Blog posts

Could the EndoBarrier be the next weapon of mass reduction?

UK obesity rates have continued to rise at an alarming rate, with figures higher than any other developed nation. Strongly associated with obesity is the increased susceptibility to developing type 2 diabetes (T2DM) which currently affects 3.2 million of the UK population. Bariatric surgery – a type of surgery aimed at inducing weight loss – usually by altering the stomach and/or intestines has revolutionised the treatment of these conditions and can lead to a 60% remission in diabetes. However, with demand for this type of surgery outstripping supply, there is a greater need to develop non-surgical alternatives to combat the ever-rising obesity and diabetes epidemic.

What is the EndoBarrier?

One promising alternative comes in the form of an innovative implant: the EndoBarrier, developed by GI Dynamics Inc. This device consists of an impermeable 60cm sleeve, made from a fluoropolymer – a tough and resistant polymer. At one end of the sleeve is a stent anchor allowing the device to affix to the wall of the duodenum. The sleeve then extends 60cm into the small intestine.

How does the EndoBarrier work?

Consequently, digested food passes through the sleeve without being absorbed and bypasses the upper part of the small intestine before coming into contact with pancreatic and bile juices at the other end where it is then absorbed. Cutting out the first part of digestion leads to changes in the metabolism of nutrients and glucose through a variety of mechanisms including:

  • modulation of gut hormones
  • alterations in the gut bacteria
  • disruption of bile flow

Consequently, the patient will begin to feel full quicker due to an increase in satiety hormones which will then decrease the amount they eat. There is also a positive shift in the metabolism of glucose in the body, so more sugar is taken up into cells, and the insulin which a person is naturally producing becomes more effective. (more…)

Do we need to think differently about COPD?

The internal structure of the lungs by Dave Farnham (CC BY 4.0)

The traditional view of COPD (chronic obstructive pulmonary disease) is that it is a self-inflicted disease caused by smoking. However, it is increasingly likely that this description is something of an oversimplification. While still very much associated with smoking, clinicians and researchers alike are getting to grips with the reality that COPD is a more complex and heterogeneous disease than previously thought. We are also becoming more aware of the fact that it is a disease which rarely occurs in isolation. The vast majority of people who present with COPD have at least one other co-existing disease or condition, and around 50% have four or more accompanying chronic diseases or ‘comorbidities’.

A disease still on the rise

This changing perception of COPD comes not before time. Unlike the situation for some other leading causes of death, we have not seen the same downturn in COPD mortality and morbidity rates over the last decade or so. Better screening programmes and primary prevention strategies have contributed much to reduced mortality rates from ischaemic heart disease in both North America and Europe, but in the meantime, the proportion of deaths due to COPD has risen. More significantly, COPD is projected to move from fourth to third place in the World Health Organization’s (WHO) top-ten list of causes of global mortality, overtaking deaths due to lower respiratory tract infections in the process.

Smoking, not the only guilty party

So is COPD really all about smoking or are there other preventable risk factors that we should be targeting in order to reduce the rising burden of COPD morbidity and mortality? Two pieces of epidemiological evidence, in particular, suggest that there may well be.  The first is the observation that – entirely contrary to expectations – the global distribution of COPD mortality and patterns of smoking prevalence do not in fact overlap but are instead almost mirror images of one another. According to WHO’s Global Burden Disease data, COPD mortality is higher in Ethiopia than it is in Russia.

Tempting though it is to point the finger of accusation at the use of biomass fuels, a recent analysis of data collected as part of the Burden of Obstructive Lung Disease (BOLD) study suggests that this might not necessarily be the explanation either. This analysis, to which several National Heart and Lung Institute staff contributed, was unable to find evidence of an association between the use of solid fuels for cooking or heating and airflow obstruction. (more…)

Updating parents on neonatal units: “You can also log in to the app!”

Better Use of Data to improve parent Satisfaction- BUDS

Alarms going off, doctors and nurses rushing across the ward, parents desperately trying to catch someone’s eye to get an update. The reality of having a baby on neonatal intensive care is undoubtedly traumatic for parents. As high as 35% of them can develop symptoms of post-traumatic stress disorder (1), which can in turn interfere with the process of baby-parent bonding (2).

Having a baby that requires neonatal care is more common than one might think. One in eight babies born in the UK are admitted to a neonatal unit and surveys show that parents struggle to adjust to this unfamiliar environment. Getting verbal updates about their babies is difficult, given how busy staff is dealing with emergencies on the unit. As a result, parents frequently feel excluded from their babies’ care. Little written information is provided to parents, apart from information packs on admission and discharge from the unit. Indeed, the latest 2014 NHS England Parents’ Experience of Neonatal Care survey showed parents across the UK were deeply dissatisfied with the communication of clinical information and involvement in neonatal care (3), with less than half of them being able to speak to a doctor as much as they wanted.

There is clearly an ongoing need to improve how we communicate with these parents. Some interventions to improve parent involvement in care have yielded good results, such as encouraging parents to hold babies skin-to-skin, Kangaroo Care, which was recently shown to improve children’s quality of life up to 20 years later (4). However, there is still a need to improve the provision of regular information to parents. There has been a focus on providing regular written updates to parents via paper letters in USA (5) and text messages in Israel (6), which could prove to be valuable adjuncts to verbal updates from staff. (more…)

SheNote Speaker: addressing the gender imbalance in science

Dr Elisabeth Bik is a microbiome researcher and science editor who runs Microbiome Digest, a blog that’s updated daily and highlights microbiome literature worth reading. In 2016 she asked scientists in the field to nominate their favourite women microbiome researchers in order to improve the visibility of women in the field. This developed to become an actively updated database of experts that’s easily searchable by research interest in microbiome science – Women In Microbiome Research. Dr Bik explains the motivation for establishing the list clearly on her site, but one of the major driving forces was the lack of women as keynote speakers, panel members or chairs at conferences.

Women scientists face enormous biases. There are quantitative biases against women in letters of recommendation for postdoctoral fellowships1, in the selection of candidates for research positions2, in peer review3, in grant review scores4, in citations of publications with female principal investigators5. A common response when conference organisers are challenged to justify their all-male conferences, is that they were unable to find female speakers in the particular discipline, or that those they did invite turned them down. There is even a bingo card for the best excuses.

Self-nominated lists of experts such as Dr Bik’s provide a pool of female experts and leaders within a field that can be consulted to identify keynote speakers. It negates this excuse. Currently at over 500 members and simple to search for different areas of expertise, the list has value even beyond conference organising. As a (lazy) journal editor I use it to find reviewers for microbiome papers, hopefully also addressing some of the gender biases in peer review; search committees can use it to expand their search pool, colleagues can identify collaborators. It also facilitates further methods of addressing the gender balance as research indicates an excellent way to increase representation of women at conferences is for a woman to convene the conference6. (more…)

Rare diseases: the hidden priority of scientific research

A rare disease, also known as an orphan disease, affects by definition less than five in 10,000 (or 0.05%) of the general population.

Hence the question arises: why a disease as rare as 0.05% of the population presents a good investment of research funding? We think the answer is simple and importantly the math adds up. Here are some facts, based on raredisease.org.uk:

  • 7% of the population, will be affected by a rare disease at some point in their lives, which translates to 3.5 million people in the UK
  • There are between 6,000 and 8,000 known rare diseases and around five new rare diseases are described in the medical literature each week
  • 80% of rare diseases have a genetic component and are often life-threatening
  • 75% of rare diseases affect children
  • Drug development and research into rare diseases can also help improve treatment for more common diseases

In 2012, the UK Government initiated the 100,000 Genome Project with a particular focus on rare diseases (and cancer). Knowledge gained from this project is already helping to make new diagnoses, thereby aiding the development of new treatments.

An important milestone for patients with rare diseases was the publication of The UK Strategy for Rare Diseases in 2013 which postulates 51 commitments that have to be implemented by 2020. Ranking very high is the urgent need for getting the correct diagnosis. Around four in every 10 patients say they found it difficult to get a correct diagnosis and find suitable support groups. Clearly, the 100,000 Genome Project is an important step in that direction. In addition, and complementary to this, the National Institute for Health Research (NIHR) has invested considerable funding into understanding the characteristics of patients with rare diseases. Finally, multiple pharmaceutical companies are investing strongly in this area. (more…)

Making the leap from PhD to postdoc

Earlier this month, the Department of Medicine hosted its annual Rising Scientist Day at Imperial’s Hammersmith Campus. The day offered PhD students the chance to share their research both with their peers, and a more general audience. In addition to poster presentations and networking opportunities, the showcase featured talks from those who had successfully made the transition from PhD to postdoc.

Here, Drs Myrsini Kaforou, Alex Thompson and Claire Byrne recount their experiences of becoming fully-fledged early career researchers for the Imperial Medicine Blog, and share their best advice for prospective postdocs.

Myrsini Kaforou – Senior Research Fellow in Bioinformatics

I guess my journey might be quite different to that of the typical PhD student in the Department of Medicine. I started my studies in electrical and computer engineering, completed an internship at the Pasteur Institute in Paris, and then moved to London to complete an MSc course in Bioinformatics and Theoretical Systems Biology at Imperial. I had always wanted to use computational approaches to confront complex problems in biology and medicine. Therefore, I decided to pursue a PhD in Professor Michael Levin’s group in developing novel approaches for analysing large gene expression datasets to identify diagnostic signatures for tuberculosis.

While writing up my thesis, a colleague of mine forwarded me a call for post-doctoral fellowships from the Antimicrobial Resistance Collaboration at Imperial College, which I applied for successfully. My fellowship extended the work of my PhD to the bigger question of the use of host RNA diagnostics to identify bacterial infection to guide antibiotic use and tackle AMR by bridging clinical research and point-of-care assay development. I worked with Dr Pantelis Georgiou and his team in the Department of Bioengineering. At the end of this year-long post, I applied for a few different schemes and was successful in getting the Sir Henry Wellcome fellowship to work on understanding and diagnosing infectious diseases using multi-level omics data. This scheme offers recently qualified postdoctoral researchers the opportunity to start independent research careers.

(more…)

Encephalitis: the rare disease with a million 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…)

Cracking the genetic code of cardiomyopathy in Egyptians

 

Over the past decade, several institutions in Egypt have been making huge scientific progress that is steadily reaching worldwide recognition. It is under these circumstances that I have been fortunate to join the Magdi Yacoub Foundation (MYF), which is recognised as one of Egypt’s most prominent charity organisations. The Aswan Heart Centre – located along the banks of the Nile in Aswan – is an integral part of MYF, offering state-of-the-art medical services for the underprivileged. It focuses on expanding the research on heart disease across the Middle East and beyond to contribute to the world’s scientific knowledge.

With the rise of precision medicine, an approach that uses clinical, molecular, cellular and genetic information to offer effective personalised treatment to patients, Imperial’s Professor Sir Magdi Yacoub emphasised the need to investigate the genetic architecture of the Egyptian population. Understanding the genetics of the disease in the local population will allow for a more accurate diagnosis, a better understanding of the disease mechanism and could potentially facilitate the development of better treatment.

The focus of my PhD project is to identify the genetic determinants of cardiomyopathy – a term which encompasses different heart diseases that often progress to heart failure. Ultimately, I will try to correlate this genetic information with the clinical phenotype of these patients. This project is a collaboration with Imperial College London under joint supervision by Dr Yasmine Aguib and Professor Sir Magdi Yacoub from MYF-Egypt and Dr Paul Barton and Dr James Ware from Imperial. (more…)

“You don’t defibrillate asystole…” and other arguments with creatives

It is a favourite pastime of anyone who works in healthcare to scoff at the mistakes we see when medicine is portrayed on film. From the back-to-front chest X-ray on Scrubs to the miraculous success rates of chest compressions in soaps we love to mock. However, for the last four years I have been working with various TV programmes to try to inject a degree of realism without dampening the drama.

This started with Holby City when I helped out on set, making sure that operating scenes looked realistic and that the actors could pass off as surgeons. This was my introduction to the tension between realism and plot. Being a medical drama, Holby had the budget and resources to try and get things right, but even they couldn’t keep viewers interested if they showed a lovely routine list of day cases where nothing goes wrong!

Holby led to me being approached by Eastenders,  which was a different type of work. With 6–8 million viewers every week, this is a show with massive reach. They have a surprising number of storylines involving medicine, ranging from characters with chronic health problems, through to the massive set piece car crashes and explosions. Even with the minor stuff, when they get it wrong they face a slew of complaints from the public and charities. Often Eastenders will want me to come up with injuries or illnesses that fit a story arc. For example, they will want someone stabbed, look like they are going to die, but then get better and be out of the hospital in seven days. This is normally straightforward, apart from making sure they aren’t reusing stuff from previous years!

Working on longer running storylines is more interesting, the most exciting of which was Phil Mitchell’s liver transplant story on Eastenders. They came to me wanting a way to rejuvenate Phil, who had become a belligerent drunk who had lost his sparkle. I suggested a storyline that took him into liver failure and then showed a long climb back to health, with a liver transplant as the final redemption. However, this was a story fraught with public health issues. It was well established that when the famous liver transplant recipient and footballer George Best started drinking again organ donation rates fell. (more…)

Autumn term – gone in a flash!

My name is James Moss and this is my second blog post (the first is here). I’m a Senior Teaching Fellow in the Faculty of Medicine and I focus on teaching physiology – the body and how it works – to our medical and science students. These posts will be my own thoughts and reflections, and will hopefully give you a (non-invasive) look inside my head at different times of the year.

Students’ arrival

After a long summer of tumbleweeds rolling through the foyer of the Sir Alexander Fleming Building, our Freshers arrived and second years returned, and the building regained its usual hustle and bustle. There were downsides, however: much longer queues for lunch and much more difficult to book a room at short notice! That said, the buzz is totally worth it.

Commemoration Day and my President’s Medal

October 2017 was the first year I attended the Commemoration Day, where our graduating students celebrate their enormous achievements in the Royal Albert Hall, alongside their friends and family. Seeing students that I’ve taught hear their name, smile widely and walk across the stage to shake hands with senior academic staff generated many proud moments.

This was a particularly humbling day for me because I was the recipient of a prestigious internal award (a President’s medal*) for my contribution to teaching. As such, my family and I were treated as VIPs for the day and even had a chaperone. For someone like me who is independent to a fault, this was a very weird situation)! My parents, wife and brother watched the ceremony from the Queen’s Box and were treated to great wine and food. Fortunately, when the time came to receive the award, I made it safely to my prearranged spot without tripping – the Events Team plan the day with military precision. Later, a student in the audience did send me a photo accusing me of sleeping during the kind words the Vice-Provost said about me. That definitely wasn’t the case! (more…)