Dr Lucas Souza is a distinguished researcher currently serving as the Research Laboratory Manager at the Royal Orthopaedic Hospital. Dr Souza’s career reflects a strong commitment to both research and education. From 2019 to 2021, he was a Marie Skłodowska Curie research fellow at Aston University. Subsequently, he joined Aston Medical School as a Clinical Teaching Fellow and the Royal Orthopaedic Hospital as a Research Associate, before taking on his current role as Research Laboratory Manager in 2023. As Principal Investigator and Lead Applicant, he secured significant funding from the Royal Orthopaedic Charity for research projects focused on regenerative medicine and cancer therapies. His co-investigator roles in grants from the Bone Cancer Research Trust, Sarcoma UK, NIHR, and Dubrowsky Charitable Funds led him to be listed among the four most promising young researchers in the field of bone cancer in the UK in the current year by the Bone Cancer Research Trust.
OPN: What drove you to choose a career in medical research and education?
LS: Since quite early in my life, education and research have been intertwined. I started doing research when I was only 19 years old during the second year of my undergraduate studies in Physical Therapy and since then I never stopped. I developed a passion for discovering new things and for teaching them to others. Thus, my transitions into a Master’s, PhD, and Teaching/Research positions were always very smooth. It felt like I was just doing what I like and that needed to be done, which was seeking to develop better treatments for bone disorders such as critical-sized bone defects and bone cancer, and in the process, I ended up accumulating lots of degrees and a somewhat decent resumé. I now see my career as my biggest chance to contribute to humanity, by developing something that could save lives or improve someone’s quality of life even long after my death. It’s this feeling of being part of something much bigger than me that keeps me always motivated to work.
OPN: You are currently undertaking research looking into bone tumours. Could you tell us more about it?
LS: The ultimate goal of our research is to develop a biomaterial that can prevent the main complications of the surgical treatment in patients with bone cancer, which are: (a) cancer recurrence; (b) implant failure, and (c) infection. The active component of our biomaterial is a bioactive glass containing gallium, an anti-cancer chemical element. Bioactive glasses are bio ceramics that have been largely used for bone regeneration in several orthopaedic and dental applications; by doping them with gallium we seek to expand its application for bone cancers. We intend to produce a minimally invasive injectable gel loaded with powdered particles of this cancer-killing bioactive glass to be used to fill in bone voids. The material stimulates fast bone formation to promote enhanced bone regeneration and serves as a drug delivery system for anti-cancer and antimicrobial ions.
OPN: What could your findings mean to help support the treatment of bone tumours and what will be the effect on patient experience?
LS: So far, we have demonstrated that primary bone cancer cells are about 4 times more sensitive to the metallic ion gallium than normal cells. This means that we have quite a large therapeutic window to explore. We then doped bioactive glasses with gallium to use the glass particles as a drug delivery system for localized delivery of gallium ions to kill cancer cells. This bi-functional material could then repair bone defects and kill bone cancer cells at the same time. We anticipate that such an approach could significantly improve treatment outcomes, reducing hospitalization times, cancer recurrence, infection rates, and the number of revision surgeries, increasing life expectancy and the quality of life of patients.
OPN: What is planned for the next stage of your research?
LS: Our research project is now split into two fronts: (1) combining our gallium-doped bioactive glass powder with biodegradable polymers to produce a minimally invasive injectable hydrogel, and (2) testing the anti-cancer potential of gallium and gallium-doped glasses upon bone metastatic cells. We are trying to raise funds to perform an animal study where we intend to use a bone tumour animal model to test the efficacy and safety of minimally invasive injectable hydrogels containing the gallium-doped bioactive glasses. Alongside this, we have extracted cancer cells from biopsies of bone metastases removed from patients in the Royal Orthopaedic Hospital (ROH) and have been investigating if they too are sensitive to gallium and gallium-doped glasses. Such finding would drastically expand the use of our biomaterial since there are significantly more patients with bone metastases than with primary bone tumours.
OPN: How does the future look in the treatment of bone tumours?
LS: Well, to appropriately answer this question I believe we need to distinguish between primary bone tumours (the ones that start within the bone tissue) and metastatic bone tumours (the ones that migrate from other tissues to bone) because they represent two very different entities with different prognosis and treatment strategies. For primary bone tumours I believe the combination of advanced diagnostic tools (e.g., improved imaging systems, liquid biopsies, etc), the use of genomics to design individualised chemotherapeutic treatment schemes, and optimized surgical approaches (e.g., fluorescence-guided surgery) with the use of smart and multifunctional biomaterials will culminate with a significant improvement in treatment outcomes with higher numbers of totally cured patients.
As for metastatic bone disease the panorama will depend on the enhancement of treatments for other types of cancers that usually migrate to bone, such as breast, prostate, renal, and lung cancers. The migration of cells from those cancers into bone usually represents an advanced stage of the disease with very poor prognosis. Looking purely in terms of the management of the bone metastases, I think that in the future, more sophisticated scanning systems will help us to spot the metastases early and fully in the body so that we can make use of minimally invasive approaches (e.g., cryoablation, injectable biomaterials, target gene therapies) to attack these metastases and slow down the progression of the disease. This would lead to prolonged patient survival and potentially with higher levels of functionality by reducing the likelihood of skeletal-related events (fractures, spinal cord compression, etc) which usually cause much pain and morbidity to these patients.
OPN: What’s the best part of your job?
LS: The thing I like the most about my job is that it constantly demands me to learn new things. My position as research laboratory manager is very multifaceted meaning that I must display a range of skills daily. These include several leadership and management skills but also policy, grant, and scientific writing, media skills, public speaking, interviewing, teaching/training, business modelling, and others. This continuous learning process keeps me always very engaged and excited about my career.
OPN: … and the worst?
LS: As an immigrant in the UK, I must say that the worst part of being a researcher here is the instability that comes with fixed-term contracts. Research contracts are usually linked to research grants, thus, lasting for 2-3 years on average. Since our visas are linked to our employment there is a real risk that we will have no visa, i.e., no right to stay in the country, by the end of our contracts. This obviously brings about much anxiety and forces us to spend much of the final year of our contracts trying to raise funds to extend our visas, instead of focusing purely on our current research projects. When you have a family to care for and a passion for what you do, like I do, this situation can be extremely distressing. I believe that for the prospect of research in the country this is also very bad because many excellent researchers are forced to make some non-ideal career choices such as abandoning a life-long project, switching research areas, or even abandoning research all together to work in other occupations just to be able to keep their visas and their right to stay in the country. Moreover, this unstable scenario forces several excellent researchers to leave the UK and pursue their career goals elsewhere.
OPN: What has been the highlight of your career so far?
LS: This year I was shortlisted for the Bone Idols award, organized by Bone Cancer Research Trust (BCRT) in the category ‘Rising Research Star’. Even though I did not win the award it felt amazing to be classified among the four most promising young researchers in bone cancer in the country. It gave me a sense that other people see value in what I am doing, and I should continue this path.
OPN: Are you planning to attend or speak at any medical conferences or events over the next year?
LS: In August I spoke at the European Sarcoma conference (EuroSarc) in France and will attend the Bone Cancer Conference 2024, in September at Leeds and the Chordoma Research Symposium, in October at London, both organized by the BCRT.
OPN: If you didn’t work in the health industry, what would you be?
LS: I would work in higher education. Apart from research I am also passionate about teaching. I still teach some lectures on human anatomy for 1st and 2nd year medicine students at Aston Medical School as honorary clinical teaching fellow. I will certainly take that as a full-time career at some point.
OPN: What would you tell your 21-year-old self?
LS: At the age of 21 I was finishing my undergraduate studies in Physiotherapy and embarking in a crazy adventure to become a researcher. I left my parent’s house to move alone to Campinas (Sao Paulo, Brazil, 2,000 km away from my family/friends) to do a Master’s and PhD in one of the best universities in Brazil, the University of Campinas (UNICAMP). If I had the opportunity to say something to myself at that age I would just say “do not be afraid, just focus on what you are doing, and many doors will open to you”.
OPN: If you were Health Minister for the day, what changes would you implement?
LS: I would probably lead a campaign to shift our paradigm regarding age-related diseases from the current wait-for-symptoms-and-treat to a more preventive approach. That would probably involve an aggressive campaign to increase awareness about actions that the general population can take to prevent the well-known chronic diseases that kill humans, e.g., cardiovascular diseases, obesity, type 2-diabetes, dementia, cancer, etc, combined with regulations to reduce consumption of alcohol, highly processed foods, drugs, and microplastics and to stimulate everyone to practice more exercise, adopt better diets, sleep better and reduce screen times. I would also increase investment in research & development for diagnostic tools to allow for cheaper and faster early screenings for signs of cancer, for example, which I believe would help us to spot them in initial stages making it much easier to fully cure them.
OPN: How do you think the future looks within the field of orthopaedic treatments and what are your predictions for 2024 and the next decade?
LS: I believe we will continue to witness a progressive improvement in treatment outcomes thanks to a better understanding of the roots of bone disorders and the continuous advancement in the diagnostic and therapeutic tools available. More specifically, I think a widespread use of genomics tools will assist us in early diagnosing autoimmune disorders that affects the skeleton such as arthritis, rheumatoid arthritis, lupus erythematosus, etc, before they cause structural and functional damage to the patient’s skeleton so that we can deploy some form of early protective therapies. In the same direction, I believe that wearables will provide us with real-time data on the health of our bones, helping to spot early signs of osteopenia before osteoporosis is fully stablished and our bones become too susceptible to fractures. Ultimately, the combination of advanced multifunctional materials such as specialized nanosized particles, bone regenerative bio ceramics, injectable hydrogels, electro spun membranes, and patient-specific 3D-printed scaffolds will allow for more individualized therapies with improved outcomes.
Image: Picture by Edward Moss Photography. All rights reserved. Royal Orthopaedic Hospital
