Metabolic Medicine & Endocrinology

The primary aim of the NIHR Imperial BRC Metabolic Medicine & Endocrinology Theme is to prevent and treat obesity and type 2 diabetes, and their complications. The approach is to apply fundamental strengths in biomedical engineering, chemistry, genetics, epigenetics, and cell biology to our experimental medicine expertise in hormone regulation, metabolism, and clinical trials. There are three main streams of work within the theme:

Preventing obesity
We are seeking public health solutions to weight gain and the prevention of obesity through molecular research into the suppression of appetite. This includes identification and testing of food-derived nutritional ingredients that act directly on satiety hormones in the gut. We work closely with the food industry to develop products that will enhance appetite suppression and prevent weight gain. Reducing the burden of obesity will have knock-on effects and reduce co-morbid conditions, such as type 2 diabetes and cardiovascular disease.

Treating diabetes and obesity
Not all patients who undergo bariatric bypass surgery achieve satisfactory results. We are working to predict which patients will be likely to benefit, and also to test modifications to the surgery and after-care that optimize the outcome. We have also established that the key effect of bypass surgery is the enhanced release of satiety hormones – our aim is to generate this enhancement in the absence of surgery, through direct infusion of analogues of these hormones. This has the potential to eliminate the risk of surgical complications, whilst producing similar results in reduced food intake and normal blood sugar in obese patients with type 2 diabetes. For patients with type 1 diabetes, we are working on strategies to improve glucose and metabolic control in order to address the risks of cardiovascular complications leading to blindness, limb amputation, and kidney failure.

Treating complications of diabetes and obesity
Female patients with obesity and diabetes can experience fertility problems, due to a deficiency in the release of reproductive hormones. We have found that the natural hormone kisspeptin can stimulate reproductive hormone release in these patients. This will be transferred to clinical use, following successful trials. There is also evidence that a second therapeutic – Neurokinin B – could further enhance fertility when administered alongside kisspeptin. In addition, we are working to develop new treatments for osteoporosis and osteoarthritis through studies of the genetics of bone mass and strength; bone and cartilage disease; the role of the hypothalamic-pituitary thyroid axis in health longevity; and the role of thyroid hormone action in osteoporosis, fracture repair, and osteoarthritis.

Our research is done in close collaboration with clinical colleagues at the Imperial Weight Centre (a Centre of Excellence for bariatric surgery) and through the Imperial Healthcare NHS Trust’s comprehensive diabetes service, which has very close links with primary care. We also work with funders and partners in public sector, charity sector, and industry.