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.

Learn, network, influence change

The best way to predict the future is to create it” Anne Marland, Advance Nurse Practitioner.

Committees have an integral role in guiding the Society – they aim to ensure that members’ interests are served in the best possible way, within the Society and beyond. Dedicated endocrinologists from different career stages and disciplines serve on these Committees, but what drives them to volunteer their valuable time?

Sherwin

Sherwin Criseno, of the Nurse Committee, considered it a matter of career progression. “Being part of a nurse expert group opens up opportunities to exchange knowledge in endocrinology”, he says. ”It also provides a platform for networking among endocrine nurses and endocrine centres, and gives you a chance to contribute in developing educational frameworks and programmes for the nurse community.”

Jeremy

Clinical Committee member, Jeremy Tomlinson, was driven to join a committee by a desire to become more involved with the Society. ”I wanted to highlight specific aspects of patient care, and work together with other endocrinologists to make a difference,” says Jeremy.

Channa

Channa Jayasena, from the Public Engagement Committee, wanted to develop his career whilst playing an active, relevant role in the Society too. ”Committee participation enabled me to establish relationships with scientists and clinicians from endocrine units across the UK, and I got to be involved in the redesign of You and Your Hormones*, the public engagement website.” *New website launching soon

Anne

 

Anne Marland joined the Nurse Committee to challenge herself and become a future-shaping, vision-creating voice for the endocrine nurse community. ”The best way to predict the future is to create it, and being part of a committee offers plenty of exposure and leadership opportunities”, Anne states. ”My favourite part of the experience has been receiving so much peer support, which has been very motivational.”

 

Why do these Committee members think you should get involved?

  • “To share your expertise, offer new perspectives and ideas, and to influence change, as this is vital in every dynamic organisation. It’s an opportunity every nurse should work and aspire for.” Sherwin Criseno
  • “To work towards implementing initiatives that can improve patient care.” Jeremy Tomlinson
  • “To be the voice of your peers and to contribute to the growth of the Society – which means a success for its members and for endocrinology.” Anne Marland
  • “To help promote endocrinology sensibly and responsibly, for example when dealing with the media.” Channa Jayasena

It is now time to submit your nominations – whether this is to put your own name forward, or that of another clinician, nurse, or scientist member, you have until 30 June 2017 to make a difference for your fellow endocrinologists by shaping the future of the Society.

 

Wondering whether there is a place for you?

There is definitely a committee for you, regardless of your previous experience and professional trajectory within endocrinology. Currently, the Society has openings on five of its committees – Clinical, Nurse, Programme, Public Engagement and Science – as well as in the Early-Career steering group and the Corporate Liaison Board sub-committee.

If you want even more insight on the value of being part of a committee, members Stephanie Baldeweg, Kim Jonas and Kate Lines told us about their committee journeys in the spring issue of The Endocrinologist.

Learning new techniques and expanding horizons in South Africa

The Society of Endocrinology is eager to help you drive your career forward and, in line with this, the Practical Skills Grant is an opportunity not to be missed. This grant enables scientists in training to visit other labs to learn new techniques, so that they can return home with an improved skill-set and plenty of research collaboration potential!

Here is the story of Dr Naomi Brooks, Senior Lecturer at the University of Stirling, who is interested in exercise physiology, muscle biology and nutrition. In 2015, she was one of the Practical Skills Awardees and travelled to South Africa to learn a challenging lab technique from world-leading experts…

Naomi Brooks blog
Dr Naomi Brooks, Senior Lecturer at Stirling University

“My application to the Society for Endocrinology Practical Skills grant was inspired by my previous success in winning a Society Early Career Grant. I chose Prof Kathy Myburgh’s lab, in the Physiological Sciences Muscle Group in Stellenbosch University, South Africa. I was aware that the particular technique I wished to learn was difficult and that the Myburgh Laboratory had detailed knowledge and success with it. I had previously worked with the Myburgh group as a post-doctoral fellow. Since I knew the group and identified the potential for collaboration, the choice to return to Stellenbosch was key for my career at that stage.

Stellenbosch is a beautiful town surrounded by mountains and vineyards. I was there during the spring and the weather was kind, not too hot, which allowed me to walk to work every day from my local accommodation. During my work week I would spend time in the lab, either with colleagues or writing and reflecting by myself. When away from the busyness of academia, I visited local areas and enjoyed the beautiful African outdoors and hospitality, and I still had time to write papers and put ideas together for grant applications!

The Practical Skills Grant enabled me to investigate a number of different methods for stem cell isolation and primary cell growth. I was able to see the technique demonstrated, trouble-shoot and have discussions about the procedure and its applications. As a result of this, the cell culture laboratory at my home institution is currently considering building collaborations with molecular investigators to apply the technique in our labs. I continue to build my personal and laboratory group skill-set to enhance our work, and thanks to this grant I was able to improve my academic opportunities as a researcher able to integrate both applied and basic research. The experience provided me with an integrated understanding of the technique, which will hopefully translate into more research opportunities and encourage my transition into an established researcher in the field.

When I lived in Stellenbosch as a post-doctoral fellow, I volunteered at an orphanage in Kayamandi, the local township.  I also started a community exercise programme, which was both a research and a community engagement and development programme. Returning to these places was very special. The exercise programme was still running 5 years later, and was coordinated by those working in the community garden project.

Creating and fostering networks and collaborations, both within the UK and overseas, is very important in the world of academia.  I would encourage those wishing to expand their horizons and learn new techniques to apply for the Practical Skills grant; especially amongst those early career researchers, as having “many strings to one’s bow” is important to establish a career.”  Naomi Brooks, Senior Lecturer at the University of Stirling.

What would you do with a Practical Skills Grant? Applications close on 31 October 2017, so better start thinking about it!

Why should you vote for the new ESE President Elect?

A great opportunity for all endocrinologists is coming up, as it will soon be time to vote for the President Elect of the European Society of Endocrinology (ESE). Professor John Wass, former EFES (now ESE) President and past Society for Endocrinology (SfE) Chairman, urges all SfE members not to miss this opportunity to influence the future of the organisation and endocrinology in Europe:

John wass large shot“I write to encourage all SfE members to vote. SfE has always played a major role in supporting ESE and gains greatly from this collaboration; therefore it is important that SfE members who are also ESE members vote in the upcoming ESE elections. SfE is an affiliated society member of ESE and an active member of the ESE Council of Affiliated Societies (ECAS). ESE runs excellent educational meetings across Europe -including its yearly congress-, provides numerous grants for basic and clinical researchers, produces guidelines, and brings together researchers across Europe and beyond as evidenced by the recent successful application for the Endocrine European Reference Network (ERN). ESE is much bigger than the EU, with members from over 90 countries and affiliated societies from over 45 countries. With Brexit on the horizon, there is no more important time to strengthen our academic and clinical links across Europe through supporting ESE. Please vote – it is important for endocrinology.”

The candidates for ESE President Elect are SfE member Prof Richard Ross (UK) and President of the Pituitary Society Prof Andrea Giustina (Italy).

E-vote submissions open until 19 April 2017. Eligible ESE members will be contacted by e-mail with further instructions on how to submit their votes.

Find out more about ESE and the election on the website.

Did you know that SfE members enjoy discounted membership of the European Society of Endocrinology?

 

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.

 

Meet your new Society President

 Meet your new President…

 A new era begins for the Society as Professor Graham Williams takes over as President at SfE BES 2016. Associate Editor of The Endocrinologist, Amir Sam, finds out more about Graham’s background, reflections and aspirations for the Society for Endocrinology. The full interview will be published in the winter issue of The Endocrinologist.

Tell us about your background

I worked as an SHO in Kidderminster and did my general medicine rotation at the Queen Elizabeth and Birmingham General Teaching Hospitals. I then got an MRC Training Fellowship with Michael Sheppard and Jayne Franklyn in Birmingham to work on thyroid hormones.  I did a year of my PhD there and then completed it at Harvard Medical School with Reed Larsen and Greg Brent at the Brigham and Women’s Hospital in Boston, where I also did some of my post-doctoral training.

I came back with an MRC Clinician Scientist Fellowship and started as a Lecturer in Birmingham with a completely empty lab and had to start from nothing!  About six months before I left Boston, I had a meeting with Reed, who was very happy to support me but said that I shouldn’t work on the same subject that he was working on because it was too small a field and it was important I develop my own independence.  He urged me to read the literature and find a new area to pursue.

I had been working on the biochemistry of transcriptional activation by thyroid hormone and retinoid X receptors and wanted to apply the basic science to clinically and physiologically important questions.  I decided to find a relevant thyroid hormone responsive target tissue that wasn’t being studied; most people were working on pituitary, heart and liver and other labs were getting into the brain. I spent a lot of time talking to various people and eventually settled on the skeleton, a clearly important target organ that had not been investigated in the context of thyroid hormones in any detail.  Having not known anything about bone, I had a blank canvas and started from scratch!  In 1995 I was approached by Raj Thakker and James Scott to move to Hammersmith as a senior lecturer.

When did you know you wanted to be an endocrinologist?

When I qualified from medical school I was all set to do surgery, but realised pretty quickly that I did not have the dexterity to be any good.  My first house job was in endocrinology at the Queen Elizabeth Hospital in Birmingham with David London. At the time there were some really fascinating cases, and working with him got me enthused and hooked on endocrinology straight away. He was definitely the biggest influence on my career selection.

By the time you finish your term of office as President, you will have held major roles at the Society for Endocrinology for over a decade.  How has the Society changed over the time?

The financial aspect of the Society has substantially increased over time. When I took over the treasurer’s role the gift aid to the Society from Bioscientifica was around £100,000 per year, and when I ended my term as treasurer it had grown to about £1 million per annum. The Society has grown incredibly in terms of its diversity; it is reaching out further to different countries and continents in a way that was never possible and is now a very professional and superbly run organisation.

How do you see the Society developing over the next few years?

We have a much greater role in education and the development of opportunities for young endocrinologists. I don’t think my plans for the future will be to fix anything in particular because I think the Society is functioning extremely well. We need to develop it further along these roles for the benefit of the next generation. We have to support our younger scientists and clinicians, retain them and hopefully attract more people to the discipline with the ultimate aim of benefiting our patients and endocrine science. We also need to strengthen our international collaborations, both scientifically and clinically.

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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