Leeds research could revolutionise vaccine development

University of Leeds | December  2019 |Leeds research could revolutionise vaccine development

A new approach to the polio vaccine has been developed by scientists at the University of Leeds, unlike traditional vaccines this approach uses harmless proteins called virus-like proteins (VLPs) rather than a live virus. The VLPs are created in the laboratory to imitate effects of a virus on the immune system. But they do not carry genetic material and are not infectious. 

Over the next couple of months, scientists will investigate the yield and quality of vaccine produced with the aim of  developing a production process that can be used by low-to-middle income countries.

The vaccine development programme has been led by Professors Nicola Stonehouse and Dave Rowlands from Leeds’ Faculty of Biological Sciences (Source: University of Leeds).

Full details are available in the University of Leeds press release 

 

 

Cancer survivors have raised heart risk, reports a US population-based study of cardiovascular disease mortality risk patients with cancer

Sturgeon, K.M , et al | 2019| A population-based study of cardiovascular disease mortality risk in US cancer patients| European Heart Journal| ehz766| https://doi.org/10.1093/eurheartj/ehz766

The European Heart Journal has published research that looked at three million US patients, across 28  types of  cancers, over a period of  40 years, the experts behind this analysis found that more than one-tenth of patients died from cardiovascular diseases. The research highlights the incidence of cardiovascular disease (CVD)  in patients diagnosed with breast, prostate, or bladder cancer.  The team also observed that from the point of cancer diagnosis onward patients with cancer (all sites) are at elevated risk of dying from CVDs compared to the general US population (Source: Sturgeon, et al. 2019).

 

The journal article is available in full from The European Heart Journal

Abstract

Aims

 

This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis.

 

Methods and results

The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3 234 256 US cancer survivors (1973–2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1 228 328 patients (38.0%) died from cancer and 365 689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at less than 35 years of age. Further, CVD mortality risk is highest within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population.

Conclusion

The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.

 

In the news:

BBC News Cancer survivors ‘have higher heart risk’

Health Foundation: Mortality and life expectancy trends in the UK

The Health Foundation | December  2019 | Mortality and life expectancy trends in the UK

The Health Foundation commissioned a research team from the London School of Economics and the Vienna Institute of Demography to carry out a comprehensive literature review and analysis of trends, and how they compared with what is happening in other countries. This research forms the basis of the report Mortality and life expectancy trends in the UK. 

 

Image source: health.org.uk

Full details from The Health Foundation 

Mortality and life expectancy trends in the UK

Lancet Public Health: Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis

Stubbs, J.L. et al. | 2019 |Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis | The Lancet Public Health | https://doi.org/10.1016/S2468-2667(19)30188-4

The findings of a systematic review with meta-analysis demonstrates the burden of traumatic brain injury (TBI) among the homeless populations. The researchers behind the study aimed to evaluate the lifetime prevalence of TBI in this population, and to summarise findings on TBI incidence and the association between TBI and health-related or functioning-related outcome. They report that marginally housed individuals have an increased prevalence than the general population, with TBI being associated with poorer health and general functioning. 

Summary

Background

Homelessness is a global public health concern, and traumatic brain injury (TBI) could represent an underappreciated factor in the health trajectories of homeless and marginally housed individuals. We aimed to evaluate the lifetime prevalence of TBI in this population, and to summarise findings on TBI incidence and the association between TBI and health-related or functioning-related outcomes.

 

Methods

For this systematic review and meta-analysis, we searched without date restrictions for original research studies in English that reported data on the prevalence or incidence of TBI, or the association between TBI and one or more health-related or function-related outcome measures. Studies were included if they had a group or clearly identifiable subgroup of individuals who were homeless, marginally housed, or seeking services for homeless people. With use of random-effects models, we calculated pooled estimates of the lifetime prevalence of any severity of TBI and the lifetime prevalence of moderate or severe TBI. We used meta-regression to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. We then summarised findings from all studies that evaluated TBI incidence and the association between TBI and health-related or functioning-related outcomes. All statistical analyses were done using R version 3.5.1. The study is registered with PROSPERO, number CRD42019119678.

 

Findings

Of 463 potentially eligible studies identified by the search, 38 studies were included in the systematic review and 26 studies were included in the meta-analysis. The lifetime prevalence of any severity of TBI in homeless and marginally housed individuals (21 studies, n=11 417 individuals) was 53·4% and the lifetime prevalence of moderate or severe TBI (12 studies, n=6302) was 24·9%. The definition of TBI, the method used to ascertain TBI history, and the age of the sample significantly moderated estimated lifetime prevalence of any severity of TBI. TBI was consistently associated with poorer self-reported physical and mental health, higher suicidality and suicide risk, memory concerns, and increased health service use and criminal justice system involvement.

 

Interpretation

The lifetime prevalence of TBI is high among homeless and marginally housed individuals, and a history of TBI is associated with poorer health and general functioning. Health-care providers and public health officials should have an increased awareness of the burden of TBI in this population. Prospective and longitudinal studies are needed to better understand how the health of this population is affected by TBI.

The article is available to download from The Lancet Public Health 

Royal College of Physicians: The case for trusts supporting clinicians to become more research active and innovative

Royal College of Physicians | November  2019 |Benefiting from the ‘research effect’: The case for trusts supporting clinicians to become more research active and innovative

The Royal College of Physicians (RCP) has published Benefiting from the ‘research effect’ which outlines how NHS trusts can better support clinicians to become research active, and the huge benefits this will deliver for patients, trusts and staff themselves.

 

Image source: rcplondon.ac.uk

Key recommendations

• The impetus for more research in the NHS has never been greater. Research-active trusts boost outcomes for patients, and the Care Quality Commission includes clinical research activity in trust inspections.
• Doctors hugely value research as an important part of their job but are hampered by a lack of protected time for patient-facing research. Participation in research is inked with better morale among staff and improved retention and recruitment.
• There is large regional variation in research activity. Smaller and rural hospitals must also be encouraged to become more research active and benefit from the research effect.
• Embedding protected time must be a key priority. Maintaining medical research funding, involving patients in research design, improving R&D departments and access to research skills are also vital.

Part of the RCP’s Delivering Research for all project to support access to research opportunities across the UK for all clinicians and patients, Benefiting from the research effect is endorsed by 20 other organisations.

Read the full report from Royal College of Physicians

Full press release from the Royal College of Physicians

In the news:

OnMedica Call for trusts to engage more in research

Manchester research: New assessment could identify risks of frailty

University of Manchester|  November  2019 | New assessment could identify risks of frailty

A group of researchers from the  Universities of Strathclyde,  Manchester, Liverpool, Edinburgh and Yale have developed a new assessment which could be used to identify individual’s risk factors for frailty. 

Increasing the risk of frailty is a defining characteristic of the ageing process but it has no precise clinical definition and there are currently no analytical techniques that can accurately quantify its status.

The assessment could also determine whether a patient would be able to withstand intensive courses of treatment, such as chemotherapy, as well as helping to understand, prevent, cure or minimise age-related impairments (Source: University of Manchester).

The research has been published in the journal Nature Communications.

Rattray, N. J. W., | 2019|Metabolic dysregulation in vitamin E and carnitine shuttle energy mechanisms associate with human frailty | Nature Communications | https://www.nature.com/articles/s41467-019-12716-2

Abstract 

Global ageing poses a substantial economic burden on health and social care costs. Enabling a greater proportion of older people to stay healthy for longer is key to the future sustainability of health, social and economic policy. Frailty and associated decrease in resilience plays a central role in poor health in later life. In this study, we present a population level assessment of the metabolic phenotype associated with frailty. Analysis of serum from 1191 older individuals (aged between 56 and 84 years old) and subsequent longitudinal validation (on 786 subjects) was carried out using liquid and gas chromatography-mass spectrometry metabolomics and stratified across a frailty index designed to quantitatively summarize vulnerability. Through multivariate regression and network modelling and mROC modeling we identified 12 significant metabolites (including three tocotrienols and six carnitines) that differentiate frail and non-frail phenotypes. Our study provides evidence that the dysregulation of carnitine shuttle and vitamin E pathways play a role in the risk of frailty.

Full article available from Nature Communications

University of Manchester [press release]  New assessment could identify risks of frailty

Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds

NIHR | September 2019| Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds

The Lancet has now published the findings of a trial that aimed to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia.

Researchers from King’s College London carried out the PHOENIX trial comparing the current and new methods in women suffering from pre-eclampsia at 34-37 weeks of pregnancy, to see if they could reduce adverse outcomes for the mother such as hypertension, and without impacting substantially on the baby.

In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications.

Lead author Professor Lucy Chappell from King’s Department of Women & Children’s Health said: “Our trial supports offering initiation of delivery in women with late preterm pre-eclampsia. Doctors and women will need to consider the trade-off between lower maternal complications and severe hypertension against more neonatal unit admissions, but the trial results tell us that these babies were not sicker from being born earlier. We suggest that these results should be discussed with women with late preterm pre-eclampsia to allow shared decision making on timing of delivery.” (Source: NIHR)

NIHR press release Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds

Full reference: Chappell, L.C., et al | 2019| Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial finds | The Lancet | DOI:https://doi.org/10.1016/S0140-6736(19)31963-4

Summary
Background

In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia.

Methods

In this parallel-group, non-masked, multicentre, randomised controlled trial done in 46 maternity units across England and Wales, we compared planned delivery versus expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia from 34 to less than 37 weeks’ gestation and a singleton or dichorionic diamniotic twin pregnancy. The co-primary maternal outcome was a composite of maternal morbidity or recorded systolic blood pressure of at least 160 mm Hg with a superiority hypothesis. The co-primary perinatal outcome was a composite of perinatal deaths or neonatal unit admission up to infant hospital discharge with a noninferiority hypothesis (non-inferiority margin of 10% difference in incidence). Analyses were by intention to treat, together with a per-protocol analysis for the perinatal outcome.

The trial is closed to recruitment but follow-up is ongoing.

Findings

Between Sept 29, 2014, and Dec 10, 2018, 901 women were recruited. 450 women (448 women and 471 infants  analysed) were allocated to planned delivery and 451 women (451 women and 475 infants analysed) to expectant management. The incidence of the co-primary maternal outcome was significantly lower in the planned delivery

group (289 [65%] women) compared with the expectant management group. The incidence of the co-primary perinatal outcome by intention to treat was significantly higher in the planned delivery group (196 [42%] infants) compared with the expectant management group. The results from the per-protocol analysis were similar. There
were nine serious adverse events in the planned delivery group and 12 in the expectant management group.
Interpretation There is strong evidence to suggest that planned delivery reduces maternal morbidity and severe hypertension compared with expectant management, with more neonatal unit admissions related to prematurity but no indicators of greater neonatal morbidity. This trade-off should be discussed with women with late preterm
pre-eclampsia to allow shared decision making on timing of delivery

The full article is available from The Lancet