Log in
Genetic, biochemical and structural characterisation of drug targets in the human pathogen Streptococcus pneumoniae by Fisher and colleagues at St George's showed that antibacterial quinolones selectively target the enzymes gyrase, topoisomerase IV, or both, and led to the concept that `dual targeting' drugs minimise the emergence of drug resistance. They demonstrated the potency and the mechanism of action of besifloxacin, a fluoroquinolone developed by Bausch and Lomb which was subsequently approved by the FDA in 2009 for treatment of bacterial conjunctivitis. This has been shown to be a highly efficacious treatment with correspondingly increased usage and sales in the USA.
Dalgleish proposed a programme to develop thalidomide analogues for their immunomodulatory and anti-neoplastic actions. Working with a small start-up company, Celgene, several analogues including lenalidomide and pomalidomide were developed and entered clinical trials. Both drugs significantly prolong patient survival in myeloma and myelodysplasia and have received FDA and NICE approval for these purposes. Celgene has grown into a large multi-national company with over 5000 employees. Lenalidomide sales were $3.8 billion in 2012.
A sustained programme of epidemiological research at St George's, spanning 20 years, has informed air pollution control policies in the UK and internationally. Time-series studies of the acute health effects of daily fluctuations in air pollutants, initially in London, were extended to Europe-wide collaborations, trans-Atlantic comparisons and studies in Asian cities. Publication bias has been explored systematically in meta-analyses of published time-series results, and the adverse effects of different particulate fractions compared in a UK setting. This evidence base has contributed substantially to the current UK Air Quality Strategy and informs ongoing debates about health impacts of shorter-lived "greenhouse" pollutants.
Systematic quantitative reviews of epidemiological evidence linking parental smoking with adverse respiratory health effects in childhood were published in 1997-1999 in Thorax. These meta-analyses were updated as a contribution to the US Surgeon-General's report on Secondhand Smoking, published in 2006, and the UK Royal College of Physicians' report on Passive Smoking and Children, published in 2010.
Over this period the adverse health effects of environmental tobacco smoke achieved prominence in public health policy, through campaigns for smoke-free workplaces (including pubs and restaurants) and publicity against parental smoking in the presence of children, both in cars and in the home.
Clostridium difficile infection (CDI) is a frequent and often fatal hospital-acquired infection. In the past, the diagnosis of CDI has been inadequate. This has had serious consequences for the management and control of infection in healthcare settings. Planche and colleagues at St George's have developed and validated a new diagnostic algorithm for CDI. This has led to policy changes in the UK Department of Health, and amongst European and US authorities, and to practical changes in the way CDI is diagnosed. Its implications for the successful understanding and management of this infection have been profound.
Researchers from St Georges have evaluated and optimised anti-fungal therapy for cryptococcal meningitis, the commonest cause of adult meningitis in sub-Saharan Africa. They have developed a "screen-and-treat" strategy to prevent the development of clinical disease in HIV-positive patients, and with collaborators developed and tested a novel point-of-care diagnostic test. These advances have led to changes in and development of a series of international guidelines and application of these new strategies in parts of Africa. A case for reduced costs of amphotericin was advanced by the group who were instrumental in reducing these costs in South Africa, allowing wider drug provision.
MacGregor and colleagues working at St George's have provided extensive clinical and epidemiological evidence that has changed UK government policy on recommendations for salt intake. In 2011 NICE recommended continued reduction in dietary salt intake in the UK. A 3 gm reduction in daily salt intake is calculated to result in 14-20,000 fewer deaths from cardiovascular disease annually, a saving of approximately £350 million in healthcare costs, and the gain of 130,000 quality-adjusted life years. The global benefits of this policy have been recognised with the WHO making recommendations for similar levels of salt reduction worldwide.