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Researchers at NIHR Cambridge BRC instrumental in developing new treatment that offers quick cure for common cause of high blood pressure

Researchers from NIHR Cambridge BRC, University of Cambridge and Cambridge University Hospitals NHS Foundations Trust have developed a vital piece of technology that has dramatically advanced the ability to diagnose primary aldosteronism,  a common cause of high blood pressure.

The UK-based study, which was a multi site collaboration between researchers at Cambridge BRC, Queen Mary University of London, Barts Health NHS Trust  and University College London Hospitals NHS Foundation Trust has led to the development of a simple, minimally invasive Targeted Thermal Therapy (Triple T) that has the potential to transform treatment of this common cause of high blood pressure.

The vital molecular tracer and PET scanning method, that have dramatically advanced the ability to detect this common condition, was developed by researchers in Cambridge.

This breakthrough, published last Friday in The Lancet, could, after further testing, help millions of people worldwide, who currently go undiagnosed and untreated.

A hidden cause of high blood pressure 

High blood pressure affects one in three adults in the UK. Around one in 20 of these are due to primary aldosteronism. However, fewer than one percent of those affected are ever diagnosed as the current diagnostic process includes an invasive, time-consuming procedure that can only be performed in the UK at fewer than a dozen specialist hospitals.

The condition occurs when tiny benign nodules in one or both adrenal glands produce excess aldosterone, a hormone that raises blood pressure by increasing salt levels in the body. Patients with primary aldosteronism often do not respond well to standard blood pressure medications and face higher risks of heart attacks, strokes, and kidney failure.

The new approach dramatically improves the outlook for people with primary aldosteronism by combining a diagnostic PET scan with Triple T.

First, a newly developed molecular tracer is injected into the blood which travels to the nodules in the adrenal gland, where it can be detected using a PET scanner– a high-tech piece of equipment that produces three-dimensional images inside the body. The PET scans take just 10 minutes and could become available at most large hospitals, meaning many more people can be diagnosed.

A game-changing alternative to surgery

Until now, primary aldosteronism has either been treated through life-long medication or via surgical removal of the entire adrenal gland, requiring general anaesthesia, a two- to three-day hospital stay, and weeks of recovery.

In future, once diagnosed, some patients could be offered Triple T which provides a faster, safer alternative to surgery, by selectively destroying the small adrenal nodules without removing the gland. This is currently only possible for nodules in the left adrenal gland which can be see via endoscopy into the stomach, from where they can be directly targeted.

Triple T is also known as endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA). It harnesses the energy of waves, adapting two well-established medical techniques: radiofrequency or microwaves generate heat in a small needle placed into the malfunctioning tissue, causing a controlled burn; ultrasound uses reflected sound waves to create a real-time video of the procedure.

In Triple T, as in routine endoscopy, a tiny internal camera—in this case using ultrasound as well as light—is passed by mouth into the stomach. The endoscopist visualises the adrenal gland and guides a fine needle from the stomach precisely into the nodule. Short bursts of heat destroy the nodule but leave the surrounding healthy tissues unharmed. This minimally invasive approach takes only 20 minutes and eliminates the need for internal or external incisions.

Successful trial shows promise 

The study is called FABULAS, the name being an acronym for Feasibility study of radiofrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone-producing adenomas.

FABULAS tested Triple T in 28 patients with primary aldosteronism, whose molecular scan had pinpointed a hormone-producing nodule in the left adrenal gland. The new procedure was found to be safe and effective, with most patients having normal hormone levels six months later. Many participants were able to stop all blood pressure medications, with no recurrence of the condition.

Professor Morris Brown, co-senior author of the FABULAS study and Professor of Endocrine Hypertension at Queen Mary University of London and Professor of Endocrinology at Barts Health NHS Trust, said: “It is 70 years since the discovery in London of the hormone aldosterone, and, a year later, of the first patient in USA with severe hypertension due to an aldosterone-producing tumour. This patient’s doctor, Jerome Conn, predicted, with perhaps only minor exaggeration, that 10-20% of all hypertensions might one day be traced to curable nodules in one or both glands. We are now able to realise this prospect, offering 21st-century breakthroughs in diagnosis and treatment.”

One of the trial participants, Michelina Alfieri, shared her experience:

“Before the study, I suffered from debilitating headaches for years despite multiple GP visits. As a full-time worker and single parent, my daily life was severely affected. This non-invasive treatment provided an immediate recovery—I was back to my normal routine straight away. I’m incredibly grateful to the team for giving me this choice.”

What’s Next? 

The success of FABULAS has led to a larger randomised trial called ‘WAVE’, which is comparing Triple T with traditional adrenal surgery. The results are expected in 2027.

Professor Stephen Pereira, Chief Investigator of FABULAS and Professor of Hepatology & Gastroenterology at UCL Institute for Liver and Digestive Health, added: “With appropriate training, this less invasive technique could be widely offered in endoscopy units across the UK and beyond.”

Clinical Endocrinology Lead at Addenbrooke’s Hospital and Professor of Clinical Endocrinology at the University of Cambridge, Professor Mark Gurnell, said: “This breakthrough was made possible thanks to the collaborative development of novel PET tracer molecules, which enable non-invasive diagnosis by allowing us to precisely locate and treat adrenal nodules for the first time.

“Thanks to this work, we may finally be able to diagnose and treat more people with primary aldosteronism, lowering their risk of developing cardiovascular diseases and other complications, and reducing the number of people dependent on long-term blood pressure medication,” he added.

A major step forward for hypertension treatment 

For the millions of people suffering from undiagnosed primary aldosteronism, this research offers new hope. The potential to be freed from a life of struggling with high blood pressure via simple, non-invasive diagnosis, and safely targeted thermal therapy, allowing faster recovery and better outcomes.

With further studies underway, this breakthrough treatment could soon become a standard procedure worldwide, transforming care for patients with this curable form of hypertension.

Successful trial shows promise 

The study is called FABULAS, the name being an acronym for Feasibility study of radiofrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone-producing adenomas.

FABULAS tested Triple T in 28 patients with primary aldosteronism, whose molecular scan had pinpointed a hormone-producing nodule in the left adrenal gland. The new procedure was found to be safe and effective, with most patients having normal hormone levels six months later. Many participants were able to stop all blood pressure medications, with no recurrence of the condition.

Professor Morris Brown, co-senior author of the FABULAS study and Professor of Endocrine Hypertension at Queen Mary University of London and Professor of Endocrinology at Barts Health NHS Trust, said: “It is 70 years since the discovery in London of the hormone aldosterone, and, a year later, of the first patient in USA with severe hypertension due to an aldosterone-producing tumour. This patient’s doctor, Jerome Conn, predicted, with perhaps only minor exaggeration, that 10-20% of all hypertensions might one day be traced to curable nodules in one or both glands. We are now able to realise this prospect, offering 21st-century breakthroughs in diagnosis and treatment.”

One of the trial participants, Michelina Alfieri, shared her experience:

“Before the study, I suffered from debilitating headaches for years despite multiple GP visits. As a full-time worker and single parent, my daily life was severely affected. This non-invasive treatment provided an immediate recovery—I was back to my normal routine straight away. I’m incredibly grateful to the team for giving me this choice.”

What’s Next? 

The success of FABULAS has led to a larger randomised trial called ‘WAVE’, which is comparing Triple T with traditional adrenal surgery. The results are expected in 2027.

Professor Stephen Pereira, Chief Investigator of FABULAS and Professor of Hepatology & Gastroenterology at UCL Institute for Liver and Digestive Health, added: “With appropriate training, this less invasive technique could be widely offered in endoscopy units across the UK and beyond.”

Clinical Endocrinology Lead at Addenbrooke’s Hospital and Professor of Clinical Endocrinology at the University of Cambridge, Professor Mark Gurnell, said: “This breakthrough was made possible thanks to the collaborative development of novel PET tracer molecules, which enable non-invasive diagnosis by allowing us to precisely locate and treat adrenal nodules for the first time.

“Thanks to this work, we may finally be able to diagnose and treat more people with primary aldosteronism, lowering their risk of developing cardiovascular diseases and other complications, and reducing the number of people dependent on long-term blood pressure medication,” he added.

A major step forward for hypertension treatment 

For the millions of people suffering from undiagnosed primary aldosteronism, this research offers new hope. The potential to be freed from a life of struggling with high blood pressure via simple, non-invasive diagnosis, and safely targeted thermal therapy, allowing faster recovery and better outcomes.

With further studies underway, this breakthrough treatment could soon become a standard procedure worldwide, transforming care for patients with this curable form of hypertension.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02755-7/fulltext

Genetic study part-funded by NIHR Cambridge BRC helps predict childhood kidney cancer development

A genetic study part-funded by NIHR Cambridge BRC has looked at how cancers arise in children who are predisposed to developing the childhood kidney cancer, Wilms tumour, which could help anticipate the development of tumours before they fully form.

Researchers at the Cambridge University Hospitals NHS Foundation Trust, Great Ormond Street Hospital, Wellcome Sanger Institute, the University of Würzburg in Germany and their collaborators, mapped the genetic differences across 137 children with Wilms tumour. This included 71 children who had a genetic predisposition, some of whom had early symptoms.

Wilms tumour is a type of kidney cancer that largely affects children under the age of five. In the UK, about 85 children are diagnosed with Wilms tumour every year.

About 30 per cent of children who develop Wilms tumour are born with inherited genetic changes that increase their likelihood of developing this cancer. The study, published in Cancer Discovery, suggests that these inherited genetic changes don’t just increase the risk of cancer but also affect how these tumours develop – including how well they respond to certain treatments, and whether the child has a higher risk of developing secondary cancers later in life.

Professor Sam Behjati

Professor Sam Behjati, co-senior author

The research team indicated that different genetic predispositions give rise to different tumour development pathways and kidney structures, and identified those that restrict the growth of tumours. They also found that Wilms tumours develop differently in children that are born without genetic predispositions.

Their findings suggest that tailoring treatment and screening programmes to a child’s genetic makeup could improve the quality of care. In the future, this research could lead to ways to guide treatment and develop new therapies based on certain genetic changes.

“Our research illustrates the power of collaborative genomic research to answer important clinical questions. At the moment, we treat all children with a predisposition the same, meaning that some children get too much and others too little treatment.

“Our findings indicate that we may be able to personalise treatment on the basis of genetic information. Moreover, since we now know the precise sequence of genetic changes that lead from predisposition to cancer, we may be able to screen for tumours more effectively and even begin to entertain the possibility of prevention.”

Professor Sam Behjati, co-senior author at the Wellcome Sanger Institute and Cambridge University Hospitals NHS Foundation Trust

Children with Wilms tumour are currently only screened for genetic predisposition if they show specific features, such as tumours in both kidneys. Treatment for these children has to balance removing tumours and reducing the risk of secondary tumours later in life, while preserving as much kidney function as possible.

Strategies to spare normal kidney tissue include chemotherapy, certain types of surgery, and extended courses of postoperative chemotherapy, along with close surveillance for recurrence. All of which are demanding for the patient and their family. Using genetics to inform treatment could allow some children to avoid these interventions if their genes show they are unlikely to develop subsequent tumours.

The team showed that tumour development differed in children with a genetic predisposition. This depended on which gene was affected and when this gene was activated during development in the womb, known as its developmental timing.

Different genetic predispositions to Wilms tumour led to specific sequences of DNA changes during childhood that eventually caused tumour formation. These DNA changes are known as driver mutations, some of which increased the children’s risk of secondary cancers as well as Wilms tumour. In particular, genetic changes in genes – WT1 and TRIM28 – resulted in the accumulation of additional driver mutations in specific pathways, which could be targeted in future drug development.

Genetic predisposition also impacted the tissue architecture of the kidneys, which could help explain why some children develop non-cancerous kidney growths before cancerous tumours.

Overall, the findings indicate that predisposition may dictate how Wilms tumour develops, with specific patterns depending on the original genetic change. Researchers suggest that in the future, it could be possible to tailor treatment and screening programmes to the type of genetic predisposition a child has, to ensure they are receiving the most effective care.

Deaf teen helps build VR therapy for hearing-impaired youth

“When it’s too noisy you can get overwhelmed and zone out. It can make socialising with friends very difficult and can be incredibly isolating.”

Kaitlyn is a 20-year-old actor and theatre student from London who was born profoundly deaf. She’s had cochlear implants to help with her hearing since she was three but the implants are far from a complete fix.

She explains: “Cochlear implants are amazing but I don’t hear what a hearing person hears. I have to work incredibly hard to lip read or find a visual way of communicating, such as British Sign Language.”

Kaitlyn is now hoping to help a generation of D/deaf children and young people thanks to her involvement in an innovative new virtual reality medical trial.

“It can be challenging growing up being deaf. Lots of everyday situations can be a struggle, from playing sport to crossing the road.

“Even when you’ve had positive experiences at school with lots of support and deaf friends, conversations can be difficult and exhausting. You can’t work out where voices are coming from and by the time you’ve found who’s speaking you’ve missed the first half of what they said.

“With cochlear implants, you’re constantly hearing new sounds that you either haven’t noticed before or just haven’t been tuned into. It can be quite scary hearing a new sound and thinking ‘should I be worried or is that okay?’ Finding ways to improve your ability to identify sounds is so important.”

In an effort to improve the lives of children and young people with similar hearing difficulties, Kaitlyn has been involved in testing and developing a Virtual Reality gaming trial that is intended to help use both ears (BEARS) together, to train listeners to better locate sounds. This is something that children and young people with cochlear implants find difficult. The BEARS suite of games includes a variety of immersive, 3-D sound and vision experiences, such as target practice, music games, and serving customers in a busy cafe.

Funded and supported by the NIHR and led by Deborah Vickers (pictured, top right) from the University of Cambridge and Dan Jiang from Guy’s and St Thomas’ NHS Foundation Trust, the project brings together speech and language therapists, surgeons, audio engineers, audiologists and children and young people using cochlear implants to create games.

Kaitlyn’s involvement began at 18 years old when she saw a flyer about the project while attending an appointment at Guy’s and St Thomas’. Intrigued by the potential of VR, she volunteered.

“My brother played VR games at home so I thought it sounded exciting and wanted to give it a go.”

She explains: “I played the games at home every week for three months and afterwards I noticed my sound location skills had improved – even after this short period of time. I fed back on the games so they could be developed further to make them as user friendly for children and young people as possible.”

Over 160 children and young people are currently enrolled onto the trial at sites in Belfast, Birmingham, Bradford, Cambridge, Kilmarnock, London, Manchester, Middlesbrough, Nottingham, Oxford and Southampton.

Jameel Muzaffar, NIHR National Specialty Lead for Ear, Nose and Throat Surgery & Audiology says: “Cochlear implants, while life-changing, do not restore natural hearing. They act as an electronic ear and send electrical pulses to the hearing nerve via electrodes placed inside the ear. But children and young people still struggle with combining sounds from both ears and listening skills don’t just come to you – you have to sit down and improve them.

“The BEARS project represents a major step forward in addressing these issues. By offering a tailored, interactive, and patient-centred approach, the BEARS VR-based training games have the potential to transform spatial hearing skills, improve understanding of speech in noisy conditions and enhance quality of life for young cochlear implant users.”

From a personal perspective, Kaitlyn sees the potential for the trial to help children and young people long into the future. “The games are not only fun for children and young people to play but it could help with real life skills so that when they are older, they feel more confident and won’t feel like they’ve been held back. They’ll feel like they managed to achieve something in the game so they can feel confident doing it in real life too.

“Living with a cochlear implant can be a struggle and so anything that could help make children and young people’s lives with them a little easier is fantastic.”

Looking back over 2024: a year in highlights

As 2024 draws to a close, we’ve put together a snapshot of some of our key research stories and events that we hosted over the year.

A massive THANK YOU to all our researchers who have carried out key research and also to the patients and members of the public who have supported our PPIE activity over the past 12 months – making research better and more relevant to you.

Click on the image below to find out more about the discoveries, trials and successes over 2024.

A very happy and peaceful festive season to all our colleagues, networks and supporters!

Making chemotherapy for Hodgkin lymphoma kinder to patients

A simple change to the chemotherapy regimen for people with Hodgkin lymphoma could reduce the long-term health impacts that can result from treatment, according to researchers in Cambridge. The findings could lead to the national guidance on chemotherapy treatment for these patients being revised.

The study published in The Lancet Oncology was led by Cambridge University Hospitals, the Wellcome Sanger Institute and supported by the NIHR Cambridge BRC. It compares the lasting effects of two chemotherapy regimens used to treat Hodgkin lymphoma in younger adults. Hodgkin lymphoma is often diagnosed in younger people (age 20-40) so kinder treatments have the potential to deliver significant benefits, such as reduced hospital time and greater likelihood of recovering fertility.

Data previously collected from 1,945 patients treated with the existing chemotherapy regime (eBEACOPP) was compared to 312 patients treated with a similar regimen, called eBEACOPDac. Both treatments use combinations of drugs, and the change replaces one of these, procarbazine, with another called dacarbazine. Both chemotherapies achieved the same success in treating cancer (93.3% in remission 3 years after treatment), but comparison of data from the two groups showed that patients treated with eBEACOPDac generally experienced fewer, less severe side effects.

A similar drug substitution is already approved for use in children and is increasingly widely used for the treatment of adults, but this is the first study to rigorously examine its impact in adult patients.

Patients treated with the new regimen spent less time in hospital, required fewer blood transfusions following treatment, and more patients showed signs of recovering fertility sooner. This also has the potential to reduce hospital admissions and demand for hospital appointments. Part of the study used whole genome sequencing at the Wellcome Sanger Institute to look at the effects of both treatments and showed that eBEACOPDac has a greatly reduced impact on patient genes.

Hodgkin lymphoma is a rare, treatable blood cancer. Around 2,000 people per year are diagnosed in the UK and treatment success is high, with over 95% of younger patients cured with treatment. The occurrence of Hodgkin lymphoma in younger people means there is a significant need to reduce the long-term health and fertility impacts of treatment.

Chemotherapy is a well-established approach for treating various cancers, including Hodgkin lymphoma. There are many different chemotherapies consisting of several different drugs used in combination. Chemotherapies are highly effective for treating cancer but also have well-known side effects (e.g. nausea and hair loss) and can have lasting effects following treatment, including anaemia and infertility.

A commonly used standard first-line treatment for people with advanced Hodgkin lymphoma involves chemotherapy known as eBEACOPP. The new eBEACOPDac regimen does not increase the cost of treatment and is administered to patients in the same way. Making eBEACOPDac the recommended treatment for Hodgkin lymphoma in adults could improve the long-term health of patients and enable more of them to go on to have children.

Professor George Follows, Consultant Haematologist at Addenbrooke’s Hospital and the Department of Haematology, University of Cambridge and co-lead author on the study, said: “Our findings highlight the potential to make the short and long-term side effects of chemotherapy much kinder for Hodgkin lymphoma patients without compromising the effectiveness of treatment. By making a small change to how patients are managed, we can greatly reduce the lasting impacts that this disease, and its treatment, has on their lives giving many more patients the opportunity to go on to raise families.”

Dr Raheleh Rahbari, Wellcome Sanger Institute and co-lead author on the study, said: “This is an example of how genomics can impact lives and help change healthcare. Through the use of genome sequencing we’ve gained a deeper insight into the lasting effects of chemotherapies, allowing us to learn more about their role in long-term health, and make progress towards effective treatments that minimise side effects as much as possible.”

Dr Cathy Burton, Chair of the UK Hodgkin lymphoma study group, and Haematology Consultant at Leeds Teaching Hospitals NHS Trust, said: “This excellent work provides strong evidence of the benefits of using eBEACOPDac for treatment of Hodgkin lymphoma. This approach of switching procarbazine to dacarbazine is preferable due to its reduced side effects and improvements in fertility recovery. Crucially, these findings are of international significance and should be used to inform treatment guidelines globally to ensure patients are receiving the best treatments.”

This work is illustrative of the benefits that can be delivered through the effective translation of research into clinical practice, which will be further strengthened through the new Cambridge Cancer Research Hospital. The next steps for this research will include more long-term follow up of patients treated with eBEACOPDac, and Professor Follows hopes it will inform a global change in the guidance for treating adults with Hodgkin lymphoma.

The study was co-led by Professor George Follows, Consultant Haematologist at CUH and Dr Raheleh Rahbari, Cancer Research UK Career Development Fellow at the Wellcome Sanger Institute. The clinical research was co-ordinated by Dr Anna Santarsieri, Haematologist at CUH, supported by the Anglia Ruskin University MD Programme. The research was also supported by the Addenbrooke’s Charitable Trust (ACT), Wellcome and National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre (BRC).

Louisa’s story

Louisa, a patient in her 30’s from Peterborough, was treated with eBEACOPDac as part of the study. Three years later, she has gone on to have her second child. She said: “When I was told I had lymphoma, it was the start of the COVID pandemic and we had a new baby in the house. It was a challenging time and instinctively, what I wanted most was to get the best treatment, that would allow me to be there for my new family and do the things I love. Undergoing treatment was still difficult but I received excellent care and support throughout.”

She added: “Regaining my fertility was the most unexpected and incredible experience. I knew my chances of fertility after chemotherapy treatment would be somewhat compromised, so to have another child last year was wonderful and I am eternally grateful to be able to experience motherhood for a second time.”

NIHR Cambridge BRC-funded research is top-five most-cited in world-leading general cardiology publication

Research from the University of Cambridge’s Cardiovascular Epidemiology Unit and funded by NIHR Cambridge BRC are listed in the top five most-cited papers in the European Heart Journal over 2023.

Occupying top spot is the research paper Mendelian randomization for cardiovascular diseases: principles and applications by authors Stephen Burgess, Adam Butterworth and collaborator Susanna Larsson. Their review describes the principles of the Mendelian randomization design and its applications in cardiovascular epidemiology, explaining the jargon, assumptions, advantages, caveats and limitations.

In fourth place is SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe, from researchers Lisa Pennells, Stephen Kaptoge and Emanuele Di Angelantonio.

This is a new risk calculator that will help to identify people with type 2 diabetes more accurately, according to country of residence, who are at high risk of developing heart and circulatory diseases in the next 10 years.

Director of the NIHR Cambridge BRC, Professor Miles Davies, said: “This is a major achievement, especially given the translational relevance of both Mendelian randomisation (particularly for drug development and repurposing) and SCORE2-Diabetes. Congratulations to all investigators involved!”

Landmark ‘Pill-On-A-Thread’ cancer screening trial welcomes first participants

Cytosponge device

A pivotal clinical trial of a ‘pill-on-a-thread’ test, which will decide if it becomes a new screening programme for oesophageal cancer, has welcomed its first participant.

The BEST4 Screening trial will find out if the capsule sponge test could be used to screen people with heartburn for Barrett’s oesophagus – a condition that can lead to oesophageal cancer.

The trial is backed by £6.4 million of funding from Cancer Research UK and the National Institute for Health and Care Research (NIHR).

The capsule sponge test takes ten minutes to do and can be done by a nurse – making it much faster and less expensive than endoscopy. The trial will find out if the capsule sponge test can reduce the need for cancer treatments and prevent deaths from oesophageal cancer. The trial showcases UK science and innovation and is the last step in a series of clinical trials to see if the capsule sponge test could be offered in the cancer screening programmes of the 4 UK nations.

Over the next three years, the trial will recruit 120,000 people who regularly take medication for heartburn – the most common symptom for Barrett’s oesophagus. Barrett’s oesophagus is a precursor condition to oesophageal cancer, where cells in the food pipe start to grow abnormally.

Invitations to join the trial will be sent by text message from NHSResearch to encourage as many eligible people as possible to take part in England. Participants will be asked to join Heartburn Health, a new platform to take part in clinical trials in heartburn-linked cancers like BEST4 Screening. Mobile screening vans will be rolled out across England to deliver the tests as part of the trial.

There are around 9,300 new cases of oesophageal cancer in the UK every year, according to analysis from Cancer Research UK*. Oesophageal cancer is the seventh most common cause of cancer death in the UK, with around 22 deaths a day from the disease**.

The capsule sponge starts off as a small, coated pill attached to a thread. When a patient swallows the pill and it reaches the stomach, the coating dissolves and the sponge inside it expands to the size of a 50p coin. The sponge collects cells from the oesophagus as it is gently pulled out from the stomach by a nurse or GP. The cells are sent for testing for two proteins called Trefoil Factor 3 (TFF3), which is only found in Barrett’s oesophagus, and altered p53 protein, which identifies cells which are starting to grow out of control and become oesophageal cancer.

The trial follows decades of research by Professor Rebecca Fitzgerald and a team of scientists, clinicians and nurses at the Early Cancer Institute, University of Cambridge and Cancer Research UK Cambridge Centre, who invented and refined the capsule sponge test. The early trials were supported by the NIHR Cambridge BRC and carried out at the NIHR Cambridge Clinical Research Facility.

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.

Cancer Research UK has funded several successful clinical trials to demonstrate that the test is safe and accurate, which have been designed and run by the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary, University of London. A previous clinical trial, BEST3, showed that the capsule sponge test picks up 10 times more cases of Barrett’s oesophagus in people with chronic heartburn, compared to routine GP care.

The test is faster, less invasive and far less expensive than endoscopy, which is currently used to diagnose Barrett’s oesophagus and oesophageal cancer. The test 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 have been diagnosed with Barrett’s oesophagus. To date, over 24,000 capsule sponge tests have been performed in pilot programmes, helping to reduce diagnostic backlogs in endoscopy and NHS pathology.

Paul Anderson (59), a stock controller from St Neots, pictured left, is one of the first participants to join the BEST4 Screening trial in Cambridgeshire. Paul said: “I first experienced acid reflux 10 years ago and I was referred for endoscopy to get it checked out. I’ve been on medication for heartburn ever since to manage it.

“I’d never been on a clinical trial before, but when the invitation came for this one, I felt I had to sign up as the acid reflux had flared back up again. I’m hoping that it may give me some more insight into my chronic heartburn, as well as helping people who may have similar concerns about their health. I’m hopeful that playing my small part in this worthy cause will help others to get checked out earlier.”

Director of the Early Cancer Institute at the University of Cambridge, inventor of the capsule sponge test and co-principal investigator of the BEST4 trials, Professor Rebecca Fitzgerald, pictured right, said: “The capsule sponge is changing how we detect Barrett’s oesophagus and oesophageal cancer. Catching it earlier can save lives by reducing the need for chemotherapy and surgery to remove the oesophagus.

“The BEST4 Screening trial is the pinnacle of many years of painstaking research, which has demonstrated that the capsule sponge can reliably identify Barrett’s oesophagus. Thousands of people have already benefited in trials and pilot programmes, and now we’re taking the test to the next level to see if we could offer this to everyone with heartburn.

“The BEST4 Screening trial could fundamentally transform the lives of people affected by oesophageal cancer by providing the crucial evidence needed to make it a viable screening programme, rolled out to every part of the UK.”

Director of the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London and co-principal investigator of the BEST4 trials, Professor Peter Sasieni, said: “Most people with Barrett’s oesophagus have heartburn, but most people with heartburn don’t have Barrett’s oesophagus. We have already shown that the capsule sponge can reliably identify people with Barrett’s oesophagus. Now we need to show that using it in a targeted screening programme can help prevent oesophageal cancer and reduce deaths from this disease.

“The BEST4 Screening trial will involve over a hundred thousand people joining across the UK. It is a huge undertaking which will take many years, but it is important that we find out whether a new routine screening programme really will prevent cancers and save lives.”

Scientific Director for NIHR Programmes, Professor Danny McAuley, said: “The capsule sponge is an innovative device that has already shown great potential to prevent deaths from oesophageal cancer.

“It’s a great milestone to see the first patient recruited on this pioneering NIHR and CRUK funded trial which in future we hope can lead to routine screening for this deadly disease.

“Thousands of people are needed to join this trial, and we encourage people to sign up as participants. This important research will help benefit patients, and inform those who plan and deliver NHS services of how best to test for the disease.”

Chief Executive of Cancer Research UK, Michelle Mitchell, said: “Around 59% of all oesophageal cancer cases are preventable. Yet endoscopy, the gold standard for diagnosing and treating this cancer, is labour-intensive and not practical for a population screening programme.

“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.

“Cancer Research UK is proud to be supporting this landmark clinical trial, bringing the capsule sponge test into the community and offering it to a much wider group of patients. After many decades of research, we’re on the cusp of transforming oesophageal cancer diagnosis forever.”

Minister for Public Health and Prevention, Andrew Gwynne, said: “This trial is a shining example of how we can harness the power of technology to improve patient experience and speed up diagnosis.

“This innovation has the potential to allow us to perform lifesaving screenings quicker and cheaper, freeing up vital NHS resources.

“As part of our 10 Year Health Plan to radically reform our broken NHS, we are committed to fighting cancer on all fronts, and ensuring patients have access to cutting edge, government-funded research.”

The BEST4 Screening trial is open to men over the age of 55 and women over the age of 65 who are currently taking medication for chronic heartburn. The Endosign test used in the trial is manufactured by Cyted Health, who also carry out the pathology tests on samples obtained by the capsule sponge.

More information about how to join the trial can be found at BEST4 or by contacting cuh.best4.trial@nhs.net.

You can also sign up to the NIHR’s Be Part of Research service to take part in clinical research. Simply answer a few questions about yourself and the conditions you’re interested in to be matched to studies happening in locations near you.

NIHR Cambridge theme lead elected to National Academy of Medicine

image of Antenatal, Maternal and Child Health Theme lead: Professor David Rowitch

Congratulations to Professor David Rowitch, NIHR Cambridge Antenatal, Maternal and Child Health theme lead, who has been elected to the National Academy of Medicine.

Professor Rowitch’s work on glial cells (cells in the nervous system) found they provide much more than ‘the glue’ to support to the nervous system but they also protect neuron cells (nerve cells which send and receive signals from your brain).

He found their function is critical to support the spinal cord and that they also might play a part in the development of the brain and neurodegenerative illnesses.

Professor Rowitch said on being elected to the prestigious academy said: “It is a great honour to have been elected to the National Academy of Medicine.”

The National Academy of Medicine announced 90 regular members and 10 international members during its annual meeting in October. It is considered one of the highest honours in the fields of health and medicine and recognises individuals who have demonstrated outstanding professional achievement and commitment to service.

New members are elected by current members through a process that recognises individuals who have made major contributions to the advancement of the medical sciences, health care, and public health.

Victor J. Dzau, NAM President said: “This class of new members represents the most exceptional researchers and leaders in health and medicine, who have made significant breakthroughs, led the response to major public health challenges, and advanced health equity.

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