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. 

12 endocrine news stories that you may have missed in 2016 – Part 3

In the final blog post in our series looking back over the endocrinology news you may have missed in 2016, we explore news on the effects of the contraceptive pill, drug pricing and more.

Find Part 1 and Part 2 here.

September: Contraceptive pill explains falls in ovarian cancer

It’s generally agreed that the pill offers protection against ovarian cancer. In September we got a better idea of just how strong this effect is, as a study published in Annals of Oncology looked back at the potential cases prevented since the pill was introduced in the 1960s. Between 2002 and 2012, the rate of ovarian cancer fell dramatically in the EU, US and Oceania, with deaths falling 10% in 28 EU countries.

The declines were particularly marked in countries such as the UK (22%), Denmark (24%) and the USA (18%), where the pill was more widely used after its introduction in the early 60’s.

“There are noticeable differences between countries such as Britain, Sweden and Denmark, where more women started to take oral contraceptives earlier – from the 1960s onwards – and countries in Eastern Europe, but also in some other Western and Southern European countries such as Spain, Italy and Greece, where oral contraceptive use started much later and was less widespread,” said lead researcher Professor La Vecchia.

The effects were also more pronounced in younger and middle aged women compared to older women. “This is possibly due to the fact that women who are middle-aged or elderly now were less likely to use oral contraceptives when they were young,” he added.

 Media headlines causing a buzz:

Making babies without eggs may be possible, say scientists (BBC)

Testosterone could treat prostate cancer (The Times)

Common contraceptive hormone could protect women from flu (The Telegraph)

First ‘three person baby’ born using new method (BBC)

 

October: The pill and depression

October was a busy month for reproductive endocrinology. Scientists found evidence that ovaries can grow new eggs and we came a step closer to a male contraceptive injection. However, the story causing the biggest stir was an association between use of hormonal contraceptives and depression. Published in JAMA Psychiatry, the study showed that women who used hormonal contraception were more likely to be prescribed an antidepressant, and to be diagnosed with depression.

pill

In a statement widely covered by the media, Society member Dr Channa Jayasena said: “This study raises important questions about the pill. In over a million Danish women, depression was associated with contraceptive pill use. The study does not prove (and does not claim) that the pill plays any role in the development of depression. However, we know hormones play a hugely important role in regulating human behaviour.”

“Given the enormous size of this study, further work is needed to see if these results can be repeated in other populations, and to determine possible biological mechanisms which might underlie any possible link between the pill and depression. Until then, women should not be deterred from taking the pill,” he added.

 

Media headlines causing a buzz:

Evidence suggests women’s ovaries can grow new eggs (The Guardian)

Male contraceptive jab ‘effective’, but side effects are common (NHS Choices, Bazian)

Zika virus could cause infertility in men, new study suggests (The Telegraph)

Prostate cancer sufferers who have hormone treatment ‘double’ their risk of dementia ( Daily Mirror)

Researchers discover the role of hormone in ‘creating fat’ (NHS Choices)

Boys conceived through IVF technique have lower than average fertility (The Guardian)

 

November: Yoyo dieting might not be your fault

While you were at the Society’s 70th annual conference in Brighton, you may have missed a study in Nature that provides some understanding into why people often regain weight after weight loss, and why yo-yo dieting is so ineffective. It appears that stubborn gut bacteria may retain a “memory” of obesity.

Scientists created a yo-yo dieting mouse model, which was cycled from high fat chow to low fat chow continuously, leading to cycles of weight gain and weight loss in the mice.

“As observed in recurrently dieting humans, a preceding obesity-weight loss cycle rendered mice susceptible to accelerated secondary weight gain, even after fully returning to baseline weight,”

The mice which had been on the “yo-yo” diet gained even more weight than mice which had eaten the high fat food the entire time. When the altered “yo-yo” gut microbiome was transferred into healthy mice on a normal diet the mice showed accelerated weight gain, which suggests the altered gut microbiome is causing the accelerated weight gain. So unfortunately, even if you lose weight, your guy microbiome might make it more difficult to keep the weight off – but it is possible! The researchers said that eventually, the microbiome goes back to normal, but this could take months, even years in humans.

 

Media headlines causing a buzz:

Infections not antibiotics may be tied to childhood obesity (New York Times)

Zika virus — concerns for male fertility (Nature)

Discovery of alcohol-regulating hormone could lead to pill which prevents cravings (The Telegraph)

 

December: Hydrocortisone price hike

This new story really got endocrinologists talking. Actavis, producer of hydrocortisone tablets, has been accused of overcharging the NHS after hiking prices from 70p per pack to £88. The accusation comes one week after Pfizer was given an £84.2m fine for similar price hikes for an epilepsy drug.

In 2008 Actavis gained the right to make generic hydrocortisone tablets which are not subject to price regulation.

“We allege that the company has taken advantage of this situation and the removal of the drug from price regulation, leaving the NHS – and ultimately the taxpayer – footing the bill for the substantial price rises,” said the Competition and Markets Authority senior responsible officer Andrew Groves.

Hydrocortisone is a life-saving drug for patients with Addison’s disease, where the body does not produce enough steroid hormone.

Normally only patent drugs are subject to price regulation. When patents expire, and other companies can create generic versions, the competition between competitors keeps prices low. In this case, lack of competitors meant prices could be elevated.

“This is a lifesaving drug relied on by thousands of patients, which the NHS has no choice but to continue purchasing,” said Andrew Groves.

 

Media headlines causing a buzz:

Pregnancy alters woman’s brain ‘for at least two years’ (BBC)

Some baby teething toys may contain hormone-disrupting chemicals (Washington Post)

Prostate cancer sufferer ‘cured’ by blasting tumours with testosterone (The Independent)

Exercise boosts men’s sperm count (BBC)

Babies made from three people approved in UK (BBC)

Autism linked to vitamin D deficiency during pregnancy, researchers find (The Guardian)