Written in blood

Maltese researchers are leading the way in developing new diagnostic tools for cancer. Dawn Gillies finds out more from Prof. Godfrey Grech and Dr Shawn Baldacchino.

Breast cancer survival rates have been improving steadily in recent years. In Malta, 86.9% of patients currently survive, up 7% over the last decade. Thanks to new targeted therapies, the outlook is increasingly bright. But precision therapies need precision testing.  

Breast cancer diagnosis has reached new heights and with current tests using tissue biopsies, pathologists can classify patients for specific treatment. Precision medicine goes a step further. It provides more information, predicting the aggressiveness of the cancer and measuring the number of cells from the tumour that spread into the bloodstream. 

Dr Shawn Baldacchino

This does not mean that all requirements in precision therapy have been met. 

At the time of writing, there is no simple method to test patients’ ongoing benefit from treatment or to measure different tumour areas from one sample. For this to be possible, we need super-sensitive tests. This is where Prof. Godfrey Grech and Dr Shawn Baldacchino at the University of Malta come in.

Detecting the undetectable  

During his PhD, Baldacchino studied a new class of breast cancer representing most cases of the triple negative type, which affects 12% of breast cancer patients in Malta. 

In triple negative breast cancers, tests for estrogen receptors, progesterone receptors, and excess HER2 protein all result in negatives and are associated with aggressive tumours.  

To detect this new class of breast cancer, Grech’s team have created a new test that uses molecular substances we naturally produce in our body—biomarkers. By pinpointing the right combination of certain biomarkers, they can test for this new class within the triple negative breast cancer cases.

They initially used the test to look at biopsies from past patients. These exercises showed that they could accurately detect the cases—even in samples that were over a decade old! In fact, the test was so successful that the team is now working with biological testing industry giant Luminex to use it in hospitals worldwide. With a patent filed, research labs will get their hands on it later this year with the hope that by 2021 it will be used to directly help patients in hospitals. 

However, there is more work ahead. Encouraged by the results so far, the team wants to take the test and other current biomarker tests a step further. They want to use a simple blood sample which is less invasive, allowing patients to be monitored during therapy.

Pushing boundaries

With the method Grech and his team have optimised, obtaining information on new classes of patients that predict therapy use, detecting different tumour areas in one sample, and the use of blood to monitor the benefits of therapy have become a

Prof. Godfrey Grech, Dr Shawn Baldacchino and the team
Photo by James Moffett

possible reality. With technologies from Luminex and Thermo Fisher, they can now read over 40 biomarkers in one test simultaneously. But with blood they need a new angle. And that is happening through another test using particles that originate from cells called exosomes.

Exosomes are tiny messenger bubbles which cells release into the blood . ‘We believe that when there is a tumour in the patient, there will be a signature in these exosomes circulating in the blood,’ says Baldacchino. 

Finding these exosomes could mean detecting cancer at an earlier stage than is currently possible. The team believes they would be able to detect the exosomes that point to cancer long before a tumour shows up in scans and other regular tests—and so, they would be able to nip the cancer in the bud. But to do this, they need to be able to decode the messages the exosomes are carrying.

Positives for patients

It’s not only in the realm of breast cancer diagnosis and classification that the team can help patients—they might also be able to improve treatment. ‘Most targeted therapies currently try to inhibit specific receptors and proteins to stop the uncontrolled growth of cancer cells,’ Grech says. But through their research, the team has found that targeting the low activity of specific complexes of proteins in tumour cells is key. Their research models show that increasing the activity of these protein complexes is possible using specific drugs.  

This is true for triple negative breast cancer, where the amount of PP2A protein is extremely low. The PP2A protein enables the body to fight the cancer, so increasing its activity would create a chain reaction in the body which could limit the growth and spread of that category of cancer cells.

This approach to treatment has applications beyond triple negative breast cancer. Grech is hopeful that PP2A production could be amped up for different types of cancer too, and lead to positive results.

Managing the unmanageable

When organising a project like this, it’s expected that things won’t go to plan. One of the biggest challenges for Grech’s team has been establishing collaborations with other groups across the globe. They need these connections to provide the samples required to test their systems. With other groups working on similar projects, time is a limited resource. Thankfully, the team found collaborators in Leeds (UK), and Barcelona (Spain), allowing the group access to the samples they need. 

What is certain is that support for this work has come in many shapes and forms. The project received funding both from public donations and the Malta Council for Science and Technology. Baldacchino also found an ally in the charity foundation Alive with the help of the Research Trust of the University of Malta (RIDT). He is the first recipient of funding from them, and their first graduate.

Predicting the future

Thanks to projects like these, cancer research has a bright future in Malta. The team has their product launch to look forward to later this year, which will see a drastic reduction to the time and effort it takes researchers and doctors to determine the type of breast tumour.

But a lot of challenges lie ahead. The biggest challenge will come in the move to early stage cancers. These cancers have low levels of substances to detect, which means that any test they develop will have to be extremely sensitive in order to be effective. Successfully identifying these cancers would signal a massive breakthrough for the global medical community—and, more importantly, for patients. Early detection through basic blood tests would open the door to early stage treatment and a higher rate of survival. Nothing could matter more. 

Project ‘Accurate Cancer Screening Tests‘ financed by the Malta Council for Science & Technology through FUSION: The R&I Technology Development Programme 2016.

Taking solar to sea

In a world first, a small team of engineers at the University of Malta is attempting to prove that harnessing solar power in the open sea is theoretically possible and cost-effective. Laura Bonnici speaks to Prof. Luciano Mulѐ Stagno to learn more about the ground-breaking Solaqua 2.1 project.

Renewable energy is in the spotlight. In Malta—an island that is said to enjoy an average of 300 days of sunshine per year—solar power has become mainstream, enabling the country to reach its goal of using 10% renewable energy by 2020. 

But any advantage Malta has in terms of abundant sunshine, it loses through its lack of another vital resource: space. Measuring just 316 km², Malta’s limited surface area means that, beyond the existing photovoltaic (PV) panels installed on rooftops or disused quarries, any land left for larger PV installations is rare and expensive. 

Prof. Luciano Mulѐ Stagno

Prof. Luciano Mulѐ Stagno at the University of Malta believes the answer to this problem lies not on land, but at sea. Malta being surrounded by water, he has proposed that installing solar panels in open water, in offshore floating PV farms, could be as cost-effective and reliable as those on land—an idea that has never progressed beyond the theoretical stage anywhere in the world. 

‘There are many PV projects happening on fresh water everywhere, from China and the UK to France and USA. But none of them are working on open sea,’ explains Mulѐ Stagno. ‘Their PV farms are installed in more sheltered, land-locked waters such as irrigation ponds or lakes, believing that PV farms cannot survive sea conditions. The Solaqua project aims to prove that they can survive, and do so at a comparable cost to land-based PV farms.’ 

When funding was secured from MCST in 2012, the previous Solaqua 1.0 project set about achieving these ambitious aims. Testing various prototypes out at sea, it confirmed that large, floating platforms were viable, cheap to construct, and could produce more power than similar systems on land.

The sea proved beneficial for many reasons. ‘The offshore panels produced around 3% more energy than similar land-based modules simply by being at sea, possibly due to the cooler temperatures at sea and a less dusty environment.’

The success of the first project inspired a second. With this one, the modular raft was designed and tested. ‘Solaqua 2.0 was financed by Takeoff [The University of Malta’s business incubator] in July 2017, with a preliminary design for the platform almost completed. Now discussions are underway about possible patents for the design,’ Mulѐ Stagno elaborates. ‘The ultimate aim is to launch a large farm in Maltese territorial water which, if it meets

Solaqua prototype 4 – testing concept of low cost structure

the cost and power output targets, will be followed by other systems worldwide.’

The Professor and his team (marine structural engineer Dr Federica Strati, systems engineer Ing. Ryan Bugeja, and engineer Martin Grech) are now starting the next phase of the Solaqua project. Before the team builds and launches a full-scale system, they have to conduct a series of rigorous wave tank tests. Using a scale model while mimicking the worst possible sea conditions that the system may encounter, the team will be able to refine the design and optimise power output by testing the effect of water motion, cooling, or even different types of panels. 

‘Through Solaqua 2.1, we hope to reassure investors that the system is viable. Once completed, we will be ready to launch a full-scale system that could be used not only by islands such as Malta, but also in coastal cities around the world which have insufficient land available for PV systems.’  

Investors are being invited to join this project to push for global commercialisation. To reach this stage, several local entities supported the project. The Regulator for Energy and Water Services, with the help of the RIDT (the University of Malta’s Research Trust), invested €100,000 to cover the cost of constructing the scale model, as well as testing, equipment, transport, and engineers. And now that the project is commanding international interest, potential investors are being sought for the half a million euros needed to achieve a full-scale floating solar farm in Maltese waters.

‘This is a homegrown project, in which Malta could be an example to the world,’ explains Mulѐ Stagno. ‘We have already placed Malta at the cutting edge of this research area by being the first to test small systems in the open sea. Now we need to find an investor willing to take the plunge and help us create the world’s first full-scale floating solar farm. With Solaqua, Malta could be at the forefront of a ground-breaking new global industry—one which has the potential to change the way solar power is collected and used the world over.’ 

A multi-disciplinary life

Winner of the National Book Council’s award for Best Novel Loranne Vella has enjoyed an eclectic career, spanning literature, teaching, translation, and theatre, then circling back to literature again. But as Teodor Reljić discovers, her journey across creative modes had its roots at the University of Malta.  

It’s not every year that the National Book Council dishes out its annual Best Novel Award to a work of time-hopping speculative fiction. But that’s exactly what happened last December, when Loranne Vella won the award for her novel Rokit (Merlin Publishers), which details the journey of Petrel, a Croatian youth who travels to Malta in search of his family roots, only to find an island ravaged by climate change. 

‘With Rokit, Loranne Vella distinguished herself with another prize-winning novel that crosses genre boundaries between adult and young adult fiction,’ wrote National Book Council Chairman Mark Camilleri. 

Such a dense and knotted work suggests hard creative labour, which Vella confirms, pointing out that the novel took five years to put together. But one shouldn’t assume that Rokit was all that commanded Vella’s attention in those years, nor that writing is her only chosen pursuit. In fact, she says the process left her hankering to return to performance. 

‘I was interested in merging my two artistic passions and experimenting with various possibilities,’ Vella says, explaining how this want led to the Barumbara Collective in 2017, ‘which focuses on collaboration with artists from different spheres.’

As it happens, Vella being awarded the Book Council prize directly coincided with a Barumbara Collective project—the multi-disciplinary performance Verbi: mill-bieb ’il ġewwa. 

Loranne Vella

And while Verbi certainly had a role to play in refreshing Vella’s creative muscles in the here and now, it also channelled key elements of her past experience. The Barumbara Collective is only the latest iteration of Vella’s involvement in the performing arts. The still-active Aleateia Theatre Group was her first and most significant project, beginning as a student project in 1992 and resulting in a generous number of experimental performances held at the Valletta Campus Theatre throughout the nineties and noughties. Vella performed, trained other actors, and documented the group’s progress. 

The Barumbara project brought more deep-seated memories back to the fore. ‘With Verbi, I wanted to involve university students from the Department of Digital Arts and the Department of Theatre Studies, seeing how the project was an interdisciplinary one where visual arts, performance and literature come together in one performative installation. I can truly say I was amazed by the hard work done by the students who collaborated. Their enthusiasm reminded me of myself as a student back in the 90s.’

Vella’s own student enthusiasm did not come as immediately as all that, however. While she is now secure in her three-pronged role as writer, performer, and translator (also acknowledging her former role as a lecturer), forging an early path as a student meant first squinting through the fog. 

‘It took me quite a while to figure out which were the right subjects for me,’ Vella confesses. ‘Before ‘91, I had spent a year struggling as a BCom student. This course was definitely not for me, contrary to what my teachers and counselor advised me at the time. Before that, I had registered for the one-year-long Foundation Course at university, intended for students like me who couldn’t make up their mind… for a while I was even considering Law…’ 

It was then that Vella learned about the Theatre Studies Programme, though a couple of years still had to pass for her to take the leap. 

‘I guess I finally decided to choose what I was interested in, rather than think too much about what my future profession or career should be.’ The choices in question were Theatre Studies and English, subsequently opting to specialise in Theatre until she finished her MA in 2000. 

‘Everything about me, since then, revolves around these two disciplines: theatre and literature.’

These pursuits became an active part of student life for Vella, who loves to turn her passions into more tangible projects. Vella collaborated with fellow Aleateia member Simon Bartolo in establishing Readers & Writers, a literary journal which featured original prose, poetry, and literary criticism. Running for five editions, the journal sowed the seeds for Vella’s future literary output. 

‘I was still writing in English back then. It took me almost ten years to start writing stories again, this time in Maltese.’

The breakthrough came in 2004, when Vella began writing the first chapters of what would eventually become Sqaq l-Infern, the first volume of the It-Triloġija tal-Fiddien, together with Simon Bartolo. Like Rokit, the trilogy would be published by Merlin Publishers, and it managed to hit a fresh nerve in the local literary circuit. 

Aimed at young readers, the trilogy proved to be a ‘Harry Potter moment’ for the Maltese literary scene. Gr

La Signora Fogli (Drowning Lilies, Aleateia, 2005 Photo by Gilbert Guillaumier

aced with eye-catching covers by renowned illustrator Lisa Falzon, its mix of local folklore and coming-of-age yarn was met with excitement and healthy sales. The trio was completed by the novels Wied Wirdien (2008) and Il-Ġnien tad-Dmugħ (2009).

‘By the time the third volume came out, Fiddien had a huge following,’ Vella remembers, observing how the trilogy also marked her first shift from theatre to literature. Another influence on this decision was her move to Luxembourg to work as a translator at the European Parliament. The next step in her literary output came in the form of MagnaTMMater, a young adult work of dystopian science fiction published in 2011. 

But there was yet another step in the interim to all this—Vella’s stint as a lecturer. For five years, she taught at the University of Malta’s Department of Theatre Studies. ‘This gave me the satisfaction of examining this reality from the opposite side, working with students while keeping in mind the difficulties I had encountered myself.’

Vella had cut her pedagogical teeth much earlier. Right after graduating with a BA Hons in Theatre Studies, Vella taught Drama and English Literature at St Aloysius College. ‘Although I had not studied to become a teacher—it was the last profession I had in mind—I had the right background to teach these two subjects. After a few years at the college, I was teaching only the literature part of the English courses, and I also became responsible for directing the annual school concerts, which became bigger and more ambitious every year,’ Vella says, adding that her time as a teacher left her with many ‘proud moments’. 

‘The best of these was perhaps the mobilisation of almost the entire body of students to put up a large scale performance—with orchestra, choir, side-acts, chorus, intermezzo, and all.’

Vella is keen to credit her alma mater with the results of this varied career. She has no trouble stating that ‘everything is connected, and there is a clear connecting line between my years at university and everything else I’ve done since.’

Which begs the question:  what advice would she give to current University of Malta students, especially those interested in working in multiple disciplines? 

‘Be passionate about the courses you follow. Experiment, explore, be curious. Ask many questions and strive to find answers. Do not just study. Discover. And make that discovery your own.’