Developing new cancer treatments

The lab is my second home, with the rugby pitch a close third. My fascination with lab work and science started when I visited Tays Hospital in Finland. It was during my bachelor degree in Medical Laboratory Science. This three-month placement helped me choose cytogenetics for my final year project. My work involved developing a technique to allow for doctors to better manage sporadic and recurrent miscarriage patients.

My interest in cytogenetics (the study of chromosomes where genes are found) evolved to genetics, when I started working at the biotech company MLS BioDNA Ltd. This laboratory focused on the testing of inherited diseases, paternity and forensics, as well as food and water microbiology. Working in a diagnostic laboratory was very satisfying but I had always wanted to pursue research. So I moved to Sheffield to read for a Masters in Molecular Medicine, with the help of the Malta Government Scholarship Postgraduate Scheme (MGSS). My intention was to just stay for the course and return home, however, my current supervisor offered me a 10-month contract to work in a molecular microbiology lab. This was a very pleasant experience, and encouraged me to pursue a Ph.D. I received a scholarship for a Ph.D. in Immunology at the University of Sheffield, which I am currently working on.

Vaccines can prevent certain infectious diseases. Potentially, they can also treat cancer. Vaccines today are based on small proteins, which by themselves do not elicit a strong immune response. To treat cancer a strong response is needed. Immunological adjuvants that amplify the immune response are used to accomplish this. However, no one really understands how these adjuvants work. For my Ph.D., I am part of a research group that focuses on an immunological adjuvant which increases the immune response by over 1,000 times. Understanding how these adjuvants work will pave the way to more targeted treatments and fewer side effects.
My job is to understand which immune cells are responsible for this effect. The adjuvant has been shown pre-clinically to be effective in B cell lymphoma, a type of cancer of the blood that originates in the lymph glands. Patients are currently treated with the drug Rituximab which depletes certain immune cells called B cells. If our treatment requires other immune cells to work, it can be used in addition to therapies such as Rituximab.

Although a Ph.D. is something which I really wanted to do, it was still a shock to my system. Scientific research can be very frustrating as long hours and hard work do not necessarily translate into results. In spite of this, the long-term goal of this project keeps me going making the sweat and tears worth it.

Funding of academic chairs by FIMBank and The Alfred Mizzi Foundation

As from the next academic year, the Faculty of Economics, Management and Accountancy of the University of Malta will be providing a course in International Trade Finance which is being sponsored by FIMBank Malta plc and the International Factor Group (IFG). The same faculty will also introduce a course in Digital Marketing which is being sponsored by The Alfred Mizzi Foundation. These new additions will offer a unique educational experience in modern commercial activities to both local and foreign students. The financing of the courses has been facilitated by the RIDT. 

Cycling for breast cancer research

Forty cyclists will be covering an endurance route of 720 km. They will cycle from London to Brussels to Paris this July to raise funds for breast cancer research at the University of Malta. For this initiative to happen, the RIDT has teamed up with two not-for-profit organisations, Action for Breast Cancer Foundation and ALIVE Charity Foundation. The former is an organisation that brings together breast cancer survivors, patients, and well-wishers, while ALIVE consists of a group of cyclists are dedicating their cycling efforts towards good causes.

The cyclists are currently undergoing training to get in shape for this challenge. Their objective is to each raise €1,800. 

Can you die of boredom?

A tricky question since boredom is a mental state. Usually it is triggered by an uninspiring, monotonous environment and/or certain brain chemicals like dopamine (more on dopamine). People who produce less dopamine, or are less sensitive to it, are bored more easily.

People bored for a very long time can suffer from clinical depression, which surely reduces lifespan. Other boredom sufferers have ADHD (attention deficit hyperactive disorder) and extreme ways of combating boredom can be equally dangerous. They could abuse drugs and alcohol or seek thrills in risky sports. Others could become sexually promiscuous. All of these behaviours reduce lifespan. 

Send your questions to think@um.edu.mt and we’ll find out if it’s the truth or just a fib!

Bad Pharma

Book Review

The author Dr Ben Goldacre is on a mission. The $600 billion pharmaceutical industry, some doctors, regulators, medical journals, and whole governments should be trembling. Goldacre wants to show the truth behind how our medicines are made. He wants transparent companies, properly informed patients, solid research, and cheap, effective drugs, preferably for all.

In typical Goldacre style, he rants. Ignore the apparent chip on his shoulder. His statements are thoroughly based on facts. The facts are shockingly scary.

Take the drug Tamiflu, the supposed miracle cure for flu. The pharmaceutical company Roche made over €500 million in 2009 on the back of the swine flu scare. The drug is known to reduce flu symptoms by a few hours, a hefty price tag for a spot of relief. Initially, Roche said that it reduces complications by 68%, amazing! Though when the gold standard reviewer Cochrane started scratching the surface they hit a brick wall. Roche refuses to publish data requested years ago and we still do not know how effective it is.

Even regulators get it wrong by being too business friendly or opaque. Diabetes drug Rosiglitazone was recently taken off the market after over 10 years of intimidating researchers who published data against the drug in 1999. Rosiglitazone increases heart problems by 43%. Regulators failed to share data transparently, which slowed action, an endemic problem.

Pharma has even failed cancer patients by stopping trials early to make drugs look better. Trials can also be run longer than needed to fuzz data. Goldacre lists endless examples to buttress his arguments. 

Companies spend double on marketing drugs compared to research. In the US they can reach and influence consumers directly irrespective of efficacy, price, or need. Where direct marketing is banned, companies shift budgets and reach doctors through drug reps, people whose job it is to convince medics that their company’s drug is the best. Pharma even disguises marketing as research fooling doctors and wasting their time. Well-respected doctors are also paid handsomely to talk about products.

Apart from scandalous facts, Goldacre is a master of explaining science simply and clearly. Chapter 2 has a great introduction on how drugs are made. He clearly explains the difference between relative risk or absolute risk, or how bias and probability are manipulated by pharmaceuticals. His lucid style makes this book a great read and well recommended for anyone wanting to know the dirty secrets behind pill manufacturing. 

Thankfully, Goldacre also suggests how it could be solved. My only advice is not to debunk the whole system when reading this book, remember the good stuff: life-saving antibiotics, disease eradicating vaccines and much more. The current system just needs some serious tweaking to remove the bad loop holes Big Pharma exploit to meet profit margins. But drug research has to go on.

The Einstein Enigma

We experience gravity everyday, but how it works is one of the biggest questions in physics. Einstein’s theory of relativity means that we don’t understand over 90% of the Universe. A team at the University of Malta is trying to put that in order.

I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the seashore’, said the famous Isaac Newton. Humanity has progressed in its search for answers by always searching for the next smooth pebble, the next pretty shell. In Malta, a small group of students is trying to understand gravity through the observation of stars and galaxies that light up the night sky.

Gravity has kept our feet on the ground since we started walking upright. Early theories by the Greek philosopher Aristotle (384–322 bc) were interesting but far from the truth. His Universe was built in concentric spheres with Earth at the centre, followed by water, air, fire, and enclosed by the heavens — a rock fell to the Earth because it wanted to go to its original sphere. Clearly, he was wrong.

Aristotle’s concepts were challenged during the Renaissance when the Italian Galileo Galilei (1564–1642 ad) infamously dropped different weights from the tower of Pisa. Contrary to the Greek theory which stated that the heavier an object is, the faster it falls, Galileo saw the objects all fall at the same rate. Theories need to match observations, otherwise they fail — an invaluable technique used time and again by any decent scientist including the Malta group of astrophysicists led by Dr Kris Zarb Adami.

“Space is a dynamic entity ‘moving forward in time, the two being bound by light itself”

The first person to suggest a good theory for why rocks fall was Isaac Newton (1643–1727 ad). As the story goes, watching an apple fall triggered Sir Isaac Newton to come up with his theory of bodies. He said that anything with mass had a force that attracted everything towards it — the bigger the mass, the bigger the force. Since the apple is smaller than the Earth, it falls towards it, and since the Earth is smaller than the Sun, the Earth goes around the Sun. Newton’s law was successfully used to predict the motion of planets and helped discover Neptune.

A star burning out
A star burning out

By the 20th century, holes in Newton’s ideas started to appear when scientists discovered that Mercury’s orbit differed slightly from Newtonian predictions. In 1915, along came Einstein (1879–1955 ad) who again revolutionised our understanding of gravity through the introduction of his theory of general relativity. Newton had considered time and our three-dimensional space to be independent. Einstein replaced this with the notion of spacetime, which combines space and time into one continuous surface. Space is a dynamic entity ‘moving forward’ in time, the two being bound by light itself.

Large objects like the Sun bend the fabric of spacetime (it is convenient to think of spacetime as a sheet of fabric with balls lying on top of it — bigger balls curve the fabric more). Smaller objects (such as the Earth) try to follow the shortest route around the Sun. The shortest way is curved and it is easy to see how this comes about.

How the mass of the earth bends spacetime and satellites go around the earth
How the mass of the earth bends spacetime and satellites orbit the earth

Consider the shortest route from the North Pole to the South Pole, you would naturally move down a curved longitude, which forms part of a circle round the Earth. This concept also explains why the Earth traces an orbit round the Sun. The orbit is the ‘best straight line’ that Earth can trace 

in the curved spacetime surrounding the Sun. As John Archibald Wheeler neatly summarises it: ‘Spacetime tells matter how to move, matter tells spacetime how to curve’.

Einstein’s biggest blunder

Einstein’s theory of general relativity describes how gravity works. Einstein wanted his equations to represent a static Universe that did not change with time. To this end, he introduced a factor called the cosmological constant that would bring the Universe to a halt. However, this idea was short-lived. Another great (though highly egotistical) physicist called Edwin Hubble discovered that the Universe was expanding; this was confirmed in the late nineties and led to a Nobel Prize in 2011. It not only means that all matter will eventually disperse throughout the Universe and future generations will see only a blank night sky, but also poses a problem in that the reason for this expansion is completely unknown and unpredicted from Einstein’s theory. And it is not a small factor at all, since this mysterious energy makes up 68% of the energy in the Universe. Nicknamed ‘dark energy’ because it is unseen, this is the biggest problem in modern astrophysics and cosmology.

“If a star’s light is being bent by a galaxy, from Earth it will appear that the star’s light has changed, when in reality it would not have changed at all”

 

Scientists either have to accept that dark energy is true, or that Einstein’s model has met its limits and physics needs a new way to model gravity, at least on the largest of scales. The Malta astrophysics group is trying to verify and find new models of gravity — these so-called alternative theories of gravity. The idea is to compare observations to the different gravitational theories, including Einstein’s, and see which works best.

Our focus is split two-ways: one is the effect that celestial bodies have on each other’s orbital motion and the other is the bending of light around heavenly bodies. For example, our sun bends spacetime, causing the planets to go round it in ellipses. The sun also wobbles around a very small orbit. Observations show that the orbiting objects go round a bit longer than we would expect. The extra amount is miniscule, so measurements are taken after many orbits as this magnifies the effect. We use this as a possible test to disqualify alternative theories and have already shown how an important alternative theory of gravity cannot be true.

This is how fundamental science works. If a model does not match observations it needs to be modified to arrive at something that does give all the predictions we require. The end result must be a complete theory by itself but the different components could find their birth in a wide variety of unconnected sources.

Computer simulation of dark matter

The Malta astrophysics group considered a theory called conformal Weyl gravity that is similar to general relativity in every respect except one. This theory behaves exactly like Einstein’s but imposes a further constraint — mainly that the gravitational field remains the same no matter how much it is stretched or squeezed. Simply put, as long as the mass remains the same, gravity does not change. This assumption solves many problems. It makes dark matter and dark energy unnecessary. Dark matter is needed to explain the motion of stars in galaxies. Like dark energy, it is called dark because it cannot be seen or analysed in any way. Making them irrelevant would fill a gaping hole of knowledge for astrophysics.

When the group tested the Weyl theory, it gave the same result as general relativity and a small additional term. That was not a problem, since effects of this term were so small that they could not be observed with today’s largest telescopes. The problem, as shown by the Maltese astrophysics group, is that the term grows larger with distance and contradicts observations at the largest galactic scales. This was an important nail in the coffin for the Weyl theory of gravity and Einstein’s theory still remains the best model.

Our next step is to test other alternative theories of gravity by analysing how objects orbit each other. In the same way we disproved conformal Weyl gravity, we hope that these tests will help astrophysicists to eventually come closer to a model that correctly explains the cosmos.

Bending light

Gravitational Lensing is perhaps the most sensitive test of gravity on cosmological scales. To understand how it works, consider a lit candle and a wine glass. Imagine holding the wine glass and peering at the candle through the glass’ base. The flame will be distorted and changes shape. Now picture you are with a friend who stands a couple feet by your side. The flame will appear normal to them since they are seeing it from a different perspective and the light does not pass through the glass. Two people with a different point of view see different flame shapes. The wine glass’ base distorts the flame because it acts like a lens changing the direction light travels. Obviously in the Universe there are no wine glasses between the stars and the Earth but objects with huge masses like our sun or galaxies can act like a lens and bend the direction of light by the sheer force of gravity.

The wine glass effect: gravitational lensing is explained using the base of a wine glass and a black dot
The wine glass effect: gravitational lensing is explained using the base of a wine glass and a black dot

When there is no mass to affect it, light travels in straight lines, but insert a massive object and hey presto, the light deflects around it as if it were going through a curved glass lens. The area in which an object feels the gravitational pull of the Earth is called the Earth’s gravitational field. Each object in the Universe has a gravitational field and can therefore pull other objects towards it — like the Earth’s effect on the Moon, which keeps it in orbit.

Anything that enters an object’s gravitational field will feel a gravitational pull towards the center of the object. Imagine a ray of light traveling from a point to another with nothing in between. In this case the ray will travel in a straight line. Nevertheless, if the ray meets with an object along its way to the Earth, the object will pull the ray towards it as a consequence of the object’s gravity. Even though the ray of light will try to keep moving in a straight line, the gravity of the object is so strong that it bends the ray’s path. If a star’s light is being bent by a galaxy, from Earth it will appear that its light has changed, when in reality it would not have changed at all. This effect is called Gravitational Lensing and is currently one of the best tests for alternative theories of gravity, since one can measure the deflection of light and check whether it agrees with the theoretical predictions.

Gravitational lensing is clearly visible on Galaxy Cluster RCS2, as viewed using the Hubble Space Telescope

Extreme situations like the bending of light by galaxies cause problems for Einstein’s theory. When summing up the masses of the galaxies, we obtain the mass of the objects that are visible in the cluster. Comparing the predicted light deflection with the observed one, astronomers consistently find that the light is bent ‘more’ than is expected. The way to solve this issue is obvious. Introduce a completely invisible mass that increases the amount of bending until the predictions fit the observation: enter dark matter!

The idea of dark matter emerged a while ago. In 1933, Swiss astronomer Fritz Zwicky suggested it when studying how a galaxy rotation changes as one goes further away from the galaxy’s center. Zwicky observed that the speed or velocities predicted by Einstein’s theory should tear the galaxy apart. In reality, something must be keeping it whole. The idea of an invisible substance called dark matter was born.

Dark matter keeps the Universe together by opposing dark energy that pushes the Universe apart. Dark energy is related to the cosmological constant, previously discarded as Einstein’s biggest blunder, now reintroduced in astrophysicists’ equations to explain the accelerated expansion of the Universe.

The problem with dark matter is that it has never been seen. There is only indirect proof of its possible existence. Deandra Cutajar’s work focused on testing theories where no dark matter is needed. If true, this would put a small spanner into Einstein’s equations.

She tested two theories. They passed the first tests, but they have to pass many more to unseat Einstein’s general Relativity. Going back to the Swiss astronomer Zwicky, the two theories could explain why galaxies are not ripped apart by the speed with which they spin. Dark matter could be dead.

In another test, both theories failed to explain the extra gravitational effect observed in lensing. One theory failed miserably, while the other yielded less accurate results than Einstein’s general relativity. Dark matter is reborn; on the other hand, it cannot remain dark. It needs to be found and studied.

No theory of gravity has yet been found to beat Einstein’s equations. The explanation of how gravity works according to Einstein is better than Newton’s. A curved spacetime clearly explains why light is bent. Einstein’s theory of gravity still holds water and apart from the cosmological constant (his biggest blunder), he was right on most things. When his stunning prediction of how light can bend was observed, he replied, ‘I knew the theory was correct. Did you doubt it?’

What the future holds for any theory of gravity is uncertain, but what is definitely true is that the astrophysics group in Malta cannot accept the fact that we don’t understand 95% of the universe.

einsteinauthors

 

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Gravitational lensing

More gravitational lensing

Gravitational lensing of distant star-forming galaxies (schematic) from ESO Observatory on Vimeo.

 

See dark matter

Assisted Conception — IVF and other procedures

Mark Brincat

Assisted conception procedures arose as a type of treatment for infertility. They opened a whole new range of possibilities for couples that were unable to have children due to a variety of problems. Initially, the difficulty addressed was of blocked or absent fallopian tubes in women. This prevented the oocyte from making contact with sperm, hence preventing the formation of an embryo. Naturally, this also prevented an embryo from moving into the uterus, implanting itself, and developing into a foetus.

In vitro fertilisation bypasses tubes by obtaining oocytes from the ovaries and fertilising these oocytes outside the body (in vitro — in glass). The procedure became a reality in humans with the pioneering work of Steptoe and Edwards and the delivery of Louise Brown in 1974. She gave birth naturally in 1999.

“In our society, infertility is becoming more common and 8 out of 10 couples can experience problems”

With the further development of ICSI (Intra cytoplasmic Sperm Injection) it was possible to fertilise an oocyte (egg) with an individual sperm. This was a breakthrough therapy for men with low or absent sperm counts. ICSI_4-jpgWhen sperm are lacking in the ejaculate, a doctor can retrieve them directly from the testicles, or the epididymis (a tightly coiled tube from the testes to the rest of the body). The procedure is known as TESA or PESA. In combination with ICSI, these techniques made it possible for these men to father children.

In our society, infertility is becoming more common and 8 out of 10 couples can experience problems. This simple statistic makes these procedures increasingly important. Nowadays, even couples with the most severe problems can become parents.

These procedures have been mixed in controversy from the beginning, with most countries allowing science to proceed within certain safeguards. This restrained approach allows for progress.

Regrettably, infertility still carries a large stigma. The thousands who have benefited from these and other simpler infertility procedures (they precede attempts for assisted conception) do not speak out. Normally they don’t because of how society would perceive them or their children.

IVF is a physically, psychologically, and financially demanding procedure. Couples normally only proceed after having spent a considerable time beforehand seeking help, investigating, and trying alternative simpler treatments. It is usually the final recommended solution to the problem.

IVF essentially means that fertilisation of the oocytes occurs out of the body. The oocytes are then fertilised with sperm and in a percentage of cases this is successful and an embryo starts to develop.

 

This article continues the focus on IVF from last year’s opinion piece by Prof. Pierre Mallia. Other local experts have been contacted and we are open for further opinions and comments from our readers.