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Author: Louise Stanley

Urine test for bladder cancer could replace thousands of invasive procedures each year

Written by Louise Stanley on . Posted in Cancer outcomes, Clinical trials, Early diagnosis and detection.

Birmingham researchers funded by Cancer Research UK and liquid biopsy company Nonacus have developed a new urine test for bladder cancer, which could reduce the need for invasive and time-consuming procedures to diagnose the disease.

The test will use highly sensitive liquid biopsy technology developed by Nonacus in conjunction with  a panel of biomarkers developed and validated by Mr Rik Bryan and Dr Douglas Ward from the Bladder Cancer Research Centre at BHP founder-member the University of Birmingham, to detect the presence of bladder cancer by finding DNA from tumour cells present in the urine.

The biomarker panel, which consists of 443 genetic mutations that are common in bladder cancer has been validated in a deep sequencing study recently published in European Urology Oncology.

In this study, which was funded by Cancer Research UK and the Medical Research Council, the researchers used the test to analyse urine from 165 people with bladder cancer that had experienced haematuria (blood in the urine), and successfully detected the disease in 144 of them (87%).

The researchers also looked at using the test in 293 patients who had already been treated for bladder cancer and were being monitored for the cancer returning. In this setting, the test returned a higher proportion of false positive results compared to when used in the haematuria clinic (37.5% vs 15.2%), with 99 positive urine tests without a tumour being seen by cystoscopy on the same day. However, during their follow up monitoring, the patients who had those positive results had almost 3-times higher (11% vs 4%) rates of the cancer returning within 24 months indicating that the test could help detect recurrent disease before it is visible by cystoscopy (the camera inspection of the bladder). Further research is needed for the test to be used for surveillance.

Lead researcher Mr Richard Bryan said: “Even though cystoscopy is good at detecting bladder cancer, it’s invasive and time consuming for patients, so we need a better way to diagnose patients. In the future our test could be an easier way to get people with bladder cancer diagnosed faster, and could mean that tens of thousands of cystoscopies on healthy patients can be avoided each year.”

Iain Foulkes, Executive Director of Research and Innovation at Cancer Research UK said “These findings show that this urine test could help diagnose bladder cancer more easily. Early detection of cancer is key for improving patient outcomes and research like this could help identify the patients that need treatment soonest, while easing the pressures of diagnostic procedures on the NHS. We look forward to seeing how the test performs in the next clinical trial.”

The researchers are working in partnership with Nonacus, a provider of genetic testing products for precision medicine and liquid biopsy, to turn their approach into a clinical test for patients to be used within the NHS, and will start a clinical study funded by Cancer Research UK and involving over 3000 patients to evaluate just how powerful the test is at reducing the number of cystoscopies.

Each year, over 300,000 cystoscopies are carried out in England, however, around 80% of patients with haematuria who’ve had cystoscopy are found to have no cancers or abnormalities1,2.  The researchers believe that using the urine test in haematuria clinic could reduce the number of patients requiring a cystoscopy by at least 45%.

Civilians and military take part in study to improve concussion prognosis

Written by Louise Stanley on . Posted in Clinical trials.

A major UK study to identify new ways to accurately predict if patients will develop long-term complications as a consequence of concussion has been launched, led by experts at BHP founder-member the University of Birmingham and the Defence Medical Rehabilitation Centre, in collaboration with the Defence Medical Services.

With year one funded by the Ministry of Defence (£2m) and projected to run over eight years, the multi-faceted study will include a trial involving 400 civilians and 400 military personnel aged over 18 with a new diagnosis of concussion (also known as a mild traumatic brain injury or mTBI) which has resulted in them needing hospital treatment or rehabilitation.

At specific time intervals over two years, the participants will take part in nine different areas of research using a variety of medical techniques and assessments to establish if these can be used routinely by medics as ‘biomarkers’ to indicate prognosis and long term impact of concussion. Medical techniques and assessments being trialled include brain imaging and function, analysis of blood and saliva samples, and headache measures, as well as mental health, vision, balance, and cognitive performance.

mTBI is common and has been declared a major global public health problem, with 1.4 million hospital visits due to head injury annually in England and Wales – 85% of which are classified as mTBI. It is also estimated that up to 9.5% of UK military personnel with a combat role are diagnosed with mTBI annually.

The research will involve 20 University of Birmingham experts working across disciplines, including neurology, psychology, sports medicine, mathematics and academics within the University’s Centre for Human Brain Health, and will be coordinated by Birmingham Clinical Trials Unit. It will also be driven by experts at the Defence Medical Rehabilitation Centre Stanford Hall; Aston University, Imperial College London; University of Westminster; University of Nottingham; Royal Centre for Defence Medicine; and University Hospitals Coventry & Warwickshire.

Alex Sinclair, Professor of Neurology at the University of Birmingham and Chief Investigator of the project, called mTBI-Predict, explained: “Although classified as mild, and many recover, the consequences of concussion can be profound with many patients suffering long-term disability due to persistent headaches, fatigue, imbalance, memory disturbance, and poor mental health including post-traumatic stress disorder, while it can have a significant impact on the economy through loss of working hours and demand on the health system.

“Identifying those patients most at risk of these disabling consequences is not currently possible. There is therefore a pressing need to develop accurate, reproducible biomarkers of mTBI that are practical for use in a clinical setting and can predict long-term complications. Our programme of research will deliver a step change in the care of patients with mTBI, enabling a personalised medicine approach to target early intervention for those most in need but also identifying those with a good prognosis who can return rapidly to activities of daily living.”

Co-Chief Investigator, Air Vice-Marshall Rich Withnall QHS Director of Defence Healthcare, UK Ministry of Defence said: “I am delighted that the Defence Medical Services, including the Defence Medical Rehabilitation Centre at Stanford Hall, will be working hand-in-glove with class-leading civilian colleagues and the National Rehabilitation Centre Programme. I fully support this ground-breaking research which I am confident will lead to significant clinical innovation to benefit military and civilian patients, and have translational positive impact for sporting activities from grass-roots to elite levels.”

Peter McCabe, Chief Executive of Headway – the brain injury association, said: “We know that even a seemingly minor head injury can have a major impact on a person’s life – and often the lives of those closest to them. This is particularly the case if the brain injury goes undiagnosed or its effects are mistaken for other conditions. The frustration of not having an accurate diagnosis or receiving the right support can be compounded by the lack of a clear recovery pathway or timeline. We therefore welcome this study in the hope that it can advance our understanding of concussion and mTBI.”

 

Genetically-determined levels of inflammation linked to neuropsychiatric illness

Written by Louise Stanley on . Posted in Inflammation and chronic disease, Mental health.

A potential link between inflammation and the structure of specific regions of the brain has been identified by researchers at BHP founder-members the University of Birmingham.

The study, published today in JAMA Psychiatry, may be particularly relevant for neurodevelopmental psychiatric disorders including autism spectrum and schizophrenia.

Researchers say the findings could open up a completely new target for the pharmacological treatment of these disorders, which has not significantly changed since the identification of antipsychotic medications in the mid-late 20th century.

The research was carried out by a team based in the University’s Institute for Mental Health and Institute and Institute of Cancer and Genomic Sciences, with collaborators from the University of Cambridge, Manchester and Bristol. It showed that genes associated with inflammation, particularly interleukin (IL) 6, are linked to a reduction in grey matter volume in certain areas of the brain known to be implicated in neuropsychiatric disorders.

Using records from the UK Biobank, a large-scale biomedical database, the team was able to compare genetic variants which affect levels of IL-6, and other inflammatory genes in more than 20,000 patients with changes in grey matter volume in specific areas of the brain.

They were able to show strong links between IL-6 and brain structure particularly in the temporal and frontal regions. Further analysis using the Allen Human Brain Atlas, showed that genes overexpressed in these areas are associated with conditions such as epilepsy, cognitive dysfunction, and schizophrenia.

Professor Rachel Upthegrove of the University of Birmingham Institute for Mental Health, explained: “This study shows that the IL-6 gene, which we know to be linked to systemic inflammation, also affects brain structure in areas associated with these neuropsychiatric disorders. Understanding these links offers an exciting opportunity to explore new treatments which target IL-6. This could be the first new target for severe mental illnesses including schizophrenia identified in more than 60 years.”

Dr John Williams, of the Institute for Cancer and Genomic Sciences at the University, a first author on the paper, said: “Current treatments for these illnesses act on dopamine, a chemical messenger in the brain associated with mood and attention. These drugs can have side effects, however, and they are not effective in all patients.

“There are drugs already on the market which target inflammation as well as the opportunity to screen potential new compounds. Finding a new avenue for exploring the links between inflammation, brain structure and neuropsychiatric disorders is really exciting.”

The work is part of the PIMS (Psychosis Immune Mechanism Stratified Medicine Study) programme, led by the University of Birmingham and set up to investigate the links between inflammation and psychosis. In the next phase of the research, the group will carry out experimental studies to knock out IL-6, as well as replicating the Biobank research in more diverse patient cohorts.

Funding boost to help improve ovarian cancer survival rates

Written by Louise Stanley on . Posted in Cancer outcomes, Early diagnosis and detection, Health inequalities.

BHP’s newest member NHS Trust has been given a charity grant of £100,000 to help improve survival rates of women with ovarian cancer.

The Pan-Birmingham Gynaecological Cancer Centre, based at SWBH’s City Hospital, is working jointly with University of Cambridge to boost the uptake in genetic testing, especially in Black, Asian and Minority Ethnic communities (BAME) where survival rates are low.

The project, called the Demonstration of Improvement for Molecular Ovarian cancer testing (DEMO), will create information about genetic testing in various languages both in leaflet and video format. The project will also improve the quality of the sample taken to aid diagnosis when there is suspicion of ovarian cancer by establishing a guidance document for all healthcare professionals involved in the process.

Dr Elaine Leung, Clinical Lecturer and Specialist Registrar at the Pan-Birmingham Gynaecological Centre which is run by Sandwell and West Birmingham NHS Trust, said: “This is a much-needed project reaching those diverse communities in the area.

“With the support of our patient representatives, the materials we co-create will be in an easy-to-understand format in both written and video form, which will give women a better understanding of the link between cancer and genetic testing.

“It’s important to ensure women know that genetic testing is similar to early detection and can help prolong life – we have already seen evidence of this through other studies.

“It helps to provide tailored treatments for patients and ultimately can mean surviving an ovarian cancer diagnosis.

“The lack of informed decision-making resources for women whose first language is not English could be a contributor to the low rates of testing within these communities. The team will co-produce information in multiple languages, as well as exploring why some groups of women are more likely to decline genetic testing.”

The project has been funded by health charity Ovarian Cancer Action and is part of a wider national initiative which includes funding for five other NHS cancer centres.

The Pan-Birmingham Gynaecological Cancer Network delivers cancer care to more than two million people in the West Midlands.

The project also builds on the team’s previous experience with the genetic testing studies, looking at BRCA testing in women with a new diagnosis of ovarian cancer before it became mainstream practice.

Lisa Bird, a former cancer patient who is part of the project, said: “When I was in my thirties I was diagnosed with ovarian cancer, which was a large shock.  My first line treatment successfully got me into remission but I wanted to know what options would be available to me if I came out of remission.

“I investigated treatment options and found that there were some treatments only available to those that have the BRCA 1 and 2 genes.  I also wanted to know if other family members were at an increased genetic risk of also getting ovarian cancer, so that I could warn them of the symptoms and ensure that they received better monitoring by their GPs.

“I’m really pleased to be part of the DEMO project team that will encourage more patients to have these same tests. I’m passionate that anyone affected by ovarian cancer should be able to have this genetic knowledge so that their healthcare teams can give them the best treatments available to them as quickly as possible. I really believe that the results of this project will help to provide patients with ovarian cancer, with a greater chance of an extended life.”

Continuation of funding secures Birmingham’s Clinical Research Facility

Written by Louise Stanley on . Posted in Experimental medicine.

The Birmingham Health Partners NIHR Wellcome Trust Clinical Research Facility (CRF) has been successful in its renewal funding bid from the National Institute for Health Research.music

The NIHR Wellcome Trust CRF was established in 2000 as one of the original 5 ‘millennium’ facilities, based at Queen Elizabeth Hospital Birmingham. It incorporated a facility at Birmingham Women’s and Children’s hospital in 2008.  This new award of £12.9million will continue to allow BHP founder-members UHB and BWC NHS Foundation Trusts to provide patients with opportunities to participate in experimental medicine research projects alongside their routine clinical care, in our ageless approach to care – from newborns through childhood, adulthood, maternity to old age.  In addition to this, the CRF is a vital facility enabling healthy volunteer studies and first in human trials for the advancement of new treatments and will continue to deliver this important work over the next five years.

The CRF supports both research and education, ensuring it maximises opportunities for staff development including all learners whether students on placement or healthcare professionals pursuing a clinical academic career.

Joanne Gray, CRF Clinical Manager said: “This is fantastic news for UHB and BWC patients and staff, allowing continuation of an established research facility leading to direct patient benefits and new technologies supporting patient care pathways.

“I am so happy to have received this news following our bid for funding at a time of such challenging times for the NHS.  It is great news for not only the CRF team but for the whole of the Birmingham region as we continue to offer research to Birmingham patients in an area the size of Scotland with the diversity of the world.”

Dr Dhruv Parekh, Programme Director, explained: “Experimental research is crucial and the stepping-stone to finding new treatments that may benefit patients. We are grateful for the on-going funding from the NIHR for the next 5 years to ensure the Birmingham Clinical Research Facility continues its excellent track record of ensuring new discoveries are translated to benefit our diverse populations across a wide range of diseases and ages.”

Professor Jeremy Kirk, Research and Innovation Director at Birmingham Children’s Hospital, said:

“We are delighted that the funding of the Birmingham Clinical Research Facilities has been renewed. This continued funding is a reflection of the very high-quality research being performed within Birmingham, including at the Children’s Hospital, the first paediatric unit of its kind in the UK.

“The early phase studies being performed within the CRF will ensure that our patients have access to the best and most promising therapies both now and in the future.”

Prof Simon Ball, UHB Chief Medical Officer added: “We are delighted to receive ongoing support for the Birmingham Clinical Research Facility from NIHR. It is a testament to our world-class facilities and professionals, the strength of the Birmingham Health Partners strategic alliance, and the relationship we have with our patients and population. We look forward to ensuring early phase clinical research is accessible to all the communities we serve.”

Matthew Boazman, Chief Officer for Strategy and Innovation at BWC said: “We are absolutely delighted to have received confirmation of funding and the ongoing support of the NIHR for the Birmingham Clinical Research Facility.

“This recognition is testament to the outstanding track record and expertise we have across the whole of our partnership for the delivery of early phase clinical trials and will enable us to continue to support experimental medicine and the advancement of new treatments from childhood through to old age over the next five years.”

Professor Lorraine Harper, Director of the CRF, added: “We are absolutely delighted to receive this funding award which reflects the world-class staff and facilities we have within our CRF.

We now look forward to offering opportunities to take part in early phase clinical research to a broader range of our diverse communities reflected within our Birmingham Health partnership”

Christopher Hodson, CRF patient/public representative, commented: “The CRF is a centre of excellence, providing vital input into early clinical and medical trials from a wide range of disciplines both from UHB and Birmingham Children’s Hospital. It is supported by a first class medical, nursing and laboratory team with a can-do ethic.  It is a privilege to be associated with it.”

Sandra Haynes, also a patient representative, added: “Involvement in the CRF and the funding means that patients get the very real opportunity to influence how research impacts on them, and make it relevant for all of us without medical backgrounds to have a say. We are the voice of those with lived experience, helping to guide researchers and experts to put patients at the centre of all they do.”

Expanded membership signifies ambition for Birmingham Health Partners

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

The second city’s University-NHS partnership Birmingham Health Partners (BHP) has expanded its membership by welcoming Sandwell and West Birmingham Hospitals NHS Trust (SWBH) on board, joining the University of Birmingham, University Hospitals Birmingham NHS Foundation Trust (UHB), Birmingham Women’s and Children’s Hospitals NHS Foundation Trust (BWC), and West Midlands Academic Health Sciences Network (WMAHSN).

SWBH’s inclusion extends BHP’s research and education capabilities, and builds on many years of successful collaboration between the Trust and BHP members, working on studies and trials in specialties as diverse as cancer immunotherapy, rheumatology and heart disease. The Trust provides acute hospitals and community healthcare services to a population of around 500,000 people across Sandwell, City and Rowley Regis Hospitals, as well as operates the Birmingham and Midland Eye Centre, the regional Sickle Cell and Thalassaemia Centre, and is the regional base for the National Poisons Information Service. It is also currently developing the Midland Metropolitan University Hospital, which will provide acute care services when it opens.

The news also follows publication of a joint report from BHP, Association of the British Pharmaceutical Industry (ABPI) and the Confederation of British Industry (CBI) which showcased the huge potential of the West Midlands’ life science ecosystem and recommended a joined-up approach to regional leadership and collaboration, in order to tackle the specific health burdens of the West Midlands and beyond.

BHP Director Professor David Adams, who is Head of the University of Birmingham’s College of Medical and Dental Sciences, explained: “Our city and region is home to a concentration of multidisciplinary health and life sciences excellence, and has the potential to strengthen the UK’s position as a world leader in the sector. This can only happen if we work inclusively and collaboratively across the Midlands. With a strong track record of research partnership between BHP’s founder-members and SWBH already in place, it is a natural next step to bring the Trust on board as a full member – demonstrating BHP’s regional leadership, commitment to delivering on our recommendations, and dedication to improving the health of our diverse population.”

Professor David Carruthers, Medical Director of SWBH, commented: “We are delighted to be part of BHP and contribute to the development of research in the West Midlands. This will build on the strong track record that SWBH has in delivering research that involves and is relevant to our patients. This partnership will reinforce our commitment to the development of our staff as well as improving the health of our local population through high quality research opportunities.”

BHP is committed to achieving health and economic impact through harnessing the combined strength and expertise of its members.