Meet VCRC-VF Fellow Mats Junek, MD, MSc
For Mats Junek, MD, MSc, the path to practicing medicine was a long and winding road. Growing up, he wasn’t the kind of kid who knew he wanted to be a doctor. “I had no idea,” he said, laughing. By the time he graduated college with his undergraduate degree, he had changed his major seven times (trying out everything from astrophysics to economics and synthetic chemistry before graduating with dual degrees in neural pharmacology and biochemistry).
Dr. Junek had some inkling he might like medicine, and was even accepted to medical school after graduation. But he turned it down, spent a year in investment banking, then moved to Australia where he worked for the government doing software engineering. Along the way, he thought about using his skills to focus on medical research, but he “wanted to talk to people.” And, well, rats can’t talk.
He eventually made his way to medical school and after a stint in bariatric surgery (which he found “not enjoyable”), he discovered public health work and rheumatology. It energized him. Rheumatology was one of the first focus areas that really kept him on his toes—and he liked it. He decided to stick with it.
Last year, just as he and his wife became parents for the first time, he applied for and was accepted into the VCRC-VF Fellowship, a mentored training program of up to two years for physician-investigators who have a strong interest in vasculitis. The fellowship was established in 2014 as a partnership between the Vasculitis Clinical Research Consortium (VCRC) and the Vasculitis Foundation (VF). Its goal is to fuel vasculitis research and increase the number of highly qualified physicians and researchers who can diagnose, treat, and improve the lives of people living with vasculitis.
Research had not originally been on Dr. Junek’s radar, but he began to feel a calling to it. “I don’t think people find research,” he said. “Research finds you. As a researcher, you spend so much of your time making so much less money; there’s no rational reason to do it. Instead, it’s like a bug”—you catch the itch. For Dr. Junek, it fueled his curiosity and, once again, kept him on his toes. “I like research that’s always challenging me,” he said.
Today, Dr. Junek says his research into vasculitis at McMaster University in Ontario, Canada has him “standing on the shoulders of those who have done a lot of work before me.” What he and his team are trying to do is treat vasculitis effectively with the least amount of drug interventions. “We are pretty good at treating ANCA vasculitis,” he said, “but there are a lot of drugs involved. What we want to figure out is: Can we do less to stay on top of this disease? How can we better refine what we’re doing for our patients—focusing on achieving control of their diseases with as few side effects as possible?”
For example, some people with GCA vasculitis are more susceptible to going blind from the disease. But what if researchers can determine who’s more likely to go blind and who won’t? If someone is determined to be less likely to go blind, is it possible for them to manage their disease with less medication? “Less medication,” Dr. Junek said, “means less toxicity.”
Many medications prescribed for vasculitis have long-term side effects. To keep vasculitis from coming back, people will often be put on maintenance therapy. “That’s probably the hardest thing,” Dr. Junek explained. “We don’t have a deep understanding of how and why vasculitis comes back. Through our research, we’re building clinical models to predict how likely people are to relapse. Right now, these models are accurate 70% of the time. Of course, we want to predict at 100%.”
Accurately predicting relapse can have a big effect on how vasculitis is treated. “If it’s very unlikely for your vasculitis to come back,” Dr. Junek said, “can we give you less medicine in the long term? Or, if you’re high risk, do we need to give you additional therapy?”
Dr. Junek believes having accurate models to predict relapse can really empower patients to make the best decisions about their care and their lives. For example, a person diagnosed with vasculitis who’s put on high-dose steroids may be worried about the side effects: Will they end up with osteoporosis and broken bones from the steroids? But if we can give people living with the disease these numbers—their likelihood of relapsing—they’ll be able to bring their own values and preferences to their treatment plan. “And as doctors,” he said, “we can provide care that’s better in alignment with their preferences and values. So often, doctors are guessing what people want—and they’re right only so much of the time. With these numbers, physicians and their patients can communicate in a meaningful fashion: ‘Here are the numbers. What would you like to do?’… This is about giving people the opportunity to be effective agents in their care.”
The VCRC-VF Fellowship has given Dr. Junek the funding to do this research and bring these clinical models to life. It has also opened him to a community of researchers. “It’s such an extraordinary group,” he said. “The opportunity to talk with these people and be supported and see my research from their perspective has allowed me to grow in a way I never thought possible.”
“I am incredibly thankful for the Vasculitis Foundation’s support,” he said. “Without this funding, I probably wouldn’t be doing what I’m doing.”
Dr. Junek never wanted to do research that left him “talking with rats.” Today, he remains connected to his patients living with vasculitis and it has shaped his worldview. “I’m constantly learning,” he said. “How do I give my patients enough so that I can get myself and the disease out of the way for them to be the person that they are?” He’s realized that the most important things in life aren’t the big things, but the little things.
He remembers a couple who had just finished studying to become teachers and were looking forward to getting married. One of them had been diagnosed with vasculitis. What they wanted most was to continue to find the beauty in their everyday lives. “From them, I’ve learned that the ability to enjoy everyday things is the most important thing you can help someone do.”
Ultimately, Dr. Junek says, “it’s not about vasculitis, it’s about my patients’ stories. This is what keeps me doing what I’m doing: witnessing the incredible stories of people doing everything they can to move forward and live with their disease.”
Written by Ashley Asti
