Neurology in the Lab, and at Patients' Bedside

Diego Centonze recalls being upset when, after obtaining his medical degree, he was refused entrance to train as a neurologist at his first-choice university in Rome, Italy. "Now I understand [that] that was the beginning of my real luck," says Centonze. After he was turned away, Centonze arranged a meeting with another school of neurology in Rome, at the Tor Vergata University, seeking to persuade them to take him on. He succeeded. Not only did he find a way to train as a clinical neurologist, but at Tor Vergata he also found two mentors who offered him the opportunity to also embark on a career in neuroscience research. "I discovered that I had the possibility to participate actively in research. It was, for me, a great opportunity," he says.

His two mentors proposed that he should work in the clinic in the morning and in the lab in the afternoon, helping him pick the skills that he needed along the way. His current dual position--he is both a clinical neurologist and a neurology researcher--is a "direct consequence" of meeting his mentors, he says, and he strongly encourages other young scientists to seek a training environment that they feel will be supportive of their career.

The Road to Medicine … and Neurology
Becoming a neurologist--or even a doctor--wasn't something that Centonze aspired to when he was young. "Life took me in very strange directions," he says. Centonze first decided to study law, but "I changed my mind because I met a couple of friends studying medicine." His friends inspired him with their dreams of taking care of people, going abroad on missions, and doing scientific research. So in 1989, he started afresh at the School of Medicine and Surgery at La Sapienza University, in Rome.

During his medical training, Centonze particularly enjoyed his physiology and neurology classes, which he saw as closely entwined. "You need to be constantly involved in the discovery of new knowledge on the brain if you want to be a good neurologist," he says. "I liked the idea to continue to study and update myself constantly." So after completing his degree in medicine in 1994, he applied to the School of Neurology at La Sapienza to train as a neurologist. "But it is very competitive, and I didn't succeed."

When Neurology Leads to Research
But Centonze was not willing to give up on becoming a neurologist, so he made enquiries at another neurology school in Rome, at the Tor Vergata University. He was surprised when the director, Professor Giorgio Bernardi, was willing to see him the very next day. "I told him I have no one that can guarantee for me, but I know that I like neurology, and I am a hard worker, and if you would give me this opportunity to stay with you, you will become aware of the quality of my work," says Centonze. Bernardi took him on.

While most neurology schools in Italy are hospitals that run small--usually clinical--research programmes, a few, like the Tor Vergata, also have programmes in basic research. Centonze declared his interest in research to Bernardi, who offered him the opportunity to spend mornings in the clinic and afternoons in the lab. "About 20 percent of the trainees in neurology at Tor Vergata have the opportunity to come and work in the laboratory," says Centonze. "But many give up after 1 or 2 years because the effort to do two jobs is great, and because many decide, or are encouraged, to spend this time learning technical abilities useful for their clinical activity."

Centonze conducted his research work--on neuron physiology--with Professor Paolo Calabresi. "My project was to study the mechanism of action of dopamine in pathological and physiological conditions." Dopamine, explains Centonze, is involved in the brain's adaptation to external stimuli, such as drug exposure and motor learning. As the brain adapts, the efficiency of the transmission of signal molecules -- dopamine in particular -- between neurons changes too, a phenomenon known as synaptic plasticity.

Combining clinical neurology and research was rewarding, but it was also challenging. Centonze had to start at the very beginning in acquiring research skills. "It is very tiring and quite difficult if you want to stay completely up to date on science," he says. What really helped him was the opportunity, during his second year, to concentrate exclusively on his research, at the Department of Pharmacology at the University of Birmingham in the United Kingdom. "I had the opportunity to see how people work, to learn techniques and practical ways of approaching scientific problems," he explains.

Settling into a Permanent Position in Italy
When Centonze completed his clinical neurology training 2 years later in Italy, he wasn't sure what his next destination should be. "The chance to do both research and clinic in neurology at a good level is not very common in Italy," he says. "I was tempted to try to [go back to] England to have more opportunities." But he decided to give Italy a chance and ended up at the Tor Vergata School of Neurology, which, he says, with its focus on international collaborations, "represents a little England in Italy."

Centonze was offered an assistant professorship at the Tor Vergata University at the age of 30, which is rather young by Italian standards. Tipping the balance in his favour, he believes, were the 50 papers or so he managed to publish in less than 5 years, thanks to a supervisory role in the lab and his involvement in many collaborations. Centonze has been similarly successful at securing money for his research; this, too, worked in his favour. "If you get a lot of money, the university can't say 'No, I can't pay him,' “ he says.

As assistant professor, Centonze still spends his mornings at the clinic and afternoons in the lab, but now teaching duties have been added to the mix. This is manageable, he says, because "I try to [condense] all my hours of teaching in one month or two a year."

Centonze is running a lab of electrophysiology staffed by one Ph.D. student and 3 M.D.s from the school of neurology. Since 2004, he has also been running a neurophysiology lab, staffed by two M.D.s, at the new Centro Europeo di Ricerca sul Cervello (CERC) in Rome. CERC is made up of three different institutes, one of which, the Fondazione Santa Lucia; offered him the second laboratory. Both his teams are looking at synaptic activity and the involvement of neurotransmitters in neurological disorders such as Parkinson's and Huntington's diseases, and in cocaine exposure.

Juggling so many responsibilities is difficult, but Centonze thinks the advantages of a dual career weigh out the disadvantages by far. One advantage, he notes, is the security it offers in the early years. Throughout his early, uncertain years as a researcher, Centonze knew that he could always make a living from his clinical work should his research career fail to pan out. "This gave me the tranquillity to really concentrate on my research," he says. Another considerable advantage is that working both at the bench and the patients' bedside gives him insight into what basic research projects are most promising as potential therapies. Apart from the advantages to patients, this also makes it much easier to get funding, Centonze reckons.

The Importance of Finding a Mentor
What was instrumental in his career, Centonze thinks, was the support of his mentors. When he knocked onto the door of the School of Neurology at Tor Vergata University, he had no idea of what he would encounter. "But 2 days later, I saw how seriously young people were working" and how seriously their career development was taken by the senior staff. Both Bernardi and Calabresi believed and invested in him, he says, and that has made all the difference. Scientists in training should pay close attention to their training environment, seeking out supportive situations like the one he had at the beginning of his research career. "Try and identify the people that can really teach you and help you very quickly," he says. And what if the institution is not supportive enough? Then they should be ready "to leave the place."

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