Academic Spotlight: Natasha Goyal, MBBS

Natasha Goyal
Natasha Goyal, MBBS

Hands-On in the Lab

As a child, Natasha Goyal, MBBS, loved science and always knew she wanted to become a doctor. After earning her bachelor’s degree in kinesiology and health sciences at York University in her hometown of Toronto, she moved to northern India and earned her medical degree from the Government Medical College and Hospital in Chandigarh.

Dr. Goyal (rhymes with “Royal”) then returned to Toronto and spent several years working as a clinical assistant in a busy family medicine practice. She also studied for her medical licensing exams in preparation for eventually applying to emergency medicine residency programs in the U.S. “I didn’t have any prior research experience and wanted to see what it was all about, so I applied for various research positions,” she said.

She met Matthew Springer, PhD, professor in the UCSF Division of Cardiology, and was invited to join his lab in 2021 as an assistant specialist. Although it was a brave new world, Dr. Goyal marvels at how much she’s learned. “I had never worked in a wet lab, and I was pretty scared,” she said. “But it’s very interesting and intriguing.” She learned how to perform ultrasound, echocardiography, blood pressure measurement, and other diagnostic procedures on animal models, and also learned how to do surgical procedures such as organ isolation.

Uncovering the Physiological Effects of Smoking and Vaping

Dr. Goyal has assisted with a number of experiments assessing how the vascular physiology of rats is affected by exposure to tobacco and marijuana. One of the main areas of study is measuring flow-mediated dilation (FMD). It is one indicator of the elasticity of arteries and their ability to expand and carry more blood, such as when the muscles of the body need more oxygen during exercise. “With smoking or vaping, we have found that there is impairment of that elasticity,” she said. “It doesn’t expand as much as it should. With smoking, people usually think of potential harm to the lungs and the increased risk of lung cancer. But they don’t necessarily think about how smoking might increase the risk of conditions like hypertension, which can lead to heart disease and heart failure.”

Although vaping devices have been promoted as a more benign way to inhale nicotine than smoking cigarettes, Dr. Goyal was part of a team that found this was not the case. They discovered that in rats, a single exposure to nicotine administered from a wide range of vaping devices impaired FMD comparably to cigarettes. She also helped out with an animal study showing that exposure to various inhaled tobacco and marijuana products, whether smoked or vaped, led to higher susceptibility to abnormal heart rhythms such as atrial fibrillation and ventricular tachycardia.

Although marijuana has been legalized in many states, including California, it remains a Schedule I controlled substance under federal law. Many previous studies of marijuana were conducted with material supplied by the National Institute on Drug Abuse (NIDA), which sourced this from a lab at the University of Mississippi. Some critics questioned whether research which used the NIDA-provided samples had real-world relevance, since they contained lower levels of THC – the active ingredient in marijuana – compared with most product that is commercially consumed. Critics also noted that commercial cannabis is dried more gently, whereas the NIDA-supplied material is dried more aggressively. Dr. Goyal was part of a team that helped to validate the use of NIDA research marijuana, demonstrating that acute exposure to marijuana smoke or vaped aerosol impairs FMD regardless of how the marijuana is dried or the level of THC content. “The Springer Lab is very particular – we like to get all our facts straight,” she said.

More recently, she assisted with a project that showed that a compound that inhibits a pathway associated with the receptor for advanced glycation end products (RAGE) appeared to improve FMD after rats were exposed to either cigarette smoke or vaped nicotine.

Currently, Dr. Goyal is working on a project examining whether exposure to tobacco and marijuana via smoke or vaping aerosol is associated with upregulation or downregulation of a gene called ACE2 in lung epithelial cells. (Interestingly, the ACE2 receptor is also the place in the lung to which the SARS-CoV-2 virus binds.) She and her colleagues are also investigating whether use of newer vaping devices is associated with reduction in heart rate variability.

Plan and Prepare

One of her biggest learnings so far in the lab is the importance of planning ahead. “Especially with animal studies, everything is very time sensitive,” said Dr. Goyal. “It’s helped me to make a schedule and plan every single procedure for every single subject. I’m old school – I print out calendars and paste them on my wall so when I come in to the lab, I know what I’m doing each day. Sometimes planning a study is harder than actually doing the study. If you have a team, you have to check on everyone’s availability so you can delegate work and determine who does what. You also need to order supplies and animals. If there’s a setback, like maybe my shipment of animals didn’t arrive, you have to re-plan things.”

She has also learned the importance of consistency. “If you’re exposing an animal to smoke for two weeks, you can’t expose it for an extra day – it has to be consistent with every other animal in the study,” said Dr. Goyal. “The animals also have to be the same age and within the same weight range. You can’t be spontaneous in research.”

Dr. Goyal’s favorite part of research is performing surgical procedures at the end of experiments. “I really like practical, hands-on work,” she said. “When we do procedures, all the tools, equipment and needles have to be ready to go. If we’re doing organ isolation, you have to be quick, because otherwise the organs won’t be viable.”

Sometimes these procedures happen after weeks or even months of exposing animal subjects to smoke or vaping aerosol. “There’s just one chance to get it right,” said Dr. Goyal. “If you make a mistake, all that data is gone. I actually love the stress and the intensity – I work well under pressure, and enjoy the adrenaline rush.”

Promoting Health Equity

That grace under pressure is part of what fuels her interest in becoming an emergency medicine doctor. Dr. Goyal also points to her medical school experience in India as a formative part of her education. “Living in India was a huge culture shock – it’s a completely different world, and it took a while to adjust to the people, the norms, the language,” she recalled. “My parents are Indian, and while I could understand every word of Hindi, it would not come out of my mouth. But after six years, I could finally speak Hindi. When I had patients of my own during my final year of internship, I had to speak in Hindi or Punjabi or a sister language.”

During her training, she rotated through various slums, including in rural areas. “I had heard about the slums in India and seen them in the movies, but it’s different when you actually see them in person and how impoverished everyone is,” said Dr. Goyal. She was assigned a family, making weekly house calls and serving as their family doctor. “I was able to talk with them, and encouraged them to get their vaccinations and check-ups,” she said. “I did a lot of patient education. It was amazing. These patients were so nice, and they appreciated the education, since the literacy rates are low. There’s a movement in India to educate young girls about things like hygiene, periods, pregnancy and sex, because those topics have been taboo in Indian culture. Giving people that knowledge to empower them is so important.”

She was disheartened by the health inequities she saw in India. “I theoretically knew that their health care system was not great, but the things I saw were very saddening to me,” said Dr. Goyal. “Everything is out of pocket. People who can afford to do so will go to private hospitals, which cost thousands and thousands of dollars. Those who can’t afford that go to government hospitals, which are usually very cheap and subsidized, but the costs are still out of pocket. Government hospitals are swamped, with gurneys in the hallway. A lot of people die because they can’t afford health care.”

Dr. Goyal was inspired by rotating through a free clinic that served people with very low socioeconomic status, but saw that it only offered outpatient care. “One of my dreams is to establish a multidisciplinary hospital – including an emergency room – for people who can’t afford health care,” she said.

Continuing her passion for service, Dr. Goyal currently volunteers twice a month as a scribe at Clinic by the Bay in the Mission District, a free clinic serving working uninsured patients. “It’s a huge learning opportunity, because the care is very patient-oriented,” she said. “After we see a patient, I get to discuss cases with the doctors I scribe for, and it feels like a clinical rotation – they ask me, ‘What do you think this is? Why do you think the patient developed this condition?’ Learning the health care system through that clinic has helped me write patient notes and has kept me in touch with clinical-based practice.”

Dr. Goyal also volunteers with Bundle of Health, a nonprofit organization focused on the education and empowerment of girls and women, and helping them improve their physical, mental and emotional health.

‘Always There for Me’

While Dr. Goyal plans to focus most of her career on clinical practice as an emergency medicine physician, she is grateful for the opportunity to get hands-on experience in research in the Springer Lab. “I know I’ll carry forward this experience throughout my entire career,” she said. “If an opportunity to do research arises, I will totally take it, now that I’m more versed in it. I’m so glad that Matt gave me the opportunity to be part of such a great lab.”

“Natasha benefits not only from her general medical training but also from field experience serving underprivileged rural communities in India,” said Dr. Springer. “The combination of these experiences has driven her to get involved in research for the betterment of public health. We’re fortunate that she’s chosen to focus on how vaping affects cardiovascular health, in research that includes studying health effects of next-generation vaping devices that lack heating coils. She's also proven to be an excellent mentor to college students who do their undergraduate research in the lab.”

Dr. Goyal appreciates the collegial atmosphere in the lab. “I love my co-workers,” she said. “They really help out and are very supportive. Whenever there’s a problem or I need help, they are always there for me and are a pillar of support. We call ourselves the ‘Springer Family.’”

Outside the lab, Dr. Goyal enjoys swimming, cooking, and baking pumpkin spice cakes, banana bread and shortbread cookies.

- Elizabeth Chur