Think — Issue 16 by Think

APRIL 2016 • ISSUE 16

ISSN 2306-0735

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EDITORIAL

MALTESE ORIGINS To communicate with us and follow the latest in research news www.twitter.com/thinkuom

ome research can change how a society perceives itself. Such discoveries do not happen often. Over the last few years DNA samples from hundreds of Maltese people have been sequenced.

The data has set in stone the origin of the Maltese people. Read about

To see our best photos and illustrations www.instagram.com/thinkuni

it in the first article (pg. 19) of our focus on The Maltese Genome. The other focus articles talk about genes for health. A University of Malta team found a novel mutation in local families connected to the blood disorder thalassaemia (pg. 26), which can lead to death in the worst cases. The researchers are trying to determin how to use this knowledge in

To view some great videos www.youtube.com/user/ThinkUni

patients suffering from the condition. Other work focuses on heart disease (pg. 32). Malta has one of the highest rates of heart attack-related deaths in Europe. A Maltese study is trying to determine which gene alterations common in Malta increase risk. Knowledge is power for treatment. Marijuana is a controversial drug. Research worldwide, including in Malta, has shown that it can potentially treat several conditions, explains

To read all our printed magazines online

Prof. Giuseppe Di Giovanni (pg. 38). Malta has double the EU average of

www.issuu.com/thinkuni

early school leavers. Cassi Camilleri writes about local research seeking solutions to this problem that is destroying communities (pg. 52). Marie Claire Gatt talks about sea birds around the Maltese Islands (pg.

For our archive from the University of Malta Library

44). These are vital for the Mediterranean Seaâ&#x20AC;&#x2122;s health. She reports on research performed to see which areas are in dire need of protection.

www.um.edu.mt/library/oar

In this issue, students talk about digital art (pg. 16) and testing octopi for heavy metal levels (pg. 15). While alumni discuss their work building security apps. The fun section rounds up the issue with reviews, fun

CONTRIBUTE

science questions, and a 100 word idea to change Malta (pg. 67â&#x20AC;&#x201C;71).

Edward Duca

EDITOR

edward.duca@um.edu.mt @DwardD

Are you a student, staff, or researcher at the University of Malta? Would you like to contribute to THINK magazine? If interested, please get in touch to discuss your article on think@um.edu.mt or call +356 2340 3451

COVER STORY

CONTENTS ISSUE 16 � APRIL 2016 TOOLKIT

MAQL

6 WITHOUT BORDERS

Science, art, academia: Star Trek

Malta Global Game Jam

DESIGN

Modern European sculpture 12

OPINION

Why practise Taijiquan?

Who owns you?

The enduring appeal of Star Trek

The Maltese Genome

Hundreds of Maltese people have had their DNA sequenced. The research is trying to identify the root of rare diseases common in Malta. The data has also revealed the origins of the Maltese people. See editorial on pg. 18

STUDENTS

Octopus around Malta: safe to eat?

Transform everything

RESEARCH

Art for research's sake How art is being used to fund research at the University of Malta

CONTRIBUTORS TOOLKIT ARTICLE Dr Noel Aquilina William Hicklin WITHOUT BORDERS ARTICLES Dr Edward Duca Prof. Victor Grech DESIGN ARTICLE Dr Edward Duca Nikki Petroni Dr Giuseppe Schembri Bonaci

OPINION ARTICLES Dr Jean Buttigieg Alan Saliba Gauci Prof. Victor Grech STUDENT ARTICLES Joshua Gili Matthew Galea RESEARCH ARTICLE Sarah Spiteri MALTESE GENOME FOCUS Dr Stephanie BezzinaWettinger

Dr Joseph Borg Prof. Alex Felice Clint Mizzi Scott Wilcockson FEATURE ARTICLES Prof. Carmel Borg Cassi Camilleri Prof. Giuseppe Di Giovanni Marie Claire Gatt Stephen Grixti Dr Milosh Raykov Dr Ing. Nicholas Sammut

ALUMNI ARTICLE Dr Nicholas MIcallef Veronica Stivala CULTURE ARTICLE Valletta 2018 Foundation FUN ARTICLES Dr Mario Aquilina David Chircop Dr Jurgen Gatt Alexander Hili Dr Philip M. Magri Costantino Oliva

COMIC STRIP Dr Ġorġ Mallia PHOTOGRAPHY Dr Edward Duca Jean Claude Vancell Elisa von Brockdorff ILLUSTRATIONS Sonya Hallett Marie Claire Gatt Jean Claude Vancell WEBSITE Lars Lorenz Jean Claude Vancell

THINK is a quarterly research magazine published by the Communications & Alumni Relations Office at the University of Malta To subscribe to our blog log into www.um.edu.mt/think/subscribe and fill in your details. � For advertising opportunities, please call 2340 3475 or get in touch by email on think@um.edu.mt Advertising rates are available on www.um.edu.mt/think/advertise

MALTESE GENOME FOCUS

The hidden history of the Maltese genome

Blood, genes & you

Heartbreakers

FEATURE

Marijuana for epilepsy? Maltese research on how the drug can be used to treat epilepsy

FEATURE

Time, space, & the ocean wanders Seabirds around Malta are critical for the Mediterranean Sea's health

FEATURE

Systematic failure, persistence and success

Rockets that fail safely Testing software to prevent disasters like the 1996 Ariane 5 rocket launch

Malta has twice the number of early school leavers as the rest of Europe. How can this problem be solved?

ALUMNI

Shiny 'appy people Security apps for good health

CULTURE

Maltese cultural participation: What do the people want?

The results are in on the Malta cultural participation survey

71 FUN

Reviews (Books, Film, Games)

THINK I D E A S

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M A LTA

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R E S E A RC H

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P E O P L E

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U N I V E R S I TY

APRIL 2016 - ISSUE 16

EDITORIAL

Edward Duca EDITOR-IN-CHIEF Scott Wilcockson FOCUS EDITOR DESIGN

Jean Claude Vancell DESIGNER COPYEDITING

67–70

100 word idea: Think critically, think Malta

What is more addictive: cannabis or coffee?

ISSN 2306-0735 Copyright © University of Malta, 2016 The right of the University of Malta to be identified as Publisher of this work has been asserted in accordance with the Copyright Act, 2001. University of Malta, Msida, Malta Tel: (356) 2340 2340 Fax: (356) 2340 2342 www.um.edu.mt All rights reserved. Except for the quotation of short passages for the purpose of research and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this magazine are correct and active at the time of going to press. However the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate. Every effort has been made to trace all copyright holders, but if any have been inadvertently overlooked, the publishers will be pleased to include any necessary credits in any subsequent issues.

Veronica Stivala PROOF READING

Patricia Camilleri, Daphne Pia Deguara PRINTING

Gutenberg Press, Malta

Toolkit

TOOLKIT

Photography by Jean Claude Vancell

MAQL

he Mobile Air Quality Laboratory (MAQL) is the

outside our window? Or is it because of the new sofa

first of its kind on the Maltese Islands. Run by a

the family next door just bought? Or perhaps it is a result

team of geoscientists at the University of Malta, the

of the redecoration the building down the road recently

MAQL can assess the quality of the air by continuously

underwent. Such data is vital for scientists to be able to

monitoring particulate and gaseous air toxics.

figure out the root of a problem, to create a model of

The particulates it can detect vary in size. The

personal exposure to the pollutants, and to develop safer

finer particles (PM1 and PM2.5) are usually the most

measures for the general public.

can also measure coarser sized particles (PM4 and

a clearer picture of the indoor air quality across

dangerous respirable fraction but the instrumentation

The MAQL facility will help scientists develop

PM10). The suite of gaseous pollutants that can be

the Maltese Islands. It will help other scientists

checked are sulfur dioxide, oxides of nitrogen, carbon

interpret older data, and enable them to design

monoxide, ozone, Volatile Organic Compounds (VOCs),

new studies. Medics can match such data with

organic and elemental carbon, and radon.

population studies and assess disease rates around

The MAQL is able to compare the air in indoor

Malta. The MAQL can determine the sources of

and outdoor spaces while recording meteorological

pollution inside buildings with the help of lifestyle

conditions onsite. The comparison helps scientists

and meteorological data, providing enough

understand from where the pollution originates. Is there

information for the construction of dwellings

so much pollution in our environs because of all the cars

which have cleaner and safer air for everyone.

• Power consumption (including cooling system): 2.5 kW

• Gaseous pollutants measurement frequency: 1 minute

• Particulate limit of detection: 1 ug/m3

• Gaseous pollutants limit of detection: < 0.5 ppb

• VOCs measurement frequency: 1 sample/30 minutes

• Cost: €0.60 million

Toolkit

QUICK SPECS

WITHOUT

BORDERS

Science, art, academia: Star Trek T

he Star Trek academic symposium will be held

drew participation from many international scholars

at the Faculty of ICT, University of Malta, on

including American philosopher Jason Eberl, UK-

15 and 16 July 2016. This event will be a platform

based neonatologist and ethicist Neena Modi.

for both academics from various disciplines as

As a result of its success, this second event

well as Star Trek fans to meet and explore the

that marks the 50th anniversary from the launch

intersection between the humanities and the

of Star Trek: The Original Series is being organised.

sciences. There will be inspirational presentations

The event will be held under the auspices of the

from national and international speakers, with the

Humanities, Medicine and Sciences Programme

programme tailored to attract a wide audience.

(HUMS), a University of Malta programme set

Contributors will be encouraged to explore

up to explore and encourage the interfaces

contemporary issues in medicine, science, and

between the humanities, medicine, and sciences.

technology as well as philosophical, psychological,

The Science Fiction Symposium will appeal to

and sociological issues connected with the

scientists and fans of science fiction alike..

science fiction entertainment franchise Star Trek. A similar symposium was held in 2014 and which

Without Borders

proved to be a worldwide first that successfully

For more information, visit: www.startreksymposium.com

Without Borders

Art by Prof. Victor Grech

WITHOUT

BORDERS Malta Global Game Jam I

ndie games are seemingly unstoppable. As

ancient temple’s rite of passage. Hashtag

mainstream blockbuster AAA games stutter,

Master Race won the local event with a game

new niches are opening up with nearly half

about angels and demons. Internationally

of gamers being female and mobile revenue

over 28,000 people participated.

increasing rapidly. In Malta, an important piece

Apart from a fun weekend, the event

in the indie game developer puzzle is the Malta

is an opportunity for one to practice and

Global Game Jam, which brings coders, designers,

learn skills, to build networks and, in a few

artists, writers, and other creatives together to

cases, build promising new IP (Intellectual

create a game from scratch in just 48 hours.

Property). Participants form a small indie

Run in Malta by the Institute of Digital

Malta Global Games Jam, the game And Then We

considerably since its inception, pulling an

Held Hands saw success and as it was distributed

international crowd from all over Europe. The

internationally following a $60,000 Kickstarter

January event this year included London-based

campaign. The experience can be used to help

games and pop-culture writer Philippa Warr and

those already in the industry, or for those

Milan-based indie design duo We are Müesli.

wishing to enter the industry, gain confidence

After keynotes and workshops to hone participants’ skills, 14 different games were created.

Without Borders

The worldwide theme was ‘ritual’. In third place

development team every year. Back in the 2013

Games since 2013, the yearly event has grown

to make more indie games or for them to join a big company with proven experience. Intense events like this play a vital role in

was the create-your-own-god game, Godowbows,

the building of a local game development

and the self-explanatory non-fun game, IKEA

scene that can soon see Malta join its

supply assistant. In second place the beautifully

international peers in producing top-notch,

designed The Passage immersed players into an

international and lucrative games.

Without Borders

DESIGN Modern European sculpture F

rench sculptor Auguste Rodin (1840–1917)

as a means of moulding his sculptures. He managed

is the progenitor of modern sculpture. He

to create a new aesthetic.

rebelled against idealised forms in order to express

The conference brought scholars from all over

the inner truths of humanity in his artworks.

Europe to discuss these and other European sculptors.

His successors went on to challenge his work,

The scholars debated topics from the mutation of

continuing to explore the aesthetic revolution he

the human form to an artist’s sense of heritage. The

had started. Key examples include Henry Moore

event focused on pioneering sculptors who went

(1898–1986), Alberto Giacometti and the largely

beyond their current socio-political context. It also

undiscovered Swiss sculptor Hans Josephsohn

helped place Malta’s own Kalleya deservedly on the

(1920–2012).

international map.

Design

These artists were studied alongside Maltese

sculptor Josef Kalleya (1898–1998) at the

The conference and exhibition were organised by

conference entitled ‘Peripheral Alternatives to

the Department of History of Art, Faculty of Arts,

Rodin in Modern European Sculpture’ (December,

University of Malta. The events were convened

2015). The international speakers created

by Dr Giuseppe Schembri Bonaci and curated

significant links between works by renowned

by Nikki Petroni. Other participants included Dr

sculptors and Kalleya, who has been poorly

Sophie Biass-Fabiani (Musée Rodin, Paris), Dr Jon

understood by his contemporaries and is unknown

Wood (Henry Moore Foundation, Leeds), Barbara

outside Malta. Kalleya developed unique methods

Vujanović (Atelijer Meštrović, Zagreb), Dr Julia Kelly

of creating photomontages alongside the innovative

(Loughborough University), and, Ulrich Meinherz

use of a knife to create powerful visceral incisions

(Kesselhaus Josephsohn, St Gallen).

Design

Top: Josef Kalleya, Study for City Gate, Valletta. Photograph of plaster model (image courtesy of the Kalleya Family Archives) Left: Josef Kalleya, L'Abbandono della Casa Materna. Photograph of lost work (image courtesy of the Kalleya Family Archives) Right: Josef Kalleya, I Santi, Bronze. Photo by Elisa von Brockdorff Opposite page: Josef Kalleya, Pierrot, Bronze. Photo by Elisa von Brockdorff

Why practise Taijiquan? Alan Saliba Gauci

n the 12th century, the Shaolin Monk Chang

known as Wu Wei (effortless effort). This means

and a crane, during which the snake managed

that those who practise Tai Chi should be soft and

to conquer its opponent with its grace. The

flexible in the same way that water flows smoothly.

monk went on to formulate a set of movements,

Water can take the form of any container yet on its

which have become the basis of Tai Chi, a martial art based on the pillars of Taoism, Confucianism

Some scientific studies have shown Tai Chi’s benefits. One study concluded that moderate Tai

being one with nature and the universe.

Chi practice helps older people maintain fitness, while other studies showed that Tai Chi was good

a system of philosophical teachings that stresses

for a healthy and well-functioning heart, as well as

that all under the sky is one family. Everyone can

to regulate blood pressure levels.

be part of this great family regardless of their social

Taijiquan is based on the principle of Yin

status, political or religious creed. By practising Tai

and Yang, an element of Chinese philosophy

Chi together and sharing knowledge, participants

that describes how two contrary forces can be

learn and develop respect and obedience; qualities

complementary. Building on this belief, those who

stressed by Chinese teacher and founder of

practise the discipline try to achieve harmony

Confucianism, Confucius.

which in turn brings with it good health.

During my Tai Chi classes, I like to first develop the technical aspects of a student’s movements in order for them to have a solid foundation. This is then followed by an emphasis on self-expression through movement and concentration on these movements. In the film Enter the Dragon, Bruce Lee tells his apprentice ‘like a finger pointing away to the moon. Do not concentrate on the finger or you will miss all that heavenly glory.’ At first a movement is just a movement. However, after constant practice and analysis, the practitioner realises that the movement has a rhythm behind it and this charges them with feeling, a process that resembles the way a musician feels the beat/the rhythm when performing.

THE BENEFITS OF TAIJIQUAN Taijiquan is a good method to alleviate stress and achieve good health. Rather than going to a gym, where a lot of energy and effort are required, with Tai Chi, a lot can be achieved without any force, Opinion

own it is formless and shapeless.

and Buddhism. Taoism upholds the importance of Taijiquan shares concepts with Confucianism,

and like Taoism, Tai Chi is based on the principle,

San Feng witnessed a battle between a snake

Who owns you? Dr Jean Buttigieg

were invalid because they did not create or alter

have already been claimed

any of the genetic information encoded in the

as US Intellectual Property.

BRCA1 and BRCA2 genes. The location and order

But should anyone own our

of the nucleotides existed in nature before Myriad

genes? And what happens

found them. The company simply discovered what

when gene ownership can drastically prevent the advancement of life-saving cures? The US Patent Office’s most controversial patents

was already there and did not create anything new. There is no worldwide consensus on whether parts of the human genome should be granted

are on BRCA1 and BRCA2, both linked to the high

intellectual property protection. The Myriad

risks of ovarian and breast cancer. They are now

patents should alert us to the injustice of having

owned by Myriad Genetic Laboratories. In 1996,

a pharmaceutical company make money out of

Myriad Genetics developed and began marketing a

cancer predictive tests that could cost 10 times

predictive test for the presence of possible cancer-

less than what is charged. The same patents

causing mutations: the ‘BRCAnalysis’ test. The

stifled diagnostic testing and research that could

price of the test was US$3,000 but the company

have led to cures as well as limiting women’s

promised that it would eventually drop the price to

options regarding their medical care in Malta as

US$300. This never happened because its patent

in all other parts of the world. There are various

holder had the right to stop any other party from

international and regional agreements that have

duplicating the patented sequences. This single

described the human genome as being part of

test accounted for over 80% of Myriad Genetics’

humanity’s ‘common heritage’, including the 1998

multibillion dollar business.

UN Declaration on the Human Genome and

In 2009, the American Civil Liberties Union (ACLU)

Human Rights. The Myriad patents controversy

decided to challenge the patenting of human genes

has shown that gene patenting does not work

on legal grounds. The ACLU was the representative of

to stimulate more research—one of the prime

20 medial organisations, geneticists, women’s health

arguments Big Pharma uses. It is time to explore

groups, and patients unable to be screened due to

other avenues that will both promote scientific

the prohibitive patents. The ACLU’s position was that

progress and technological development but

Myriad’s patents violated the patent law on the issue

at the same time protect the special nature of

of patent-eligibility.

human genes that make us who we are. No

The case went before the Supreme Court. By 3 June, 2013 it was declared that the Myriad patents

one should own our genes—they should be exploited in the interest of everyone.

Opinion

ne fifth of human genes

The enduring appeal of Star Trek Prof. Victor Grech

am often asked why Star Trek appeals to me

to all since no deities are invoked. When people

lies with its founder, the humanist Gene

invoke God or gods this almost inevitably

Roddenberry. Humanism is defined as ‘a faith

precipitates arguments on which religion is

in and commitment to shared humanity’.

correct or true. Such conflicts are a principal

Secular Humanism is not an ideology or

source of past, present, and future contention.

fixed ethical system but a collection of general

Opinion

Television aliens can be read as ciphers and

guidelines that should allow humanity to

metaphors for humanity. Humanism could

increase its knowledge to further its collective

be interpreted as a belief system that is a

wellbeing. The philosophy seeks to establish

useful point of reference to explore human

moral principles that are independent of

differences. The medium of science fiction

any mystical sources, though they remain

combines these two, leading to open dialogue

conducive to the freedom and wellbeing of

and self-insight to bridge the artificial gulfs

the populace based on ethical reasoning. The

that separate us as individuals and as races.

term Secular Humanism explicitly rejects the

The Star Trek universe continues to offer

supernatural and the primacy of moral codes

‘an alternative, liberal future that not only has

based solely on religious convictions. Secular

eliminated poverty, racism, sexism, jingoism, and

Humanist philosophy offers an alternative to

colonialism, but also challenges contemporary

more traditional ethical and moral concepts.

society to rectify such unacceptable states of affair’.

Humanism is rooted in the oeuvre of the

Star Trek’s brand of secular Humanism appeals

and so many others. For me, the answer

Star Trek, like other science fiction, has an

philosopher John Locke, who asserted that

unshakeable ‘belief in the liberating power of

everyone has the natural right to ‘life, liberty,

the imagination’ to optimistically create utopian

and property’ as well as in the work of

worlds that help us realise ‘our limitations, and

philosopher Adam Smith, who addressed the

thereby to move beyond them toward a more

importance of private property and free trade.

inclusive awareness’ of humanity’s potential.

STUDENTS Octopus around Malta: Safe to eat? Joshua Gili

eavy metals can be toxic to humans. They need to be

liver. Each tissue was gathered into one pool by site,

monitored to ensure environmental levels do not go

then homogenised, dried, and acid-treated. Afterwards a

above dangerous levels. The European Commission has

technique called polarography was used to determine the

set acceptable maximum levels of metals allowed in food

levels of each metal. This data helped Gili decide whether

since most metals end up in humans through their diet.

metal accumulation in the tissue of octopi is affected by

But how do metals find their way into our food in the first place? Heavy metals can enter the environment in

biometry, season, or geography. In Malta, metal levels depended on where the octopus

a number of ways, including through volcanism, fossil

was caught. In general, the concentrations were lower

fuel burning, and antifouling paint use. The heavy metals

than other Mediterranean regions. The levels of cadmium

bind with biomolecules inside living tissue, and can build

and lead in the tentacles were below toxic levels as

up to dangerous levels. One prime example of how such

stated by the European Commission, indicating that local

metals end up in the food we eat can be seen in the case

octopus is safe to eat.

of the common octopus (Octopus vulgaris). The octopus is susceptible to accumulating high levels of heavy metals

This research was performed as part of Joshua Gili’s

due to its high ingestion rate of benthic fauna.

Bachelor of Science (Honours) in Biology and Chemistry,

Joshua Gili (supervised by Prof. Victor Axiak) recorded the concentrations of cadmium, copper, lead, and zinc

which he is reading at the Faculty of Science, University of Malta.

in the common octopus. Specimens were collected from around Malta during summer and winter. The analysis was performed on two of the species’ tissues—the tentacles and the digestive in a similar way to the human

Students

glands— which function

Transform everything Matthew Galea

igital technology opens up new possibilities for the visual arts. It allows artists to

The multidisciplinary approach also allowed Galea to investigate chemistry and physics as

go beyond the traditional constraints of art.

ways of generating content and engaging with the

Sculpture is a centuries-old tradition reliant on the

artefact. Galea produced an art installation that

relationship between the artefact, and its material

made use of the night sky, which itself has held

and space around it. In the past, sculpture was

multiple interpretations by humankind throughout

confined to being a physical act; it produced three-

time. The artwork transformed movement into

dimensional tangible objects that had little to do

audio and visual content.

with the digital world. But this is just one side, if you would forgive the

Thanks to his research, Galea helped show how hyperdisciplinary artefacts that fuse various art

pun, to sculpture. Sculpture can be viewed as a

forms are possible through digital technology.

mental process. It is the act of remediating things,

Computers can transform data into an image,

or rather reassigning meaning to objects. Marcel

audio, or text. Software can transform anything.

Duchamp’s infamous sculpture ‘Fountain’ (1917)

Digital technology can enhance artworks'

is perhaps a perfect example of this. Meaning is

interactivity with the audience, making visitors

a social and cultural construct created through

part of the artwork.

interactions by people with the objects and their environment. Since meaning is fabricated by society,

To see the project’s outcome visit:

then it stands to reason how the same objects have

www.behance.net/gallery/27174125/Map-of-

held multiple interpretations through time.

the-Heavens

Students

Matthew Galea (supervised by Dr Vince Briffa)

This research was performed as part of a

explored these social and cultural constructs to

Master of Fine Art in Digital Art which Matthew

create novel artworks. To do so, he employed

Galea completed at the Faculty of Media and

skills from different disciplines including drawing,

Knowledge Sciences (MaKS), University of Malta.

painting, sculpture, music, and the other

It is partially funded by Master it! scheme. This

performing arts. But instead of expressing them

scholarship is part-financed by the European

individually he fused them into one art form.

Union—European Social Fund (ESF) under

The various art forms could be experienced

Operational Programme II—Cohesion Policy

collectively, for example, as a musical instrument,

2007–2013, ‘Empowering People for More Jobs

or a painting, or even through movement.

and a Better Quality of Life’.

Photos by John Ambrogio

Art for research’s sake Performing artists support medical research through the University of Malta’s Research, Innovation and Development Trust

science and research.

the event, who passed away in 2013. Jonathan Shaw, the producer of

the importance of supporting the work that is being carried out in the

When it comes to

Teatru Unplugged, explains that ‘a part

field of cancer research […], work

raising funds for

of the proceeds or the money raised

that may not have an immediate

medical research, artists

through initiatives associated with

result, but by supporting it we are

and art lovers around the world

Teatru Unplugged has always gone to

supporting a long term plan.’

have always been at the forefront.

good causes,’ but ever since Nirvana

The most recent event was held

Concerts, art exhibitions, and art

passed away, Teatru Unplugged has

on Easter Sunday. RIDT presented

auctions have long been effective

focused specifically on cancer-related

Vivaldi’s The Four Seasons at St

platforms for raising funds for research,

causes.’ This year the organisers

Publius Church, Floriana, featuring

particularly medical research.

decided to go one step further, and

internationally acclaimed violinist

collaborated with RIDT. Shaw adds

Carmine Lauri together with a

the inception of the the University

that ‘we believe that investing in

14-piece string ensemble, under the

of Malta’s Research, Innovation and

research to help find possible or

direction of Prof. Mro Michael Laus.

Development Trust (RIDT), a growth

potential solutions to a problem is just

The concert was supporting Brain

has been observed in terms of

as important as helping those who

Awareness Week that aims to raise

support for and contribution towards

are currently facing that scenario. It

funds for research in brain-related

research from the art industry. This

is important to channel support to

studies, and was supported by APS

growth in support comes from both

the long-term solution at the root.’

Bank and the ADRC Trust.

the artists themselves as well as the

The 25th edition of Prelude to

Over the past four years, since

producers of artistic events. It is

Christmas, a concert for Christmastime

encouraging to see a culture change

held at the Mdina Cathedral by the

whereby research is being recognised

Amadeus Choir, raised funds for

as a cause worthy of support.

cancer research conducted at

Noteworthy examples of this are

the University of Malta. Mro

two music events that took place in

Brian Cefai, director of the

December 2015. The 18th edition

Amadeus Choir comments

of Teatru Unplugged was held at

that ‘as a choir we have been

the Manoel Theatre, Valletta and

raising funds for charitable

raised funds for cancer research.

causes for decades. This

The initiative also honoured Nirvana

year we decided to support

Azzopardi, one of the co-founders of

RIDT because we recognise

Research

rt is no stranger to

SP EC I AL

F EATURE

NA is what life is made of. Found in every cell of the human body, it has sent criminals to jail and been the focus of controversial court cases. Dr Jean Buttigieg discusses these legal and ethical issues (pg. 13). DNA has also

transformed the meaning of being human, with traits from disease to intelligence all linked to it. DNA is changing the world. Malta has not lagged behind in genetics research. One of the largest local research groups has been investigating for decades the genetics behind haemoglobin switching and the blood disorder thalassaemia. Their research is recognised worldwide (pg. 26). They recently discovered a mutation, in some Maltese families, that led them to a master regulator that could help bone marrow alleviate the disease. They are trying to turn this knowledge into a treatment for sufferers worldwide. In the worst cases thalassaemia is fatal. Another large scale study is looking into heart disease (pg. 32). The mortality rate in Malta is higher than the European average. This is partly our lifestyle but there is also a genetic component. The Maltese Acute Myocardial Infarction (MAMI) study is focused on finding the genetic component behind three key heart-disease related problems. The local studies on Maltese genetics are very ambitious (pg. 19). They have already partially sequenced tens of people and plan to map the genomes of 4,000 Maltese people, around 1% of the population. Malta would suddenly become one of the best genetically documented in the world. This research has already borne fruit with a public health genomics database, a biobank, and the origin of the current Maltese population finally nailed. The Malta Human Genome Project (MHGPâ&#x20AC;&#x201D;Grant Agreement R&I 2013-041) is funded by the Malta Council for Science and Technology in the Health & Biotechnology sector. Research consortium lead: University of Malta.

Maltese Genome Focus

Partners: Mater Dei Hospital, Erasmus MC, Rotterdam, The Netherlands and Complete

Genomics Inc., California, Silicon Valley, USA.

The Hidden History of the maltese genome

By reading someone’s DNA one can tell how likely they are to develop a disease or whether they are related to the person sitting next to them. By reading a nation’s DNA one can understand why a population is more likely to develop a disease or how a population came to exist. Scott Wilcockson talks to Prof. Alex Felice, Dr Joseph Borg, and Clint Mizzi (University of Malta) about their latest project that aims to sequence the Maltese genome and what it might reveal about the origins and health of the Maltese people. Illustrations by Sonya Hallett.

The first draft of the Human Genome has been

launched the largest biological project

invaluable to researchers all over the world who

in history. Over the course of 13 years,

sought to understand the intricacies of human

the Human Genome Project sought to

biology and evolution. Another major outcome was

decipher the sequence of human DNA;

the rapid surge in DNA sequencing technologies.

the chemical code found in every cell of

The first human genome took over 200 scientists

our bodies that contains the information to

13 years and $3 billion to complete. The newest

create an entire human being. The completion

technology, known as Next Generation Sequencing

of this project, and the subsequent boom

(machine-based sequencing technologies), now

in the field of genetics, has turned the

allows a small group of scientists to sequence one

21st century into the age of genetics.

person’s genome in a few weeks for around

Maltese Genome Focus

n 1990, geneticists all over the world

$1,000. Such a low price has fuelled

groups of populations. Caucasians

innovation—from reimagining medicine

have particular DNA variations

(into precision medicine that considers

that make them unique from East

The three-year Maltese Genome Project

a person's gene variations, environment,

Asian populations and vice versa.

was launched in 2015, based on nearly

and lifestyle) to teasing out the origins

Maltese Genome Focus

25 years of human genomic research

of humankind through projects like

genome falls short when one attempts

in Malta. It will map the genomes

The Cancer Genome Atlas and the

to study a specific population’s genetics.

of around 4,000 Maltese people, or

International 1,000 Genome Project.

Researcher Clint Mizzi explains, ‘there

1% of the population, in order to

have been a number of [genome

obtain an averaged or referenced

human genome does not paint a

sequencing] projects but how many

Maltese genome sequence. This

complete picture of every person alive

Maltese people were included? […]

means that the end result will not

today. While 99.9% of the sequence

Populations from different countries

be the sequence of any one person’s

of every human’s DNA is the same,

have different variants that appear in

genome but a representative example

the 0.1% which is slightly different

different percentages of the population,

of the entire Maltese population.

(called variations or mutations) makes

thus some [gene variants] may be

us unique. Borg explained, ‘all of our

found mainly in the Maltese population

will be invaluable to geneticists and

traits, such as eye colour and height,

[while] others are absent.’ This is why

clinicians to diagnose rare diseases

boil down to small variations in our

many countries worldwide are initiating

and investigate new therapies. Borg

DNA sequence. Importantly, diseases

their own genome projects. Now

describes how ‘if they embark on their

are also attributed to [gene] mutations

Malta has entered the foray with the

own genetics project and uncover a

and variants.’ While every person

Maltese Genome Project and a partial

mutation […], instead of having no

is genetically different, so are large

genome has already been completed.

idea how frequently it occurs [in the

While useful, the first draft of the

Thus, the current data on the human

A GENOME FOR THE PEOPLE

Having this kind of information

Maltese population] or what it does,

than exploring […] work that might be

reference genome to match everything

they will now have a reference they

futile, which can be very frustrating.’

up like a giant jigsaw puzzle. By

can look to.’ This knowledge will vastly improve the understanding

comparing the genomes, any variations

CONVERTING PEOPLE INTO BIG DATA

in the DNA sequence specific to the

Getting hold of a person’s DNA is quite

researchers can then focus their

easy: a cheek swab or some blood is

efforts on the specific gene variants

FORGETTING PAST TECHNOLOGY?

all you need. Once the DNA has been

or mutations that are affecting the

prepared—which involves cutting it up

Maltese population. Mizzi stresses

into tiny fragments—it is placed in one

‘that bioinformatics does not stand

Malta has a long history of genetics

end of a DNA sequencing machine and

alone. […] The machines are not 100%

research. Older genetics technologies

left to run. These machines essentially

perfect, although there are a number

were less focused and much more

make a copy of the DNA fragments and

of [methods we use] to minimise the

of how particular gene variants affect the Maltese population when studying disease mechanisms.

Maltese population can be singled out. With this information, the

labour intensive. They looked at one gene at a time, forcing the researcher to choose particular genes, possibly missing the gene linked to a disease or condition. Modern whole genome sequencing (next generation sequencing) is fast, relatively inexpensive, and allows

This knowledge will vastly improve the understanding of how particular gene variants affect the Maltese population when studying disease mechanisms.

researchers to look at every single gene and all the DNA in between.

monitor which molecules are added

errors. […] So it is important to go back

So does this mean that next

in sequence to the growing chain of

to the laboratory to confirm results and

generation sequencing technology will

new DNA. This then allows you to

do experimental functional studies.’

signal the end for old technologies? On

determine the original sequence. Then

It is imperative to check that the

the contrary, Borg explains that ‘we are

it is someone else’s job to make sense

variants or mutations have an effect

at a stage where we usually sequence

of what comes out the other end.

on our biology. By working together,

the whole genome […] but if we can

Say 'hello' to the bioinformaticians!

researchers from different fields are

obtain enough data [about the Maltese

Clint Mizzi is a bioinformatician at

population], researchers no longer need

the University of Malta working on the

to sequence everything. Once we have

Maltese Genome Project. He explains

bright future for our understanding

the thousands of unique and non-

that ‘bioinformatics encompasses

of human physiology and what

unique [gene] variants, a researcher can

multiple disciplines […] involving an

treatment is best when our genes

study a Malta-specific [range of genes]

understanding of biology, computer

turn against us. But the field of

that can be more precise and less time

science, mathematics, statistics,

genetics is not only about working

consuming.’ Far from replacing the old

and some engineering. We apply

towards a better future. Hidden deep

technology, whole genome sequencing

mathematical sciences to biological

within our DNA are clues of our

can work alongside it to streamline

data.’ A single person can equate to

distant past. By reading the Maltese

research. ‘[Genome sequencing]

200–400 gigabits of raw data and

genome one can understand the

will help direct research to specific

Mizzi needs to make sense of it.

origins of the contemporary Maltese

can] tailor design experiments rather

Once Mizzi has the DNA sequence fragments he aligns them to a

The age of genetics heralds a

population and the evolutionary forces that shaped their genome.

Maltese Genome Focus

genes,’ Borg explains, ‘[so a scientist

putting this knowledge to good use.

Lebanese DNA contributed less than 5% to today's Maltese DNA

MALTESE ORIGINS

specific parts of the mitochondrial

population, known as M and N, moved

DNA (known as haplogroups, that

into the Middle East and made their

The Mediterranean has enjoyed a

remain largely unchanged over

first steps toward global colonisation.

turbulent past with more civilisations

time so are shared worldwide)

and empires rising and falling than a

researchers are able to trace ancestry

entered Continental Europe. Felice

year's hot dinners. This question of

through the female lineage.

explains that ‘over a relatively short

‘where did the Maltese come from?’

The second is the Y chromosome. Human DNA is broken up into 46

the pre-existing humanoids, mostly

To understand how this modern

chunks known as chromosomes, with

Neanderthals in Europe, due to some

nation arose needs a bit of history.

each parent contributing half. Gender

kind of Darwinian advantage.’ Some

is determined by two chromosomes

cross-breeding took place between

Africa, the environment was just

known as X and Y. XX makes a female,

the two humanoids but gradually

right for the beginning of humankind.

XY makes a male. The combination

Homo sapiens took over the planet

Modern humans (Homo sapiens)

depends on one's father. The Y

(except Antarctica). Malta was only

entered the world stage around

chromosome also has haplogroups,

colonised around 7,000 years ago.

200,000 years ago—exact dates are

making it a useful genetic marker for

still unknown. Evolutionary genetics

evolutionary studies on men's origins.

THE FIRST PEOPLE OF MALTA

THE VOYAGE OF HUMANITY

The first humans in Malta are presumed

This DNA is distinct from the rest of

Around 80,000 years ago humans

brought cattle and crops over that

our DNA found in the cell nucleus.

embarked on the most important

changed the Maltese landscape. After

Mitochondrial DNA is found in

journey in humanity’s history. They

more than a millennium, the culture of

small energy producing factories

left Africa. From the analysis of

this people took an interesting turn.

known as mitochondria—if they

mitochondrial DNA, humans 'exited

They built over 30 temple complexes,

stop working, death follows quickly.

from East Africa as a small group of

the oldest free-standing stone

These are inherited only from

male and female modern humans,’

structures in the world. This Temple

one's mother and only transmitted

explains Prof. Alex Felice. Two

Period saw the rise of a complex

through daughters. By looking at

splinter groups of the Eastern African

civilisation with a ritualistic and artistic

studies that look into our distant past rely on two genetic markers. The first is mitochondrial DNA.

Maltese Genome Focus

period of time […] humans replaced

has been debated for centuries.

A long time ago in South-East

By 40,000 years ago, humans had

to have been Sicilian farmers, who

culture (see Death of the Temple People

completely uninhabited; there is not a

day colonial areas based on haplogroups

in THINK, Issue 10, pp. 34–41).

very good record, but in principle there

in modern day Lebanese people. Late

For one and a half millennia the

was not a substantial population [...].

Stone Age farmers in Greece, Crete,

Temple People flourished, leaving

It was probably a mixture of the main

and Southern Italy had the same piece

behind their distinctive mark on

populations of the time,’ he continues.

of DNA. The Maltese population did

the Maltese and Gozitan landscape.

The Temple People were replaced

too, but this small genetic footprint

However, their departure left us with

by Bronze Age settlers. Then came the

could have been left behind by others

Malta’s greatest mystery: why did

Phoenicians around 700 bc, followed

like the Stone Age ancestors. The

they suddenly disappear around 2500

by the Carthaginian Empire in 332

methodology of this study turned out

bc?

bc,

to be flawed. Maltese history does not

then the Romans during the First

proposed, including environmental

Punic War in 218 bc. Malta's population

reflect a large Phoenician population

stress and their own religious fervour.

was thought to be very small, Felice

that could have lasted till today

The real reason is being unravelled

adds how there was ‘maybe a small

by the FRAGSUS project involving

urban presence in modern Mdina and

Maltese come from? Research carried

archaeologists, biologists, engineers,

[a few other places], but apparently

out in Malta points to just a few

and others from the Universities of

only a couple thousand at most.’

hundred miles north. A study published

Cambridge, Belfast, and Malta. Events like this seem to echo

So where do the contemporary

in the Annals of Human Genetics in

DESCENT FROM PHOENICIA OR SICILY?

2004, on which Felice collaborated,

[humanity’s presence in Malta] is like

In 2004, a National Geographic magazine

and identified common population

that of the dinosaurs. The Temple

interview sparked exciting revelations

groups. ‘Data on Mitochondrial DNA

People were here but they seem

on the origins of the Maltese people.

[from the ongoing Maltese Genome

to have been replaced by others,’

Early results of a Y chromosome study

Project] is also nearly complete but

comments Felice. For the next four

showed that 50% of Maltese men are

what we have also points in the same

millennia Malta constantly changed

of Phoenician origin. In 2008 the study

direction [as the previous study]:

hands, closely following the rise and fall

was published in The American Journal

that most contemporary Maltese

of the great Mediterranean Empires. ‘It

of Human Genetics. The researchers

males and females can trace their

is not correct to say that the island was

looked for Phoenician DNA in modern

ancestry to Sicily and [Southern]

throughout Malta’s history. ‘The archaeological record is such that

looked at Y chromosome haplogroups found throughout the Mediterranean

Maltese Genome Focus

A number of theories have been

Italy around 1,000 years ago,’ reveals

THE PRICE OF PROSPERITY

of St John and second, as in the rest

Lebanese DNA, contributed less

‘So this is the [genetic and historical]

a certain degree of public hygiene

than 5% to today's Maltese DNA.

data on the recent origins of the

and prosperity […]. The populations

contemporary Maltese. This is

of Europe and Malta started to grow

NORMAN DOMINION

important for a number of reasons.

exponentially. It was during this time

Firstly it addresses questions such as:

that rare diseases accumulated’.

History reflects the DNA evidence.

Who am I? Where am I going? Where

The decline of the Roman Empire was

did I come from?’ Felice observes,

was estimated at 12,000 with 5,000

followed by Arab rule of the Islands for

adding, though, that ‘there are also

residing in Gozo. Within 10 years, the

at least two centuries from around

important questions [for Malta today]

estimate had almost doubled to 22,000

870. First under the Aghlabid

regarding public health’ that must be

in Malta and 6,500 in Gozo, including

Emirate and then the Fatimid

asked. For millennia ships have dropped

the Knights. Despite sieges and

Caliphate. Malta was either

anchor along the Maltese shore and

depopulations of Gozo, by 1814 the

uninhabited or there were very few

the ripples can still be felt today.

Island's population boomed to 41,000.

Felice. Middle Eastern DNA, including

of Europe, this was the beginning of

In 1528 the population of Malta

people. The turn of the first millennium brought a documented influx of people from Arab-ruled Sicily. At the turn of the 11th century a new set of players entered the game. Adventurers from Northern

Who am I? Where am I going? Where did I come from?

France had gained a foothold in Southern Italy and sought to expel

fallen out of favour with the Maltese toward the end of the 18th century

The current population of Malta

due to the opulence of Grandmaster

stands at just over 420,000 and

Pinto’s reign. On 9 July, 1798

By 1091, Count Roger I landed in

originates from a small population that

Napoleon Bonaparte landed in Malta

Malta and established Norman rule.

settled here after the first millennium.

and, by the 12th of the month, Malta

Felice explains, ‘these [people] were

was added to the French Empire.

the Arab administration until 1127

visited by small groups, military

when Count Roger II of Sicily, the son

details of young men who stayed

memory of their evil French

of Roger I, finally displaced the Arab

for a short time […] and left genetic

overlords, rule under France was not

governors and established complete

memories in the form of gene variants

all that bad. Napoleon planned the

Norman dominion. Over the next few

and mutations […].’ This, he notes, is

building of hospitals and invested

centuries, the Maltese population grew

what we now recognise as Founder

in education. Unfortunately, the

with an influx of Sicilian and Norman

Effects. As the small population

new rules did not sit well with

settlers. Felice explains ‘there was

expanded over the centuries, these

the clergy who stood to lose their

[still] a strong Arab subculture in Sicily

newly introduced Founder Mutations

significant power over the Maltese.

and Southern Italy […]. If you go to the

became widespread across the

So they initiated a rebellion. The

small villages outside [Sicilian] towns

population for better or worse.

Maltese were induced to revolt 82

today they speak very differently to

Maltese Genome Focus

Nothing lasts forever; the Knights had

the Arab and Byzantine occupiers.

Malta continued to be governed by

EXPERIMENTING WITH NEW MASTERS

The history of Malta continued to

Despite the Maltese collective

days after accepting French rule

modern Italians, not too different from

become more and more interesting

(see Malta: Stockholm Syndrome in

what we call Maltese. These [people]

with various groups and nations

THINK, Issue 13, pp. 48–55).

began to re-inhabit Malta, although

visiting over the centuries, which

there were only around 20,000 people

provided ample opportunities for these

in great suffering. Malta's population

up to ad 1500.’ Once again, Malta was

Founder Mutations to arrive and mix

plummeted by 18.7% around this

colonised by Sicilians who gradually

with genomes from distant countries.

time from 114,000 to 93,000 due to

latinised the island and brought their

Felice describes two major events

war, famine, and disease. By 1800,

unique Siculo-Arabic language that

that occurred after 1500: ‘first was

the French relented and the Maltese

evolved into modern Maltese.

the arrival of the Order of the Knights

won their freedom back. Without

The two-year-long siege resulted

Malta being involved in the negotiations, it was handed back to the Knights with the British acting as protectorate. The British amalgamated Malta into their empire. The Maltese were deemed incapable of governing themselves leaving Malta to enjoy 164 years of British rule.

BOTTLENECKS AND FOUNDER EFFECTS Events over the last millennia have shaped the modern Maltese people. The rise and fall in population numbers created genetic bottlenecks. These events impacted genetic diversity so much that rare DNA mutations became common spreading disease. The problem is evident today. ‘There are a number of mutations that give rise to rare diseases, those [found] in less than one in 10,000 people. […] So, there is this genetic burden,’ explains Felice. ‘In the 1990s we set up, with the Department of Health and the late Dr Joe Louis Grech, the Laboratory University of Malta] and the

blood disorders like thalassaemia. One

technology, over the next few years

Thalassaemia Clinic at St Luke's

study in 2007 by Felice and his team

research and diagnostics shall be

Hospital, now at Mater Dei Hospital,

focused on a mutation in the SPR gene

moving to whole genome sequencing.’

and we began to identify some of

that leads to a rare disorder known

With the Maltese Genome in hand,

these mutations.’ Interestingly, the

as Segawa’s Disease, a motor neuron

researchers will be able to figure out

research on these disease-causing

disorder with some similarities to

how to treat diseases widespread

mutations supports the Y chromosome

Parkinson’s Disease. A single mutation

locally while helping others worldwide.

and mitochondrial DNA studies

in the SPR gene was found in a high

Researchers will generate a complete

carried out in Malta: most of the

proportion of the population. Because

picture of where the Maltese came

Islands' genetic mutations are shared

of this discovery, babies are diagnosed

from and who they are today.

with Sicily and Southern Italy.

at birth and treated immediately

Some mutations that cause rare diseases are disproportionately high

preventing severe disability. Genetics is making great strides.

The study’s co-principal investigators are Prof. Alex Felice and Dr Joseph

in the Maltese population and include

Felice adds that ‘because of the

Borg with Clint Mizzi and Dr

gangliosidosis, coeliac disease, and

efficiency and costs of the new

Nikolai Pace as close associates.

Maltese Genome Focus

of Molecular Genetics [at the

Maltese Genome Focus

BLOOD, GENES, & YOU

Over the course of nine months, an entire human body is sculpted from a few cells into a baby. The blueprint is the information written into our DNA. But what happens if there is a mistake in these blueprints? Decades worth of research carried out in Malta and abroad have aimed to understand how these errors lead to a disease common in Malta and prevalent worldwide. Scott Wilcockson talks to Dr Joseph Borg (Faculty of Health Sciences, University of Malta) to find out more.

ou are unique. This is not just

Thalassaemia, which has become the focus of Dr

saying that to make you feel good

Joseph Borg’s research after he joined Prof. Alex

about yourself. Everyone is unique.

Felice's research group that has studied how a

Every person is moulded by their

genetic quirk could be used to treat this illness.

upbringing, experiences, and genes.

made a distinct person with a unique DNA

WHEN BLOOD TURNS BAD

sequence, randomly passing on the best and

Borg explained that ‘thalassaemia is an inherited

worst of themselves to the next generation.

blood disorder caused by an inability to produce

The information written into your DNA, or

sufficient amounts of haemoglobin, the [molecule]

genome, supplies the embryonic ‘you’ with the

in red blood cells that binds and transports oxygen

instructions to build your entire body and then to

to our various tissues and organs.’ The most

maintain it throughout your life. While all human

prominent form in the Mediterranean is Beta

beings possess a common set of genes—around

Thalassaemia. This is caused by mutations that

23,000 of them—our DNA is not exactly the same

affect the production of the beta-chain sub-unit

for all of us. We are all riddled with small variations,

of the haemoglobin molecule in blood cells.

or mutations, throughout our genomes. Many of

There are around 300 known mutations that

these mutations result in biological quirks that play

cause thalassaemia worldwide. In Malta, a single

a role in our individuality. For example, mutations

mutation in the beta-globin gene was found to be

in the OCA2 gene are a major determinant of

the main culprit in the late 1980s by Prof. Christian

eye colour. Other mutations can have more

Scerri (Faculty of Medicine and Surgery, University

profound effects on health and well being.

of Malta) and had been designated the very

Most diseases have some sort of genetic element,

catchy name of β+ IVS-I-6 (T→C). This mutation is

though the exact cause can vary. Some diseases,

common throughout the Western Mediterranean

like diabetes or cancer, are due to many genes

and accounts for two thirds of all Maltese cases.

malfunctioning and are known as multifactorial.

Unfortunately, treatment options are limited. Borg

The multiple genetic mutations acting in concert

explains that ‘adult patients have to undergo lifelong

trigger disease progression. Others on the other

blood transfusions every month, or a bone marrow

hand are monogenic as they are triggered by

transplant in rare cases.’ Hope is in sight, however.

one gene mutation. One such disease is Beta

Studies are now focusing on a biological

Maltese Genome Focus

By fusing together their DNA, our parents have

Left to right: Dr Joseph Borg, Jeanesse Scerri, Stefanie Inguanez

quirk that could hold the key to

oxygen molecules. Following birth,

treating patients. In the 1990s, a study

babies are able to obtain plenty of

on the Maltese population carried out

oxygen on their own and switch from

by Prof. Alex Felice (Faculty of Medicine

primarily foetal to adult haemoglobin.

and Surgery, University of Malta) and

Intriguingly, the switch is not

his team identified another common

always complete. Borg described

mutation within the gamma-globin

how a small portion (less than 1%)

gene. This gene contains the blueprints

of all our haemoglobin is foetal even

needed to make another haemoglobin

in adulthood. However, some adults

protein known as the gamma-chain. In adults the beta-chain is used to make haemoglobin. In babies the gammachain is used instead in the developing foetus and up to six months after birth.

A QUIRK OF NATURE When a foetus is developing, oxygen is provided through the mother’s blood supply. Oxygen diffuses through the mother’s placenta in the womb where it is picked up by the baby’s red blood Maltese Genome Focus

cells. The foetus needs to be able to

absorb as much oxygen as possible and therefore uses a different type of haemoglobin (foetal haemoglobin) that has a stronger attraction toward

The relative ease with which researchers can sequence all of a person’s genes is paving the way for a much greater understanding of how diseases develop and how to treat them.

can have much higher levels because of certain genetic mutations. This phenomenon is known as Hereditary Persistence of Foetal Haemoglobin (HPFH). Felice first discovered a Maltese person with HPFH, and now whole families have been found. Earlier, Prof. Maurice Cauchi (now Melbourne, Australia) had discovered the Hb F Malta I variant in the gammaglobin gene. The mutation is found in around 2% of Maltese newborns. Together with other variants they are the most valuable quantitative markers of the foetal to adult globin gene switch unique to Maltese families. Individuals who have two mutant genes, one from each parent, can have

treatment. No more medicine. It would

to be foetal. One mutant gene

give them a better quality of life.’

leads to between 15–34% foetal

In 2010, this team published

This study revealed how the mutation in the Maltese family blocks the KLF1 protein from binding

haemoglobin. This particular quirk

(together with ERASMUS) a seminal

to DNA and doing its job. KLF1

of biology does not cause any ill

work in the world-leading journal

normally switches on the adult beta-

effects, as foetal haemoglobin

Nature Genetics. The work identified a

globin gene and turns off the foetal

functions well and individuals with

key factor that caused the haemoglobin

gamma-globin gene. By stopping

the mutation usually do not find

switch in the first six months of a

KLF1 from doing so the Maltese

out until they have it tested.

baby’s life. The study looked at an

mutation causes a lot more foetal

This biological peculiarity is of

entire Maltese family, where ten out

haemoglobin to be produced in adults.

great interest to researchers like

of 27 members exhibited HPFH with

Felice and Borg. ‘We wanted to use

varying degrees of foetal haemoglobin

a major regulator of the switch. Borg

the knowledge of this mechanistic

production ranging from 3–20% of

cautions however, that ‘after our

imbalance [in the switch] to

the total haemoglobin. Borg and his

publication, other groups identified

understand how best to treat those

colleagues sequenced the recruited

similar and also conflicting results

who suffer from blood disorders like

family’s DNA to identify the genetic

because of different KLF1 mutations

thalassaemia and sickle-cell disease.’

mutations causing this imbalance.

[...]. This [suggested] that KLF1 is

People with these disorders usually

They found that a single gene called

not acting alone.’ Another puzzle

have normal foetal haemoglobin

KLF1 was mutated in all family

was that foetal haemoglobin levels

but abnormal or insufficient adult

members with HPFH and, to date,

varied greatly in family members.

haemoglobin. Increasing the level

this mutation seems Malta-specific.

They ranged from 17–20% to only

of foetal haemoglobin in adulthood

This gene provides the blueprint

This exciting discovery identified

3–5%. The KLF1 mutation alone did

effectively cures these diseases.

to make the KLF1 protein. KLF1 is a

not explain the difference, which

Borg added how ‘if you can augment

transcription factor. It binds to specific

means it was not capable of driving

higher levels of foetal haemoglobin

parts of the DNA and turns genes

high foetal haemoglobin levels on

[in adults] you can render [patients]

on or off. KLF1 switches on genes

its own. Other factors and gene

independent of transfusions. No more

involved in red blood cell production.

mutations must be at play.

Maltese Genome Focus

around 58% of their total haemoglobin

INHERITANCE OF THALASSAEMIA

This leads us to the next stage of the research. ‘We have now identified three other Maltese families with the

PARENTS

same KLF1 mutation but with normal [foetal haemoglobin] levels, less than 1%.’ Felice, Borg, Ruth Galdies, and

Father a carrier

their team sequenced all of the DNA (a

Mother a carrier

genome) of over 50 individuals. They are now comparing the genomes of these new families with the earlier study. ‘KLF1 is a common factor [in

all families]. We can cancel it out and

see what [genes] we are left with. […] We suspect we will be left with the ‘friends’ or ‘foes’ of KLF1 controlling the [foetal haemoglobin] levels.’ The relative ease with which researchers can sequence all of a person’s genes is paving

R R

the way for a much greater understanding of how diseases develop and how to treat them.

MIMICKING BIOLOGY Child healthy

Child a carrier

Child with Thalassaemia

Gene therapy is a possible method to treat diseases like thalassaemia. The idea is to change the gene’s sequence or activity within living people. Borg describes new methods known as gene editing that could be used to

Ruth Galdies

reactivates the production of foetal

disease types. ‘This could be used

haemoglobin in adults and blocks the

in the form of a vaccine [injected

formation of mutant haemoglobin,

into the patient which] then can

which keeps the disease in check.

MEDICINE MADE JUST FOR YOU... Personalised medicine is a rapidly

home in [and] turn off the [gene].’

Hydroxyurea has similarly been tried

growing idea that uses a person’s

Gene therapy is still experimental,

to treat thalassaemia. The results have

genetic information to determine

due to health and safety concerns,

been mixed, with some responding

the best drug cocktail. By knowing

but Borg believes that ‘we are not

better than others. The drug can also

a person’s genetics, an individual’s

too far away [from a treatment].’

have serious side effects and can kill

drug response can be estimated.

blood cells. It seems that the bone

The right treatment can be matched

technology are rapidly turning

marrow of thalassaemia patients

to the right patient without

science fiction into science fact.

is inflamed and highly sensitive to

wasting time and money, while

Once developed, gene therapy is

hydroxyurea. The dosage needs to

reducing threats to the patient’s

a giant leap over traditional drugs.

be carefully regulated to minimise

health—a dream that needs

‘What is beautiful is that with today’s

these effects, but also to ensure

more research to be realised.

technology, you can either choose to

that individuals are not needlessly

fully or partially [turn off a gene],’ Borg

exposed to the drug if they do not

information studied by geneticists

explains. ‘This may be very important

respond to it. This is where genetics

is migrating from labs into clinics.

because the complete absence of a

comes back to save the day.

Thanks to researchers like Felice,

The advances in gene sequencing

The enormous wealth of

gene can have dire consequences.’

Borg, and the rest of the team the

For now, humanity will have to wait

ways in which diseases develop

till this technology develops.

are being understood. The aim is

Luckily, gene sequencing has started to be used alongside conventional medical treatment. Attempts to mimic the effects of HPFH by elevating foetal hemoglobin levels in adults using drugs have been going on for a while. Sickle-cell disease (a disease similar to thalassaemia) is already being treated. The drug Hydroxyurea

By knowing a person’s genetics, an individual’s drug response can be estimated.

to tailor treatments for individual patients. We all share the same 99.9% of DNA. But that 0.1% makes a big difference. The study’s principal investigator is Prof. Alex Felice with Jeanesse Scerri, Ruth Galdies, and Dr Joseph Borg as close associates.

Maltese Genome Focus

correct genetic defects to treat these

Maltese Genome Focus

32 Illustration by Jean Claude Vancell

Every person possesses the same genes within every cell. Their DNA provides the information to first create an entire functioning body and then keep it running. While all humans share more than 99.9% of their DNA, it is the subtle differences in our DNA that ensure individuality. Many differences are superficial effects, like hair colour, but some can have disastrous health effects. Scott Wilcockson talks to Dr Stephanie Bezzina-Wettinger (Faculty of Health Sciences, University of Malta) about her research on these subtle differences and how they can contribute to heart attacks.

y this time next year, around 17

‘Many years before a heart attack, the artery wall

million people will have been lost

develops what is known as an atheroma plaque,’

to heart or cardiovascular disease.

Bezzina-Wettinger explains. ‘This is where cells

Almost half of these deaths will

from the blood start to accumulate, begin taking

have been due to coronary heart

up fat, and secrete a lot of inflammatory molecules

disease, commonly resulting in heart attacks

[which have a number of roles, including attracting

(myocardial infarction)—the world’s leading

more blood cells and promoting blood clotting]. At

cause of death. While mortality rates are

some point the plaque can rupture, liberating its

steadily declining throughout Europe, the

contents into the bloodstream [which] can trigger

death rate in some countries, including Malta,

blood clotting. This can then either heal […] or end

remains much higher than the EU average.

up causing a [heart attack] because heart tissue

Unfortunately, our modern way of living

dies off [as] it is starved of oxygen and nutrients.’

threatens to turn the tide against reducing

Now a large collaborative study headed by

deaths. A growing love for junk food and a

Bezzina-Wettinger is investigating the genetics

loathing for vegetables is leading to high rates

that leave the Maltese susceptible to plaque

of obesity and diabetes, while alcohol, tobacco,

formation, known as atherosclerosis, and

and other drugs are abused of regularly.

subsequent heart attack. The Maltese Acute

Altogether, these lifestyle factors account for

Myocardial Infarction (MAMI) study is focused

around a third of all cardiovascular disease in the

on three key topics: inflammation, fatty lipid and

developed world. But this information is nothing

cholesterol deposition, and blood clotting. The

new. We have known about this for years.

idea is to search for genes that could in some way contribute to each of these three processes.

These lifestyle factors act on our genetic make-up.

IT'S ALL IN THE GENES

Like most other conditions, cardiovascular disease

So genes are the instructional element of DNA and

has a genetic element. Back in 1994, a study into

can be imagined as a specific sequence of letters.

death by coronary heart disease in twins showed

These letters are read to provide the blueprints for

that genetics plays a role in our susceptibility and

the construction of proteins that regulate every

accounts for 40–60% of the variability between

aspect of our biology. While we all share the same

individuals. Research being carried out by Dr

set of genes, the exact sequence of letters can

Stephanie Bezzina-Wettinger and colleagues is

vary from person to person resulting in different

looking into how genetics can have a hand in

variants of the same genes. ‘All of us have literally

driving heart attacks in the Maltese population.

tens of thousands of [gene] variants,’ clarifies

Maltese Genome Focus

PREDISPOSED TO A BROKEN HEART?

or animal can come in multiple different forms or shapes. The most dramatic biological example is the existence of males and females. Genetic polymorphism refers to the same gene existing in a population in multiple variations. For example, there are a small group of polymorphic genes that determine your hair colour and so, whether your hair is blonde, brown, black, or red depends on which gene variants you receive from your parents. Bezzina-Wettinger explains that many of the genes we know are linked to heart attacks are polymorphic. These are the focus of her research.

DISSECTING THE MALTESE HEART Previous studies carried out on other nationalities worldwide have identified groups of gene variants associated with an increased risk of heart attack. Dr Stephanie Bezzina-Wettinger

Bezzina-Wettinger, and the effect that these variants have on us, if any at all, depends on multiple different factors. ‘The genetics of [heart attacks] is very complicated. We talk about it as a complex disease, [...] one caused by a mixture of genes and [variants] that interact with one another as well as with the environment, such as lifestyle and physiological factors like diabetes.’ These interactions can make

Maltese Genome Focus

identifying the gene variants to blame

Malta has its unique genetic mix so

Malta has its unique genetic mix so these studies could not be blindly applied to the Maltese population.

these studies could not be blindly applied to the Maltese population. Bezzina-Wettinger explains that ‘we knew a lot about the epidemiology but in terms of the genetics, there was nothing when we started.’ To study the Maltese population they had to start from scratch. Collecting all the material necessary for population-based studies can seem like a mammoth task and the MAMI study is a substantial project that involves collaboration over many

for complex diseases harder than usual

disciplines. The team consists of

and this is further complicated by the

clinicians, technicians, and cardiologists

fact that many of these gene variants

from Mater Dei Hospital, as well as

are quite common. These variations

geneticists from the University of Malta.

are known as polymorphisms. This is

Just over 1,000 participants were

the idea that a single type of object

involved, including around 400 who

had had a heart attack, 400 ‘control’

smoking, diabetes, high blood

along with the power to process,

participants who did not, and 200

pressure, and high cholesterol.

store, and analyse the vast amounts

relatives of heart attack victims. A lot

Regular consumption of alcohol can

of data this technology produces.

of data was obtained for every single

be associated with decreased risk

Bezzina-Wettinger’s team are using

patient, starting off with each answering

of heart attacks, but before running

a method known as Whole Exome

an extensive questionnaire that delved

to the bar to get another drink, you

Sequencing that focuses specifically

into all aspects of their daily lives.

should only be having a few drinks

on genes and misses out the DNA

This was accompanied by a number

a week. Too much alcohol has the

in between. ‘We take one group of

of biochemical tests to gauge their

exact opposite effect. Binging on six

proteins that we think are involved

general health, such as whether liver

drinks or more on a daily basis greatly

[in heart attacks] and look at all their

and kidney were functioning correctly.

increases your risk. Moderation is key.

genes—there can be something like

The next step will be to look into

the general lifestyle and health of the

the genetics. To do this, the team are

variants.’ This technology has enabled

patients involved in order to determine

using Next Generation Sequencing

Dr Ritienne Attard, a former Ph.D.

the lifestyle risk factors that predispose

technology that vastly decreases

student of Bezzina-Wettinger, to

the Maltese people to heart attack.

sequencing costs. Since the advent

compare the variation in sequences

of the Human Genome Project in

between members of the same family.

shown that the Maltese are not

the 1990s, our ability to sequence

By doing this, Attard hopes to identify

immune to the conventional risk

DNA is becoming increasingly easier,

gene variants that could predispose

factors for heart attack including

cheaper, and readily accessible,

individuals to heart attack.

The study’s early results have

100–200—and then we look for the

Maltese Genome Focus

These tests provided an overview of

ADDING COMPLEXITY: THE GENE-LIFESTYLE LINK

non-diabetic, and have low cholesterol,

What you have to keep in mind when

or [people with] high cholesterol the

studying the genetics of complex

risk goes up 6.6-fold. Now, only a part

diseases, like heart attack, is that you

of this is due to the [lifestyle factors]

can be looking at very common gene

because someone with the same

variants. ‘If you study the genetics alone

lifestyle factors but without this [gene

you don’t really get anything conclusive

variant] only has a four-fold increased

[….] You could start to see a genetic

risk.’ The difference between these two

[variant] that has no effect in the general

is down to the gene variant which does

population. But, for example, in smokers

nothing at all in a healthy individual.

with this [variant, you find] they will

Inherited genes play a role, but there is

have a higher risk. So we do see these

a chance to change the outcome with

kinds of gene-lifestyle interactions’. This

the lifestyle you choose for yourself.

the risk is the same as the base line population. But in smokers, diabetics,

phenomenon is prevalent in all complex diseases, including the plethora of cardiovascular diseases, type 2 diabetes, and many common cancers. Thus we can introduce the idea of one being

So is the Maltese population

predisposed to a particular illness.

particularly predisposed to heart

Maltese Genome Focus

The initial results of the MAMI

THE BEATING HEART OF MALTA

attacks? Answering this question

genetics study show just this. Bezzina-

is not straightforward. The genetic

Wettinger describes one of the team’s

information obtained so far relates to

results whereby a single letter is

single families and is not representative

changed in the sequence of one gene.

of the entire population. While the

‘In [people] who are non-smokers,

genetic variants, or polymorphisms,

Inherited genes play a role, but there is a chance to change the outcome with the lifestyle you choose for yourself.

Photo by Yevgen Belich / Shutterstock.com

that have so far been studied are

to reduce the incidence of heart attack

not there yet when it comes to heart

common, the frequency can vary

in the general population. However,

attacks. ‘The very fact that the influence

greatly from one population to the next.

we know the major risk factors in the

of a gene can change depending on

In addition, lifestyle factors can also

developed world with well-founded

the lifestyle of that individual makes

vary. For example, one nation’s average

gene-lifestyles links (smoking, obesity,

it far more complex... Eventually the

diet can be very different to that of

alcohol use, high blood pressure, and

major drivers [of heart attack] will be

the neighbouring country. Bezzina-

high cholesterol) and so these will

identified and treatments, either direct

Wettinger adds that ‘the prevalence

remain key targets in the fight to reduce

or preventative, will be developed.’

of diabetes is higher here and this

heart attack incidence. The advent

So while the age of personalised

[provides] a background within which

and growth of this field of research

medicine may have already begun,

some of these gene variants have an

now presents new possibilities when

our knowledge of the genetics of

effect.’ The results of the MAMI study

it comes to patient treatment or the

disease still has a way to go yet.

have yet to be fully published and

application of preventative measures. Accompanying the arrival of

Annoyingly, complex diseases are quite complicated.

sequencing of the exomes of all 1,000

cheap Next Generation Sequencing

participants. This will markedly increase

technology, there has been an

This research by the University

the team’s ability to identify the gene

explosion in the field of personalised

of Malta forms part of the IAAMI

variants that increase risk to disease

medicine. This is the idea of tailoring

and NGS projects conducted in

and link them to the environment and

a patient’s treatment to the individual.

collaboration with Mater Dei

lifestyle of the Maltese population.

Everyone has a unique genetic

Hospital and funded through the

According to the World Health

makeup that can influence how they

National Research and Innovation

Organisation, there are over 300

react to treatments and drugs. This is

Programme (Malta Council for

risk factors associated with coronary

already being applied in some cases,

Science and Technology). The

heart disease including depression,

particularly in certain types of cancer,

study’s principal investigator is

low socioeconomic status, and illicit

to determine the best course of

Dr Stephanie Bezzina-Wettinger

drug use. This information could be

treatment for that individual. However,

with Dr Rosienne Farrugia and Dr

useful to policy-makers when aiming

Bezzina-Wettinger believes we are

Ritienne Attard as close associates.

Maltese Genome Focus

proposed future work includes the

MARIJUANA FOR EPILEPSY?

Feature

Marijuana has been used for centuries for medical reasons. In the early 20th century it was first linked to treatment for epilepsy. Over the last few decades researchers have been unravelling the truth behind the drug. Prof. Giuseppe Di Giovanni tells us more about using marijuana for medical research and his own research on this controversial drug.

hen I was a high school

behind the increasingly claimed medical

student my dream was

benefits of marijuana is vital for scientists and

to become a university

now governments worldwide. At present, the

professor and carry out brain

medical uses of marijuana as treatments are still

research. I achieved my

controversial and anecdotal. All pharmaceutical

dreams but I did not plan to end up as a marijuana

drugs on the market need gold standard large

researcher.

double-blind controlled clinical studies that make

I only recently started studying the effects of

sure a drug is safe, or at least safe enough. To date,

chemicals found in Cannabis sativa, better known

no such clinical studies have been carried out

as marijuana. A few years ago, I was trying to

to examine the beneficial effects of cannabis in

establish a scientific collaboration with a friend

different disorders.

and colleague of mine, Dr Roberto Di Maio

Anecdotal evidence is not good enough for

(Neurology Department, Pittsburgh University),

treatments. In my laboratory, I am imposing some

who is interested in epilepsy and marijuana.

scientific rigour on what has become a very big

While researching the topic I found out that many

ad hoc experiment (Medical School, University of

epileptic patients have turned to marijuana to try

Malta). In Malta, the use of marijuana for research

to control their seizures. I had no idea of the extent

or medical reasons is allowed, but is strictly

of medical use of marijuana in the U.S.

controlled by national legislation. To get some

Medical marijuana has many powerful uses.

solid data, I focused part of my research on the

Apart from reducing epileptic seizures, medical

effect of cannabinoids (after the plant’s formal

marijuana can treat glaucoma, pain, and nausea in

name) on different types of epilepsy. I did not use

cancer and HIV patients, but it also protects the

the chemical found in marijuana called delta-9

brain from the effects of trauma, eases the spasms

tetrahydrocannabinol (Δ9-THC), which induces

of multiple sclerosis, slows the growth of tumours

marijuana’s psychotropic effects, but a synthetic

and reduces brain damage in Alzheimer’s disease.

analogue named win 55,212-2, that is many times

It appears that marijuana is effective for all sorts of

more powerful than Δ9-THC. To understand how

disorders of the body, mind, and soul.

this chemical can help epilepsy sufferers I will

Considering the bounty of treatments linked to

explain how the condition arises.

the drug, it is unsurprising that today 23 U.S. states are expected to follow suit and other countries will probably also follow in America’s steps. The situation is very different for the recreational

WHAT IT IS EPILEPSY? Around 60 million people have epilepsy worldwide—in Malta, the number is 3,000. The

use of marijuana. The drug has been decriminalised

common neurological condition is caused by

in many countries including Malta (up to 3.5 gr) but

recurring disruptions to the brain’s usual activity.

legalised in only a few parts of the world (four U.S.

The disruption is usually short-lived. The outward

states, the Netherlands, and Bangladesh) and is

signs of epilepsy are known as seizures. Some go

‘tolerated’ in many others. This is probably due to

unnoticed while others lead to involuntary muscle

generalised governmental policy. Marijuana is still

spasms and loss of consciousness. The type of

listed by the U.S. federal government as a Schedule

spasm depends on the part of the brain affected

1 drug, alongside LSD and heroin. This class has

and how far the disruption has spread.

no other drug that has already been accepted for

The brain is made up of billions of nerve cells that

medical use.

process information from our senses, thoughts,

Marijuana is moving onto centre stage. Understanding the neurobiology and chemistry

memories, emotions, and actions, and any (or all) of these activities can be affected by a seizure.

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allow the use of medical marijuana. Other states

Epileptic seizure without the drug

Epileptic seizure with the new drug

Most seizures are over within a few minutes or less, and the person recovers quickly. Epileptic syndromes are classified as either generalised seizures, which affect the entire brain, or partial seizures, which occur within specific brain regions. Conventional drugs are not fully effective in 30–40% of patients meaning that research is needed to find new treatments. During my time in Palermo I started to study temporal lobe epilepsy (TLE),

unexpected discovery. Synthetic cannabinoids only had a modest effect on the development of seizures. When another chemical called serotonin was activated, their effectiveness multiplied, stopping the fits. Not all types of epilepsy are created equally. In temporal lobe epilepsy, synthetic cannabinoids were even more effective than the epileptic drug phenytoin. The only problem that we

Unfortunately, marijuana can have

found with this treatment was that

results in partial seizure in humans. We

some serious cognitive side effects

the dose of cannabinoid impaired

showed the anti-epileptic role of nitric

that have been the major obstacle

the hippocampus, an important part

oxide—a gas produced naturally in our

in its medical use. Marijuana impairs

of the brain. The process it blocks is

brain. When I moved to Cardiff, I joined

perception, reaction time, and short-

needed for learning and memory. This

Prof. Vincenzo Crunelli’s (University

term memory. Marijuana can be

side effect was very frustrating; our

of Cardiff and now also University

addictive but only mildly so: 9% who

treatment was effective but could

of Malta) group. We unexpectedly

try it will become addicted, according

harm patients. Dr Stefania Butini

discovered that absence epilepsy is not

to a recent study. The same study listed

(University of Siena, Italy) synthetised

largely a neuronal disease, but a defect

alcohol at 15%, 17% for cocaine, 23%

a new compound that could block the

in glial cells (the part of the brain that

for heroin, and 32% for nicotine. So

breakdown of the natural cannabinoids

supports and modulates neurons)—

although marijuana may be addictive

our brain normally makes. The new

work we published in Nature Medicine,

for some, 91% of those who try it do

drug boosted the amount of our own

one of the world’s most important

not get hooked.

marijuana in epileptics’ brains. The

2009 I brought this research with me.

Feature

experiments that led to one important

the most common form of epilepsy that

journals. When I moved to Malta in

We unexpectedly discovered that absence epilepsy is not largely a neuronal disease, but a defect in glial cells.

For our study, we first focused on

new compound was less effective

status epilepticus, a life-threatening

in stopping epilepsy but was longer-

condition in which one epileptic

lasting without major memory side

CANNABIS TO TREAT EPILEPSY?

fit follows the other without the

effects. We are currently following

sufferer recovering consciousness.

this line of intervention, trying other

Dr Roberto Colangeli, a researcher in

drugs that increase the levels of our

Cannabis has been used to treat

my group, (now at the University of

own cannabinoids when and where

epilepsy for centuries (see table).

Calgary, Canada), conducted many

they are needed to avoid any possible

MEDICAL MARIJUANA FOR EPILEPSY: THE EVIDENCE MEDIEVAL TIMES Arab writer Ibn al-Badri Hashish reportedly uses marijuana to cure the sick son of the Caliphate Council’s chamberlain in Baghdad.

side effects. This research could treat millions of epilepsy patients safely.

THE BRAIN’S OWN MARIJUANA The active ingredient in marijuana comes from a plant, whose extracts would not normally have any affect on the human brain. However, this active ingredient is different. Why? The answer is simple; it happens that the active ingredient in cannabis is very similar to that which the human brain produces naturally. By taking the drug you elevate the chemical levels, switching on the brain to abnormal highs. Other drugs like LSD, opium, caffeine, and nicotine also have analogues that are produced naturally in our brains. It seems incredible that everyone produces a form of these drugs in their own brain. As mentioned previously, the brain’s own marijuana compounds are called endogenous cannabinoids or endocannabinoids. In

16TH CENTURY German physician Leonhart Fuchs names the plant Cannabis sativa (A.D. 1542). 19TH CENTURY British army surgeon William Brooke O’Shaughnessy introduces marijuana into medical practice as a treatment for pain, nausea and convulsions (A.D. 1842). MODERN TIMES • In a 1967 study by Martin Keeler and Clifford Reifler marijuana smoking was associated with an increase in seizure frequency. • In the 1980s, Δ9-THC (active ingredient in marijuana) was characterised as an anticonvulsant in animal studies. Convulsions are a common symptom in epilepsy. • A 1990 epidemiological study by Mervyn Susser and colleagues found that chronic marijuana use protects against seizures. • According to a 2001 questionnaire conducted by Elisabeth Gordon and Orrin Devinsky and completed by 215 epileptic patients using marijuana regularly, 7.4% experienced a reduction, 2.3% an increase, and 90.2% no change in seizure frequency. • Recent studies by Robert DeLorenzo’s group (Virginia Commonwealth University) show that endocannabinoids can block epilepsy (status epilepticus and temporal lobe epilepsy) in cell culture and animal models. • In a 2014 survey, conducted by Orrin Devinsky on parents who had children with epilepsy and who were at the time using cannabis products, 16/19 respondents reported a reduction in seizure frequency while taking medical marijuana; others reported beneficial effects such as improved sleep and mood. • In a 2015 retrospective survey, conducted by Craig Press and colleagues on paediatric patients with different types of epilepsy who were taking oral cannabis extracts, 57% of respondents reported improvement in seizure duration and frequency.

1992 Raphael Mechoulam (Hebrew University, Israel) discovered the first endocannabinoid, naming it anandamide (n-arachidonoylethanolamine or AEA) after the Sanskrit word ‘ananda’ (bliss) Piomelli (University of California, USA)

Feature

and ‘mide’ (chemical). In 1997 Daniele

discovered lipid 2-arachidonoyl glycerol

why cannabis does not threaten your

irritability are common, undesirable

(2-AG), the other major endocannabinoid

heart or breathing with no overdoses

side effects. This is because the brain

in humans. The endocannabinoids

ever recorded from cannabis use.

concentration of Δ9-THC reached

(classified as neurotransmitters) pass on

CB2, the other main cannabinoid

– after smoking a joint or eating

signals in our brains and bind to proteins

receptor, is found mostly in the

marijuana – is much higher than the

called receptors found in neurons. These

immune system. The immune system

normal level of endocannabinoids and

two cannabinoids bind to the CB1 and

triggers inflammation and studies

greatly magnifies the effect. The result

CB2 receptors that help to regulate

show that marijuana can reduce

is the well-known marijuana high.

appetite, mood, memory, and many

inflammation. Its presence there

I find it difficult to answer the

other functions.

interests scientists because the

question: is marijuana good or bad

immune system triggers inflammation,

for you? I do not think there will

type, are widely distributed in the

and studies show marijuana can have

ever be a black or white answer,

brain, with high concentrations in

an anti-inflammatory effect.

and it will always be somewhere in

CB1 receptors, the more common

regions of the brain linked to epilepsy,

The active ingredient in marijuana,

between. Although many scientists

and are involved in pain perception

Δ9-THC, can bind to these CB1/

agree that marijuana is safe enough

and forming new memories (the cortex

CB2 receptors to artificially trigger

to temporarily alleviate the symptoms

and hippocampus). There are low

the same mechanisms in the brain.

of certain medical conditions, both

levels of CB1 in the brainstem, where

The cascade of events releases

the short- and long-term use of the

cardiac and respiratory functions are

neurotransmitters (the molecules that

drug may harm the body and mind.

regulated. This is one of the reasons

brain cells use to communicate with

Marijuana’s continued popularity among teenagers raises particular

I find it difficult to answer the question: is marijuana good or bad for you? I do not think there will ever be a black or white answer.

concern because the drug might hinder the ongoing maturation of the adolescent brain. For medical use, trying to boost our own marijuana (endocannabinoids) levels will probably be safer. The best approach will probably be by blocking the enzymes that break it down. Research is needed to develop these new drugs to treat a host of different brain disorders. Several research groups in the world, including mine in Malta, are seeking answers to reinvent marijuana uses. Prof. Giuseppe Di Giovanni (giuseppe.digiovanni@um.edu. mt) is the Coordinator of the Malta Neuroscience Network, who

Feature

Prof. Giuseppe Di Giovanni

one another). Suddenly,

organised the first Brain Awareness

they make the world

Week, from 14–20 March 2016, the

seem hilarious and

global campaign engaging the public

normal foods taste

with brain research. Prof. Di Giovanni

delicious. Under the

is also the Editor-in-Chief of Xjenza

influence of marijuana,

Online, the journal of the Malta

people generally

Chamber of Scientists www.mcs.org.

feel happy, relaxed,

mt/index.php/xjenza

and introspective,

This is the first article in the Malta

although paranoia and

Neuroscience Network (MNN) series.

POTENTIAL APPLICATIONS OF MEDICAL MARIJUANA EPILEPSY Multiple animal studies have suggested that Δ9-THC may inhibit the brain processes thought to cause seizures. Highquality human studies are lacking and this leaves many questions unanswered. CANCER The active ingredient in marijuana, Δ9-THC, and its synthetic derivatives have been approved by the U.S. Food and Drug Administration to control nausea in cancer patients undergoing chemotherapy and to stimulate appetite in patients with AIDS. Yet it may not be as effective as other recently developed drugs, so marijuana is not considered as a first-line treatment for these symptoms. Numerous recent studies have suggested that cannabinoids might directly inhibit cancer growth. MULTIPLE SCLEROSIS (MS) A large trial published in 2012 found that a cannabis extract significantly decreased muscle stiffness and other symptoms associated with multiple sclerosis (MS). A smaller study found that smoking cannabis reduced spasticity and pain in participants resistant to other treatments. Given the few therapies available for MS, a 2011 review concluded that medical marijuana might help manage certain symptoms. GLAUCOMA Several studies have found that smoking marijuana lowers pressure inside the eye, relieving glaucoma-related discomfort for about three to four hours. Other pharmaceutical drugs have now been found to be a better treatment than medical marijuana. PARKINSON’S DISEASE (PD) Recent studies do not offer a complete understanding of the role of endocannabinoids and cannabinoid receptors in Parkinson’s disease (PD). Research supports the notion that the endocannabinoid system plays an important role in movement disorders like PD. The studies can lead to novel therapies. STROKE There is conflicting evidence on the usefulness of cannabinoids in the treatment of stroke—more research is needed.

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PAIN AND INFLAMMATION Marijuana is only slightly better than a placebo in reducing acute inflammation, and it may even increase the perception of pain in some patients. When taken in combination with other medications, various cannabis-derived drugs are moderately effective in reducing chronic pain.

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Time, space, & the ocean wanders Malta is one of the bird migration hotspots in the Mediterranean. As an archipelago, the Maltese Islands have been a hotspot for seabird nesting since time immemorial. Marie Claire Gatt talks about her research and a major EU project determining sea bird colony location and which areas need to be saved. Photography by Jean Claude Vancell.

Back to the cliff ledge. I have just been slapped

ledge at l-A침rax tal-Mellie침a (Malta),

in the face by the wing of an unsuspecting

I listen intently to the ghostly calls of

Yelkouan as it returns to its nest hole. I pick up

the seabirds, Yelkouan shearwaters

the confused bird and pass it to Ben Metzger,

(Garni, Puffinus yelkouan), as they

who reads out the identification number on the

return to their nests after a day foraging at sea.

metal ring on its leg: EE01105. It is 2013 and

Like albatrosses in the southern hemisphere,

Metzger is the Head of Research at the EU LIFE+

shearwaters and petrels spend their life roaming

Malta Seabird Project, a conservation research

the seas and oceans, feeding on fish, squid, and

project led by BirdLife Malta. This male bird was

other marine animals, only approaching land

first handled in Malta in 2007 and fitted with this

during the breeding season to nest. Even then,

ring by seabird researcher John J. Borg; it has

these birds cover hundreds of kilometres at sea

been breeding yearly at the same location ever

every day just to feed.

since. Metzger and a team of colleagues and

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itting in pitch darkness on a hidden cliff

700,000 The number of seabirds estimated to die globally as fisheries bycatch every year

Light pollution from Madeira

volunteers (such as me) have been building on past efforts by monitoring the three seabird species which nest on Malta’s coasts and islands: the Yelkouan shearwater, its close relative, the Scopoli’s shearwater (Ċiefa, Calonectris diomedea), and the tiny

Seabird behaviour is closely tied to the rhythms of marine life

Mediterranean Storm petrel (Kanġu ta’

petrel’s hunting efficiency was being influenced by this predicted difference in food availability across the lunar cycle. To our surprise, it appeared as though these birds were managing to catch just as many fish and squid, no

small, soot-coloured petrel which the

matter the moon cycle, during their

Around 10% of the world’s population

Portuguese call Alma-negra—black soul!

breeding period. This raised more

as much as 50% of Mediterranean

questions than it answered, as is

LIFE AT SEA

typical of ecological studies, and more

of Filfla. I have been involved in this

Seabird behaviour is closely tied to the

them out. Other studies on bird activity

project since its start in 2011, and this

rhythms of marine life. The Bulwer’s

outside the breeding season seem to

experience inspired me to study the

petrel feeds on fish and squid species

suggest that Bulwer’s petrels can adjust

lives of this group of birds.

that occupy greater depths of the sea

their behaviour to get food when they

during the day compared to the night.

need it most.

Storm petrels breed in the rock scree

A year later and 2,850 km due west,

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I investigated whether the Bulwer’s

Filfla, Hydrobates pelagicus melitensis). of the Yelkouan breed in Malta, while

at night. While on Deserta Grande,

investigations were needed to figure

I am standing outside the remote

These fish and squid follow plankton

Seabirds are top predators in the

research station on Deserta Grande,

along their vertical migration up and

marine environment. They hold an

Madeira, surrounded by Bulwer’s

down the water column. The plankton

important place in the food web

petrels (Bulweria bulwerii) swiftly

seem to sink to the darker waters to

and reflect the health of the seas in

manoeuvring around me to join their

hide from predators, while returning to

their success. Unfortunately, they

partners in nest burrows among the

the surface at night to feed. They are

are also very vulnerable. Albatrosses,

rock scree. I have flown out to the

at their most abundant at the surface

shearwaters and petrels pair with a

Madeiran archipelago from Manchester

during the new moon period when

single mate throughout their life and

Metropolitan University to join the

there is no moonlight. Their predators

lay no more than a single egg every

research group of two biologists from

seem to follow them. Likewise, the

year. Both pair members take turns

Lisbon studying the ecology and

Bulwer’s petrel. It can only feed from

to incubate the egg for days at a time

behaviour of the Bulwer’s petrel—a

the sea surface so it hunts mostly

while the other parent is foraging.

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Marie Claire Gatt

They nest in the same site all their life,

on Deserta Grande Island, I came

discourage the birds from approaching

returning every year to the same spot

across several Bulwer’s petrel’s eggs

the fishing gear, reducing seabird

from halfway around the world. The

that had been abandoned by their

bycatch by up to 99%. Other simple

chicks that make it then take between

parents; the birds may have either

mitigation measures include weighting

two to 12 years to reach sexual maturity

not found enough food in time to

lines to quickly sink beyond the reach

in the different species. All these facts

exchange incubation duties or died

of foraging seabirds. Conservatively,

add up to a low birth rate and a high

at sea. The major cause of incidental

700, 000 seabirds are estimated to die

dependence on a stable habitat. The

death is fishing gear. Fishermen do not

globally as fisheries bycatch every year.

loss of just a few birds can have a big

intentionally target birds but the birds

The situation in the Mediterranean is

impact on the population.

become entangled in their gear as they

not yet known.

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While attached to their breeding

try to catch baited fish. A number of

Seabird numbers are also hit by

colony, seabirds depend on food being

modifications to fishing gear are starting

overfishing; 80% of fish stocks are

relatively close to their nest to be

to be implemented in the southern

overexploited. Overfishing, pollution,

able to regularly swap the incubation

hemisphere. These adjustments do

and the degeneration of our seas result

shift with their partner. When the

not badly hamper fishing fleets. For

in increased stress for seabirds—and

chick hatches they need to bring back

example, in South Africa streamer lines

fishermen—to catch enough fish. Ship

food at an even faster rate. While

on trawl cables were introduced that

traffic, dumping, sea pollution, and

Map: Marine Important Bird Areas identified by the LIFE+ MSP Scopoli at sea. Photo by Ben Metzger

5 10

Nautical miles

offshore windfarms can also harm

zone (EEZ) will hopefully soon be

seabirds where these activities overlap

incorporated into Malta’s Natura2000

with critical seabird areas.

network. But seabirds have no regard

Metzger’s team at the Malta

for national boundaries so their

Seabird Project have been tracking the

conservation depends on international

movements of Malta’s breeding seabirds

research teams and intercontinental

to map important flyways, feeding

initiatives to halt threats.

areas, and other communal hangouts which need attention. Each EU country is responsible for protecting and

RISKS ON LAND

managing marine habitats under the

Let us have another look at coastal

Natura2000 framework. In 2015, the

seabird colonies. Deserta Grande is

LIFE+ Malta Seabird Project presented

much like an oversized Filfla—it is a

the areas around Malta on which

16km-long ridge of stratified volcanic

Maltese breeding seabirds depend in

rock and bays of loose boulder scree.

various stages of their lives. Those that

Both islands are uninhabited nature

fall within Malta’s exclusive economic

reserves, with strict access control and negligible direct human disturbance.

Seabirds hold an important place in the food web and reflect the health of the seas in their success. Unfortunately they are also very vulnerable

And both still belong to seabirds. The Bulwer’s petrel colony on Deserta Grande is probably the biggest in the Atlantic, much like how Filfla likely hosts the biggest population of Mediterranean Storm petrels in the world. If the quality of these land areas deteriorated, the populations could suffer a fatal blow. Shearwaters and petrels only approach their coastal breeding colonies under the cover of darkness to escape predation

HOW TO FOLLOW SEABIRDS Large-range at-sea movements are difficult or impossible to trace visually. Cutting edge technology can come to the rescue. Remote data loggers are relatively small devices that can be attached to animals and use one of a range of techniques to record their position. Device applications change depending on their size and weight, level of accuracy, and battery life. The smallest devices available use the time of sunrise and sunset to approximate seabirds’ position on the globe. The most accurate devices record GPS location via satellite connection. As data loggers continue to become smaller, more accurate, and cheaper, their applicability to new questions and smaller species increases.

and harassment by gulls. However, the lighting up of promenades has exposed some cliff lines and made

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them unattractive to seabirds. Several

Seabird Project draws to an end,

their disappearance is for worldwide

historic breeding colonies in Malta have

BirdLife Malta has just launched a new

research to go hand in hand with

probably been abandoned because of

LIFE project—Arċipelagu Garnija—

political and social willpower to make

light pollution. Chicks ready to fly the

which will aim to protect birds on land.

sure that seabirds keep shearing

nest also wait for night-time to take

Metzger is now heading a fresh team

the seas.

off, unaided towards the horizon, but

to identify threats to the Yelkouan

street lights can, instead, attract many

Shearwater colonies scattered across

Members of the public can learn more

fledglings to fly inland.

the Maltese Islands. Arċipelagu

about the Maltese Islands’ seabirds

Garnija also wants to engage with

and enjoy them in their natural habitat

threat on land, particularly on islands.

the public and bring them on board.

during yearly pelagic trips organised

Rats are the most notorious. With

Small changes like not leaving litter

by BirdLife Malta:

no natural predators in Malta, their

for rats, reducing light pollution, and

www.birdlifemalta.org.

numbers can quickly explode by feeding

keeping sound disturbances low near

on our litter. Rats are intelligent, curious,

colony sites will go a long way to help

was partially funded by the Master

and agile, and are able to swim several

preserve seabird populations.

it! Scholarship Scheme (Malta).

Alien invasive species are a huge

hundred metres. Their presence at

These ocean wanderers captivate

Marie Claire Gatt’s Master degree

This scholarship is part-financed

breeding colonies spells disaster, as the

me. They have attuned themselves

by the European Union—European

rodents prey on eggs and chicks and can

to the ways of the seas for the past

Social Fund (ESF) under Operational

easily wipe out a breeding season.

35 million years. Now they are one of

Programme II—Cohesion Policy 2007-

the most endangered groups of birds

2013, ‘Empowering People for More

in the world. The only way to stop

Jobs and a Better Quality Of Life.’

But it is not all doom and gloom. It is now 2016, and as the LIFE+ Malta

FLEDGING RECOVERY

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In June and July many disoriented young Yelkouan shearwaters are found, and in September and October, Scopoli’s shearwaters—sitting ducks for anything that wants an easy kill. Should you come across a disoriented seabird fledgling, please get in touch with BirdLife Malta on 21347 645/6. The bird will be collected by a licensed bird handler, ringed, and released in a safe place at the coast, giving it a second chance to roam the sea.

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Ben Metzger

Systematic Failure, Persistence and Success Feature

A tale of early school leavers 52

In Europe, around one in 10 students (18-24 years old) is an ‘early school leaver’. For Malta, it is one in five. A fifth of our local student population is neither in school, nor in training, and with less than five SEC exams under their belt, Malta’s public education investment (~6% GDP) is not seeing much fruit. Cassi Camilleri speaks to Prof. Carmel Borg about what is needed to abandon the antiquated system our communities are being marred by. Photography by Elisa von Brockdorff.

here was once a time when a

of Society. But this is not to say that the journey

certificate meant a secure job. But

did not bring challenges with it—far from it.

that time is long gone. Education

Hurdles were present from the word go. ‘There is a

is increasingly expensive and

dearth of research when it comes to the correlation

time consuming. Many a time,

between early school leaving and wellbeing,’

graduates enter the job market with little to no

says Borg, hence work had to start from scratch.

experience, with most taking entry-level jobs

Piles of data from copious surveys conducted

that do not pay nearly enough to compensate

by local and major European and International

for the work they put into their studies.

Institutions, needed to be sifted through and

From this perspective, the high number of dropouts and poor update of tertiary education is unsurprising. It is a worldwide

analysed. What’s worse was that ‘they were not even meant to study this correlation,’ says Borg. Despite the difficulties, however, the project

phenomenon. The premise is simple: why not

has been going on for over a year and the

get on the job ladder early and work your way

first phase has been completed. Published in

up through dedication and experience?

December 2015, the report outlines a series of

In Malta, however, 20.4% of students become

emerging trends. Sadly, they are not positive.

‘early school leavers,’ meaning they finish their their belt. Does the same reasoning above

STAY IN SCHOOL

still apply? Are the long-term effects of such a

The truth is that early school leavers are struggling.

decision as negligible as some might think?

According to the study, the low incomes prevalent

Prof. Carmel Borg and Dr Milosh Raykov

among this group are resulting in serious financial

(Faculty of Education, University of Malta)

difficulties for families, even restricting access

joined forces about a year ago to answer

to important learning tools, such as computers

these questions. They looked into the

and the Internet, for their own children. Money

effects of early school leaving on individuals’

problems are just the tip of the iceberg. Negative

emotional, social, and financial wellbeing.

emotions and a lack of optimism are widespread

A pioneering study, Borg and Raykov’s work

in their lives. They are less optimistic about their

was supported by the Observatory for Living with

futures and experience exhausting time-pressures.

Dignity, one of five research entities within the

They have little to no time to do things they

Maltese President’s Foundation for the Wellbeing

actually enjoy, and as a result they feel less

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education with five ‘O’ levels or less under

‘Education is simply the soul of a society as it passes from one generation to another’ Gilbert Chesterton happy, less calm, and less peaceful.

the problems in our education

a result, he left when he was 16 as

Feelings of social exclusion have also

system are multi-faceted.

soon as a business opportunity arose.

been reported, a direct result of their perception of a low social status.

*Names have been changed to protect the person’s identity

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In his famous TED talk titled

Twenty-one year-old Elisa*was not

‘Changing Education Paradigms,’ Ken

ready to make decisions about which

Robinson deconstructs current models,

subjects she wanted to pursue at the

taken lightly,’ says Borg, especially

pointing out how we are trying to fit

age of 11. She ended up making the

when looking at the state the

within an educational ideal conceived

wrong decisions then abandoning

current student population is in. By

during the industrial revolution.

her course to start work at 19.

international standards, around 5–6%

Schools function like factories,

of pupils are doing exceptionally

Robinson explains, and this system is

changing its pupils,’ says Borg. And this

well. But a staggering 45% are

out of date. This kind of schooling is

statement refers to both early school

doing very badly. This is a ticking

about conformity, not learning, and

leavers and the students who stay

time bomb of early school leavers

Borg agrees wholeheartedly. Different

on. The bulk of our education system

just waiting to go off. What is even

children have different needs and

is devoted to exam preparation and

more worrying is that the majority

skills and most institutions, both in

regurgitating information. Even at

of the people making up the 45%

Malta and other countries, operate

University level, ‘there is [generally]

cohort are students from a lower

within a standardised curricular

very little critical thinking,’ Borg

socio-economic status. To have these

regime, streaming, and testing that

claims, with ‘very little happening

staggering gaps across social strata in

ignore individual needs. ‘How can you

beyond accumulating knowledge’.

such a small country is ‘ethically and

speak of inclusion, social diversity, and

morally unacceptable,’ says Borg.

justice when you have an educational

leaving is not a problem to be

process that is largely informed by an

placed squarely on the shoulders of

anti-educational routine?’ he asks.

educational institutions. The issues

This is ‘a struggle which cannot be

Prof. Carmel Borg and Dr Milosh Raykov

This is what has made education a personal mission for Borg. ‘Those who know me well are aware that my

Interviews with a number of former

‘Our schooling system is short-

All this being said, early school

leading up to early school leaving are

agenda is focused on social justice,

students, though not early school

equity, and inclusion in education,’

leavers by definition, reinforced the

says Borg. ‘I believe in social justice

above. Now 22 years old, Adam* was

leaving school such as chronic health

and I believe education is a very

frustrated in school because he felt

issues and genuine learning difficulties

important instrument in achieving it.

classes were too easy for him and his

which might have been inadequately

teachers failed to challenge him. As

addressed. One’s community also

The urgency is obvious but

complex and lead down many avenues. There can be personal reasons for

contributes. An economically or socially depressed community sees greater

A RAY OF HOPE

involving preventative, intervention, and compensatory measures.

numbers of early school leavers.

Malta’s current status with regards

Family is another factor. Chronic

to early school leaving is far from

professionals in communities working

Preventative measures see

intergenerational unemployment, very

enviable, but it is not all bad. As a result

directly with families. This would

low expectation from parents—all these

of Borg and Raykov’s work, long-term,

help deal with problems like chronic

play a role in an individual’s decision

steadfast solutions are being proposed.

intergenerational unemployment and

whether to stay on at school or not.

The approach is three-pronged

very low family expectations. Such

‘Many times,’ Borg says, ‘all of these issues are present in their own right and combine, creating dropouts and early school leavers. There isn’t just one reason.’ One more element contributes considerably to early school leaving.

Around 5–6% of pupils are doing exceptionally well. But a staggering 45% are doing very badly The economy. When economies do well, early school leaving rises. This might seem counterintuitive but it is not. A prospering economy is able low level skills and competencies because there are more jobs. However, such early school leaving levels cannot be sustained. Eventually, skill gaps emerge which need to be filled by foreigners. The currently booming e-gaming industry in Malta is the perfect example. Struggling to find local talent, foreigners are brought in to take up the new roles. But this is a band aid, a temporary solution. A powerful economy cannot grow and prosper on low skill, low income, and precarious jobs.

ASKING THE RIGHT QUESTIONS The research undertaken by Prof. Carmel Borg and Dr Milosh Raykov is multidimensional in nature, trying to shed light on the social, economic, and emotional wellbeing of early school leavers. It attempts to answer the following questions: What are the work experiences, job characteristics and social status of early school leavers? How does the decision to leave school early affect happiness levels and quality of life? And what is the impact of early school leaving on mental and physical health? The work also has a wider scope, determining the economic repercussions of early school leaving and how that would affect not only an individual’s living conditions but also the country as a whole. Can a country and its economy progress with high levels of early school leaving? Feature

to absorb many more people with

conditions can be countered by high

in its programme already, thanks to

but more work needs to be done to

quality day care and preschool. As

its foundation courses, allowing those

retain students. ‘A high percentage of

children grow older, schools need

with no qualifications to start school

the people who sign up for MCAST

to remain relevant. This means that

again. In itself, this is a great initiative

foundation courses are gone by

vocational education will have to

the end of the year,’ says Borg.

occupy a prominent position within secondary education to cater for people who want to work in more practical fields. The needs of high academic achievers need to be met through alternative programmes within mainstream schooling. Intervention measures come into play when an individual risks leaving school. These students, such as teen mothers, need solid support networks. Investing in student and parent afterschool programmes would greatly help. Compensatory measures focus on reintegrating people back into some

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form of education after leaving school.

MCAST has a second chance element

‘We need to break that cycle of

Malta has now hit a plateau. This could have something to do with the fact that the number of females becoming early school leavers is rising fast

failure and disappointment. What we cannot do is continue reproducing the same systems and hoping that they will lead to a different result.’ Change is sorely needed. The good news is that the wheels are already in motion to make that happen. The Youth Guarantee programme, launched in April 2014 by the Maltese government, is the first port of call. The programme, which is also being implemented throughout Europe, works with young people to provide support, motivational training, and guidance on employment. It also recognises the effectiveness of

a combination of off-the-job and on-the-job training, giving trainees the opportunity to garner practical training either in a simulated workshop or in a real working environment. According to the programme’s report on the 2015 scheme, dropouts were prevalent. Of the 606 applications

early school leaving,’ notes Borg. In

saw it at 43.1%, Malta has now hit a

received, 418 opted out. What was

fact, their research is being welcomed

plateau. This could have something

noted from the scheme echoes

with open arms by the Directorate for

to do with the fact that the number

Borg’s words: ‘the rates still highlight

Lifelong Learning. Borg is also certain

of females becoming early school

how essential it is to further invest

that these authorities will step up to

leavers is rising fast. ‘At best, we

in similar initiatives to try and reach

the plate and sponsor more studies

might hit the 10% mark by 2025. But

this cohort and re-engage them in

in the years to come. This is essential.

this too seems unlikely,’ says Borg.

education, training, or employment.’

In Malta, research gaps go hand in

But the task is far from easy.

hand with policy gaps. ‘We need

So where does this leave the Maltese public?

Malta is trying. It ranks high

to produce more knowledge upon

At the second phase of Borg and

in education investment. In fact,

which we can design good policy.’

Raykov’s research, popular wisdom

according to the latest figures from

Across Europe, the aim is to bring

and research will come together as

the World Bank (2012), about

down early school leaving to 10%

the pair interview a number of early

6.8% of its GDP (Gross Domestic

by 2020, but Malta will not achieve

school leavers. ‘We will be digging

Product) goes towards education.

this goal, according to Borg. While

deep, excavating narratives, and

figures show that the rate declined

biographies,’ Borg says. They will be

considerably over recent years, 2004

looking into personal experiences

‘Education authorities are highly aware and genuinely concerned about

and mining for further solutions to reduce early school leavers. This three-year project has a long