Category: Department of Medicine

Encephalitis: the one-in-a-million disease with a million and one implications

 

22 February is World Encephalitis Day. Founded by The Encephalitis Society four years ago, it aims to help raise awareness of the disease on an international scale.

In a nutshell, encephalitis refers to the inflammation of the brain. Up until recently, it was thought that encephalitis was simply either a viral or bacterial infection. However, in 2005, research described a new version of the disease: auto-immune or ‘anti-NMDAR encephalitis’, which is caused by antibodies that attack the brain tissue. In all its forms, encephalitis is incredibly rare: herpes simplex encephalitis (HSE), for instance, affects approximately one in 1,000,000 children. Although there are clear treatment routes available, viral encephalitis is incredibly destructive. The virus can cause irreversible damage in the brain, which will continue to impact upon a patient’s quality of life well after their short-term recovery from the disease itself.

Despite its often devastating consequences, the rarity of encephalitis might raise some important questions for those hearing about the disease for the first time, namely: why should we spend our time researching something that affects so few people?

It’s crucial to acknowledge that just because something is rare, it doesn’t mean that it’s not important. I started working on herpes simplex encephalitis during my time as a postdoc, because it’s an incredibly useful paradigm for studying genetic disorders, and human genetics in general. Looking at cases of encephalitis can also tell us so much about human immune responses to infection. By investigating what has gone wrong in the body in these rare cases of encephalitis, we also learn more about which immune responses are essential to fighting diseases in the average person. Not only does our research into encephalitis allow us to better combat the disease itself, it also give us insights into the mechanisms at work in our body that help to protect the brain from infection and inflammation. We’re beginning to see that our findings have far-reaching implications for other neurological disorders that may be linked to encephalitis via a crossover of immune mechanisms.

With the relatively recent discovery of anti-NMDAR encephalitis, the field of autoimmune encephalitis has blossomed. Although my primary research is rooted in the viral, infectious type of the disease, we’re beginning to investigate its relationship to this newer form. I’m now working with Dr Ming Lim at the Evelina’s Children Hospital at King’s College London, and Dr Yael Hacohen at the Great Ormond Street Institute of Child Health at UCL, to try and pinpoint whether there is a link between the two. More specifically, I’m interested in finding out if suffering from HSE means that a patient is more predisposed to developing autoimmune encephalitis further down the line. (more…)

Leprosy in 2018: an ancient disease that remains a public health problem today

World Leprosy Day. Image courtest of Wellcome Collection.

28 January 2018 is World Leprosy Day

I have always found leprosy a fascinating disease. It is an incredible example of how microbiology, immunology, and social sciences can collide and impact significantly on human health.

Leprosy has been affecting humans for at least 4000 years. It has played a huge part in teaching us about disease caused by bacteria. In 1873 when Hansen discovered Mycobacterium leprae in tissue samples from patients with leprosy, this became the first bacteria to be directly linked to causing disease in humans. Since then we have developed an understanding of the complex range of types of leprosy that occur depending on how an individual’s immune system responds to the challenge of infection with Mycobacterium leprae. We have also observed the consequences of the deformities and disability caused by the body responding to Mycobacterium leprae, which favours human nerves and skin. In turn, we have seen how the appearance of individuals with disability and disfigurement from leprosy has driven stigma, misinformation, and the discrimination of those affected by the disease.

For many people in the UK and around the world, leprosy, or Hansen’s disease, is an ancient condition of our ancestors. It is something that we hear about in religious scripture or watching films like Ben-Hur or the Life of Brian.  Associated with exile from communities, deformity, and poverty. Something that no longer affects the modern world that we now live in.

Leprosy is often referred to in Sanskrit from around 1400 BC, with the term “kushtha” used to describe it. This translates to “eating away”. Courtesy of Wellcome Collection.

In 2000, the World Health Organisation (WHO) made an announcement that leprosy had been eliminated as a public health issue, with the global prevalence finally falling below one case per 10,000 people. This was the culmination of many years of identifying and treating patients with leprosy. This included the development of multi-drug therapy – a real game-changer in the treatment of Hansen’s disease. In total, over 16 million people affected by leprosy were treated, often free of charge. This was a great success.

And so for the elephant in the room. If we have eliminated leprosy as a public health problem, why do we still need to worry about World Leprosy Day?

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Could gut hormones help make Dry January last all year?

After the excesses of Christmas and New Year, it has become fashionable for January to be promoted as a time for reassessment and resolutions. There are promises and attempts at living a healthier lifestyle, including stopping drinking alcohol (‘Dry January’), joining that gym, stopping smoking, and eating better. However, we know how difficult it is to maintain behaviour change over the longer term. People start drinking excessively again, put back on the weight they lose, start smoking again, and their attendance at the gym wanes. For people who have hazardous levels of drinking, and those who are dependent on alcohol, this is particularly problematic.

If people manage to stop drinking alcohol, we know that there are high relapse rates. In some studies, 60% of people with alcohol dependence have started drinking alcohol again after 6 months of abstinence. This is often precipitated by exposure to social events and situations where there is drinking, and stresses with family, job, and social circumstances. What is needed are strategies to help prevent relapse into drinking. While psychological and group support can be of benefit, there is also a potential role for medications to help reduce the craving for alcohol and the response to stress.

The Division of Brain Sciences in the Department of Medicine at Imperial College London are currently running a research study in this area. We are investigating the potential benefit of a completely novel therapeutic strategy to prevent relapse in alcohol dependence. This is the ‘Gut Hormone in Addiction’ (GHADD) Study, funded by the Medical Research Council. This is targeting hormones from our guts, which can act on our brain to influence eating and addictive behaviours. (more…)

Festive feasting: the good, the bad and the microbiome

As the festive season approaches, one wonders how our bodies prepare for the enormity of food that will be ingested in a relatively short space of time.  In the UK alone, the average person consumes 7000 calories on Christmas Day alone.  This is three times the recommended calorie intake per day, and most of us will have reached the recommended calorie intake before Christmas lunch has even been served. And of course, it’s not just about eating more. We are also a great deal more sedentary, with the average person in the UK spending 5.5 hours a day in front of the television over the Christmas period desperately awaiting reruns of Blackadder and yet another Christmas special!

Of course, this massive increase in consumption over the festive period inevitably means we put on weight, with research showing maximum weight gain reached within 10 days of Christmas Day, peaking around 3 January, and then falling.  However, despite this relatively rapid increase in weight in the space of a few days, approximately half of the weight gained seems to remain until the summer months or beyond.  The cumulative effects of this annual increase in weight during the holiday period likely contribute to one’s overall lifetime weight gain.

Obesity results from a mismatch between food intake and energy expenditure.  So is this festive weight gain a result of eating too much and spending too much time on the sofa?  What if it was more than just that? We now know that the gut is a crucial organ in the maintenance of energy homeostasis.  It releases a whole host of hormones such as glucagon-like peptide-1 and peptide YY that regulate appetite in response to nutrient intake.  Much of my work has focused on looking at the effect of dietary protein on appetite.  High protein diets reduce food intake and improve body composition, and if people can stick to them, they lose weight.  (more…)

World AIDS Day: Professor Robin Shattock on the elusive HIV vaccine

World AIDS Day takes place annually on 1 December as an opportunity for people worldwide to unite in the fight against HIV and to show support for people living with HIV/AIDS.

To mark World AIDS Day 2017, we have published a series of blog posts to highlight the important and varied research that takes places at Imperial. Three experts from Faculty of Medicine share their interest in HIV/AIDS which spans from the elusive vaccine to the economics of the epidemic.


Where are we in the battle against HIV/AIDS?

The past thirty years have seen enormous gains. We’ve seen the development of highly effective therapy that today can ensure the health of an HIV positive individual for rest of their natural lifespan. We used to speak of HIV/AIDS as if they were the same thing, now you can be HIV positive and never develop AIDS (Acquired Immunodeficiency Syndrome). Globally over 18 million people are now receiving life-saving drugs, preventing millions of deaths each year. Treatment also dramatically reduces the risk of passing on the infection. Excitingly, recent studies have shown that taking a daily pill (known as pre-exposure prophylaxis or PrEP) can prevent people from contracting HIV infection and this is now being made available in the UK.

However, significant challenges lie ahead

Treatment is for life and is not a cure; we are currently unable to eradicate the virus once someone has been infected. As many as a third of individuals infected with HIV are unaware that they have contracted the virus and late diagnosis significantly impacts on the benefit of available treatments. While great strides have been made to make global treatment accessible, only half of those currently infected are accessing treatment and for every individual starting treatment, one or two people are newly infected. This means that the population requiring life-long medication will continue to expand with associated pressure on global financial resources and already stretched health systems. (more…)

World AIDS Day: Professor Mark Bower on HIV-related cancers

World AIDS Day takes place annually on 1 December as an opportunity for people worldwide to unite in the fight against HIV and to show support for people living with HIV/AIDS.

To mark World AIDS Day 2017, we have published a series of blog posts to highlight the important and varied research that takes places at Imperial. Three experts from Faculty of Medicine share their interest in HIV/AIDS which spans from the elusive vaccine to the economics of the epidemic.


Oncologist turned HIV expert

As a medical oncologist at Chelsea and Westminster Hospital, I specialise in the treatment of HIV-related cancers at the National Centre for HIV Malignancy – Europe’s largest research and treatment institute for these cancers. Over the last 25 years, I have seen an astonishing improvement in the outcomes of people diagnosed with both HIV and cancer, so that patients under my care with most HIV associated cancers now have the same overall survival as HIV negative patients.

The population of people living with HIV is ageing

One less welcome finding in recent years is the rising number of non-AIDS defining cancers – cancers not previously associated with severe immunosuppression and AIDS – amongst people living with HIV. Overall, the risk of cancer rises with age, although the age-related risk of individual types of cancers varies. In the UK half of all cancers are diagnosed in people over the age of 70 years old. The combination of increasing age of people living with HIV and the rising rates of cancer with age, is reflected in the changing epidemiology of non-AIDS defining cancers amongst people living with HIV. This was first described in the US by Shiels in 2011 who reported a three-fold rise in the rates of non-AIDS defining cancers between 1991 and 2005, and by 2005, 60% of these cancers occurred in people over 50 years old. We have since described the same phenomenon at the National Centre for HIV Malignancy, Chelsea and Westminster Hospital and in a pan-European cohort. (more…)

Alcohol Awareness Week: seeking a responsible alternative


Most of us are aware that chronic, heavy alcohol consumption and binge drinking leads to a plethora of health issues including liver damage and addiction. However, many of us are still unaware of the dangers associated with even moderate alcohol consumption or the cumulative effects that alcohol can have on our health. So just what are those regular trips to the pub, or the frequent cocktails after work really costing us?

Research into effects of alcohol provide a range of results. Some research (funded by the alcohol industry) has even been claimed to demonstrate that alcohol consumption is actually beneficial to our physiological health. Conversely the International Agency for Research into Cancer has demonstrated that the more alcohol you drink directly increases the risk of seven common cancers including: mouth, throat, oesophageal, larynx, breast, liver and bowel.

Similarly, new research published in the British Medical Journal has revealed a potential link between moderate drinking and shrinkage of the hippocampus, a brain region associated with memory. These results suggest a link between moderate alcohol consumption and a potentially permanent alteration in brain structure. (more…)

World Osteoporosis Day: love your bones!

As a young girl I spent many long afternoons in piano lessons.

Years later, I remember very little from the lessons – but I do vividly remember the teacher. She was very strict, had hair like candy floss and a severe hunch. She always made the lessons run long, but she would give me a chocolate bar if I helped her hang out her washing afterwards. She needed my help because she couldn’t reach the washing line anymore. One day I asked my mum why she had a hunched back and she told me it was because she had osteoporosis. At the time I didn’t really comprehend what that meant, but I knew it wasn’t good. One day she fell and broke her hip, and sadly, not long after that she passed away.  As you read my story, I am sure it sounds familiar to a lot of you. Maybe not with a piano teacher, but with a relative, family friend or neighbour. The reason I say that is due to the rising prevalence of osteoporosis – one in three women and one in five men over the age of 50 are affected. (more…)

Blood Cancer Awareness Month: all roads lead to EVI1

For the last 10 years I have been a clinical scientist in genetics working across various London NHS Trusts. Whilst I loved diagnostics, last year I left my job to complete my PhD. I worked in a part of life sciences called cytogenetics. This meant when a patient was diagnosed with blood cancer, I would analyse their chromosomes – the structures into which DNA is organised – from their blood or bone marrow to look for specific abnormalities. For some patients, this can lead to a definitive diagnosis. For others a refined prognosis, and in some, it’s simply a way of monitoring how well the patient’s leukaemia is responding to their treatment.

Histopathology of chronic myeloid leukaemia

Blood cancer can be very straightforward to diagnose and it was perfectly possible to provide genetic confirmation of a blood cancer diagnosis in a matter of hours. For example, in patients with chronic myeloid leukaemia (CML), I would find a particular abnormality called a Philadelphia translocation between chromosomes 9 and 22. Finding this translocation means a patient will benefit from a targeted therapy – called a tyrosine kinase inhibitor (TKI) – which reverses the effect of the translocation with relatively few side effects. TKIs are a tablet taken once or twice a day at home. Compared to chemotherapy, TKIs have revolutionised the treatment and outcomes of CML, which has been life-changing for CML patients. It was always satisfying to call the referring clinician and let them know their patient had a Philadelphia translocation because I knew that would set the wheels in motion for a TKI to be prescribed. Ultimately I knew I had made a difference to a patient on those days. (more…)

How teaching life skills can help children with ADHD

I started working with young people with attention deficit hyperactivity disorder 25 years ago. Over the years, our knowledge and understanding of ADHD has come a long way – mostly down to scientific research – taking the condition from a relatively unheard one to a household one. Too often, we associate ADHD with children, however it’s now recognised to be a lifetime condition with many undiagnosed adults continuing to experience symptoms throughout their lives, despite the abundance of international guidelines on the assessment, treatment and management of ADHD. With many young people reaching adulthood with undiagnosed ADHD, or even misdiagnosed, they will not receive the optimal treatment for their symptoms and associated problems. Unfortunately, many will not reach their potential, and for some, they feel their future is bleak.

It doesn’t have to be this way. The good news is that there are large treatment effects for ADHD interventions and one can intervene at any age. However, early intervention is key if children with ADHD are to mature into confident young adults who experience good mental wellbeing and can effectively plan and organise their lives. I’ve always believed that we should be providing early intervention programmes that work directly with the child as well as those involved in their care and education. Hence, drawing on cognitive behavioural therapy (CBT) – a technique commonly used for phobias, depression and bipolar – I developed the ‘Helping Children with ADHD’ individual treatment and ‘The STAR Detective’ group intervention to provide life skills to children, their parents/carers and others involved in their care. (more…)