Meet the endocrinologist: Professor Julia Buckingham

Meet Professor Julia Buckingham, Vice-Chancellor and President of Brunel University London and 2017 Society for Endocrinology Jubilee Medal winner. Professor Buckingham’s work focuses on the mechanisms controlling the hypothalamo-pituitary-adrenocortical (HPA) axis. Her outstanding work together with her contribution to the Society, of which she was President from 2009 to 2012, has led to her being awarded this medal, to be presented the annual conference, SfE BES 2017, in Harrogate, 6-8 November 2017. In this interview, Professor Buckingham tells us about her journey in endocrinology.

Q: Can you tell us more about your career path and research interests? 

I developed my passion for endocrinology as an undergraduate student at Sheffield University, where I was inspired by my amazing teachers.  My love for pharmacology, triggered by a short spell in the pharmaceutical industry, came later, before I started my PhD.  Since then I have worked in both endocrinology and pharmacology and have remained firmly wedded to academia. Throughout my career I have combined research and education, and I passionately believe that the two are symbiotic. In fact, I get very cross with people who are ‘too posh to teach’ – we all have a responsibility for the next generation, just as previous generations did for us.  I have had enormous fun over the years working with my research group (and contributing a little bit, I hope!) to our knowledge and understanding of the HPA axis.  I have also been privileged to work with the broader academic community – research funders, publishers, learned societies, particularly the Society for Endocrinology.  Looking back on my career, I think I have probably always been interested in leadership roles, although I didn’t think about it in those terms.  My previous role as Pro-Rector for Education at Imperial College London opened my eyes to the broader issues facing higher education in the UK and internationally, and that led to my current role as Vice-Chancellor of Brunel University London.

Q: What specifically are you presenting at your Jubilee Medal Lecture at SfE BES 2017?

At the conference I will be talking about the complex relationship between the host-defence system and the HPA axis. I will specifically focus on the role of a family of receptors, which were first identified as targets for formylated bacterial peptides, and which contribute to the pathological response to infection.

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

The programme is fantastic as always, and it is difficult to choose.  I always try to go to the plenary lectures and I am particularly looking forward to brushing up my knowledge of POMC processing.

However, the most interesting insights you can get at these events often come from talking to people who are presenting posters, so I would urge everyone to spend time doing that.

Finally, I look forward to catching up with old friends and colleagues, of course.

Q: What has been your career highlight so far?

My research team would say it is seeing new data – and they would go to great lengths to wind me up by telling me they’re not sure how an experiment has gone because they haven’t worked the results out yet! But if you ask me, the greatest highlights are always when seeing someone in my team do well and progress to the next stage of their career, and as Vice-Chancellor, seeing the pride and joy of parents from across the globe when their sons and daughters collect their degrees at graduation.

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

I am very focused on my work at Brunel at the moment and I haven’t given much thought as to what comes next.  Theoretically it should be retirement, but I can’t imagine that – when my time at Brunel comes to an end I shall be looking to do something else!

Q: Who do you most admire professionally?

That’s a very difficult question as I have met so many hugely impressive people in different walks of life – it would be unfair to pick one.

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

Follow your passions, keep an open mind and don’t let a hypercritical referee’s report get you down.

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

If I knew the answer to that I would be working on it now!

 

You can attend Professor Buckingham’s lecture, ‘Bacteria, steroids and formyl peptide receptors – more twists to the inflammatory response’, at SfE BES 2017 on Wednesday 8 November, 16.15-16.45. See more details in the scientific programme.

Meet the Endocrinologist: Interview with Prof David Hodson

Meet Professor David Hodson, Society for Endocrinology Starling Medal winner for 2017. Prof Hodson is based at the University of Birmingham, where his work investigates how failure of pancreatic beta cell function contributes to type-2 diabetes. He is particularly interested in using multidisciplinary and innovative approaches to answer these research questions, which 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 Birmingham

I originally trained as a Veterinary Surgeon at the University of Bristol, where I studied for a PhD in reproductive neuroendocrinology. Tempted by warmer climes, I then migrated to the South of France to join Patrice Mollard’s lab at the CNRS Montpellier, France. This was an exciting time when Patrice had just discovered pituitary networks, and I was lucky enough to be involved in some of the seminal work that followed. This period cemented my passion for microscopy and method development. I then took up a post as a Non-Clinical Lecturer at Imperial College London in Guy Rutter’s Section, applying optical approaches to the study of islet biology and generally learning how to survive in academia. I moved to the University of Birmingham 18 months ago through their Birmingham Fellows Scheme, convinced that the availability of world-class imaging/metabolomics and abundance of young talent would help me to push my research to the next level. Now a Professorial Research Fellow, I am tasked with the exciting role of expanding diabetes research, as well as further developing our imaging capability. This despite my initial reservations about the city following the BAFTA award-winning “Peaky Blinders”!

 Q: What more specifically are you presenting at your Medal Lecture at SfE BES 2017?

It is becoming increasingly clear that, rather like society, beta cells are not equal. In fact, a small number of beta cells may be responsible for driving insulin release, as well as proliferation/renewal, similar to how just a few individuals own most of the world’s wealth. Or alternatively, how you are only ever six people away from knowing Kevin Bacon (of “Tremors” or “Footloose” fame). This is a really hot topic that challenges our understanding of how beta cells may fail (or respond to treatment) during type 2 diabetes. Therefore, I’ll talk about the recent questions that have arisen in terms of beta cell diversity, the tools we have developed to try and understand this and how this has changed our viewpoint of beta cell function under normal and diabetic conditions. There will be lots of colour, movies and practically no text.

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

 My first SfE BES conference was last year and I’m a convert! It will be great to see how endocrinology is progressing in the UK and to catch up with colleagues whilst discussing research in a friendly, informal and supportive environment. In particular, I am looking forward to the “Tissue Engineering for Regenerative Medicine in Endocrinology” symposium. This holds promise not only for diabetes treatment, but also for many endocrine disorders. I’m also looking forward to the social programme. I’d be lying if I said that food and alcohol didn’t play an important role in any conference attendance!

Q: What has been your career highlight so far?

To be honest, I’m relatively new to this and the lab has been working across so many disciplines/topics that it’s difficult to pinpoint a particular highlight. I’m very appreciative that I’ve got excellent collaborators and we are just pleased to be involved in any output that falls under the ‘team science’ banner. Having said that, getting to see Wrestlemania 33 at the same time as ENDO 2017 this year in Florida has to be pretty good, right? Does this count as a career highlight?

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

Our biggest challenge remains how to translate our basic findings on beta cell function from the bench to the bedside. We are amassing detailed knowledge regarding the mechanisms underlying insulin secretion, especially in the ‘omics era, but need to strive to harness this for therapeutic potential. On the flip side, lack of understanding about basic mechanisms will hold back progress on all fronts, so we should not make this the only criteria for our research.

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

Honestly, I haven’t really thought that far ahead. I’m content following up the avenues created by current research and just having fun doing what we’re doing. Maybe become a Vice-Chancellor? The pension seems decent.

Q: Who do you most admire professionally?

I have to admit that I most admire my postdocs, students and technicians. The fact that they have chosen to research diabetes with relatively little reward and in tough academic times really speaks volumes about their motivation and personalities. They do it because they love to do it. I am lucky to have such good people.

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

Endocrinology is bound by shared mechanisms and concepts. Therefore, as a basic or clinical researcher, don’t be afraid to apply thinking from one field to another field, as well as take risks with the research. The outcome and impact can be quite dramatic compared to the high-throughput, predictable science that the funding climate seems to encourage. If someone asks you what is the point of doing this, then it’s generally a positive thing!

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

There is a realisation that current drugs are difficult to improve upon. Certainly, pharma pipelines, profits and innovation are all shrinking as the list of FDA requirements rightly grows (e.g. concerning cardiovascular safety margins). Therefore, directed or personalised treatment may represent the next breakthrough in the field, for example through production of unimolecular agonists where a few licensed drugs are ‘bolted’ together or matching patient genotype to drug efficacy.

You can hear Prof Hodson’s Society for Endocrinology Starling Medal lecture, “Next generation tools to understand endocrine function in health and disease” on Monday 6 November, 18:00-18:30, and see the full scientific programme for SfE BES 2017.

 

Meet the Endocrinologists: Miriam Asia & Andrea Mason

Miriam Asia (right) and Andrea Mason (left), Clinical Nurse Specialists (CNS) in endocrinology at Queen Elizabeth Hospital Birmingham (QEHB) tell us about their work in endocrine nursing and what they are looking forward to at SfE BES 2017, 6-8 November in Harrogate.

Q: Tell us a little about yourself and where you work

Miriam: As an endocrine specialist nurse, I run the adrenal nurse-led clinic, post-traumatic brain injury endocrine screening clinic and support the young adult clinic. I have also completed the Non-Medical Prescribing course at Masters Level and I am planning to start a masters in endocrinology.

Andrea: I currently look after three nurse-led clinics; late effects of cancer treatment (transition clinic from children’s to adult services), pituitary and a new clinic that monitors patients who have developed immune-related adverse events in response to immune check-point inhibitor treatment. I have a particular interest in the quality of life issues surrounding endocrine conditions.

 Q: What inspired you to work in endocrinology?

Miriam: I only knew about endocrinology through nursing textbooks but now, being able to see endocrine patients, reviewing them in clinic and working with them through their endocrine journey makes me realise even more how fascinating and exciting endocrinology is. Especially when I see the difference it makes to our patients during and following treatment.

Andrea: During my nurse training I developed a keen interest in cancer nursing and worked in oncology for many years until an opportunity for me to branch out into endocrinology as a Clinical Nurse Specialist arose. This position was to cover maternity leave and I knew little about endocrinology, so I had to learn on the job quickly! During my first week, I attended the Society’s Endocrine Nurse Update and was totally blown away by the specialty. The journey had started; I spent evenings studying after work trying to get to grips with the basics.

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

Miriam: As well as the plenaries and nurses’ sessions, I am also looking forward to the ‘Meet the Expert’ and ‘How Do I…’ sessions, especially those relevant to my clinical practice.

Andrea: This is my second SfE BES and I am looking forward to the nurses’ sessions, particularly those on opiate-induced endocrinopathy, and development of endocrinopathy following metastatic melanoma treatment. I also enjoy meeting and networking with other endocrine nurses.

Q: What are your career highlights so far?

Miriam: I recently completed a sky dive (see photo right), with some of my CNS colleagues, in support of our QEHB charity for the Young Adult Clinic!

Andrea: Highlights in my nursing career, include working as an Endocrine Nurse Specialist and successfully completing the Non-Medical Prescribing course at Masters Level.

Q: Who do you most admire professionally and why?

Miriam: My endocrine colleagues – nurses and doctors – at QEHB who work with such competence and dedication to look after our endocrine patients

Andrea: I have had an inspiring and passionate Endocrine Lead Nurse to guide me throughout the last five years and support my development. I have also had the support and patience from a caring team of endocrinologists.

Q: What advice would you give to someone starting out in endocrine nursing?

Miriam: Although endocrine nursing is a challenging specialist role that requires a lot of reading and studying, it is rewarding in the end.

Andrea: It does take time to understand the speciality and additional studying is required but when you understand the basics of the endocrine system, it is all very logical. I would say to any nurse…. go for it!

Q: What are your future career aspirations?

Miriam: To complete my masters in endocrinology and become more confident and competent in dealing with complex endocrine cases as a result. I also hope to see more nurse consultants and nurse led clinics being set up.

Andrea: My future plans are to remain in my current position and I am looking to complete a master’s degree in endocrinology.

Don’t miss the dedicated Nurses’ Lounge at SfE BES 2017, giving nurses the opportunity to meet and network in their own space. This is especially beneficial when you are travelling on your own, or if you are a first-time attendee, as there is nearly always somebody there to chat to. At designated break times there is at least one member of the Nurse Committee on hand for you to get to know.

Follow the links to find out more about SfE BES 2017, view the scientific program and register online.

Meet the Endocrinologist: Interview with Prof Simon Pearce

Meet Simon Pearce, Professor of Endocrinology at Newcastle University and Programme Secretary for SfE BES 2017, in Harrogate, 6-8 November. We caught up with him to find out more about his work and to discover his upcoming highlights and top tips for the conference.

 Q: Tell us a little about your career path and endocrine interests

I qualified in medicine at the Newcastle University, completed my postgraduate education at the Royal Postgraduate Medical School in Hammersmith, Brigham & Women’s Hospital in Boston and as a Lecturer in Newcastle. I was appointed Senior Lecturer in Endocrinology in 2001 at Newcastle University and became Professor in 2007.

My main research area is the treatment for autoimmune thyroid diseases and Addison’s disease. I have published around 150 papers over the last 20 years spanning molecular endocrinology, clinical trials and guideline papers.

Q: Tell us a little about your role as SfE Programme Secretary

As Programme Secretary I organise the scientific programme for the annual conference. It’s a great privilege to be able to choose the speakers that I want to learn from. My assumption is that if I am interested in the topic, then it will interest others too.

2016 was my first year as programme secretary and the informal feedback about the quality of the symposia and meet the expert sessions as the meeting progressed was great. I was very happy on the last day when it was all over though, with no significant hitches.

Q: What do you think are the programme highlights at SfE BES 2017?

There is a very strong programme on several subjects including calcium and bone, thyroid, and female reproductive endocrinology. Following the success of last year’s thyroid masterclass, we have scheduled a bone masterclass with two internationally respected experts on osteoporosis, a clinical management symposium on hyper- and hypo-calcaemia and a session on steroids and bone.

The meet the expert sessions on opiate-induced hypopituitarism, hyperthyroidism in pregnancy and next-generation DNA sequencing promise to keep you up to date on the latest advances in these important and fast-moving areas.

We also welcome more than 20 overseas speakers, including cutting edge plenary lectures from some giants in our field, Teresa Woodruff, Andrew Arnold and Martin Schlumberger. Home-grown highlights will also include two well-known members of our Society, Andrew Hattersley and Julia Buckingham, who never fail to both entertain and inform.

Q: What are you particularly looking forward to?

I always enjoy the plenary lectures, and Andrew Hattersley has been an inspirational role model for me; translating the highest quality laboratory science to change clinical practice and improve patient outcomes. So I think his talk will be a highlight.

Q: Do you have some words of wisdom for anyone attending SfE BES for the first time?

Have a good look at the programme at a glance page and plan your most interesting sessions carefully. I receive  frequent comments that there is too much going on at the same time during the meeting and people would like to split themselves in two. My advice is go to the session that you know least about, as you stand to learn the most from this, even if it feels slightly outside your normal ‘comfort zone’.

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

It’s clear that there is a lot of pharma work on small molecules that target several receptors at the same time to modulate appetite and metabolic phenotypes. I am also excited that during the next 10 years we may see new treatments for hyperthyroidism; the first advance since the early 1950s.

Follow the links to find out more about SfE BES 2017, view the scientific program and register online.

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.

From small seeds grow mighty oaks: how the Endocrine Nurse community is growing together to share knowledge

Lisa Shepherd, an Endocrinology Advanced Nurse Practitioner at Heart of England NHS Foundation Trust and Chair of the Society for Endocrinology Nurse Committee, discusses continuing education opportunities and the value of networking for endocrine nurses.

Endocrinology is a fascinating but complex area and nurses often work in isolation, so opportunities to develop and update their knowledge, benchmark their practice and network with other nurses are invaluable. The Society for Endocrinology Nurse Committee supports a number of strategies that promote networking amongst the Endocrine Nurse community.

Social media is increasingly used to build professional networks, so the Nurse Committee have set up an invite-only group on Facebook for endocrine nurses, which is a fast and easy way for the community to share protocols and information. Nurse Members of the Society also have a Twitter feed where training opportunities, research and nursing practice can be promoted to the wider community.

Face-to-face networking remains an effective means of sharing experience and learning from others, so a ‘nurses lounge’ was recently introduced at the SfE BES conference, to give nurses a dedicated space to meet each other in person. As many nurses are working in isolation it is valuable to provide a variety of opportunities, across different media that encourages endocrine nurses to support and learn from each other.

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Endocrine Nurse Update (ENU) is coming up soon. This yearly update is designed by nurses for nurses and offers a varied and active programme of endocrinology topics. I am very excited that this year’s ENU will feature the inaugural Endocrine Nurse Award lecture by winner, Nikki Kieffer. This award was introduced to recognise excellent nursing practice that can be shared to advance knowledge and understanding in the discipline. Nikki is an endocrine nurse specialist at Leicester Royal Infirmary and led the project that developed the Competency Framework for Adult Endocrine Nursing. This project is a great example of nurses working together to share best practice and Nikki will deliver the prize lecture at ENU 2017 in March.

There are also great benefits to networking with other closely related communities and this year, for the first time, ENU will include a workshop run collaboratively between clinician and nurse colleagues, Dr Richard Quinton, Dr Channa Jayasena and Dr Andrew Dwyer. Whether you are a nurse new to endocrinology or a nurse with many years of experience, the ENU programme, in combination with Clinical Update has something to offer all. I hope you can join us at the meeting or follow us online, to learn from your colleagues and share your experience.

Nominations for the 2018 Endocrine Nurse Award are open until 16 June 2017, find out more.

Travel grants are available for ENU 2017, apply before 15 March.

View the ENU 2017 programme.

 

Post-Radioiodine Graves’ Management: The PRAGMA Study

Petros Perros is a Consultant Endocrinologist at Newcastle Hospitals, and Honorary Senior Lecturer at Newcastle University. He is the Project Lead for the PRAGMA Study, a Society for Endocrinology research project which compares the incidence of dysthyroidism in post-radioiodine patients treated with difference management strategies.

Petros will be presenting the PRAGMA study’s latest findings next week in Brighton, which is hosting this year’s SfE BES conference. Ahead of the event, we asked him to write about the project and why it’s such an important Society project.

For more information, be sure to check out Petros’ talk at 16.45 on Tuesday 8 November in Syndicate One. Our Scientific Programme has more details.

Project Background

Grave’s Disease, an autoimmune condition, is the most common cause of hyperthyroidism. Radioiodine (RI) is an effective, safe and cheap treatment for hyperthyroidism, though it results in most patients with RI-treated Graves’ disease requiring life-long thyroid hormone replacement.

Ideally the transition from hyperthyroidism to a stable thyroid status (through thyroid hormone replacement) should be rapid and smooth. However, in practice fluctuations in thyroid status in the first year after RI are not uncommon.

In an attempt to achieve and maintain euthyroidism (in which the thyroid gland is functioning normally) after RI, endocrinologists employ different strategies. These will eventually include the introduction of levothyroxine, a synthetic thyroid hormone chemically identical to thyroxine. The two most typical treatment strategies are:

  • The use of anti-thyroid drugs for a period of time after RI. These are used either alone or in combination with levothyroxine – with levothyroxine is known as the “block and replace” strategy
  • Watchful monitoring and introduction of levothyroxine when required

This variation in management in response to fluctuations in thyroid status following RI was the inspiration for the PRAGMA Study. We set out to determine the extent of thyroid instability after RI, and to explore whether different strategies of management are associated with different degrees of thyroid instability.

The study was funded by the Clinical Endocrinology Trust and was included in the NIHR portfolio.

What has been achieved so far?

Thirty-four hospitals in the UK have recruited 812 patients over 2 years. One of the most striking findings was that a very large proportion of patients – 67.2% – had at least one episode of hypothyroidism within the first year after RI, and 36% had an episode of hyperthyroidism. Patients treated with the “block and replace” regimen after RI were least likely to experience hypothyroidism and gain weight, though hypothyroidism was still experienced in 26% of cases.

What next?

We continue to collect data in the management of this condition. Additional interventions need to be identified and implemented to improve outcomes for patients with Graves’ disease treated with RI, and this study provides us with great possibility.

The level of engagement of colleagues with the PRAGMA Study proves that large scale studies addressing common, simple, clinically relevant questions can be conducted with ease and minimal cost. It is a great asset to the field of clinical endocrinology research.

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Should prednisolone be the first line for glucocorticoid replacement in adrenal insufficiency?

At 18.30 on Monday 7 November Professor Jeremy Tomlinson is chairing a debate on the treatment of adrenal insufficiency at SfE BES 2016. Ahead of the debate, we asked Professors Stafford Lightman and Karim Meeran to give you a little taste of their stance on this hot topic in endocrinology.

 

Professor Jeremy Tomlinson, University of Oxford – Chair

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The optimal strategy for glucocorticoid replacement in patients with adrenal insufficiency remains a contentious issue. In the majority of cases, hydrocortisone is used, but there are issues relating to the need for three times a day administration alongside the high costs of treatment. Are there alternatives?

Prednisolone is significantly cheaper, has a longer duration of action and therefore can be administered twice daily. However, it is a synthetic glucocorticoid that does not act in an identical way to hydrocortisone.

Head-to-head comparisons with meaningful clinical end points are lacking, and in the modern NHS, treatment costs play an increasingly important role.

Let the debate begin!

 

Professor Stafford Lightman, University of Bristol – AGAINST

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The evolution of Homo sapiens from early mammals has taken about 200,000,000 years. During this time we have developed many highly specialised physiological systems –including the key homeostatic system we call the Hypothalamo-Pituitary-Adrenal axis. This system maintains key cognitive, metabolic and immunological systems in optimal state and is also a rapid response system to protect us against stress. The hormone that has evolved to do this is cortisol.

In the absence of endogenous cortisol no-one would disagree that the gold standard therapeutic hormone replacement should be the closest we can get to normal physiology, so if we have to go second-best and provide a different steroid or pattern of plasma steroids it is incumbent on us to prove that this alternative treatment is as good as the best possible therapy available with the native compound.

Prednisolone differs from cortisol in many ways. Not only does it have different characteristics of glucocorticoid mediated gene transcription with no simple dose response comparison to cortisol, but its plasma half-life and metabolism are also unphysiological.

During the debate, I shall demonstrate why these aspects of prednisolone replacement are potentially disadvantageous at cognitive, metabolic and immunological levels. I will explain why I feel it would be dangerous to submit patients to such long duration therapy unless appropriate long term studies are able to show non-inferiority of this regime.

 

Professor Karim Meeran, Imperial College London – For

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Patients with endocrine deficiency need replacement therapy.

We are getting better at making new analogues of replacement hormones that are more patient friendly and improve compliance by lasting longer. Thus for insulin, we have moved away from normal human insulin to analogues of insulin that have variable half-lives, but are a totally different molecule. There is no evidence that the new analogues are any better than native insulin, but production of some preparations of native human insulins have ceased and many of us use these new insulin analogues. Vasopressin is replaced with a modified molecule, 1-desamino-8-D-arginine vasopressin; the D-enantiomer is used (which never occurs in nature) because it lasts longer. The argument in some quarters that “natural” cortisol would be better thus has no basis.

Similarly, rather than give hydrocortisone several times a day, we need to modify the molecule slightly by inserting a double bond, which increases its half-life and potency, and enables once daily administration. A slow release preparation has been developed and costs £400 per month, but it is far better to use a drug that has an appropriate half-life.

We don’t need to develop one because, remarkably, prednisolone has a half-life that is perfect for a once-daily administration. It happens to be extremely cheap, but that should not deter us from using it!

We now have an assay available for prednisolone, and present data at a number of posters at the BES in November confirming that a once-daily dose of prednisolone 3mg is equivalent to hydrocortisone 10mg plus 5mg plus 5mg. I have converted several patients, who regularly report how well they feel on prednisolone 3mg, and how much easier it is to take.

The main reason that patients should take once-daily prednisolone is its convenience. Added benefits for those in the UK are the low price of prednisolone compared to hydrocortisone, which is substantially more expensive in the UK than in other countries because of a peculiar licensing issue, and the fact that the NHS is not allowed to import it.

We have a serious problem in the UK with the cost of hydrocortisone, and every patient who is switched to prednisolone will save over £100 per month.

 

SfE BES – Call for abstracts!

The annual Society conference, SfE BES, takes place this year in Brighton on 7-9 November 2016. It’s a great chance to network with colleagues, showcase your work and explore new research in your area of endocrinology. Our programme of events is varied yet specific – bringing together the best of basic science, clinical investigation and clinical practice, you have the chance to expand your horizons into other parts of the field whilst also attending those lectures which are really specific to you.

The submission system for abstracts is open until midnight on Wednesday 22nd June – so you have more than enough time to polish your final abstract and send it along. It’s not just a chance to show your colleagues across the whole field of endocrinology what you’ve been working on – it’s a chance to tell them why what you’ve been working on is important.

Last year at SfE BES, a great programme highlight was a session entitled ‘Evolving model systems for complex tissues’, which was chaired by Kevin Doherty and Shareen Forbes. In the ’90s, manipulation of human embryonic stem cells (hESCs) was something of a new thing. It was anticipated that the ability to grow human tissues in culture using hESCs would provide incredible model systems for drug development, toxicity testing and cell therapy.

However, it wasn’t until 2005 that reliable markers had been developed and a significant number of important signalling pathways had been elucidated in the path to differentiation. By this point, some ten years later, finally a tool box existed for nearly every tissue type. This lead to some of the first clinical trials, using pluripotent cells to treat age-related macular degeneration. However, liver disease, diabetes and neurodegeneration were still elusive and challenging goals.

By 2014, fully functional human beta cells has been generated, and they took only 45 days and 7 stages in culture. This was a hugely exciting moment for diabetologists and researchers across the world. But then, of course, the question sprang up: could they be used as a source of islet cells for replantation? Or would they merely serve as an invaluable model?

At Kevin and Shareen’s BES session, they gave a detailed overview of both the background to the field of complex tissue model systems, and the current state of basic science and clinical research, highlighting very recent advances, and discussing the potential future.

The stem cell field continues to expand rapidly. 2016 has already been the year that Chinese scientists grew functioning mouse spermatozoa from skin cells – these went on to fertilise egg which developed into embryos and grew to successful progeny. What will the second half of 2016 bring?

With over 1000 delegates, 100 abstract lectures, 10 plenary lectures, and an evening of awards and prizes, SfE BES is the best place for you to spread the word on your research, and meet the colleagues that you want to work with in future. Your lecture might be the one were talking about all the way into June 2017.

So submit your abstract now through our submission system. Submissions close on Wednesday 22nd June at midnight.brighton 2

See you in November!