Professor Adrian Clark is an Honorary Professor of Endocrinology at Bart’s & the London School of Medicine & Dentistry, and Chair of Bioscientifica. He enjoyed a varied academic career in endocrinology, from studying at Bart’s Medical College to becoming Head of the Academic Department of Endocrinology at Bart’s. He is the current editor-in-chief for Endocrine Connections. In our interview he discusses his academic career, the importance of resilience in research, and tells us what we can expect from his SfE BES 2022 lecture.
Tell us about your career so far
I trained in medicine and biochemistry at Bart’s Medical College, and following various junior clinical training positions, took up a research position with Harry Keen at at Guy’s Hospital Medical School before moving to the National Institutes of Health (NIH) in Bethesda, USA to work on cloning the epidermal growth factor (EGF) receptor with Ira Pastan. I subsequently moved to Kevin Catt’s lab at NIH, working on cloning the angiotensin receptor, before returning to London to Mike Besser’s Department of Endocrinology at Bart’s to establish the Centre for Molecular Endocrinology with Medical Research Council support. I later became Head of the Academic Department of Endocrinology on Mike’s retirement, and Deputy Director of the William Harvey Research Institute. I took on the post of Dean of Research at St George’s University of London in 2012 before retiring from full time work in 2015. Since then I have maintained my research involvement at Bart’s and been Chair of Bioscientifica since 2017. I was editor-in-chief of the Journal of Endocrinology andJournal of Molecular Endocrinology for 6 years, and now I’m editor-in-chief of Endocrine Connections.
What attracted you to endocrinology?
Endocrinology provided ‘precision medicine’ decades before the term was even invented. It was the ability to apply objective data to the diagnosis and management of human disease in contrast to all other medical specialties at the end of the last century that was perhaps the main attraction. In addition, the opportunity to understand disease processes as aberrations of biology really brought science and medicine together in a manner unequalled at that time, which appealed to the basic scientist in me.
“The opportunity to understand disease processes as aberrations of biology really brought science and medicine together in a manner unequalled at that time, which appealed to the basic scientist in me”
Who has inspired you most in your career?
This is impossible to answer. I have worked with, and been taught by, many great endocrinologists over the years – Mike Besser – whose teaching sessions as a medical student were legendary, Lesley Rees, Steve Bloom, Harry Keen and Kevin Catt, to name a few. My greatest “inspiration” however was at a University of Exeter open day as a seven year old when I visited the biology department. I can still remember my amazement at the many exhibits there, such as viewing living protozoa under the microscope. My parents had to drag me away.
What are you most proud of academically?
In research, pursuing the idea that the adrenocorticotropic hormone (ACTH) receptor required an adrenal co-factor when precedents were lacking, and for eventually discovering this co-factor through a rather unexpected route. Perhaps a greater achievement, though, is maintaining a research environment that trained many outstanding researchers and leaders in endocrinology in this country and abroad!
What do you think are the biggest challenges in your field?
Research funding, and attracting and supporting talent. Research in endocrinology understandably lacks the mass appeal of cancer, brain or cardiovascular research. Arguably, this means that funded endocrine research has to be of greater quality, but it also means that endocrinology can be a tough and discouraging place to establish a career at the post-doctoral and junior faculty level. Added to this is also the probability that the attractions of studying and working in the UK will be significantly reduced since Brexit, depriving us of the wealth of European talent from which our research has undoubtedly benefitted in the past.
“My greatest ‘inspiration’ was at a University of Exeter open day as a seven year old when I visited the biology department. I can still remember my amazement… My parents had to drag me away”
Where do you see the next breakthrough happening in your field?
I think that with the greater understanding of the molecular mechanisms underlying signalling we are on the brink of development of really sophisticated tools that could be used to manipulate the pituitary-adrenal axis in patients.
Can you tell us about your SfE BES 2022 lecture?
I aim to summarise about three decades of work which led to the discovery and understanding of the unique role of the melanocortin receptor accessory proteins (MRAPs) and to highlight a couple of underexplored aspects of their role in the control of adrenal function.
Do you have any words of wisdom for future endocrinologists?
Resilience, when papers and grant applications are rejected, it is an essential requirement for success. Ask questions – those you fear are silly questions are often the most revealing. Find and keep a mentor you trust. Keep abreast of developments in other areas – they sometimes provide you with remarkable insights and even real “eureka” moments.
You can attend Professor Adrian Clark’s Jubilee Medal Lecture “The MRAP Files” on Tuesday 15 November from 8:30 – 9am.
Take a look at the full scientific programme for SfE BES 2022.
Professor David Moore was appointed Professor in the Department of Nutritional Sciences and Toxicology at theUniversity of California Berkeley in 2020. He studies the diverse functions of nuclear hormone receptors, with a particular focus on their roles in normal and diseased liver and gut. In our interview, he tells us more about his research and his proudest achievements, so far.
Tell us a little about your career path so far
I started my lab at Massachusetts General Hospital and the Harvard Medical School in 1981, then in 1997 I moved to Baylor College of Medicine in Houston TX. I have recently moved to become Professor in the Department of Nutritional Sciences and Toxicology at UC Berkeley, where my research will be focused on the role of nuclear receptors in metabolism and metabolic disease. Since my younger brother has already retired twice, the wisdom of starting a new lab may be questionable, but I am still excited by the prospect. Our studies will continue to investigate the regulation of basic metabolism, dysregulation in metabolic syndrome and diabetes, as well as the impact of nuclear receptors in hepatocellular carcinoma, cholestasis, fibrosis and inflammatory bowel diseases.
“the discovery of all 48 members of the nuclear receptor superfamily before the human genome sequence was completed, is a great accomplishment. On the other hand, it could be argued that if we had just waited they would have been handed to us on a platter!”
I’ve always been interested in gene regulation and came to endocrinology because it provides great systems for studying this central process. This is particularly true for the nuclear hormone receptors that have been the focus of my entire career.
Who were you most inspired by?
There are a number of really great scientists in the nuclear receptor field who have set a very high bar. In a bit earlier generation this includes Bert O’Malley and Pierre Chambon. Closer to my age the list is longer but includes Mitch Lazar, Ron Evans, David Mangelsdorf and Steve Kliewer, and Holly Ingraham. I am happy to consider all of them friends, and apologies to many other friends and colleagues who also deserve mention.
What are you proudest of in your career, so far?
As a personal achievement, I was proud to be elected to the US National Academy of Sciences. As a scientific accomplishment, the fact that our early efforts in the orphan field, along with those of others, led to the discovery of all 48 members of the nuclear receptor superfamily before the human genome sequence was completed, is a great accomplishment. On the other hand, it could be argued that if we had just waited they would have been handed to us on a platter!
How much has your field changed since you started out?
This is an easy question – the explosion of “omics” tools. The human genome is the most obvious example, but there has been a fundamental transition of experimental focus from gene-by-gene or protein-by-protein to the whole system level.
“Follow your dreams and visions. Pursue the questions that you find the most intriguing, not those that someone else says are more practical!“
Being able to follow ideas where they lead to yield new insights.
What will you be presenting in your lecture at SfE BES 2021?
I’ll be discussing our latest research on how the liver manages its resources in the presence and absence of food.
Any words of wisdom for aspiring endocrinologists?
Follow your dreams and visions. Pursue the questions that you find the most intriguing, not those that someone else says are more practical!
You can attend Professor David Moore’s Medal Lecture, “Feast and Famine: Nuclear Receptor Control of Liver Energy Balance” on Tuesday 9 November at 08:30 GMT.
Find out more about the scientific programme for SfE BES 2021.
Professor Greet Van den Berghe is the head of the clinical department and laboratory of Intensive Care Medicine at KU Leuven University and its University Hospitals in Belgium. The Leuven Clinical Intensive Care department is a large, tertiary referral centre treating over 3,100 patients per year. She is also Professor of Medicine at KU Leuven and actively researches the endocrinology and metabolism of critical illness. Here she tells about her career, research and how important it is to break boundaries and challenge classical ideas in the pursuit of better patient care.
Tell us a little about your career path After obtaining my medical degree, I trained in anesthesiology and intensive care, then in biostatistics and later completed a PhD in endocrinology. I followed this path so that I could work at the boundaries of several disciplines, which provided an excellent opportunity to build a multidisciplinary research team and to expand on translational research in endocrinology and metabolism of critical illness, from bed to bench and back.
What inspired you into research? When I was a junior attending physician in the intensive care unit (ICU), I observed that long-stay ICU patients, both children and adults, quickly began to look much older than their chronological age. At the same time they showed endocrine and metabolic abnormalities that mimicked certain characteristic of ‘ageing’. I hypothesised that maybe this ‘accelerated ageing’ phenotype of ICU patients could in part be iatrogenic, and if so, may be preventable. These thoughts formed the basis for my PhD research, in which I demonstrated that dopamine infusion, a drug commonly used at the time for haemodynamic and renal support, was causing an iatrogenic suppression of the anterior pituitary with harmful consequences. Based on these findings the practice of infusing dopamine in the ICU was abandoned.
“Together we have made exciting discoveries and we were able to repeatedly close the loop from an original idea triggered by patient care, to basic research in the lab and back to randomised-controlled trials in patients.”
In my postdoctoral research, we went a step further and identified biphasic neuroendocrine and metabolic responses to acute and prolonged critical illness in both patients and animal models. This research clarified many earlier, apparent paradoxes and provided the basis for our later work that focused on the acute and long-term harmful impact of hyperglycemia, the early use of parenteral nutrition and the pathophysiology of the HPA axis response to the stress of critical illness.
What are you proudest of in your career, so far? In 2002, I inherited a very large and well organised clinical intensive care department to chair, upon which I have built research from bed to bench and back again. There was no research in the department when I started, so I had to build everything from scratch. Over the years, this growing symbiosis, between high-level patient care and research, has proved to be very successful. This also allowed me to recruit the best clinicians and scientists who now work effectively together as a very close team.
“I enjoy thinking outside the box, creating new ideas by crossing boundaries between classical disciplines”
Together we have made exciting discoveries and we were able to repeatedly close the loop from an original idea triggered by patient care, to basic research in the lab and back to randomized-controlled trials in patients. That is such great fun! So, I am most proud of my team, and grateful to them for making me happy every day!
What do you enjoy most about your work? I enjoy thinking outside the box, creating new ideas by crossing boundaries between classical disciplines, and working with young, enthusiastic physicians and scientists, to generate new knowledge that forms a solid basis for better patient care.
What will you be presenting in your lecture at SfE BES 2021? In my talk, entitled “Re-thinking critical illness induced corticosteroid insufficiency”, I will present novel insights from our recent research on HPA axis changes that occur in response to acute and prolonged critical illness. I will challenge the classical paradigm of stress-induced increased ACTH-driven cortisol production as the basis for increased systemic cortisol availability in severely ill patients. I will also challenge the idea that a short ACTH stimulation test can diagnose failure of this stress response.
To say it with a metaphor: “What you see is not always what you get”.
Any words of wisdom for aspiring endocrinologists? Look further than the boundaries of your own discipline, there is much to be learnt and innovated when you go beyond them!
You can attend Professor Van den Berghe’s Medal Lecture, “Re-thinking critical illness induced corticosteroid insufficiency” on Tuesday 9 November at 18:45.
Dr Julia Prague is a clinical consultant and clinical academic at the Royal Devon and Exeter NHS Trust and University of Exeter. In our interview, she tells us about her clinical practice and research projects, as well as how she thinks endocrine practice will evolve after the COVID-19 pandemic.
Tell us a bit about your current positionand what you enjoy most
As a clinical consultant and clinical academic I split my time almost 50/50 through the week. At the moment, my clinical commitments include outpatient endocrinology, and inpatient endocrinology, diabetes and general medicine. I moved from London to Exeter last year, and one of the big reasons to move was that near 50/50 split between clinical commitments and research. It’s a great balance that gives me time and space, not only to be with the patients, but also to investigate and take forward some of the issues that they bring up in clinic. Forming new collaborations and being in a new unit with new colleagues is pretty exciting too.
Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet!
Research wise, I’m particularly interested in the menopause through a number of different collaborations. I’m working with the respiratory department on a project looking at lung conditions and sex hormones. Investigating the impact of the menopause in diabetes. I’m also still involved in establishing the role of neurokinin 3 receptor (NK3R) antagonists to treat hot flushes and improve sleep during the menopause.
What got you interested in research on menopause?
Spending hours with the women in our research study of a new treatment for menopausal flushes, and from receiving hundreds of emails from menopausal women wanting to take part. My admiration for them was huge, not least because they so often described themselves as struggling to cope, yet they were the complete opposite of that, meeting endless challenges with amazing fortitude and whilst mostly suffering in silence. To then see them leave misery and suffering behind and find themselves feeling vibrant and human again was rewarding beyond measure.
Furthermore, the majority of women will have menopausal symptoms that impact on all aspects of their daily life, but many will also have co-existing medical conditions before their menopause and these can also be impacted too. Many medical conditions are influenced by the menstrual cycle and that’s an aspect that is under-investigated and I think is really interesting. Inflammatory bowel disease, for example, can fluctuate during the menstrual cycle and Crohn’s disease typically gets better in pregnancy.
Diabetes is also impacted by the menstrual cycle, and it’s the same hormones that are changing during the menopause but this hasn’t been investigated, which is why I’m now interested in this, as this is something patients often report as being a problem for them. I think it’s important to listen to what patients are telling you and then try and investigate why that is, to hopefully find an improved solution for them.
There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.
How was your work affected by the COVID-19 pandemic?
I was a Senior Registrar at King’s College Hospital at the height of the first wave, so I became involved in a lot of the management and service re-design work within the diabetes and endocrinology department, including rota management to facilitate re-deployment to general medicine but whilst maintaining a core specialist service and whilst supporting our junior trainees and particularly our international medical graduates who were isolated from their families, and ensuring our patients were supported and aware of sick day rules and had all the medications they needed. Our department was also therefore part of the frontline team. I was the medical registrar on call for the first peak weekend of King’s admissions. Then I got COVID-19 and could not get out of bed/off the sofa for 4 weeks.
I moved to Exeter towards the end of summer 2020 to take up my Consultant job. Since then I have continued to do quite a lot of frontline COVID inpatient medicine. Now we’re involved in recovery and trying to catch up. Many patients couldn’t be seen through the pandemic because resources had to be syphoned off elsewhere.
The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
I never imagined I would interview for my consultant job on Zoom! Moving to a new city, a new department, a new consultant role and a new research role during the pandemic was definitely an interesting twist at such a significant stage of my life and career.
What are you proudest of in your career so far?
My work on menopause and NK3R antagonists – being published in The Lancet was a huge honour, and the potential that this work has to relieve suffering of women is incredible. As a doctor, all you want is to relieve suffering in your patients and this has that opportunity. It’s also given me a platform to continue working in that field and to be invited to speak at international conferences, as well as develop new collaborations.
This drug class are now in phase three studies and it looks like they’re probably going to be marketed from around 2023/2024. This research is still advancing within the pharmaceutical field, butte top-line results coming out continue to show great promise for the therapy. Seeing the NK3R antagonists come to market will be amazing. For me, to have played some part in that will be awesome and to see patients being able to go to clinicians and get that medication prescribed will be great.
There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.
What do you think are the biggest challenges in endocrinology?
We have to mention COVID recovery, in what was an already overstretched system. However, somewhat linked to that, is the pull of general medicine on our time as endocrinologists. The pandemic has further highlighted this to be an important issue. Hospital inpatient medicine is busy and can’t be cancelled. However, it is essential for recruitment, training, and retention that our specialist time is more protected. The new internal medicine training (IMT) programme will change the number of specialty training years to shorten it, which could have some quite big consequences for the endocrine discipline.
COVID-19 has brought some positives though; it’s highlighted that we can achieve quite a lot remotely with patients using virtual appointments, and some patients prefer fitting their appointments in to their life rather than having to attend the hospital. How this translates going forward though could involve big changes for the specialty.
The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
What do you think will be the major changes in the future of endocrinology?
I think there will continue to be a drive for a smaller number of national centres of excellence in endocrinology. There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic. That will be good for patients overall but the downside could be that there will be a smaller number of centres with specialist services, which means that staff may have less involvement in specialist endocrinology. A lot of these changes will be driven by the GIRFT recommendations, which will affect how all services are delivered going forward.
What challenges do you see for your research?
Availability of funding will be critical. COVID has had an impact on available funding but so has Brexit, there’s now a lot of European grants that UK researchers will not be eligible for. Universities have less money because they’ve had fewer students and international students may think differently about studying in the UK post-Brexit and post-pandemic. Charities that fund research have also been hit as many of their fundraising activities were suspended during the COVID restrictions. The Government has a significant financial deficit to address. Availability of research funding was already challenging but it’s going to be even more difficult in the years to come. It’s usually funding that restricts research activity rather than a lack of ideas or collaborations.
How would you like to see the Society develop?
My overwhelming memory of attending my first Society meetings in 2006/2007 is of a lot of senior white men wearing tweed jackets! Now every time I come to Society meetings it’s such a stark change from that. Everything that the Society has done, and is doing, to make itself more reflective of everyone within it is really important. Recruiting the next generation is also a huge part of that, and it is great to also see more focus on this now than then too. The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
That level of change takes time and effort and over the years I’ve tried to play some part in helping to make the Society a more different place to the one that I initially knew.
As a Leadership and Development Awardee I was really looking forward to SfE BES 2020 as we were going to be paired with award lecturers, and it is also always a great opportunity to catch up with friends, previous colleagues, and previous as well as potential new collaborators. But of course, that didn’t happen. I’ve just been finding my feet as a new consultant and researcher in a new city but being an Awardee has opened up other opportunities. I’ve been involved in discussions with an external organisation exploring new collaborations and identifying our shared goals and objectives that we could achieve together. I’m sure that being an Awardee has helped me be offered these opportunities.
Who have you been most inspired by?
Prof John Wass, obviously, but I have also been very lucky to have amazing clinical and research mentors. From the literal beginning to the end of my clinical training and beyond (now over 15 years!) with Dr Simon Aylwin at King’s and Dr Roderick Clifton-Bligh in Sydney. I also learnt a lot from Prof Waljit Dhillo whilst doing my PhD at Imperial.
Why do you love endocrinology?
The balance of the acute and long-term follow up of patients, and the importance of making the right diagnosis for patients based on their history, examination and targeted investigation. Many patients with endocrine conditions go undiagnosed or misdiagnosed for a long time, so when you make the right diagnosis and instigate the right treatment, they feel and do so much better and you often see it unfold in front of you. As endocrinologists we are also part of a much wider multidisciplinary team, which is great.
Any words of wisdom for aspiring endocrinologists?
I’ve always tried to be involved with the Society in recruiting the next generation. It’s important that they get to see the ‘real’ endocrinology and diabetes because often, those rotation attachments are mostly inpatient general medicine.
My advice would be to try to get to clinic as much as possible because a lot of our patients are outpatients, and also to go and review specialty patients on the wards when they are admitted. Remember also that there’s lots of different sub-specialties within endocrinology (and diabetes) so there is a place for everyone and an opportunity to be involved in the areas that you find most interesting/rewarding.
Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet! I also always recommend going to SfE BES, it’s a really good platform for meeting other clinicians and scientists involved in the field, and hearing about the patients that we look after. Get involved, come along and see what the specialty really has to offer.
The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!
We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.
SfE BES is all about bringing endocrine professionals together to share knowledge and spark future collaborations. This year, for the first time, delegates are invited to hear specific research proposals and contribute their insights, data or resources to really help get these fledgling projects off the ground.
Here, Dr Kate Lines, from the Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, talks about her proposal to be presented at an Endocrine Network Research Incubator Meeting to further understanding of pancreatic neuroendocrine tumours. To complete her project, she needs SfE BES 2017 delegates to provide more patient samples!
My research mainly focuses on learning more about how pancreatic islet cell tumours (pancreatic neuroendocrine tumours) grow, and using this information to develop new therapies. One specific area that has begun to interest me recently is inflammation. Inflammation is a process in which the body sends cells of the immune system (or white blood cells) to specific areas to defend against foreign substances. It has now been shown that many tumours can hijack this system by releasing chemicals to lure in white blood cells. Once the white blood cells reach the tumour they are encouraged to secrete small proteins (cytokines), which help make the perfect environment for the tumour to grow. The perfect growth environment is different for different tumours, therefore the specific white blood cells and cytokines needed by each tumour is also different. Currently, not much is known about which white blood cells and cytokines are most important for supporting pancreatic neuroendocrine tumours.
I submitted a proposal for the Endocrine Neoplasia Syndromes Network Research Incubator Meeting at SfE BES 2017 that suggests examining the area around dissected tissue from pancreatic neuroendocrine tumours for these specific cells and cytokines. Once we have this information we can use it to either help diagnose the tumours (as the cytokines can be detected in the blood), or target them with specific drugs to try to make the environment less ideal for the tumour to grow. However, the trouble with pancreatic endocrine tumours is that although they can be deadly, they are also rare. This is the main stumbling block for the proposed study, as our hospital alone doesn’t have enough samples for us to be confident that the specific cells and cytokines we see are representative of those occurring in all patients.
The Endocrine Neoplasia Syndromes Network Research Incubator Meeting provides a rare opportunity for us to try to access these samples from different hospitals in different locations, which ultimately could provide a set of samples that is truly representative of all the pancreatic neuroendocrine patients in the UK. Not only could the members help by providing samples for this study, but as our work continues they could also provide further samples, such as blood, for future work stemming from this proposal. I therefore hope that the other members of the network will be as interested in this area as I am and would like to provide us with lots of patient samples to investigate. In addition, as an early career researcher it is rare to get the chance to present new ideas to my peers. I am therefore looking forward to what I hope will be an exciting and stimulating discussion on a new area of research for me.
The Endocrine Network Research Incubator Meetings will take place on Tuesday 7 and Wednesday 8 November, 07:45–08:30, come along to the Endocrine Network Meeting most relevant to your research interests and read the full scientific programme for SfE BES 2017 for more details.
To join an Endocrine Network login to the ‘My profile’ section of the ‘Members’ Area and select Endocrine Networks.
Meet Professor David Hodson, Society for Endocrinology Starling Medal winner for 2017. Prof Hodson is based at the University of Birmingham, where his work investigates how failure of pancreatic beta cell function contributes to type-2 diabetes. He is particularly interested in using multidisciplinary and innovative approaches to answer these research questions, which has earned him this award, to be presented the annual conference, SfE BES 2017, in Harrogate, 6-8 November 2017. Learn more about his endocrine journey in this exclusive interview.
Q: Tell us a little about your career so far and how you ended up in Birmingham
I originally trained as a Veterinary Surgeon at the University of Bristol, where I studied for a PhD in reproductive neuroendocrinology. Tempted by warmer climes, I then migrated to the South of France to join Patrice Mollard’s lab at the CNRS Montpellier, France. This was an exciting time when Patrice had just discovered pituitary networks, and I was lucky enough to be involved in some of the seminal work that followed. This period cemented my passion for microscopy and method development. I then took up a post as a Non-Clinical Lecturer at Imperial College London in Guy Rutter’s Section, applying optical approaches to the study of islet biology and generally learning how to survive in academia. I moved to the University of Birmingham 18 months ago through their Birmingham Fellows Scheme, convinced that the availability of world-class imaging/metabolomics and abundance of young talent would help me to push my research to the next level. Now a Professorial Research Fellow, I am tasked with the exciting role of expanding diabetes research, as well as further developing our imaging capability. This despite my initial reservations about the city following the BAFTA award-winning “Peaky Blinders”!
Q: What more specifically are you presenting at your Medal Lecture at SfE BES 2017?
It is becoming increasingly clear that, rather like society, beta cells are not equal. In fact, a small number of beta cells may be responsible for driving insulin release, as well as proliferation/renewal, similar to how just a few individuals own most of the world’s wealth. Or alternatively, how you are only ever six people away from knowing Kevin Bacon (of “Tremors” or “Footloose” fame). This is a really hot topic that challenges our understanding of how beta cells may fail (or respond to treatment) during type 2 diabetes. Therefore, I’ll talk about the recent questions that have arisen in terms of beta cell diversity, the tools we have developed to try and understand this and how this has changed our viewpoint of beta cell function under normal and diabetic conditions. There will be lots of colour, movies and practically no text.
Q: What are you particularly looking forward to at SfE BES 2017?
My first SfE BES conference was last year and I’m a convert! It will be great to see how endocrinology is progressing in the UK and to catch up with colleagues whilst discussing research in a friendly, informal and supportive environment. In particular, I am looking forward to the “Tissue Engineering for Regenerative Medicine in Endocrinology” symposium. This holds promise not only for diabetes treatment, but also for many endocrine disorders. I’m also looking forward to the social programme. I’d be lying if I said that food and alcohol didn’t play an important role in any conference attendance!
Q: What has been your career highlight so far?
To be honest, I’m relatively new to this and the lab has been working across so many disciplines/topics that it’s difficult to pinpoint a particular highlight. I’m very appreciative that I’ve got excellent collaborators and we are just pleased to be involved in any output that falls under the ‘team science’ banner. Having said that, getting to see Wrestlemania 33 at the same time as ENDO 2017 this year in Florida has to be pretty good, right? Does this count as a career highlight?
Q: What do you think are the biggest challenges in your particular research area right now?
Our biggest challenge remains how to translate our basic findings on beta cell function from the bench to the bedside. We are amassing detailed knowledge regarding the mechanisms underlying insulin secretion, especially in the ‘omics era, but need to strive to harness this for therapeutic potential. On the flip side, lack of understanding about basic mechanisms will hold back progress on all fronts, so we should not make this the only criteria for our research.
Q: What are your future plans for your work & career?
Honestly, I haven’t really thought that far ahead. I’m content following up the avenues created by current research and just having fun doing what we’re doing. Maybe become a Vice-Chancellor? The pension seems decent.
Q: Who do you most admire professionally?
I have to admit that I most admire my postdocs, students and technicians. The fact that they have chosen to research diabetes with relatively little reward and in tough academic times really speaks volumes about their motivation and personalities. They do it because they love to do it. I am lucky to have such good people.
Q: Any words of wisdom for aspiring endocrinologists out there?
Endocrinology is bound by shared mechanisms and concepts. Therefore, as a basic or clinical researcher, don’t be afraid to apply thinking from one field to another field, as well as take risks with the research. The outcome and impact can be quite dramatic compared to the high-throughput, predictable science that the funding climate seems to encourage. If someone asks you what is the point of doing this, then it’s generally a positive thing!
Q: What do you think will be the next major breakthrough in your field?
There is a realisation that current drugs are difficult to improve upon. Certainly, pharma pipelines, profits and innovation are all shrinking as the list of FDA requirements rightly grows (e.g. concerning cardiovascular safety margins). Therefore, directed or personalised treatment may represent the next breakthrough in the field, for example through production of unimolecular agonists where a few licensed drugs are ‘bolted’ together or matching patient genotype to drug efficacy.
You can hear Prof Hodson’s Society for Endocrinology Starling Medal lecture, “Next generation tools to understand endocrine function in health and disease” on Monday 6 November, 18:00-18:30, and see the full scientific programme for SfE BES 2017.
Miriam Asia (right) and Andrea Mason (left), Clinical Nurse Specialists (CNS) in endocrinology at Queen Elizabeth Hospital Birmingham (QEHB) tell us about their work in endocrine nursing and what they are looking forward to at SfE BES 2017, 6-8 November in Harrogate.
Q: Tell us a little about yourself and where you work
Miriam: As an endocrine specialist nurse, I run the adrenal nurse-led clinic, post-traumatic brain injury endocrine screening clinic and support the young adult clinic. I have also completed the Non-Medical Prescribing course at Masters Level and I am planning to start a masters in endocrinology.
Andrea: I currently look after three nurse-led clinics; late effects of cancer treatment (transition clinic from children’s to adult services), pituitary and a new clinic that monitors patients who have developed immune-related adverse events in response to immune check-point inhibitor treatment. I have a particular interest in the quality of life issues surrounding endocrine conditions.
Q: What inspired you to work in endocrinology?
Miriam: I only knew about endocrinology through nursing textbooks but now, being able to see endocrine patients, reviewing them in clinic and working with them through their endocrine journey makes me realise even more how fascinating and exciting endocrinology is. Especially when I see the difference it makes to our patients during and following treatment.
Andrea: During my nurse training I developed a keen interest in cancer nursing and worked in oncology for many years until an opportunity for me to branch out into endocrinology as a Clinical Nurse Specialist arose. This position was to cover maternity leave and I knew little about endocrinology, so I had to learn on the job quickly! During my first week, I attended the Society’s Endocrine Nurse Update and was totally blown away by the specialty. The journey had started; I spent evenings studying after work trying to get to grips with the basics.
Q: What are you looking forward to at SfE BES 2017?
Miriam: As well as the plenaries and nurses’ sessions, I am also looking forward to the ‘Meet the Expert’ and ‘How Do I…’ sessions, especially those relevant to my clinical practice.
Andrea: This is my second SfE BES and I am looking forward to the nurses’ sessions, particularly those on opiate-induced endocrinopathy, and development of endocrinopathy following metastatic melanoma treatment. I also enjoy meeting and networking with other endocrine nurses.
Q: What are your career highlights so far?
Miriam: I recently completed a sky dive (see photo right), with some of my CNS colleagues, in support of our QEHB charity for the Young Adult Clinic!
Andrea: Highlights in my nursing career, include working as an Endocrine Nurse Specialist and successfully completing the Non-Medical Prescribing course at Masters Level.
Q: Who do you most admire professionally and why?
Miriam: My endocrine colleagues – nurses and doctors – at QEHB who work with such competence and dedication to look after our endocrine patients
Andrea: I have had an inspiring and passionate Endocrine Lead Nurse to guide me throughout the last five years and support my development. I have also had the support and patience from a caring team of endocrinologists.
Q: What advice would you give to someone starting out in endocrine nursing?
Miriam: Although endocrine nursing is a challenging specialist role that requires a lot of reading and studying, it is rewarding in the end.
Andrea: It does take time to understand the speciality and additional studying is required but when you understand the basics of the endocrine system, it is all very logical. I would say to any nurse…. go for it!
Q: What are your future career aspirations?
Miriam: To complete my masters in endocrinology and become more confident and competent in dealing with complex endocrine cases as a result. I also hope to see more nurse consultants and nurse led clinics being set up.
Don’t miss the dedicated Nurses’ Lounge at SfE BES 2017, giving nurses the opportunity to meet and network in their own space. This is especially beneficial when you are travelling on your own, or if you are a first-time attendee, as there is nearly always somebody there to chat to. At designated break times there is at least one member of the Nurse Committee on hand for you to get to know.
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.
Meet Professor Antonio Vidal-Puig, endocrinologist and Society for Endocrinology Medal winner for 2017. Prof Vidal-Puig is based at the Institute of Metabolic Sciences, Cambridge University and at Addenbrooke’s Hospital, where his outstanding research, focusing on the link between obesity and associated metabolic complications, has earned him this award, to be presented the annual conference, SfE BES 2017, in Harrogate, 6-8 November 2017. Learn more about his endocrine journey in this exclusive interview.
Q: Tell us a little about your career so far and how you ended up in Cambridge.
Originally from Spain, I studied medicine and trained in endocrinology at Valencia Medical School and Granada Medical School. I held post-doctoral positions in Boston at the Massachussetts General Hospital and Beth Israel Hospital/Harvard Medical School from 1992-1999. There I had excellent mentors including Jeff Flier, Brad Lowell, David Moller and Leo Krall. This was a very intense, exciting and uncertain period, at the epicentre of major discoveries in the field of obesity. This was a period that defined my career, scientific focus, approach to science and reinforced my values. I have been developing my career in the UK, since arriving at Cambridge University in 2000, and now have an established laboratory and have become a Professor of Molecular Nutrition and Metabolism.
Q: Tell us more about your research that led to you being awarded the Society Medal
The lab is interested in why obesity results in diabetes, insulin resistance, fatty liver and ischaemic heart disease, in order to find ways of preventing these complications.
The key concept of our programme is lipotoxicity, which links obesity-related metabolic complications with the excessive accumulation of lipids outside adipose tissue, in organs including muscle, liver and heart. From the concept of lipotoxicity we have developed three main research directions:
understanding how the adipose tissue works, with the aim of improving its function and ensuring that lipids remain in adipose. This led to the development of our “adipose tissue expandability hypothesis”, which is now widely accepted by the scientific community
developing strategies to burn the excess lipids and prevent lipotoxicity through activation of brown fat
promoting that the quality of dietary lipids should be as healthy as possible, to prevent toxic effects.
My Medal Lecture at SfE BES 2017 will summarise our contribution to these three directions.
Q:What are you particularly looking forward to at SfE BES 2017?
I will use this conference for updating clinical aspects of my work. The presentation quality is always good and helpful. One session I am really curious about is Workshop 1: Tissue Engineering for Regenerative Medicine in Endocrinology. I think technology is essential to retain a competitive position in research and the topics presented are highly transferable and of interest. I think tissue engineering approaches to increase brown fat mass could be really helpful in preventing obesity and diabetes, I am curious about the concept and possibilities of using 3D bioprinting.
Q: What have been your career highlights so far?
I feel content about my career progression. I consider highlights to be our best pieces of research; our papers tend to be quite comprehensive and we believe they make important contributions. I think for this reason these contributions are well respected by our colleagues. Our reputation as a lab is important for us. Also as a proud introvert, I have not touted our highlights and have not needed to for our professional highlights to be widely acclaimed, however I do understand that it is important to make the public aware of their implications. Also, as a laboratory leader I know that to disseminate these highlights is important for the careers my lab members. In this respect, winning the Society for Endocrinology Medal is a highlight that reflects the quality and commitment of the present and past members of the laboratory.
At a more personal level, I admit I have an aesthetic approach to science. I enjoy understanding and identifying sophisticated mechanisms, developing models that explain reality and learning how biological systems self-regulate. I don’t think this is unusual amongst endocrinologists. Also, becoming a Professor at Cambridge University was a moment of satisfaction I shared with my colleagues and family. In some ways my career has provided me with professional freedom, which is a key value for me, beyond other motivations, such as power or fame, that I have always found energy draining and restrictive of my autonomy.
Q: What do you think are the biggest challenges in your research area right now?
I think a big challenge in my research area, and others, is how to extract value from the excessive information generated by recent technological advances. Our challenge is how to analyse this information to prioritise the types of mechanistic validation that are necessary for estimating its relevance. Also, it is not only the amount of data, but the amount of unnecessary noise coming from poor quality research that makes this task more difficult.
Q: What are your future plans for your work & career?
As you become more senior in science, you often suffer the disadvantage that your professional horizon is shorter. However, this position also has the advantage that you can be more selective in your choice of projects, with more freedom to take risks. I think my laboratory in this respect is quite entrepreneurial, we are innovating by entering new fields/technologies, which I think is important for remaining competitive. For example, we have opened a new lab at Sanger, funded by the European Research Council to work on stem cells and adipose tissue. We are also developing two new programmes of research; one in Nanjing focused on murine models of fatty liver, and another in Bangalore focused on adipose tissue stem cell biology to model obesity and diabetes in India. These are exciting challenges that will provide opportunities for my younger associates in their future careers.
Q: Who do you most admire professionally?
I have learned a lot from many of my mentors, colleagues and trainees. In some way these experiences have shaped my values and my strong views about science and leadership. For example, I have always admired the intellectual rigour and scientific honesty of Brad Lowell. I admired the consistency and confident leadership of Jeff Flier and the legacy of Daniel Lane, who developed many academic scientists in his lab to share his cultural values and collegiality, which they now disseminate to the next generations. I find this very impressive.
Q: Any words of wisdom for aspiring endocrinologists out there?
Endocrinology is not a specialty that will make you rich, but it is a specialty where you can fulfill your intellectual scientific needs and enjoy the human aspect of practicing medicine. It is very satisfying because your patients get better and, given that treatments are required long term, an important factor in the success depends on establishing an empathetic relationship with them. You will get to know many of your patients well, from whom you will receive gratitude and a sense of meaning and fulfillment. In this respect it is a very rewarding profession.
Q: What do you think will be the next major breakthrough in your field?
I think real breakthrough with long term impact requires deep knowledge and new technologies, I have become quite sceptical about quick or easy breakthroughs that address complex problems. It is important to understand how regulatory systems operate, to learn what the adaptive changes of the organism or cell to maintain normality are, and to determine the intrinsic capacity of these systems to recover normality if the early factors of the disease are removed. For this reason, we focus on early disease events, aiming to prevent or reverse excessive damage to the homeostatic system and regain metabolic control. In this sense, we think it is as important to learn how the problem occurs as it is to learn the trigger and why it occurs. In our field I think understanding how lipids mediate disease could be used for prevention, early diagnostic and therapeutic purposes.
You can hear Prof Vidal-Puig’s Society for Endocrinology lecture on Wednesday 8 November, 15:45-16:45, and see the full scientific programme for SfE BES 2017.
The annual Society conference, SfE BES, takes place this year in Brighton on 7-9 November 2016. It’s a great chance to network with colleagues, showcase your work and explore new research in your area of endocrinology. Our programme of events is varied yet specific – bringing together the best of basic science, clinical investigation and clinical practice, you have the chance to expand your horizons into other parts of the field whilst also attending those lectures which are really specific to you.
The submission system for abstracts is open until midnight on Wednesday 22nd June – so you have more than enough time to polish your final abstract and send it along. It’s not just a chance to show your colleagues across the whole field of endocrinology what you’ve been working on – it’s a chance to tell them why what you’ve been working on is important.
Last year at SfE BES, a great programme highlight was a session entitled ‘Evolving model systems for complex tissues’, which was chaired by Kevin Doherty and Shareen Forbes. In the ’90s, manipulation of human embryonic stem cells (hESCs) was something of a new thing. It was anticipated that the ability to grow human tissues in culture using hESCs would provide incredible model systems for drug development, toxicity testing and cell therapy.
However, it wasn’t until 2005 that reliable markers had been developed and a significant number of important signalling pathways had been elucidated in the path to differentiation. By this point, some ten years later, finally a tool box existed for nearly every tissue type. This lead to some of the first clinical trials, using pluripotent cells to treat age-related macular degeneration. However, liver disease, diabetes and neurodegeneration were still elusive and challenging goals.
By 2014, fully functional human beta cells has been generated, and they took only 45 days and 7 stages in culture. This was a hugely exciting moment for diabetologists and researchers across the world. But then, of course, the question sprang up: could they be used as a source of islet cells for replantation? Or would they merely serve as an invaluable model?
At Kevin and Shareen’s BES session, they gave a detailed overview of both the background to the field of complex tissue model systems, and the current state of basic science and clinical research, highlighting very recent advances, and discussing the potential future.
The stem cell field continues to expand rapidly. 2016 has already been the year that Chinese scientists grew functioning mouse spermatozoa from skin cells – these went on to fertilise egg which developed into embryos and grew to successful progeny. What will the second half of 2016 bring?
With over 1000 delegates, 100 abstract lectures, 10 plenary lectures, and an evening of awards and prizes, SfE BES is the best place for you to spread the word on your research, and meet the colleagues that you want to work with in future. Your lecture might be the one were talking about all the way into June 2017.
The Endocrine Post 