Featured

Enhancing endocrine education: for medical students by medical students

Vaishali Limbachia is an intercalating medical student at Norwich Medical School, University of East Anglia (UEA). Vaishali has completed four years of the course enter their final year in September 2021. Last year, Vaishali became Secretary of UEA Endocrinology Society and in November 2020 became an Endocrine Ambassador for the Society for Endocrinology. In this guest blog, Vaishali shares what the UEA Endocrinology Society has been up to so far, and the importance of supporting and encouraging students in endocrinology.

*pictured Vice President, Vaishali Limbachia (left), and President of UEA Endocrinology Society, Milly Green (right).

First, I would like to introduce our society. We are a society run by medical students, for medical students. The committee consists of 4th year, intercalating, and 5th year medical students. Guided by the President, we organise revision sessions for medical students currently learning diabetes and endocrinology, in addition to other events that aim to raise interest in endocrinology. We also run social media pages, keeping our members informed of our society news and events, as well as Society for Endocrinology activities. To further engage with our members, weekly diabetes and endocrinology exam-style, multiple-choice questions are created by the committee members and posted on our social media pages.

Each academic term we have organised and delivered a teaching session on diabetes and on endocrinology. The aim of these sessions is to revise content from the medical school curriculum, which at Norwich Medical School, is taught in year 3. The presentation slides used for lectures are constructed by committee members. It can be challenging to cover a module worth of content in a couple of hours. The sessions are taught by medical students who have undergone diabetes and endocrinology teaching, placements and exams, so are able to provide useful tips.

On top of the teaching sessions, we organise and run mock objective structured clinical examinations (OSCEs), aiming to give medical students a practice run. We design 6 stations, for example a diabetic foot examination and communication skills station, to give members a realistic experience of the summative OSCE. Each committee member runs one station to keep that station consistently delivered. At the end of each station, we feedback verbally to students. In addition, we provide a marking scheme, which we constructed for written feedback, so students can see where marks were given. This allows students to gauge their learning needs in preparation for their summative OSCE. These mock exams are highly subscribed and the feedback is very positive.

This year I organised our first Diabetes and Endocrinology Careers Event, targeted at medical students. Three consultants kindly volunteered their time to speak at the event. Each spoke about their motivating force that led them to choose this specialism, their professional journey, what their day-to-day life is like and shared top tips for medical students. This was followed by an opportunity to ask questions. Speakers shared highly interesting patient cases, showing how the specialism involves detective work and how endocrinology impacts multiple systems. Each speaker’s professional journey was very different, emphasising how there is more than one path to follow. Many useful tips were shared, for example getting involved in research, and opportunities at the Society for Endocrinology. It was a highly inspiring and informative event, that I personally enjoyed, and the feedback was positive, with the only suggestions for improvement being they wished it was longer! I found the event reinforced my passion for specialising in diabetes and endocrinology in the future.

I have had a fantastic year working with great colleagues, who share an interest in diabetes and endocrinology, in organising events and sharing our interests with other students. Next academic year, I will fortunately continue being a part of this brilliant society and assume the role of Vice President of UEA Endocrinology Society. I look forward to working with the new committee members, putting on more events and continuing to share Society for Endocrinology activities and opportunities to members.

Find out more and apply to become an Endocrine Ambassador.

Please email ambassadors@endocrinology.org if you have any questions.

Featured

Meet Daniel Drucker the Society’s 2020 Transatlantic Medal winner

Dr Daniel Drucker is a clinical researcher involved in the development of treatments for diabetes, obesity and intestinal disorders at the University of Toronto Lunenfeld-Tanenbaum Research Institute. He also holds the Canada Research Chair in Regulatory Peptides and the Banting and best Diabetes Centre-Novo Nordisk chair in Incretin biology. He will be giving his Society Transatlantic Medal Lecture during SfE BES Online 2020. In this interview he tells us a little about his research and career.

Tell us about your research and lab in Toronto

I have a medium-sized lab of 8 people, where we use molecular biology and mouse physiology to study peptide hormone action. Whenever possible, we also try and extend our findings to humans, using available tissues, or occasionally, by carrying out small clinical trials. The lab has carried out basic research leading to two new treatments for type 2 diabetes and one new therapy for short bowel syndrome.

Tell us about your career path

I was very fortunate to learn molecular biology under the tutelage of Joel Habener in Boston. I returned to Toronto and was guided to adopt transgenic and knockout mice, which proved to be wise counsel. I think I am most proud of my dozens of trainees and their success. We also take pride in being extremely careful-that sounds trite, but we are generally not as concerned about being first, rather, we are very focused on making sure the data and observations are as correct as they can be. This article includes some of my career highlights in discovery, characterization, and clinical development of glucagon-like peptides.

What inspired you to choose endocrinology as a career?

I had a great role model, Gerard Burrow, who was an enthusiastic mentor, and head of endocrinology. At the same time, endocrinology was appealing since one could understand many of the disorders, and there were multiple treatments available to correct endocrine deficiencies or hormone excess states.

What do you enjoy most about your work?

I like the ability to ask questions, carry out experiments, and then scrutinise the answers. Watching trainees mature as scientists is also very enjoyable. Finally, having the good fortune to see basic science translated into new medicines is a privilege and extremely rewarding.

What are you presenting during your Medal Lecture at SfE BES Online 2020?

My presentation, ‘Incretins and Cardiometabolic Disease-An Inflammatory Perspective’ will examine how inflammation underlies many of the common endocrine disorders in metabolism, from type 2 diabetes to heart disease, to the complications of obesity and fatty liver. Gut peptides, exemplified by GLP-1, attenuate inflammation in many organ systems. I will describe how GLP-1 might work, and highlight many unanswered questions, surrounding the anti-inflammatory actions of GLP-1.

What do you think about the move to virtual meetings?

Virtual meetings allow for a broader and larger global audience, and enable us to continue to share data and concepts. I suspect that many of us still miss the social and personal interactions, and we will be keen to return to many of the in person meetings once this is feasible.

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

Funding!

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

I am hopeful that stem cell therapy will solve many challenges and mature to allow for true beta cell replacement therapy for people with type 1 diabetes.

Any words of advice for aspiring endocrinologists?

Have fun, find a good environment, choose mentors that are supportive, and don’t take yourself too seriously!

You can hear Dr Daniel Drucker’s Medal Lecture “Incretins and Cardiometabolic Disease-An Inflammatory Perspective” on Wednesday 18 November at 15:55 GMT.

If you haven’t already, register for SfE BES Online now!

Featured

Video advice for adrenal insufficiency patients

Kerrie Grounds, Lead Endocrine Specialist Nurse (ESN) at the Royal Liverpool University Hospital (RLUH) and her team have produced an educational video for patients with adrenal insufficiency. Here she explains what inspired them to create this invaluable and informative patient resource.

Kerrie Grounds adrenal crisis video image

I work with a team of fabulous, dedicated ESN’s named: Amanda Hamilton, Karen Jones and Michelle Lewin. We have created a short video for all our patients with adrenal insufficiency to access via the internet. This video provides education regarding steroid replacement therapy; sick day rules and demonstrates how to prepare and administer the hydrocortisone emergency injection should this be required in the event of an adrenal crisis. We feel this information is vital for improving quality of life for all patients with adrenal insufficiency and urge you to share the video.

Why did we create the video?

Prior to the COVID-19 pandemic, we commenced group education sessions for all our patients with adrenal insufficiency to deliver education regarding their steroid replacement, sick day rules and hydrocortisone emergency injection training. We ensured that at the end of each session everybody received their emergency injection prescription/ancillaries/travel letter/ sharps bin and patient information support pack, including surgical guidelines /steroid treatment card/medic alert identification etc. These sessions have been well received and the feedback has been very positive. It was delivered in a relaxed environment and I think the tea/coffee and biscuits also helped!

Then COVID-19 arrived! A very difficult and scary time for everyone involved and our main aim was to ensure all our adrenal insufficiency patients had access to an emergency injection. We have over 300 patients at present under our ESN team that we review. As we had to suspend our group education sessions, we created a letter for our patients to take to their own GP’s to prescribe the emergency hydrocortisone injection. Primary care played a vital role in ensuring our adrenal insufficiency patients all had access to this injection. We also sent our patient information packs, which we used to provide in our education sessions, to our patients alongside ancillaries (needles and syringes) to enable them to administer their injections, which also covered guidance from the Society for Endocrinology COVID-19 guidelines. We provided our ESN contact details and advised them to access the ADSHG Professor John Wass video regarding their emergency injection training. We tried our very best to ensure our patients received as much information as possible to protect them in the event of an adrenal crisis. We had an administration clerk, Ann Marie Brookes, whom played a vital role in assisting us with this. I will be forever grateful to my team for working together at such a difficult time.

We can honestly say that although Professor John Wass’ emergency injection video was very informative and inspired us, we felt that our patients would receive the video better if they saw familiar faces….who better to deliver this than their own ESN’s. We also wanted to cover steroid replacement during illness. Due to lockdown we were unable to provide face-to-face education sessions and we felt that creating a video was not only the best way, but the safest way forward. Our departmental manager gained funding for us to record the video, we created the script and practised it on our own and then filmed the video, all in one day. Please remember we are nurses and not actors and it was rather nerve racking for us all!

Why am I so passionate about this?

My ESN role is not just an occupation for me. I am passionate about endocrinology and have learned so much in the 8 years I have worked with the Endocrinology team, here at the RLUH. I work with a fabulous team of Endocrine/Diabetes Consultants at the RLUH and as mentioned above Endocrine Specialist Nurses. It still fascinates me every day and there is always room to learn within this role.

However I also have Addison’s disease. I was diagnosed at the age of 18 and have lived with this condition for 22 years now. I have always been a positive person and my glass is always half full. When diagnosed I weighed about six stone and had been unwell at home for three months, fading away. I could not stand up or eat anything, I was nauseous, vomiting, had headaches, the fatigue was so debilitating and it was frustrating for me and family as we did not know what was wrong. However, a positive side to that was I had a fabulous tan!. When I was eventually admitted to hospital and diagnosed with Addison’s disease I remember being so thankful to all the nurses and doctors who had helped me. This was when I realised I wanted to be able to give something back, so I trained to be an adult registered nurse and have never looked back. I can honestly say that when the ESN job post was advertised I thought I knew quite a bit about my Addison’s disease but I knew nothing! This job has literally saved my life. This is why I will always be thankful to my Endocrinology Consultants and fellow ESN’s here at the RLUH for the education and training they provided me, to be able to not only ensure I have a perfectly normal quality of life but to be able to provide specialist advice and empathy for my patients.

I know only too well the symptoms of low cortisol and adrenal crisis and I would say the fatigue is the worst symptom that we have to learn to live with. However, I am a mother to two beautiful boys and a full-time ESN. I have perfectly normal quality of life and feel blessed every day that I am able to manage my Addison’s disease.

Here is our Emergency Injection Steroid Replacement Video on the RLUH website or watch it on YouTube. Please share this widely and help to keep adrenal insufficiency patients safe and informed.

Learn more about Society for Endocrinology guidance on managing adrenal crisis, including a downloadable NHS Emergency Steroid Card.

Learn more about the adrenal glands and related diseases.

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.

How can the Masters-level Module in Endocrine Nursing help your career?

Recent graduate Helen Loo reveals all

Helen Loo, Endocrine Specialist Nurse at Oxford University Hospitals, is one of our first students to successfully complete the Oxford Brookes Masters-level Module in Endocrine Nursing. This module provides nurses with an opportunity to develop their careers and improve standards of patient care in line with the Competency Framework for Adult Endocrine Nursing. The Society collaborates with Oxford Brookes to deliver this 40-credit module, enabling nurses to get academic recognition for all their hard work. All credits can be directly counted towards the Oxford Brookes University MSc in Health Sciences or transferred to Masters-level qualifications at other institutions.

Read our interview with Helen to get valuable insights in to the module and find out about her career as an endocrine nurse.

What inspired you to choose endocrinology as a career?

Before I started working in endocrinology I was living abroad. When my family and I decided to move to the UK, I saw a position advertised to work in endocrinology. After I started researching the area, I was inspired to apply. Endocrinology appealed to me as the discipline is so vast and mixes both acute medicine and chronic disease management.

Tell us a little about your current position and what you enjoy most about your work

I work in a large endocrine team at a busy tertiary referral centre at Oxford University Hospitals, and see patients with many diverse endocrine disorders. Endocrinology is a rewarding area to work and study within as the discipline is constantly changing. There are many opportunities to learn and to apply your learning in practice. I particularly enjoy developing innovative solutions to improve quality of care and nursing practice. As an endocrine nurse, I also feel very privileged to be able to support our patients holistically through the various stages of their diagnosis and treatment.

Tell us about your main research interest

I take a special interest in the areas of male fertility, adrenal insufficiency, gender dysphoria and support the treatment and diagnosis of patients with Cushing’s syndrome. During my Masters-level Module in Endocrine Nursing, I specifically looked at the management of adrenal insufficiency, prevention strategies, and innovation in endocrine nursing care. I was interested in this area of endocrinology because I was inspired by a complex patient who came to us with a medical alert dog, who alerts the patient when their cortisol levels drop. In 2019, I presented a poster at the Society’s Annual BES Conference on this subject and was privileged to be the recipient of the Annette Louis Award. You can read more about this in The Endocrinologist.

Why did you decide to apply for the Oxford Brookes module?

I applied for the Oxford Brookes module as I wanted to build on my experience, knowledge, and skills in endocrine nursing, while advancing my understanding of the health needs that directly relate to our patients. I hoped that it would develop my confidence in undertaking research, enhance my critical enquiry skills and improve my evidence-based practice.  All these expectations were met and more!

What is your advice for anyone considering doing the Oxford Brookes module?

This is an excellent course and will really help to give you more expertise in your chosen area and develop your profession. I would advise those considering the module to plan well and to take a responsible approach to their own learning.

What were the challenges of the module and how were you supported?

My biggest challenges were that it had been quite a few years since I had done academic work and I also had two primary aged children. The university provided me with support to get back into writing academically and I reduced my hours to enable me to have a better work life balance. My mentor was also amazing. She supported and encouraged me to manage my own learning to develop my skills and maximise my potential.

What are the biggest challenges in your field?

I think some of the biggest challenges are working within the constraints of the NHS, as well as the effects of the pandemic on health care. Challenges always provide opportunity however, and it is with this mind set I move forward.

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

Endocrine nursing is a continually evolving specialty and is now becoming academically accredited. The competency framework benchmarks endocrine nursing with continual scope for development and innovation. I am really excited for the future and the part I will play.

Embracing the diversity of endocrinology: an interview with Dr Julia Prague

Dr Julia Prague is a clinical consultant and clinical academic at the Royal Devon and Exeter NHS Trust and University of Exeter. In our interview, she tells us about her clinical practice and research projects, as well as how she thinks endocrine practice will evolve after the COVID-19 pandemic.

Tell us a bit about your current position and what you enjoy most

As a clinical consultant and clinical academic I split my time almost 50/50 through the week. At the moment, my clinical commitments include outpatient endocrinology, and inpatient endocrinology, diabetes and general medicine. I moved from London to Exeter last year, and one of the big reasons to move was that near 50/50 split between clinical commitments and research. It’s a great balance that gives me time and space, not only to be with the patients, but also to investigate and take forward some of the issues that they bring up in clinic. Forming new collaborations and being in a new unit with new colleagues is pretty exciting too.

Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet!

Research wise, I’m particularly interested in the menopause through a number of different collaborations. I’m working with the respiratory department on a project looking at lung conditions and sex hormones. Investigating the impact of the menopause in diabetes. I’m also still involved in establishing the role of neurokinin 3 receptor (NK3R) antagonists to treat hot flushes and improve sleep during the menopause.

What got you interested in research on menopause?

Spending hours with the women in our research study of a new treatment for menopausal flushes, and from receiving hundreds of emails from menopausal women wanting to take part. My admiration for them was huge, not least because they so often described themselves as struggling to cope, yet they were the complete opposite of that, meeting endless challenges with amazing fortitude and whilst mostly suffering in silence. To then see them leave misery and suffering behind and find themselves feeling vibrant and human again was rewarding beyond measure. 

Furthermore, the majority of women will have menopausal symptoms that impact on all aspects of their daily life, but many will also have co-existing medical conditions before their menopause and these can also be impacted too. Many medical conditions are influenced by the menstrual cycle and that’s an aspect that is under-investigated and I think is really interesting. Inflammatory bowel disease, for example, can fluctuate during the menstrual cycle and Crohn’s disease typically gets better in pregnancy.

Diabetes is also impacted by the menstrual cycle, and it’s the same hormones that are changing during the menopause but this hasn’t been investigated, which is why I’m now interested in this, as this is something patients often report as being a problem for them. I think it’s important to listen to what patients are telling you and then try and investigate why that is, to hopefully find an improved solution for them.

There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.

How was your work affected by the COVID-19 pandemic?

I was a Senior Registrar at King’s College Hospital  at the height of the first wave, so I became involved in  a lot of  the management and service re-design work within the diabetes and endocrinology department, including rota management to facilitate re-deployment to general medicine but whilst maintaining a core specialist service and whilst supporting our junior trainees and particularly our international medical graduates who were isolated from their families, and  ensuring our patients were supported and aware of sick day rules and  had all the medications they needed. Our department was also therefore part of the frontline team. I was the medical registrar on call for the first peak weekend of King’s admissions. Then I got COVID-19 and could not get out of bed/off the sofa for 4 weeks.

I moved to Exeter towards the end of summer 2020 to take up my Consultant job. Since then I have continued to do quite a lot of frontline COVID inpatient medicine. Now we’re involved in recovery and trying to catch up. Many patients couldn’t be seen through the pandemic because resources had to be syphoned off elsewhere.

The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.

I never imagined I would interview for my consultant job on Zoom! Moving to a new city, a new department, a new consultant role and a new research role during the pandemic was definitely an interesting twist at such a significant stage of my life and career.

What are you proudest of in your career so far?

My work on menopause and NK3R antagonists – being published in The Lancet was a huge honour, and the potential that this work has to relieve suffering of women is incredible. As a doctor, all you want is to relieve suffering in your patients and this has that opportunity. It’s also given me a platform to continue working in that field and to be invited to speak at international conferences, as well as develop new collaborations.  

This drug class are now in phase three studies and it looks like they’re probably going to be marketed from around 2023/2024. This research is still advancing within the pharmaceutical field, butte top-line results coming out continue to show great promise for the therapy. Seeing the NK3R antagonists come to market will be amazing. For me, to have played some part in that will be awesome and to see patients being able to go to clinicians and get that medication prescribed will be great.

There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.

What do you think are the biggest challenges in endocrinology?

We have to mention COVID recovery, in what was an already overstretched system. However, somewhat linked to that, is the pull of general medicine on our time as endocrinologists. The pandemic has further highlighted this to be an important issue. Hospital inpatient medicine is busy and can’t be cancelled. However, it is essential for recruitment, training, and retention that our specialist time is more protected. The new internal medicine training (IMT) programme will change the number of specialty training years to shorten it, which could have some quite big consequences for the endocrine discipline.  

COVID-19 has brought some positives though; it’s highlighted that we can achieve quite a lot remotely with patients using virtual appointments, and some patients prefer fitting their appointments in to their life rather than having to attend the hospital. How this translates going forward though could involve big changes for the specialty.

The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.

What do you think will be the major changes in the future of endocrinology?

I think there will continue to be a drive for a smaller number of national centres of excellence in endocrinology. There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic. That will be good for patients overall but the downside could be that there will be a smaller number of centres with specialist services, which means that staff  may have less involvement in specialist endocrinology. A lot of these changes will be driven by the GIRFT recommendations, which will affect how all services are delivered going forward.

What challenges do you see for your research?

Availability of funding will be critical. COVID has had an impact on available funding but so has Brexit, there’s now a lot of European grants that UK researchers will not be eligible for. Universities have less money because they’ve had fewer students and international students may think differently about studying in the UK post-Brexit and post-pandemic. Charities that fund research have also been hit as many of their fundraising activities were suspended during the COVID restrictions. The Government has a significant financial deficit to address. Availability of research funding was already challenging but it’s going to be even more difficult in the years to come. It’s usually funding that restricts research activity rather than a lack of ideas or collaborations.

How would you like to see the Society develop?

My overwhelming memory of attending my first Society meetings in 2006/2007 is of a lot of senior white men wearing tweed jackets! Now every time I come to Society meetings it’s such a stark change from that. Everything that the Society has done, and is doing, to make itself more reflective of everyone within it is really important. Recruiting the next generation is also a huge part of that, and it is great to also see more focus on this now than then too. The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.

That level of change takes time and effort and over the years I’ve tried to play some part in helping to make the Society a more different place to the one that I initially knew.

As a Leadership and Development Awardee I was really looking forward to SfE BES 2020 as we were going to be paired with award lecturers, and it is also always a great opportunity to catch up with friends, previous colleagues, and previous as well as potential new collaborators. But of course, that didn’t happen. I’ve just been finding my feet as a new consultant and researcher in a new city but being an Awardee has opened up other opportunities. I’ve been involved in discussions with an external organisation exploring new collaborations and identifying our shared goals and objectives that we could achieve together. I’m sure that being an Awardee has helped me be offered these opportunities.

Who have you been most inspired by?

Prof John Wass, obviously, but I have also been very lucky to have amazing clinical and research mentors. From the literal beginning to the end of my clinical training and beyond (now over 15 years!) with Dr Simon Aylwin at King’s and Dr Roderick Clifton-Bligh in Sydney. I also learnt a lot from Prof Waljit Dhillo whilst doing my PhD at Imperial.

Why do you love endocrinology?

The balance of the acute and long-term follow up of patients, and the importance of making the right diagnosis for patients based on their history, examination and targeted investigation. Many patients with endocrine conditions go undiagnosed or misdiagnosed for a long time, so when you make the right diagnosis and instigate the right treatment, they feel and do so much better and you often see it unfold in front of you. As endocrinologists we are also part of a much wider multidisciplinary team, which is great.

Any words of wisdom for aspiring endocrinologists? 

I’ve always tried to be involved with the Society in recruiting the next generation. It’s important that they get to see the ‘real’ endocrinology and diabetes because often, those rotation attachments are mostly inpatient general medicine.

My advice would be to try to get to clinic as much as possible because a lot of our patients are outpatients, and also to go and review specialty patients on the wards when they are admitted. Remember also that there’s lots of different sub-specialties within endocrinology (and diabetes) so there is a place for everyone and an opportunity to be involved in the areas that you find most interesting/rewarding.

Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet! I also always recommend going to SfE BES, it’s a really good platform for meeting other clinicians and scientists involved in the field, and hearing about the patients that we look after. Get involved, come along and see what the specialty really has to offer.


The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Embracing the diversity of endocrinology: an interview with Dr Alexander Comninos

Dr Alexander Comninos is a consultant in endocrinology and diabetes and honorary clinical senior lecturer at Imperial College London. His research interests are in reproductive endocrinology and metabolic bone disease and he has presented internationally, winning several prestigious prizes including the Society’s Early Career and Clinical Endocrinology Trust Prizes. Alex currently sits on the Society’s Science Committee and is a previous Leadership and Development Awards Programme Awardee. Read our interview with him to find out about his career, the current challenges in his field, and how he thinks endocrinology will change in the future.

*A late night collaborative meeting at a Kebab House during SfE BES 2015

Tell us about your current position

I feel very fortunate as my current role combines clinical work, research and teaching. One day I may be running our endocrine bone clinic, the next day I could be on call for acute medicine, or analysing data and finishing a research paper, lecturing and tutoring undergraduates, or meeting my PhD students. I really enjoy the fact that each day is different and endocrinology is the theme through most of it, with so many opportunities to combine clinical and academic work.

I love endocrinology because it encompasses the whole body system and has so many possibilities for research to improve patient care.

What are you proudest of in your career so far?

Looking back on my career so far, I am so happy that I made it through all the harder times in medicine and academia. Long runs of night-shifts and previous unsuccessful grant applications certainly tested my perseverance but made me stronger!

What do you think are the biggest challenges in endocrinology right now?

With increasing patient use of social media and the internet in general sometimes misinforming patients, we have to ensure that we provide clear and accurate information to patients and address their concerns. In addition, although we are hopefully emerging from the COVID-19 pandemic, an element of remote medicine is clearly here to stay. With patient compliance, subtle symptoms and blood tests so integral to endocrinology, we need to find new ways to monitor these in a remote medicine environment.

How do you think your field of research will change in the future

Genetics is such a rapidly developing field. I suspect we will be routinely performing full cheap gene sequencing and using this information to guide management at an individual level.

In the future I think we will see the increasing incorporation of genetics to guide individualised treatment.

What is it like being involved with the Society for Endocrinology?

We are lucky to have such a well-run society. I currently sit on the Science Committee which is an absolute pleasure. Interacting with other basic and clinical endocrinologists, each with different opinions and interests is really fascinating and constantly thought-provoking. I would like to see the Society push on with in-person meetings, when safe to do so, as I feel this is so important for our morale on an individual as well as a collective basis.

Who are your most inspirational endocrinologists?

Like many others, Professor Karim Meeran is a large part of why I chose endocrinology, and Professor Waljit Dhillo is the inspiration behind my academic pursuits. Their dedication to trainee development, super approachable nature, calmness and sense of what is best, is really incredible and I am sure numerous trainees would agree. I also have to say that Dr Cox at St Mary’s has been a real clinical inspiration for me. I was his house-officer many years ago, and now to sit next door as a consultant colleague always makes me smile. His incredible experience, knowledge and deep interest in endocrine physiology have certainly helped shape my early consultant years, and we have had many enthralling clinical discussions!

Any words of wisdom for aspiring researchers in endocrinology?

It is a wonderful specialty, full of surprises and opportunities. Be inquisitive constantly, question things to understand concepts and remember the journey is lifelong.



The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Embracing the diversity of endocrinology: an interview with Dr Gareth Nye

Dr Gareth Nye is a lecturer in anatomy and physiology at the University of Chester. His main research interests are maternal and foetal health. In our interview, he tells us about his career so far, his research and how he thinks his field will develop in the future.

Tell us a bit about your current position

My recent research has been focused on improving outcomes for both mum and baby before, during and after pregnancy. More specifically I’ve been researching placental causes of foetal growth restriction, whilst also looking into the ongoing impact of the COVID-19 outbreak on maternity care.

I love endocrinology because it impacts every aspect of human health and disease

The most enjoyable aspect of my role as a lecturer is getting engagement from the students. When a student is really exploring a topic and that enthusiasm comes out in lectures or otherwise, it’s such a great feeling. With my research being in a field where you can make such a huge difference is also so rewarding. There’s still so much we don’t fully understand around pregnancy, so there is always new areas to look into.

What are you proudest of in your career so far?

There are many career moments that I’m proud of, for a wide range of reasons. Being nominated for “most inspirational lecturer” from students at the University of Chester is an achievement I’m proud of, for both personal and professional reasons.

Additionally, I’m particularly proud of our review of placental oxygenation in the Journal of Physiology and finally, speaking at the International Federation of Placenta Associations conference in Tokyo was an amazing experience!

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

I think there are multiple challenges within maternal and foetal health and pregnancy research. If I had to name three major themes they would be

  • Ensuring every baby is delivered healthy and that every mum remains healthy, during and after the pregnancy. Finding novel interventions to improve foetal outcomes in utero, without the need for early delivery and shining a spotlight on the physical and mental changes that pregnancy has on the mother’s body, both during and after the pregnancy itself
  • Fully understanding the impact the maternal environment has on foetal lifelong outcomes – this involves the discussion around Developmental Origins of Health and Disease
  • Exploring the maternal/foetal interface to improve outcomes for the baby – this includes the placenta, breastmilk and circumstances following birth

Can you explain more about how you think your field of research will change in the future?

In the future we will challenge the current understanding around pregnancy and early childhood. Not enough is known yet and it's limiting our ability to intervene productively.

As pregnancy research, particularly in humans, is challenging for a number of reasons I can see the field collaborating more with other disciplines, even though not necessarily involved in medicine. For example, I have recent research papers with mathematicians, engineers and physicists, who can bring their knowledge and expertise to fill in gaps in our biological knowledge. Additionally, with the improvement of imaging techniques, we can slowly begin to understand the important microanatomy of the placenta and uterus to see if/how we can improve pregnancy outcomes. Without thinking of our research fields as one slice in a huge pie, we can never make true advances and so collaborating with different areas is key. Particularly as everything can be influenced by the body’s endocrinology!

What is it like being a Society for Endocrinology member?

I have to say, since joining this society I have felt so welcomed into a community. I’ve been given opportunities that have never been presented to me before from other societies. The Society on the whole seems to actively push and support their more junior members.

Unfortunately, I’ve not had the chance to attend any Society events in person yet but hopefully I will get the opportunity to attend soon!

Who is your most inspirational scientist?
Again, speaking personally, the most inspirational endocrinologist to me is Frederick Banting, the discoverer of insulin. This is because my 4 year old daughter has type 1 diabetes and without insulin, she wouldn’t be with us anymore! I think a lot of people have Banting’s discovery to thank!

John Hunter always sticks out as someone who should be more famous than he is. He truly is one of the greatest anatomists of our time, discovering much of what we know now around anatomy and physiology all without a formal school education. Of interest to my work – he was the first to note that maternal and foetal blood supplies are separate during pregnancy

Any words of wisdom for aspiring researchers in endocrinology?

Speaking from experience, something I like to tell my students is not to stick to your own little bubble. Everything in medicine and biology is connected in one way or another and keeping an open mind to your research can allow you to progress, where you may not have otherwise. Due to this, don’t be afraid to switch “topics” because you can always find common themes.

Finally, make sure you enjoy what you do! I’ve been lucky to work in some amazing areas, with amazing people but what’s really helped is enjoying my work!



The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Embracing the diversity of endocrinology: an interview with Professor Rachel Crowley

Professor Rachel Crowley is a consultant endocrinologist at St Vincent’s University Hospital Dublin and a Clinical Professor at University College Dublin in Ireland. In our interview, she tells us about her career, shares her thoughts on the future of endocrinology and considers the possible improvements patient care.

Tell us a bit about your current position

My job is a mix of clinical work, research and teaching. Ours is a busy centre for neuroendocrine tumours and adrenal pathology, and I run the rare bone disease service which is a national Orphanet clinic. I also cover pituitary, gonadal, thyroid and general endocrine clinics, inpatient diabetes and endocrinology consults and general internal medicine. I love endocrinology because for each patient I assess and reason from scratch, it’s never boring.

What are you proudest of in your career so far?

I love endocrinology because for each patient I assess and reason from scratch, it’s never boring.

I’m proud of how the trainees I have worked with on my team have progressed in their own careers and how they have kept in contact. The Christmas cards, emails and WhatsApp messages from around the world are lovely to receive. I gave a talk at virtual ENDO this year and a trainee in Canada realised I would be getting a train home late from work after the panel discussion – she messaged me to be sure I got home safely! These personal connections make a big difference.

How much has your work changed since you started your career?

The general internal medicine commitment has increased, even in the relatively short time since I have been a consultant. The developments in endocrine genetics and in adrenal medicine have happened quickly in the last 10 years so it can be challenging to keep our practice up to the standards we expect of ourselves. The increased contact with patient advocacy groups is very welcome and rewarding – that was something that we didn’t learn about as undergraduates or have much exposure to as trainees.

The more access we have to genomics and proteomics, the more I think we’ll be able to deliver an individual treatment plan for the patient sitting in front of us – I think that’s really attractive to patients and satisfying for us in our own practice.

What do you think have been the major milestones in clinical practice during your career?

There is far more insight into the impact of genetic profiling on the clinical care plan for individual patients. Immunotherapy has had a huge impact on clinical oncology but has generated a whole new cohort of patients for us as endocrinologists. Improvement in oncology patient survival has also generated a cohort of survivors who have a wide range of endocrine late effects we need to address, as well as recognising the psychological impact of their experience.

What do you think are the biggest challenges in endocrinology right now?

I think the big challenge is reconciling the need for specialisation with the need for good basic care. Endocrinologists are often committed heavily to general internal medicine and I think we’re very good at it, because our specialty is broad and our training makes us excellent problem solvers. Our specialty contribution should not be overlooked because of our general medicine contribution. And of course we need to recognise when we need expert input and when we need to step up and become that expert ourselves.

What are you most looking forward to as part of the future of endocrinology?

The increased contact with patient advocacy groups is very welcome and rewarding – that was something that we didn’t learn about as undergraduates or have much exposure to as trainees.

I’m looking forward to more recognition of our specialty by outside stakeholders – because I think that will lead to more robust funding of doctors, nurses and research by national bodies. I think we’re working hard towards that increase in profile. The more access we have to genomics and proteomics, the more I think we’ll be able to deliver an individual treatment plan for the patient sitting in front of us – I think that’s really attractive to patients and satisfying for us in our own practice.

Who has inspired you most in your career?

I have had the benefit of lots of mentors over my career. Chris Thompson supervised my MD in craniopharyngioma and I learned the importance of intellectual rigour and patient-focused intervention from him. His colleague Mark Sherlock was a peer mentor, if such a thing can be said; Mark’s value for collegiality and networking to deliver better patient outcomes has led to ongoing clinical and research collaboration today. In my time at the University of Birmingham Paul Stewart and Wiebke Arlt led by expecting the highest standards from all of us – everybody raised their game – and Neil Gittoes was a key link with the Society for Endocrinology and my career development after completing training.

Do you have any words of wisdom for aspiring endocrinologists?

Keep reading. Keep asking questions. Keep going to meetings and thinking – how does this apply to my patients? Keep talking to your patients and telling them about these new developments you’re hearing about. Keep in touch with your former colleagues and be a good collaborator. Keep an open mind, apply scientific rigour and make up your own mind.


The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!

We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.

Would you like to get involved and share your views? Simply complete this short questionnaire or send your comments to media@endocrinology.org.

Meet Early Career Nurse Committee Member, Emily Falconer

Read this interview with our new Early Career Member of the Society Nurse Committee and Endocrine Clinical Nurse Specialist at Maidstone Hospital, Emily Falconer, to find out more about her career what she enjoys most about endocrine nursing.

Tell us a little about your current position

I’ve been working in my role at Maidstone Hospital and Tunbridge Wells Trust for just over a year. My role varies from day to day – each day usually consists of dynamic function tests, running nurse-led thyroid clinics, presenting at multidisciplinary team meetings, patient steroid education clinics and chasing and interpreting results. Aside from this, I have recently joined as the Early Career Nurse Representative for the Society for Endocrinology Nurse Committee.

What inspired you to choose endocrinology as a career?

Before my current role, I was working on a busy acute medical ward specialising in gastroenterology, cardiology and endocrinology. It was here that I developed an interest in endocrinology and its vast array of conditions. I was then fortunate to take over the role of Endocrine Clinical Nurse Specialist when the position became available within my Trust.

What do you enjoy most about your work?

I love the patient interaction and enjoy being a person of contact for them if they are in need of help or reassurance with their condition. I find it very rewarding when you can see the difference in patients’ wellbeing and empowering them to manage their condition.

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

I suppose I am proud of what I am doing today! I qualified in 2016 and then worked on the wards and as a Junior Sister. I am extremely excited to work as a Specialist Nurse in a field that I have great interest in and that has many potential areas to get involved in.

Do you have research interests?

Currently I feel I am still on a steep learning curve so I am focussing on progressing and developing within my current role. However, research is definitely something I would like to explore in the future and having been involved with the Society, I have now realised the extensive opportunities and prospects within endocrine research.

How has the COVID-19 pandemic affected your work?

I have been fortunate enough to be able to continue our endocrine service throughout the COVID-19 pandemic. However my unit where I perform my dynamic function tests has been moved a total of five times during the pandemic, which has kept me on my toes! It has also meant that unfortunately I have had to temporarily postpone my learning and training at alternative Trusts.

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

Aside from COVID-19, the large amount of patients we are treating with lasting endocrine effects from the immunotherapy agents used in cancer therapy.

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

I am excited by the new prospects in the medical management of Cushing’s, such as the development of medications including Osilodrostat and Melanocortin-2 receptor antagonists.

Any advice for anyone interested in endocrine nursing?

If you would like a role which treats a magnitude of fascinating conditions and allows you to keep patient contact while making a difference to quality of life, then this a great opportunity to do all of that! I would advise to gain basic knowledge within an endocrine setting if possible. Working on an endocrine ward really helps as an introduction to the field.

Meet the 2020 Society for Endocrinology Dale Medal winner, Professor Frances Ashcroft

Our 2020 Society for Endocrinology Dale Medal winner, Frances Ashcroft, is Professor of Physiology at the University of Oxford and a Fellow of Trinity College Oxford. She will be talking about her fascinating research on ion channels and their role in insulin secretion during SfE BES 2020 Online. Find out more about her career and research and get some invaluable words of advice in this interview article.

Tell us a little about your current research

My research interests are ion channels and the metabolic regulation of insulin secretion. These two fields come together in our studies of the role of ATP-sensitive potassium channels in insulin release. I am excited to understand how the metabolism of beta cells works, and how high blood glucose levels in diabetic patients change these beta cells, so that they don’t secrete insulin anymore.

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

I did my undergraduate and graduate studies at the University of Cambridge in zoology. I then did post-docs in Leicester with Peter Stanfield and Los Angeles with Susumu Hagiwara, where I worked on calcium and potassium currents in muscle. After this I set up my own lab in Oxford and chose to study beta cells. I used a technology called patch clamping to look for ion channels closed by glucose. I was a total novice at patch clamping and I was fortunate that others helped me get started and that I got a grant to do it. I have always been led by the science and followed what I am interested in, which in my case is ion channels. I have written a popular book on this subject called the Spark of Life.

I’m most proud of the success of all the brilliant students and post-docs who have worked in my lab. It’s also been wonderful to meet some of the neonatal diabetes patients who have been helped by our work.  Andrew Hattersley and his team found that 50% of neonatal diabetes cases are due to mutations on the ion channel I had been working on for 20 years, and we were able to show that these mutations impaired the ability of ATP to close the channels and thus prevented insulin secretion. However they could still be closed by sulphonylurea drugs. This was very exciting because it enabled the patients to transfer from insulin injections to oral tablets.

What inspired you to choose endocrinology as a career?

When I was an undergraduate it was thought that electrical activity was mainly confined to muscle and nerve cells, so I remember being fascinated at finding that it also occurred in endocrine cells, like pancreatic beta-cells. When I took up an independent position at the University of Oxford, I decided to work in a field that was different from my previous one and where there were people at Oxford with whom I could collaborate. I picked beta-cells because of their interesting electrical activity and because I met Stephen Ashcroft, who was working on the biochemistry of insulin secretion. It was the start of a long and happy collaboration.

What do you enjoy most about your work?

There are three main things I enjoy most about my work. Firstly, making discoveries – there is nothing quite like the exhilaration of finding out something new. Secondly, seeing the people who have worked in my lab flourish is a constant joy.  And finally, the wonderful long-term collaborations I have had with some outstanding scientists, such as Steve Ashcroft, Patrik Rorsman, and Andrew Hattersley.

How has the COVID-19 pandemic affected your research?

Lockdown was a twofold problem because it prevented us from working in the labs. It was also impossible to keep all of our animal colonies going because of reduced staff in the animal house. We are back in the labs now, but social distancing means that we cannot work at the same intensity as normal. There’s also a constant low level of anxiety about the virus that affects everyone.

What will you be presenting during your lecture at SfE BES online 2020?

I’ll be talking about our work on the role of the ATP-sensitive potassium (KATP) channel in glucose-stimulated insulin secretion. Glucose has to be metabolised by the beta-cells for it to stimulate insulin release. This is because metabolically generated ATP closes the KATP channel, thereby triggering electrical activity, calcium influx and insulin exocytosis. I’m going to show how mutations in the KATP channel that impair ATP inhibition cause neonatal diabetes and increase the risk of type 2 diabetes. I’ll also talk about how chronic hyperglycaemia impairs the metabolic generation of ATP, reducing insulin secretion and speeding the progression of impaired glucose tolerance to full-blown diabetes, and what this means for diabetes therapy.

What do you think about the move to virtual meetings?

The biggest benefit is that you don’t have to travel – which is both good for the planet and saves a great deal of time.  Another benefit is that if the talks are posted online, you can listen to bits you’re particularly interested in again at your own convenience. This means you don’t run the risk of missing a talk because another you want to hear is scheduled at the same time. The drawback is that you don’t get to meet your colleagues in person and you miss out on those unexpected and stimulating conversations that lead to new collaborations.

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

I think this year has taught us that making any predictions about the future is very unwise, because we never know what’s going to come around the corner!

Any words of advice for aspiring endocrinologists?

My best advice is to ‘find a friend’ – a good person to collaborate with who you not only admire scientifically, but whose company you enjoy. My collaborators have supported me through the inevitable difficulties a scientific life throws at us, have celebrated with me when things went well, and are endlessly and wonderfully stimulating to interact with.

I also think it is important to do what makes you excited and follow what you are interested in. As science is a hard field, unless you love what you are doing, it is perhaps not the best career for you. I’d also recommend you remember Churchill’s advice – never, ever, give in. Perseverance gets you a long way in science.

You can hear Prof Frances Ashcroft’s medal lecture “Metabolic regulation of insulin secretion in health and disease” during SfE BES 2020 Online on Wednesday, 18 November, at 13:05-13:35 GMT. If you haven’t already, register for SfE BES Online now!

Meet our 2020 International Medal winner, David Mangelsdorf

David Mangelsdorf is Professor and Chair of the Department of Pharmacology at UT Southwestern and an Investigator of the Howard Hughes Medical Institute. His research focuses on nuclear receptor regulation of metabolism. Dr Mangelsdorf will present his Medal Lecture at SfE BES Online 2020, on Monday 16 November. Learn more about his research, upcoming presentation and career in our interview.

Tell us a little about your career

I became Chair of Pharmacology in 2006, which I inherited from Alfred Gilman, who discovered G proteins and won the Nobel Prize for it. At first I was reluctant to become Chair but then I realised that the role isn’t just about holding together a department but also mentorship and recruiting great, young talent. Here the Chair is given quite a bit of latitude, you keep the Chair as long as you want it and are doing a good job – really you are a benevolent dictator, where you make the rules but they are for the benefit of everyone.

I wanted to be able to juggle three balls, the department, my research lab and my family. Our department has a great administrative team to support me in managing the department and I run a joint lab with Steve Kliewer. We did our PhDs together and have now been working together since 2002.

What inspired you in to endocrinology?

As a graduate student I was in Mark Haussler’s lab, which discovered the hormonal form of vitamin D and its receptor. Mark Haussler was a great scientist and mentor who supported and inspired my work. I then went on to investigate orphan nuclear receptors.

What are you most proud of in your career so far?

The accomplishment of understanding the role of orphan nuclear receptors. I was involved in deorphanising several nuclear receptors.

I am most proud of the discovery of the farnesoid X receptor (FXR), as it has become an important therapeutic target for biliary cholangitis and more recently nonalcoholic steatohepatitis, a type of fatty liver disease. Our work showed how FXR affected liver and lipid biology and to see it now being developed into a therapeutic target is one of my most significant accomplishments.

Steve Kliewer and I are a team, we worked on FGF hormones together, to establish what they do. We worked out the FGF signaling pathway and showed the important role of FGF19 and FGF21 in liver function and metabolism.

Please tell us a little more about what you will be presenting during your Medal Lecture at SfE BES online 2020?

I will be focusing on how FGF21 signals from the liver to the brain to regulate metabolism and nutrient stress, which has implications for obesity, diabetes and the response to alcohol. You can think of FGF21 as a stress hormone, it responds to nutrient stress and two of its most common inducers in people are sweets and alcohol. FGF21 signals to the brain to trigger an anhedonic response – intended to tell you to stop consuming it.

If you give animals a choice between water and water with something sweet or alcoholic added, they will choose the sweet or alcohol up to a point but when FGF21 is administered they stop and return to only drink the water. However, if you knock out the FGF21 signal entirely, they not only keep drinking the sweet or alcoholic water but they drink it even more. FGF21 also encourages more water drinking, presumably to encourage hydration when consuming sugar or alcohol.

Why do you think people eat and drink to excess then?

This is more of an addictive or conditioned behavior but there is no evidence, yet, that FGF21 can affect this in people. We know FGF21 is active in the human brain and perhaps even in areas that control addictive behavior. It is possible that the human FGF21 pathway evolved to compensate for the intake of very sweet or alcoholic foods. We know that people who enjoy drinking, and who drink more, have more of a certain genetic marker in their β-klotho gene than teetotalers. β-klotho is a co-receptor for FGF21. This may have evolutionary significance as alcohol is a natural preservative and there was an evolutionary advantage to having a little alcohol in things like water, to prevent disease. When you start drinking, you might like a sip of beer or wine but would hate stronger alcohol like vodka. People condition themselves to drink more as they get a buzz from it.

Could the FGF21 pathway have therapeutic applications for obesity and alcoholism?

There are very few things known to limit the intake of sugar and alcohol in humans, so there is potential therapeutic value in FGF21 but this needs much more investigation. However, human genetics do point towards a role for FGF21 in overdoing alcohol and sugar consumption.

How has the COVID-19 pandemic affected your research?

Significantly, I think like everyone else it has set us back. We thought it would be just 2 weeks lockdown back in March but even now we are not back to full working capacity. We do a lot of animal work, so we couldn’t do anything. Our long-term studies using animal models had to be stopped and that meant we had to cull colonies. So when we came back we needed to restart everything – in some studies it has set us back as much as 6 months to a year.

The other problem is the inability to interact directly with other people, either in a laboratory or at conferences.

What do you think about the move to virtual meetings?

Doing virtual talks is a terrible experience in my view, it is so artificial and the technology isn’t quite up to par yet. You really miss the human interaction.

The only benefit is saving money on travel and being able to be present at meetings you might not have been able to attend. I’ve enjoyed being at home with my family but do miss interacting with colleagues directly.

What do you enjoy most about your work?

Well, before COVID-19, I enjoyed interacting with the lab – I have an open door policy. I enjoy the element of discovery, I like to be inspired, to take bold steps, not to be afraid to ask a big question, and to go in new directions. I love learning about new areas, we have just started working in neurobiology.

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

Specifically in my work it is the complexity of the central nervous system. It takes a long time to do thorough and careful investigation in the brain.

More generally, the lack of funding makes it difficult to take risks and move the field forward. Investigating new areas, defining new pathways and developing new models needs a lot of funding and a lot of time.

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

To demonstrate whether FGF21 and FGF19 are viable therapeutic targets. When looking at treatments that are given long-term, there will always be problems. All drugs have side effects but the longer you are exposed to them the more likely adverse effects may occur. We need to establish if these targets are good for designing new treatments. Deciphering the neuroendocrine circuits of metabolism and behaviour is ongoing and will be key to establishing new therapeutic targets.

Any words of advice for aspiring endocrinologists?

You have to ask a big question to answer a big question. Don’t be afraid, if you want to make a difference, you have to take risks. As long as you are asking an important question, you are going to learn something – you shouldn’t spend time trying to put a round peg in a square hole, whilst losing sight of what the science is telling you.

For example, we were trying to find the ligand for a different nuclear receptor when we discovered the one for LXR. The graduate student had used a negative control that came up positive in her experiment. She was distressed that her experiment had failed but in fact she had inadvertently found the LXR ligand.

In the spirit of the times, my advice is that you should practice safely masking your face, but not your science!

You can hear David Mangelsdorf‘s Medal Lecture “FGF21 and Nutrient Stress: Eat and Drink, But Don’t Get Too Merry” on Monday 16 November at 13:40 GMT. If you haven’t already, register for SfE BES Online now!

Meet our 2020 Clinical Early Career Prize Lecture winner, Dr Steve Millership

Dr Steve Millership, Research Fellow at Imperial College London, is one of our 2020 Early Career Prize Lecture winners. His research focusses on the beta cell epigenome and the impact of diet on beta cells and he will be giving his lecture “Tracking of imprinted gene hypervariability and diet-induced deregulation in pancreatic beta cells” at SfE BES 2020 Online on Tuesday, 17 November. Read this interview to find out more about his talk and get some expert advice on how to become a successful scientist.

Can you tell us a little about your career, research and an achievement you are proud of?

I started my career in metabolic energy homeostasis and cell biology and have always been fascinated with it. I did my PhD in Cardiff University and moved to the London Institute of Medical Sciences to complete a post-doc on imprinted genes and modelling diabetes in mice. In the last year or two I have been writing grants and fellowships, as well as doing a short term fellowship with the Welcome Trust at Imperial College London to continue exploring the modulation of the beta cell epigenome and the effect of diet on beta cells in diabetes. I had been in this position for about 2 months and in the transition phase of getting set up on my own, before the pandemic started.  

A proud moment for me was winning the Early Career Prize Lecture – very exciting and unexpected! I would have originally said my proudest moment was when my first paper was accepted, but that has now been overshadowed by winning this award.

Can you tell us a little more about what you will be presenting at SfE BES Online 2020?

There are two main angles to my talk. The first is that beta cells are not all equal and a small percentage are doing different jobs to the rest. This is important to help understand how they secrete insulin as a whole islet. The model I created has the ability to image imprinted gene expression longitudinally and you can look at individual cells and analyse them. The second part to my talk is about how the diet can deregulate and alter expression of beta cell genes, which could explain why diet is so essential to beta cell function.

How has the COVID-19 pandemic affected your research?

I didn’t go in to the lab for six weeks and have mostly been grant and application writing at home, so it has been good to have the opportunity to do that and make lockdown feel more productive. In our lab we have had restricted occupancy so there is only ever 5 people in the lab at a time. This means you don’t get the same lab environment, as everyone just gets on with their own thing and as everyone is so spread out, there is little socialising. However one benefit I have noticed is that my efficiency and organisation levels gone through the roof, as you have to make the most of limited time in the lab. I’m not usually an organised person so that is one thing that has changed for the better!

What do you enjoy most about your work?

I’ve always really enjoyed having hypothesis driven conversations and not knowing what is to come is exciting. I find it really interesting solving mysteries and working on something that has a high impact on human health.

What do you think about the move to virtual conferences?

I went to two conferences in the last month and I found having everything laid out in front of you provides an opportunity to focus on certain bits that are beneficial to you in more detail, and you can go to more talks than in person. Another benefit is having access to conferences you wouldn’t usually go to as there is no need to travel, which can be expensive.  However a major drawback of online meetings is not having as much opportunity to network with other attendees. Sometimes talking with other people you can find out valuable bits of information or find better opportunities to collaborate.

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

One of the biggest challenges in beta cell biology is determining what the best method to treat diabetes is – there is always the divide between advancing beta cell function, or reducing insulin resistance. We always had the belief that efficiently functioning pancreatic beta cells is better for diabetic patients and saving beta cell function is a better option, but it is hard to decide which pathway is most effective as there are still things we don’t fully understand.

What advice would you give to aspiring endocrinologists?

One piece of advice I would suggest is, when you are writing grant or fellowship applications, give yourself time and let your ideas develop. You ideally need to give yourself between 6-12 months and write them as you go along, getting feedback from talks and people from the field.

My PhD mentor gave me a couple great pieces of advice which I didn’t expect to be so helpful.  She said to make sure you have got at least one main paper coming out of your post-doc which you can call your own, and also to get on with people! It’s difficult to achieve anything if you aren’t collaborative and you don’t get anywhere by keeping your experiments to yourself and not getting help or feedback. You need to be open to ideas and having your work critiqued and then take that feedback on board.

You can hear Dr Steve Millership’s lecture “Tracking of imprinted gene hypervariability and diet-induced deregulation in pancreatic beta cells” on Tuesday, 17 November at 15:55 GMT. If you haven’t already, register for SfE BES Online now!