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Advancing liver health through microbiome research

Dr Benjamin Mullish

On World Liver Day, Dr Benjamin Mullish from the Department of Metabolism, Digestion and Reproduction, discusses the research being done on the microbiome and faecal (or ‘intestinal’) microbiome transplants (FMT), and how he hopes that can be converted from ‘bench to bedside’ to improve the lives of patients with liver conditions. 

When most of us hear the words ‘gut bacteria’, we think about germs that can cause infection and make people ill.  However, more recently, scientists and doctors have recognised that we also have billions of ‘beneficial’ bacteria (and other microbes) in our gut that play important roles in keeping us healthy.   The specific ‘mix’ of microbes that a person has in their gut, and the environment in which they live – now often called the gut microbiome – is distinct between different people like a fingerprint.  Furthermore, the gut microbiome is influenced by and altered by a number of factors, including our diet, our medications (particularly antibiotics), and how old we are.

Of further interest, we now think that our gut microbiome plays an influence over our vulnerability to developing a range of medical conditions, how the condition progresses if we do develop it, and even how well we might respond to different treatments used for the condition.  This includes a number of different liver diseases; the gut and the liver are very close physically within the body, and the gut microbiome seems to be an important factor that impacts upon how these two organs ‘talk to’ each other in health and disease.  Within the Section of Hepatology and Gastroenterology, one of our major areas of research relates to how an altered gut microbiome may contribute to different liver diseases, and whether we might be able to alter the gut microbiome as a new approach to treating them.

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From Britpop to breakthroughs: Reflecting on 30 years of HIV testing and treatment

Born on what would eventually be recognized as World AIDS Day in the 1970s, Dr Mike Emerson, now affiliated with the National Heart and Lung Institute, relocated to vibrant London during the early 1990s amidst the fervour of the Britpop era. In the backdrop of Blur and Pulp melodies, 1990s London faced the AIDS crisis. Three decades later, he is at the helm of a team investigating cardiovascular ailments in people with HIV. In this piece, Dr Emerson reflects on the advancements in HIV diagnosis and therapy, and reiterates the ongoing importance of  National HIV Testing Week. 

I was born on what was to become World AIDS day way back in the 1970s, and moved to the big smoke in the early 90s. London was exploding with Britpop excitement, and in the absence of mobile tech, we went out every night to the sounds of Blur and Pulp. 90s London was also the epicentre of the UK’s bit of the global AIDS crisis. People in their early 20s, as I was, were dying (of ignorance the government told us). I quickly learnt not to hold birthday celebrations in Soho; celebrating and mourning young friends and sons don’t mix well. Exactly 30 years later, I lead a team investigating cardiovascular disease as people live with HIV for decades and succumb to the diseases of old age. This week is HIV testing week, so it’s a good time to reflect on how far we have come and remind ourselves of the importance of HIV testing. 

Back in 1981, a couple of obscure articles noted incidences of fatal pneumonia and rare skin cancers in otherwise healthy young American men. Oddly, these men were all gay. Within months, there was an explosion of terrifying fatal illness amongst the gay communities of New York, San Francisco and, not far behind, London. People became infected with HIV following blood transfusions, and babies were born with the condition and died. When HIV tests became available, the prospect of one was terrifying, involving a week-long wait for results and a recommendation to take a friend when results were due to be delivered. 

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Sharing dumplings, jetlag and the stage: co-presenting at conferences, the way forward

Dr Lindsay Dewa, Advanced Research Fellow in Mental Health, and Pelumi Fatayo, co-producer of Nexus, reflect on their experiences of presenting together at an international conference, and the value of putting co-production into practice. 

“Oof – long day that wasn’t it! Is it 11pm or 7am? Is it Friday or Saturday? I’m so confused!” – Lindsay

That was a question I had asked Pelumi following over 24 hours of travelling from London (and Manchester for Pelumi) to South Korea. But I could see it was already well worth the trip before we’d even stepped out of the taxi – the bright lights, the heat… the friendly taxi driver trying to figure out where our hotel was on his five digital devices… we were excited! But what I was most looking forward to was co-presenting about co-production in mental health research at a prestigious international conference – ISQua – with one of my young co-producers, Pelumi. The conference theme was “Technology, culture and co-production: Looking to the horizon of quality and safety” so we felt it was perfect for us to share our experiences.

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Involving critically ill children in research: Is that even possible?

When a young patient’s life hangs in the balance, the last thing on the minds of stressed parents, families and patients would be to get involved in research. Or is it? Despite the turmoil, some brave families and children have volunteered to support clinicians in their research by taking part. Dr Padmanabhan Ramnarayan, Clinical Reader in Paediatric Critical Care in the Department of Surgery and Cancer and Honorary Consultant in Paediatric Intensive Care at Imperial College Healthcare NHS Trust and West London Children’s Healthcare, explains why.  

I have been a children’s intensive care doctor for over 20 years, and for most of that time, I have been leading research that has involved critically ill children. My patients are young, their parents and families are super-stressed, and most of the treatments are given in an emergency – all of which seem like perfectly valid reasons to not involve sick children in research. Despite this, my experience is that parents and families are overwhelmingly in support of research. Why? 

The evidence gap 

Since children’s intensive care is a young speciality, much of our practice is ‘borrowed’ from adult intensive care or newborn intensive care. This is not ideal because our patients range from birth to 18 years of age, with diseases as diverse as asthma, respiratory infections, accidents and trauma, sepsis and brain injury. Without high-quality research to guide care, the treatments provided to sick children may not be the best or the most effective. Doctors and nurses, and parents and families, understand this. By agreeing to include their children in research studies, parents want to improve the care provided to future patients. 

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Professor Sir Peter Barnes knighted for excellence: Reflections on his career in respiratory science

Professor Sir Peter Barnes FRS FMedSci, from the National Heart and Lung Institute (NHLI), was made a Knight Bachelor in this year’s King’s Birthday Honours “for services to respiratory science.” Sir Peter is Professor of Thoracic Medicine at the NHLI and he was Head of Respiratory Medicine at Imperial until 2017. Here he writes about his reaction to his award and describes some of the current research projects in chronic obstructive pulmonary disease (COPD).

A surprise! 

My wife opened the letter “On His Majesty’s Service” as she thought it was a tax demand – I was absolutely shocked to see I had been offered a knighthood. Of course, I was and am delighted with the award. It is very good for respiratory science and medicine, which generally receives little public attention. This is surprising as chronic lung diseases are amongst the most common in the UK, affecting one in seven people and the third ranked cause of death. I would like to dedicate this award to all the brilliant students, post-docs, research fellows, visiting scientists and colleagues that I have worked with at Imperial College London over many decades.  

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Navigating LGBTQIA+ discrimination in healthcare: where do we go from here?

Avi Kaura, LGBTQIA+ Student Officer

As a chronically under-represented and under-researched group, the unique experiences of LGBTQ+ healthcare staff in the workplace are often neglected. Third-year medical student, Avani Ela Kaura, highlights why it’s imperative that we listen, address and support the specific needs of LGBTQIA+ people.

Exploring how work-related stress affects LGBTQIA+ healthcare professionals in my recent Letter to the Editor was greatly saddening, and a little dark. However, having been published in The BMJ  and reaching a wider audience, my hope is that awareness has been raised, granting volume to these silenced voices. This is especially important as the unique yet varied experiences of LGBTQIA+ people are in-genuinely, or more frequently, not explored. Despite being at the dawn of my career, I am keen to pioneer a movement of change.

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