Dr Maresa Carulli
Dr Maresa Carulli is a specialist registrar and an Arthritis Research UK clinical research fellow at the Royal Free and University College Medical School, London.
What does your work involve?
My research is based at the Royal Free Hospital within the Centre for Rheumatology. Here, clinical activity and research have focused for the last 15 years on improving the treatment of patients with scleroderma and understanding the mechanisms that initiate and perpetuate the disease, making this an unique place to study this uncommon rheumatic disease. In particular, my research project aims to understand the role of a protein called MCP-1 in the development of scleroderma.
How long has Arthritis Research UK been funding you?
I was granted an Arthritis Research UK clinical research fellowship which started in February 2003 and finished in March 2005.
What's the most important thing you've found out in the past 12 months? Why?
MCP-1 protein is expressed in high levels in skin and blood of patients with diffuse scleroderma very early on the disease, and those with higher levels have a tendency to develop serious internal organ involvement and have more aggressive disease in general. This is an important preliminary observation as it suggests that MCP-1 is involved in the development of the disease and also that it may be a useful marker to tell us which patients need aggressive treatment very early on.
What do you hope or expect to achieve as a result of your Arthritis Research UK funding?
I hope that my own work will help us gain some understanding of the complex processes involved in scleroderma and that in particular it'll answer whether blocking this protein or its receptor could be useful in treating the disease.
What do you do in a typical day?
On a typical day I spend most of my time in the laboratory carrying out different types of experiments. Writing research articles is also an important activity that takes up a lot of the time. One day a week I join in the scleroderma clinic and see patients with scleroderma-associated pulmonary hypertension and scleroderma in general. Seeing the problems that scleroderma patients experience brings home to me the difficulty of managing this disease. Teaching the medical students on the basics of rheumatology is also a regular challenge!
What's your greatest research achievement?
Our research focuses on fibroblasts, the cells that are responsible for making too much collagen in scleroderma and causing fibrosis (the thickening of the connective tissue in the body). So far my work has shown for the first time that scleroderma fibroblasts express a receptor specific for MCP-1, called CCR2. This receptor is a special protein positioned on the surface of the cells, which is activated by MCP-1, and following its activation transmits signals into the cell. This observation suggests that MCP-1 may be involved in the development of fibrosis via its receptor, CCR2, and that there may be an advantage in blocking it.
Why did you choose to do this work?
To study a complex disease for which there's still no satisfactory therapy is very stimulating and exciting. It's also challenging to face and try to solve the burden of problems that scleroderma patients carry. I consider myself very fortunate because I can combine my research work with the clinical activity.
Do you ever think about how your work can help people with arthritis?
As a clinician I value research that ultimately results in an improvement in the care of patients. I'd like to think that my research project will lead to further studies to assess if blocking MCP-1 can be used as treatment of scleroderma and perhaps also the many more common rheumatic diseases in which fibrosis occurs.
What would you do if you weren't a scientist?
I'd love the idea of being and architect and building stunning, innovative buildings, perhaps even beautiful hospitals!
I'm an Italian in love with London. I've lived here for 10 years but I still enjoy making the most of what the city has to offer from restaurants to theatres, although my favourite places now are those which are most children-friendly so I can go with my 2-year-old son James! At weekends, if I'm not playing with him, I'll be busy buying antique (or just old) furniture for the house that my husband Andrew and I have finally finished renovating or cooking a meal for a large group of friends or family.
This article first appeared in Arthritis Today Winter 2005, issue 127.