Category: Department of Metabolism, Digestion and Reproduction

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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Early onset Type 2 Diabetes: A growing concern

Dr Shivani Misra

While traditionally seen as a disease of older adults, type 2 diabetes is increasingly affecting younger people. This “early onset” form carries a higher risk of complications and earlier death. To mark Diabetes Awareness Week, Dr Shivani Misra from the Department of Metabolism, Digestion and Reproduction sheds light on her research which aims to tackle early onset type 2 diabetes in individuals from minority ethnic backgrounds.

When I was at medical school, I learned that type 2 diabetes was a condition that affected middle-aged or older adults often living with obesity. However, these days the demographics of who is affected by type 2 diabetes have drastically changed. More and more younger adults and children are affected with type 2 diabetes and we call this early onset type 2 diabetes, typically defined as a diagnosis before the age of 40 years.

What we do know from large analyses across the world, is that when you’re diagnosed with type 2 diabetes at earlier age, your diabetes can progress through to complications very rapidly and also reduce life expectancy. Of even greater concern is the impact on women living with early onset of type 2 diabetes, in whom pregnancy can be complicated because of  type 2 diabetes and there’s a higher risk of foetal death, sadly.

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Advancing liver health through microbiome research

Dr Benjamin Mullish

On World Liver Day, Dr Benjamin Mullish from the Department of Metabolism, Digestion and Reproduction, discusses the research being done on the microbiome and faecal (or ‘intestinal’) microbiome transplants (FMT), and how he hopes that can be converted from ‘bench to bedside’ to improve the lives of patients with liver conditions. 

When most of us hear the words ‘gut bacteria’, we think about germs that can cause infection and make people ill.  However, more recently, scientists and doctors have recognised that we also have billions of ‘beneficial’ bacteria (and other microbes) in our gut that play important roles in keeping us healthy.   The specific ‘mix’ of microbes that a person has in their gut, and the environment in which they live – now often called the gut microbiome – is distinct between different people like a fingerprint.  Furthermore, the gut microbiome is influenced by and altered by a number of factors, including our diet, our medications (particularly antibiotics), and how old we are.

Of further interest, we now think that our gut microbiome plays an influence over our vulnerability to developing a range of medical conditions, how the condition progresses if we do develop it, and even how well we might respond to different treatments used for the condition.  This includes a number of different liver diseases; the gut and the liver are very close physically within the body, and the gut microbiome seems to be an important factor that impacts upon how these two organs ‘talk to’ each other in health and disease.  Within the Section of Hepatology and Gastroenterology, one of our major areas of research relates to how an altered gut microbiome may contribute to different liver diseases, and whether we might be able to alter the gut microbiome as a new approach to treating them.

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A new dawn for disease modelling and precision medicine at Imperial College London

Tamas Korcsmaros

In a ground-breaking stride towards advancing medical research, earlier this year, the NIHR Imperial Biomedical Research Centre (BRC) proudly inaugurated the state-of-the-art Organoid Facility. This monumental achievement is the result of years of meticulous planning and the outstanding contributions of researchers like Tamir Rashid, Gary Frost, Nick Powell, and Harry Leitch, who laid the foundation for what promises to be a revolutionary venture in the field of organoid science. Generously backed by five years of strategic funding from the NIHR, the Organoid Facility is poised to become a pivotal resource, not just within Imperial College but across the academic community. Dr. Tamas Korcsmaros, Senior Lecturer in Intestinal Epithelial Biology for the Department of Metabolism, Digestion and Reproduction shares more about the launch of the Facility and how they hope to transform precision medicine.

Understanding diseases better and improving how we model them has been the focus of biomedical research for the last couple of decades. Relevant, scalable and useful animal models have been established to understand the basic biology of cellular and mammalian systems in vivo – experiments conducted for research purposes on whole living organism. Rodent models have been used for preclinical and toxicology testing of promising drug molecules. To complement these efforts, immortalised, cancer-related human cell lines have been used to understand in vitro (experiments conducted for research purposes outside of a living organism e.g., test tube) how these systems work in a human cell. However, all these systems possess different limitations: Animal models are often not completely resembling human processes, especially when we are thinking of host-microbe interactions for example, where a mouse gut is very different from a human gut. Human cell lines are often altered due to their immortalization. In addition, many cell types cannot be kept in cell lines, resulting in no data or testing option on key cell types. Around 15 years ago a new technology started to emerge based on isolating and differentiating specific stem cells of an organ. With this approach, a simplified but 3D models of an organ, mostly containing only its epithelial layer can be developed. They are called organoids.

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From Paris to London, via The Gambia—my journey as a clinician scientist

Prof Maud Lemoine with key collaborators, including Dr Yusuke Shimakawa and Dr Gibril Ndow
Prof Maud Lemoine with key collaborators, including Dr Yusuke Shimakawa and Dr Gibril Ndow

On the national day of France—known as ‘Bastille Day’ in English—we hear from Prof Maud Lemoine, Professor and Honorary Consultant in Hepatology at Imperial’s Department of Metabolism, Digestion and Reproduction. She completed her medical degree and PhD in Paris, France, before working in The Gambia, and then the UK  

What brought you to London, and Imperial?

Initially I came a bit by chance. I was working in a teaching hospital in Paris as a full-time clinical consultant, having completed a PhD in physiopathology of non-alcoholic fatty liver disease. I wanted to work abroad and was very interested in working on viral hepatitis and liver cancer in sub-Saharan Africa. I wanted to work in a non-French speaking environment and meet other cultures. In 2011, by chance, I met Prof Mark Thursz who gave me the opportunity to join his team. I spent about 2 years and a half in The Gambia where I implemented a very ambitious research programme on liver diseases in West Africa. Then, in 2014, I moved to London. I hadn’t planned to move to London, but then I discovered a different culture—where I was given so many more opportunities than I’d have in the French system. I was extremely motivated but more importantly I felt really supported by Imperial and my department to develop my ambitions and create my own research group. I do still miss the French system from which I have learnt a lot.

I was initially going to spend a year or two as a lecturer at Imperial, but then I secured more funding to expand my research activities and really enjoyed the work environment and its management based on trust and creativity—especially as it’s much more diverse here. There are so many different nationalities represented in our department, it’s really nice.

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Targeting both incretin receptors together for a new generation of diabetes therapies

Close up of woman's hands checking blood sugar level using glucose meter

Dr Alejandra Tomas, Senior Lecturer at the Department of Metabolism, Digestion and Reproduction, explores new and emerging incretin-based therapies for managing diabetes.

Diabetes is a disease that has reached epidemic proportions, with millions of people dying or suffering from a myriad of associated complications. Given that cases are projected to increase worldwide over the coming decades – especially in low- and middle-income countries – there is an urgent need to develop and deploy effective treatments for the disease.

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Food for thought: Experiences from Imperial’s Food Student Research Network Conference

Dr Aaron M. Lett, Director of the Food Student Research Network, providing a plenary talk and officially launching the Food Student Research Network.

Recognising the value of interdisciplinary learning, Imperial’s Food Student Research Network aims to bring together students from across the College’s faculties to enable the cross-fertilisation of ideas and research in fields relevant to food. Here, members reflect on the Network’s inaugural conference.

In September, Imperial’s Food Student Research Network hosted its first Annual Conference. Reflective of the ethos of the network, this conference was an event for students, led by students.

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Standing up for the facts: COVID-19 vaccination, fertility and pregnancy

This festive period Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

Dr Viki Male explains how she took matters into her own hands in response to the mixed messaging around COVID-19 vaccination advice and pregnancy.

In 2003, the world was on the brink of a SARS-1 pandemic. As a Year 12 student at the time, I followed developments closely. Although the outbreak eventually died out, my interest in infectious diseases did not. Surely, the big one was coming. And I would be ready for it.

But by the time the big one came, my research has taken me in a different direction. At university, I had become passionately interested in a family of immune cells, called NK cells, that control viral infection. But these cells have another role that captured my imagination: they help the placenta to implant during pregnancy, and my lab is working out how. In March 2020, as immunologists around the world raced to make a vaccine, I shut my lab and went home to spend the next 12 weeks home-schooling my children. I would sit this one out. What use is a reproductive immunologist in a pandemic, anyway?

Some use, it turned out. In December 2020, as the vaccine rollout began, rumours started to circulate that antibodies raised by COVID-19 vaccination would target a placental protein, called Syncytin-1, causing infertility and miscarriages. There was no basis to this claim and if I, a reproductive immunologist, wouldn’t stand up and explain why, then what was the point of me? So I began engaging with the public, first on social media and then in print and broadcast. Here’s what they taught me… (more…)

Future of Nutrition: Student experiences from the Nutrition Futures Conference 2021

The Imperial Conference committee with The Nutrition Society Student Committee Leads.
The Imperial Conference committee with The Nutrition Society Student Committee Leads.

Three Imperial postgraduate research students recount their experiences of hosting the Nutrition Futures Conference 2021 in collaboration with The Nutrition Society.

In September 2021, Imperial’s Section of Nutrition Research hosted the Nutrition Futures Conference 2021 in collaboration with The Nutrition Society at the Cavendish Conference Centre, Marylebone.

The Nutrition Society is one of the largest learned societies for nutrition in the world. In late 2019, Dr Aaron Lett led the bid to bring this student-focused conference of the Nutrition Society’s conference calendar to Imperial College London. This was the first conference the Section of Nutrition Research at Imperial has hosted and provided the perfect opportunity for Imperial to share its expertise in nutrition-related research and strong ethos and enthusiasm for student development to undergraduate and postgraduate nutrition students across the world. (more…)

A letter to our taught students and their loved ones

This is an open letter from Mr Martin Lupton, Vice-Dean of Education to taught students in the Faculty of Medicine and their loved-ones.

Dear Students and their friends and families,

My eldest son has recently returned to University in the UK and, even though I work in both the health and education sector, I have to acknowledge that I have a certain level of anxiety about him. It is very difficult to read the news about all that has happened during this time of COVID and not to worry.

I am telling you this because I want you to understand that I have some inkling of what you may be feeling right now, particularly if you come from overseas or your daughter, son or relation, has just started their university life. The first thing I want to say is “Welcome to the Faculty of Medicine”. We are very proud of what we have achieved during this global pandemic; the Faculty of Medicine at Imperial College has been a key player contributing to the world’s understanding of the virus, the mapping of the virus, teaching people about the virus and developing a new vaccine. However, that is not all that we have been doing. (more…)