Category: NHLI

Lung volume reduction – new hopes and missed opportunities in COPD


COPD, chronic obstructive pulmonary disease, has traditionally been thought of as an irreversible and somewhat hopeless condition. Many patients with COPD may be missing out on the possibility for a dramatic improvement in their condition. They deserve better.

COPD, is a common and important condition. There are 1.3 million people with a diagnosis of COPD in the UK and it’s now the third leading cause of death worldwide. The main symptoms are breathlessness, cough and sputum production.

The term COPD encompasses a range of pathological processes, usually caused by smoking or inhaling other noxious materials. It includes chronic bronchitis – inflammation and damage to airways as well as emphysema – destruction of the lung tissue itself and damage to the blood vessels in the lung. In emphysema the walls of the alveoli (air sacs) break down. The lung tissue loses its elasticity and becomes baggy, and air gets trapped in the lungs making breathing uncomfortable.

There are treatments including inhaled medication, pulmonary rehabilitation and flu vaccination, and for people who continue to smoke, smoking cessation is the most effective. Despite the best standard care the condition is progressive and conventional treatments cannot so far reverse the underlying process. (more…)

Understanding our achy breaky hearts

Broken heart syndrome, officially known as takotsubo syndrome, is an acute type of heart failure, where the bottom of the heart stops beating in situations of extreme stress. A condition predominantly affecting post-menopausal women, it has been dubbed broken heart syndrome owing to the frequent occurrence during bereavement after the loss of a loved one. However, this is just one example of the various circumstances in which takotsubo syndrome can occur. Indeed, any stressful event can lead to a surge in adrenaline which can result in takotsubo syndrome. This could be physical or emotional, and includes trauma such as car accidents, drug abuse, and even happy events such as weddings!

This varied list of triggers and the association with a ‘broken heart’ has attracted interest from the media. Furthermore, the specific localisation of the poorly contracting region of the heart and patient demographics are also very interesting from a research standpoint. Often when describing my PhD, the concept of a ‘broken heart’ understandably resonates with people. (more…)

Vaccines are vital


Originally published on the MRC Insight blog and reproduced under CC BY 4.0, here Peter Openshaw, Professor of Experimental Medicine at Imperial and President of the British Society for Immunology, says we cannot afford to be complacent about vaccines.

As a clinician working in research, I want to improve peoples’ health. The NHS was set up to focus on treating people with disease. But how much better would it be if we could prevent people from getting sick in the first place?

This is where vaccines come in. As vaccinologists, we use our scientific knowledge to design new or improved vaccines to stimulate the immune system. This creates natural protection against infections and prevents disease.

New and improved vaccines

The current vaccines we have are excellent and safe but many could be better. There are also new ways to use vaccines and lots of diseases which do not yet have effective vaccines.

The science of vaccinology advances monthly. There are hundreds of new vaccines at different stages of testing, many of which could lead to improved human health and wellbeing. In response to this fast-changing landscape, the MRC and BBSRC have recently funded five collaborative networks to drive UK vaccinology forward for the benefit of global health. (more…)

World Heart Day: Building new hearts at the BHF Regenerative Medicine Centre

We are excited by the news that our BHF Regenerative Medicine Centre has been renewed for another four-year term from 1 October 2017! At Imperial we have been concentrating on the big challenge of producing new muscle for the damaged heart, along with our partners in the Universities of Nottingham, Glasgow, Hamburg and Westminster.

The heart has a very limited capacity to repair itself after a heart attack, or during the more insidious damage from high blood pressure, diabetes or chemotherapy. We have been looking at various kinds of stem cells to explore their power to become new cardiac muscle cells – one of the big successes of the current Centre. Pluripotent stem cells – those which have the capability of turning into any cell type in the body – can now be turned very efficiently into beating heart muscle in the laboratory dish, and made into strips of engineered heart tissue. Our partner, Professor Chris Denning, at the University of Nottingham has automated the process of making the cells and Professor Thomas Eschenhagen in Hamburg has contributed his technology for converting this into muscle. (more…)

From bakery to benchside: a medical student’s journey in research

The TB Research Centre’s staff and students

It was extremely challenging for me to stare back at the four rejections that faced me. Four rejections from four separate medical schools. Four independent reviewers telling me I was not to be a doctor. I had to endure seemingly unending encouragements and sympathies from friends and family. Their attempts were well-meaning, but often repetitive. My particular favourite was “I believe Edward Jenner didn’t get into medical school the first time round”. This, of course, was a complete fabrication. I think I always had this naïve cockiness about me, an artless assumption that I had the necessary experiences to stroll into medical school. Perhaps rejection had a subduing effect on my ego, though, I probably would presume most of those who know me would thoroughly disagree.

Nevertheless, it occurred to me that I had a year to convince the doctors of now that I could be a doctor of the future. But then I thought again. I had an entire year to do what I wanted. I found myself avoiding medical work of any sort, and take up a job in a bakery. I normally stop here when I want to impress people, to give the impression that I mastered the art of conjuring delicious, enticing pastries. In fact, it is due to my semi-duplicitous nature that many people still think of me as a great baker. But I’m not. In reality, my primary role was to serve customers, clean and wash up (as well as outline the difference between spelt bread and gluten-free bread: a distinction I still don’t understand to this day). It was an enjoyable job, and it provided me with some money to fuel some travelling later on. Moreover, I had the blessing of taking home two full bags of artisan breads untouched by the day’s customers — a perk which became more and more hedonistic as the year went on. (more…)

TB or not TB? Why tuberculosis remains one of the top 10 causes of death today

Tuberculosis

I was always a sickly child – when I was eleven years old, doctors injected my forearm with tuberculin in order to check whether my immune system raised a response to the bits and bobs of dead tuberculosis (TB) bacteria in it. If it did, it meant my immune system had already been prodded into battling TB, that is, it had previously encountered or was currently encountering an infection with TB bacteria. The injection site swelled like a furious bee sting, the doctors decided TB was the root cause of all my troubles, and I was intensely medicated for the next six months. My symptoms improved, and I have since evolved (visibly even!) towards the hale and hearty end of the healthiness spectrum.

In retrospect, now that I am medically trained and pursuing a PhD in TB immunology, I can appreciate all that my care team must have had to consider before starting an eleven-year-old child on a rigorous anti-TB treatment based on an educated guess. My symptoms were not typical of classical lung TB, the most common and infectious form of TB, they were mostly gastrointestinal, but then TB has also been known to stitch the gut into uncomfortable knots. My mother had recently been diagnosed with a cold abscess, due to TB of the bone, and though this could not possibly be infectious (based on centuries of observation) it still raised flags as it meant I had a history of contact with a TB patient. I showed an immune response to the tuberculin skin test (TST), but then I had received the BCG vaccine, which is a close relative of TB bacteria. This meant I could elicit a cross-reactive immune response and result in a positive TST even in the absence of TB infection due to the similarity of the two bacteria. (more…)

Weighing up dodgy diets

Weighing up dodgy dietsMagazines and newspapers are full of so-called ‘tips’ or ‘advice’ for the image conscious, detailing extreme diets followed by the rich and famous to achieve dramatic weight loss, or new diets apparently supported by the latest scientific research. One example is the gluten-free diet, made fashionable particularly in the sporting world by former world number one tennis player Novak Djokovic (1). Having had a reputation for being physically weaker than his rivals, Djokovic was eventually diagnosed with coeliac disease and the resulting gluten intolerance. Eliminating gluten from his diet transformed his career.

Many have since adopted the gluten-free diet with the hope of boosting their own energy levels, but have had mixed results. Recent studies show that being ‘gluten-intolerant’ is hardly a medical condition that can be diagnosed and scientists have struggled to establish a mechanism for supposed gluten intolerance. So unless you suffer from coeliac disease triggered by gluten, following a gluten-free diet could do more harm than good, as gluten-free foods are often low in fibre and key nutrients, and high in sugar. (more…)

Smoke and the burnout of muscles

Image: Shutterstock - SMOKE & THE BURNOUT OF MUSCLES
Smoking is a leading cause of preventable death and disease in the world. It is estimated that the society costs associated with smoking are approximately ₤12.9 billion a year, including the NHS cost of treating smoking related diseases and loss of productivity.

Chronic obstructive pulmonary disease (COPD) is one of the major diseases caused by smoking. The disease ranks third among the leading causes of death worldwide. Around 1.2 million Britons suffer from the disease (Source: British Lung Foundation). The usual clinical picture is that of a smoker with symptoms that include shortness of breath and chronic cough. The muscle lab team at the Royal Brompton Hospital’s BRU, led by Professor Michael Polkey and Dr Nicholas Hopkinson is looking at different ways to improve COPD care, and at the different mechanisms by which interventions improve patient outcomes in the disease.

Wide-ranging consequences

In recent years, it has been discovered that the negative consequences of the pulmonary disease are not just limited to within the rib cage. The wider effects of the disease on multiple body systems has a large and solid evidence base to support it. More than half of COPD patients suffer simultaneously from at least two other conditions known to often occur alongside the disease (so-called ‘comorbid’ conditions); the presence of which is commonly used as an indication of disease severity (1). The disease burden usually takes its toll on the patients’ quality of life, daily physical activities and social interactions. (more…)