The laboratory of Vijay Ramakrishnan, MD focuses on the outcomes of airway inflammation in chronic rhinosinusitis. Ramakrishnan received his MD from Baylor College of Medicine and completed a residency in Otolaryngology at the University of Colorado. After Rhinology Fellowship at the University of Pennsylvania, he worked as Otolaryngology faculty at the University of Colorado for twelve years, as a surgeon-scientist in the Rhinology Division. While maintaining a busy clinical practice and helping to build the Endoscopic Skull Base Program there, he developed a translational research program while completing an NIH K23 award in chemosensory studies of the nasal cavity. He moved to IU School of Medicine in January 2022 as Professor of Otolaryngology-Head and Neck Surgery, Director of Rhinology Research, and Affiliate Scientist in Health Services Research at Regenstreif Institute, Inc.
Dr. Ramakrishnan’s basic science research interests revolve around airway inflammation in chronic rhinosinsusitis. His lab focuses on dynamics of the sinus microbiome, detection and clearance of airborne irritants, and inflammation that results from these processes. As a surgeon-scientist, a high degree of translation is maintained, with ongoing projects centered on surgical outcomes, novel diagnostic tools, and personalized medicine approaches to chronic sinus disease.
Submerged Cell Culture
CRS primary epithelial cells grown at air-liquid interface.
Microbiome of the sinuses
The Ramakrishnan Lab has been interested in the role of the microbiome in the chronic inflammatory state of CRS. In collaboration with the Frank Lab, we have shown healthy sinuses are not sterile and that clinical cultures are insufficient in enumeration of bacteria in disease. In fact, bacteria colonize the sinonasal mucosal surface in similar amounts in healthy sinuses when compared to sinuses in CRS subjects. Using modern bacterial DNA detection techniques, we have demonstrated that the local microbiome in CRS is compositionally different than that found in healthy subjects, even despite the underlying between-subject differences. Some common differences have been replicated by other labs, such as the preponderance for anaerobes in CRS, and the potential protective effect of certain healthy taxa. In a JACI 2015 article, we described sinonasal microbiome differences in CRS phenotypes, and identify Actinobacteria as predictive of surgical outcomes in refractory CRS cases. Dysbiosis in the CRS microbiome may seemingly serve as a biomarker or additional factor to endotype CRS subjects. However, we are currently interested in identifying functional roles for the microbiome in the healthy state, and potential causal mechanisms for induction or sustenance of chronic inflammation in CRS. This includes study of factors governing establishment of the airway microbiome, host-bacteria interactions at the airway surface, induction of inflammatory pathways, and resilience to perturbation. We have found age and cigarette smoke exposure to be factors in multivariate analysis of healthy subjects, and continue to explore mechanistic aspects of the microbiome in the airway.
In different investigations, the Ramakrishnan Lab also was one of the first to identify solitary chemosensory cells and taste transduction machinery in human sinonasal tissues. Research mentors at the Rocky Mountain Taste and Smell Center (Finger, Tizzano) described the function of such cells in rodents, and established a role for their function in detection of irritants in the airway surface liquid. These cells are elongated in shape with a microvillar tuft on the apical projection, express sweet and bitter taste receptors on their surface, utilize canonical taste transduction machinery, and are frequently innervated in rodents. Subsequently, we described the presence of such cells and taste transduction molecules in human sinonasal tissues using PCR and immunohistochemistry. Interest in extraoral taste receptors, particularly bitter taste receptors, has exploded in the past few years. Their presence, whether on cilia or localized to specialized chemosensory cells, has been documented in many organ systems and they may serve a role in varied physiologic functions. Our current research focuses on SCCs in the respiratory tract and their response to airway irritants. We are using novel mouse models and in vitro studies of human airway samples in collaboration with colleagues across several institutions including the RMTSC.