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There are 125 million contact lens wearers worldwide and most use some form of disinfection system for their safe use, accounting for a $1.5 billion global market per annum. In 2008, an outbreak of infection caused by the amoeba Acanthamoeba led to the global recall of the contact lens solution Complete® MoisturePlus®. Dr Kilvington led the root-cause investigation into the outbreak showing, for the first time, that components in contact lens care formulations can cause Acanthamoeba to transform into the highly resistant cyst stage. In 2008, he was seconded to the manufacturer of the recalled solution in the USA to develop and launch a new lens care product (AMO RevitaLens®) which has significantly improved antimicrobial properties, notably against Acanthamoeba. The outbreak and our subsequent work has had a global impact on the contact lens industry and regulatory bodies, resulting in a greater awareness of the risks from Acanthamoeba, development of new test methodologies and safer care solutions in the prevention of blindness.
Dr Fiona Henriquez's research into the debilitating eye infection Acanthamoeba keratitis (AK) has significantly impacted on the handling of contact lenses and their cases to the benefit of the world's 125 million contact lens users. Her research findings have been ground-breaking for the research community and have featured widely in the media reaching audiences from scientists, industry professionals, the general public and individual contact lens users. The research has resulted in 2 patents and there are 3 non-disclosure agreements in place with companies relating to commercialisation projects. Related work on Acanthamoeba cysts has resulted in a fourth commercialisation project.
Research at the University of Liverpool (UoL) has demonstrated the importance of intestinal tapeworm infection as an important and hitherto unrecognised risk factor for a major life-threatening acute intestinal disease (colic) in the horse. A novel serological test for exposure to the tapeworm infection was developed at UoL to provide a diagnostic tool for research and clinical applications. As a result, "best practice" equine preventive healthcare programmes now include anti-helminth and tapeworm control protocols and anti-tapeworm anthelmintics are licensed for use in the horse and marketed throughout the world. This research has had a major impact on equine health resulting in welfare and economic benefits for horses, their owners, veterinary practices and industry.
Sustained research by the University of Oxford's Mahidol Oxford Tropical Medicine Research Unit in Thailand (MORU) has been the driving force behind the current World Health Organization recommendations for the management of acute and chronic infection in patients with melioidosis. This research has motivated improvements in treatments and provided new strategies to identify at-risk populations, enabling clinicians to make early diagnoses. Melioidosis is a major cause of severe illness in parts of Southeast Asia and there are increasing numbers of cases in India, China, and Brazil.
Research at Strathclyde has brought about a change in eye surgery practice throughout Europe and worldwide. A four-year cross-Europe study in collaboration with the European Society of Cataract and Refractive Surgery (ESCRS) investigated antibiotic treatment to prevent endophthalmitis, a complication arising during cataract operations which typically results in loss of sight. The findings showed that when the treatment is given at the start of surgery it leads to a 5-fold reduction in the risk of endophthalmitis. The European Society of Cataract and Refractive Surgery has endorsed the discovery and widely promoted the uptake of the treatment through publications and guidelines, which over the last 6 years has led to the prevention of loss of sight in thousands of patients. In Europe alone it is estimated that each year there have been 7500 fewer cases of blindness following cataract surgery as a result of the ESCRS guidelines.
The human influenza A (H5N1) infection emerged in China in 2003 and quickly spread throughout Asia, killing more than half of those infected. Researchers at the Oxford University Clinical Research Unit in Vietnam (OUCRU) provided rapid information to the World Health Organization (WHO) on the pathological and clinical features of H5N1 infection in humans, as it emerged in Vietnam. The WHO used this front line information to inform recommendations for the investigation, diagnosis, management, and treatment of H5N1 globally, ultimately reducing mortality by up to 19%.
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.
Research at the University of Nottingham has defined the clinical phenotype and management of lymphangioleiomyomatosis, a rare and often fatal multisystem disease affecting 1 in 200,000 women worldwide. The group has led the development and evaluation of new therapies and diagnostic strategies which are now part of routine clinical care. The research has underpinned the transformation of this previously under recognised and untreatable disease into a condition recognised by respiratory physicians, with international clinical guidelines, patient registries, clinical trials, specific treatments and a UK specialist clinical service.
Impact: Health and welfare; policy in the form of national and international guidelines; diagnostic service; engagement with patient groups.
Significance: UoE-formulated diagnostic criteria adopted by the World Health Organisation (WHO), the European Centre for Disease Prevention and Control (ECDC) and US Centers for Disease Control and Prevention (CDC), enable reliable case ascertainment and longitudinal study of disease trends. The UoE Creutzfeldt-Jacob Disease Unit acts as an international reference centre for diagnosis. Case ascertainment has improved.
Beneficiaries: Patients with prion disease and their families, policy-makers, the NHS, charities.
Attribution: The UoE CJD Unit led the work with international collaborators.
Reach: Worldwide; diagnostic criteria are WHO-endorsed and have been adopted worldwide. Pooling of data across Europe has enabled assessment of 11,000 cases of sporadic CJD.
In 2012, around 19,500 kidney transplant operations were performed in the UK and USA. The greatest infection risk to transplant recipients is from cytomegalovirus (CMV), the standard 2-4 week treatment for which involves an average of 5 days as an inpatient, which can cost up to £13,000. University of Glasgow research has led to revised standards of care for the prevention and treatment of CMV disease in kidney transplant recipients (KTRs). First, that antiviral treatment with oral valganciclovir for 200 days can be used to prevent CMV disease in postoperative KTRs and is twice as effective as treatment for 100 days. Secondly, the team found that the use of oral valganciclovir was a practical and cost-effective alternative to intravenous ganciclovir for treatment of mild CMV disease in solid-organ transplant recipients. Since 2009, the use of these therapies has been recommended in key national and international guidelines for the care of KTRs. The research also provided the evidence base that was used for evaluating, and subsequently amending, the marketing authorisation of oral valganciclovir for use in preventative treatment of CMV disease in KTRs in the UK and USA.