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Use of the iron chelator drug deferiprone — first developed by researchers at King's College London (KCL) — has extended the lives of thalassaemia patients and is of great utility for those with cardiac problems as it can remove excess iron from the heart. For this reason deferiprone has more recently gained United States approval. KCL researchers have also developed methods for the synthesis and analysis of markers of iron chelation therapy that are being utilised in clinical trials by Novartis Pharmaceuticals and Vifor Pharma and by clinicians. Several neurodegenerative diseases are associated with elevated brain iron levels and the use of deferiprone is also being investigated in clinical trials by ApoPharma and hospitals in the UK and France.
Neurons in the central nervous system do not normally regenerate following injury, due in part to the presence of `inhibitory' molecules that actively prevent the growth and/or collateral sprouting of axons. King's College London scientists identified myelin associated glycoprotein (MAG) as the first myelin inhibitory molecule and demonstrated that inhibition of MAG function with a monoclonal antibody promotes axonal regeneration. They have gone on to promote MAG and its receptor (called the NgR1) as druggable therapeutic targets. Their discovery has led the UK's largest pharmaceutical company — GlaxoSmithKline — to develop monoclonal antibodies to MAG and a second myelin inhibitor as clinical drug candidates. The anti-MAG therapeutic successfully completed Phase I and II clinical trials in humans for stroke during 2008-2013.
The research team at Bucks New University has provided the groundwork for a number of applications to use cardiac power output as a novel functional measurement in the clinical evaluation of patients with heart failure and other related diseases. It involved validating the measure, assessing its reliability and applying it to a group of patients with end-stage heart failure. The success of this procedure is now evidenced by the number of national and international clinical centres adopting cardiac power output as a key functional measurement.
Laser eye surgery is one of the most performed and successful types of surgery in the world. King's College London (KCL) researchers have been intimately involved in the development and improvement of techniques for both surgery and after-care to provide optimal results for the tens of millions of patients who undergo this type of treatment. KCL work is used by the world-penetrating companies Zeiss and Avedro to show evidence of the development of their latest techniques such as ReLEx and corneal cross-linking and by guidelines both in the UK (NICE) and abroad (the American Academy of Ophthalmology) to provide information on the long-term benefits and side-effects of laser eye surgery.
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.
We have developed a new technique of performing cardiac catheterisation in children and adults with congenital heart disease. This has led to the commercialisation of hybrid MRI and X-ray cardiac catheterisation laboratories, a new scientific technique for studying cardiac physiology and pathology and most importantly is being routinely used in clinical practice as it dramatically reduces X-ray radiation exposure (by a factor of 8) and improves the accuracy of physiological measurements leading to better clinical decision making and impact.
As a result of research undertaken by Professor Mervyn Singer and colleagues at UCL, the oesophageal Doppler haemodynamic monitoring device is now a standard of care in intensive care units and operating theatres. The research underpinned the development of the CardioQ Oesophageal Doppler Monitor that guides optimisation of the circulation in critically ill and perioperative patients. In multiple studies its use has led to significant reductions in postoperative complication rates and length of stay in patients undergoing high-risk surgery. Over 500,000 patients have now benefitted from this technology that, between 2008-13, generated over £33m in sales for its manufacturer, Deltex Medical. The device is recommended in NICE guidance and has been identified by the Department of Health as one of six high impact innovations to be implemented fully across the NHS.
The development of a cardiac magnetic resonance technique at Imperial College and Royal Brompton Hospital to quantify myocardial iron concentration has resulted in the early identification of thalassaemia major patients at risk of heart failure and targeted cardiac treatment with a hitherto little used iron chelator, deferiprone, following randomised controlled trials of efficacy. Since 2008 these advances have resulted in a 71% reduction in cardiac death from myocardial siderosis in thalassemia major in the UK.