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Award-winning Norwegian medical student credits RCSI for success
Natalya Anderson

Natalya Anderson speaks to Dag Netteland, the Norwegian student whose project on the effects of silencing angiogenin on motoneuron survival earned him and honourable mention at last year's Irish Healthcare Awards

Earning an honourable mention at last year’s Irish Healthcare Awards for his project on the effects of silencing angiogenin on motoneuron survival has been a highlight in Dag Netteland’s experience as a medical student in Ireland. But he credits his Irish teachers and colleagues at the Royal College of Surgeons in Ireland (RCSI) for keeping him most content in his studies away from his home in Norway.


“I like Ireland very much and find Dublin to be a very interesting and dynamic city,” said Netteland. “To be honest, I wouldn’t really miss Norway that much at all. I do spend a fair bit of the year on study breaks back home, though.”

Friendly people
He continued: “I find Irish people friendly and open and, in the context ofmedical training, they would generally be helpful and willing to lend you their time, even as a patient in a hospital.”Along with his project team, Netteland found angiogenin to be up-regulated in response to hypoxia in motoneuron-like cells.

They indicated that the main transcription factors involved in controlling this up-regulation were HIF-1 alpha and NF-kappa B, and that silencing angiogenin expression using a small interfering RNA (siRNA) approach did not in itself affect cell viability, but did increase motoneuron vulnerability to injury-induced cell death.

Cell death
“Perhaps the most important finding of this study is that silencing angiogenin in itself does not effect motoneuron survival, but it increases the vulnerability of motoneurons to injury-induced cell death,” said Netteland. “This is of direct relevance to amyotrophic lateral sclerosis (ALS), as the mutations in angiogenin identified in ALS patients are suggested to result in a loss of angiogenin function. Therefore, mutations in angiogenin may increase the susceptibility of motoneurons to cell death from injury such as oxidative stress and excitotoxicity in these patients.”

According to Netteland, his goal with the project was to examine how motoneurons respond to hypoxia and, more specifically, to examine the role of angiogenin in this response. He and his colleagues set their research against the backdrop of a study previously conducted by RCSI researchers.

Mutations
This previous team had discovered mutations in ANG in patients with ALS. “The ANG gene encodes for angiogenin, a protein that is involved in angiogenesis - formation of new blood vessels - in response to decreased oxygen in tissues,” said Netteland. “However, its role in motoneurons remains undetermined. Since ANG mutations were found in ALS patients, a dysregulated response to hypoxia may be involved in the development of ALS.

“Hence,” he added, “we aimed to characterise the hypoxic response of motoneurons with a particular focus on the role of ANG.” Netteland says the bulk of his team’s project was carried out during 10 weeks in the summer of 2006, under the supervision of Dr Dairin Kieran and Prof. Jochen Prehn, both of RCSI’s physiology department.

The students’ work included writing up detailed descriptions of their research as requirements for their Bachelor of Medical Science (BMedSci) degree. The team is continuing their work on this tributary of the project.

The motivation for beginning the project was first instilled in Netteland through his research supervisor, Dr Kieran. Various topics within the area of neuroscience were appealing to him as project subjects.

“As I was already, at that time, very much interested in the field of neurology, I decided to apply to the ALS project via the SPUR (Summer Programme in Undergraduate Research) program,” explained Netteland.

“The SPUR programme is an excellent programme that’s run by the RCSI with funding from Science Foundation Ireland, and it entails a structured educational programme for students doing research in an RCSI-affiliated laboratory.” According to Netteland, the RCSI had a major impact on his move to Ireland.

Many of his secondary school friends have attended, or are now attending, the college also, and he says that they have all had positive experiences. He added that the RCSI’s extensively international student body was also very attractive to him (the college boasts a student body from 60 countries worldwide, as well as established schools in Malaysia and Bahrain).

Now in 4th Med – which is actually his 5th year at RCSI, including his year of Pre-Med – Netteland says his training is structured into pre-clinical and clinical blocks. His current study year is comprised of rotations in speciality areas, including psychiatry, otolaryngology, obstetrics, gynaecology and paediatrics.

He also participates in rotation in clinical medicine and surgery. Netteland says his pre-clinical years involved basic science studies.

Rotations
“This year would also involve several peripheral rotations, which is particularly interesting for someone from Norway in that we get to see other parts of Ireland,” said Netteland.

“Final Med would mainly focus on clinical medicine and surgery, and [would] involve rotations in these fields. Generally, I am very much satisfied with the training at RCSI. “My overall impression of the pre-clinical teaching was that it was very good and, although I’m just starting the clinical training, so far I am very much satisfied.”

While intrigued by Ireland and his studies in the country, Netteland is not certain that he will settle here. He says it is likely that he will return home at some stage in the future, but that the appeal of Ireland stretches beyond the training he trusts at RCSI. “Interestingly, whether or not you get an internship back home is decided by lottery,” said Netteland.

“All applicants - graduates from Norwegian and international medical schools alike - draw a number, and if you draw a low number you are unlikely to get a place straight after you graduate, and would expect to wait for six months.

“This waiting for six months would not be a good option with the loans that have built up. So, in short, I’m not sure and would still be considering both options. I would view both both staying here for further training and going back home as good options.”

Tradition of Norwegians
Netteland says that there is a tradition of Norwegians at the RCSI going back many decades, and that its reputation is very good in his home country. He adds that the Norwegian government once sponsored 10 placements a year at the college through a programme that allowed students to attend medical schools outside of Norway.

“The programme was set up, I believe, due to a view that Norway did not produce enough doctors at the time,” said Netteland.

“The criteria for being accepted for these places would have been similar to those of applying to a Norwegian medical school. This programme was stopped four years ago due to, I believe, projections that Norway will have enough doctors in the near future. I’m in the last year where there are fully-sponsored Norwegian students.”

Netteland’s tuition fees for the 2007/2008 school year were €40,750. He says that only a small portion of this is sponsored by the Norwegian government in his particular case. Fees reportedly rise as students reach their final years of study. Netteland does not work while studying in Ireland, but does do some assistant medical work when he is at home during summer breaks.

During the summers of 2005 and 2007, he was employed as a nurse assistant in a regional cancer centre which mainly specialises in radio- and chemotherapy at Ullevaal University Hospital.

He spent the summer of 2006 working strictly on his ALS research project.
It was his combined desire to work with people on a daily basis in a biological science role that drew Netteland to medical school.

Positive influence
“I think I was hoping for a future job where the work performed could potentially influence people in a positive and important manner,” said Netteland. “Medical education in Ireland, and in RCSI in particular, has a reputation in Norway for being very good.

“I’ve been very satisfied with the education provided at RCSI, and I am also very happy to have moved to Ireland, of which I am growing very fond.”

Netteland says that these later years of medical study are proving more fast-paced and intriguing, and are preparing him for life as a doctor in the ‘real world’. “Now that I am going into the clinical years and approaching final exams, life as a medical student is getting busier with requirements of performing like a professional,” said Netteland. “But it is also becoming more interesting.

“Doing this research project has been a valuable experience that is different from that gained in medical school, and it has promoted individual working skills,” he continued. “It has provided a view into the research side of medicine and its methods, which is so commonly referred to in clinical teaching.

“More specifically, I think I have gained knowledge on neurodegenerative diseases in the field of neurology. I feel it has been a valuable experience I wouldn’t have wanted to be without,” he concluded.

Posted in Features on 07 March 2008