Komal P. Singh, Ph.D.

  • Senior Associate Consultant, Division of Nursing Research
  • Assistant Professor of Nursing, Mayo Clinic College of Medicine and Science

What sparked your interest in individualized medicine?

Personal and professional experiences have influenced my interest in individualized medicine. Several members in my family were diagnosed with cancer. My mother and her sister were diagnosed with breast cancer, my second maternal aunt was diagnosed with pancreatic cancer, and finally my father was diagnosed with prostate cancer. Despite similar diagnoses of early-stage breast cancer, my mother and her sister's symptom trajectories post-treatment were vastly different. Compared to my mother, my aunt had worse outcomes.

As a research and development scientist working in biotechnology and pharmaceutical industry for over ten years, I performed gene expression, genotyping and proteomics assays to evaluate molecular risk factors and drug targets for various diseases related to immune dysfunction. As a clinician I was intrigued by the consistent pattern I observed, where patients in the hospital treated for the same disease condition had vastly different outcomes. I decided to investigate interindividual differences in phenotypic and molecular risk factors associated with patient treatment-related adverse events.

What is your focus as a Gerstner Family Career Development award recipient?

My research study funded by the Gerstner Family Career Development Award evaluates associations between chemotherapy-induced nausea and changes in the gut microbiome. The goal is to investigate interventions to alleviate unrelieved nausea and co-occurring symptoms in patients with cancer. Despite major advances in evidence-based antiemetic treatments, between 30% to 60% of patients with cancer report chemotherapy-induced nausea. This debilitating symptom can lead to nutritional deficits, decrease in quality of life and discontinuation of treatment.

At Mayo Clinic, my program of research aligns with the Center for Individualized Medicine's strategic foci of Genomics in Action and Beyond DNA. Within the Genomics in Action focus area, my program of research falls under the umbrella of the Clinomics Program. My team analyzes the stool samples of patients with cancer before their first chemotherapy cycles and after the receipt of chemotherapy for metagenomics and metabolomics data. This discovery research will provide evidence for changes in the gut microbiome and metabolites as risk factors for chemotherapy-induced nausea. Withing the Beyond DNA focus area, my program of research falls under the umbrella of the Microbiome Program. My translational research efforts will attempt to improve interventions such as fecal material transplant to adjust microbiome composition profiles for mitigating chemotherapy-induced nausea.

How will your research improve patient care?

The research project supported by the Gerstner Award aims to improve chemotherapy treatment outcomes in patients with breast cancer or genitourinary cancer.

My team is using a multi-omics approach to analyze stool samples before and after chemotherapy to identify changes in the diversity and abundance of the microbiome and changes in the gut metabolites. Keeping the microbiome and metabolites close to baseline levels — that is, close to the levels before chemotherapy — may help alleviate severity and occurrence of the neuropsychological and gastrointestinal symptoms that the patients experience after chemotherapy.

Findings from this study will help identify patients who are at high risk of adverse events. It also will help identify individualized interventions to alleviate adverse events during treatment and after it's done. The composition of the gut microbiome and the levels of metabolites may need to be individualized for patients to improve their treatment outcomes.

How has the Gerstner Family Career Development Award helped advance your research?

The receipt of Gerstner Family Career Development Award has guaranteed the necessary training and data generation to continue my path to become an independently funded investigator in individualized medicine.

The research project supported by the Gerstner Award builds on a previous study of mine that provides indirect evidence for associations between gut microbiome-regulated biological pathways and occurrence of chemotherapy-induced nausea. Specific chemotherapy-induced changes in the gut microbiome in association with patient symptom experience are not known. This study will help address that major scientific knowledge gap.

With this award, I'm gaining the expertise I need to evaluate underlying biological mechanisms for chemotherapy-induced nausea. This will help me identify risk factors related to the gut microbiome and find potential individualized strategies to mitigate nausea and co-occurring symptoms.

Why did you choose Mayo Clinic to explore research?

The research environment at Mayo Clinic is a perfect fit to achieve my study goals and obtain the necessary mentorship and training experience.

I have hands-on experience in the front-end molecular omics-based methodologies, but limited experience in downstream metagenomics and metabolomics analytics. I have some experience in drug discovery research, but I need mentoring to conduct future clinical trials. As a nurse scientist, I have experience with patient recruitment and retention, phenotypic assessments, conducting epidemiological studies and statistical analyses. But I need guidance to be a successful nurse leader in symptom science and symptom management.

To overcome these limitations, I have assembled an interdisciplinary team of mentors at Mayo Clinic who have expertise in metagenomics and metabolomics analyses and in conducting prospective clinical trials. In addition, I'm benefitting from mentorship to be a future nurse leader in symptom science and symptom management.

Finally, Mayo Clinic has all the resources to conduct my study. Working with my team, I will be able to enroll and consent patients at three sites in the United States, use in-house biorepository resources, and utilize metagenomics and metabolomics core laboratory services to obtain data. I also benefit from biostatistician and bioinformatics support in Mayo Clinic's Division of Quantitative Health Sciences.