Featured

Meet the Endocrinologist: Matthew Simmonds, expert in pancreatic transplant genomics

Meet the Endocrinologist: Meet Dr Matthew Simmonds a Senior Lecturer in Biomedical Science at the University of Lincoln. His research is focused on the genetics of pancreatic transplant function and he will be presenting at the Early Career session at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, he tells us more about his work and what he is looking forward to at the SfE BES 2018 conference.

Can you tell us a little about your current position and research?

I am a Senior Lecturer at the University of Lincoln where I have been now for just over two years.  My research career has revolved around trying to identify genetic contributors to a series of autoimmune endocrine diseases including autoimmune thyroid disease and type-1 diabetes.  My current research is specifically focused on looking at genetic predictors of long-term pancreas transplant function in people with severe type 1 diabetes.

What inspired you in to this field?

The immune system is amazing and without it we would never have survived and evolved on this earth. What I find so interesting about the autoimmune endocrine diseases is how the immune system, which is meant to protect us, actually starts to attack parts of the body leading to changes in how the endocrine system works.  I am passionate about understanding how disease pathways are triggered/progress and how we can use these insights to inform better treatments for people with these different conditions.

What do you think are the biggest challenges in your field of research?

I think the major challenge within pancreas transplantation is both the number of donor organs available for transplantation into people with severe type-1 diabetes and trying to ensure that the transplanted organ remains functional throughout the recipient’s life to ensure the benefits these transplants provide, of retuning insulin production and halting/reversing secondary diabetes related complication in that person, remain for as long as possible.

What do you think will be the next major breakthrough in your field?

I think both the advances being made in using induced pluripotent stem cells, combined with gene editing, to create new beta cells, will provide unparalleled new opportunities for transplantation purposes. Combined with the decreased costs around genome and other proteomic screening for patients and our increased understanding of how genetic variation impact upon autoimmunity and transplant success this will give us new understanding of disease progression and provide better individual tailoring of therapeutics.

What will you be doing at SfE BES 2018 in Glasgow?

Well as you have asked – nothing like a bit of shameless plugging – I will be doing a talk on the Tuesday as part of the Early Careers session ‘Navigating the Academic Pathway’.  My talk is entitled ‘The lectureship route’ where I will be providing some insights into this career pathway, the challenges and benefits of this route and some tips on how to be get such a position.

What are you looking forward to at this year’s conference?

I think as an early career researcher I loved going to conferences to be able to present my work and network with others working in the field – which is the same reason I enjoy attending conferences to this day. Whilst there are lots of fantastic talks, plenaries and other sessions throughout the conference with something to suit everyone’s research interests, one thing I would suggest to early career researchers is to take time to speak to other early career researchers at the poster sessions and after their talks.  You would be surprised how much you have in common with other researchers and how random conversations at conferences can lead to new collaborations and possibly job offers in the future.

Who do you most admire and why?

 I have been really lucky to have worked with some of the most amazing researchers in diabetes and endocrinology throughout my career so far – both in the centres I have worked and through numerous collaborations. I have been very lucky to have some amazing mentors throughout the years, and think that whatever stage in your career you are at it is important to keep listening, learning and being inspired by researchers at every level.

What words of wisdom do you have for someone starting out in research?

These type of questions always make me feel old.  Joking aside, I think the best advice I can give to any early career researcher is to think about where you want your career to go but don’t be so rigid in your approach that you may miss out on some unexpected opportunities that come your way. Also listen to your gut feeling about career decisions.  Whilst is it perfectly normal to be scared to take on new challenges be it new techniques, moving into different project areas or new jobs, sometimes you instantly know if something is a good or a bad move. From my own experience I have learnt that sometimes saying no to something that is not right for you is as important as the opportunities you say yes to.

You can hear Dr Simmonds presentation, “The lectureship route” on Tuesday 20 November, as part of the Early Career: Navigating the Academic Pathway session at 16:00-17:30. Find out more about the scientific programme for SfE BES 2018.

 

 

Featured

Meet the Endocrinologist: Interview with Prof Antonio Vidal-Puig

Group Photo - June 2017

Meet Professor Antonio Vidal-Puig, endocrinologist and Society for Endocrinology Medal winner for 2017. Prof Vidal-Puig is based at the Institute of Metabolic Sciences, Cambridge University and at Addenbrooke’s Hospital, where his outstanding research, focusing on the link between obesity and associated metabolic complications, has earned him this award, to be presented the annual conference, SfE BES 2017, in Harrogate, 6-8 November 2017. Learn more about his endocrine journey in this exclusive interview.

Q: Tell us a little about your career so far and how you ended up in Cambridge.

Originally from Spain, I studied medicine and trained in endocrinology at Valencia Medical School and Granada Medical School. I held post-doctoral positions in Boston at the Massachussetts General Hospital and Beth Israel Hospital/Harvard Medical School from 1992-1999. There I had excellent mentors including Jeff Flier, Brad Lowell, David Moller and Leo Krall. This was a very intense, exciting and uncertain period, at the epicentre of major discoveries in the field of obesity. This was a period that defined my career, scientific focus, approach to science and reinforced my values. I have been developing my career in the UK, since arriving at Cambridge University in 2000, and now have an established laboratory and have become a Professor of Molecular Nutrition and Metabolism.

Q: Tell us more about your research that led to you being awarded the Society Medal

The lab is interested in why obesity results in diabetes, insulin resistance, fatty liver and ischaemic heart disease, in order to find ways of preventing these complications.

The key concept of our programme is lipotoxicity, which links obesity-related metabolic complications with the excessive accumulation of lipids outside adipose tissue, in organs including muscle, liver and heart. From the concept of lipotoxicity we have developed three main research directions:

  • understanding how the adipose tissue works, with the aim of improving its function and ensuring that lipids remain in adipose. This led to the development of our “adipose tissue expandability hypothesis”, which is now widely accepted by the scientific community
  • developing strategies to burn the excess lipids and prevent lipotoxicity through activation of brown fat
  • promoting that the quality of dietary lipids should be as healthy as possible, to prevent toxic effects.

My Medal Lecture at SfE BES 2017 will summarise our contribution to these three directions.

Q: What are you particularly looking forward to at SfE BES 2017?

I will use this conference for updating clinical aspects of my work. The presentation quality is always good and helpful. One session I am really curious about is Workshop 1: Tissue Engineering for Regenerative Medicine in Endocrinology. I think technology is essential to retain a competitive position in research and the topics presented are highly transferable and of interest. I think tissue engineering approaches to increase brown fat mass could be really helpful in preventing obesity and diabetes, I am curious about the concept and possibilities of using 3D bioprinting.

Q: What have been your career highlights so far?

I feel content about my career progression. I consider highlights to be our best pieces of research; our papers tend to be quite comprehensive and we believe they make important contributions. I think for this reason these contributions are well respected by our colleagues. Our reputation as a lab is important for us. Also as a proud introvert, I have not touted our highlights and have not needed to for our professional highlights to be widely acclaimed, however I do understand that it is important to make the public aware of their implications. Also, as a laboratory leader I know that to disseminate these highlights is important for the careers my lab members. In this respect, winning the Society for Endocrinology Medal is a highlight that reflects the quality and commitment of the present and past members of the laboratory.

At a more personal level, I admit I have an aesthetic approach to science. I enjoy understanding and identifying sophisticated mechanisms, developing models that explain reality and learning how biological systems self-regulate. I don’t think this is unusual amongst endocrinologists. Also, becoming a Professor at Cambridge University was a moment of satisfaction I shared with my colleagues and family. In some ways my career has provided me with professional freedom, which is a key value for me, beyond other motivations, such as power or fame, that I have always found energy draining and restrictive of my autonomy.

Q: What do you think are the biggest challenges in your research area right now?

I think a big challenge in my research area, and others, is how to extract value from the excessive information generated by recent technological advances. Our challenge is how to analyse this information to prioritise the types of mechanistic validation that are necessary for estimating its relevance. Also, it is not only the amount of data, but the amount of unnecessary noise coming from poor quality research that makes this task more difficult.

Q: What are your future plans for your work & career?

As you become more senior in science, you often suffer the disadvantage that your professional horizon is shorter. However, this position also has the advantage that you can be more selective in your choice of projects, with more freedom to take risks. I think my laboratory in this respect is quite entrepreneurial, we are innovating by entering new fields/technologies, which I think is important for remaining competitive.  For example, we have opened a new lab at Sanger, funded by the European Research Council to work on stem cells and adipose tissue. We are also developing two new programmes of research; one in Nanjing focused on murine models of fatty liver, and another in Bangalore focused on adipose tissue stem cell biology to model obesity and diabetes in India. These are exciting challenges that will provide opportunities for my younger associates in their future careers.

Q: Who do you most admire professionally?

I have learned a lot from many of my mentors, colleagues and trainees. In some way these experiences have shaped my values and my strong views about science and leadership. For example, I have always admired the intellectual rigour and scientific honesty of Brad Lowell. I admired the consistency and confident leadership of Jeff Flier and the legacy of Daniel Lane, who developed many academic scientists in his lab to share his cultural values and collegiality, which they now disseminate to the next generations. I find this very impressive.

Q: Any words of wisdom for aspiring endocrinologists out there?

Endocrinology is not a specialty that will make you rich, but it is a specialty where you can fulfill your intellectual scientific needs and enjoy the human aspect of practicing medicine. It is very satisfying because your patients get better and, given that treatments are required long term, an important factor in the success depends on establishing an empathetic relationship with them. You will get to know many of your patients well, from whom you will receive gratitude and a sense of meaning and fulfillment. In this respect it is a very rewarding profession.

Q: What do you think will be the next major breakthrough in your field?

I think real breakthrough with long term impact requires deep knowledge and new technologies, I have become quite sceptical about quick or easy breakthroughs that address complex problems. It is important to understand how regulatory systems operate, to learn what the adaptive changes of the organism or cell to maintain normality are, and to determine the intrinsic capacity of these systems to recover normality if the early factors of the disease are removed. For this reason, we focus on early disease events, aiming to prevent or reverse excessive damage to the homeostatic system and regain metabolic control. In this sense, we think it is as important to learn how the problem occurs as it is to learn the trigger and why it occurs. In our field I think understanding how lipids mediate disease could be used for prevention, early diagnostic and therapeutic purposes.

You can hear Prof Vidal-Puig’s Society for Endocrinology lecture on Wednesday 8 November, 15:45-16:45, and see the full scientific programme for SfE BES 2017.

Meet the 2019 winner of the Clinical Endocrinology Trust Basic Science Abstract prize

Professor Fadil Hannan, Director of the Oxford Centre for the Endocrinology of Human Lactation, is this year’s well-deserved winner of the Clinical Endocrinology Trust Basic Science Abstract prize. His research focusses on the endocrine control of lactation and bone and mineral disorders. In this interview, Prof Hannan tells us more about his research and what he will be presenting at SfE BES 2019.

Can you tell us about your current position and research?

I’m based at the University of Oxford and have recently been appointed as the Director of the Oxford Centre for the Endocrinology of Human Lactation (OCEHL). I also work on characterising the genetic basis of bone and mineral disorders. In addition, I am an honorary consultant chemical pathologist at the John Radcliffe Hospital in Oxford.

Please tell us a little about your career path so far, and what you are most proud of?

My background is in chemical pathology – this is a small, clinical discipline with very few academics. I decided to become an academic chemical pathologist after undertaking a PhD in the lab of Prof Rajesh Thakker FRS, at the University of Oxford. My proudest achievements include the discovery of disease-causing mutations in the GNA11 and AP2S1 genes, which has led to insights in the genetic basis of parathyroid gland function.

What are you presenting at your Medal Lecture at SfE BES 2019?

I am presenting data on a mouse model for a disorder known as familial hypocalciuric hypercalcaemia type 3 (FHH3). This is a recently identified disorder and we are utilising this model to better understand the phenotype of FHH3, and also to evaluate targeted drug therapy.

Is there anything you are particularly looking forward to at this year’s conference and you would recommend to others?

I’m looking forward to the nature versus nature debate for body weight. Clearly both influences are important but it’ll be nice to hear the arguments in favour of each contribution. 

What do you think are the biggest challenges in your research area right now?

I think more funding is needed to support curiosity-driven research, as this is the type of research that is most likely to lead to substantial advances in our understanding of biology.

What do you think will be the next major breakthrough in your field?

This is difficult to predict, however, I hope that suitable cellular models can be developed to allow us to study complex physiological processes, such as lactation.

What do you enjoy most about your work?

I really enjoy coming up with a scientific idea and then going ahead and testing whether this idea has any merit or not. This process pretty much sums up what science is about.

Who do you most admire professionally, or otherwise, and why?

I have many scientific heroes, so will mention just a couple of them. I have huge admiration for Rajesh Thakker, who is my mentor. He is always on hand to provide helpful advice and I have really enjoyed our robust scientific discussions over the years. In addition, Carl Sagan has made a great impression on me. He was a true scientific visionary and one of the great communicators of science. I always wish that I’d had the chance to meet him.

Any words of wisdom for aspiring endocrinologists out there?

If you’re interested in working in an intellectually fascinating field, which involves interactions between many tissues and organs and includes a wealth of cutting-edge science, then endocrinology is the specialty for you!

You can hear Prof Hannan’s presentation, “Mice harbouring a germline heterozygous AP2S1 mutation, Arg15Leu, are a model for familial hypocalciuric hypercalcaemia type 3 (FHH3)” on Tuesday 12 November at 10:25. Find out more about the scientific programme for SfE BES 2019.

Meet the winner of the 2019 Society for Endocrinology Medal

Prof Philippa Saunders is Chair of Reproductive Steroids at the University of Edinburgh and proud winner of the Society for Endocrinology Medal. Prof Saunders speaks to us about her research and career, ahead of her Medal Lecture at SfE BES 2019.

Can you tell us about your current position and research?

I lead a research team based in the Centre for Inflammation Research at the University of Edinburgh. Our work is focussed on exploring the role(s) of steroids and their receptors in the endometrium, so that we can develop better medical therapies to treat endometrial disorders including endometriosis, infertility and heavy periods, which affect millions of women in the UK and world-wide.

Please tell us a little about your career path so far, and what you are most proud of?

My first degree was in microbiology – the recent explosion of interest in the microbiome has made this more useful than previously. After graduation I was unsure what to do and took a job in Cambridge examining the role of uterine factors in supporting development of the pig blastocyst – this turned out to be an absolutely fasinating topic and I made it the basis of my PhD project. I spent 3 years as a postdoc in the USA, which was pivotal in convincing me that I wanted to become a successful principal investigator (PI), leading my own team. After a brief period working in London, I moved to Edinburgh where I was fortunate to have the chance to start my own lab within the MRC Human Reproductive Biology Unit. I was made a Professor in 2005 and have taken on a number of leadership roles including Head of Centre and Director of Postgraduate Research. I am proud of my successful application for the MRC Centre for Reproductive Health and the work my team have done to advance our understanding of the impact of oestrogens and androgens on endometrial health and disease.

What more specifically are you presenting at your Medal Lecture at SfE BES 2019?

I am going to be talking about our most recent work exploring the impact of steroids on endometrial function – this has a strong translational focus and benefits from access to human samples, as well as bespoke mouse models.

Is there anything you are particularly looking forward to at this year’s conference and you would recommend to others?

I am really looking forward to the Basic Physiology Workshop: Modelling endocrinology in vitro, in vivo & in silico and hearing about the exciting work done by the early career researchers.

What are the biggest challenges in your research area right now?

Funding! We are trying to better understand the mechanisms that predispose some, but not all, women to develop endometriosis, a chronic condition that can cause severe pain as well as subfertility. Even though up to 10% of women are affected during their reproductive years, it is incredibly challenging to get money to fund basic research into the aetiology of this condidition. Endometriosis and women’s health charities have little money and funders with deeper pockets have many equally important claims on their funds. We are looking at alternative sources of funding and have been happy to receive several small donations and philanthropic funding.  

What do you think will be the next major breakthrough in your field?

I am excited about the use of new technologies such as single cell sequencing and advanced in situ image analysis, as I believe these will give us the tools to study spatial and temporal changes in cell function within complex tissues, such as the endometrium.

What do you enjoy most about your work?

I enjoy working with my team and clinical collaborators, all of whom are focused on doing their best to improve the lives of women. One of the best aspects of the job is helping junior colleagues advance their careers by encouraging them to be ambitious and open to new ideas. I have also been fortunate to use my position as a Fellow of the Academy of Medical Sciences to support a number of initiatives that are supporting junior PIs to achieve their full potential – these include chairing the Springboard grants panel, acting as a mentor and as co-chair of the Team Science project.

Who do you most admire professionally, or otherwise, and why?

I have huge admiration for my clinical academic colleagues (Andrew Horne, Hilary Critchley) who are dealing with the challenges of running multicentre clinical trials. These trials are vital if we are to improve the lives of women who are at risk of hormone-dependent disorders but involve many hours of work, both to obtain funding and also to manage a diverse team based in multiple locations.

Any words of wisdom for aspiring endocrinologists out there?

Endocrinology is a really important topic so please continue to work in the field and promote it to others. In your own work please consider the impact of hormones on health and disease, across the life course and in different genders, so that your results will be relevant to as many people as possible.

You can hear Prof Saunders’ Society for Endocrinology Medal Lecture, Sex steroids and the endometrium: dynamics and disorders” on Wednesday 13 November at 16:50. Find out more about the scientific programme for SfE BES 2019.

Meet the winner of the 2019 Society for Endocrinology European Medal

Prof Felix Beuschlein is head of the Department of Endocrinology, Diabetology and Clinical Nutrition at the University of Zurich and winner of the Society for Endocrinology European Medal. He has carried out ground-breaking work in adrenal research for many years, now with a focus on endocrine tumours and hormonally-induced hypertension. In our interview, Prof Beuschlein tells us more about his research, career and his prize lecture at SfE BES 2019.

Could you tell us about your current position and your research?

I’m the head of the Department of Endocrinology, Diabetology and Clinical Nutrition at the University of Zurich clinic in Switzerland. I have been in the field of adrenal research since the start of my career, and my research has two broad directions. The first is on endocrine hypertension and everything to do with endocrine cardiovascular research, and the other is on endocrine tumours. 

Can you tell us a little more about your career path and what you are most proud of?

I specialised in adrenal research for my doctoral thesis, then moved several times within Germany and to the U.S. during my medical career, before moving to Switzerland. As you can imagine, moving so often was not always appreciated by my family and it can make friendships more difficult. However, you also get to engage with many different people from your field, sharing new ideas and opportunities all the time. So I view these moves as an enrichment of my career, rather than a challenge.

I am most proud of the very good and broad network of people, from all the different places I have worked and beyond. I have many colleagues in Europe and all over the globe, who I can rely on and trust, which has led to many interesting collaborations. I am also proud to be a co-founder of the European Network for the Study of Adrenal Tumours.

What will you be presenting at your SfE BES 2019 Medal Lecture?

My lecture will tell the story of how tiny little deviations that start off in the genome of a single cell can lead to a myriad of changes in the human body. There are very specific genetic changes that we, and others have identified, that predispose for adrenal tumours by causing small modifications in biological pathways. For example, hypercortisolism or excessive secretion of aldosterone, causes many changes in target organs, which then affect metabolism and lead to metabolic changes that define the phenotype witnessed by medical doctors.

Is there anything that you are particularly looking forward to at the conference?

Usually when I go to meetings like this I don’t prepare too much and like to just see what’s happening – maybe by chance I will find a brilliant talk, which I might have otherwise missed. In general, I like intersecting fields that are not immediately apparent to be endocrine-related but encourage us to think outside the box, opening our field to new ideas and new thinking.

What do you think have been the biggest challenges so far in your research area?

Right now one of the biggest problems is the maintenance of good registries and biobanks for clinical research. It is a major challenge to find funding to build and maintain them, to keep them going for a long period of time, so that you can build a cohort of patients with very rare diseases, and then follow up on them. Another challenge is keeping up awareness of particular topics, be it from the patient perspective, or that research is necessary. Then of course there is the challenge of Brexit and nations drifting apart and not knowing how that will turn out.

What do you think will be the next major breakthrough in your field?

I would say pattern recognition and artificial intelligence. As an endocrinologist this would mean not measuring one hormone, but rather looking for patterns of different hormones. ‘Omics technologies make it possible not only to measure one particular analyte, but a whole bunch. This means we can generate large datasets, over longer periods of time. Not a human being, nor an endocrinologist, nor a doctor are able to digest this information by themselves but computerised analysis of this data can indicate if disease is present or not. I think these possibilities will not only change science but also how we diagnose patients. Although this may be seen as frightening from some doctors’ perspectives, I think it will happen in the near future. We are already able to generate so much more data, but making sense out of it is the real challenge.

What do you enjoy most about your work?

My work in general is very varied, from seeing patients every day, to doing administrative things, to doing research. I also enjoy engaging with my network of scientists, talking and discussing with bright minds all over the globe. This is particularly rewarding, very interesting and is probably among the best things about research. Regardless of nationality, religious beliefs or any other differences, you come together and find common ground for discussion.

Who do you admire most professionally and why?

I have had a number of colleagues over the years who I see as role models but there are two that stand out most Martin Reincke has been a colleague and friend for over many decades and has followed my career very closely. The other important person is Bruno Allolio who was my mentor and teacher early in my career. He unfortunately passed away far too early but I remember him in many aspects of my scientific and medical career.

Do you have any words of wisdom for aspiring endocrinologists?

When I think back to what I have enjoyed the most and what I am most proud of in my career, I think it’s important for young endocrinologists to get connected with colleagues and other researchers. These networks are the fertile ground for all your future projects and career path. Endocrinology is a close community, so it is likely you will meet the same people again, which is also a great starting point for new friendships. It is also important professionally to have these networks to help you start multi-disciplinary or multi-centric projects.

You can hear Prof Beuschlein’s plenary Medal Lecture, “Mechanisms and consequences of endocrine autonomy – lessons learned from the adrenal cortex” on Tuesday 12 November at 18:20. Find out more about the scientific programme for SfE BES 2019.

Misleading medical reporting in the media: Over-diagnosis of low testosterone levels in men

A story published on Monday 9 September in the Guardian has provoked outrage at the Society for Endocrinology.

Dr Richard Quinton, Dr Channa Jayasena and Dr Ahmed Al-Sharefi, three of our expert Media Ambassadors, contacted the Society Press Office to express their concerns over the lack of accuracy and impartiality in the article: ‘My energy is back: how testosterone replacement therapy is changing men’s lives’ by .

They feel that this article is written and presented in an irresponsible manner that is misleading to the reader and potentially exploitative. The Society is committed to helping promote accurate and responsible reporting of endocrinology-related topics in the media, so we have backed their concerns, in the form of the open letter below, as our official position, and call on the Guardian to retract the article, pending appropriate revisions.

“Dear Guardian,

This article published in the Guardian addresses the important issue of treating hypogonadism. However, we are concerned that the article will (inadvertently) serve as an advertisement for “fringe” private medical healthcare services that contradict the advice and experience of qualified NHS specialists, who have specifically trained in hormone medicine (endocrinology),  with no platform offered to provide a more informed viewpoint.

It is easy to do a blood test for testosterone but it is equally easy for a non-specialist doctor (such as those quoted in the article) to misinterpret the result, and thereby misdiagnose hypogonadism.  In healthy, normal men, testosterone levels peak in the early morning and fall during the day; they also fall after meals, so it’s vital for accurate diagnosis that the blood test (preferably 2 of them on different days) be performed fasted and before 10-11 am. Moreover, testosterone levels also fall naturally below “normal” after a sleepless night, or during any form of illness, and men who are overweight or obese typically have low levels of the testosterone-binding protein, such that their levels of biologically-active free testosterone may be normal, even when total testosterone is slightly low.

What doctors lacking training in hormone medicine may also fail to appreciate is that properly documenting two separate low testosterone levels (total and calculated-free) is not a final diagnosis in itself, but rather an entry point to making a proper diagnosis, which may even involve MRI scanning the pituitary gland. Thus, just starting a man with “low testosterone” on testosterone replacement, not only exposes them to the risks of unnecessary treatment – testosterone-induced infertility, shrinkage of testes, or an abnormal rise in haemoglobin that can predispose to heart attacks, along with the costs to them or the NHS of drugs and monitoring blood tests – but also to the risk of a serious underlying condition being missed, such as a pituitary gland tumour, which could expand and cause blindness.

There has been an explosion in testosterone prescribing in the UK over the past 20 years, much of which has been exploitative of the vulnerabilities and insecurities of middle-aged and older men, but which has sadly passed other men completely by, whose genuine hypogonadism has not yet come to specialist medical attention.

We therefore highlight, four simple red flag features that should make any doctor take the finding of a low testosterone level (fasted & early morning) that much more seriously and refer to an appropriately qualified specialist:

– the presence of anaemia or low haemoglobin
– a history of osteoporosis or fracture
– a history of infertility
– raised levels of pituitary hormones LH or prolactin”

Dr Richard Quinton MA MD FRCP(Edin), Consultant Endocrinologist, Newcastle-upon-Tyne Hospitals & University 

Dr Channa N. Jayasena PhD FRCP FRCPath, Clinical Senior Lecturer in Endocrinology, Imperial College London

Dr Ahmed Al-Sharefi MBChB , MRCP (UK), Senior higher specialty trainee in endocrinology, The Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation trust

Declaration: Both Richard Quinton and Channa Jayasena are Investigators on the National Institute of Healthcare Research (NIHR) funded Testosterone Efficacy and Safety (TestES) Consortium, and Media Ambassadors for the Society for Endocrinology*

Our Media Ambassadors have successfully worked with Health and Science correspondents at the Guardian in the past to ensure accurate and responsible reporting, and we look forward to continuing to work with them on endocrine-related stories in the future.

The Society is committed to engaging journalists, patients and the public with hormone science to encourage informed health decisions, and to demonstrate the value of endocrinology to the wider world. Our Media Ambassadors are experts that work alongside the press office to help provide expertise, context and analysis to promote accurate and responsible reporting.

If you are interested in helping to improve the quality of science and health reporting, read our Media Ambassador guide or email media@endocrinology.org to find out how you can get involved.

Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia

CARLA MORAN WEB IMAGES 1 (3)Dr Carla Moran is a Consultant Endocrinologist at the University of Cambridge and a convenor of the Society’s Thyroid Endocrine Network. In 2017 she was awarded a Society Themed Scientific Meeting Grant to hold the one-day meeting, Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia, on 8 March 2019 at Churchill College in Cambridge. The meeting brought together international and UK experts, as well as practicing clinicians and non-clinical scientists, to discuss advances in the field. Here Carla gives us a report of the day.

Need for the meeting
The landscape of investigation for thyroid neoplasia and management of low risk thyroid cancer is changing. Overascertainment of thyroid nodules has fuelled an epidemic of thyroid neoplasia but the death rate from thyroid cancer is unchanged. Many of these nodules are unnecessarily over-investigated, and if cancer is detected, may be overtreated. It has been suggested that more than 200,000 cases of thyroid cancer have been unnecessarily detected in the USA between 1988 and 2007, and the UK has not avoided this phenomenon of overdiagnosis[1]. In addition, in the UK, almost all radiologically and cytologically indeterminate nodules undergo surgery for diagnosis, resulting in high rates of unnecessary surgery for benign disease. Although our international colleagues are using RNA and DNA diagnostic techniques to stratify the likelihood of malignancy in these nodules, such tests have not been evaluated in UK clinical practice. Pathological definitions of thyroid neoplasia are being revised, such as redesignation of follicular variant of papillary thyroid cancer to noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP). Lastly, management of thyroid cancer is evolving, with surgical extent, radioiodine use and dose and TSH suppression all being tailored to disease risk. This suggests that a stratified approach, with use of better markers (radiological, cytological, molecular) to select nodules for investigation and treatment, is required.

Overview of the day
Current guidelines advocate a multidisciplinary approach to thyroid nodules and cancer, with input from endocrinologists, radiologists, pathologists, surgeons, oncologists and nurse specialists, however no national meetings are held with all these disciplines in attendance. Led by the Society Thyroid network, in partnership with the British Thyroid Association and UK Endocrine Pathology Society, this meeting gathered international and UK experts in all these disciplines, as well as practicing clinicians and non-clinical scientists, to discuss current UK practice and advances in the field. Invitations extended to members of other societies (e.g British Association of Endocrine and Thyroid Surgeons) and patient groups (British Thyroid Foundation, Butterfly Thyroid Cancer Trust) interested in the field.

Topics reviewed included: the thyroid cancer epidemic (Krishna Chatterjee, Cambridge), ultrasonographic classification (Steve Colley, Birmingham), cytological categorisation (Sarah Johnson, Newcastle), molecular pathogenesis (Chris McCabe, Birmingham), nodule molecular diagnostics (Bryan McIver, USA), pathological risk stratification (David Poller, Portsmouth), surgical management of low risk tumours (Dae Kim, London), papillary microcarcinoma (Carla Moran, Cambridge) and stratified management of thyroid cancer (Jonathan Wadsley, Sheffield). Oral presentations demonstrated that high quality UK research is being performed in this field.

Collaboration is key
Collaboration between disciplines was essential for this meeting; the primary speciality leading diagnosis & management of nodules varies widely between centres across the UK, such that specialist society (e.g. endocrine, surgery, pathology, radiology) meetings often exclude many interested professionals; it is exceptionally rare for all relevant disciplines to meet to discuss the topic. Discussing areas of uncertainty identified by all specialties allowed us to compare approaches. Internationally, variation in practice variation is also substantial, most notably with regard to the use of molecular diagnostic techniques. Clinicians in the UK do not have any significant experience of using such diagnostic tools, such that Dr McIver’s experience and opinion of this area was highly informative. Lastly, attendees were individuals experienced and interested in the field; this ensured that discussions were highly applicable and informative.

Funding was crucial
When organising this meeting, funding received from the Society for Endocrinology was invaluable; without it we would not have been able to attract such high-quality speakers from the UK and US. Feedback from the meeting was universally strongly positive, with many attendees expressing a desire to attend a similar meeting in future.

Future
A unique aspect of the meeting was the workshop held the day after the main programme, attended by those interested in pursuing research aiming to identify solutions to challenging areas of current practice. We hope the meeting will inform scientific design of a UK-wide, multicentre, prospective study to evaluate diagnostic utility of new molecular technologies alongside current cytological/pathological practice. In addition, participants in this meeting are likely to be key members of a working group which will formulate national guidance on the diagnosis & management of thyroid nodules in the UK.

References
1. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. N Engl J Med. 2016 Aug 18;375(7):614-7.

Meet the editor – Professor Martin Haluzík

Meet Professor Martin Haluzík, Professor of Internal Medicine at the Charles University in Prague, Deputy Head of Centre for Experimental Medicine and Head of the Department of Experimental Diabetology at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic. Professor Haluzík is a deputy editor of the Journal of Endocrinology and Journal of Molecular Endocrinology. His major research focus is on the etiopathogenesis of obesity, insulin resistance and type 2 diabetes. In this interview, Professor Haluzík tells us more about his research and career.

Tell us about your particular field and research?

Our lab explores the etiopathogenesis of obesity and type 2 diabetes aiming to find preventive and treatment strategies. We are particularly interested in bariatric surgery and endoscopic methods of treatment along with novel pharmaceutical targets. Our research is both experimental and clinical, involving patients with obesity and type 2 diabetes.

What techniques do you use in your research?

At the moment, a lot of our research is focused on immunometabolism/subclinical inflammation in adipose tissue using flow cytometry and continuously trying to refine it. We are also using metabolomic and proteomic methods in collaboration with other laboratories. In patients, we often use glucose clamps to characterise insulin sensitivity before and after interventions. We are also testing numerous novel endoscopic methods for treatment of obesity/type 2 diabetes in both experimental models and in patients.

What inspired you into endocrinology?

It was primarily my mentor, Professor Vratislav Schreiber, who was a leading, internationally-recognised, experimental endocrinologist. His primary focus was hypothalamus/hypophysis research but he was the one who, after discovery of adipose tissue hormone leptin, came up with the idea that we should focus on the endocrine function of fat.

What do you enjoy most about work?

I really enjoy its variability – doing both experimental and clinical research brings some challenges but this combination is never boring. I very much like scientific discussion with my colleagues about our results and brainstorming how to explain it and put it into context. I also like writing the papers, especially when nobody is calling and I have a couple of hours to focus on thinking about data and writing.

What does your day-to-day work life involve?

I do both clinical work (seeing patients with diabetes/endocrine diseases) and experimental research. Nevertheless, I have to admit that I am not very useful in the lab anymore. My job is mostly to write grant applications, organize things, write and refine the papers and support my colleagues and PhD students.

What are you most looking forward to in becoming an editor?

I am very much looking forward to a chance to contribute to shaping and refining the focus of such well-respected journals of Journal of Endocrinology and Journal of Molecular Endocrinology. Also, I really like interaction with the Editorial Board and other members of the team that bring most interesting ideas that help us to improve the journal.

Who/what research has inspired you the most?

My first mentor, Professor Vratislav Schreiber, who contributed to the discovery of TRH. He was very inspiring by a combination of being extremely smart and modest at the same time, while having an unforgettable sense of humour.

What is the best feedback or advice you have ever received?

“Work smart not hard” although I am still learning how to do it, which involves a lot of hard work.

Is there any advice you can give to someone just starting off in science?

Go for it! I would make the same choice again if I could start over. It is a lot of work but you don’t really need any other hobbies. You can think about science all the time.

How can we inspire our future leaders in endocrinology and the Society?

Graham Williams with Award winners SfE BES 2017
Prof Graham Williams (centre) with Award winners SfE BES 2017

The Society has launched a new Leadership & Development Awards Programme, to recognise and nurture emerging talent in endocrinology and help Awardees become the future leaders of our discipline. In our interview, Prof Graham Williams, President of the Society for Endocrinology, introduces the Awards Programme and explains how it will be used to inspire and support our leaders of tomorrow, and why early career endocrinologists should apply.

What are the aims of the new Awards programme?

My main priorities as President of the Society have been to ensure that we cater for every member and that we are prepared for the future by being able to develop and respond to change. An important part of that is to support people who are enthusiastic and dedicated to endocrinology so they are equipped to be our future leaders. The Society Officers and Council have introduced the Leadership & Development Awards Programme to help identify these individuals and prepare them; by providing opportunities to learn more about how the Society works, how it is governed, how the committees work and what its strategic aims are. The main purpose is to give everybody an equal opportunity to become more involved, and to ensure that all categories of our membership are well represented in the future.

Towards this goal, the Awards Programme is open to clinicians, clinicians-in-training and research scientists. We are also considering, with the Nurse Committee, how to bring forward a similar initiative that will suit our nurse members, who have different career pathways and needs, and will require an alternative selection process.

The overall aim is to ensure the Society is in a strong position for the future, by securing the engagement of our most dedicated members to help grow and develop our community.

Why do we need an Awards Programme to identify our future leaders?

Our members have always been engaged with endocrinology but the discipline is rapidly changing. It is no longer so easy for people to identify themselves as endocrinologists. There has been a move away from a traditional organ and disease based focus, with increasing emphasis towards interdisciplinary science, whole organism physiology and cellular and molecular signalling. This means many more people are dipping in and out of endocrinology as a discipline, which in turn impacts on the Society. We need to move with the times and ensure we include cross-cutting disciplines that are integrated fully within the Society and endocrine community.

What are your hopes for the Awards Programme in the longer term?

I don’t want to predict the future but I think the Society needs to be agile and responsive as the discipline changes. So we aim to equip Awardees with the skills they need to influence Society strategy and develop our plans as the field advances. Endocrinology is also global discipline and I think that building collaborations with other medical disciplines will be essential both in the UK and also with colleagues all over the world.

What advice would you give to applicants for the Award?

Answer all the questions as completely as possible but most importantly be yourself. When people answer honestly, it allows them to express their true sense of excitement and enthusiasm – and that is what we are looking for – people who are the ‘enthusiastic doers’.  Of course we are looking for those who can demonstrate clinical and scientific excellence in endocrinology, but they need to be excellent communicators and ambassadors as well.

What qualities do you think are important in our future leaders?

I think openness, honesty and the ability to listen to, and to take advice from, others are some of the most important leadership qualities. By sitting on lots of committees you can learn a lot from the chairs. The best ones are great listeners, adept at summing up and have the ability to direct people towards a sensible consensus. Excellent communication skills and wanting to help others are essential qualities for all leaders.

Apart from a dedication to endocrinology, it is important that Awardees are rounded individuals with other outside interests . Working hard is important but it is important to switch off at times and enjoy other interests.  For me this has come from sport and the great outdoors, but whatever it is “work hard and play hard” and you won’t go far wrong!  Having diverse interests also helps with networking, getting to know colleagues and in developing long-lasting friendships that cement the endocrine family together.   

What have you enjoyed most while serving on Committees and as President?

It has to be the people. I feel in a really privileged position to be able to work in the field I love, but serving the Society has extended that experience into being part of a community. Being able to meet and work with like-minded and fantastic people, from different disciplines, from all over the world, and who all want to achieve similar things has been very inspiring.

Who were your early mentors?

I have been fortunate to have had many outstanding mentors over the years but here are the early ones that inspired me into endocrinology and then research. As a medical student, I loved anatomy and was all set to be a surgeon.  However, my first house job was with Professor David London at the Queen Elizabeth Hospital in Birmingham.  He is an eminent clinical endocrinologist and long-standing Society member.  During my time as his houseman, we had lots of interesting endocrine challenges and his infectious enthusiasm got me hooked, so I decided to change and take up a career in endocrinology.

After completing general medical training, I was encouraged to move into the laboratory to work on thyroid hormone action with Michael Sheppard and Jayne Franklyn.  They subsequently encouraged me to branch out and go to Boston to continue my research training at Harvard Medical School, and this move inspired me to pursue an academic career in basic clinical science.  Throughout my career many people have been inspirational and provided support and this never stops; you develop an expanding network that brings new ideas, collaborations and opportunities.  It is here that the Society makes such a difference and will continue to do so as the next generation takes the reins and leads us into the future.

I feel strongly that the new Leadership & Development Awards Programme will serve the future of the Society and the future of endocrinology well.  It will provide unique opportunities for those who apply and I hope it will help to support the careers of our talented trainees.  The applications are open to all so please don’t feel inhibited – just go for it!

Are you an early career endocrinologist interested in developing your leadership skills and becoming more involved with the Society? Applications for the Leadership & Development Awards Programme are open 1 April – 14 May 2019.

Full details of the selection process, benefits and how to apply are on our website.

Tackling inaccurate and misleading reporting on science in the media

A story published on Saturday in The Times has provoked outrage amongst some Society members.

Dr Richard Quinton and Dr Channa Jayasena, two of our expert Media Ambassadors, contacted the Society Press Office to express their grave concerns over the article: The £195 hormone cream that’s changed my life by Olivia Falcon.

Both Dr Quinton and Dr Jayasena feel that this article is written and presented in an irresponsible way that is misleading to the reader, on a potentially unsafe and improperly tested product. The Society is committed to helping promote accurate and responsible reporting of endocrinology-related topics in the media, so we passed their concerns, in the form of the open letter below, to The Times.

Dear Editor

In 1916, a $20 fine was levied in Rhode Island, USA for the misbranding of Clark Stanley’s Snake Oil Liniment to treat rheumatism and bunions and animal bites. The term ‘snake oil salesman’ is still used today to describe someone who knowingly sells fraudulent goods. Anti-ageing products are in ever-increasing demand. Whereas, cosmetic (i.e. non-medicinal) products are established in the market, there is growing speculation that hormone (endocrine) supplementation could provide additional benefit for older men and women. However, it is critical to understand that products claiming to alter the endocrine (hormone) system should be termed drugs, and are quite rightly subject to rigorous safety regulation. Crucially, the websites from which Endo-Test cream can be purchased explicitly state that “it is for scientific or laboratory use only and not for human consumption”.

Endo-Test cream described in last Saturday’s edition claims to ‘increase testosterone levels dramatically’ and nearly double sperm count and The Times’ journalist reported that these claims were based on an independent study by the manufacturer. However, we were unable to find any evidence of scientific peer review or publication of these findings. Furthermore, there is currently no medication in existence known to increase a man’s sperm count, so the findings appear improbable.

Interestingly, whereas The Times’ journalist correctly described Endo-Test cream as a “hormone cream”, the AQ company website claims prominently that Endo-Test is “hormone-Free”. For the record, the cited ingredients include a human androgen (testosterone-precursor) hormone (DHEA), a major insect moulting hormone (20-hydroxyecdysone) and a synthetic hormone (Gonadorelin) whose clinical application in humans is to shut down reproductive hormones entirely for men with prostate cancer and women with endometriosis, or as part of hormone treatment of trans-gender individuals. The extent to which these are absorbed through the skin, as opposed to through their conventional routes of administration, has likewise not been substantiated. 

To protect the interests of the public, it is important that manufacturers make substantiated claims and that journalists scrutinise evidence of these claims prior to publication. Without this, how would people know whether or not ‘snake oil’ was indeed the fountain of youth?

Dr Richard Quinton MA MD FRCP, Consultant Endocrinologist, Newcastle-upon-Tyne Hospitals

Dr Channa N. Jayasena PhD FRCP FRCPath, Clinical Senior Lecturer in Endocrinology, Imperial College London

Declaration: Both are Investigators on the National Institute of Healthcare Research (NIHR) funded Testosterone Efficacy and Safety (TestES) Consortium, and Media Ambassadors for the Society for Endocrinology*

*Please note these views are of expert members Channa Jayasena and Richard Quinton, and do not necessarily reflect the official position of the Society for Endocrinology.

The Times is now looking into the matter and will report back to us on how this will be addressed shortly. Our Media Ambassadors have successfully worked with Health and Science correspondents at The Times in the past to ensure accurate and responsible reporting, and we look forward to continuing to work with them on endocrine-related stories in the future.

UPDATE 8 March 2019 – The Times have now taken this article down, we thank them for their assistance with this matter and taking this positive action.

The Society is committed to engaging journalists, patients and the public with hormone science to encourage informed health decisions, and to demonstrate the value of endocrinology to the wider world. Our Media Ambassadors are experts that work alongside the press office to help provide expertise, context and analysis to promote accurate and responsible reporting.

If you are interested in helping to improve the quality of science and health reporting, read our Media Ambassador guide or email media@endocrinology.org to find out how you can get involved.

 

 

 

 

 

 

How an endocrine disease may have shaped British history

At SfE BES, Ashley Grossman, Professor of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, gave a presentation entitled, ‘What killed Queen Mary’. In our latest interview, he tells us about his investigation into the unclassified illness that plagued Queen Mary and ultimately led to her premature death, and what we can learn from her tragic story.

Can you tell us why you think Queen Mary’s death was endocrine related?

Reading through Mary’s life history, which is quite a sad story, it seemed to me that something endocrine-related may have been going on and I came up with some interesting conclusions about her death. Mary was unfortunately plagued with illness throughout her life and her documented symptoms included her periods stopping, she starting to lactate, suffered from increasingly bad headaches and, just before Mary died, she began to go blind. All of these symptoms suggest she was suffering from an expanding prolactin-secreting pituitary tumour. Increased prolactin levels would explain her lactation and amenorrhoea. As the tumour expanded it would have compressed the brain, including the optic nerve leading to blindness. It may also have made her infertile explaining her failure to produce an heir. Ultimately, as the tumour expanded it likely placed pressure on vital areas within her brain  that may have been the cause of her early death in 1558 at age 42.

What sparked your interest in Queen Mary?

 I confess, initially I did not know much about history or Queen Mary. However, when my third daughter pursued history as an undergraduate and then as a Master’s degree student, it sparked my interest. I delved in and began reading books on the Tudors and Mary seemed quite fascinating. The fact that she died so young and childless was pivotal, as it completely altered the course of British History. If she had produced a child, then Britain would have remained catholic and Phillip II would have become King, dramatically changing history, with no future Elizabeth I on the throne.

Is there any way we could prove your theory?

Of course, the conclusion that Mary died from a pituitary tumour remains speculation. However, renowned Austrian physician – Victor Cornelius Medvei, whose passion for endocrinology led him to write the definitive textbook – A History of Endocrinology – also investigated the death of Queen Mary in some detail. To my delight his conclusions, discussed with Prof. Howard Jacobs, matched my own and reading his research really firmed up what I thought.

Mary’s buried in Westminster Abbey, so we could do a computerised tomography scan of her coffin to see whether or not her pituitary was indeed enlarged. However, I don’t think the monarchy would be very happy for anyone dig up her coffin and do that! To make a diagnosis on someone who lived hundreds of years ago is not hard science, but it is amazing to think that a pituitary tumour changed the course of British history.

What can we learn from your research?

Although historical, I think there certainly are things people can learn from Mary’s tragic story. I believe it’s important that people recognise how much life has been transformed by modern medicine, and how lucky we are to have treatments to disorders that just a few hundred years ago were highly debilitating or even lethal. For example, what destroyed the catholic British monarchy can now be treated simply with a few tablets and the disease might virtually disappear.

Ashley Grossman presented ‘What killed Queen Mary’ at the annual SfE BES conference in Glasgow on 20 December 2018. Discover more about the work of endocrinologists in our Meet the Endocrinologist series of blog interviews.