Dr Dagan Lonsdale - “Pharmacologist In Phrame”!

Dagan Lonsdale is a reader in clinical pharmacology and intensive care medicine at City St George's University of London. He is also the pharmacometrics and pharmacokinetics lead for the university's undergraduate BSc in Clinical Pharmacology. Dagan Chairs the BPS Clinical Committee and is the Society's Vice President - Clinical

1. What inspired you to pursue a career in Clinical Pharmacology?

I think, like many clinical pharmacologists, I was first drawn into this field by the people within the discipline. I knew I wanted to pursue an academic clinical career within an acute specialty, but I had little idea of how to make that a reality. Meeting Professor Emma Baker (a previous Vice President and Trustee of the BPS) and Dr Andrew Hitchings at St George’s was pivotal to my career—Professor Baker introduced me to translational research through a project on the effects of hyperglycaemia on lung epithelium, and Dr Hitchings shared his passion for combining intensive care with clinical pharmacology. Their mentorship opened the door to the discipline, and I have not really looked back.

A period in Brisbane, Australia, followed where I was once again lucky enough to work with inspirational people. Professors Jeff Lipman and Jason Roberts worked together in the intensive care department, and I was struck by their approach to choosing drug doses, particularly antibiotics. They wouldn’t simply turn to a prescribing guideline and use the recommended ‘one dose for all’, they would think about the individual patient, what factors might drive drug kinetics in the case and then agree on a dose. I read about their work in antimicrobial trials and pharmacokinetic modelling and started to feel that this might be the right fit for the skills I had, and the career I wanted to pursue

As I developed as an intensivist back in the UK, I became increasingly aware of how often we lack robust evidence to guide drug dosing in special populations. On daily ward rounds, I found myself asking how to safely and effectively prescribe drugs for patients receiving renal replacement therapy, or for those with complex pathophysiology that existing guidelines simply didn’t address. Those unanswered questions became the foundation for my career combining research, education and practice in clinical pharmacology and intensive care medicine.

2. What research are you currently working on?

I continue to work on projects that are aimed at understanding how we can optimise drug dosing in populations that are not studied in the initial phase of development. Much of this work is in antimicrobials in critical illness, in collaboration with my PhD Supervisor Professor Joe Standing. We have just started some work looking at antibiotic pharmacokinetics during continuous renal replacement therapy. We have an ongoing project looking at the evolution of resistance in Candida species in critical illness and the impact of drug exposure on this (CandiRes) and we are doing some work modelling PK-PD of flucytosine in cryptococcal infection. I continue to collaborate with Professors Baker, Lipman and Roberts in this work and we are about to run the UK elements of an antimicrobial pharmacokinetic study that is being led by the Brisbane group (DALI II).

I’m lucky in that my clinical pharmacology training gave me a lot of skills in the clinical trials space and so I have been able to take on roles helping to deliver National Institute for Health and Care Research (NIHR) portfolio research at our centre and we are also working with some commercial organisations to deliver early phase trials in our intensive care unit, as well as working on a device trial that utilises artificial intelligence (AI) in the identification of sepsis.

Finally, a lot of my time is spent in education. The skills I have learned in the data science of pharmacometrics are a recognised need for the UK’s pharmaceutical sector. We deliver a BSc in Clinical Pharmacology at City St George’s, University of London, where I lead the pharmacokinetics education on the course. I try to introduce quantitative pharmacology from the outset and in our final year, students can learn how to model pharmacokinetic data.

3. How did you choose your PhD project in antimicrobial pharmacokinetics?

A small part was determination to work in this area, but the major factor was serendipity. At the time I was looking for a project, Professor Baker had a chance conversation with Professor Mike Sharland, who was working with a bioanalytical chemist (Dr Karin Kipper) on some new assays for antimicrobials. I was brought in to deliver the clinical elements of the project – investigating pharmacokinetic variability of antimicrobials in critical illness. Early in the project setup, I was introduced to Professor Joe Standing, an expert in pharmacometrics and I had support from my intensive care trainers Professors Philips and Rhodes. This became a core group of mentors and formed the basis of my PhD supervisory committee. The project had been initially planned for children and neonates. Most of my clinical experience was in adults. The group thought we might be able to use allometric scaling principles to inform the description of drug handling in early life, where we anticipated obtaining samples might be more challenging. The project evolved from there, and we were able to describe beta-lactam kinetics from neonatal to nonagenarian critically ill patients.

4. How do you balance your time as both a clinician and a researcher?

I’m not sure I do! I try to pursue projects where I can utilise skills from across the domains of my career, but quite often I just find that I am very, very busy. Being an intensivist and working in education helps, as I am able to schedule my work in blocks – a clinical week here, a month delivering a module there. I am very fortunate to have a career where I get to enjoy working across the spectrum of academic medicine.

5. How would you choose a mentor and what are your thoughts on mentorship?

This is a hard question to answer. I think your choice needs to consider where you are in your career and what you are looking to develop at the time. If you are lucky, you will find yourself someone like Professor Baker – she has shown extraordinary belief and patience in me, has challenged me to push on and helps to open doors that have enabled me to have a varied and interesting career. I owe her a great deal.

In the more recent period of my career, I have needed a broad range of mentorship that covers the breadth of my work as a clinician and researcher. There are probably now half a dozen people in my career who I would currently regard as a mentor, each providing help in a different area. I suspect that some of them probably don’t realise that I consider them a mentor.

6. What do you enjoy doing outside of work?

Spending time with my family. Food and theatre with Erin, who I am lucky enough to be married to and anything and everything with our three children. Now, as we move into summer, everything is cricket – I help to run my son and daughters’ teams, despite knowing very little about the sport myself.

7.What would be your advice for the next generation of early-career researchers?

Don’t pay too much attention to people who tell you that what you want to achieve, or the career you wish to pursue is impossible.

Rapid-Fire Round with Dr Dagan Lonsdale