By Michael Cape
With medical research being essential to the development of treatments for a variety of conditions and illnesses, experts at university research facilities, hospitals and life sciences companies are striving to make the next significant breakthrough that will save lives.
To achieve the best outcomes, it is important that those involved in research projects work together to make the most of their pioneering findings, and the recently launched Newcastle Academic Health Partners (NAHP) is leading the way in collaborative working, as it brings together two NHS Foundation Trusts – Newcastle Upon Tyne Hospitals and Northumberland, Tyne and Wear – with Newcastle University to deliver world-class healthcare.
Newcastle has an international reputation as a centre of excellence for clinical trials, topping the UK league table for the past seven years as regards the number of trials carried out annually. It is also the only city awarded competitive national funding for both a Medical Research Council (MRC) pathology node and a Diagnostic Evidence Co-operative.
These two pieces of clinical research infrastructure enable Newcastle to deliver diagnostic and health improvements, and are the reason why a North East company was able to get its diagnostic test for flu up and running in the winter of 2014-15 in a timeframe that had previously been thought impossible.
When you add in that the region is both an NHS Genomics Medicine Centre and a National Institute for Health and Care Excellence Technology and Evaluation Centre, it is easy to appreciate why the life sciences cluster in the North East is in growth mode.
This meets one of NAHP’s objectives (alongside targets to improve physical and mental health in age-related diseases such as dementia, and enhancements in the treatment of cancer), namely to mobilise all three of its partners “in support of economic growth”. Improvement in health is linked to enhancing the wealth of the region.
NAHP is reaching out to the life sciences industry for co-operation in projects in a way that has never before been seen, as historically this has been – and remains – a highly competitive sector where the rewards are significant for those involved.
The North East has a long-standing reputation of co-operation between clinical medicine, life sciences and industry. Recognising a knowledge gap across the three sectors, however, researchers at Newcastle University were successful in attracting MRC funding to promote greater engagement.
This scheme, led by Professor Nick Reynolds of the university’s Institute of Cellular Medicine, is called Proximity to Discovery and is designed to ensure that medical research in the North East genuinely engages with industry.
A clear indication that this approach is working comes with the news that, earlier this month, scientists from five major pharmaceutical companies attended a week-long educational conference on dermatology and rheumatology at Newcastle University – held in conjunction with Newcastle Upon Tyne Hospitals NHS Foundation Trust – where they discussed potential new projects and ways of working together.
It also indicates that Newcastle University is recognised as a centre of excellence in dermatology, and this is reinforced by an ongoing MRC grant funded research project into severe psoriasis.
The Psoriasis Stratification to Optimise Relevant Therapy (PSORT) consortium, led from Manchester, involves Newcastle and London (King’s College London along with Guy’s and St Thomas’ hospitals) as the core centres in developing personalised delivery of new and more effective “biological” psoriasis drugs.
An additional ten pharmaceutical companies around the UK have signed up to be involved in the research – which Professor Reynolds says is “a sure sign that things are changing out there and that industry sees the real benefits of joining and contributing to such a consortium”.
The research is seeking to identify markers to indicate which one of a possible family of three new drugs will prove most beneficial to individual patients. Currently the drugs are administered by trial and error, often in rotation until the right one is found. Not only can this cause side effects or delays in response in patients, it can also prove expensive given that a yearlong course of any one of the drugs costs £10,000.
While affecting about 2 per cent of the population overall, psoriasis is regarded as an umbrella term and has several sub classifications. There appear to be real differences, for example, between early onset (usually late teens / early twenties) and late onset (aged 50-plus) psoriasis, including potential responses to individual therapies.
“The objective of the PSORT consortium is to develop a combination of clinical, biochemical and gene markers to predict which patients are likely to get better results using drug x rather than drug y,” Professor Reynolds says. “We are on the right track but haven’t yet cracked it. However, we wouldn’t have even got this far without this multidisciplinary collaboration.”
NAHP has delivered a five-year plan that includes recruiting and training the next generation of researchers and providing national leadership in healthcare education. It is an exciting time, as this collaborative approach is helping to attract some of the brightest researchers and practitioners to Newcastle and the North East.
New understanding of chronic fatigue syndrome
If you have ever felt that chronic fatigue syndrome (CFS) was ruining your life but have heard the urban myth that there is no such medical condition, then Professor Julia Newton, director of Newcastle Academic Health Partners (NAHP), is able to prove conclusively that there is one after all.
The Clinical Professor of Ageing and Medicine at Newcastle University, who also works within Newcastle Upon Tyne Hospitals NHS Foundation Trust, oversees a specialist NHS Cresta (Clinics for Research and Service in Themed Assessments) fatigue clinic. The team at the clinic are very aware of the reality of CFS, having already treated some 400 sufferers from across the UK who live with the debilitating symptoms.
Researchers at the clinic have made a major breakthrough in understanding the condition, having found for the first time an abnormality of a protein known as AMPK which could open the door to new drugs and treatments for CFS sufferers.
A total of 40 people – 20 with CFS and 20 without – took part in the groundbreaking study, exercising in an MRI (magnetic resonance imaging) scanner while experts measured how much acid accumulated in their legs. Participants were recruited via Newcastle Upon Tyne Hospitals NHS Foundation Trust, and staff at Northumberland, Tyne and Wear NHS Foundation Trust screened those involved for symptoms of depression to ensure that any abnormalities found were linked solely to CFS rather than to anything else.
Initial findings revealed that CFS patients developed 20 times more acid in their muscles than those without the illness, highlighting the defect with AMPK. Muscle biopsies were then obtained from ten patients with the condition and ten without, and muscle cells were grown in a laboratory to analyse what changes occur during exercise.
“Our study focused on whether there were any biochemical changes,” says Professor Newton, “so that we can start to understand what happens in the muscle with fatigue and, therefore, explore if there are drugs we can use to reverse this. What we have been able to identify is that production of AMPK is impaired in patients with CFS compared to those without. This is an important finding because there are drugs currently available that we know will modify this abnormality.
“The next step is to carry out experiments to see whether or not we can reverse changes in AMPK with drugs that might ultimately form the basis of clinical trials. In a condition where we have no clinical trials of treatments ongoing in the UK at the moment, this is an exciting step towards that holy grail of trialling medicinal products.”
The pioneering nature of the clinic’s work becomes clear given that fatigue is the main reason UK residents visit their GP, even more so than stress. It is believed that the condition affects around 600,000 people in the UK, causing severe muscle pain that can create long-term disability.
As a result of its work, the clinic won the Bright Ideas in Health award, an example of the effectiveness of NAHP in delivering the best care possible for patients.