Meet the Endocrinologist: Joseph Takahashi, expert on the genetic and molecular basis of circadian rhythms

Meet Joseph Takahashi, Professor of Neuroscience at the Howard Hughes Medical Institute at UT Southwestern Medical Centre. His research focuses on the genetic and molecular basis of the circadian clock in mammals. He has been awarded the SfE Transatlantic 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. 

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

I’m an Investigator in the Howard Hughes Medical Institute, and Professor and Chair of the Department of Neuroscience at the University of Texas Southwestern Medical Center in Dallas, Texas. My lab studies the genetic and molecular basis of the circadian clock in mammals. More broadly we are interested in the genetic basis of behavior. My lab is known for discovering the first circadian gene in mammals known as the Clock gene.

One of the initial surprises from cloning the mammalian clock genes was that they are ubiquitously expressed. This eventually led to the discovery that the circadian clock is cell autonomous and that virtually every cell in the body has the capacity for circadian oscillation. Thus, all of our major organ systems contain intrinsic circadian oscillators. This has led to a revolution in studies aimed at understanding the role of clocks in peripheral tissues as well as studies focused on understanding the systems level organisation of the multiple clocks in the body. The core circadian molecular pathway regulates thousands of genes in mammals, and this has led to the discovery of direct molecular links to a myriad of molecular, cellular and physiological pathways. These include direct links to endocrinology, metabolism, immune function, cell growth and cancer.

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

I have been incredibly fortunate to have had great mentors and colleagues as well as research institutions and funding agencies that have supported me throughout my career.  In college, I was interested in biology, but did not know what careers one could pursue except for med school. Later I had the good fortune to do an independent research project and learned that one could go to graduate school in biology(!). That was the beginning of my research career.  I took a post-baccalaureate year to work with Patricia DeCoursey, one of the pioneers in mammalian circadian rhythms, and then went to work with Michael Menaker for graduate studies. Menaker was the perfect mentor for me. He had a free and open lab environment that encouraged creativity, independence and scale and automation. We pioneered long-term ex vivo culture of tissues that contained and expressed circadian rhythms in the late 1970’s. These initial forays continue to pay off decades later as the entire circadian field uses large-scale data collection, automation and long-term in vitro circadian models.

After graduate school, I did a 2-year post doc with Martin Zatz at the NIH where we worked on the pharmacology circadian rhythms in the chick pineal in vitro.  I was then recruited to Northwestern University by Fred Turek. As an independent faculty member at Northwestern, my lab focused on reductionist dissection of the circadian oscillator in the chick pineal.  In addition to pharmacology, we worked on the biochemistry of various circadian pathways in the pineal.  However, eventually we were stymied, and my interest in the molecular biology and genetics of circadian rhythms was growing.  We knew that molecules and genes had to be important for mammalian circadian rhythms, but how to get there?  That was the beginning of my ‘second career’ as a geneticist.  Ironically as an undergraduate, I was not very interested in molecular biology or genetics (I was interested in animal behavior), but luckily I ‘had’ to take these courses.

In 1990, Larry Pinto, Fred Turek and I decided to use mouse genetics to try to find circadian rhythm mutants. We collaborated with William Dove at the University of Wisconsin-Madison, and Martha Vitaterna conducted our first screen of mice that were ENU mutagenised in the Dove lab.  In our first screen, we isolated the Clock mutant mouse which has a 28-hour period length and a loss-of-rhythm phenotype in circadian activity.  This mutant mouse then provided the means to identify the Clock gene by positional cloning. The isolation of the Clock mutant and the positional cloning of gene was the crowning achievement of my lab.

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

I plan on giving an historical account of our forward genetic approach to finding clock genes in mammals. The effort to clone Clock was massive.  Ten members of my lab worked together as a team for three years to complete the project. In the 1990’s there was no genome sequence. The Clock gene turned out to be huge: it had 24 exons and covered over 90 kB of genomic DNA. Then I will discuss more recent molecular and genomic analyses of the circadian clock gene network. Finally, I will describe our new work on the importance of time and caloric restriction for aging and longevity.

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

I am very much looking forward to seeing all the advances in the field of endocrinology as well as the plenary lectures.

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

It is of paramount importance to support research in basic science. It is very important to translate these basic science discoveries, but one must remember where these advances had their beginnings.  It is impossible to predict new discoveries and how they will impact medicine in the future.

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

Many important breakthroughs in the circadian field will be their connections to all aspects of cell biology, cancer and metabolism. New views of metabolism and longevity are already being linked to circadian biology.

What do you enjoy most about your work?

I love the fact that we are supported to pursue knowledge and discovery of biological systems.  Making scientific discoveries is like a treasure hunt for adults.  It never gets old, and one discovery always opens the door to countless new questions.  Also, as an academic, we have intellectual freedom that is rare in other professions.

Who do you most admire professionally?

My role models have been: Seymour Benzer at CalTech, who pioneered genetic approaches to complex behaviors; Eric Kandel at Columbia, whose systematic and scholarly approach to understanding learning and memory in simple model systems was fundamental; and Denis Baylor at Stanford, whose biophysical analysis of phototransduction was a thing of beauty.

Any words of wisdom for aspiring researchers out there?

My mantra is:  Always begin with first principles. What I mean by this is that you must understand what you are doing. To an electrophysiologist or biophysicist this is self-evident. But in today’s world of molecular biology and informatics, the kits that you use in the lab and the computer programs that you employ are frequently applied without a fundamental understanding what they are doing and how they work.

 

You can hear Professor Takahashi’s SfE Transatlantic Medal Lecture, “Circadian Clock Genes and the Transcriptional Architecture of the Clock Mechanism” on Monday 19 November, in the Lomond Auditorium at 18:00. Find out more about the scientific programme for SfE BES 2018.

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: Maria-Christina Zennaro, expert in the genetic mechanisms of aldosterone-related disorders

Meet Maria-Christina Zennaro, a professor in the Paris Cardiovascular Research Center at the French National Institute of Health and Medical Research (Inserm).  She specialises in genetic mechanisms of aldosterone-related disorders. She has been awarded the SfE European 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 work and what she is looking forward to at the SfE BES 2018 conference.

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

I am a research professor heading the team exploring the genetic mechanisms of aldosterone-related disorders at the Paris Cardiovascular Research Centre at the French National Institute of Health and Medical Research (Inserm). My team is interested in unravelling the genetic and genomic mechanisms of aldosterone-related disorders, particularly primary aldosteronism, by combining clinical work with genome-wide strategies and mechanistic studies in cell and animal models. I am also an associated investigator at the Genetics Department of the European Hospital Georges Pompidou (HEGP) in Paris, where I coordinate the genetic diagnosis of pseudohypoaldosteronism type 1 and primary aldosteronism at the genetics laboratory, which is the French referral centre for the genetic diagnosis of these diseases.

What inspired you into endocrinology?

I received my MD and board certification in endocrinology at the University of Padova (Italy) and completed a PhD in molecular endocrinology at the University Pierre et Marie Curie in Paris. I had the chance to have great mentors, in particular Decio Armanini, who shared his passion for research with me, and John W Funder, who has supported my career ever since. In Paris, I had the chance to work with major players in the field of arterial hypertension and aldosterone, setting the basis for my future research.

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

After obtaining a tenured position as an Inserm researcher twenty years ago, I developed my own research group, which is now benefitting from the outstanding environment of the Paris Cardiovascular Research Centre and HEGP. I am particularly proud of having been able to create our research group, with the successive recruitment of two great researchers, with whom I have taken pleasure in sharing my working career with for many years.

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

I will present an update on the genetic and molecular mechanisms involved in the development of primary aldosteronism. In particular, I will summarise our current knowledge on the genetics of primary aldosteronism, notably our recent paper identifying a new gene in early onset primary aldosteronism, and discuss the pathogenic mechanisms leading to increased aldosterone production and cell proliferation. I will also discuss perspectives for clinical management of patients and open questions to be addressed by future research.

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

There are many great sessions on the adrenal gland, featuring world-leading experts in the field, which I highly recommend. There are exciting plenary lectures and I am looking forward to hearing about the influence of the microbiome in endocrine disease on Tuesday afternoon.

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

I think the challenges are threefold. First, the scientific challenge of improving our understanding of common and rare endocrinological disorders. Second, to be able to efficiently transfer this knowledge to patient care, in particular the knowledge generated from large-scale ‘omics’ studies. Improving diagnosis, management and implementation of precision medicine in clinical practice is really important, and should be affordable and available for everyone anywhere. Lastly, but not least, a major challenge is gathering funding for research in endocrinology.

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

I hope it will be the development of new diagnostic procedures for endocrine hypertension, which will have a major impact on treatment of those patients and prevention of cardiovascular and metabolic complications, improving their quality of life.

What do you enjoy most about your work?

Most certainly it is the scientific exchanges with my colleagues all over the world and mentoring young people to transmit my knowledge with passion to future generations.

Who do you most admire professionally?

I have had the chance to meet many extraordinary colleagues, many of whom I admire for different reasons. I particularly admire a few of my senior colleagues and mentors: I consider it a great opportunity to meet them every year at different meetings around the world, to have discussions with them and benefit from their profound scientific knowledge and incredible experience, especially when they talk about experiments they did 30 years ago!

Any words of wisdom for aspiring researchers out there?

Endocrinology requires a deep understanding of the complexity of endocrine feedbacks and interactions throughout the body. Research in the field of endocrinology is exciting, as it addresses the many questions we have on the mechanisms regulating endocrine physiology and hormone action. In this sense, it is also very diverse, ranging from genetics to cellular and molecular mechanisms, not only in hormone-producing organs but also in the multitude of target organs.

You can hear Professor Zennaro’s European Medal Lecture, “Molecular mechanisms in primary aldosteronism” on Wednesday 21 November, in the Lomond Auditorium at 15:30-16:00. Find out more about the scientific programme for SfE BES 2018.

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

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

What inspired you into endocrinology?

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

Tell us a little about your current clinical work

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

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

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

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

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

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

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

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

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

What do you enjoy about being a Network convenor?

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

Do you have any words of wisdom for aspiring endocrinologists?

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

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

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

 

 

 

10 things your Society achieved in 2017

What a year 2017 has been! Although the bar was set high in 2016, this year was just as prosperous and filled with accomplishments, thanks to the work of all those who are part of the Society.

Here are some of the things your Society achieved in 2017…

1. Doubled the number of users of You and Your Hormones, our public facing website

The Society’s commitment to disseminating accurate information and expertise to non-specialists has been fruitful this year. In July, a more engaging, easier to navigate, and optimised for mobile viewing version of the You and Your Hormones website was launched. Since then, the number of visitors has more than doubled!

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2. Made it easier for members to publish Open Access

At the start of the year, Society members were gifted with free Open Access publishing in Endocrine Connections, leading to savings of up to £950 per publication, and encouraging members to support this high quality, peer-reviewed journal in its aim to be the leading Open Access title in the field. In June, the journal received its first impact factor of 2.541. Over the course of 2017, journal submissions have doubled, and published articles have increased almost four-fold!

Find out all about this and other member benefits on our website!

3. Launched the new Endocrine Nurse Grant

In order to support our nurse community, the Society’s Nurse Committee developed the Endocrine Nurse Grant, a new grant aimed at furthering nurses’ careers and improving nursing and clinical practice.

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4. Identified our first endocrinology champions!

Aimed at advancing the discipline and increasing the profile of endocrinology, the Endocrine Ambassador scheme was launched this year. By organising small research seminars in their home institutions, and representing and promoting the Society for Endocrinology, our Endocrine Ambassadors champion endocrinology and help to increase interdisciplinary collaborations.

5. Received outstanding impact factors for Society journals

2017 has been an excellent year for Society journals – all of them receiving strong impact factors that contributed to keep making these journals a reliable, high-impact home to publish the best science.

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Endocrine Connections received its very first impact factor – an impressive 2.541.  Journal of Endocrinology’s impact factor was its highest to date at 4.706, positioning the journal as the highest ranked basic science endocrinology journal for two years in a row. The Journal of Molecular Endocrinology’s impact factor increased an impressive 21% to 3.577, making this journal the leader in its field. Endocrine-Related Cancer received 5.267, its highest impact factor since 2003. The journal remains in the top quartile of both the oncology and the endocrinology and metabolism categories. And last but not least, Clinical Endocrinology received a strong impact factor of 3.327.

6. Helped improve media reporting of over 120 endocrinology-related stories

This year, the work of our Media Ambassadors, members who provide comments or advice to help journalists cover endocrinology-related topics, have helped improve science and health media reporting for over 120 stories, a 50% increase on last year!

Check out some examples of how our Media Ambassadors have helped journalists this year.

7. Empowered our members to meaningfully engage with non-specialists

Engaging with wider, non-specialist audiences is increasingly more important amongst the scientific and clinical community. It can deepen the impact of your work in the community, and it is also expected of higher education institutions. To help equip members with the skills needed to approach public engagement successfully, we offered two free-for-members, full-day workshops: an Introduction to Public Engagement session run by the National Co-ordinating Centre for Public Engagement (NCCPE), and a Media Interview Training session run by Boffin Media. Both workshops were highly rated by participants, and were described as comprehensive and highly professional.

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Outreach training opportunities are advertised on the Society website – be sure to check it out for updates!

8. Facilitated information sharing amongst the Endocrine Networks

We love to encourage community-building, and understand that our membership has diverse interests with different needs. To facilitate the work of the Endocrine Networks, in 2017 we established the Endocrine Network webpages – dedicated hubs for knowledge exchange amongst basic and clinical researchers, clinical endocrinologists and endocrine nurses that work in particular specialist fields.

To further promote interdisciplinary collaboration, SfE BES 2017 also introduced the Endocrine Networks Research Incubator Meetings, where a selection of research ideas were presented to a panel of experts and the audience, in order to get constructive advice, identify collaboration opportunities and get new research ideas off the ground.

Wondering how to get involved? Joining an Endocrine Network is easy – just log into the Members’ Area and select ‘Endocrine Networks’.

9. Kept you updated on the latest in the endocrine world

This spring, we offered our membership exclusive access to Society event abstracts in the new volume of Endocrine Abstracts: Society for Endocrinology Endocrine Update, which included abstracts from National Clinical Cases, Obesity Update and Clinical Update.

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10. Promoted the success of your endocrine units, and worked together to overcome challenges

The Society Interdepartmental Peer Review scheme is an opportunity to improve the work of endocrine units, and achieve better clinical practice for clinicians, nurses and patients. Relaunched this year, the scheme allows centres to identify their strengths and weaknesses, and work collaboratively to support the changes needed to facilitate the delivery of best care, backed by sustainable services.

Read more about how the scheme can help strengthen endocrinology.

 

We can’t wait to see what 2018 holds in store for us all…

Happy holidays and happy New Year!

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

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

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

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

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

Q: What are you currently working on?

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: How do you think this debate be resolved?

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

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

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

Q: Who do you admire most and why?

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

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

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.

Embracing excellence in endocrinology

How can you encourage undergraduate students to specialise and continue in endocrinology? The Society’s Undergraduate Achievement Award enables departments to reward and recognise the outstanding, endocrine-related work of undergraduate students. Successful departments receive £300 per year for three years, to award to students in any way they decide is most effective.

Director of Learning and Teaching at Kingston University Nigel Page tells us about the value of the award to his department, and his former student Nirun Hewawasam talks about how the experience set her off on a career in endocrinology.

“Recognising the talents of our students is vital, and the Society for Endocrinology Undergraduate Achievement Award gives us the perfect opportunity to do just that! This prestigious award has been a great way of encouraging academic excellence and bringing the field of endocrinology to the forefront of our students’ study. We have been able to offer the award to outstanding performances in our final year projects that have a specific endocrine theme. All of our winners from the last three years have felt the award has impacted on their decisions and confidence in being able to go on and successfully develop their careers in endocrinology, and have decided to undertake endocrinology related postgraduate research studies.

At Kingston University, this award has allowed us to recognise our most talented students and has helped in getting them to where they are today. In addition, it has been a fantastic way to advertise the work of the Society to our students and many of our undergraduates have taken the initiative to become members.

Each year we have been able to announce the award at our graduation ceremony to parents and guests, which is a real honour! The impact of receiving the award has been very positive to all parties, and is certainly something our students will always take away with them.”  Dr Nigel Page, Kingston University.

Nirun Hewawasam joined Kingston University as an undergraduate pharmacology student. As she had a particular interest in type 2 diabetes, her final year project focused on investigating the role of the novel protein SMOC-2 in beta cell growth factor signalling. She received her Undergraduate Achievement Award in July 2014.

Endocrinology Prize
Nirun, receiving her award with Drs Nigel Page and Natasha Hill

“I have always been interested in the field of diabetes, and although my project required a lot of effort and commitment, winning a Society for Endocrinology Undergraduate Achievement Award was highly rewarding and encouraged me to continue in the field of endocrinology. Currently, I am doing a PhD entitled “Intercellular communication and pancreatic islet function in type 2 diabetes” at the University of Roehampton, where I am investigating how two pancreatic islet hormones can modulate islet function and survival in type 2 diabetes. Being a research student has given me a lot of confidence, and being part of life changing research is exciting and fulfilling. So far it has been a great journey full of exciting experiences, including successful moments and hardships, but with rewarding outcomes.

I believe that the Undergraduate Achievement Award contributed to my being awarded my PhD studentship, thereby increasing my career prospects. The award constitutes a great opportunity to encourage any student to undertake a career in the field of endocrinology.” Nirun Hewawasam, Kingston University 2014 Awardee.

IMG_2941
Nirun, working in the lab at the University of Roehampton

Applications for the Undergraduate Achievement Award are open from 14 June 2017 until 15 September 2017. Find out more about how to encourage excellence in your students!

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?

 

Happy International Women’s Day!

This year, in celebration of International Women’s Day, we reached out to some of the female members who are an integral part of our Society (44% of our membership base!) to find out know what motivates, drives and inspires them, and what their proudest moments are. Notepad in hand, we interrupted their busy schedules to ask them some questions. Here’s what they said:

Dr Anna Crown and Dr Helen Simpson both completed their PhDs whilst starting a family and value the career support they received:

anna-and-helen

“I think this is an example of how it is possible to achieve a ‘work life balance’ and a reminder to senior colleagues of how important and influential their backing and encouragement can be”, says Anna.

Helen adds, “I frequently thought I would never finish my PhD. I will be eternally grateful for the support received”. Despite the challenges, Helen’s research achieved a citation for Excellence in Published Clinical Research in the Journal of Clinical Endocrinology & Metabolism.

Louise Hunter agrees that support is one of the essential ingredients for career success:

“My biggest achievement has been securing my MRC Clinical Research Training Fellowship. It made me value the faith others had in me, and taught me the importance of persevering towards a goal!”

Other members value being mentors or good role models. Lisa Shepherd’s proudest moment was becoming SfE Chair of the Nurse Committee, “representing, supporting and educating Endocrine Nurses in the UK. This also led to my becoming one of the founding members of the Federation of International Nurses in Endocrinology.”

louise-and-lisa

Professor Karen Chapman has several proud moments: “They have all been every time one of my PhD students or RAs have won a prize or recognition for their research. That’s a wonderful feeling.”

Dr Antonia Brooke was proud to be told by one of her male trainees that she was his role model, and likes to think that she leads by example: “I’m training programme director and Clinical Lead whilst running a household and a family (and being the major breadwinner).”

antonia-and-karen

And acknowledgement never goes amiss – For Professor Maralyn Druce, “my proudest career moment was the first time that anyone sent me a party invitation addressed to ‘Professor Druce’. – That was pretty cool.”

Maralyn updated

Anna Crown and Karen Chapman have previously contributed to The Endocrinologist, submitting some of their thoughts about women in science. Anna also shared some tips on how to survive endocrinology as a woman with The Endocrine Post.

Be Bold for Change

This year’s International Women’s Day campaign tag line, ‘Be Bold For Change’ prompts all of us to continue to push the agenda for gender parity. So what are our members doing to ‘be bold’?

Here’s some tips on following their example: 

    • Act as a mentor for men and women
    • Share tips on how to juggle responsibilities to achieve a work-life balance (e.g. challenge out of hours career-related meetings)
    • Promote women’s networking or leadership events
    • Create opportunities for women to discuss the challenges they face in their careers
    • Attend inspirational talks or events by successful women in any career path
    • Raise the issue of equal representation in boards or committees.
    • Recommend or nominate women for committees, talks or chair sessions.

Do you know an amazing endocrinologist you’d like to nominate for a Society Committee? We’d love to hear about them! Find out how to nominate them.