Medical student focuses research on blood vessels

The Virginia Tech Carilion School of Medicine Medical Student Research Symposium is an annual event that highlights the research students conduct over their four years at the medical school. The event is free and open to the public and will be held from noon-5 p.m. March 28 in Roanoke. This article focuses on one of the 2025 Letter of Distinction recipients. 

Student: Farwah Iqbal

Research project: Characterization of Macrophage and Smooth Muscle Cell Communication in Neointima Formation

Hometown: Toronto, Canada

Education: Undergraduate degree from Queen’s University in Kingston Ontario, Canada, a Ph.D. from University of Toronto in Ontario, Canada, a postdoctorate at Harvard Medical School

What inspired you to pursue a career in medicine and what drew you to the Virginia Tech Carilion School of Medicine (VTCSOM)?

I pursued a career in medicine later in life. During college, I did four years of research studying how abnormal vascularization and blood flow occur during pregnancy. My love for blood vessels is what began my journey in academic medicine. During my earlier years, I became interested in identifying biomarkers and proteins in vascular disease so we can develop targeted drugs to inhibit pathological processes. This research encouraged me to obtain my Ph.D., where I worked on stem cell therapeutics to improve blood flow in the heart after a heart attack. My interest in medicine started when I found it challenging to develop therapeutics when I didn’t know much about the targeted patients or their pathology. I knew medicine was a big commitment, so I pursued my postdoc to ensure it was what I wanted.

Naturally, I was no longer 21 years old after many years of academic research. My priorities, goals, and optimal learning environments had changed. Fostering positive and personal connections with my peers and teachers was essential. The class size of 49 was attractive because I knew I wouldn’t get lost in the numbers and had better chances of making life-long friends. Most schools encourage research during medical school, but few incorporate it throughout the four years, and that was important to me. I had a clear vision of what research I wanted to do in medical school, and the research curriculum was ideal. I remember explicitly during my interview the feeling of “being home.” They asked me meaningful questions and were interested in learning beyond my grades and CV. That was important to me, and I knew VTCSOM was where I wanted to be. 

Can you provide a brief overview of your project and its key findings? 

It has always fascinated me that the root of most diseases is due to inflammation and blood vessels. When you think about heart disease, vascular disease, cancer, and autoimmune disease, they are all caused by abnormal vascularization and imbalance of immune cells. It is easier to think about blood vessels like the plumbing pipes of the body. They deliver blood to organs and extremities while removing waste. In some patients, these pipes become clogged or burst, and that can be due to many reasons, including diet, smoking, and genetics. To unclog the pipes, surgeons place wires and catheters in the pipes to blow up balloons and insert stents to keep the pipes open. These operations save lives, but we also see that in some patients, these interventions damage the inner cells of the blood vessels, which are called endothelial cells. This initiates a cascade that activates immune cells at injured regions, stimulating resident cells to multiply and eventually leading to another clogged pipe. Our group has found that specific immune cells, called macrophages, home to injured parts of the blood vessel and create breaks in the vessel. This allows cells to form contact points with each other and exchange signals. This causes smooth muscle cells to proliferate, which we call neointimal hyperplasia. By understanding how these mechanisms occur, we aim to develop better drugs to coat balloons and stents to prevent patients from requiring more interventions.  

What motivated you to choose this research topic? Was there a personal or academic influence behind it? 

It sounds cheesy, but blood vessels are my first love and are the foundation of my research and academic goals. I came to medical school wanting to pursue vascular surgery because many of our patients suffer from vascular disease, and there is much room for better therapeutic options. If I go through all my research projects during the 11 years of research before starting medical school, the common denominator is blood vessels. During medical school, I wanted to collaborate with vascular surgeons and scientists to better understand the mechanisms of vascular disease and the role of immune cells, while taking steps toward drug discovery. Before moving to Roanoke, I contacted Dr. Scott Johnstone to join his research group. We have similar research interests, and after our first Zoom chat, I decided to join his lab. I have learned so much from the group and have a better understanding of the individual cells that make up blood vessels. I learned how to use cool technologies to help answer my research questions, and I began to think like a physician-scientist for the first time. 

How do you see your research contributing to the field of medicine or patient care in the future?

My research has already started the conception of new projects I plan to pursue during my residency training. I am working on a grant that focuses on identifying disease-driving cell populations in human-diseased blood vessels by using single-cell RNA sequencing. I hypothesize that patients who undergo neointimal hyperplasia have unique cell populations that cause smooth cell proliferation and propagation of disease. I am working with groups to identify unique biomarkers and proteins in patients with vascular disease to create better drug therapeutics. Lastly, I am interested in understanding how vascular disease manifests in patients with collagen disorders like Marfan’s disease or Ehlers Danlos. We find that a subset of these patients suffers from aortic aneurysms later in life due to abnormal collagen matrix in the aorta. Not all patients experience this, and I wanted to develop a test where we can determine which patients will suffer from an aortic aneurysm or rupture, which can be deadly. As you can see, my research has set a strong foundation for my future work as a vascular surgeon-scientist. 

What were some of the biggest challenges you faced during your research, and how did you overcome them?

The most significant challenges were time constraints, balancing clinical obligations, and studying while conducting research. Having a supervisor who supports autonomy and is willing to work with your schedule is essential. Dr. Johnstone did that and was always available to review data and the project aims around my schedule. The other challenge I faced was optimizing new technologies in the lab. A four- to six-week period may seem like a lot of time, but it goes by fast. During one of my periods, I spend most of my time optimizing the analysis of serial block face scanning electron microscopy images. It was frustrating, but I did it by contacting other scientists who have published similar analyses, worked with the software developers, and reviewed steps with Dr. Johnstone. Science and discovery are about troubleshooting and finding a new avenue. You must be comfortable with feeling uncomfortable in research.  

Did your research experience shape your career aspirations? What field of medicine are you planning to specialize in? 

My research experience and interests have led me to become an aspiring vascular surgeon-scientist. I spent 11 years trying to understand the pathophysiology of vascular disease, which has led me to want more. I not only want to develop new therapeutics, but I want to learn about my patients and be at their bedside. I genuinely believe I can create personalized interventions by understanding my patients' better. Although vascular disease follows similar patterns, manifestation still varies between patients. But most importantly, a patient's life outside the hospital differs and plays a significant role in disease, recovery, and mortality. Many don’t realize it, but this is one of the strongest dictators of the trajectory of disease and recovery. I am so thankful to my supervisors, lab mates, and techs who have supported my academic research journey that has led me to this point in my career. 

Beyond research, what has been the most rewarding part of your experience at medical school?

Beyond research, I have met my life-long friends and mentors at VTCSOM. My class has some of the kindest and most intelligent people I have ever met. I am so happy to be on this journey with them. Although I am saddened that we will go our separate ways, I am excited to see the amazing things they will do in their life. I will have trusted doctors in different states to whom I can refer to my friends and family for a second opinion. I have also found life-long mentors who helped me during various stages of my medical training. Dr. Joshua Adams, Dr. James Drougas, and Dr. Michael Nussbaum have helped me navigate the field of vascular surgery and supported me during my residency application. Dr. Michael Pratt became my mentor after a PBL (problem-based learning) block. We both realized we had a lot in common, and he helped me tremendously in navigating personal and academic endeavors. He has been my right hand during my journey. Dr. Johnstone is both a mentor and friend whom I hope to collaborate with on an NIH (National Institutes of Health) grant one day. Lastly, my patients are the most rewarding part. I have written many short stories about patients that have made an everlasting impact on my life. Many of my “first” patients I met here. They will always be a part of my story, and I am grateful that they have allowed me to participate in their care. 

What advice would you give to future medical students who are interested in research? 

My advice is, do what you want to do. Forget what looks good on your CV and forget what you should do. Sometimes, we lose sight of our desires. We get pulled in by the stress and competitiveness of our environment. If you trust your gut and do what excites you and makes you happy, it will always guide you to the path meant for you. Does doing vascular research look good if you apply for vascular surgery – yes. But why do you want to do vascular surgery or research? Ask yourselves those questions. I did vascular research because it excites me. A plate of endothelial cells or angiography gives me an adrenaline rush. I am genuinely excited to walk into the lab every morning, regardless of how tired I am. The lab is my happy place. Being in the vascular OR makes me happy and fulfilled. I forget how tired I am, and I forget about the pain from wearing heavy lead or the pain in my feet. I don’t look at the clock waiting for the case to be over. That is how I know I am exactly where I need to be. Do what makes you happy and not what you should do.