Building Bridges: Manasi Shah, MD, discusses how endocrinologists can play an important role in transplant medicine.

On behalf of the Endocrine Society’s Early-Career Special Interest Group (SIG), Milay Luis Lam, MD talks with Early-Career SIG steering group member, Manasi Shah, MD, on bringing science to the transplant bedside and discusses her endocrine journey from her native Mumbai, India, to conducting clinical trials in the U.S.

You could say that treating people with diabetes was the “family business” for Manasi Shah, MD, since both of her parents were involved with treating such patients, especially pediatric patients. When she was growing up in India, her first exposure to the world of endocrinology came at a very young age when she witnessed one of her friends undergoing a fingerstick to measure blood sugar levels. “Those moments made me realize how much impact timely care could have,” Shah says, “and I decided early on that I wanted to help people with diabetes.”

Fast forward to her current position as an assistant professor of medicine at Eastern Virginia Medical School in Norfolk, Va., where she researches as well as treats patients undergoing kidney and pancreas transplants who have developed post-transplant diabetes. “Clinically, I was struck by how often our transplant patients struggle with glycemic control, weight gain, and complex insulin regimens after surgery,” Shah explains. “When I began prescribing GLP1-RA in this population, I saw dramatic improvements — better glucose control, fewer hypoglycemic episodes, and simpler regimens. Additionally, there are reports of improved graft function and long-term survival with these drugs.”

However, despite the progress she has seen, Shah says that there are still many unanswered questions, “particularly about appetite suppression, protein intake, and lean body mass, which are critical in patients who often lose muscle during pre-transplant dialysis.” Shah speaks to Endocrine News about her circuitous career path, her earliest mentors (hint: her parents!), and how a recent grant will help further her research on transplant endocrinology.

Endocrine News: You’ve had a fascinating journey in India as well as United States through endocrinology. What first sparked your interest?
Manasi Shah: I was very lucky to grow up around endocrinology! Both my parents are physicians specialized in diabetes in Mumbai, and I often tagged along to the diabetes camps they organized for children with type 1 diabetes. I remember being five years old and watching my friend Rachita check her fingerstick blood sugars before we could get back to playing.

EN: You’ve had an unusually rich research journey — from multinational clinical trials to basic science labs. Can you share how those experiences shaped you as a physician-scientist?

Shah: My research journey really began in Mumbai, where I volunteered with my parents, who were principal investigators for multinational trials like SAVOR TIMI-53 and TECOS. With Dr. Shashank Joshi, I worked on some retrospective research studies and presented our work at ENDO in 2014. After observing basic science research for the first time at Barbara Davis Center of Childhood Diabetes, I was curious to learn more. Fortunately, I was able to join Michael Brownlee’s lab at Albert Einstein College of Medicine as a research volunteer to study mechanisms underlying metabolic memory in diabetes complications. I learned to perform qPCR, gel electrophoresis, tissue culture, and histology — and co-authored a paper in Diabetes showing how a GLP-1 cleavage product disrupts ROS-generating feedback loops. One of my proudest achievements was co-writing an invited review on the molecular and cellular mechanisms of cardiovascular disorders in diabetes for Circulation Research — creating original figures on design software and watching that paper become highly cited.

During my internal medicine residency at University at Buffalo, I worked with Dr. Paresh Dandona on clinical trials and designed my first investigator-initiated biomarker study on galectin-3 in hypogonadism-related insulin resistance, presenting the results at ENDO 2018.

“I believe we’re entering an era where endocrinologists will play a larger role in transplant medicine — not only in diabetes management but also in obesity treatment, bone health, and metabolic optimization pre- and post-transplant. We need more evidence to guide diabetes and metabolic care around transplant, and endocrine researchers are perfectly positioned to lead this effort.” — Manasi Shah, MD, assistant professor of medicine, Eastern Virginia Medical School, Norfolk, Va.

In endocrine fellowship at UT Southwestern Medical School (UTSW), I immersed myself in adipose tissue biology under Dr. Philipp Scherer. I performed human fat biopsies, histology, adipocyte sizing, RNA extraction, and metabolomics for Dr. Kyaw Soe’s multi-institutional study of gender-affirming hormone therapy (GAHT) on metabolism. This work won the Outstanding Achievement in Research Award at UTSW and later the ENDO 2022 Outstanding Abstract Award and is now under submission for publication.

As clinical faculty at Eastern Virginia Medical School (EVMS) at Old Dominion University, I went back to clinical trials; being a co-PI on seminal trials in diabetes with my chair, Dr. Elias Siraj.

None of this would have been possible without the amazing mentorship I have received! Over the last 10 years, my mentors, research coordinators, post-doc researchers, students and patients have taught me to critically analyze data, design rigorous studies, and connect molecular mechanisms to real-world clinical outcomes — skills I now apply in my current transplant endocrinology research.

EN: That’s right! You’ve moved from diabetes research into a very specialized area — transplant endocrinology. How did that transition happen?

Shah: It wasn’t planned! At Eastern Virginia Medical School (EVMS), I was asked to serve as the director of Inpatient Diabetes Program and lead endocrinologist at the Sentara Kidney-Pancreas Transplant Center. Suddenly, I was evaluating transplant candidacy for patients with type 1 diabetes, making ethically complex decisions about living donors with prediabetes, and managing post-transplant diabetes in a very vulnerable population. This experience really changed the trajectory of my research career.

EN: What kinds of questions come up when you’re working with transplant donors and recipients?

Shah: A big one is whether it’s safe to clear a living kidney donor who has prediabetes. We don’t have much long-term data, which makes it a very difficult decision for both clinicians and patients. That question inspired one of my research projects — a study using the TriNetX global database to look at long-term risks of diabetes, chronic kidney disease, and cardiovascular disease in more than 5,000 living donors with prediabetes. Along with a research statistician and medical master’s student, we performed this analysis and found some exciting results (stay tuned)!  

EN: You also manage post-transplant diabetes. What have you learned from your patients?

Shah: Managing diabetes after transplant is incredibly nuanced. These patients have just gone through major surgery, are on high doses steroids and immunosuppression, and are trying to rebuild their strength. I co-run a shared clinic with our diabetes educator, Diane Snyder, where patients talk about their experiences in a very open way. It’s inspiring — patients with long-standing diabetes share their struggles and often their regrets too; they help motivate those who are newly diagnosed after transplant.

EN: Congratulations on receiving research funding for your work in transplant diabetes! Can you tell us more about this project and why it matters?

Shah: Thank you — this institutional career development grant is incredibly meaningful to me. It supports my research studies in patients with post-transplant diabetes under the mentorship of Dr. Salvatore Carbone and others. This grant allows me to systematically study kidney transplant recipients in the early post-transplant period, combining clinical outcomes with metabolic assessments.

“Endocrine Society conferences and committees have been central to my life in endocrinology. I would like to use this opportunity to inspire early-career members to explore this exciting field of endocrinology and offer my guidance, mentorship and collaboration to anyone who is interested in connecting!” — Manasi Shah, MD, assistant professor of medicine, Eastern Virginia Medical School, Norfolk, Va.

Receiving this funding means I have protected time and money to follow patients closely, learn new research skills, collect objective data, and collaborate with my multidisciplinary team — including nutritionists, transplant surgeons, nephrologists, diabetes educators and basic scientists — to generate evidence that can directly guide patient care. For me, this is the perfect blend of bench-to-bedside science: translating what I observe in clinic into studies that could shape future guidelines and improve long-term transplant outcomes.

EN: What’s next for you and for transplant endocrinology?

Shah: I believe we’re entering an era where endocrinologists will play a larger role in transplant medicine — not only in diabetes management but also in obesity treatment, bone health, and metabolic optimization pre- and post-transplant. We need more evidence to guide diabetes and metabolic care around transplant, and endocrine researchers are perfectly positioned to lead this effort. Recently, I joined American Society of Transplantation (AST) taskforces and received enthusiastic responses from transplant colleagues around the world; they were thrilled to have an endocrinologist on board! Of course, Endocrine Society conferences and committees have been central to my life in endocrinology. I would like to use this opportunity to inspire early-career members to explore this exciting field of endocrinology and offer my guidance, mentorship and collaboration to anyone who is interested in connecting!

Lam is a division chief and medical director at Meritus Endocrinology, Meritus Medical Center, Hagerstown Md.