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Author: Louise Stanley

Second city’s strategic health alliance welcomes mental health trust as new member

Written by Louise Stanley on . Posted in Birmingham Health Partners, Mental health.

Birmingham Health Partners has underlined its commitment to delivering research that enhances health and wellbeing by welcoming Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT) as its fifth NHS member.

BSMHFT was founded in 2003 and provides a wide range of inpatient, community and specialist mental health services – including early intervention and rehabilitation – and is one of the largest mental health trusts in the country with a workforce of around 4,000 across 50 sites. With a national and international reputation for research, BSMHFT maintains strong academic links with a number of prestigious institutions including BHP members the University of Birmingham and Aston University, and its portfolio includes studies focused on dementia, eating disorders, addictions, mood disorders and perinatal mental health.

Roisin Fallon Williams, Chief Executive of BSMHFT, commented: “My colleagues and I welcome the opportunities that membership of Birmingham Health Partners will provide to both our service users and our Trust, through the benefits of continued research and innovation in provision of mental health care in our region. We believe passionately that research is complementary to service delivery, rather than surplus to it, and BHP’s ethos of embedding research into all stages of clinical care is a perfect fit with our own culture.”

Professor David Adams, Director of BHP, commented: “BHP’s mission is to work collaboratively to ensure our community are ‘born well, live well, and die well’. The importance of mental health and wellbeing to this vision cannot be overstated, and neither can the intrinsic link between physical and mental health be overlooked. BSMHFT is already a long-term partner in many of the mental health studies and trials run across BHP, and so their formal inclusion in our partnership is a natural extension of our collaborations to date.”

BHP’s membership now comprises: the University of Birmingham; Aston University; Birmingham and Solihull Mental Health NHS Foundation Trust; Birmingham Women’s and Children’s NHS Foundation Trust; the Royal Orthopaedic Hospital NHS Foundation Trust; Sandwell and West Birmingham Hospitals NHS Trust; University Hospitals Birmingham NHS Foundation Trust; and the West Midlands Academic Health Science Network.

‘Vein-on-a-chip’ could help scientists study blood clots without animal models

Written by Louise Stanley on . Posted in Experimental medicine.

Blood clot researchers could benefit from a new device that mimics a human vein, replacing the need for animals for some studies.

The vein-on-a-chip model has been developed by scientists at BHP founder-member the University of Birmingham, and can be used in experiments to understand mechanisms of blood clot formation in conditions such as deep vein thrombosis (DVT).

DVT is the development of blood clots in veins, usually in the legs. It is a serious condition because the clot can detach and travel to the lungs, where it may block blood vessels, causing breathing difficulties that prove be fatal. DVT is the third most common cardiovascular disease after myocardial infarction and stroke, with tens of thousands of people in the UK developing this condition every year. Mechanisms of deep vein thrombosis require further research to improve clinicians’ understanding and ability to treat or prevent the condition.

The new device, described in a recent paper published in Frontiers in Cardiovascular Medicine, is a tiny channel, which includes structures called valves that ensure the correct direction of blood flow.

UoB researchers Dr Alexander Brill from the Institute of Cardiovascular Sciences, together with Drs Daniele Vigolo and Alessio Alexiadis from the School of Chemical Engineering, led the development of the new device.

Dr Brill said: “The device is more advanced than previous models because the valves can open and close, mimicking the mechanism seen in a real vein. It also contains a single layer of cells, called endothelial cells, covering the inside of the vessel. These two advances make this vein-on-a-chip a realistic alternative to using animal models in research that focuses on how blood clots form. It is biologically reflective of a real vein, and it also recapitulates blood flow in a life-like manner.

“Organ-on-a-chip devices, such as ours, are not only created to help researchers move away from the need for animal models, but they also advance our understanding of biology as they are more closely representative of how the human body works.

“The principles of the 3Rs – to replace, reduce and refine the use of animals in research – are embedded in national and international legislation and regulations on the use of animals in scientific procedures. But there is always more that can be done. Innovations such as the new device created for use in thrombosis research are a step in the right direction.”

This research was funded by the NC3R, British Heart Foundation and Wellcome.

Drug combination could overcome tumour resistance in paediatric cancers

Written by Louise Stanley on . Posted in Cancer outcomes, Clinical trials.

Children with some solid tumours may benefit from receiving a combination of inhibitor drugs, according to interim results of research presented at the American Association of Cancer Research’s Annual Meeting 2023, held April 14-19.

The ongoing research being conducted by an international team including the University of Birmingham suggests that a combination of the PARP inhibitor olaparib (Lynparza) and the investigational ATR inhibitor ceralasertib showed clinical benefit in paediatric patients with solid tumours exhibiting DNA replication stress and/or DNA repair deficiencies.

Dr Susanne Gatz, associate clinical professor in pediatric oncology at the Institute of Cancer and Genomic Sciences of the University of Birmingham presented the study.

Dr Gatz said: “To our knowledge, the combination of PARP inhibitors and ATR inhibitors has not been widely investigated in adult tumour types. This is the first proof of principle that the combination is well tolerated and can lead to clinically relevant responses in paediatric cancers.”

AcSé-ESMART is an international European proof-of-concept platform trial intended to match paediatric, adolescent, and young adult patients with relapsed or treatment-refractory cancers with a treatment regimen targeted to their cancer’s mutational profile. Gatz and colleagues, including Birgit Geoerger, MD, PhD, head of the AcSé-ESMART trial, have so far evaluated 15 different treatments, mostly combination strategies, in more than 220 children following mandatory high-throughput genomic profiling of their tumours.

Arm N of AcSé-ESMART is tailored toward patients with malignancies that exhibit defects in DNA replication and damage repair. Impairments in homologous recombination (HR), a type of DNA repair, can sensitize cells to drugs called PARP inhibitors. PARP inhibitors have proven effective against specific adult cancers with HR deficiencies—most notably, mutations in BRCA1 or BRCA2. How to best use PARP inhibitors in paediatric patients where BRCA1/2 mutations are rarely found remains unclear.

Dr Gatz said: “Paediatric cancer cells proliferate rapidly and have some element of replication stress and a dependency on ATR. We think there might be a kind of primary resistance of paediatric cancers to PARP inhibitors and that combination with an ATR inhibitor could potentially overcome that.”

Gatz also explained that paediatric cancers are often driven by complex mechanisms, making it difficult to identify an effective treatment regimen. Single-agent therapies targeting one mutated protein are often insufficient in paediatric patients, necessitating additional research into combination therapies and mechanisms of response.

“So far, it is unclear if the molecular alterations based on which the patients were enrolled in this trial are the sole reasons for response,” Gatz said.

“Further, it may be difficult to identify patterns of response in specific tumour types due to the tumour-agnostic nature of the study. Nevertheless, this study design can give preliminary indications of signals in specific alterations and tumour types and can provide the basis for future clinical trials.”

Gatz and colleagues plan to evaluate biomarkers of response from the raw sequencing data of the enrolled patients, from the expression of key target proteins such as ATM, and from RNA sequencing data.

Gatz noted that these analyses may identify “molecular constellations” indicative of response to olaparib plus ceralasertib.

“There are enormously valuable drugs currently in development and, provided there is a good clinical or preclinical rationale, we need to apply them more creatively to diseases for which the drug is not currently indicated,” Gatz said.

Limitations of this study include a small, non-randomized sample intended primarily as a proof of concept and to determine the optimal dose for study expansion.

The study is as yet unpublished.

West Midlands Innovation Accelerator to Spark Growth and Innovation

Written by Louise Stanley on . Posted in Birmingham Health Partners.

The Universities of Birmingham and Aston – both BHP members – are to participate in the West Midlands Innovation Accelerator announced this week by the West Midlands Combined Authority.

Designed to bolster the region’s innovation and R&D capability, as well as sparking commercial growth and investment, the Innovation Accelerator will receive a share of a new £100m fund from Innovate UK. This fund, first announced in the Government’s 2022 Levelling up White Paper, will be divided across three regional Innovation Accelerators over the next two years.

Aims of the Innovation Accelerator include accelerating the region’s engineering research & development, boosting inward investment, and reinforcing the West Midlands’ position at the frontier of the UK innovation revolution by enabling businesses to develop new products, processes and services.

The West Midlands Innovation Board has targeted investment on five projects enabling new solutions around Medical and Clean Technologies.

The University of Birmingham is leading the 6D Innovation Accelerator project, bringing together key stakeholders (universities, hospitals, industry and government-funded ‘Catapults’ for manufacturing innovation) to supercharge the region’s ability to accelerate new health and medical technologies. Its aim is to deliver a streamlined programme to help companies navigate “pinch-points” in the process of medical translation.

Professor Liam Grover, of the University of Birmingham’s Healthcare Technologies Institute, said: “Taking health and medical technologies into the market place can be a minefield of regulatory, funding and management issues. We aim to develop clear processes that will help companies navigate the obstacles and deliver marketable products that will enhance people’s lives.”

The 6Ds are:

      • Diagnosis of company needs
      • Definition of major NHS and industry-based challenges to target
      • Development and refinement of prototype products
      • Deployment of innovation in real-world NHS settings
      • Diversification of supply chains, skills and services
      • Demonstration of significant economic and health benefits for our region

The University is also playing a key role in a second project, Digital Innovation Transformative Change (DIATOMIC), led by Connected Places Catapult, the UK’s innovation accelerator for cities, transport and place leadership. Partners include Aston University, Birmingham City Council, Birmingham City University, Greater Birmingham Chambers of Commerce.

DIATOMIC will accelerate place-based innovation in the West Midlands. Harnessing the region’s existing international relationships and through a series of targeted initiatives, it will focus on growing the region’s clean tech, health tech and med tech markets.

Through DIATOMIC civic leaders will be able to set innovation challenges, support local SMEs to respond and benefit the community through the UK’s first inclusive innovation hub. It will also promote the use of data to enable better place-based decision making and develop an impact assessment toolkit.

Announcing the Innovation Accelerator, Andy Street, Mayor of the West Midlands, and chair of the WMCA, said: “I’m delighted to see the Innovation Accelerator fund finally land in our region which will unlock a further £150m of private sector co-investment. The funding will inject momentum into the delivery of the West Midlands Plan for Growth which sets out how we will unlock hundreds of thousands of new jobs and be home to major global companies in this decade.

“One of my key mayoral missions is to restore our status as the fastest growing region outside of London – just as we were pre-pandemic. Innovation is central to achieving that mission.

“We’re already a leading region for UK innovation when it comes to automotive and aerospace – with every £1 of Government spending for Research & Development translating in to £4 of business investment. This latest news will help us to build on our progress to date – with Government’s forthcoming Trailblazer Devolution Deal and proposed programme of Investment Zones set to usher in exciting times ahead.”

Minister of State for Science Research & Innovation at DSIT George Freeman said:  “Through Record investment in our UK science, technology & innovation sectors, the Innovation Economy is creating new career opportunities in the campuses, clusters & companies of tomorrow.

“That’s why UKRI is putting clusters at the heart of its of its £25bn budget up to 2025, and why our £100m Innovation Accelerator Program provides £33m each to 3 emerging clusters to attract industrial co-investment and become major, globally competitive centres for research and innovation.

“The West Midlands Cluster is becoming a world class hub of R+D in med tech and clean tech.

“I’m delighted that local leaders have come together to use our £33m to launch such exciting programs with industry and Universities in this exciting area.”

Learning from the pandemic: Birmingham Health Partners publishes rapid evaluation study of remote outpatient appointments

Written by Louise Stanley on . Posted in Birmingham Health Partners.

Birmingham Health Partners (BHP), the second city’s University-NHS partnership, has called for greater engagement with clinicians and a deeper understanding of patient experience when considering the continued use of remote outpatient appointments post-Covid.

A new report, ‘Learning from the pandemic shift of outpatient services to a remote footing: a rapid evaluation study’, has been published by researchers and clinicians from across the three founding members of BHP (University of Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust and University Hospitals Birmingham NHS Foundation Trust), and offers advice about how remote outpatient consultations might best be used as we ‘return to normal’.  The authors set out a suggested approach to making decisions about when a remote outpatient consultation might be appropriate or not; explore the issues facing patients, carers and health professionals; and point to the many operational issues that need to be addressed as new care pathways that embrace both remote and in-person consulting are developed.

The report was co-ordinated by Birmingham Health Partners’ new Rapid Evaluation Service and comprised interviews with a range of BHP staff involved in remote consultations as well as health data gathered on the use of these appointments across both Trusts, and a pragmatic literature review.

Lead author Dr Richard Lewis, Senior Associate at the University of Birmingham’s Health Services Management Centre commented: “While the shift from face-to-face to remote consultations occurred quickly in both Trusts – reaching around half of all consultations at its peak – the proportion of remote consultations has, to some extent, fallen back from pandemic lockdown levels.  This research is intended to inform clinicians and managers as they plan how best to organise outpatient services beyond the pandemic, with a mix of in-person and remote consultation offers.  There is a risk of missing a unique opportunity to draw on experience of sudden and unplanned changes in outpatient consultations to apply these lessons to more sustained reform of how at least some appointments might be delivered longer term.”

Matt Boazman, Interim Chief Executive of Birmingham Women’s and Children’s NHS Foundation Trust, added: “This study has demonstrated the significant potential for continued innovation in how we deliver care to patients, particularly across outpatients. It also serves to illustrate the importance of ensuring that we fully consider the views of patients and carers who will have different views on consultation formats depending on their personal circumstances. The authors are right to point out the need to pay careful attention to any potential unintended consequences, including the impact on patient-clinician relationships and ensuring that there are robust mechanisms in place to continue to support safeguarding.”

The report can be downloaded here: 

The BHP Rapid Evaluation Service was established in 2022 to provide time-sensitive, formative evidence on innovations in healthcare and capacity building. It carries out rapid and effective service evaluations, often running in parallel with service implementation; helps spread learning to other sites; and helps build local capacity for in-house evaluations.

The Health Services Management Centre (HSMC) at the University of Birmingham is one of the UK’s foremost centres for research, evaluation, teaching and professional development for health and social care organisations. HSMC has established a unique reputation as a ‘critical friend’ of the healthcare community and strives constantly to bridge the gap between research and practice.

Skull model

New drug can lower brain pressure and treat blinding IIH headaches, finds trial

Written by Louise Stanley on . Posted in Clinical trials.

Patients with Idiopathic Intercranial Hypertension (IIH) – a condition which causes raised brain pressure and debilitating headaches – could be treated with an injectable peptide used for type 2 diabetes, a new trial has found.

The study, published in the journal Brain, reports on a phase two trial of a drug called exenatide, a GLP-1 receptor agonist, as a potential treatment for IIH.

The IIH Pressure Trial led by a team of neurologists from BHP founder-members the University of Birmingham and University Hospitals Birmingham found that the seven patients who received regular injections of the drug, currently approved for use in Type 2 Diabetes, experienced a drop in pressure in the brain during both short (2.5hrs and 24hrs) and long term (12 weeks) measurements.

The trial also saw significant reductions in the numbers of headaches across the 12 weeks that participants took part, with an average of 7.7 fewer days per month of headaches compared to the baseline, compared to only 1.5 fewer days in the placebo arm.

Alex Sinclair is Professor of Neurology in the Institute of Metabolism and Systems Research at the University of Birmingham, an Honorary Consultant Neurologist at University Hospitals Birmingham NHS Foundation Trust, and Principal Investigator of the study, said: “This is a major trial for the rare and debilitating condition IIH that can lead to people, usually women, going blind and suffering disabling daily headaches. There are no current licenced drugs to treat IIH and hence this result is a major step forward for IIH patients.

“We are delighted to see that the phase two trial resulted in our treatment group having lower brain pressure both immediately and after 12 weeks and nearly 8 fewer headache days across the 12-week period, and that all the women were able to continue the treatment throughout with few adverse effects. We now hope to see a much larger trial of exenatide to literally ease the pressure for the many people around the world suffering with IIH.”

Dr James Mitchell, Lecturer in Neurology at the University of Birmingham and first author of the paper said: “The results of this clinical trial are a shot in the arm for finding clinical treatments for IIH. While we need to do further trials before such a treatment could be available for patients in the future, we are encouraged by the significant results from this trial that made a real difference for those in the treatment arm and this treatment may prove relevant for other conditions resulting in raised brain pressure.”

In this study the drug was given as a twice daily injection into the subcutaneous tissue. To reduce the need for frequent injection in the future, a once-weekly subcutaneous injection called Presendin will be trialled though University of Birmingham Start-up company, Invex Therapeutics.

Shelly Williamson, the Chair of patient charity IIH UK said: “This is such exciting progress. New drug options is vitally important for IIH and this trial brings hope to the millions of patients living with the condition. We very much look forward to the next steps and seeing the drug tested in two large Phase 3 clinical trials.”

The IIH Advance is a Phase 3 clinical trial in Adolescents run in the UK, sponsored by the University of Birmingham and IIH Evolve is running in adults internationally sponsored by Invex Therapeutics. Ultimately the aim is to gain enough evidence to allow the drug to be licensed for use in IIH patients in the future.