Tag: ITM News

Birmingham Health PArtners researchers from the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust (UHB) have launched a new study funded by The Drake Foundation to review and potentially enhance concussion diagnosis in football.

This new study, supported by the Premier League Doctors Group, which is allowing access to players, is running throughout the 2018/19 football season. It involves saliva and urine samples being collected from injured Premier League players, as well as uninjured “control” players, by club doctors immediately post-match and at further time points over the course of a players’ recovery.

These samples are then being tested in BHP laboratories using a new ground-breaking test, called the ‘Birmingham Concussion Test’, which has been developed following a decade of research led by academic neurosurgeon Professor Tony Belli.

The test looks for molecules in the blood, saliva or urine known as microRNAs, which can act as biomarkers to indicate whether the brain has suffered injury. The patented technology from the University is being commercially developed in partnership with Mirna Diagnostics Limited which owns the global patent licence of these biomarkers.

This expands research also being carried out by BHP, which began in 2017 and is currently ongoing, testing the urine and saliva of concussed Rugby Football Union players.

This research is part of the ongoing REpetitive COncussion in Sport (RECOS) study, by BHP in collaboration with the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC).

In the future, it is hoped that the Birmingham Concussion Test could be used pitch-side and would have the potential to assist in return-to-play decisions or concussion diagnosis across sports, from grassroots to professional, in addition to military and other frontline settings.

Early and accurate diagnosis

Professor Belli explained: “Early and accurate diagnosis of concussion is one of the biggest challenges we face clinically and is particularly a major concern in the sporting world.

“This exciting new study is an important addition to the breadth of research we are undertaking into concussion and player welfare in sport more broadly.”

Dr Patrick O’Halloran, Sports Concussion Research Fellow at the University of Birmingham, Sport and Exercise Medicine Registrar at UHB, and Academy Doctor at Wolverhampton Wanderers FC, said: “This research has the potential to benefit professional, grassroots and youth level footballers alike, making the process for diagnosing concussion as effective as possible. Similarly, this may be valuable in other sports or for patients in NHS A&E departments.”

James Drake, Founder of The Drake Foundation, a not-for-profit organisation committed to improving evidence-based measures for the management of concussion injuries in contact sport, said: “We are delighted to fund this essential study in Premier League football. The conversation around concussion has come a long way in the last five years and scientific research such as this is essential in keeping our players safe.”

This latest study will also look to evaluate the effectiveness of the current Premier League Doctors Group Standard Operating Procedure for diagnosis of concussion. When a team doctor suspects a player has been concussed, the following data will be sought to accelerate and more accurately diagnose any potential concussion:

• Pitch-side assessment
• Video review of the incident at the pitch-side
• Subsequent clinical reviews of the player after the match and in the days following the game
• The time course and trajectory of recovery post injury

Scientists at the University of Birmingham have developed a novel eye drop that rapidly reduces sight-threatening scarring to the surface of the eye.

The surface of the eye (the cornea) is usually transparent, but scars resulting from eye infection or trauma make it opaque causing blurred vision or in extreme cases complete blindness.

Their pre-clinical research, published in npj Regenerative Medicine, shows that within a matter of days the eye drop speeds healing, reduces scarring and improves corneal transparency compared to the current standard of care for Pseudomonas aeruginosa, an eye infection commonly associated with poor contact lens hygiene.

The current standard of care for eye infection are eye drops containing antibiotics and corticosteroids to reduce inflammation, followed by intensive lubrication to prevent further damage to the eye during blinking. These treatments effectively sterilise the eye, although some patients are left with visual ‘hazing’ due to scars on the cornea.

The only option to correct this is costly and cumbersome surgical interventions, such as corneal transplants, which are fraught with risks of failure or rejection.

The Birmingham scientists, led by Professor Liam Grover, Director of the Healthcare Technologies Institute (HTI) at the ITM, and Professor Ann Logan from the University’s Institute of Inflammation and Ageing, have developed the eye drop which consists of a fluid gel loaded with a natural wound-healing protein called Decorin.

Professor Ann Logan said: “This innovative fluid gel in the eye drop is designed to retain the Decorin on the surface of the eye, and form a ‘therapeutic bandage’ that promotes scarless healing.”

Professor Liam Grover explained: “The fluid gel is a novel material that can transition between a solid and liquid state. This means it contours itself to the surface of the eye, is retained there, and is only slowly removed by blinking.”

This research has shown for the first time that the fluid gel has a therapeutic effect in its own right, and the researchers believe it forms a protective barrier that protects the surface of the eye from further damage caused by blinking. The fluid gel has been patented by University of Birmingham Enterprise.

Dr Richard Moakes, also from the School of Chemical Engineering explained: “We are now continuing our work to test and refine the formulation for this novel anti-scarring eye ‘bandage’.”

Dr Lisa Hill, from the University’s Institute of Clinical Sciences, said: “The anti-scarring eye drop has the potential to vastly improve outcomes for patients with eye infection and trauma. It could also help save many people’s sight, particularly in the developing world where surgical interventions such as corneal transplants are not available.”

University of Birmingham researchers based at the Institute of Translational Medicine have found two biomarkers that could be used to identify a heart condition known as atrial fibrillation in patients who have three ‘clinical risks’.

Atrial fibrillation is the most common heart rhythm disturbance, affecting around 1.6 million people in the UK. Those with atrial fibrillation may be aware of noticeable heart palpitations, when their heart feels like it is pounding, fluttering or beating irregularly. Sometimes atrial fibrillation does not cause any symptoms and a person who has it is completely unaware that their heart rate is irregular.

Now scientists have identified patients are more at risk of atrial fibrillation if they have three ‘clinical risks’ – they are older aged, male and have a high Body Mass Index. These patients, say the scientists, could be screened for atrial fibrillation by testing their blood to see if they have elevated levels of two biomarkers – a hormone secreted by the heart called brain natriuretic peptide (BNP) and a protein responsible for phosphate regulation called fibroblast growth factor-23 (FGF-23).

The research was carried out by scientists from the Institute of Cardiovascular Sciences and the Institute of Cancer and Genomic Sciences at the University’s College of Medical and Dental Sciences and is published today in European Heart Journal.

First author Dr Winnie Chua said: “People with atrial fibrillation are much more likely to develop blood clots and suffer from strokes. To avoid strokes it is important for them to take anticoagulant drugs to prevent blood clotting. However, atrial fibrillation is often only diagnosed after a patient has suffered a stroke.

“Therefore it is important that patients at risk are screened so that they can begin taking anticoagulants to prevent potentially life-threatening complications.”

Joint First author Yanish Purmah added: “An electrocardiogram (ECG), a test which measures the electrical activity of your heart to show whether or not it is working normally, is usually used to screen patients for atrial fibrillation.

“ECG screening is resource-intensive and burdensome for patients therefore it is important that the right patients are selected for this type of screening

“The biomarkers we have identified have the potential to be used in a blood test in community settings such as in GP practices to simplify patient selection for ECG screening.”

Until now, most studies identifying biomarkers in patients with atrial fibrillation have been hypothesis-driven and involved the analysis of a single or small selection of blood biomarkers. In this study, the scientists analysed 40 common cardiovascular biomarkers in a cohort of 638 hospital patients who were recruited between September 2014 and August 2016.

To obtain the results, the scientists combined traditional statistical analysis with completely new and innovative machine learning techniques.

Senior author Dr Larissa Fabritz said: “The research outcomes were surprising. While BNP is already a known and widely used in clinical practice biomarker, the results around the effectiveness of the FGF-23 biomarker was an unexpected and new finding. FGF-23 is only currently used in a research based environment, but we have shown how its use could be invaluable in a clinical setting.”

Corresponding author Professor Paulus Kirchhof, Director of the University of Birmingham’s Institute of Cardiovascular Sciences, said: “We hope that, as the result of our findings, more people with what can often be a silent disease are diagnosed so that any complications can be prevented.”

Funded by the University of Birmingham, the research was supported by CATCH ME, an EU-funded consortium led by the University of Birmingham, the British Heart Foundation and Leducq Foundation. The research was carried out in collaboration with Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals Birmingham NHS Foundation Trust, the European Society of Cardiology, The German Atrial Fibrillation NETwork (AFNET), and Health Data Research UK.

Professor Metin Avkiran, Associate Medical Director at the British Heart Foundation (BHF), added: “Atrial fibrillation increases the risk of stroke, a serious condition that causes over 36,000 deaths in the UK each year, but is often detected too late. This research has used sophisticated statistical and machine learning methods to analyse patient data and provides encouraging evidence that a combination of easy-to-measure indices may be used to predict atrial fibrillation.

“The study may pave the way towards better detection of people with AF and their targeted treatment with blood-thinning medicines for the prevention of stroke and its devastating consequences.”

The research, which began in 2013, is ongoing and next steps will involve follow-up appraisals of the patients recruited to the study in order to further improve the prevention and treatment of atrial fibrillation.

The Centre for Rare Diseases at the Institute of Translational Medicine has this week become part of the NIHR (National Institute for Health Research) BioResource network. The BioResource team at will be led by Dr Graham Lipkin while Humeira Hafsa, research nurse, will take on the role of Clinical Trials Coordinator.

The NIHR BioResource for Translational Research in Common and Rare Diseases is a national resource of samples collected from patients and members of the public who have volunteered to be recalled for research, based on their genotype and phenotype.

When patients are recruited, Humeira will collect a range of blood samples and add them to the national ‘biobank’ for future use in research. Being involved in biobanking is obviously optional – patients can opt in and out as it suits their lives and condition.

Possible candidates will be identified by Humeira and then approached to become involved and given further information when they come in for an appointment with their own consultant. If interested they will then meet with Humeira who will talk more about the system before signing them up and taking samples.

The NIHR BioResource provides researchers with unprecedented access to highly characterised patients with common and rare diseases, as well as volunteers from the general population. Patients and the public can volunteer to provide a DNA sample and information about their health, lifestyle and family history. Following genomic and phenotypic characterisation, specific individuals can be recalled, on a national basis, to participate in both academic and industry-led early translational (experimental medicine) research studies.

Humeira has been a research nursing assistant for two years, previously assisting in various trials. Before moving across to research she worked as a Health Care Assistant on the wards and started off as an apprentice in business and administration at UHB.

The NIHR BioResource has been established through a partnership with NHS Blood and Transplant, and builds on the expertise of NIHR Biomedical Research Centres and NIHR Clinical Research Facilities.

Over 100,000 people have already been recruited to the NIHR BioResource and up to 50,000 new participants will be recruited each year. The NIHR BioResource is also increasing the number of study participants available through recruitment of people with selected conditions, such as inflammatory bowel disease, fatty liver disease and up to 100 rare diseases.

The NIHR BioResource uses information on people’s genotype, phenotype or both, to match them to research studies that are looking for volunteers with and without health conditions. By joining, you will be helping researchers investigate and understand why some people have a disease. If you would like to join the NIHR BioResource, email: nbr@bioresource.nihr.ac.uk.

The first military and civilian wound research centre of its kind in the world was officially opened at the Institute of Translational Medicine, as part of the Queen Elizabeth Hospital in Birmingham today, aiming to minimise the psychological and physical impact of scarring among armed forces personnel and civilians wounded in terrorist attacks. The Scar Free Foundation Centre for Conflict Wound Research is a ground-breaking national facility that marks a vital step in achieving the charity’s goal of achieving scar free healing within a generation.

The new world-class centre has the potential to improve the lives of the estimated 4.5 million people in the UK who currently live with a physical scar which affects their wellbeing. Scarring has a particularly significant long-term impact on survivors of conflict and terrorist attack, with more than 6,000 members of the British armed forces having been seriously injured or scarred in recent conflicts.

Veterans who have survived physical injury are also at greater risk of experiencing mental health problems. The new centre will support the creation of bespoke psychosocial interventions to help veterans and their families adjust to living with scars.

Building on the UK’s leading role in wound healing and regenerative research, the new centre will bring together scientists and clinicians to investigate the body’s healing process following trauma common to conflicts and attack (chemical, burn and blast injury). Over 480 patients, many of them injured veterans, will take part in research over the next three years, and the expert team will spearhead the development of new psychological, clinical and biological treatments including:

• The first clinical trial of a battle-ready, transportable dressing, which can be used in the field of conflict to help the skin heal with reduced scarring – this has potential civilian use e.g. at the scene of traffic accidents and other severe trauma.
• Pilot of tailored psychological treatments to help seriously injured Armed Forces personnel cope with life with an altered, scarred appearance. This project will involve veterans from recent operations in Iraq and Afghanistan, recruited through The CASEVAC Club (which represents injured veterans – pictured above).
• Development of improved laser treatment to correct historic scarring amongst veterans and civilians.

Brendan Eley, Chief Executive of the Scar Free Foundation, said:

“The physical and emotional effects of scarring are serious and often life changing. Our aim is to deliver scar free healing within a generation by establishing a pioneering programme of medical research in the UK. The launch of this centre is an important part of achieving our goal, and by working with world leading experts, scientists, and researchers, we are discovering revolutionary new treatments that will transform the lives of millions worldwide.”

The Scar Free Foundation Centre for Conflict Wound Research has been established in partnership with Birmingham Health Partners founder members the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, as well as the Centre for Appearance Research at the University of the West of England, and The CASEVAC injured veterans club. Crucially, the centre will be closely integrated with a wider network of academic and clinical institutions in the UK and beyond to ensure that the work is inclusive and at the forefront of scarring research.”

Professor Naiem Moiemen, Director of The Scar Free Foundation Centre for Conflict Wound Research, said:

“We are delighted to host the new Scar Free Foundation Centre for Conflict Wound Research here in Birmingham. It builds upon our ongoing partnership with the Scar Free Foundation since June 2012, with the Centre for Burns Research. We are honoured to be able to continue our work with Scar Free and are committed for the long-term to achieve the Scar Free Foundation’s mission to achieve scar free healing within a generation.”

Research undertaken at The Scar Free Foundation centre will cost £4.8 million over three years. This is being funded by the Chancellor using LIBOR funds of £3 million – the largest grant announced in the final round of LIBOR funding – alongside an additional £1.5 million from the Foundation’s partners, including the Ana Leaf Foundation and JP Moulton Charitable Foundation.

The work carried out is actively supported by senior armed forces personnel including the Chief of the Defence Staff and the Surgeon General. Other Armed Forces charities including Help for Heroes, Royal British Legion and Forces in Mind Trust are also cooperating in research activity.”

Birmingham Health Partners-led RePHILL (REsuscitation with Pre-HospItaL bLood products) is the UK’s first trial in which eligible patients are recruited by ‘pre-hospital emergency medical (PHEM) teams’ and are randomly allocated treatment with either pre-hospital blood products or the standard care, saline.

The RePHILL trial assesses the effects of giving trauma patients blood products after a major injury, but before reaching hospital, and thanks to regional collaboration, has now recruited over 100 patients. [As at August 2019, the team has now reached 300 recruits.]

Alongside the work taking place by the trial sponsor, University Hospitals Birmingham NHS Foundation Trust (UHB), this regional partnership project includes the University of Birmingham, Midlands Air Ambulance, The Air Ambulance Service, East Anglian Air Ambulance, MAGPAS Air Ambulance, emergency departments and blood banks across the West Midlands and the East of England.

The trial, which at its most basic is about saving lives and making the best use of precious blood stocks, is being run by the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) team (based here at the ITM) and  is managed by the University of Birmingham Clinical Trials Unit.

Amy Bamford, Senior Research Sister, said: “Currently several ambulance services and air ambulance routinely give blood to trauma patients, but there is no strong evidence to demonstrate that giving these is beneficial and, of course, there are significant clinical, logistical and financial consequences to giving all patients this treatment.

“RePHILL randomly allocates patients to receive either a combination of O-negative blood and freeze dried plasma or saline (the standard care), and the aim is to assess if early use of these precious resources does actually save lives”.

Hazel Smith, Research Paramedic, emphasised how important collaboration has been in expanding the trial and reaching recruits: “It’s not easy in an emergency situation to stop and think about the trial, but all those involved have been brilliant at doing just that, and then following up with the inevitable paperwork it produces.”

Time is of the essence when a recruit to the trial is being treated. A two hour window is vitally important to follow up after the patient is initially treated, which is then followed by thirty days of measurements and organ function monitoring. Currently 11 nurses at UHB between them provide 24/7 cover for the trial, plus a trial pharmacist.

Some of the support the trial receives has been free from local charities, including Midlands Freewheelers. This team, usually seen on motorbikes moving blood products and other medical essentials around the region, are helping to get the large boxes of blood and saline where they need to be and so have taken to four wheels, rather than two, to manage this.

Hazel added: “All of those involved play an essential role in keeping this long term trial running, from the people who so carefully pack the randomised boxes – to those who get them where they need to be and then the doctors and paramedics for putting the treatment into action.” It is hoped that at the current rate of recruitment the trial will end in 2019.