Latest / Rad Chat / E225: Pierre Montay-Gruel - Radiobiology and the FLASH Revolution
Transcript
- Jo McNamara Rad Chat Host (00:00) Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara. Naman Julka-Anderson (00:04) And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives. Jo McNamara Rad Chat Host (00:21) We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or your personal time by providing insights into both technical skills and career development, helping you to progress confidently in your field and shape your professional future. Naman Julka-Anderson (00:38) Just to let you know, our episodes may contain sensitive and difficult topics that you might find distressing or triggering. Please consider checking out another episode. Jo McNamara (00:47) This episode is part of our education and workforce development series. Today we're going to be chatting to our amazing guest, Pierre Montay-Gruel as one of the most beautiful and intelligent men that I know. I'm particularly excited to hear everything that he knows about radiobiology. I'm really excited. We're definitely going to geek out this evening. Welcome, Pierre, to Rad Chat, finally. Pierre Montay-Gruel (01:10) Thank you so much. I'm super excited to be with you both. yeah, so I am a radiobiologist. My name is Pierre. I was trained in France, the country I grew up in. and then moved to Switzerland to do my PhD in Lausanne, in the beautiful city of Lausanne. And after my PhD in radiobiology, I moved to California for a moment during COVID as a postdoc. That's where I stayed for a little bit more than 18 months outside of the of the world during COVID. And I came back to Europe five years ago in Antwerp, Belgium, where I started my own research group in radiobiology. And I'm developing mostly flash radiotherapy, ultra high dose rates radiotherapy. And my goal is really to on one side improve the treatment against cancer using new techniques of radiotherapy, and on the other side reduce as much as we can the toxicity, the side effects on on the patients so they can have a better quality of life. And I don't do it as healthcare worker, I do it as a researcher. Naman Julka-Anderson (02:29) Why did you want to get into cancer research? Pierre Montay-Gruel (02:31) That's an excellent question. I think it it first went through my curiosity for biology when I was a kid. I've always been very curious about how the body was working. I remember my favorite book was about about the human body. and it went when it was time to to pick my my bachelor program, I went to biology. And I was quickly very interested in cell biology, in cancer. And I think it probably came because when I was a teenager, I went through two different things, seeing my best friend's mother fighting breast cancer for 14 years, and also the wife of my stepbrother being diagnosed at the age of 32 with a lymphoma. And I really was like, come on, we got we gotta find something. We gotta find a cure for cancer. I was confronted for the first time to cancer and I was like, This is so unfair. it's not like other viruses, other bacteria, other infections. Sometimes we have nothing and and we need to find something. And that's when I discovered that they were research groups that were specifically working on cancer. And I picked up my master's studies in France, in Paris, at Gustave Institute, where I specifically studied oncology and cancer. And during my first year, I had an amazing lecture by Éric Deutsch, who is the head of the radiation oncology department at Gustave. And I discovered radiotherapy. And that's when everything became an evidence for me. There is physics, there is biology, and potentially we can treat cancer, all cancers with radiotherapy. And I said, I want to be a radiobiologist. And that's how I entered the radiobiology program in Gustave Roussy and became a trained radiobiologist. Jo McNamara (04:49) So for anyone listening who's never heard of the term radio biology before, how would you describe it to someone? Pierre Montay-Gruel (04:56) Radiobiology is a very wide discipline. Let's say if you have to give give a definition of radiobiology, it's the science that studies the interaction of ionising radiation. So any irradiation that has an energy high enough to damage tissues with biological entities. And as a radiobiologist, we look at it from the smallest molecule, DNA to cells, to tissues, to organs, and to the whole body. And that's radiobiology. But what I do is a specific discipline in radiobiology. It's radiobiology applied to radiotherapy. So how tumors and how normal tissue, healthy organs, react to to radiation. It's very interesting because it covers a lot of different topics. And through radiobiology studies, let's say for well for the last 80 years or so, a lot of the concepts that we are using today to treat patients have been discovered by radiobiologists in radiobiology studies. This is the case, for example, of fractionation. Fractionation was developed by radiobiologists, by people who were doing radiobiology, and from fractionation studies we have defined, for example, what we call the seven R's now of radiobiology. The concept that by interacting with biological tissues, tumors, and normal tissue, they're Many things that are important. The first thing is how cells will repair the damage. And we know that the tumors repair badly, whereas the normal tissue will repair better, and we can influence that playing with radiobiology. So preserving the normal tissue. There is also the reoxygenation. Oxygen is extremely important to be toxic for the tumors. So by fractionating the dose, we can actually re-oxygenate the tumour and be more efficient the day after when we treat the tumour. there is the redistribution. So by irradiating, we will rearrange the cells, especially in their what we call cell cycle, and make them more sensitive, the tumour cells more sensitive. Through radiation, so we will optimise the treatment. there is also we can play on the immune system. So by irradiating, we can stimulate the immune system to fight, help us fight against the tumour. there are many concepts like that that we can we can use and that we can play with in order to, on one side, be more toxic and treat the tumour better. And on the other side, preserve the normal tissue. So that's that is what radiobiology is, and that is what we can do as a radiobiologist, or the the topics we can study as radiobiologists applied to radiotherapy. Naman Julka-Anderson (08:12) Amazing, felt like I was back in university, I loved it. Pierre Montay-Gruel (08:15) Yeah. Naman Julka-Anderson (08:16) Such an important aspect to our roles in the clinical world. I think we always maybe don't talk about it enough to our patients because you're there looking after them. You need to this treatment, this is what's going to happen. We're trying to reduce the side effects really, really quickly. think every radiographer or clinician has their own version of the same thing we say to our patient about all of that. It's amazing to hear it from your angle. How do you... decide on the pre-clinical models that you work with. Pierre Montay-Gruel (08:45) This is an excellent question actually, because it's a challenge that we face every day in science is how to pick the models so we can actually on the one side perform the experiments that we want to do, and on the other side be as clinically relevant as possible, because our goal, and we should never forget it, is to obtain results that we can apply to patients. And for that there are two things. We have a list of models that we can use that go from cells in a Petri dish to more complex cell structures. Now we can have cells in three dimensions, we can also grow tissues coming from patients to more complex, let's say, models, in vivo models we call them, and in the in vivo models list you have mice you have rats and we have to pick the model that fits to our question and for example if i want to study the toxicity or the side effects on the skin using a mouse might not be the right model. Why? Because the mouse skin is very different from the human skin. Now, which skin is the closest to the human skin? Probably the pig skin. But is it okay? Like, is my research important enough to use a pig to look at side effects on the skin? Maybe not. So if my question doesn't require to be that close to a human skin, maybe I can actually use mice and just say that it's a limitation. Or maybe I can even go to cells because if I want to look at certain molecular modification, modification of DNA, modification of proteins, modification of lipids, I might not need a whole organism to look at it. It's an everyday question we're asking ourselves as researchers. Which model is the most pertinent so I can have an answer to my questions. And at the same time, when I have this answer, I can share it with the rest of the community and say, you might be able to use this result in the clinics because I picked the right model or we think that it could be interesting, but we have to confirm it in another model. And that's how research is done, not only in radiobiology, also in pharmaceutical industry and that's one of the and that's also why it takes so much time between the moment we discover something and the moment we can apply it safely to patients. So your model question is very interesting. Jo McNamara (11:53) Yeah, one of the questions we get asked a lot from patients is around radio sensitivity and the fact that, you know, one patient might respond very differently to radiotherapy compared to another patient. Why is that in terms of radiobiology? Pierre Montay-Gruel (12:13) The the answer to that is that everybody is different. We all have different genetic material, different DNA, different gene expression, and for this reason we all respond differently to stimuli. This stimuli can be for some people the same light intensity can really hurt their eyes for another person, it will be just normal for radiation, it's the same. When you expose your cells, your body to radiation, you activate a lot of different pathways, mechanisms to that are meant to fix the damage that was produced by this irradiation. And this involves a lot of proteins. That are expressed by that are coded by genes. And all these genes, the the ones I'm carrying for the same protein is going to be different from the one you are carrying. And sometimes we have what we call mutations. These mutations, if nothing happens to you, you will never realise that you are more radiosensitive. And for some reason, when you are exposed to radiation, especially in the case of radiotherapy, well, this protein might not be working as much as it should be because it's a little bit mutated. Or this protein is just not present because you have a mutation that makes it absent from your cells. Unfortunately, it's essential for your cells to fix the damage. And if it's not there, if it doesn't work properly, then the cells will unfortunately die. If it's the tumour, it's completely fine. That's what we want. If it's a cell in your healthy organs, that's a problem. Because it means that the healthy cells will not able to regenerate themselves, will not survive, they will die. And that's when you will start seeing drastic side effects that can really be debilitating for the patients. Luckily, we have identified a lot of these genes, a lot of these mutations, and they're what we call biomarkers. And we can actually now identify patients in a better way, radiosensitive patients in a better way. When you start observing very drastic side effects in certain patients, sometimes it's very important to investigate these biomarkers to know, okay, this patient is hypersensitive to radiation, we should adapt our treatment. I'm really hoping that, and I think the field is is going towards that direction, that soon, in the context of personalised medicine we will be able to perform screening on maybe all patients before radiation therapy to predict the side effects that we might observe. Naman Julka-Anderson (15:28) When is is that going to be? Pierre Montay-Gruel (15:30) That's the one billion dollar question. it takes a lot of research. First, to identify all these biomarkers, and I identifying biomarkers is very difficult. second of all, how many millions of people are treated with radiotherapy in the world today? Not all healthcare systems could absorb this. Costs, it will cost a lot of money if we have to screen all the patients. So luckily, with the technological developments, all these costs are going down. This is a great thing. So maybe one day we will be able to do it. is it going to be tomorrow? No, it's super frustrating. And I can hear it. Mm-hmm. Yeah. Naman Julka-Anderson (16:09) It's a bit frustrating though because you have genomics for chemotherapy and there's money after money after money pumped into that but radiotherapy which often does a lot more of the curing it's just it's not quite there is it. Pierre Montay-Gruel (16:23) I can hear the frustration. I really can hear the frustration. And and this, I think at some point it goes above our research or your work as healthcare workers. We also need companies, the industry to go on that topic and to invest money and say, Okay, now we are ready to invest money in this and we want to do it worldwide nationwide, European, in at the European level, and actually make a difference. And we need the help of the industry for that. Jo McNamara (16:57) I do remember going to an ESTRO one year and it was being presented about just how much money goes into chemotherapy versus radiotherapy and it is a shocking inequity. When Pierre Montay-Gruel (17:11) Yeah. Jo McNamara (17:11) you think that actually 50% of cancer patients will have radiotherapy, it is frustrating for anyone working within the field to just see how underfunded it is for what is essentially a treatment that can save lives or improve quality. of life for patients. It's hopefully something that will change in the future and hopefully the work you're doing, the work that Estro's doing, the work that Naman and I do, it's about raising the profile of radiotherapy isn't it? Pierre you talked about flash and you're not going to flash us are you? What is flash? Tell us a little bit about what it is and why you're so interested in it. Pierre Montay-Gruel (18:00) So flash radiotherapy, it's it's not an acronym. it's just flash, like a flash, and you will understand why. It uses ultra high dose rates. So what it means is that instead of delivering radiotherapy within a few minutes, the same dose, the exact same amount of radiation, is delivered within milliseconds, sometimes microseconds. So that's why we call it flash. you deliver this huge amount of radiation in a very, very short time. And what happened is around two thousand ten, maybe a little bit before, a group in France at the Institut Curie had a linear accelerator capable of delivering such amount of dose within a very small time, and they decided to expose mice to to that kind of radiation. And what they observed is that they were actually inducing an anti-tumor effect. So the tumors were decreasing in size, but the normal tissue seemed almost unaffected by radiation, as if this amount of radiation had never been delivered or less amount of radiation than expected had been delivered to to the healthy organs. And that's what they called the flash effect. It was published for the first time in 2014 by Vincent Favodon and Marie-Catherine Vosno. actually they did not discover it because in the 60s, 50s, 70s. They already were experiments that showed that when you were increasing the dose rates, so decreasing the time of irradiation, you were protecting the healthy organs. But these studies never investigated tumors. So the flash effect actually was discovered and published for the first time in 2014. And when I was looking for a master's internship, I contacted Marie-Catherine Vosna, who was working back then in Lausanne in Switzerland, and she gave me two possibilities to work on two different projects. The first one was on heart side effects, and the second one was on flash radiotherapy and glioblastoma and the brain. And I've always been fascinated by the brain. And I was like, okay, I think I prefer the brain to the heart. So that's why I chose Flash. And then I discovered what Flash was. We were the only ones in the world working on it. And as a master's student, I felt like, okay, this is new. This is exciting. You know, nobody else is doing it. We're the only ones. Let's do it. And then I just realised it's not a good thing to be the only ones because everybody else is looking at you and saying that what you do is completely crazy. But I got the opportunity to to do my PhD on it, and slowly we developed a network with more researchers interested in it who wanted to collaborate. The results were reproduced first in the US then in other labs around the world, and it kind of became a hype, you know, like everybody was talking about it and everybody had an opinion about it. And that's why I was fascinated by Flash and still am actually. I think it's it's a fascinating research topic. Jo McNamara (22:05) From a flash perspective, what's happening at a cellular level that's maybe different to standard radiotherapy. Pierre Montay-Gruel (22:16) So that's where it becomes more difficult and more challenging and interesting for a scientist. We don't exactly know why flash radiotherapy is toxic against tumors, but partially protects healthy organs. We have clues though. Fundamentally, normal cells and tumour cells are very different. They're very different cells. Even though these cells grow in your body and come from one of your organs, they do not work the same way. They don't have the same metabolism. They don't use the energy the same way. They don't have the same structure. They don't proliferate at the same rate. They don't have the same safety nets when they are exposed to stress, etc. So we immediately thought that there was a fundamental difference in healthy cells and tumour cells in the way they were responding to flash. We immediately thought about oxygen. Why? Because in radiobiology, in radiotherapy, oxygen is essential. If there is no oxygen, you get rid of 70% of the toxic effect on tumour cells. We also know that the oxygen concentration in tumors and in normal tissue is different. So this might be an explanation. Even if it's absolutely not the only one, then we looked at the impact on other molecules, on proteins, on lipids, and you have a lot of data out there that shows that Flash has a different effect on lipids, on proteins compared to what we call conventional radiotherapy, so the radiotherapy that is used in the clinics. It doesn't interact the same way with these molecules. So probably there is also something at this molecular level. What is in my opinion for sure it is that the difference happens very, very fast after the exposure to radiation that's when the everything happens. Like probably a few femtoseconds, picoseconds after irradiation, that's when the difference already happens. And then all the differences we see later in terms of early side effects, late side effects is just a consequence of what happens very early after exposure. You now have dozens of labs around the world that are looking at the biological mechanisms of flash radiotherapy, everybody is coming with a new hypothesis, almost not every month, but every other month for sure. And I think it's a multifactorial mechanism and we will not have like the key to flash, but more the keys to understand the flash effect. Jo McNamara (25:32) Pierre you mentioned oxygenation and something that I know some private centres here in the UK have looked at is actually getting patients to exercise prior to actually receiving their radiotherapy. Does that fit with the kind of radiobiological model? Pierre Montay-Gruel (25:52) So first of all, exercise is always a good idea before radiotherapy, after radiotherapy. when you have cancer, when you don't have cancer, it's it's also I mean proven that if you have if you exercise you reduce your chances to to have side side effects of treatment, but also to have less cancers. But I guess why they are telling patients to exercise before radiotherapy is because you have a better oxygenation of your tissues. Why? Because you have a vasodilation of your vessels because of the heat, because you need to give your organs and more importantly, your muscles more blood, more oxygen. So the chances that there will be more oxygen in the tumour at the moment of the irradiation are higher. If you have more oxygen in the tumour, then you induce more lethal effects on the tumour due to the radiation. And I'm not aware that there are radiation oncologists and teams that advise the patient to exercise before, but I would say that's that's probably why they do it. And it fits completely to the basics of radiobiology. Oxygen is a mediator of the damage produced by radiation on the tumour cells. No oxygen, no lethal damage. And that that's why we have extremely radioresistant tumors. That's because they're not well oxygenated. and that's a clinical challenge. They really are a clinical challenge. Naman Julka-Anderson (27:39) So why don't we get everyone in a hyperbaric oxygen chamber before treatment? Pierre Montay-Gruel (27:46) Yeah, because that's not enough. It's been done. Naman Julka-Anderson (27:47) I'm not saying we should, but I know. Pierre Montay-Gruel (27:50) It's been done it's been published. Yeah, that's not enough. and other techniques have been used, carbogen breathing. So carbogen is a mix of oxygen and C02 it has the capacity to highly increase the oxygenation of tissues. Two problems here. It might not be enough for the tumour because the the hypoxia is not only induced by the fact that there's not enough oxygen in the blood, but also because the blood vessels are not going to the center of the tumour. You don't have access, the the tumour cells don't have access to oxygen, but also because if you increase the oxygen too much, you also increase it in the surrounding organs, and then you will increase the side effects that you will observe on these organs. So it's like a double-edged sword, you know? And so far, no good technique has been found to to have a proper oxygenation except for fractionation. We shouldn't forget that one of the reasons, one of the reasons why we use fractionation, it's because we have this one of these seven R's of radiobiology, reoxygenation we by killing the the the the tumour cells that are around the tumour, we allow for the reoxygenation of the center of the tumour that was hypoxic. And then we can kill the day after and the day after in a better way. Jo McNamara (29:30) So Pierre, you are heavily invested in ESTRO and especially the Early Career Committee. Tell us a little bit about your role and why and how did you get involved in ESTRO? Pierre Montay-Gruel (29:44) That's that that would be a very long story. I started going to ESTRO meetings, I think it was in 2016. I was in my second year of PhD. and that was impressive, you know, this this huge meeting, all these people that I did not know back then. and I've always been extremely interested in it because that was the door for me, or the possibility to meet people that are actually treating patients. And there are very few radiobiologists and biologists within ESTRO. And I quickly understood or felt like maybe I could make a difference. If I was involved within ESTRO, I could have the voice of radiobiologists heard by the people who actually treat patients every day. So when I came back to Europe, In 2021, I got aware that there was an open position within the young ESTRO committee. Back then it was called Young ESTRO. And I applied. I wasn't selected the first time. They were not looking for a biologist, but the round after they were actually looking for biologists, and I applied again and I got selected by back then the chair of the committee was Stephen Petit from Rotterdam. And that was impressive. All these people who already had so many actions, so so many things to to do within the early career committee. They had a mentoring program, they had so many different things made for early career researchers, early career ESTRO members. I was lost. But slowly I find I found my way in, and I started participating to different actions within the early career committee and started knowing more people. I was selected as an observer in the scientific committee of ESTRO. Yeah, and that's by making connections, I I slowly develop my network within ESTRO and I really love it. Naman Julka-Anderson (31:59) It's also really nice every year, you get to meet new people, don't you? Pierre Montay-Gruel (32:02) Yeah. Naman Julka-Anderson (32:02) It's still one of my favourite tracks every year at ESTRO so far. No disrespect to Jo and the RTT committee, obviously. Pierre Montay-Gruel (32:08) Yeah. Naman Julka-Anderson (32:09) But the Monday is really good fun because it ends with a quiz, which every year I think I'm going to get better, I'm going to know the same answers from the year before, but I think the only one I always get right is what is an RTT. It's an important question if Michelle Leach is listening. Pierre Montay-Gruel (32:20) Yeah, but it's an it's a very important question. It's there Jo McNamara (32:26) you Pierre Montay-Gruel (32:27) every year at the quiz and still every year we have people who do not answer correctly to it. Jo McNamara (32:34) just goes to show, doesn't it, why we need to raise the profile of our profession. Pierre Montay-Gruel (32:39) Yeah. Jo McNamara (32:40) If we can't get it in ESTRO, where can we get it? So Pierre, we could probably chat all night and listening to you is incredible and all of your knowledge and expertise around radiobiology. But we've introduced a new ending to Rad Chat that we find is a bit fun. It's quite fast paced and it's basically quickfire questions. So I'm going to present them to you take too long to think about it and your answers need to be snappy and quick okay so let's go with the first one tea or coffee? Pierre Montay-Gruel (33:20) Coffee. Jo McNamara (33:21) Early morning researcher or late night researcher? Pierre Montay-Gruel (33:25) Mm, more early morning, but I try to have normal working hours. Jo McNamara (33:29) I love that. Favourite city you've lived or worked in and you've you've been around haven't you? You've lived in a lot of cities. Pierre Montay-Gruel (33:37) Very difficult question, but I think it's where the heart is. So that's Lausanne in Switzerland. Jo McNamara (33:43) best piece of career advice you've ever received? Pierre Montay-Gruel (33:48) Do something that you like. Jo McNamara (33:50) One thing you'd wish you'd done at the start of your career? Pierre Montay-Gruel (33:53) That there is a lot of administration to do when you're a researcher. It's not only science. Jo McNamara (33:59) Photons or Protons? Pierre Montay-Gruel (34:01) Photons all the way. Jo McNamara (34:03) Flash hype or Revolution. Pierre Montay-Gruel (34:07) Revolution. Jo McNamara (34:09) ESTRO Congress, what's your favourite part? You might be slightly biased here. Pierre Montay-Gruel (34:12) Early career Yeah, early career comedy events or dinner. Jo McNamara (34:19) I love it. If you weren't a radio biologist, what would you be? Pierre Montay-Gruel (34:23) A veterinarian. Jo McNamara (34:26) nice, dream research project if funding wasn't an issue. Pierre Montay-Gruel (34:31) What I do right now, but without funding problems. Jo McNamara (34:35) Yeah the dream. Person Pierre Montay-Gruel (34:36) Mm-hmm. Jo McNamara (34:37) in science you'd most like to have dinner with. Pierre Montay-Gruel (34:40) I know it will never be possible, sadly, but I think it's Juliana Denicamp. Jo McNamara (34:46) Favourite paper you've ever published. And we'll link Pierre Montay-Gruel (34:48) The f Jo McNamara (34:48) it to this episode as well so that people can go have a read. Pierre Montay-Gruel (34:52) The very first one. Yeah. Jo McNamara (34:55) Amazing. One piece of advice for early career research, so we couldn't not ask you this question. Pierre Montay-Gruel (35:01) That's always what I tell early career researchers when I meet them, do not forget yourself in the process. Jo McNamara (35:09) And what are you most excited about in radiotherapy for the next 10 years? Pierre Montay-Gruel (35:14) Having patients involved in what we do, more patients involved and work as a multidisciplinary community, like truly interdisciplinary community I should say. Jo McNamara (35:28) amazing. Well thank you so much Pierre for joining us, it's been really interesting. What's the take-home message you want for people to kind of leave this episode with? Pierre Montay-Gruel (35:38) I think it's important to as I said, it's valid for everybody, not only early career committee, early career members, sorry, or or researchers. do not forget yourself in the process. Whatever you're going through at work in life, think about yourself. It's not being selfish that at some point tell yourself, wait, am I doing good? Am I doing the right things for myself at this moment? It's essential. We sometimes forget that and it leads to terrible things. As whether you are a professional, whether you are a patient, think about yourself and also don't hesitate to contact people around you because what you're going through, there is someone who is or who has already gone through it, and they will be able to give you some piece of advice to help you go through it, or just to tell you, listen. I am present if you need it, if you want to talk about it, I'm here for you. And you're not alone. Think about yourself and everything will be okay at some point. Jo McNamara (36:47) Amazing advice. A huge thank you again to our guest Pierre for talking all things radiobiology. Thank you all for listening Pierre Montay-Gruel (36:51) Thank you. Thank you to both of you. Jo McNamara (36:55) to Rad Chat with Jo McNamara and Naman Julka-Anderson. Jo McNamara Rad Chat Host (36:58) So what do you do now? Well you can use this episode as part of our free continual professional development accredited content which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources and link to the completed form to receive your accredited certificate. Naman Julka-Anderson (37:07) Stay up to date with the latest radiotherapy and oncology advancements by liking and following us on social media and hitting subscribe wherever you get your podcasts. Jo McNamara Rad Chat Host (37:17) Please do join our supportive community designed by professionals who understand the unique challenges of working within radiotherapy and oncology. Follow us across all of our social media channels and make sure to check out our website www.radchat.co.uk. Together we're actively working to improve our profession and make a lasting positive impact on cancer care. Naman Julka-Anderson (37:40) It goes without saying that we can't achieve this alone. It takes all of us working together to create real change. That's why we value every voice and every contribution. We ask that you listen and learn and spread the word, share your story with us and connect with us. Jo McNamara Rad Chat Host (37:55) And if you have liked this content, why not buy us a coffee? Go to our website and drop us some love. Thank you all for listening and take care.