No simple choices: tickets now open for our Cambridge Festival panel discussion on privacy and consent in health data research
How is health data used for research? What choices do researchers make when using patient data for their research?
And what impact do those choices have not only on the quality and reach of their research, but also on patient privacy and public trust?
At this free in-person and virtual event, researchers Professor Angela Wood, Dr Raj Jenner and Dr Ari Ecole will join patient advocate Rosanna Fennessy as they look at four real-life examples of local research where health data was used.
The panel will then explore the challenges and concerns that emerge from different types of data use – followed by a Q&A from the audience including those logging in online.
Book your tickets on EventBrite
Join us either in person at the University of Cambridge Clinical School or virtually from the comfort or your own home, on Thursday 14 March 2024 from 5.30pm to 7.00pm. Make sure you don’t miss out: visit our Eventbrite page to reserve your spot.
Event directions and accessibility information
For more information about this event, including directions and accessibility Information, visit our PPIE section on our website.
This event is part of this year’s Cambridge Festival. We will also be at the Cambridge Academy of Science and Technology for the Festival’s family weekend on 16 March – put it in your diary now!
About the NIHR
The National Institute for Health and Care Research (NIHR) is the UK’s largest funder of health and care research. Its mission – to improve the health and the wealth of the nation through research – is shared across all its constituent programmes, units and centres.
Candidates sought for NIHR senior leadership posts
Do you want to work for an outstanding organisation at the forefront of Health and Care research delivery?
The National Institute for Health and Care Research (NIHR) is seeking individuals with extensive experience of senior leadership within a health or care specialty or setting for 30 National Specialty Lead and four National Setting Lead part-time roles to act as high calibre ambassadors for the NIHR Research Delivery Network and to provide senior leadership and strategic direction for matters of research delivery across the relevant specialty and setting.
The roles are available in the following Specialties and Settings on a 0.1 Full-Time Equivalent (FTE) basis (more FTE may be available for several posts as detailed in the further particulars):
Ageing; Anaesthesia, Perioperative Medicine and Pain Management; Cancer; Cardiovascular; Children; Critical Care; Dementia & Neurodegeneration; Dermatology; Diabetes, Metabolic & endocrine; Ear, Nose & Throat; Gastroenterology & Hepatology; Genetics; General Practice; Haematology; Imaging; Infection; Mental Health; Musculoskeletal & Orthopaedics; Neurology; Ophthalmology; Oral & Dental; Palliative Care; Public Health; Renal; Reproductive Health & Childbirth; Respiratory; Social Care; Stroke; Surgery; Trauma & Emergency Care.
Hospitals; Primary Care; Community-Based; Residential Care.
These high-profile national roles will report into the RDN Strategic Development Director and form part of the RDN National Specialty and Setting Leadership team, and will proactively develop effective relationships with decision-makers in the public sector, charity and life science organisations (non-commercial, pharma, medtech, diagnostics and biotech) and other related external stakeholders to further the aims of the NIHR RDN. The posts will commence from April 2024.
To apply please submit a concise CV and a supporting statement (maximum of three pages of A4, font size 12) setting out your vision and suitability for the role. The deadline for applications is midnight on Sunday 25 February and virtual interviews are anticipated to take place during the period 11-22 March.
For further information about these roles and to submit an application, please visit the University of Leeds website or for any queries please contact NSSLappts@nihr.ac.uk.
New trial brings screening for oesophageal cancer closer
A man from Cambridge is the first to join the surveillance part of a clinical trial part-funded by NIHR Cambridge BRC and supported by the NIHR Cambridge Clinical Research Facility, that could see routine screening for oesophageal cancer introduced into the NHS, potentially halving deaths from this cancer every year.
The capsule sponge, known as the pill-on-a-thread, is a quick and simple test for Barrett’s oesophagus, a condition that can be a precursor to cancer. Heartburn is a common symptom of Barrett’s oesophagus, a changing of cells in the food pipe.
The BEST4 trial launched at Addenbrooke’s today is the final step to see if the capsule sponge can prevent oesophageal cancer when used to screen or monitor those most at risk of the disease. If so, it could become a national screening programme across the NHS, in the same way mammograms are used to screen for breast cancer.
The first stage of the trial, BEST4 Surveillance, is for people already diagnosed with Barrett’s oesophagus. It will look at whether the capsule sponge test could replace endoscopies to monitor their condition. Participants will receive both examinations during the trial with results used to assess their risk of developing oesophageal cancer.
The second stage of the trial, BEST4 Screening, opens in the summer and will recruit 120,000 people aged over 55 on long-term treatment for heartburn.
Tim Cowper, 49, a brewer from Cambridge (pictured), has had acid reflux, or heartburn, every night since he was 16. A routine health check while he was at university resulted in the shock diagnosis of Barrett’s oesophagus. After his diagnosis, he has been monitored ever since.
Tim said: “I was alarmed when I was told that having Barrett’s meant having pre-cancerous cells in my gullet. Cancer is never a nice word to hear, especially when you are so young, but luckily, I’ve had my condition monitored.
“Since my diagnosis, I’ve been going for an endoscopy at least once every three years to monitor my oesophagus. It is not pleasant at all. Each time I have a thick tube pushed down through my mouth and I can feel every single one of the biopsies taken by the camera. Swallowing a capsule sponge is a much better experience and I now get the test before my regular endoscopy appointment.”
The trial builds on decades of research led by Professor Rebecca Fitzgerald (pictured), a doctor and researcher at Addenbrooke’s and the University of Cambridge. She and a team of scientists, clinicians and nurses at the Early Cancer Institute, University of Cambridge and Cancer Research UK Cambridge Centre, invented and refined the capsule sponge test.
Prof Fitzgerald said: “The capsule sponge, a quick and simple test for Barrett’s oesophagus, could halve the number of deaths from oesophageal cancer every year. Cases of oesophageal cancer have increased six fold since the 1990s. On average only 12% of patients live more than five years after diagnosis. Most don’t realise there’s a problem until they have trouble swallowing. By then it is too late.
“The first phase of the trial looks at whether the capsule sponge can be used as a cancer early warning system for patients diagnosed with Barrett’s. Using the capsule sponge and a new set of lab tests, we will be monitoring patients to see if we can prevent more cases of cancer.”
Barrett’s oesophagus is currently identified via an endoscopy and a biopsy in hospital following a GP referral. It is time-consuming, unpleasant, and quite invasive for patients, as well as being expensive for the healthcare system.
The capsule sponge is a small, easy to swallow capsule on a thread, which contains a sponge. The patient swallows the capsule which dissolves in the stomach and the sponge expands to the size of a 50p coin.
The sponge is carefully pulled back up using the string, collecting cells for laboratory testing. The test takes just 10 minutes and can be done in a GP surgery.
Cancer Research UK and others have funded several successful clinical trials to demonstrate that the test is safe, accurate and can detect 10 times more cases of Barrett’s oesophagus than standard practice.
The test is faster and cheaper than endoscopy, which is currently used to diagnose and monitor Barrett’s oesophagus and oesophageal cancer. It has been piloted in health services in England, Scotland and Northern Ireland for patients who are currently on waiting lists for endoscopy because they have long-term heartburn or diagnosed with Barrett’s oesophagus.
Executive Director of Research and Innovation at Cancer Research UK, Dr Iain Foulkes, said: “Around 59% of all oesophageal cancer cases are preventable. Yet endoscopy, the gold standard for diagnosing and treating this cancer, is labour-intensive. We need better tools and tests to monitor people most at risk.
“Backed by funding from Cancer Research UK, the capsule sponge has become one of the most exciting early detection tools to emerge in recent years. It’s a remarkable invention by Professor Fitzgerald and her team, and previous trials have shown how powerful it can be in identifying cancer earlier.
“There are 9,200 people diagnosed with oesophageal cancer in the UK every year and the capsule sponge will mean they can benefit from kinder treatment options, if their cancer is caught at a much earlier stage.”
The future Cambridge Cancer Research Hospital will bring together clinical and research expertise, including Professor Fitzgerald’s work, under one roof. It will enable the development and discovery of more non-invasive devices like the capsule sponge, to detect cancer earlier, and save more lives.
Tim said: “I’m really lucky as my own condition hasn’t got worse and there are no signs of progression to full cancer. I take care with my diet to keep my acid reflux in check, but I can still have the odd curry and, most importantly, taste the beer I make!
“Taking part in this study means a lot to me. My condition was caught before it even became a fully-fledged cancer. Sadly, many others aren’t so lucky. The capsule sponge could help others whose acid reflux is causing something more sinister.”
The BEST4 Surveillance Trial is led from Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, with trial design, coordination and analysis of results by the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London. More information about the BEST4 trial can be found at www.best4trial.org
Paediatric cancers: a researcher’s quest to find answers
Clinician, researcher, teacher, mother: it’s exhausting just listing the many hats that paediatric consultant oncologist Dr Aditi Vedi wears.
But we interviewed Aditi not to find out how she ended up in Cambridge UK, 12,000 miles away from her home in Sydney, nor how she raised three young children while working on her PhD (although these are also fascinating!)
Instead we wanted to find out more about her two main research projects that NIHR Cambridge BRC is funding.
It started with a question that Aditi asked herself: What does chemotherapy do to stem cells?
Aditi explained: “We know that children who have chemotherapy are at increased risk of leukaemia, diabetes, metabolic disease and heart disease in the future.
“But just recently, in the space of a year, two children who had received chemotherapy for other reasons were back in hospital because they had developed leukaemia.
“I looked in the scientific literature and, although rare, there are reported cases of this happening and no one really understands why.
“That got me thinking, can I build on what I know about stem cell behaviour from my PhD and look at what chemotherapy does to those stem cells in children?”
In her PhD, Aditi looked at how genetic mutations affect blood stem cell development in adult leukaemia patients.
She found that the gene mutation DNM3TA blocks the production of healthy blood stem cells in adult patients, which then predisposes them to leukaemia.
Now working in paediatric oncology, Aditi decided to build on her knowledge of stem cell behaviour to see how they behave in children with all types of cancer who have received chemotherapy.
That led to the research project on therapy-related AML in children, , in which Aditi will study the effects of gene mutations in blood stem cells from children who developed leukaemia after getting chemotherapy for another cancer. This is in collaboration with Dr Alex Thompson from Nottingham University and is part-funded by the NIHR Cambridge BRC and the Little Princess Trust.
At the same time that Aditi was setting up this trial, she was working on another to investigate making whole genome sequencing (WGS) faster. If successful, this trial has the potential to change clinical practice in England.
Aditi said: “WGS has changed clinical practice for many paediatric cancers, and the NHS has now commissioned this test for all children and young adults up to 25 with cancer or relapsed cancer.
“But it can take up to three months to get the results back. And for aggressive cancers like leukaemia or metastatic disease that’s often too late – and doctors have to make clinical decisions before the data’s back.”
So Aditi is working with current NHS WGS supplier Illumina on a trial to develop a pipeline to deliver WGS data in 24-48 hours.
The Ultrafast WGS study has already recruited 11 patients, and preliminary results are so promising that Aditi has applied for more funding from a number of organisations including Addenbrooke’s Charitable Trust and the Rosetrees Trust to expand the study to 100 patients, whom she hopes to recruit throughout 2024.
Aditi explained: “This is achievable, especially if we include another site and several other hospitals have approached me about joining the study, including Great Ormond Street Hospital who are already very proactive about recruiting patients into WGS.
“If we can get to 100 patients then that would hopefully provide enough data to clearly demonstrate that not only is it feasible but superior to the current NHS pipeline.
“And it could replace not just the WGS pipeline but also other tests including DNA and RNA sequencing, that the NHS currently pays for separately as needed.
“It may work out cheaper to run the single new test rather than up to five smaller tests.”
While the sequencing is the most expensive part of the trial, the funding from NIHR Cambridge BRC covers staff time, including the appointment of a genomics nurse and dedicated research time for Aditi and the geneticists involved.
Both projects are expected to take about three to four years. After that, Aditi plans to undertake more discovery and translational science: “My passion lies in acute myeloid leukaemia (AML), which is less common than lymphoid leukaemia in children, but much more aggressive, and which hasn’t really had any major new treatments over the last two decades.
“I’d like to work with other scientists to look at how AML develops in children, and how we can target its weaknesses with newer medications.
“Research is so rewarding, it gives me a purpose for what I do in the clinic, to look for the answers to the questions that directly relate to my patients.
- To celebrate the work and impact of the NHS research workforce, the NIHR ran its Shape The Future campaign throughout November – find out more here: https://www.nihr.ac.uk/explore-nihr/campaigns/nhs-75/
Research nurses “the key to study delivery”
The publication of a small research study completed during his Master’s in the early noughties was enough to give Dr Adrian Boyle the research bug.
The Consultant in Emergency Medicine at Addenbrooke’s said: “It was a small study and in fact not even very exciting, but it made me want to discover new ways of looking after patients.
“I saw the benefits of research on patient care, and wanted my department to take part in big multi-centre trials.”
His initial attempts met with failure: “In 2005, the international study CRASH-2 opened, looking at the effect of the generic drug tranexamic acid (TXA) on mortality in bleeding trauma patients.
“I wanted our department to join but the logistics were too difficult, the processes were too complicated, and this really important study was done without us.”
Launch of NIHR
Then in April 2006 the NIHR (which was then called the National Institute for Health Research) was created under the government’s health research strategy, Best Research for Best Health.
Adrian said: “The launch of the NIHR and its funding for dedicated research nurses was a game-changer.
“Yes, it took some time to embed our research nurses and initially they were employed on short-term contracts.
“But we got interesting results from the studies we took part in, which built up our reputation.
Changing standard of care
“Then when CRASH-3 started in 2012, we were in a position where we could take part, and we recruited more than 150 patients, one of the best recruiting sites worldwide.
“This trial showed that giving TXA to people with head injuries actually saved lives.
“As a result this is now a standard of care around the world, and in the UK TXA is given to everyone with a major head injury.”
Embedding a research team
The Emergency Department at Addenbrooke’s currently has three research nurses, with a combined working full-time equivalent of 2.2 nurses.
Kerry Meynell is one of the research nurses. She said: “I love the research we do, and what we achieve, and working in a team who are all trying to make a difference to healthcare.” The role’s flexibility is also a big plus for Kerry: “My husband’s in the army and we have three children, so I really need a role that not only gives me job satisfaction but also work/life balance so I can fit it around my family life.”
Another key member of the team is the administrator, Audrey.
Kerry said: “With research there’s a huge amount of paperwork, record-keeping and associated tasks to complete. The research nurses used to do them all but having Audrey on board means we can spend more time on educating staff and patients/families about the research and on recruitment.”
Adrian added: “When I look back over the last two decades, research delivery has improved beyond all recognition. When I started as a consultant at Addenbrooke’s, it was very much a case of here’s a study, here’s some money, now go and recruit a research nurse to do that study.
“And this was a really time-consuming, inefficient process.
“Now we have support from embedded research nurses, we also have regular access to our local NIHR Portfolio Support Manager, who’s been invaluable in terms of planning and supporting our studies.
“We’ve shown the model works. You don’t have to shift the dial very much in terms of either the money or the support to create an embedded team in the clinical team.
“And that leads to more research capability. In the emergency department we’ve grown from having just one or two studies open to six to eight studies open at the same time, including a head injury study, chest studies around pneumothoraces and an infection study screening for severe infections.
The research that takes place in the Emergency Department is not all to do with major health events such as trauma, heart attacks and strokes; it can also be preventative and the embedded research nurses are ideally placed for this kind of research. Kerry explained: “One of the first trials I worked on was the CoSTED trial. While patients were in the waiting room, I approached them to discuss their smoking status.
“It was a good opportunity to prompt positive behaviour change. The patient’s in Emergency Department, they’re thinking about their health and the consequences of their lifestyle, so it can be an ideal time to talk about stopping smoking and the help which is available.”
Transforming research delivery
Adrian said: “The step change in research delivery has been a career highlight for me.
“We’re now at that level of organisation and support where we can run big studies very quickly and efficiently, as was seen in the pandemic, when we ran diagnostic studies trialling new technologies for COVID-19 tests.
“This just wouldn’t have been possible without that built-in research nurse structure.
“This is good for UK science, it’s good for investment, we already had the access to patients and we now have an infrastructure which can do a lot of the research delivery.
“But the key to delivering any study are the research nurses. If we want to further transform research delivery in this country, investing in research nurses is absolutely the way to do it.”
- To celebrate the work and impact of the NHS research workforce, the NIHR has been running its Shape The Future campaign throughout November – find out more here: https://www.nihr.ac.uk/explore-nihr/campaigns/nhs-75/
World-leading Quantitative Genetics Professor to share his insights in lunchtime lecture
One of the world’s leading statistical and quantitative genetics researchers will be talking about some of his work in a lunchtime lecture on 1 December at the Victor Phillip Dahdaleh Heart and Lung Research Institute.
Aimed at staff and researchers working on the Cambridge Biomedical Campus, Professor Peter Visscher’s talk will look at “Exploiting within-family segregation variance to study complex traits,” and show unpublished results from an analysis of more than 100,000 siblings pairs with GWAS and trait data.
Professor Visscher is known for his research investigating the genetic basis of complex human traits, including common diseases. His research focuses on the causes and consequences of human trait variations and he was one of the first to propose, advocate and show that genome and trait data can be used to predict individuals who are genetically at high risk of disease. The use of “polygenic risk scores” in health care is now being trialled worldwide.
The talk will take place from noon on Friday 1st December at Room R109/101, VCP Heart & Lunch Research Institute. No booking is required and a light lunch will be available afterwards.
- Professor Visscher is in the process of moving his Lab from the University of Queensland to the Big Data Institute, University of Oxford.
- If you’d like to meet with Professor Visscher, please contact Michael Inouye (email@example.com firstname.lastname@example.org) cc Nicole Staudt (email@example.com firstname.lastname@example.org), who are helping to coordinate his schedule.
Top research award for Neuroscience Theme co-lead Prof Hutchinson
Congratulations to our Neuroscience theme TBI (Traumatic Brain Injury) co-lead Professor Peter Hutchinson, who has been awarded the Vilhelm Magnus Medal from the Norwegian Neurosurgical Association in Oslo, following delivery of the prestigious Vilhelm Magnus Lecture.
The award, which is often described as the “Nobel Prize of Neurosurgery”, was given to Prof Hutchinson and his team for their work on TBI, including a number of studies addressing the concept of “Rescuing the Injured Brain.”
It is the latest in a long list of acclaimed work by Prof Hutchinson, who is also Director of the National Institute of Health and Care Research Global Health Research Group on Acquired Brain and Spine Injury, and the National Institute of Health and Care Research Brain Injury Medtech Co-operative.
The photo shows Prof Hutchinson (right) receiving the medal from Professor Tor Ingebrigtsen.
Watch Professor Hutchinson and Neuroscience Theme Lead Professor Chinnery talk about the theme’s research in this short video:
Shaping the future for women with prolapse
Cambridge physiotherapist Claire Brown believes a physiotherapist-led pessary service for women with prolapse could be life-changing – and has embarked on a year-long research fellowship as a first step to investigating this.
Pelvic floor dysfunction is a common and distressing condition which can affect all adults but particularly women who have had children.
Symptoms include bladder and bowel problems, pelvic organ prolapse (where organs slip down from their normal position into the vagina) and pain, affecting patients’ quality of life and limiting their life choices.
Claire, a clinical specialist pelvic health physiotherapist at Addenbrooke’s, said: “As a physio I work closely with my specialist network group, Pelvic Obstetric and Gynaecological Physiotherapy (POGP), and three years ago we worked as part of a multi-disciplinary team to launch clinical guidelines for best practice in using vaginal pessaries for prolapse.
“These are simple devices that you pop inside the vagina to support the internal walls and reduce the symptoms of a vaginal prolapse.
A vaginal pessary is a mechanical device (not a hormonal pessary) inserted inside a vagina to relieve prolapse symptoms. There are many different types, materials and sizes of pessaries. This is a ring pessary.
“But the guidelines were not backed up by sufficient evidence to show pessaries were effective in the younger age groups we wanted to target, which may explain why they haven’t been widely adopted.
“That’s incredibly frustrating for us as clinicians, and even more for the women with prolapses because this treatment could work.”
So Claire is now on a mission to collect the evidence needed to convince health practitioners to adopt clinical guidelines for vaginal pessaries for younger women; this autumn she started a full-time research fellowship, during which she will conduct qualitative interviews with women patients who have vaginal prolapse and with the GPs, nurses and physiotherapists who look after them.
Claire said: “This will provide the pilot data that I need for my research, including finding out what makes access to treatment easier – and harder?
“Another key part of my research will be forming a PPI steering group, this will be invaluable because the direction we take will be steered by members’ direct experience of prolapse treatment – and how easy or difficult it was to access.
Getting the evidence
Claire wants to concentrate on collecting the data – or evidence – to show that pessaries can help women with prolapses.
She said: “The women who could benefit aren’t getting the treatments, partly because doctors aren’t offering pessaries to women because there is an age bias.
“Most of pessary research is conducted in the older population, however childbirth is one of the biggest risk factors for developing a prolapse.
“But clinically, pessaries work, but we need the hard evidence to back this up, and to show pessaries are acceptable to younger women as a treatment option.”
Claire has a few simple words of advice to others thinking about working in research: “Do it – because if you don’t follow your passions, you’ll regret it. Then keep going!”
What’s next for Claire?
“I plan to apply for the Doctoral Clinical and Practitioner Academic Fellowship (DCAF) scheme, which will enable me to undertake a PhD by research.
“This is funded by NHS England and NIHR, and if successful I will spend approximately 80% on my research and around 20% in clinical practice.
“Thanks to NIHR Cambridge BRC which enabled this research, I will have pilot data and more experience in conducting my own research to underpin my application.
“It’s another fantastic opportunity for me personally but even more, I hope, for the women who will benefit from service improvements as a result of the research.”
- This November NIHR is launching its Shape the Future autumn campaign, to celebrate the work and impact of the NHS research workforce. It encourages researchers to learn more about research, explore research careers and how to add research to their practice, learning and development.
- If you’re a healthcare proressional in the NHS and are inspired by Claire’s story and are interested in finding out more about pursuing a career in research, visit our Training & Professional Development area on our website for training opportunities and contacts.
November events for your diary: save the dates!
Want to find out more on how research improves patients’ outcomes? Or on the problems of the health and social care workforce from different research perspectives?
Two events taking place in November may be just the ticket.
NIHR Cambridge BRC public open evening: What difference does research make in improving hospital care?
It’s a fact – research-active hospitals have better patient outcomes. And in our first in-person public open evening since lockdown, you can find out more about some of our ground-breaking research in cancer, obesity, endocrine tumours and hearing loss.
Taking place at the Cancer Research UK Cambridge Institute on Tuesday 7th November, our researchers in will look at the difference research is making in improving hospital care.
You will have the opportunity to ask questions, and there will be time afterwards for networking. Refreshments will be available on arrival and after the lectures.
Doors open at 5.30pm, with the talks taking place from 6-7.30pm.
Register online for NIHR Cambridge BRC open evening
This event is suitable for members of the public and healthcare staff. Booking is essential. To find out more visit our Open Evening page on our website or go straight to EventBrite to book your ticket.
We need to talk about the workers: Researching the health and social care workforce: online lecture
The 2023 lecture from the Cambridge Centre for Health Services Research (CCHSR) will take place online on Tuesday, 14 November 2023, 12.30–1.30pm. Professor Jill Manthorpe CBE from King’s College London will explore the problems of the health and social care workforce from different research perspectives and how solutions seem to rise and fall in popularity.
Themes will include the UK reliance on international recruitment, numerous recruitment initiatives, scant retention interest, and a surprising short-sightedness in preparing for workforce ageing or workforce caring responsibilities. Research interest in the workforce is growing and ideas for approaches and studies will be canvassed.
About the speaker
Jill Manthorpe is Professor Emerita at King’s College London Policy Institute. For 20 years she was Director of the Policy Research Unit in Social Care Workforce and then the Policy Research Unit in Health and Care Workforce.
To book your free place for Researching the health and social care workforce: online lecture please visit EventBrite.
To book your free place for NIHR Cambridge BRC open evening please register on EventBrite.
Risks from smoking while pregnant more than double previous estimates
Cambridge researchers have shown that women who smoke during pregnancy are 2.6 times more likely to give birth prematurely compared to non-smokers – more than double the previous estimate.
The study analysed data collected during the Pregnancy Outcome Prediction (POP) study, which was supported by NIHR Cambridge BRC, and is published today in the International Journal of Epidemiology.
It also found that smoking meant that the baby was four times more likely to be small for its gestational age, putting it at risk of potentially serious complications including breathing difficulties and infections.
But the team found no evidence that caffeine intake was linked to adverse outcomes.
Women are currently recommended to stop smoking and limit their caffeine intake during pregnancy because of the risk of complications to the baby. For example, smoking during pregnancy is associated with an increased risk of fetal growth restriction, premature birth and low birthweight, though it has also been linked to a reduced risk of preeclampsia (high blood pressure during pregnancy).
High caffeine intake has also been shown to be associated with lower birthweights and possibly fetal growth restriction. Caffeine is more difficult to avoid than cigarette smoke as is found in coffee, tea, chocolate, energy drinks, soft drinks, and certain medications.
Studies looking at the links between smoking, caffeine and adverse pregnancy outcomes tend to rely on self-reported data to estimate exposure, which is not always reliable. A more objective measure is to look at levels of metabolites in the blood – chemical by-products created when substances such as tobacco and caffeine are processed in the body.
Researchers at the University of Cambridge and the Rosie Hospital, part of Cambridge University Hospitals NHS Foundation Trust, recruited more than 4,200 women who attended the hospital between 2008 and 2012 as part of the POP study. The team analysed blood samples taken from a subset of these women four times during their pregnancies.
To assess exposure to cigarette smoke, the team looked at levels of the metabolite cotinine, which can be detected in blood, urine, and saliva. Only two out of three women with detectable levels of cotinine in every blood sample were self-reported smokers, showing that this measure is a more objective way of assessing smoking behaviour.
A total of 914 women were included in the smoking analysis. Of these, 78.6% were classified as having no exposure to smoking while pregnant, 11.7% as having some exposure and 9.7% as having consistent exposure.
Compared to women who were not exposed to smoking while pregnant, those with consistent exposure were 2.6 times more likely to experience spontaneous preterm birth – more than double the previous estimate of 1.27 from a meta-analysis of studies – and 4.1 times as likely to experience fetal growth restriction.
Babies born to smokers were found to be on average 387g lighter than babies born to non-smokers – that is, more than 10% smaller than the weight of an average newborn. This increases the risk that the baby will have a low birth weight (2.5kg or less), which in turn is linked to an increased risk of developmental problems as well as poorer health in later life.
Unlike in previous studies, however, the team found no evidence that smoking reduced the risk of pre-eclampsia.
Professor Gordon Smith, Head of the Department of Obstetrics and Gynaecology at the University of Cambridge, said: “We’ve known for a long time that smoking during pregnancy is not good for the baby, but our study shows that it’s potentially much worse than previously thought. It puts the baby at risk of potentially serious complications from growing too slowly in the womb or from being born too soon.
“We hope this knowledge will help encourage pregnant mums and women planning pregnancy to access smoking-cessation services. Pregnancy is a key time when women quit and if they can remain tobacco free after the birth there are lifelong benefits for them and their child.”
Smoking cessation is offered routinely to all pregnant women and the NHS has local smoking cessation services for anyone, pregnant or not. Further information is available on the NHS website.
To assess caffeine intake, they researchers looked for the metabolite paraxanthine, which accounts for 80% of caffeine metabolism and is both less sensitive to recent intake and more stable throughout the day.
915 women were included in the caffeine analysis. Of these women, 12.8% had low levels of paraxanthine throughout pregnancy (suggesting low caffeine intake), 74.0% had moderate levels and 13.2% had high levels. There was little evidence of an association between caffeine intake and any of the adverse outcomes.
Professor Charlotte Coles receives top honour from Royal College of Radiologists
The Gold Medal is the highest honour that the College can give to a Fellow (radiologist or clinical oncologist) for important work that benefits patients.
Charlotte, who is Professor of Breast Cancer Clinical Oncology and NIHR Research Professor at the University of Cambridge, and Honorary Consultant in Clinical Oncology at Addenbrooke’s Hospital, leads practice-changing research on the best way to deliver radiotherapy treatment to breast cancer patients.
Her research aims to provide breast cancer patients with the best chance of cure with least side effects by personalising radiation techniques based on risk of recurrence.
Charlotte’s work has influenced international hypofractionation policy and she is Chair of the Lancet Breast Cancer Commission, an international multidisciplinary team aiming to influence global policy and improve the lives of people at risk of, and living with, breast cancer.
She leads CRUK RadNet Cambridge, one of seven centres of excellence across the UK pioneering new radiotherapy technologies and techniques to provide better radiotherapy treatments for patients with fewer side effects.
On receiving the Gold Medal at a ceremony at Central Hall Westminster last week, she said: “I feel very honoured and privileged to receive this award on behalf of collaborative patient-centred research in breast cancer and radiation therapy research.”
BRC-supported invention to be showcased at major industry fair
A digital health invention supported by NIHR Cambridge BRC is to be showcased at a major industry fair in London.
BloodCounts!, developed by NHS Blood and Transplant’s Dr Nicholas Gleadall and Dr Michael Roberts at the University of Cambridge, will be presented by NIHR Cambridge BRC partner Cambridge Enterprise at the IP4U University Tech Fair on 19-20 September.
It’s the first time that the Technology Transfer Offices (TTOs) of the University of Cambridge, Imperial College London, Oxford University and University College London have held such an event, which will showcase 80 inventions in sustainability and health.
IP4U will be an opportunity for industry to some of the researchers behind the innovations, and find out how they can partner with academics to commercialise their research.
Early warning system
BloodCounts! uses data from routine blood tests and powerful AI-based techniques to scan for abnormal changes in the blood cells of large populations. Based on this information, doctors can then alert public health agencies to potential emerging infectious disease outbreaks,
The development of the algorithms used in BloodCounts! was only possible due to the EpiCov data-sharing initiative pioneered by Cambridge University Hospitals (CUH) and funded by NIHR Cambridge BRC. The EpiCov database contains de-identified patient and NHS staff data from the CUH Electronic Health Record systems, including scan images and laboratory results.
It includes routinely collected information about patients diagnosed with COVID-19 or suspected of having COVID-19, and staff who have been tested for COVID-19. It also includes information about a large number of control patients who do not have a diagnosis of COVID-19.
- For more information including how to register visit https://ip4u.tech.
Prestigious laureate award for Theme Lead Prof Farooqi
The award honours an internationally recognized clinical investigator who has contributed significantly to understanding the pathogenesis and therapy of endocrine and metabolic diseases. It is one of only a handful of Laureate Awards made by the society each year, to celebrate the achievements of the world’s top endocrinologists.
Professor Farooqi researches the fundamental mechanisms that control human energy homeostasis. She discovered the first genes whose disruption causes severe obesity and established that the principal driver of obesity is a failure of the central control of appetite. She also is a keen advocate to raise more awareness around weight stigma and obesity as a disease.
I am delighted and honoured to receive this prestigious award which recognises the dedication and contributions of past and present team members. I would particularly like to thank the many patients and volunteers who have contributed to our clinical research over the years, allowing us to find new ways to diagnose and treat people with severe obesity.
The Endocrine Society is a global community of physicians and scientists, dedicated to accelerating scientific breakthroughs and improving patient health and well-being. Their main annual meeting, now called ENDO, has been held each year since 1916, except for 1943 and 1945 during World War II. Professor Farooqi will be presented with her award at ENDO 2024 in June next year.
Largest genetic study of brain structure identifies how the brain is organised
The largest ever study of the genetics of the brain – encompassing some 36,000 brain scans – has identified more than 4,000 genetic variants linked to brain structure. The results of the NIHR Cambridge BRC-supported study, led by researchers at the University of Cambridge, are published in Nature Genetics today.
Our brains are very complex organs, with huge variety between individuals in terms of the overall volume of the brain, how it is folded and how thick these folds are. Little is known about how our genetic make-up shapes the development of the brain.
To answer this question, a team led by researchers at the Autism Research Centre, University of Cambridge, accessed MRI scans from over 32,000 adults from the UK Biobank cohort and over 4,000 children from the US-based ABCD study. From these scans, the researchers measured multiple properties of the outermost layer of the brain called the cortex. These included measures of the area and volume of the cortex as well as how the cortex is folded.
They then linked these properties, measured both across the entire cortex as well as in 180 individual regions of the cortex, to genetic information across the genome. The team identified over 4,000 genetic variants linked to brain structure.
These findings have allowed researchers to confirm and, in some cases, identify, how different properties of the brain are genetically linked to each other.
Dr Varun Warrier from the Autism Research Centre, who co-led the study, said: “One question that has interested us for a while is if the same genes that are linked to how big the cortex is – measured as both volume and area – are also linked to how the cortex is folded. By measuring these different properties of the brain and linking them to genetics, we found that different sets of genes contribute to folding and size of the cortex.”
The team also checked whether the same genes that are linked to variation in brain size in the general population overlap with genes linked to clinical conditions where head sizes are much larger or smaller than the general population, known as cephalic conditions.
Dr Richard Bethlehem, also from the Autism Research Centre and a co-lead of the study, said: “Many of the genes linked with differences in the brain sizes in the general population overlapped with genes implicated in cephalic conditions. However, we still do not know how exactly these genes lead to changes in brain size.”
Dr Warrier added: “This work shows that how our brain develops is partly genetic. Our findings can be used to understand how changes in the shape and size of the brain can lead to neurological and psychiatric conditions, potentially leading to better treatment and support for those who need it.”
This study was supported by the Wellcome Trust. It was conducted in association with the NIHR CLAHRC for Cambridgeshire and Peterborough NHS Foundation Trust, and the NIHR Cambridge Biomedical Research Centre.
- Read the paper by Dr Varun Warrier et al, “Genetic insights into human cortical organisation and development through genome-wide analyses of 2,347 neuroimaging phenotypes” in Nature Genetics.
Brain’s ‘appetite control centre’ different in people who are overweight or living with obesity
Cambridge scientists, in research supported by the NIHR Cambridge Biomedical Research Centre, have shown that the hypothalamus, a key region of the brain involved in controlling appetite is different in the brains of people who are overweight and people with obesity when compared to people who are a healthy weight.
The researchers say their findings add further evidence to the relevance of brain structure to weight and food consumption.
Current estimations suggest that over 1.9 billion people worldwide are either overweight or obese. In the UK, according to the Office for Health Improvement & Disparities, almost two-thirds of adults are overweight or living with obesity. This increases an individual’s risk of developing a number of health problems, including type 2 diabetes, heart disease and stroke, cancer and poorer mental health.
A large number of factors influence how much we eat and the types of food we eat, including our genetics, hormone regulation, and the environment in which we live. What happens in our brains to tell us that we are hungry or full is not entirely clear, though studies have shown that the hypothalamus, a small region of the brain about the size of an almond, plays an important role.
Dr Stephanie Brown from the Department of Psychiatry and Lucy Cavendish College, University of Cambridge, said: “Although we know the hypothalamus is important for determining how much we eat, we actually have very little direct information about this brain region in living humans. That’s because it is very small and hard to make out on traditional MRI brain scans.”
The majority of evidence for the role of the hypothalamus in appetite regulation comes from animal studies. These show that there are complex interacting pathways within the hypothalamus, with different cell populations acting together to tell us when we are hungry or full.
To get around this, Dr Brown and colleagues used an algorithm developed using machine learning to analyse MRI brain scans taken from 1,351 young adults across a range of BMI scores, looking for differences in the hypothalamus when comparing individuals who are underweight, healthy weight, overweight and living with obesity.
In a study published today in Neuroimage: Clinical, the team found that the overall volume of the hypothalamus was significantly larger in the overweight and obese groups of young adults. In fact, the team found a significant relationship between volume of the hypothalamus and body-mass index (BMI).
These volume differences were most apparent in those sub-regions of the hypothalamus that control appetite through the release of hormones to balance hunger and fullness.
While the precise significance of the finding is unclear – including whether the structural changes are a cause or a consequence of the changes in body weight – one possibility is that the change relates to inflammation. Previous animal studies have shown that a high fat diet can cause inflammation of the hypothalamus, which in turn prompts insulin resistance and obesity. In mice, just three days of a fat-rich diet is enough to cause this inflammation. Other studies have shown that this inflammation can raise the threshold at which animals are full – in other words, they have to eat more food than usual to feel full.
Dr Brown, the study’s first author, added: “If what we see in mice is the case in people, then eating a high-fat diet could trigger inflammation of our appetite control centre. Over time, this would change our ability to tell when we’ve eaten enough and to how our body processes blood sugar, leading us to put on weight.”
Inflammation may explain why the hypothalamus is larger in these individuals, the team say. One suggestion is that the body reacts to inflammation by increasing the size of the brain’s specialist immune cells, known as glia.
Professor Paul Fletcher, the study’s senior author, from the Department of Psychiatry and Clare College, Cambridge, said: “The last two decades have given us important insights about appetite control and how it may be altered in obesity. Metabolic researchers at Cambridge have played a leading role in this.
“Our hope is that by taking this new approach to analysing brain scans in large datasets, we can further extend this work into humans, ultimately relating these subtle structural brain findings to changes in appetite and eating and generating a more comprehensive understanding of obesity.”
The team say more research is needed to confirm whether increased volume in the hypothalamus is a result of being overweight or whether people with larger hypothalami are predisposed to eat more in the first place. It is also possible that these two factors interact with each other causing a feedback loop.
The research was supported by the NIHR Cambridge Biomedical Research Centre, the Bernard Wolfe Health Neuroscience Fund and Wellcome, with additional funding from Alzheimer’s Research UK.
- View the paper online at Elsevier Science Direct.
Leading professor of paediatric medicine from Canada to visit as part of our Distinguished Lecturer programme
The NIHR Cambridge BRC is delighted to announce that Professor Catherine Birken, Professor of Paediatric Medicine at the University of Toronto, will visit as part of our Distinguished Lecturer Programme this Thursday 21 September.
Professor Birken will deliver a lecture on obesity prevention trials in early childhood, and how interventions from before conception to infancy and early childhood aim to reduce childhood obesity and optimise early child development, nutrition, and other healthy behaviours.
As well as her research in the promotion of healthy growth, development and well-being in young
children, Professor Birken’s clinical care activities include attending children – including those with complex obesity – at the Hospital for Sick Children (SickKids), affiliated with the University of Toronto. This is Canada’s most research-intensive hospital and the largest centre dedicated to improving children’s health in the country.
The Distinguished Lecturer programme is run by the NIHR Cambridge BRC and features world-leading experts and is open to researchers, clinicians and staff working on the Cambridge Biomedical Campus. There are usually two to three lectures a year.
Professor Birken’s lecture will take place from 4-6.45pm on 21 September at the Jeffrey Cheah Biomedical Centre lecture theatre on the campus, ending with a drinks reception.
Registration is not necessary but helpful for catering purposes. If you would like to attend please email email@example.com by Monday 11 September.
NIHR employees invited to create LGBTQ+ staff network
As part of Pride Month at NIHR, plans have been announced by the NIHR Research Inclusion team to create an NIHR LGBTQ+ Staff Network that will also be open to all NIHR Infrastructure as well as NIHR coordinating centres.
The acronym LGBTQ+ stands for lesbian, gay, bisexual, trans and queer, with the plus encompassing a number of other identities relating to sexual orientation and gender identity including, but not limited to, asexual, pansexual, non-binary, intersex and genderfluid.
NIHR is starting its inclusive staff network journey with an LGBTQ+ Staff Network in response to the interest we received from colleagues during our 2022 Pride activities. The LGBTQ+ Network will serve as a pilot forerunner to other potential NIHR-wide staff networks focusing on different aspects of diversity and inclusion.
Inclusion is one of the NIHR’s operating principles, and embedding inclusion into our systems, processes and culture is one of the areas of strategic focus highlighted in Best Research for Best Health: The Next Chapter.
LGBTQ+ Network membership
The Network will be open to all staff working as part of NIHR (such as staff in coordinating centres, LCRN core teams, delivery staff in LCRN partner organisations and staff in NIHR infrastructure e.g., ARCs and BRCs) who identify as part of the LGBTQ+ community, as well as any staff who consider themselves friends, family or allies to LGBTQ+ people.
Some staff may already be part of LGBTQ+ groups or networks at their employing organisations – the focus of the NIHR LGBTQ+ Staff Network would be to support members around their roles and functions, rather than in relation to their employer.
What is the purpose of the LGBTQ+ Staff Network?
The NIHR Research Inclusion Team is keen to ensure that those within the Network play an active role in deciding what the Network is for.
The NIHR LGBTQ+ Staff Network may provide a space for peer support, developing mentoring relationships and networking across the NIHR for LGBTQ+ staff. The Network may organise events and activities around inclusion of LGBTQ+ people in the work of the NIHR, such as for key dates such as Pride Month, LGBTQ+ History Month, World AIDS Day, Trans Day of Visibility, etc. It may also contribute to activities that support NIHR’s wider strategic inclusion priorities, to ensure inclusivity around sexuality and gender identity in all aspects of the work of the NIHR.
How do we find out more or get involved?
You can get involved in one of two ways:
- register your interest in joining a small working group to help us determine the aims and focus of the LGBTQ+ Staff Network and how it will work
- register your interest in joining the Network once it has been designed.
If you are interested in being part of the Network in either or both of the above capacities, please complete this short form by 14 July 2023 for the NIHR Research Inclusion Team.
Please contact the NIHR Research Inclusion Team if you have any further questions or comments.
- Visit the About Us section on our website to find out more about Nurturing Inclusive Research at NIHR Cambridge BRC.
Researchers awarded prestigious Academy of Medical Sciences Fellowships
Four NIHR Cambridge BRC researchers have been elected to the Academy of Medical Sciences Fellowship.
Theme Leads Professors James Rowe and Serena Nik-Zainal, together with researchers Professors Charlotte Coles and Emanuele Di Angelantonio, received the awards in recognition of their outstanding biomedical and health research which has translated into benefits for patients and wider society.
Academy of Medical Sciences President Professor Dame Anne Johnson said: “These new Fellows are pioneering biomedical research and driving life-saving improvements in healthcare. It’s a pleasure to recognise and celebrate their exceptional talent by welcoming them to the Fellowship.”
- This year Fellows were chosen from 353 candidates, and a shortlist of 126 candidates for peer review. To find out more about the Fellowship visit the Academy of Medical Sciences website.
Cambridge researcher wins prestigious award for rare eye disease gene replacement therapy research
Neuroscience researcher Professor Patrick Yu-Wai-Man has won the 2023 Ludwig von Sallmann Clinician-Scientist Award from the Association for Research in Vision and Ophthalmology (ARVO) Foundation.
The award was given in recognition of Prof Yu-Wai-Man’s research on gene replacement therapy for Leber hereditary optic neuropathy (LHON).
LHON is a genetic disorder caused by mutations in mitochondrial DNA (mtDNA). Strictly inherited down the maternal line, it is an important cause of inherited blindness in the young adult population. Currently, there are limited treatment options for LHON and most affected individuals will remain within the legal criteria for blindness.
Prof Yu-Wai-Man said: “I have been working in the field of mitochondrial diseases for nearly 25 years and despite the amazing advances made during that period, finding effective treatments has proven challenging.
“Mitochondrial optic neuropathies have led the way and this award is a recognition of the translational breakthroughs seen in recent years, in particular gene replacement therapy for Leber hereditary optic neuropathy.”
Prof Yu-Wai-Man has worked on several studies using a modified version of the MT-ND4 mitochondrial gene packaged into an adeno-associated viral vector (AAV2) that is injected into the eye. Promising results have been obtained for individuals treated within one year of disease onset with a significant and sustained improvement in vision observed during long-term follow-up.
On receiving the Ludwig von Sallmann Clinician-Scientist Award, Prof Yu-Wai-Man said: “It is a great honour and my hope is that this award will highlight the significant unmet needs for individuals affected with mitochondrial optic neuropathies, which result in significant visual impairment in children and young adults.
“We need to attract more research funding and talents into rare genetic eye diseases. Success breeds success and the future certainly looks bright in this field.”
This article is adapted from arvo.org
Three more great events at this year’s Cambridge Festival – and they’re all from BRC researchers
We’ve already publicised our webinar and family event taking place as part of this year’s Cambridge Festival – now we want to let you know about three more events taking place during the Festival, and they’re all from researchers we fund and support.
Check out the details below – and don’t forget to find out about our events (if you haven’t already) and other NIHR events taking place in Cambridge.
The crisis in mental health in young women and girls: does our education system make it worse? What should we do?
Why are girls and young women suffering levels of stress and anxiety so far in excess of those their mothers and grandmothers experienced? What part does stress at school and university play? Do we have too many exams? Is the content of university courses too onerous? Does the method of assessment at UK universities stress out young women? Why are university students more likely to suffer anxiety than their counterparts at work?
Join Professors Sarah-Jayne Blakemore and Tamsin Ford as they examine some potential solutions, in this hour-long talk from 6-7pm on Monday 27 March, taking place at the Babbage Lecture Theatre, Downing Street.
To find out more and book your place.
New medical imaging techniques in the era of A.I.
Dr Joshua Kaggie is an MRI physicist and senior research associate in the Department of Radiology, where he works on developing new imaging techniques. Dr Kaggie moved to Cambridge from Utah in 2015 and has been involved in a range of projects including osteoarthritis, cancer, and dementia imaging.
This talk will discuss some of the more novel imaging techniques that are being developed at Addenbrooke’s Hospital, including the use of heavy hydrogen (deuterium) for use as a new cancer imaging method. This talk will discuss artificial intelligence / machine learning (AI/ML) techniques, their current and future impact on medical imaging and diagnostics, and medical imaging research underway at Addenbrooke’s Hospital – with an emphasis on MRI techniques. The talk will feature a live demonstration of interesting AI developments, some of which may not relate to medicine – yet.
The talk is on Monday, 27 March, from 7.30-8.15pm, at University of Cambridge Admissions Office, New Museums site, Bene’t Street. For more information and to book your place.
Neurodegenerative Disease and Dementias
Memory Matters – an in-person discussion about brain health
This event, taking place from 3.30-5.00pm on Thursday 30 March in the Herchel Smith Building, Robinson Way, will be an opportunity to join researchers for a discussion about brain health in the context of ageing and dementia.
Many of us are worried about our memory as we get older, or following stress to the body (such as long COVID), and it is common to wonder whether we might be developing dementia. But, how much do you know about dementia and how it is detected and treated? In this workshop, you will have the chance to meet, and ask questions of, the doctors, psychologists and nurses who run the world-famous Addenbrooke’s Hospital Memory Clinic.
Short presentations will be followed by a live Q&A session with members of the Memory Clinic team.
For more information and details on how to book.