 20-year professional expertise and over 100000 patients.
Thanks to a grant won by Prof. Grupcheva's team, Medical University - Varna has had at its disposal the only one in Bulgaria confocal microscope, with which different layers of the cornea and the cellular elements in them can be observed live. Prior to the invention of this technology, the cornea biopsy was the only diagnostic possibility. Not only is an immediate diagnosis performed by means of the confocal microscope now, but it also allows the monitoring of the patient over the time, and using time as a fourth dimension.
"Confocal microscopy is an element of the research work of the majority of young doctors working with me. This gives us an extremely good opportunity in terms of future projects planned. We have a serious portfolio in terms of ideas that we intend to develop in one direction or another. However, the most essential part is related to diagnostics and treatment of the anterior segment and in particular - the cornea. We have been performing the greatest number of amniotic membrane transplantations in the country-more than 70-80 per year. This is performed for people with impaired ocular surface - erosions, infections, burns, trauma and other diseases."
The amniotic membrane is donated by mothers who have had a cesarean section birth, after that it is checked, prepared and stored in a specific way. The next step is the grafting of this tissue as a coating that hardens the anterior eye surface. The impaired surface of the richly innervated cornea is accompanied by a very strong, almost unbearable pain. "There is almost nothing in the human body that hurts so badly at every single movement of the eyelid. We blink almost as many times as we chew - about 15-16 times a minute. It is estimated that an eyelid passes 40 km per year. If you had to go on an uneven surface by your hand, you could imagine what would happen to your hand. Imagine what is happening between the eyelids and the anterior eye surface of the cornea when there is a cornea with impaired surface."
At the clinic, where Prof. Grupcheva works, limbal stem cell transplantation has been performed as well. "At the moment it is at the level of an autologous graft - we take limbal stem cells from the healthy eye. But if we could multiply limbal cells on an amniotic membrane, then we would be able to help many more people. And this is where our efforts have been targeted at."
"I've always been interested in social ophthalmology and more precisely in preventive programmes. The better we can conduct prophylaxis, the better our results will be after that because we will treat fewer patients with advanced diseases." The professional interests of the team have been currently aimed at identifying the effects of ultraviolet sun rays on the eye.
"This summer we had another unique opportunity - for three months we were able to work with a special ultraviolet camera of Minas Coroneo. The younger colleagues, Dr. Boyadziev and Dr. Neshkinski, took screening photographs for detecting UV damage." The results appeared to be very interesting. The impairments that were registered were related to specific characteristics of the people, in whom they were detected, in terms of their habits, concerning the protection from sunlight, the colour of their skin and eyes. It turned out that people with darker skin and eyes protected themselves from the sun to a less degree, in consequence they had more damages. In people with light eyes, who were more sensitive to the sun and prevented themselves from the sun, the team detected changes more rarely.
"In recent years there has been a change in the ultraviolet radiation, we are not aware of its range because nobody has been measuring it, but it certainly has an impact on the eye as well. The consequences of the influence of the UV-rays are connected with the death of stem cells, disruption of the transparency of the cornea, the glands that secrete the tear film die, dry eye, a change in the characteristics of what we see - contrast, colours, peripheral vision."
The challenges Prof. Grupcheva faces as Vice Rector for Innovations and Translational Medicine
I asked Prof. Grupcheva whether the new position she had taken would be linked to her professional field. "My plans and tasks as Vice Rector for Innovations and Translational Medicine are in no way related to my direct professional interests as an ophthalmologist. This position implies joint efforts of the whole University, to outline the guidelines in order to make it work as one large structure. Our University is unique with the fact that it comprises specialists absolutely from the entire spectrum of health services - doctors, pharmacists, dental doctors and specialists in public health, which closes the circle. We must use this potential. Translational Medicine is often called the medicine of the three "B" of the English words bench, bed and back. This means development of the idea in the laboratory, its transfer to the bed of the patient, and after a clinical trial its return to the lab to find new more effective therapeutic decisions. I am honored that I was given this unifying role."
"The future is definitely in Тranslational Мedicine. Тhere is no point in being focused on a specific problem in a certain field, developing it, and after that leaving it in a file or a dissertation. What really makes sense is doing something that is useful for more than one discipline and implementing it in direct clinical practice. The main idea of this position is to achieve an overall coordination between the different directions because there is no such a thing as a walking hand, a walking ear or a walking eye. A man is a complete organism. For example, if the sunlight damages the human eye, it also damages the skin and this could be united in one common direction, which would include public health specialists, dermatologists, ophthalmologists."
"The main idea is to work in several major areas in which there is a place for all specialties - only in this way, working together, we will have a greater chance to implement the results in clinical practice. The advantage related to the fact that we have a variety of clinical facilities is really great and it allows working at high speed and on a large scale."
"What has to be done in the short term is the coordination of the work between the different departments and identification of the general trends. Undoubtedly, one of the fields will be the genetic one, because it is definitely a leading science in the modern world. Certainly, there will be a pharmacological trend as well, in which clinical trials of pharmaceutical substances will be carried out. Each good idea will find its way and implementation."
Several intensive working teams will be established, which are going to carry out the translation of this knowledge. Both specialists from our University and external consultants will be involved in these teams. Prof. Grupcheva believes that in our modern world multidisciplinarity is more than required for two reasons - the first is that the level of the global knowledge we have is so detailed that it is not possible for a single person to be able to cover everything. The second one lies in the tendency of high specialization. "Therefore, we really need something to unite us and guide our efforts because if we get bogged down in our narrow specialization, at some point we might delve so deeply that we might not see other obvious things. We need to focus our efforts so that they won't get dissipated. I'd love to work with the whole team and I really have great expectations for exciting and productive projects."
The interview was done by D. Velcheva