Author: ITM_admin

A new technique for 3D printing soft materials – such as gels and collagens – offers a major step forward in the manufacture of artificial medical implants.

Developed by Birmingham Health Partners researchers at the Institute of Translational Medicine, the method could be used to print soft biomaterials that could be used to repair defects in the body.

Printing soft materials using additive manufacturing has been a big challenge for scientists because if they are not supported, they sag and lose their shape. The new technique, called Suspended Layer Additive Manufacturing (SLAM), uses a polymer-based hydrogel in which the particles have been manipulated to create a self-healing gel. Liquids or gels can be injected directly into this medium and built up in layers to create a 3D shape.

The method offers an alternative to existing techniques which use gels that have been minced to form a slurry bath into which the printed material is injected. Called Freeform Reversible Embedding of Suspended Hydrogels (FRESH), these offer many advantages, but frictions within the gel medium can distort the printing.

In a study published in Advanced Functional Materials, a team led by Professor Liam Grover, in the School of Chemical Engineering, show how particles in the gel they have developed can be sheared, or twisted so they separate, but still retain some connection between them. This interaction creates the self-healing effect, enabling the gel to support the printed material so objects can be built with precise detail, without leaking or sagging.

“The hydrogel we have designed has some really intriguing properties that allow us to print soft materials in really fine detail,” explains Professor Grover. “It has huge potential for making replacement biomaterials such as heart valves or blood vessels, or for producing biocompatible plugs, that can be used to treat bone and cartilage damage.”

SLAM can also be used to create objects made from two or more different materials so could be used to make even more complex soft tissue types, or drug delivery devices, where different rates of release are required.

A new collaboration to tackle the biggest health challenges faced by the West Midlands’ six million residents will use real-time clinical trials and health data to speed up research and improve cancer care, maternity services, child health, obesity, and dementia.

Birmingham Health Partners has teamed up with the Association of the British Pharmaceutical Industry (ABPI) and its members to make Birmingham a world leader in the development of precision medicines tailored to patients based on genetic, environmental and lifestyle factors.

The collaboration, founded on a Memorandum of Understanding, will create the Birmingham Health Partners & Industry Steering Group (BHPISG). The MoU was signed today at the Institute of Translational Medicine.

The West Midlands is already building an internationally competitive health and care infrastructure, with BHP at the heart of a collaborative and innovative ecosystem bringing together multidisciplinary clinical-academic teams to deliver on key elements of the Life Sciences Industrial Strategy and West Midlands Local Industrial Strategy.

This new collaboration will play to Birmingham’s strengths in health care data, digitalisation of health care services, genomic medicine, diagnostics and clinical trials and will help address the biggest challenges facing the city and region

The aim is to accelerate the development and adoption of new data-enabled innovations into clinical practice to benefit patients.

The new arrangement will work on four key regional health challenges – chosen because they have national or international relevance and can be scaled up if successful. It will build on the region’s strengths and expertise and the potential for significant economic impact. These are:

• Improving cancer outcomes
• Addressing maternal and paediatric health
• Tackling multimorbidity in an ageing population
• Improving NHS care by matching patient results with ongoing research.

Read the full story on the BHP website.

New research funded by the British Heart Foundation (BHF) aims to inform and improve clinical care for those living with an artificial heart pump.

A left ventricular assist device (LVAD) is a battery-operated, mechanical pump surgically implanted into patients who have end-stage heart failure. It is sometimes given to people who are on the waiting list for a heart transplant, and it helps the failing heart by restoring normal blood flow.

There are around 300 people currently living with an LVAD in the UK. While the device is both life-saving and symptom-relieving, recipients must undergo open heart surgery, and then have to carry the portable LVAD equipment with them at all times. These factors, as well as the need to sleep attached to a monitor, can have a detrimental impact on patients’ quality of life.

Patient-reported outcome measures (PROMs) – often in the form of short questionnaires – can help clinicians to assess quality of life through identifying what is going well and what might need addressing in a patient’s care.

However, people living with an LVAD believe that current PROMs are not fit for purpose, and that those used to measure quality of life do not address the wide range of problems that living with an LVAD presents. This includes psychological issues, such as anxieties over the equipment and impact on body image.

Now, thanks to £240,000 funding from the BHF, Birmingham Health Partners researchers will work with 150 LVAD patients from across the UK to produce a new PROM that will better measure their quality of life.

The research will be led by Dr Anita Slade, of the Centre for Patient Reported Outcomes Research (CPROR) at the University of Birmingham, who is based within the ITM. The CPROR is supported by the NIHR Birmingham Biomedical Research Centre – also within the ITM.

“Although an LVAD can extend the life of those living with severe heart failure and improve their symptoms, it does bring its own issues and requires substantial environmental and lifestyle changes for recipients and their families.

“Through discussions with a small group of people who have experience of life with an LVAD we have found that current patient related outcome measures (PROMs) do not address their specific needs and therefore are not able to accurately monitor changes in their quality of life. Understanding this is crucial when developing and evaluating new interventions to improve their health and well-being.

“Developing a new PROM with input from patients will ensure their voices are central to their care, and allow us to better understand how to improve their quality of life now and in the future.”

– Dr Anita Slade

It is hoped this research will inform and improve the clinical care of those living with an LVAD and even advise future research, policies and design proposals for the device.

Dr Lucie Duluc, Research Advisor at the BHF, added: “Implanting an LVAD can be life- saving and also buys more time for those awaiting a heart transplant. Some patients who were too unwell to walk around can see massive improvements to their life once receiving an LVAD, with many able to return to normal activities.

“However, recipients have to adapt to the many changes this makes to their life, and this can have an adverse impact on their health. Patients say that current PROMs do not address this, so this research will be pivotal to better reflect the real experience of people living with an LVAD. By putting patients at the core of this research, this could ultimately help shape the care they receive.

“We can only fund research like this thanks to the generous support of the public, in driving forward our mission to beat heartbreak forever.”

James’ story

James Maund, aged 48 and from Gloucester has been living with an LVAD since 2016 and will participate in this project.

The father-of-four said: “I was diagnosed with dilated cardiomyopathy and was told that my heart had enlarged and was functioning at 16%. Doctors told me I would need a heart transplant, but would need an LVAD first to get well enough to be eligible.

“After a high-risk operation, I began living my life with an LVAD. For the first three months, there was a lot of concern, including how I was going to support my family. Psychologically, I struggled with how this would affect my body image.

“I have come to terms with living with an LVAD, as without it, I wouldn’t be alive. I’m pleased that the views of people like me will be reflected in the development of the PROM.”

Injuries to the surface of the eye – as a result of burns, infections, inflammation, trauma and surgery – are a leading cause of sight loss. Despite this, there are few therapeutic options to modify, minimise or reverse scarring to maintain corneal transparency and visual function, and these are not always effective. With a global prevalence of 5.1%, the incidence of visual loss is around eight million people per year – accounting for around £150 billion in annual healthcare spending. As such, the WHO has made this a priority area programme to prevent world-wide blindness.

Birmingham hosts the largest medical device cluster in the UK with an impressive and extensive infrastructure in addition to world class hospital trusts. Specialist facilities here at the Institute of Translational Medicine including the Medical Device Testing and Evaluation Centre (MD-TEC) and the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) provide academics, clinicians and industry with a perfect environment to bring multi-disciplinary teams together and rapidly mature their emerging technologies.

In this case, bringing together neurosciences and ophthalmology expertise with Professor Liam Grover’s healthcare technologies team led to an important discovery – that combining decorin and collagen results in enhanced anti-scarring bioactivities. The team found that as a result, scarless wound healing was possible thanks to a new microenvironment that enables anti-fibrotic and anti-inflammatory factors. In addition, clinician and/or patient-reported visual outcomes were improved.

This combination of academic, clinical and technological expertise secured over £5million of internal and external funding from MRC, Wellcome Trust and NIHR to accelerate development of a synthetic, transparent, anti-scarring eye drop for the management of patients at risk of corneal scarring.

We are currently leading the first in-human clinical trial to assess the treatment’s safety and efficacy in patients with microbial keratitis. This will create a unique collaboration between the University of Birmingham, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust and the Queen Elizabeth Hospital Birmingham. The trial will also help move the technology along the translational pathway towards regulatory approvals and commercial realisation – already, the research team has consulted with patients, practitioners and regulatory bodies, and potential commercial partners have registered their interest in the technology.

The anti-scarring eye drop will not only have significant positive impacts for patients, but also socio-economic impacts – patients with ocular damage will carry a reduced cost-of-treatment burden as the eye drop may be self-administered in a home or community setting, negating the need for prolonged hospitalisation and clinic attendance. In the not too distant future, patients will be able to access this revolutionary sight-saving eye drop to prevent the devastating consequences of corneal damage.

Two trials, led by the NIHR Birmingham Biomedical Research Centre’s Gastroenterology team, are leading to changes in the diagnosis and treatment for patients with inflammatory bowel conditions.

The OPTIMA trial uses confocal laser endomicroscopy to detect a number of labelled  antibodies in patients, which acts as a reliable indicator for how well patients will respond to treatment, particularly in the early stages. The results from OPTIMA are also leading to better genotypic (genetic information) and phenotypic (physical characteristics) information.

Confocal laser endomicroscopy helps to increase the image quality of microscopes, which leads to a better understanding of cells and tissues in the body.

OPTIMA have currently recruited 30 patients with a range of inflammatory conditions. The results of OPTIMA could lead to stratified treatments, where a patient’s treatment plan is more closely tailored to them, rather than the conventional standard treatments, which may not work for all patients. The endocytoscope, a very high magnification endoscope, is also being used in parallel to the OPTIMA study to accurately detect the healing of the lining of the intestine upon treatment.

PICASSO is an ongoing trial that has so far recruited more than 300 patients across several centres. The trial is likely to lead to a new endoscopic scoring system, which will lead to a more effective assessment for how well patients with ulcerative colitis are recovering from their disease after treatment.

The team, based in the Institute of Translational Medicine on the Queen Elizabeth Hospital Birmingham (QEHB) site, are led by Dr Marietta Iacucci, Honorary Consultant Gastroenterologist at University Hospitals Birmingham and a Reader in Gastroenterology at University of Birmingham – both founding members of Birmingham Health Partners.

“Both OPTIMA and PICASSO are assessing how new technology could be used to provide improved outcomes for patients,” said Dr Iacucci.

“In fields like inflammatory bowel disease and cancer, treatment is going to become increasingly specific and tailored to individuals, which should lead to both reduced complication and better outcomes.

“The use of instruments like the endocytoscope and the confocal laser endomicroscope means we can clearly see at the histological level whether treatments are actually working, with the clearer, sharper, magnified images providing more information for healthcare professionals than ever before.”

Dr Iacucci and her team were also recognised for their innovative work at the recent Birmingham Health Partners Research Showcase, with their exhibit awarded the Best Stand prize.