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Professor Norman Williams and colleagues, based at Queen Mary, developed innovative surgical procedures for patients with anorectal diseases to preserve function, reduce morbidity, eliminate the need for a permanent stoma and reduce its complications. They tested these in clinical trials and showed them to be effective and improve quality of life. The APPEAR procedure (designed to preserve continence in patients who would otherwise require a permanent stoma) is now used internationally and electrically stimulated gracilis muscle (ESGN) is well established as a treatment for end-stage faecal incontinence (FI). The team has harnessed the science of neuromodulation to provide minimally invasive methods of treating FI and developed robust processes for technological development, training and dissemination. Two patents have been filed for innovative surgical instruments and these have been developed commercially.
Glaucoma is the commonest cause of irreversible blindness world-wide and, in many parts of the world, surgery to create a new drainage channel is the only practical treatment. The commonest cause of surgical failure is scarring, and the use of injections of cytotoxic agents prevents scarring but has many complications. Our research identified how convenient single 5-minute treatments with cytotoxic drugs work and led us to carry out pilot and randomised trials, which showed they reduced post-operative scarring. Combined with other refinements of surgical technique (named the Moorfields Safer Surgery System) this has improved outcomes of glaucoma surgery world-wide.
Impact: Health and wellbeing; translation of a clear evidence base for reducing red blood cell use in intensive care and surgery into guidelines and changed clinical practice.
Significance: A 20% reduction in overall UK red blood cell usage between 2002-2012, saving the NHS approximately £100M annually; 7000 fewer patients are exposed to red cell transfusion annually, saving 500 lives.
Beneficiaries: Patients in intensive care units; the NHS and healthcare delivery agencies.
Attribution: Studies were led by Walsh at UoE with NHS and Canadian collaborators.
Reach: 7000 patients per year, UK-wide; incorporation into international guidelines.
Novel research into the cardiovascular and other health benefits of consuming flavanol-containing foods at the University of Reading prompted a multi-national food and confectionary producer, Mars Incorporated, to invest over £1.1 million in research into the absorption, metabolism and health effects of cocoa-derived flavanols in humans. This research informed the development of a cocoa-extract supplement drink and supplement extract, both widely available in the US since 2010. This in turn sparked interest from other multinational corporations looking to market flavanol- and other flavonoid-containing health products, resulting in an additional £917K investment by industry. Mars' cocoa-extract supplements currently hold a 1% share of all food and drinks marketed on a cardiovascular health platform in the US; a market worth US$3.1 billion in 2012. Research by Reading and others has provided evidence that consumption of these products can improve memory and cognition, cardiovascular health and digestive health for consumers. These and other research findings have been widely disseminated to the general public by the Reading researchers.
The work of Colledge and colleagues between 2000 and 2007 has identified and characterised a molecule which is an important regulator of fertility: the neuropeptide kisspeptin.
The identification of its role in fertility has led to kisspeptin and its analogues being tested in clinical trials to make IVF treatment safer (Phase II: one trial), and as therapeutic agents for reproductive system conditions such as delayed puberty, menopause and absence of menstruation (Phase I: four trials). In April 2013, 11 months after the start of the Phase II IVF study, a healthy baby has been born to a participant treated with kisspeptin. Patients enrolled in these fertility trials have testified to the improvement in quality of life which the hope of being able to conceive that this alternative to conventional IVF has brought them.
University of Bristol researchers at the Bristol Heart Institute (BHI) have pioneered the development and clinical take-up of the novel technique of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical trials and several large cohort analyses have assessed the impact of this technique on elective and high-risk patients. The results have shown that it is as safe as the conventional coronary artery bypass grafting (CABG) technique that uses a cardiopulmonary bypass pump and cardioplegic arrest. Most importantly, however, OPCAB significantly reduces the risk of post-operative complications, and reduces morbidity and mortality. It also uses less hospital resources, reducing time in intensive care and length of hospital stay. In 2011 (the last year for which data are available), 20% of CABG operations in the UK were carried out with the OPCAB technique and it has had significant take-up overseas (for example, 18% of CABG operations in the US and 21% in the EU in 2010). NICE has recommended the safety and efficacy of OPCAB surgery.
Imperial College preclinical studies guided the desired selectivity profile for long-acting muscarinic receptor antagonists (LAMA). Binding, functional and clinical studies from Imperial laboratories were the first to demonstrate the long duration of tiotropium bromide (Spiriva®) in human tissue, and confirmed its long duration of action in patients and established it as the first-line treatment for chronic obstructive pulmonary disease (COPD). Tiotropium has had a beneficial impact on the management of COPD and is incorporated into the major international treatment guidelines. It improves symptoms, reduces exacerbations and mortality, and provides a cost-effective therapy. Imperial have also produced the first pre-clinical and clinical data for the next LAMA in development (glycopyrrolate, Seebri®), which has recently been marketed. Our profiling of tiotropium has also led to the development of several novel LAMA.