Think out of the box

Bella Ungar is a gastroenterologist at The Chaim Sheba Medical Center in Israel. Her work mainly focuses on biological therapies for IBD. Bella is also head of the immunology laboratory and studies gut transcriptomics and drug safety.

Could you tell us a bit about yourself, and your career as a female clinician and scientist?

After completing my internal medicine training I have trained in Gastroenterology. Following that I traveled to the UK to get some basic science training at Birmingham University. I have then also completed a period of training in molecular and computational biology at the Weizmann institute of Science. I am married and I have 2 sons.

Since returning full-time to Sheba in 2022 I am dividing my focus into 2 main aspects:

1. In parallel to the IBD clinic at the Sheba Gastroenterology Center, we have recently opened the IBD Femme clinical for female IBD patients planning pregnancies / dealing with fertility issues and female organ-related symptoms. 
2. We also have a team of researchers (scientists and coordinators), which I lead, working on translational and basic science studies related to Gut immune disorders. 

You are also working a lot with biological therapies in IBD. In some countries with limited resources practitioners are just starting to introduce these drugs into the clinical routine. Could you give us some advice in the field of biological drug safety in IBD? Maybe some tips for the early beginners in this field.

Biological drugs have revolutionized IBD therapy in recent years. These drugs are effective in a large proportion of moderate to severe Crohn's and ulcerative colitis patients. In recent years, biosimilars to infliximab and adalimumab have been developed, which allow more accessible and cost-effective care. Furthermore, small-molecule drugs have also become available. Those are often much more convenient for patients (administered orally). Nevertheless, with these new drugs new issues arise including adherence issues (patients sometimes forget or skip a dose – which could be substantial for a pill with a short half-life) and interactions with other medications (such as antibiotics) and food. The main advice would be – try to choose the right drug for a specific patient. Currently, we have several drugs on board and therefore we should choose our drug based on safety, patient preferences, patient's comorbidities, past therapies, etc.

What is the role of gut transcriptomics in managing GI pathologies? Why is it important?

We currently study transcriptomics as a possible tool for predicting response to therapy and outcome in IBD patients. We know that IBD is a multi-factorial clinical scenario with great immunological variability between patients and multiple inflammatory pathways involved. Therefore, "one size" does not necessarily "fit all".
Transcriptomics allows analysis of the levels of RNA for all genes detected in a certain sample. Thereby, we get a comprehensive picture based on multiple genes involved in the inflammatory process. This allows us to determine a specific transcriptomic picture that is unique to a certain patient. In the future, we aim to enable patient-specific therapy (choosing the right drug for a specific patient) based on this transcriptomic picture. 

What advice may you give to beginners that wish to proceed with their career in gastroenterology especially in the field of IBD?

I believe Gastroenterology is a fascinating field of medicine with evolving and innovative aspects. It has a wide clinical field as well as multiple options for innovative research. Choose your field based on your main areas of interest and try to "think out of the box".