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.

 

 

Meet the Endocrinologist: Jeremy Turner, expert in bone and calcium endocrinology

Prof Jeremy Turner is a consultant endocrinologist at Norfolk and Norwich University Hospitals NHS Foundation Trust. He has a particular clinical interest in calcium and metabolic bone disorders and is a convenor of the Society’s Bone and Calcium Endocrine Network.

What inspired you into endocrinology, and bone and calcium in particular?

I was fortunate enough to undertake my early postgraduate training in endocrinology at the (then) Royal Post Graduate Medical School/Hammersmith Hospital in the mid-1990s, where I worked with some inspirational colleagues in the bone and calcium field. I then went on to undertake an MRC clinical training fellowship in Raj Thakker’s lab in Oxford. The latter experience firmly cemented the place of calcium and bone endocrinology in my endocrine repertoire.

Can you tell us a little about your current work?

I have been consultant endocrinologist for the last 9 years in Norwich and was more recently promoted to honorary professor at the Norwich Medical School. I run the clinical metabolic bone/calcium service in Norwich with my great friend and colleague Professor Bill Fraser. We have established a good reputation for our clinical service and referrals come in from far and wide. We provide over 120 consultant delivered lists per annum and have succeeded in getting Norwich recognised as a Paget’s Association Centre of Excellence.

Historically, bone and calcium disorders have been somewhat “Cinderella” conditions in the wider context of endocrine services and I particularly enjoy advocating for this population of patients and developing services in this area. I am medical advisor to Hypopara UK and of course promote the charity and its work to our large population of hypoparathyroid patients. I have led the writing of a number of clinical guidelines including a post-operative hypocalcaemia avoidance and management guideline, have developed services such as a one-stop osteoporosis clinic and am currently working with colleagues in Cambridge to set up a rare bone disease network in the East of England. Naturally, the achievement I am proudest of is being appointed as a network convenor for the Bone and Calcium Endocrine Network of the Society for Endocrinology!

Over the last decade or so, what do you think have been the most useful/impactful advances in bone and calcium?

As a pure endocrinologist, the single most exciting advance has been the arrival of recombinant human parathyroid hormone (PTH) for the treatment of hypoparathyroidism. Finally, clinical endocrinologists now have a “full set” of replacement hormones to use in hormone deficiency states and this day has been a long time coming. However, no answer to this question would be complete without reference to the arrival of the many new therapies for osteoporosis and perhaps, as importantly, the expansion in understanding of treatment of osteoporosis that has occurred in recent years. This has included appreciation of risks of treatments as well as benefits, how to use the different therapies, where they fit in relative to each other, the growing use of bone markers, fracture risk calculators and so on – all of which are driving more nuanced, considered and targeted clinical approaches to treatment of osteoporosis.

What do you think are the biggest challenges faced by endocrinologists?

In my opinion, the biggest challenge faced by all endocrinologists has to be management of remorselessly growing demand. The population is expanding and ageing and at the same time more treatments are available across endocrinology. Awareness is growing amongst patients and general practitioners and thus referral rates are rising. This is a good thing, it means that our specialty is able to help more and more people for whom perhaps help was not always available in the past and also means that the place of endocrinology in clinical medicine as a whole is better recognised and appreciated. However, it is up to us to manage this demand, find new ways to see and treat as many people as possible and to modernise aspects of our practice. Not changing how we work is probably not an option!

Are there any controversies in bone and calcium endocrinology?

Of course there are many controversies but one of the greatest at the moment is probably the recent recognition of the end-of-treatment effect of anti-RANK ligand therapy whereby fracture rates may rise quite fast in some patients upon withdrawal of this therapy. This is a very pressing clinical challenge as numbers on this exciting and novel treatment are quite large, we have been using this for a period of time that means that some are already arriving at what was originally intended to be the end of treatment but now we know that simply stopping the treatment is probably not the best option for many patients. At the same time, there is a relative lack of evidence base to inform us with regard to what we should be doing next. While it is helpful that some guidance is beginning to emerge, this is largely based on expert opinion and it will be very interesting to see how this controversy unfolds over the next few years.

What do you enjoy about being an Endocrine Network convenor?

 So far it is early days but I am enjoying working with my co-convenor (Caroline Gorvin), with colleagues in the society and am looking forward to playing my own very small part in further raising the profile of bone and calcium medicine and research within endocrinology.

Do you have any words of wisdom for aspiring endocrinologists?

Yes, this is perhaps the easiest question; Enjoy your endocrinology! If you are enjoying your clinical practice you will be happy and more importantly your patients will be happy, correctly diagnosed and correctly treated.

 

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.

Meet the Endocrinologist: Dr Barbara McGowan, expert in obesity and bariatric surgery

Barbara McGowan is a consultant in diabetes and endocrinology at Guy’s and St Thomas’ in London, and a convenor of the Society’s Metabolic and Obesity Endocrine Network. Dr McGowan leads the obesity bariatric service at the hospital and her areas of research interest include gut hormones and remission of type 2 diabetes post-bariatric surgery.

What inspired you into endocrinology?

My initial biochemistry degree was inspired by a wonderful chemistry teacher. I had considered medicine at that time but the thought of a further five years in higher education was enough to suppress those feelings. I then tried my hand at selling my soul to the city and five years as an investment banker was enough to rekindle my spirit and courage to go to medical school. My love for molecules and metabolism made endocrinology an easy choice for me. I was lucky enough to stumble across Prof Meeran and Prof Bloom during my SHO years, who steered me towards a PhD in gut hormones and appetite control, which was supported by an MRC clinical fellowship. In 2009 I took a consultant post at Guy’s & St Thomas’ where I was tasked with developing a leading obesity service from scratch.

Tell us a little about your current clinical work

My work involves management of general and complex endocrinology, with a focus on hereditary endocrine disorders such as SDH disease and multiple endocrine neoplasia. As a lead for the medical obesity service, I also run a Tier 3/Tier 4 obesity service. My clinical research involves the running of several clinical trials on pharmacotherapy and metabolic surgery for the treatment of obesity. I am most excited about trying to understand mechanisms for weight loss and remission of type-2 diabetes post-bariatric surgery.

What do you think have been the most impactful advances in obesity and metabolism clinical practice?

From a clinical point of view, with the exception of metabolic surgery, we have had very little in terms of clinical advances for the treatment of obesity, which is quite surprising given that we have an epidemic of this disease. We have medication coming through but this is still not available in the NHS.

What do you think will be the next big breakthrough for treatment of obesity?

I am hoping that we will soon have much more effective pharmacological treatments that will include more powerful GLP-1 agonists and gut hormone combination therapies, to replicate outcomes from bariatric surgery, but without the surgery. The aspiration is to have better molecular markers that will help us to select patients likely to respond to different therapies.

What do you think are the biggest challenges faced by your clinical specialty?

Attracting high calibre trainees is big challenge. Endocrinology used to be considered an academic specialty, however service provision in NHS Trusts has become a burden that has detracted from the specialty. Furthermore, physicians wishing to pursue an academic career face funding challenges.

Are there any controversies in your practice area? How do you think they will be resolved?

Stigma regarding obesity is still rife, we need to educate the public, media and healthcare professionals and recognize obesity as a chronic disease. Until such time, prevention and treatment of obesity is unlikely to be prioritised.

What do you enjoy about being a Network convenor?

As a convenor, I am able to push the obesity agenda to help ensure it is well represented at SfE meetings. I was able to set up an annual Obesity Update conference at the Royal College of Physicians, and now run by Bioscientifica. The Network makes you part of an obesity family and allows like-minded people to get together and collaborate. Recently, I was able to use the Network to ask for opinion and support as to whether ‘Obesity should be recognized as a disease’. I would urge all members interested in obesity to join the network.

Do you have any words of wisdom for aspiring endocrinologists?

Endocrinology is a wonderful specialty, it spans many important organs and provides a diagnostic challenge for disease management. Do not be put off by the uncertainties and go for it! Speak to your mentors, friends and colleagues for advice, it is a friendly community. And for those interested in obesity as a specialty, sign up to the Network and I look forward to speaking to you!

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.

 

 

 

Meet the Endocrinologist: Prof Kevin Murphy, expert in central control of metabolism

Kevin Murphy is Professor of Endocrinology & Metabolism at Imperial College London and a convenor of the Society’s Metabolic and Obesity Endocrine Network. His research focuses on the role of the hypothalamus in the control of energy homeostasis and reproduction, and in this interview he tells us more about his research and career.

What inspired you into endocrine research?

I moved to London with a BSc in Zoology and Physiology, and for three months, applied for every job in London that needed a BSc but no experience. I was lucky enough to have an argument about what killed off the dinosaurs with an interviewer in the Endocrinology Unit at Imperial College that we both enjoyed, and was given a technicians job. Over the following year, I realised that I was really interested in how hormones influenced behaviour, especially feeding behaviour. And it’s been downhill ever since…

Tell us a little more about your current research

I’m interested in how the gut senses macronutrients, and in particular protein, to regulate appetite and metabolism. I’m excited about using approaches such as metabolomics to investigate how foods are detected to change food intake – for example, comprehensively measuring the changes in the thousands of different metabolites produced in the gut following digestion of a particular food, and investigating how they might drive gut hormone release.

What do you think will be the next big or important advances in metabolic research?

The use of genome-wide association studies to identify and establish novel causes of obesity have really advanced the field. Linking big genetic data to the physiological effects of the genes will be important to further advance the field.

The explosion of information on the role of the microbiome in energy homeostasis and metabolism is also having a great impact, as are new tools for manipulating endocrine cell function. I think establishing reliable pharmaco- and optogenetic method equivalents for endocrine cells will be a big breakthrough in metabolic research.

What do you think are the biggest challenges faced by academic science?

Convincing an increasingly disillusioned public that there might be an objective truth behind particular issues is a big challenge for all scientists.

For newcomers to scientific research, I think it is hard to establish a career. To get a PhD studentship these days, you need to have been polishing your CV from the age of 13. And then there aren’t a lot of academic jobs to go for when you are a post-doc.

For older researchers, funding and juggling different aspects of their job makes it difficult to maintain a career over the long term.

What do you enjoy about being a Network convenor?

It’s nice to hear from other Network members at the meetings, and to maintain the profile of obesity and metabolism at the annual SfE BES conference.

Do you have any words of wisdom for aspiring endocrinologists?

I’m not sure how wise they are…but think about what evidence you have on your CV to show you can do certain things (attract funding, teach, manage a project) and try to get some experience if you don’t have any. Get a feel for how the science funding system works, as this is really helpful later in your career. Make sure you enjoy the work, otherwise there are lots of other fulfilling careers you could probably pursue with less effort. Join the Society for Endocrinology…

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.

Meet the Endocrinologist: Dr Scott MacKenzie, expert in adrenocortical biology

Scott MacKenzie is a lecturer at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow. Dr MacKenzie’s research focuses on adrenocortical production of the steroid hormones, aldosterone and cortisol, and investigates how genetic variability can affects their involvement in causing high blood pressure. In this interview, he tells us more about his research, career path and his role as an Adrenal and Cardiovascular Network convenor.

What inspired you into endocrinology, and why adrenocortical research in particular?

I got into endocrine research by chance. I was studying for an undergraduate degree in genetics at the University of Glasgow in the mid-90s and a lecturer happened to mention that any students interested in a summer research project should go and see John Connell. Everything came from that. Professor Connell, alongside Robert Fraser and Eleanor Davies, was particularly interested in aldosterone secretion by the adrenal gland and the genes that regulated it. At that time, there was also emerging evidence that other tissues including the brain were making aldosterone, so I was set to work on that through a Society for Endocrinology Summer Studentship. Unfortunately, the 8-week project went extremely smoothly, generating some nice data and giving me completely unrealistic expectations of scientific research! On the basis of this, I was then offered a PhD project in the same lab devoted to investigating extra-adrenal production of aldosterone in the rodent brain. I continued researching in this area, but over the years, I came to the conclusion that extra-adrenal production of aldosterone is unlikely to be of any physiological importance in humans. Fortunately, new questions were starting to be asked around adrenal secretion of aldosterone and I was able to apply the methods I had developed to that area. Now I am involved in projects that cover several aspects of this, with particular interest in how secretion can become dysregulated or excessive, as in primary aldosteronism (PA).

Tell us a little more about your current research?

I’m currently involved in various projects examining aspects of aldosterone secretion, which I think is an interesting and important field of endocrinology that has an impact on the cardiovascular health of large sections of the population. My current work includes aldosterone regulation by microRNA, analysis of common genetic polymorphisms that might predispose large sections of the population to PA (and therefore hypertension), and the identification of circulating biomarkers that might aid in the earlier and more accurate diagnosis of different forms of endocrine hypertension. The things I tend to be most proud of are the little bits of problem solving that arise in the course of lab work. I was quite pleased with a slightly obscure method I developed to confirm the unequal expression of two different forms of the highly similar CYP11B1 and CYP11B2 genes.

What do you think will be the next big or important breakthrough in adrenocortical research?

The discovery that the majority of aldosterone-producing adenomas contain mutations at one of just a few key genes encoding ion channels was really a big breakthrough that advanced our understanding of the pathophysiology underlying the majority of PA cases. At the same time, improvements in diagnostic testing for PA are revealing it to be far more common than we had previously thought. I think this will lead to a redefinition of PA to some extent, as we identify mechanisms that result in aldosterone hypersecretion under certain environmental circumstances or in certain sections of the population who are genetically predisposed to respond in this manner. Ultimately, this could result in better diagnosis and more targeted treatment for endocrine-related hypertension.

I’m currently very interested in the impact of environmental and physical stress on aldosterone secretion. The hypothalamic-pituitary-adrenal axis has long been thought to regulate aldosterone secretion in a very limited manner, but recent clinical studies suggest a sizeable minority of hypertensive individuals react to stress by producing high levels of aldosterone. Understanding what predisposes these people to respond in this manner is, I believe, of great importance and could have major implications for how we react to stressful situations in everyday life and its impact on our cardiovascular health.

What do you think are the biggest challenges faced by academic research?

I think the greatest challenge in current scientific research doesn’t apply to any one field but to us all. That is how we ensure that young researchers­­ coming through – particularly basic scientists – have a viable and stable career structure that enables them to progress and thrive in an academic environment. A lot of time, money and training is being invested in these people, but too many are being lost to science as they become disenchanted by successive short-term contracts and the uncertainty surrounding a career in scientific research. I think it is incumbent on older scientists to recognise just how much the career prospects and funding structures have altered in recent years, and to use whatever influence we have to push for greater early career support at institutional and national levels.

Are there any controversies in your research area? How do you think they will be resolved?

There are certainly controversial areas in my field; some may argue with my opinion that extra-adrenal aldosterone production in humans is of no importance. Others (if the comments on my recent grant proposal are anything to go by) will disagree with my assertion that stress is an important factor in aldosterone secretion. But, ultimately, any scientific disputes will be resolved as they have always been: by well-designed and well-executed experimental study.

What do you enjoy about being an Endocrine Network convenor, and how do you think it may benefit others?

I think that Endocrine Networks have tremendous potential to provide opportunities for researchers, particularly those in their early careers, by enabling them to gain supportive and informed advice from more senior members. I hope we are able to build a vibrant online community that is complemented by ‘real-life’ meetings, such as the Research Incubators at the SfE BES 2017 conference, which proved an excellent forum for researchers to get feedback on projects under development. Ultimately, the success of these initiatives depends on its participants, so I would urge all members in relevant areas of research to sign up to a network and get involved.

Do you have any words of wisdom for aspiring endocrinology researchers?

Although I think opportunities are harder to come by now than they were in ‘my day’, young researchers can still distinguish themselves from their peers in the same ways. That means taking every opportunity to make themselves known to prospective employers and supervisors (the dreaded ‘networking’) while at the same time not being too discouraged by the high number of rejections that almost inevitably follow. It also means exploiting opportunities that organisations like the Society for Endocrinology make available to them, such as Travel Grants, Early Career Grants and Career Development Workshops. Applying for these or getting involved with the Networks or the Early Career Steering Group can be an excellent way to develop your research and get your name known in endocrine circles.

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.

Meet the Endocrinologist: Professor Franks, expert in reproductive biology and medicine

Stephen Franks is Professor of Reproductive Endocrinology at Imperial College Faculty of Medicine and Consultant Endocrinologist at St Mary’s and Hammersmith Hospitals, London. Prof Franks’ clinical and laboratory research focuses on the hypothalamic-pituitary-ovarian axis, with a particular interest in polycystic ovary syndrome. In this interview, he tells us more about his research, current challenges in reproductive endocrinology and his role as a Reproductive Endocrinology and Biology Network convenor.

What inspired your passion for endocrinology, and reproductive endocrinology in particular?

As a young medical registrar with no experience of research, I was offered a research fellowship to study the physiology and pathology of prolactin (my supervisor and mentor was Howard Jacobs whose enthusiasm was contagious). It was an exciting time for prolactin research because measuring prolactin in blood was new. Radioimmunoassays for prolactin were problematic and I had to set one up from scratch that enabled us to show that hyperprolactinaemia was a common cause of amenorrhoea. The project got me hooked on endocrinology, and reproductive endocrinology in particular, so I carried on to train in internal medicine and endocrinology before finding the ideal clinical academic staff position, which I have held ever since.

Tell us a little more about your current position and work?

As Professor of Reproductive Endocrinology, my clinical practice focuses on reproductive endocrine problems with strong collaboration among my gynaecological colleagues. My main research goals for the last 30 years have focused on trying to unravel the complexities of both reproductive and metabolic problems of polycystic ovary syndrome (PCOS). This has involved clinic-based studies, epidemiological studies and lab-based studies, using human ovarian cells and animal models. My lab-based studies are jointly led with my colleague Professor Kate Hardy, a reproductive biologist.

Over the last decade, what do you think have been the most significant advances in reproductive endocrinology research or clinical practice?

There are many, including the discovery of the importance of the neuroendocrine signalling relay that impacts on gonadotropin secretion, notably the role of kisspeptin, neurokinin and dynorphin neurones. In the area of PCOS research, new data emerging from genome-wide association studies have given us clues to the genetic basis of this complex endocrine disorder.

What do you think has been the most surprising discovery in the field over the last decade?

Discovery, in the mouse at least, that anti-Mullerian hormone (AMH) has receptors in hypothalamic neurones, and can affect secretion of gonadotropin-releasing hormone (GnRH). For many years, it was thought that AMH was simply a local hormone, produced by the Sertoli cells of the testis, that played a key part in differentiation of the male reproductive tract. However, much more recently, AMH was also found to be synthesized and secreted by granulosa cells of the ovary, and has since been widely used as a clinical marker of ovarian follicular reserve. So, the report, by Dr Paolo Giacobini and colleagues in Lille, that this hormone has specific receptors in the mouse hypothalamus and that AMH has a profound effect on GnRH secretory activity was, to say the least, unexpected. The relevance of these findings to human physiology remains to be seen but perhaps we should not be too surprised, given that related gonadal growth factors, such as inhibins and activins, also have actions on the hypothalamic-pituitary axis.

What clinical advances do you think could make a difference for patients affected by reproductive health conditions in the near future?

I would hope that understanding more about the genetic basis of PCOS, particularly differences in genotype between individuals, will lead to more specific and effective ways of treating PCOS, rather than (the nevertheless important) management of symptoms.

What do you think are the main challenges faced by your clinical specialty?

There is a shortage of endocrinologists with a special interest in reproductive endocrinology. This is partly because not all endocrine training programmes offer sufficient experience of this sub-specialty.

Are there any major controversies in your practice area?

One good example is whether PCOS is a risk factor for cardiovascular events. Women with PCOS have risk markers for cardiovascular disease but do they actually have more heart attacks? We lack long-term, longitudinal studies on this, and therefore it would be wise to consider appropriate screening for cardiovascular risk factors in women with PCOS (including cholesterol, lipid and lipoprotein measurements), especially if they are obese. Despite the lack of definitive information about cardiovascular events in women with PCOS, it seems sensible to advise women with PCOS about the importance of diet and exercise to reduce the risk of cardiovascular disease.

What is the most unusual part of your work?

As a reproductive endocrinologist, much of my work and research centres around problems related to reproductive health and ovarian disorders. That naturally means that I have close links with my gynaecological colleagues and, for example, we ran a joint infertility clinic, albeit with a focus on induction of ovulation. Much of my research is laboratory based and, in that area, my long-term collaboration with my reproductive scientist colleague, Professor Kate Hardy, plays an important part. We jointly run our research group and the interaction between clinical and basic scientists is an important aspect in both research and training.

What do you enjoy about being a Reproductive Endocrinology and Biology Endocrine Network convenor, and how do you think the Network can benefit others?

The network facilitates interdisciplinary research through meetings in reproductive endocrinology and biology, using joint sponsorship from the Society for Endocrinology and the Society for Reproduction & Fertility (SRF), by providing a platform for collaborative research. Andy Childs and I (together with Kate Hardy) are currently putting together a programme of international speakers for a meeting on growth factor signaling in the ovary, to which the Society has contributed a meeting grant. An important feature of our Network is that it also involves input (both intellectual and financial) from the SRF, and we shall also be seeking involvement from them. Also, in planning, is another meeting of ReproSouth (again, jointly with SRF), an informal event where students and post-docs (from the Midlands and Wales, as well as London and the South) are encouraged to present work in progress (scheduled for June, this year). Ahead of our next Network meeting at SfE BES 2018 in November we will be canvassing topics for collaborative research across centres in the UK.

Further details on the ReproSouth meetings can be obtained from Stephen Franks and Andy Childs directly.

Do you have any words of wisdom for young endocrinologists out there?

Whether you are planning a career in academic endocrinology, clinical practice or related pathways, there is no substitute for the experience and excitement of being involved in a research project. My own experience of being introduced to research as a very junior physician is that it opened up a completely new way of thinking. So, whether you stay in research or not, it allows you to approach problems in a unique way. And, despite the trials and tribulations, the rewards of a career in academic endocrinology are many, including the privilege of being part of a national and international “family” of colleagues and friends.

The Endocrine Networks are platforms for knowledge exchange and collaboration amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses. The Networks enable members to discuss and find solutions to challenges within their specialist field.

To join an Endocrine Network login to the ‘My profile’ section of the Members’ Area and select ’Endocrine Networks’.

 

 

The conference that stirred my scientific passions (and got me a cool mug!)

What to expect from SfE BES as an Early Career researcher / medical trainee

Scientific conferences are not just an unparalleled opportunity to dive deeper into what’s going on in your specialty. Much more importantly, they are where the little things – the random encounters, the unexpected conversations that can lead to career turning points happen. Do you remember, or can you imagine, the nervous expectation, the excitement -perhaps a tinge of bewilderment- of being there for the first time?

Matthew Sinton, PhD student in Cardiovascular Science at the University of Edinburgh attended his first ever scientific conference, SfE BES, in November 2017. Read how the experience saw him equipped with a sense of purpose, and a taster of what the endocrinology community can do for his career (and could do for yours too, if you’re an SfE BES newbie!).

Amongst the multitude of questions whirling around in my head when I started my PhD, there was one I never realised would be so important: which societies should I join? The first one recommended by my supervisor was the Society for Endocrinology, so I did my due diligence – I found out what the role of the Society was, and how it could support me throughout my PhD and my career beyond.

One of the first opportunities that I came across was the Society for Endocrinology BES Registration Grant, which is available to trainee scientists, as well as others trainees and students, and covers the cost of conference registration. The aim of the grant is to enable those who are still choosing their career paths, or are new to the field of endocrinology, to attend and hear the latest basic and clinical research in the field, and to network with both peers and experts. A few weeks after a straightforward, painless application process, I received an email confirming my award of the grant. While I was delighted about it, I also felt a little nervous – this was my first ever conference but I wasn’t presenting anything, and although I knew a few people who were also attending, they would be busy with poster presentations and meetings. How could I make use of all that spare time to wander around by myself?

As I made my way, on the train from Edinburgh to Harrogate (where the conference was being held), still feeling somewhat apprehensive, I read the conference programme again, and got my notebook out so that I could make a list of things that I would like to see. As I put this list together, a feeling of excitement overtook my nerves – there were such a range of different topics, including engaging with the media, cancer metabolism, food taxation, and alternative career paths. Thinking about opportunities for people at my same career stage, I also made a note to check out the Early Career Lounge.

Once in Harrogate, and too early to check into my hotel, I headed straight to the convention centre. I quickly registered and made my way to the main exhibition hall to see all the posters and exhibition stands. It was still very quiet, so I joined the coffee queue, with the intention of enjoying my caffeine kick whilst looking at the posters in more detail. To my surprise, however, a collaborator who I had not yet had the opportunity to meet in person, joined the queue behind me, and we got chatting. This chance encounter made me feel far more at ease, and afterwards I took the time to wander around. I stopped to check the posters I thought I would be most interested in, then headed to my first talk of choice, on engaging with the media, by Giles Yeo. Like most of the talks that I attended during the conference, it was insightful and engaging, and I really enjoyed being able to listen to experts in their respective fields discussing science and endocrinology from so many different perspectives.

The first evening of the conference I went to the Early Career Quiz, where I had been assigned a seat with people from my home institute, including other postgraduates and PIs. Although I’d seen the other postgraduates around the university, I’d never had the chance to talk to them, so this was a brilliant opportunity to get to know each other better and find out about the projects that everyone was working on. To our (brief) dismay, we didn’t do that well in the quiz, finishing slap-bang in the middle, but it didn’t matter – the evening was so much fun! That night I went back to my hotel feeling exhausted, but still managed to spare some energy to plan my next day.

The following morning, after a quick breakfast and a coffee, I walked back to the convention centre and went straight to the Early Career Lounge, to find out more about the Society and what was on offer in terms of career development. Whilst I want to stay in academia after I finish my PhD, I’m realistic enough to know how competitive it is, and that I need to develop additional skills away from the bench. At the Lounge I spoke with Matt Grant, the Society Careers and Engagement Officer. We chatted for quite a while, about opportunities within the Society, and about what I thought the Society could do to further support people at my career stage. At the end of our chat, I was feeling excited about the various events that I could attend, and Matt promised to email me with any opportunities that arose (which he did). The icing on the cake was, of course, the free Society for Endocrinology mug that I got after our chat…!

I would encourage anyone to apply for the Society for Endocrinology BES Registration Grant and attend this conference, as it really is a fantastic experience. I learned about areas of science that I would otherwise have missed, and met people that I would not normally have the opportunity to meet, including those from the institute that I’m based at! I’m really looking forward to staying involved with the Society, throughout my PhD and beyond!

 

Do you want to know more about Matthew’s unusual career path? Read how quitting his first PhD led him to refocus his career on endocrinology here.

Meet the Endocrinologist: Dr Carel le Roux, Consultant in Metabolic Medicine and Obesity Update speaker

Meet Dr le Roux, Consultant in Metabolic Medicine at Imperial College London and Chair of Experimental Pathology at University College Dublin. During his career, he successfully established an independent research group and has been an important influencer in the field of metabolic medicine. His research focuses on diabetes and obesity, specifically the increased morbidity and mortality associated with these conditions.

Dr le Roux will be speaking at Obesity Update 2018, in the debate ‘Will metabolic surgery replace pharmacotherapy for the treatment of type 2 diabetes?’ Ahead of the event, we interviewed him to find out more about his career path, research interests and his position in the upcoming debate.  

 Q: Tell us more about your background and career highlights so far?

I am a metabolic medicine physician with an interest in obesity; specifically in how bariatric surgery and pharmacotherapy can improve patient outcomes.  I graduated from the University of Pretoria and completed my specialist training in Metabolic Medicine at St Bartholomew’s Hospital and Imperial College. I was awarded a Wellcome Clinical Research Fellowship and completed my PhD at Imperial College. I then received an NIHR Clinician Scientist Award, which enabled me to set up the Imperial Weight Centre, and was then offered a Chair at the Diabetes Complications Research Centre at University College Dublin. The proudest moment of my career was receiving the President of Ireland Young Research Award at Áras an Uachtaráin.

Q: What are you currently working on?

My research investigates using a combined approach of bariatric surgery with pharmacotherapy to reverse the complications of diabetes. We are aiming to treat people with diabetic complications, e.g. diabetic kidney, renal, neural or cardiovascular disease, with both surgery and medication to put these symptoms into remission and stop the development of the disease.

Q: What most excites you about your work and the contribution you can make?

I am most excited about the opportunity to hear what obese patients report about their disease, and applying this knowledge together with basic and clinical science to pursue these symptoms and understand the mechanisms of obesity. I am also excited about the progress we have made in the field; for example, the discovery that obesity is a subcortical brain disease opens up new treatment options, while also reducing the discrimination that patients suffer.

Q: The theme of the 2018 Obesity Update debate is whether surgery is more effective than pharmacotherapy in the treatment of type 2 diabetes. Can you tell us why there is a difference of opinion on this?

Until recently, bariatric surgery – that is gastric by-pass or sleeve surgery – was not considered to be a viable treatment for patients with type 2 diabetes. However, a systematic review of 11 randomised controlled trials, published in 2013, showed that those who undergo surgery do better and outperform patients on pharmacotherapy for weight loss, glycaemic and blood pressure control. This, of course, has great implications for type 2 diabetes patients.

Given the aforementioned trials and their results the question becomes: should every type 2 diabetes patient be offered surgery as a treatment? However, the issue here is not really whether or not we should use surgery – but if and when bariatric surgery is the best strategy to follow.

Q: You will argue that surgery cannot replace pharmacotherapy but, if surgery is so successful, why not?

The main issue is that not all patients with diabetes are the same – the risks of morbidity or diabetic complications are extremely varied and thus, their treatment options should accommodate these differences and find a balance between the risks and gains of bariatric surgery vs. pharmacotherapy.

Although the risks associated with surgery are very low, they still aren’t as low as those associated with medication. Considering this, patients at high risk of diabetic complications for whom best medical treatment is not sufficient may hugely benefit from surgery. On the other hand, for those patients who respond positively to pharmacotherapy there is little value in offering surgery as well.

Additionally, we must not forget that pharmacotherapy is constantly improving. Due to such advances, if we had a randomised controlled trial today that compared outcomes between surgery and medical care, it would be very difficult to imagine that surgery would have any additional benefits beyond best medical care when it comes to mortality. We’d love to say that if you have an operation you’re going to live longer but we simply don’t have that evidence. However, we do have evidence to say that using drugs, such as a sodium-glucose co-transport inhibitor or a GLP-1 analogue, will help diabetes patients to live longer.

Q: In your opinion, when would bariatric surgery be appropriate?

We should offer surgery when it adds value to the patients – helping them to lose weight, and achieve better glycaemic and blood pressure control – and to facilitate the work of diabetologists that treat these patients. It’s not about surgery against medicine, it’s about how surgery can make medicine better. This is precisely what’s done in cancer therapy – we use surgery to control the disease, then chemo or radiotherapy to keep it in remission. We don’t expect surgery to be sufficient on its own – after surgery we still follow the patient and make sure to control all the other consequences of the surgery.

In summary, the model should shift to actually using surgery as an add-on therapy to pharmacotherapy. This way, the benefit of using surgery is that patients need much lower doses of medication. It may allow someone who needs insulin to control type 2 diabetes to move on to requiring only metformin or other oral medications. That would be a massive improvement for the patient’s quality of life. Taking it a step further, a patient with fully controlled diabetes on oral medication could use surgery to put diabetes into remission, and then use a lower dose of metformin to keep the diabetes in remission.

Q: How do you think this debate be resolved?

I think we will all agree that more surgery should be offered to patients; and that we need to use this combined treatment model more frequently in patients with diabetes, especially for those that would benefit most. However, it is how this cohort of patients will be defined that will provoke further debate.

Q: What do you enjoy doing in your spare time?

I have recently started sailing Flying Fifteens and am currently training to qualify for the World Championships in 2019.

Q: Who do you admire most and why?

Rodin – as a sculpture artist he was able to communicate very complex concepts using the human body, but he did so in a simplistic way that influenced how people thought, thus moving civilization forward.

Obesity Update 2018, an event sponsored by the Society for Endocrinology and the Association for the Study of Obesity, will be held in London, 1 February 2018. Register now to attend.

Conference delegate SOS – help get our research proposals off the ground!

SfE BES is all about bringing endocrine professionals together to share knowledge and spark future collaborations. This year, for the first time, delegates are invited to hear specific research proposals and contribute their insights, data or resources to really help get these fledgling projects off the ground.

Here, Dr Kate Lines, from the Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, talks about her proposal to be presented at an Endocrine Network Research Incubator Meeting to further understanding of pancreatic neuroendocrine tumours. To complete her project, she needs SfE BES 2017 delegates to provide more patient samples!

My research mainly focuses on learning more about how pancreatic islet cell tumours (pancreatic neuroendocrine tumours) grow, and using this information to develop new therapies. One specific area that has begun to interest me recently is inflammation. Inflammation is a process in which the body sends cells of the immune system (or white blood cells) to specific areas to defend against foreign substances. It has now been shown that many tumours can hijack this system by releasing chemicals to lure in white blood cells. Once the white blood cells reach the tumour they are encouraged to secrete small proteins (cytokines), which help make the perfect environment for the tumour to grow. The perfect growth environment is different for different tumours, therefore the specific white blood cells and cytokines needed by each tumour is also different. Currently, not much is known about which white blood cells and cytokines are most important for supporting pancreatic neuroendocrine tumours.

I submitted a proposal for the Endocrine Neoplasia Syndromes Network Research Incubator Meeting at SfE BES 2017 that suggests examining the area around dissected tissue from pancreatic neuroendocrine tumours for these specific cells and cytokines. Once we have this information we can use it to either help diagnose the tumours (as the cytokines can be detected in the blood), or target them with specific drugs to try to make the environment less ideal for the tumour to grow. However, the trouble with pancreatic endocrine tumours is that although they can be deadly, they are also rare. This is the main stumbling block for the proposed study, as our hospital alone doesn’t have enough samples for us to be confident that the specific cells and cytokines we see are representative of those occurring in all patients.

The Endocrine Neoplasia Syndromes Network Research Incubator Meeting provides a rare opportunity for us to try to access these samples from different hospitals in different locations, which ultimately could provide a set of samples that is truly representative of all the pancreatic neuroendocrine patients in the UK. Not only could the members help by providing samples for this study, but as our work continues they could also provide further samples, such as blood, for future work stemming from this proposal. I therefore hope that the other members of the network will be as interested in this area as I am and would like to provide us with lots of patient samples to investigate. In addition, as an early career researcher it is rare to get the chance to present new ideas to my peers. I am therefore looking forward to what I hope will be an exciting and stimulating discussion on a new area of research for me.

The Endocrine Network Research Incubator Meetings will take place on Tuesday 7 and Wednesday 8 November, 07:45–08:30, come along to the Endocrine Network Meeting most relevant to your research interests and read the full scientific programme for SfE BES 2017 for more details.

To join an Endocrine Network login to the ‘My profile’ section of the ‘Members’ Area and select Endocrine Networks.