A Year in Grants 2017 - 2018
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Dear All, We are delighted to present an overview of our Grants Activity for the twelve months to March 2018. During this period, the Charity made the transition to giving larger and more strategic grants aligned with our vision for transforming patient outcomes in London and beyond with total grants made of £28.5m. We are proud to support the remarkable work of our Partners at Barts Health NHS Trust and Barts and The London School of Medicine and Dentistry (SMD) at Queen Mary University of London. We do this by developing and funding high impact projects with our Partners which focus on transformational medical research, stateof-the-art equipment and technology and innovative healthcare projects. Although we focus on London, our projects often have national and international impact.
This booklet highlights the Large Project Grants (from £50,000 to £500,000) and Programme Grants (from £500,000) we have made in the last twelve months. We have also made a number of smaller grants (under £50,000) across the Trust and School over the course of the year, of which we are equally proud, and which provide catalytic funding for a range of projects. The last twelve months have also seen a step change in our voluntary income, harnessing the passion and commitment of supporters and Major Donors. However we want to do much more over the coming years to ensure that we can sustain our current level of giving for an extended period. Thank you for all your support in the last twelve months, and we look forward to working with you in the coming months and years. Regards The Barts Charity Team
“I am immensely proud of the strong partnership that unites Barts and The London School of Medicine and Dentistry, QMUL with Barts Charity. Together, we have undertaken high quality medical research which has led to improved clinical care. This has improved healthcare nationally and globally as well as addressing important health issues in some of the most vulnerable communities in the East End of London.” Prof Steve Thornton – Vice Principal (Health), Barts and the London School of Medicine and Dentistry, Queen Mary University of London “Barts Charity provide absolutely vital support to our hospitals, our staff and most importantly our patients. Some of our most exciting, state of the art equipment, most innovative research and cutting edge projects are funded by Barts Charity. I am hugely grateful for their role in helping us provide safe and compassionate care to patients in East London and beyond.” Alwen Williams – Chief Executive, Barts Health NHS Trust 2
Barts Charity
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Contents Programme Grants 4 Transforming Women’s and Neonatal Services at Whipps Cross Hospital 6 Establishing Two New Research Groups at the World Leading Barts Cancer Institute
11 Barts Liver Centre - Addressing the Rising Burden of Liver Disease, ‘A Slient Killer’ in East London; Building an International Academic Liver Unit at Barts Health/QMUL
8 Bringing Robotic Surgical Services to Barts Health NHS Trust 10 REAL – Health, a Research Enabled Learning Health System in East London: Unlocking the Potential of Big-Data Science to Improve Public Health
Large Project Grants 12 Improving Adolescent Asthma Control: A Cluster Randomised Controlled Trial
16 Novel Epigenetic Therapies for Crohn’s Disease (EpiTheC)
12 Expert Technical Support for CREATE Lab 3D Bio Printing and Tissue Engineering Pump Priming Projects
16 Understanding the Mechanism of AKT Expression and Activity During Skin Cancer Progression
13 New Hope for Patients with Uncontrolled High Blood Pressure: A Single Centre UK Registry for Baroreflex Activation Therapy
17 Investigating the Causes of Atrial Fibrillation: Implications of Epicardial Fat Inflammation
13 Digital Health to Enable Better Care for Barts Health Inpatients 14 Can CPAP Ventilation Help Prevent Respiratory Complications After Major Abdominal Surgery? Prevention of Respiratory Insufficiency after Surgical Management (PRISM) Trial 15 Creating a Facility for InflammoMetabolism Science at QMUL 15 A Minimally-Invasive Non-Surgical Treatment for the Prevention of Tooth Loss
18 Understanding the Link between Rheumatoid Arthritis and Cardiovascular Disease: Vagal Regulation of RvDn-3DPA in Cardiovascular Protection during Inflammatory Arthritis 18 The Effect of Anaemia and Blood Transfusion on Gut Tissue Injury in Preterm Infants 19 Regenerative Potential of Induced Pluripotent Stem Cells in Cardiovascular Disease: Can we use Skin Cells from Patients of All Age Groups to Help Regenerate and Repair their Heart? A Year in Grants 2017-18
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Transforming Women’s and Neonatal Services at Whipps Cross Hospital Mr Funlayo Odejinmi, Dr Reeba Oliver, Ms Kirsty Webb-Wood and Ms Deborah Twyman Awarded £6.8M
The award supports the complete remodelling of the Maternity and Neonatal units and the creation of a Barts Charity Women’s Health Centre of Excellence at Whipps Cross.
A nurse preparing the incubator for a newborn baby
At least 50,000 women over the next 10 years will benefit directly from the service transformation and this investment will bring significant clinical and patient benefit, creating a cohesive maternity, neonatal and gynaecology service that will streamline patient pathways and ensure women receive safe, high-quality care. Additionally, the funds will create a dedicated clinical research space enabling the expansion of the Whipps Cross based research team and will strengthen links with the academic team at Barts Women’s Health Research in East London (BARC), established in spring 2017. BARC is leading population wide translational health research focused on tackling problems affecting mothers and their unborn and newborn babies. This investment will increase the volume of Neonatal and Paediatric research at all sites, with potential impact for mothers and babies worldwide.
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Barts Charity
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Programme Grants A Year in Grants 2017-18
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Establishing Two New Research Groups at the World Leading Barts Cancer Institute: Targeting Tumour Cells and the Tumour Micro-Environment Professor Nicholas Lemoine, Professor John Marshall, Dr Sarah Martin, and Dr Jane Sosabowski, Professor Kairbaan Hodivala-Dilke, Professor Frances Balkwill Awarded £5M Barts Cancer Institute is one of the UK’s leading centres of cancer research, with the overriding objective to ensure that research conducted impacts directly on cancer patients by reducing the burden of disease through prevention; increasing the chances of survival through early detection and diagnosis, and through advancing the discovery and development of new more effective therapies. This award will enable new discoveries, and the development and delivery of innovative new cancer treatments by developing strategies that can target both the cancer cells and their microenvironment – the tumour stroma. As part of the prevention strategy, a new Gallium-68-PET advanced imaging service will be established at Barts Health to allow early diagnosis of metastatic prostate cancer, providing immediate impact for patients.
The Professor of Tumour Stroma Biology will enhance and synergise with the existing research in this area, working with current groups to identify novel therapeutic targets at the cellular and molecular level. These studies will span state-of-the-art discovery science and pre-clinical models using in silico, in vitro and in vivo cancer models. This significant investment will play an important role in driving future clinical research activity at Barts Health, helping to give patients a chance at recovery through access to the most advanced therapies for the hardest to treat cancers.
The new Professor of Translational Cancer Metabolism will unify the developing activities identifying new therapeutic targets in deregulated metabolic pathways occurring in cancer cells.
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Barts Charity
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Programme Grants
Two carcinoma cells completing the process of division
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Bringing Robotic Surgical Services to Barts Health NHS Trust
Ms Elly Brockbank and Mr Stephen Edmondson Awarded ÂŁ4.7M
We funded the introduction of robotic surgery at Barts Health with the joint purchase of two state of the art da Vinci robots at the Royal London Hospital and St. Bartholomew’s Hospital to be used across 7 surgical specialities. While not yet standard within the NHS, robotic surgery is rapidly gaining momentum, with its many clinical, operational, and reputational advantages. The two surgical robots will increase the number of surgeries completed via minimally invasive procedures, bringing important advantages to patients including reduced blood loss, reduced pain, reduced post-operative complications and shorter hospital stays. Barts Health serves a population with significant social deprivation linked to higher rates of cardiovascular disease, obesity and a significantly increased cancer risk. Robotic surgery will play a critical role in minimising peri-operative and anaesthetic risks in the complex and high-risk patients that we serve across Barts Health hospitals and through this investment, patients will be able to access the highest quality surgical services with improved outcomes.
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The St Bartholomew’s Hospital Robotics Team
Funding the latest specialist surgical equipment is also helping to ensure that Barts Health hospitals can continue to attract world leading surgical talent and develop the next generation of promising young surgeons, who can now be trained in robotic surgery.
Barts Charity
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Programme Grants
Elly Brockbank, Joy Ongcachuy and the newly arrived robot at the Royal London Hospital
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REAL – Health, a Research Enabled Learning Health System in East London: Unlocking the Potential of Big-Data Science to Improve Public Health
Dr John Robson, Professor Christopher Griffiths, Professor Carol Dezateaux and Professor Adam Timmis Awarded £2.2M REAL-Health creates a unique opportunity to develop the infrastructure and capacity at scale for an innovative, nationally and internationally leading, ‘first in class’ Research Enabled Learning Health System. The System will align science, informatics, incentives, and culture for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge capture. REAL – Health builds on existing expertise and assets to develop three exemplar research projects which demonstrate the scientific and service applications of big data and health data science applied to important clinical and public health issues: REAL – Child Health (childhood obesity, sickle cell and congenital thyroid disorders) will provide unique information for policy and practice including development of a programme to support families to reduce childhood obesity. It will also improve management of sickle cell disorders.
REAL – Respiratory Health: asthma affects 1 in 10 of the local population. Neither hospital admission rates nor mortality have reduced in the last decade. The aim of this study is to reduce admissions in poorly controlled asthma by 10%. REAL – Cardiovascular Health: heart attack and stroke prevention through the optimisation of blood pressure treatment, use of statins and anticoagulants to internationally leading levels. REAL – Health will also create easier access for clinicians and scientists to linked big data sets from electronic health records. Clinicians will be directly informed about individual patient clinical care including treatment decision support, safety flags, and monitoring. This linked data will also provide wider opportunities for translational research leveraging additional research funding.
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Professor Graham Foster, Dr Patrick Kennedy and Dr William Alazawi Awarded £1.3M
Programme Grants
Barts Liver Centre - Addressing the Rising Burden of Liver Disease, ‘A Slient Killer’ in East London; Building an International Academic Liver Unit at Barts Health/QMUL
The Barts Liver Centre aims to improve liver health in East London and develop strategies and care pathways that will impact on patients around the world.
in accessing ‘difficult to reach’ communities allowing Prof Foster’s group to transition from highly successful studies in hepatitis C to another major cause of liver disease.
Tower Hamlets ranks amongst the worst in the country for most indicators of liver mortality and morbidity. The high rate of serious liver disease in the local community presents a significant clinical challenge to regional health care services, but also an opportunity for our clinicians to develop innovative new approaches to transform disease management.
Non-alcoholic fatty liver disease: can we identify patients who have the progressive non-alcoholic steatohepatitis (NASH) from those who have non-progressive steatosis without doing a liver biopsy? Developing such advanced diagnostics would provide important information to aid patient lifestyle choices, more appropriate screening for clinical trials and the selection of patients for novel therapies. Linking to East London Genes and Health, this project will examine, for the first time, healthy humans with genetic lesions to determine how inflammatory signals are affected when key components of the ‘liver inflammation pathway’ are disrupted.
Liver diseases may develop over many years with persistent injury from alcohol, dietary fats or viruses damaging liver cells. Injury causes inflammation and scar tissue (fibrosis) to form in the liver. Eventually, fibrosis leads to cirrhosis, which in turn can lead to liver cancer, liver failure and death. Even patients with cirrhosis can be asymptomatic and so liver disease really is a ‘silent’ killer. This award will support the recruitment of three new senior post-doctoral basic scientists and three PhD students, who will work on three pioneering projects to reduce the burden of liver disease: Exercise and Alcohol: an innovative clinical trial to address the issue of alcohol abuse that will examine whether supervised exercise can reduce excessive alcohol consumption. This novel trial builds on the unit’s reputation
Chronic Hepatitis B (CHB) is a leading cause of liver disease and liver cancer, accounting for 780,000 deaths per year worldwide. Whilst current treatment cannot provide a cure, early treatment can avert the complications of chronic infection. This work will undertake a detailed study of the virus using the latest techniques to identify differences in the virus make-up which might contribute to different disease outcomes. A deeper understanding of the virus and the immune response will enable identification of patients at greatest risk of the complications of CHB and those with the greatest need for treatment. A Year in Grants 2017-18
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Improving Adolescent Asthma Control: A Cluster Randomised Controlled Trial Professor Jonathan Grigg Awarded £458,000
Asthma is the most common chronic disease in children and young people, with 1.1 million young people affected. In 65% of cases asthma-related deaths are preventable, with factors like insufficient medical adherence, and a lack of understanding of the risks relating to the condition playing an important role in the avoidable deaths of many children and young people. This project will develop a school-based intervention programme on disease management. Barriers to adherence include forgetfulness, incorrect medication beliefs, and discomfort about taking medication at school, due to embarrassment and bullying concerns and this programme will work to help children and young adults overcome these barriers.
Asthma awareness theatre workshop
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Expert Technical Support for CREATE Lab 3D Bio Printing and Tissue Engineering Pump Priming Projects Dr John Connelly Awarded £191,679
The application of 3D printing technology to the engineering of human tissues has opened up exciting new opportunities to develop new therapies for tissue repair and regeneration. To take advantage of this technology, Queen Mary University of London recently invested in state-of-the-art bio-printing equipment for the newly established CREATE Lab in the Blizard Institute. This project will maximise the impact and benefit of the CREATE Lab during the initial start-up period by providing users with expert technical support for proof of concept studies and new 3D bio-printing projects, essential for researchers to collect preliminary data for future grant applications and to access new sources of funding. Over the long-term, research supported by the CREATE Lab will expand QMUL’s research capacity in advanced tissue engineering and promote the development of novel regenerative therapies that will significantly improve patient health and well-being.
Barts Charity
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Digital Health to Enable Better Care for Barts Health Inpatients Professor David Van Heel Awarded £497,574
Dr Melvin Lobo Awarded £499,055 High blood pressure (hypertension) is a major public health issue leading to heart attacks, strokes and kidney failure. For patients with uncontrolled hypertension who cannot tolerate medications (refractory hypertension: Ref-HTN) and those patients with highly variable blood pressure (BPV), no novel treatment strategies have yet been devised. These patients carry an enormous risk of stroke and early death, often spend weeks in hospital with hypertensive crises and are affected daily by debilitating symptoms.
An efficient healthcare system should empower clinicians and improve the patient experience. This project will explore how the adoption of 21st century technology can change health care systems and better serve patient populations and will implement the use of digital health records in place of traditional paper/cardboard records, to provide the following advantages: Key information is held centrally. Improved quality of care e.g. instant digital communication with GPs, reduced adverse drug events, real-time data available at all sites to all clinicians. Cost reduction e.g. reduced medical records and printing costs. Cost avoidance e.g. reduced length of stay, reduced duplicate tests. Income improvement: better clinical coding, NHS England targets would be exceeded.
©Tunde Euba
To help this group of patients the registry will monitor and evaluate a new devicebased treatment to lower stubborn high blood pressure called baroreflex activation therapy. The blood pressure clinic at the Royal London was the first in the UK to provide this new therapy to NHS patients for whom all other therapies had failed. The device provides electrical stimulation to nerves in the neck using an implantable pulse generator placed under the skin in the chest, like a pacemaker. This sends signals to the brain using the body’s baroreceptors to control blood pressure.
Large Project Grants
New Hope for Patients with Uncontrolled High Blood Pressure: A Single Centre UK Registry for Baroreflex Activation Therapy
The UK registry will work to evaluate a promising new therapy that Barts Health clinicians have helped to pioneer within the NHS, for patients with limited treatment options. Digital Health Records: a workstation on wheels
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Can CPAP Ventilation Help Prevent Respiratory Complications After Major Abdominal Surgery? Prevention of Respiratory Insufficiency after Surgical Management (PRISM) Trial Professor Rupert Pearse Awarded £152,084
This large clinical trial will evaluate the clinical effectiveness of ‘Continuous positive airway pressure’ (CPAP) ventilation to discover whether its administration should become a routine part of patient care after major abdominal surgery to help prevent serious respiratory complications in patients. More than 600,000 patients have major abdominal surgery in the UK every year, and 37,000 die within three months following the operation. The elderly and those with long- term disease, especially lung disease, commonly suffer complications, even when surgery and anaesthesia are uneventful. Breathing problems, such as pneumonia, are among the most serious complications but are not always prevented by standard treatments; these patients often never fully recover and their long-term health can deteriorate.
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CPAP, is a safe and widely used treatment for breathing disorders, which involves breathing air at a slightly increased pressure to improve how the lungs work. Whilst CPAP may prevent serious breathing problems after surgery, at present it is rarely used in this way. Currently CPAP is only offered to patients undergoing major abdominal surgery once they have developed a respiratory complication, so this work marks a potential major step change in helping to prevent serious respiratory complications of surgery. Pulmonary Failure
Barts Charity
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A Minimally-Invasive NonSurgical Treatment for The Prevention of Tooth Loss
Dr Katiuscia Bianchi Awarded £497,691
Dr Luigi Nibali Awarded £462,625
Inflammation, the body’s response to injury or infection is a major protective process, but when dysregulated, contributes to serious chronic illness like arthritis and cardiovascular disease and plays an important role in cancer.
Severe periodontitis (gum disease) is the sixth most common disease worldwide and the most common reason for tooth loss. This study will test a new minimally-invasive intervention for the treatment of deep defects to the bone around teeth (‘intrabony defects’), which are associated with rapid disease progression and are usually treated surgically. It will investigate the use of a new treatment strategy, minimally-invasive nonsurgical periodontal treatment (MINST), for the treatment of these defects, with the ultimate aim of generating bone re-growth.
Clinicians and researchers are exploring ways to correct these harmful inflammatory settings. A new notion in the field is ‘inflammo-metabolism’, or the recognition that metabolic pathways are altered during pathological settings. The SMD/QMUL is developing cutting edge expertise in this new area to i) identify new processes/ mechanisms of etiopathogenesis, ii) develop novel therapeutic approaches by ‘selectively’ targeting metabolic pathways and (iii) identify metabolic-based biomarkers for diagnosis and prognosis. This will equip the SMD/QMUL with the technological support required to propel basic-and-translational science in the context of ‘inflammo-metabolism’ thus nurturing areas of excellence within the School identified as research priorities, i.e. cancer, cardiovascular, inflammation, trauma. These studies will offer insights into the development of innovative treatments and stratification approaches for patient benefit.
Large Project Grants
Creating a Facility for Inflammo-Metabolism Science at QMUL
Results of this study could represent the first strong evidence for the wider use of MINST for severe gum disease, with considerable patient benefits as well as reductions in morbidity and NHS costs. Increased bone remineralisation following MINST treatment, improving the chance of maintaining the tooth without surgery and bone grafts
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Novel Epigenetic Therapies for Crohn’s Disease (EpiTheC) Professor Andrew Silver Awarded £495,006
Gut inflammation in Crohn’s disease (CD) leads to debilitating scarring (fibrosis) and bowel obstruction (strictures). There is no cure and surgery is often the only option. However, strictures often recur, making repeated surgery necessary, shortening the bowel and causing difficulties for patients in absorbing essential dietary nutrients and compromising daily quality of life. New medical treatments are urgently needed and this work offers important hope to patients. The project will investigate a chemical modification (acetylation) in proteins called histones in CD fibrosis. Defects in acetylation are linked to inflammation and fibrosis in other diseases and these can be treated using drugs. They have shown that fibrosis in CD is linked to low levels of histone acetylation and that increasing histone acetylation levels using drugs can inhibit fibrosis.
Understanding the Mechanism of AKT Expression and Activity During Skin Cancer Progression Dr Ryan O’Shaughnessy Awarded £194,013
The skin has a critical role in protecting us from the harsh external environment. During everyday life, the skin is constantly bombarded with UV radiation which causes genetic changes that can lead to skin cancer. The ability of skin to serve as a barrier to the outside environment is controlled by a molecular switch called AKT1, whose loss causes an impairment in the skin barrier. It is known that AKT1 is lost in the early stages of the squamous cell carcinoma skin cancer. This project will focus on understanding whether loss of AKT1 leads to tumour development and will work to determine whether reactivation of AKT1 can stop cancer progression by recapitulating the cancer protective properties of the skin.
Fibroblasts from a CD patient were exposed to a mediator of inflammation, and analysed by immunofluorescence
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Dr Paula Longhi, Awarded ÂŁ206,146
Atrial fibrillation (AF) is one of the most common heart rhythm disturbances, affecting more than one million people in the UK and is a major cause of stroke. An irregular heartbeat that can lead to blood clots, stroke and heart failure, the causes remain largely unknown, despite its prevalence. Recent studies indicate that generalised inflammation caused by the body’s white blood cells circulating in the bloodstream may play a role in altering the properties of the heart and increasing the likelihood of AF, particularly if inflammation occurs near the heart.
Large Project Grants
Investigating the Causes of Atrial Fibrillation: Implications of Epicardial Fat Inflammation
The heart is surrounded by a thick layer of fat, called epicardial adipose tissue (EAT), which hosts white blood cells, and which in turn can produce inflammatory mediators that react with the heart tissue to induce erratic electrical impulses. This work will focus on understanding the direct link between EAT inflammation and the likelihood of AF with the intention of developing new treatments for the prevention and management of the disease.
Sections of Epicardial Adipose Tissue
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Understanding the Link between Rheumatoid Arthritis and Cardiovascular Disease: Vagal Regulation of RvDn-3DPA in Cardiovascular Protection during Inflammatory Arthritis
The Effect of Anaemia and Blood Transfusion on Gut Tissue Injury in Preterm Infants Professor Narendra Aladangady Awarded ÂŁ213,245
Dr Jesmond Dalli Awarded ÂŁ201,599 Rheumatoid arthritis (RA) leads not only to joint inflammation and pain, it is also linked with a higher chance of cardiovascular disease, one of the main causes of death in RA patients. The applicants recently found that the body produces molecules termed resolvins that regulate white blood cell responses and vessel inflammation. Results from ongoing studies indicate that the production of these molecules in the blood stream and in other tissues is controlled by the nervous system, specifically the vagus nerve. In RA patients, they found a marked reduction in resolvin production, in particular those produced from the fatty acid n-3 docosapentaemoic acid (RvDn-3 DPA) in the blood. This work will explore whether impaired neuronal control of these molecules results in increased cardiovascular disease in patients with RA and whether these molecules can be used to treat blood vessel and joint inflammation.
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This study will investigate the effect of anaemia and blood transfusion on gut tissue oxygenation and intestinal injury in preterm infants, in order to establish evidence based guidelines for initiating blood transfusion that will minimise gut injury, helping to improve and standardise UK practice. Severe anaemia, blood transfusion or indeed both can cause gut injury in preterm infants. The majority of pre-term infants born before 30 weeks of gestation will develop anaemia and receive a blood transfusion. Anaemic infants have reduced capacity to carry oxygen, due to low Haemoglobin (Hb) levels, which may cause tissue hypoxia and injury and require blood transfusion. However, blood transfusion is also potentially associated with gut injury. Trials have so far failed to determine the ideal Hb levels at which blood transfusion is indicated, leading to a wide variation across the UK, making this study a much needed next step in improving the care of preterm babies.
Barts Charity
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Dr Fiona Lewis Awarded £50,000
Cardiovascular disease (CVD) is the main cause of death worldwide, with the incidence and prevalence increasing steeply with age. At present the only cure for the damage caused to the heart by CVD is heart transplantation, a treatment available to only a small number of patients due to a lack of donor organs. New safe and efficient treatment strategies are desperately required. In recent years, stem cells have emerged as a potentially valuable tool for repairing damaged hearts and a breakthrough discovery has shown that stem cells can be generated from a patient’s own skin cells. However, evidence also suggests that induced pluripotent stem cells (iPSCs)
Large Project Grants
Regenerative Potential of Induced Pluripotent Stem Cells in Cardiovascular Disease: Can We use Skin Cells from Patients of All Age Groups to Help Regenerate and Repair their Heart?
generated from ‘aged’ cells have deteriorated functions and may be unsuitable for clinical application. To investigate this finding, the applicants will generate iPSCs from skin cells of older CVD patients and assess their suitability for clinical application. They will also profile some secreted nanosized particles, known as exosomes, to gain further insight into the implications of reprogramming ‘aged’ cells and uncovering their therapeutic potential.
Pluripotent stem cells, identified here by the surface marker TRA-1-60 (orange)
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Confocal microscope (Barts Charity funded) image showing the cytoskeleton of a patient fibroblast
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