Blog posts

A deep dive into 30 years of progress and challenges

Professor Jonathan Valabhji

Diabetes now affects over half a billion people globally, including 3.8 million people in England. Type 2 diabetes, which accounts for 90-95% of all cases, has obesity as its primary modifiable risk factor. Expanding waistlines, both nationally and globally, have driven a steady increase in type 2 diabetes rates in recent decades. To mark World Diabetes Day, Professor Jonathan Valabhji OBE, from the Department of Metabolism, Digestion and Reproduction, reflects on his 30 years of experience in the field, in clinical practice, in national leadership, and in clinical and epidemiological research.  

My background in Diabetes research and clinical practice 

I qualified as a doctor in 1990 from St Bartholomew’s Hospital Medical College, London. I undertook specialist training in diabetes, endocrinology, and general medicine in North-West London, and landed at Imperial College in 1997 to undertake my MD (Doctor of Medicine degree) as a British Heart Foundation Junior Research Fellow. In those early years, I was interested in cardiovascular disease in diabetes, which at that point was responsible for the majority of deaths in people with diabetes. My work centred on understanding the paradox in type 1 diabetes: although patients often displayed healthy cholesterol profiles, they were at elevated risk of heart attacks and strokes. I spent 3 years in a lipid laboratory, using ultracentrifugation (a technique used to separate and isolate particles based on their density) to isolate high-density lipoprotein (HDL) cholesterol particles from blood samples, to try to disentangle the paradox.  

Population-level progress in cardiovascular health  

While I like to think that some of that early research advanced the field a little, it was other epidemiological and societal factors that saw cardiovascular disease fall in people with diabetes over the next two decades. Public health initiatives, such as reduced smoking rates, and improved management of blood glucose, blood pressure, and cholesterol, have collectively driven a marked decrease in cardiovascular complications, resulting in longer lifespans for people with diabetes. However, with this success came new challenges, as other and multiple long-term conditions (MLTCs) have increasingly become leading causes of illness and death. This has complicated care for patients, healthcare professionals, and the NHS.  At the same time, obesity has driven younger onset of type 2 diabetes, contributing to accelerated development of MLTCs at younger ages. 

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From Aleppo to Imperial: One surgeon’s journey

Dr Hadi Alagha

Dr Hadi Alagha from the Department of Surgery and Cancer shares his inspiring journey of becoming an orthopaedic surgeon. Learn about his remarkable path from Aleppo to Imperial College London and the hurdles he encountered along the way.

My path has been anything but ordinary, shaped by a deep desire to make a difference.

My story starts in Syria, a home that I have not returned to since I left in 2012. At that time, I had successfully completed three years of undergraduate medicine at the University of Aleppo. Like many others, due to the war I had to leave behind my family, friends and memories. This experience ignited a fire in me to pursue my dream of becoming an academic orthopaedic surgeon.

After some searching, I found my way to the University of Debrecen in Hungary, where I joined as a third-year medical student. It was here that I discovered my passion for scientific research, leading me to complete a Master’s in Sports and Exercise Medicine at the University of Nottingham with distinction in 2016. By the time I graduated from medical school in 2018 summa cum laude, I ranked second among my peers, a proud moment that set the stage for my future.

Transforming hip replacement outcomes with machine learning

I chose to pursue my PhD at Imperial under the supervision of Professor Justin Cobb because of his pioneering work in introducing innovative technologies to the field of arthroplasty – surgery to restore the function of a joint. I hold Professor Cobb in high esteem as both a valued confidant and mentor, whose insights and support have greatly enriched my academic journey. I joined the PhD programme in Clinical Medicine Research at the MSK Lab in October 2018, and my journey was a thrilling ride. My doctoral thesis, titled “Predictive factors and outcomes in primary hip arthroplasty,” focused on developing and validating machine learning (ML) models to predict patient outcomes after hip replacement surgery.

Clinical practice and implant selection for hip disease requiring replacement often exhibit significant variability, making it difficult to predict outcomes. Differences among patients, surgeons, and units can obscure the effectiveness of certain approaches. Machine learning provides a powerful complement to traditional statistical methods, such as multivariate regression models, by handling large numbers of predictor variables and their complex interactions. This allows for more accurate forecasting of clinical outcomes.

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Breastfeeding and Breast Cancer: Exploring the potential link

PhD Sophia D'AlessandroOctober is Breast Cancer Awareness Month. This is a crucial time to raise awareness about screening, treatment, and prevention of breast cancer. PhD student, Sophia D’Alessandro from the Department of Surgery and Cancer examines her research looking at the link between breastfeeding and the reduced risk of breast cancer in our latest blog.

Breast cancer is one of the most prevalent cancers in the world, alongside prostate, lung and colorectal cancer. It is estimated that there are more than 150 new cases diagnosed every day. But why does breast cancer occur? We know cancer is a multifactorial disease caused by a variety of different factors, which can include mutations in key cancer-causing genes, and lifestyle-related risk factors such as age, being overweight, smoking, family history of breast cancer and hormone therapies. However, there are also factors that can reduce a person’s risk of breast cancer risk, such as breastfeeding. 

Current research suggests that the risk of developing breast cancer decreases by 4% for every 12 months of breastfeeding. But it’s not yet clear why. The primary function of the human breast is to produce nutrient rich milk for babies. Therefore, the complex structure of the breast is designed for this function. It is comprised of fatty adipose tissue, surrounding lobules and ducts. The lobules produce milk, and the ducts transport it to the nipple, where it can be expelled and fed to a baby. In addition to this, the ducts of the breast are lined by a layer of specialised cells known as epithelial cells. It has been shown previously that breast milk may contain some of these breast epithelial cells, which are then digested in the babies’ stomach and cause them no harm. However, around 85% of breast cancer cases arise from the epithelium, so it is thought that the loss of mutated breast epithelial cells through breastfeeding may play a role in reducing breast cancer risk.  

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Guide to Sober October: what’s in it for you?

David Nutt

This month, people worldwide will take on the 31-day ‘Sober October’ challenge, a movement that began in the UK to raise funds for Macmillan Cancer Support, benefiting those with cancer. Even if you’re not officially participating, Sober October offers a chance to reset your body and rethink your relationship with alcohol. In our latest blog, Professor David Nutt from the Department of Brain Sciences shares expert tips on how to make the most of this healthy, alcohol-free month.

Sober October is here, and it’s the perfect opportunity to hit reset on your relationship with alcohol – whether you’re looking to completely abstain or simply cut down. Much like Dry January or Dry July, this month-long challenge is about taking a break from alcohol and reassessing its place in your life.

With alcohol consumption on the decline among Gen Z and Millennials, it’s clear that more and more people are recognising the benefits of taking a break from booze and now is the perfect time to jump on board.

Sober October is a global movement encouraging people to stop drinking for the month of October. For many, it’s a time to take a break and rest after summer’s social gatherings and prepare for the end of year holiday season with a clearer mind. It’s not just about abstinence; it’s also about fostering better health, improving mental clarity, and building positive habits for the future.

Progress not perfection

Stopping alcohol intake for a whole month can have major health benefits.  People who participated in previous abstinence challenges like Dry January have reported improved sleep (56%), weight loss (38%), and better mental health. Even those who didn’t make it through the full month still saw long-term reductions in alcohol intake and enhanced well-being, showing that it’s about progress, not perfection.  There are also likely to be measurable physiological improvements such as lowering your blood pressure if you are hypertensive, losing weight (as alcohol has more calories than most people imagine) and putting more money in your pocket – perfect for upcoming holiday shopping.

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The complex relationship between viruses and our immune system

Prof John TregoningVirus Appreciation Day, celebrated annually on 3 October, serves a dual purpose: to foster respect and understanding for viruses while raising awareness about their serious impacts on health. To mark the day, Professor John Tregoning from Imperial’s Department of Infectious Disease shares valuable insights into influenza viruses, highlighting their effects, the importance of vaccination, and ongoing research for universal vaccines against evolving strains in our latest blog.

Viruses have an enormous impact on human health, but they don’t only infect humans. Many viruses also infect animals, plants and even bacteria. Some viruses are quite promiscuous, infecting a wide range of animal species before passing on to humans through a process known as zoonotic transmission. One of the most problematic of these zoonotic infections is influenza virus.  

The main natural reservoir of influenza virus is wild birds, particularly ducks and geese. The virus can then transmit from these birds into domestic poultry, like chickens, and to livestock, such as pigs, before ultimately reaching people. In the past five years, a new strain of avian influenza has emerged with an ability to infect an even wider range of mammalian species. It has been detected in cattle in the US.  

Influenza, the disease caused by the virus, poses a substantial health burden. It resulted in nearly 15,000 deaths in the UK in the 2022-23 winter season. As well as death, it is a significant cause of hospitalisation and general illness – with a long tail of recovery. Additionally, influenza infection doubles the risk of heart attacks and strokes for up to a year after illness. Given these risks, getting an influenza vaccine this time of year is highly recommended. As I discovered researching my latest book Live Forever one of the simplest ways of extending your life is through vaccination. A vaccine will give you protection against the most severe forms of disease caused by the virus and protect you against subsequent illness.Vaccines train your body to recognise pathogens and fight them off. To do this, they make use of a facet of immunity called immune memory. When re-exposed to the same virus, your immune response activates faster and stronger, stopping the infection in its tracks. Several aspects of immune memory can prevent subsequent infections, but an important one are antibodies – this is a type of protein that is highly specific in what it can recognise and bind. When you are immunised with influenza vaccine, you make influenza virus specific antibodies that can stop the virus from infecting you. 

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The power of CAR-T cell therapy

The CAR – T Apheresis team with Professor Anastasios Karadimitris

To mark Blood Cancer Awareness Month, Dr Lucy Cook, Consultant Haematologist at Imperial College Healthcare NHS Trust and Honorary Senior Clinical Lecturer from the Department of Immunology and Inflammation, shares how CAR-T cell therapy is transforming blood cancer treatment for patients.

September is Blood Cancer Awareness month, a time dedicated to raising awareness of blood cancers, which often don’t receive the same recognition as other types of cancer types. According to the charity Blood Cancer UK, over half of British adults cannot name a single blood cancer symptom. With over 100 different types of blood cancer, patients often know the name of their specific diagnosis (such as leukaemia, lymphoma, myeloma, myelodysplastic syndrome, CML etc.) but may not realise that these are all forms of blood cancer. Collectively, blood cancers are the third most common group of cancers. Raising awareness among both the public and health care professionals is critical to improving early detection and diagnosis.

At Imperial College London and Imperial College Healthcare NHS Trust, September gives us the opportunity to reflect on the progress made since last year’s Blood Cancer Awareness Month.  One of the most exciting aspects has been the delivery of CAR-T cell therapy for lymphomas (a type of blood cancer that affects white blood cells) and acute lymphoblastic leukemia (a rare type of cancer that affects the blood and bone marrow). This year, the National Institute for Health and Care Excellence (NICE) also approved several new bispecific antibody therapies (BITEs) for lymphoma and myeloma (a type of cancer that develops from plasma cells in the bone marrow). BITEs are special proteins designed to help the immune system fight cancer. CAR-T and BITEs are a new wave of therapies, that harness the immune system to kill the cancer cells, rather than relying on conventional chemotherapy.  Following successful clinical trials, these therapies are now broadly approved for use in patients who have not responded to chemotherapy, offering potentially curative treatments for patients who previously faced poor prognoses. Clinical trials for CAR-T cell therapy are in progress for multiple myeloma, which is really exciting, offering hope for longer remissions for patients with a cancer subtype where no curative treatments currently exist.

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Staying active as we age: Reflections and tips on National Fitness Day

Professor Alison McGregor

To mark National Fitness Day, former NHS physiotherapist and elite sports researcher, Professor Alison McGregor from the Department of Surgery and Cancer, reflects on her lifelong passion for physical activity. She explores the benefits of staying active as we age, offering practical advice on breaking sedentary habits and maintaining fitness throughout life.

My career began as a physiotherapist in the NHS, but I dreamed about working in sport. At that time, I played a range of racquet sports and hockey. Oddly enough my engagement with elite sport came through my research career rather than my academic career. For nearly 18 years, I worked with elite rowers and the GB rowing team. In 2012, I had the honour of running with the Olympic torch in London, representing Imperial.  

My passion for sport and activity persists, and although I no longer compete, I run most days, cycle to work and occasionally go on long hikes and expeditions to stunning parts of the world including Kilimanjaro in Tanzania, Machu Picchu in Peru, the Manaslu Circuit in Nepal and Hadrian’s Wall which is closer to home. But why do I remain so active as I get older? 

We all know that physical activity is good for our health and wellbeing. National Fitness Day is a great time to think about our lifestyle choices, particularly our balance of physical activity and sedentary activities.  Sitting for more than 6-8 hours – which many of us do during the average working day – is not good for us. So, how do we change this?  

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Better, quicker and more effective treatment for patients with sepsis

Sepsis kills five people every hour and accounts for about 50,000 deaths per year in the UK alone. To mark World Sepsis Day, Professor Anthony Gordon, Chief Investigator of the SepTiC study and Head of the Division of Anaesthetics, Pain Medicine and Intensive Care (APMIC), who is also a consultant in intensive care medicine and NIHR Senior Investigator, sheds light on how the study aims to find more effective treatment for sepsis patients.

Sepsis is one of the most serious conditions medical teams deal with. It’s life threatening and always considered a medical emergency. We don’t fully understand why it effects some people at different times but we do know it is caused by the immune system having an extreme response to an infection, most commonly due to an infection caused by bacteria. This causes organs to stop working properly and the body to damage itself because of that immune response, sometimes leading to multiple organ failure.

Patients with sepsis can deteriorate rapidly and this can sometimes be difficult to spot because the symptoms, such as fever, pain and breathlessness, are common to many other diseases. Anything we can do to improve care for these patients is vital to improving outcomes.

For patients receiving critical care in the intensive care unit, this can be even more challenging because they aren’t always able to tell us how they are feeling. But these patients are also at the highest risk because they are already so unwell.

This is why research to refine and improve treatments for sepsis is so vital – so we can respond as quickly as possible, in the most effective way, to help more patients make a full recovery, without lasting side effects.

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Know your numbers – How home monitoring is redefining hypertension care

Dr Amit KauraDr Amit Kaura, Honorary Clinical Lecturer in the National Heart and Lung Institute, discusses the future of blood pressure monitoring in this blog post for ‘Know your Numbers!’ week – a campaign encouraging people to check their blood pressure.

Hypertension, or high blood pressure, is a major global health issue, affecting over 1.3 billion people. Yet, despite its prevalence, many people don’t fully understand what hypertension is, how it impacts health, and how they can manage it effectively.

Hypertension occurs when the force of blood against the walls of your arteries is consistently too high. This force, known as blood pressure, is measured in two numbers: systolic pressure, the pressure in your arteries when your heart beats, and diastolic pressure, the pressure when your heart is resting between beats. A normal blood pressure reading is considered to be around 120/80 mmHg, while readings consistently at 140/90 mmHg or higher indicate high blood pressure.

Often called the ‘silent killer,’ hypertension typically presents no symptoms until significant damage has occurred. Left unchecked, uncontrolled hypertension can lead to serious health issues, including heart disease, stroke, and kidney failure.

My journey into hypertension research is rooted in my background in data analytics in cardiovascular sciences. Hypertension, with its inherently numerical nature, fascinated me from the start. It is not just a static measurement; it is dynamic, with fluctuations that occur throughout the day and in response to various stimuli. This complexity piqued my interest and led me to explore the deeper intricacies of how we define and diagnose hypertension.

The traditional approach of diagnosing hypertension based on a single cut-off value – usually 140/90 mmHg – seemed overly simplistic to me. Through my research, I began to question whether this binary threshold truly captures the nuanced reality of hypertension. There is a wealth of data on the fluctuations and patterns of blood pressure that could offer more insight into cardiovascular risk than a one-time measurement.

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Embracing sleep for cognitive health: Insights from our recent study

Dr Raha West presenting her findings in South Korea

Are you a morning ‘lark’ or a night ‘owl and how is this linked to brain performance? To mark Sleeptember, Dr Raha West from the Department of Surgery and Cancer explores her recent research on over 26,000 people which found those who are naturally more active in the evening scored better on intelligence, reasoning and memory tests.

As we slip towards Sleeptember, a month dedicated to raising awareness about the importance of sleep, it’s the perfect time to reflect on the findings of our recent study published in the BMJ Public Health. Our analysis delves into how sleep duration, chronotype (whether you’re a morning person or an evening person), and various health and lifestyle factors influence cognitive performance in older adults. 

The Motivation Behind Our Study 

The importance of sleep in maintaining overall health, particularly brain health, has always intrigued me. The idea that our daily sleep patterns, including how long and when we sleep, could significantly impact our cognitive abilities led me to explore this further. Previous research has shown that poor sleep quality and duration are linked to various health issues. Still, the specific influence of chronotypes on cognition, especially in older adults, remains under-explored. 

Methodology and Participant Selection 

Our study utilised data from the UK Biobank, which includes a comprehensive set of health information from over half a million participants aged 40 and above. We focused on 26,820 individuals who completed detailed sleep and cognitive assessments. Participants were divided into two cohorts based on the cognitive tests they completed, ensuring a robust data analysis. 

Key Findings: Sleep Duration and Cognitive Performance 

We discovered that sleeping 7-9 hours per night is optimal for cognitive health. Both shorter and longer sleep durations were associated with poorer cognitive performance. This finding emphasise the importance of maintaining adequate sleep duration to support brain function.   

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