Meet the Endocrinologist: Stafford Lightman, expert on regulation of the hypothalamo-pituitary-adrenal axis

Meet Stafford Lightman, Professor of Medicine at the University of Bristol. His research focuses on understanding the role of the hypothalamo-pituitary-adrenal (HPA) axis in health and disease, and in particular its interface with stress and circadian rhythms and its effects mediated through glucocorticoid signalling. He has been awarded the SfE Medal and will be delivering his Medal Lecture at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, he tells us more about his career, research and what he is looking forward to at the SfE BES 2018 conference.

*Prof Lightman is pictured at the Goroka Festival, Papua New Guinea’s equivalent of Glastonbury! 

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

When I was appointed Professor of Medicine at the University of Bristol, very little endocrine research was going on there, which had the great advantage of providing me with a clean slate and the ability to develop my own research theme. Now I have a lab group that ranges from the very basic cell and molecular science through physiology, right up to clinical research. I really enjoy being able to translate up to humans and then back translate down again to animal models. Having a group of scientists and clinicians working together is a really exciting environment to work in.

Can you tell us a little about what inspired you into endocrinology?

I was always interested in human biology and my earliest research was in anthropology, which naturally led into human behaviour and to neuroscience. I initially wanted to be an academic clinical neurologist but at that time neurology research centred around the peripheral nervous system, and I was interested in the brain! The one way I could investigate brain function was through the window of hypothalamic-pituitary function, therefore I became a neuroendocrinologist. Since then I have been working at the interface of endocrinology and neuroscience, which I find fascinating.

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

I am most proud of the people that I have helped to train, who have gone on to do well afterwards. It is also really rewarding to have set up lots of collaborations with mathematicians, and fascinate them in the dynamics of hormones. They have of course also been very both for me and the subject, developing   the concept of hormone dynamics. With the exception of GnRH, endocrinology was often considered a homeostatic but relatively static science, where hormone levels are measured and found to be either too high or too low. This is clearly far from reality and trying to bring the idea of dynamic hormonal systems into the mainstream is something I have been very involved with.

Tell us what you enjoy about your role as President of the British Neuroscience Association (BNA)?

I love meeting lots of really interesting people. The brain is such an interesting area and I enjoy understanding how it interacts with all aspects of our lives. The BNA 2019 Festival of Neuroscience will be held in Dublin on 14-17 April 2019, and will be in collaboration with the British Society for Neuroendocrinology, and include a scientific symposium sponsored by the Society for Endocrinology. So, there will also be a strong element of endocrinology running throughout the meeting. However, it is a great event for bringing together lots of diverse areas of neuroscience.

What are you presenting in your Medal Lecture at SfE BES 2018?

I will be discussing how aspects of HPA physiology are governed by dynamics, from the stress response to the circadian rhythm. The underlying dynamics of this system are what allow us to be flexible and to maintain a homeostatic state. I will also be talking about improved ways of diagnosing endocrine disorders. If we can harness novel technologies to measure dynamic changes in hormone levels in patients at home, we can gather much better information for diagnosis and treatment.

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

From my own point of view the best part of the conference will be discussing posters with young, enthusiastic scientists right at the start of their careers. The posters are a really exciting area where people are putting out new ideas, in all areas of endocrinology. I like to be educated, so enjoy going to posters in areas where I don’t know much and hearing about what people are doing and why they find it exciting.

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

I think there are two main challenges, one of which I alluded to earlier.

  1. In terms of HPA the challenge lies around how we can measure dynamic changes in hormone levels in patients at home. I think the whole field of medicine is moving away from keeping people in hospital, to do lots of blood tests, sending them home, calling them back in to discuss results and finding you don’t have the right answer. Diagnosis can then be prolonged, inaccurate and very expensive, all of which is bad for patient care. The real challenge is finding better ways of doing this, and doing it in patients at home.
  2. Another challenge concerns the best way to give glucocorticoid replacement therapy. There is currently great debate on this in the field but it is important that we find the answer. Poorly managed glucocorticoid replacement is associated with considerable morbidity and mortality, so lots of attention is focused on finding a better way of doing it.

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

I think the ability to monitor patients’ hormone levels over a 24 hour period will be a major breakthrough, and will provide the basis for better understanding of normal physiology and better diagnostic methodologies.

We have been developing a wearable collecting device that can be worn by patients at home. Using this device, patients would need only a quick visit to have it fitted and another, 24 hours later to have it removed. This is sufficient to provide full tissue biochemistry over a 24 hour period. This would minimise the time in hospital and provide a personalised medicine approach with a wealth of data that gives an overall picture of the individual’s health. This type of approach could revolutionise diagnostics and really improve patient care.

Once we understand how to apply this technology we will have better more rational ways of targeting and timing treatments, to address the challenges mentioned in the previous question.

What do you enjoy most about your work?

I love the challenge of new ideas and using them to work out answers to important questions. It is also a pleasure and privilege to have the opportunity to work with great colleagues.

Who do you admire most in the world of endocrinology?

The first piece of endocrinology that ever excited me was Vincent Wigglesworth’s work on the hormone, ecdysone. He was a brilliant entomologist and his beautifully designed experiments on the extraordinary process of metamorphosis was a real eye opener. He was my first endocrine hero!

Any words of wisdom for aspiring endocrinologists out there?

Enjoy, enjoy, enjoy! You really need to enjoy your work, or you should be doing something else. I describe what I do as privileged play!

You can hear Professor Lightmans’s SfE Medal Lecture, “HPA activity: Don’t forget the dynamics” on Monday 19 November, in the Lomond Auditorium at 17:30. Find out more about the scientific programme for SfE BES 2018.

Meet the Endocrinologist: Leanne Hodson, expert on metabolic physiology

Meet Leanne Hodson, Professor of Metabolic Physiology at the University of Oxford. She specialises in changes in metabolism caused by nutrition including the metabolic consequences of obesity.  She has been awarded the SfE Starling Medal and will be delivering her Medal Lecture at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, she tells us more about her career and what she is looking forward to at this year’s conference.

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

I am currently a British Heart Foundation Senior Research Fellow in Basic Science and Professor of Metabolic Physiology at the University of Oxford. The lab is focussed on research related to human health and metabolism; this includes the influence of specific nutrients and the consequences of obesity and obesity-related diseases, such as non-alcoholic fatty liver disease (NAFLD). Although our work has a focus on hepatic metabolic physiology, it covers a number of broader areas including: endocrinology, nutrition, hepatology, diabetes and liver transplantation.  We use a combination of human in vivo, ex vivo and in vitro models to undertake our studies.

Can you share some of your proudest career moments?

I am originally from New Zealand and had various career paths before eventually making it to University, where I obtained my PhD.  In 2004, I received the Girdlers Health Research Council (New Zealand) career development fellowship which provided the opportunity to work at the University of Oxford with Professors Keith Frayn and Fredrik Karpe. I was awarded a British Heart Foundation Intermediate Basic Science Research Fellowship in 2011, and became an Associate Professor of Diabetes and Metabolism in 2014. In 2015, I was awarded a British Heart Foundation Senior Basic Science Research Fellowship and in 2018 became Professor of Metabolic Physiology.

I am proud of many things including the reputation and the quality of work my lab, which leads to collaboration requests from well-respected and very talented scientists. Getting my fellowships, becoming a professor and getting the SfE Starling medal are definitely highlights. However, I am most proud of the environment I have been able to create for my research group, which is dynamic, productive and supportive – I am fortunate to work (and collaborate) with a wonderful group of individuals.

What are you presenting at your Medal Lecture at SfE BES 2018?

My group is interested in understanding why fat starts to accumulate in the liver and what the effects of insulin and specific nutrients or therapies are on this process, including the subsequent effect this then has on metabolism. In my Medal Lecture I will present what we have learnt over the last 14 years and how we have further developed and incorporated new models and state-of-art methodologies to study human liver fat metabolism.

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

I am very much looking forward to hearing the Early Career talks and going to the poster sessions, as it is a great chance to learn what work is coming out. Also I am going to the applied physiology workshops, as these are something I have not experienced before and I am sure I will learn a lot from them.

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

Developing models (particularly in vitro models) that better recapitulate the human disease that we are trying to study, as the historical ones, although interesting, are not reflective of human physiology.

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

Good question! I would like to think we will soon have more sensitive and specific biomarkers to detect the different stages of NAFLD. Improved biomarkers will allow us to study changes in hepatic metabolism at clearly defined stages during the progression of NAFLD, therefore increasing our likelihood of developing therapeutic agents to treat the disease.

What do you enjoy most about your work?

There are two things I most enjoy about my work:

  • the process of watching projects come to fruition and seeing the results come together is really exciting,
  • creating a supportive environment that challenges individuals to reach their full potential and grow in confidence.

Who do you most admire professionally?

Professionally, there have been many people (both senior and junior) past and present who I admire for a multitude of reasons; including their professionalism, patience, knowledge, determination, resilience and enthusiasm. They have passed on little gems of information – through their actions and words. These individuals know who they are and I cannot thank them enough for their support over the years.

I have been involved in the sport of rowing for over 30 years and, as a coxswain, I have been involved in boats that had world-class coaching and two coaches particularly stand out, despite their very different coaching manners. They both fostered a strong team commitment, had the ability to personalise their coaching to bring out an individual’s full potential (and beyond), and kept the focus on the process (rather than the outcome). For this I have huge admiration and have learnt to apply these techniques to my academic career.

Finally my grandfather, who passed away 4 years ago was a very important person in my life, along with a great work ethic (and zest for life) he was an incredibly well-respected rugby coach who had a unique ability to bring out the best in teams.

Any words of wisdom for aspiring endocrinologists out there?

Take the unexpected opportunities that present themselves (they could be the best decision you ever make) and if you are unsure find a mentor, who you trust and who is honest and constructive (listen to their advice, even if it is not what you want to hear). Remember that an academic career comes with disappointments. I don’t use the word failure as none of us fail, we just take different paths to successes, so it is important to persevere and build resilience but most importantly enjoy what you do!

 

You can hear Professor Hodson’s Starling Medal Lecture, “Hepatic fatty acid metabolism: the effect of metabolic and nutritional state” on Monday 19 November, in the Lomond Auditorium at 14:45-15:15. 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: 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.

How to get into peer review and why

Peer Review Week 2016 is taking place from September 19-26. The global event celebrates the essential role that peer review plays in maintaining scientific quality. The central message is that good peer review is critical to scholarly communications.

This year, the theme is ‘Recognition for Review’, so we have asked some of our members to tell us about how they first got involved in peer review, why it’s important to them, and why is it essential for the continuation of high-quality science and clinical research.

 

Li Chan is a clinical scientist in paediatric endocrinology at Queen Mary’s University London. She discusses why peer review is important to her – and you.

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Remember that peer review isn’t just about the journals and funding bodies; it’s also important to the author and the reviewer. The author receives constructive feedback to ensure that their work is presented in the best way and backed up by necessary experimental data. Reading other reviewers’ comments and alternative views on a given set of data may allow you to consider your work from another point of view – and that could make the difference between published and unpublished.

On the other hand, the reviewer gains career development and insight. The reviews you write for others will only aid your own future submissions. Over the years I have learnt an immense amount from both writing reviews and receiving them – and I believe this understanding of both sides of the process is necessary for it to work really effectively.

But how did I get into peer review? During my PhD years, my supervisor would ask me if I wanted to review a submission. I always said yes – working with my supervisor at the start was a useful way of learning the process as I could discuss my final report with someone more experienced. Gradually, I developed my own style and expertise.

If you are a young researcher wanting to get into peer review, I would recommend you speak to senior members of staff. They will only view your enthusiasm with positivity. And don’t think for a moment you’re underqualified; science is such a broad subject – we need reviewers with expertise in all areas, and that includes yours!

 

Karen Chapman is the Society General Secretary, as well as a member of the Editorial Board for the Journal of Endocrinology and Journal of Molecular Endocrinology. She discusses the importance of peer review in career development.

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Publications are the main criterion we are judged on – and I believe the quality of our outputs is dependent upon a thorough review process. With this in mind, I believe we all must do our part to get involved in peer review. We depend on others to review our own papers, and so we all need to reciprocate.

After over 30 years as a research scientist (and not far off 30 years as an Editorial Board member of one sort or another), I have plenty of experience of peer review – from both sides. Yes, it is tough to read the rejection letters and to have your research critically appraised by someone whose identity you can only guess at, but most of the time the reviewers have a fair point, and often their comments substantially improve a manuscript.

Many of us (me included) get into peer review by appraising a manuscript passed to us by a co-worker or lab head. My first one took me forever. I think I read all the references! However, I soon learned to speed up, and concentrate on the data and how they are interpreted. This process also taught me what to look for in my own research and how to evaluate my data through a reviewer’s eyes. I believe reviews work best when a writer suggests a mechanistic experiment that can really nail the conclusions presented. It does happen; and this could be the sign of a great reviewer!

You stand to gain an awful lot from getting involved with peer review, but if you still aren’t convinced, remember that reviewing is also beneficial for keeping up with what is new. It’s a great way to stay ahead of the game!

 

We’ll be on Twitter all week showing our support for the campaign using the official hashtag #RecognizeReview  – and we’d love to hear your experiences of peer review! Also, check out some of our online talks for even more advice on getting into the peer review game:

Wayne Tilley – The Peer Review Process
Dr Josef Koehrle – Responding to reviewers comments

You can also sign up for free webinars and talks through the Peer Review Week 2016 official website.

 

Five tips for applying to medical school

Society member Seb Shaw is probably not your typical medical student. Currently studying for a Masters degree at Brighton and Sussex Medical School, he’s keen to dispel myths and give a little insight into the real world of medicine. Here are his five top tips for applying to med school….

Continue reading “Five tips for applying to medical school”

Women in endocrinology: hints and tips

The latest issue of The Endocrinologist explores some of the issues facing women in endocrinology. As an addendum to her article ‘Addressing the Challenges’, Anna Crown imparts her ‘hints and tips for those in the thick of it’…

Choosing a partner

When I got married, the vicar alluded to a panel on the Bayeux tapestry.  The text states that ‘the bishop comforted the troops’, whilst the illustration shows the bishop with a big pointy spear, prodding the troops out into battle.  This, he said, was a true interpretation of the term ‘comfort’ in the context of marriage; that each partner should encourage the other to take on new challenges.  This is important.  Pick a partner to ‘comfort’ you, but not one who deep down is looking for a ‘traditional wife’ (whatever their protestations). Continue reading “Women in endocrinology: hints and tips”