hheadmin, Author at Hospital Healthcare Europe

Press Releases

Take a look at a selection of our recent media coverage:

Guidelines on management of fast heartbeat published by ESC

3rd September 2019

The European Society of Cardiology (ESC) Guidelines on supraventricular tachycardia have been published in the European Heart Journal, and on the ESC website.

Supraventricular tachycardia (SVT) refers to a heart rate above 100 beats per minute (normal resting heart rate is 60 to 100). It occurs when there is a fault with the electric system that controls the heart’s rhythm. SVTs are frequent arrhythmias, with a prevalence of approximately 0.2% in the general population. Women have a risk of developing SVT that is two times greater than men, while people 65 years or older have more than five times the risk of developing SVT than younger people.

SVTs usually start and stop suddenly. They arise in the atria of the heart and the conduction system above the ventricles, and are rarely life-threatening in the acute phase, unlike arrhythmias from the ventricles. However, most SVTs, if left untreated, are lifelong conditions that affect the heart’s function, increase the risk of stroke, and affect quality of life. Symptoms include palpitations, fatigue, light-headedness, chest discomfort, shortness of breath, and altered consciousness.

The guidelines provide treatment recommendations for all types of SVTs. Drug therapies for SVT have not fundamentally changed since the previous guidelines were published in 2003.

But Professor Josep Brugada, Chairperson of the guidelines Task Force and professor of medicine, University of Barcelona, Spain, said: “We do have more data on the potential benefits and risks associated with several drugs, and we know how to use them in a safer way. In addition, some new antiarrhythmic drugs are available.”

Antiarrhythmic drugs are useful for acute episodes. For long-term treatment these drugs are of limited value due to relatively low efficacy and related side-effects.

The main change in clinical practice over the last 16 years is related to the availability of more efficient and safe invasive methods for eradication of the arrhythmia through catheter ablation. This therapy uses heat or freezing to destroy the heart tissue causing the arrhythmia.

Professor Demosthenes Katritsis, Chairperson of the guidelines Task Force and director of the 3rd Cardiology Department, Hygeia Hospital, Athens, Greece, said: “Catheter ablation techniques and technology have evolved in a way that we can now offer this treatment modality to most of our patients with SVT.”

SVT is linked with a higher risk of complications during pregnancy, and specific recommendations are provided for pregnant women. All antiarrhythmic drugs should be avoided, if possible, within the first trimester of pregnancy. However, if necessary, some drugs may be used with caution during that period.

“Pregnant women with persistent arrhythmias that do not respond to drugs, or for whom drug therapy is contraindicated or not desirable, can now be treated with catheter ablation using new techniques that avoid exposing themselves or their baby to harmful levels of radiation,” said Prof Katritsis.

What should people do if they experience a fast heartbeat? “Always seek medical help and advice if you have a fast heartbeat,” said Prof Brugada. “If SVT is suspected, you should undergo electrophysiology studies with a view to catheter ablation, since several of the underlying conditions may have serious long-term side effects and inadvertently affect your wellbeing. Prevention of recurrences depends on the particular type of SVT, so ask your doctor for advice. Catheter ablation is safe and cures most SVTs.“

Guidelines on management of fast heartbeat published by ESC

Self-monitoring solution can help uncontrolled asthma

A study by researchers at Karolinska Institutet shows that a treatment adjustment algorithm based on lung function and symptoms in a mobile phone can be an efficient tool in managing uncontrolled asthma.

The study is published in the European Respiratory Journal.

Asthma is a widespread disease that affects around 10% of Sweden’s population. Approximately half the affected people have so-called uncontrolled asthma and frequently experience breathing difficulties or asthma attacks. Inadequate management and/or incorrect use of medicines are common causes of this.

“Previous research has shown that asthma sufferers’ health and quality of life improves with patient education that focuses on self-care, self-testing and clear management plans. Additionally, health and medical care costs fall if patient involvement and knowledge can be leveraged,” states Björn Nordlund, paediatric nurse and research group leader at the Department of Women’s and Children’s Health, Karolinska Institutet, Sweden.

Consequently, along with his colleagues, Björn developed a digital, automated, self-care system for asthma. Called AsthmaTuner, it enables the measuring of lung function via a wireless spirometer connected to a mobile telephone app. Symptoms are evaluated using questions linked to an individual treatment plan. The system was approved for use in medical care in 2018. It is now marketed by MediTuner AB, a company partly owned by Björn Nordlund.

“The system analyses lung function and symptoms in accordance with asthma-care guidelines,” he explains. “It then gives feedback in the form of automated, doctor-prescribed, treatment recommendation. Users also receive a picture of the inhaler that is to be used and instructions on whether the medication is to be maintained, increased or decreased.”

The now published study was carried out in primary care and at the Astrid Lindgren Children’s Hospital in Stockholm, Sweden. Its purpose was to evaluate the digital tool’s impact on symptoms and whether users more readily remembered to take their medicines.

The study comprised 77 uncontrolled asthma sufferers aged 6 upwards. Around half of these were children and adolescents. Study participants were randomly chosen to use AsthmaTuner for at least eight weeks as a support for self-management; and, also for at least eight weeks, receive traditional asthma care with a printed, individual, treatment plan.

“In parts, the results were hard to interpret. However, we could see that asthma symptoms improved more with the digital tool than they did with traditional care. Adult patients who used the tool at least once a week also more often remembered to take their medicines. Thus, we conclude that this tool can contribute to alleviating uncontrolled asthma sufferers’ symptoms,” says Björn Nordlund.

As asthma requires long-term, regular management, the researchers regarded the shortness of the study as a weakness. Hence the plans to continue the work.

“We do not know if the effects last longer than eight weeks. Thus, we are starting a larger study this autumn. It will run for a longer period and be conducted in Norrtälje’s Tiohundra medical care district and paediatric medical care in Stockholm (the Astrid Lindgren Children’s Hospital).”

Self-monitoring solution can help uncontrolled asthma

Lack of government action on staffing undermines ambition to diagnose cancer early

In just one year, around 115,000 cancer patients in England are diagnosed too late to give them the best chance of survival, according to new calculations from Cancer Research UK.

This means that nearly half of all cancers diagnosed with a known stage in England are diagnosed at stage 3 or 4. And of these, around 67,000 people are diagnosed at stage 4 – leaving them with fewer treatment options and less chance of surviving their disease.

There are lots of things that can influence how early or late someone is diagnosed, but workforce shortages are a large contributor. There is a desperate shortage of NHS medical staff trained to carry out tests that diagnose cancer, meaning that efforts by the health system to diagnose and treat cancer more swiftly are being thwarted.

Last year, the Government made an important pledge to improve the number of people diagnosed with early stage cancer – a jump from two in four diagnosed early to three in four by 2028 which could save thousands of lives. Cancer Research UK has calculated that to reach this target, an extra 100,000 patients must be diagnosed early each year by 2028.

NHS staff are working tirelessly to offer the best care possible, and the NHS is implementing important new initiatives to address late diagnosis and improve staff efficiency. But there just aren’t enough of the right staff available on the ground now, and there are no plans to significantly increase the numbers needed to transform the health service.

An earlier diagnosis can be the difference between life and death. If bowel cancer is diagnosed at the earliest stage, more than nine in 10 people will survive, but if it is diagnosed at the latest stage, just one in 10 people will survive their disease for at least five years.

Efforts to diagnose more patients at an early stage means more people being referred urgently for tests, a vital shift for prompt diagnosis and treatment. But increasing referrals have left diagnostic staff under great pressure because of vacant posts, a lack of funding to train new doctors and growing lists of patients.

At least one in 10 of these posts is empty, so the Government needs to urgently invest in the cancer workforce if they plan to save more lives now, and in the future. Without the staff, the Government will not achieve its own ambition.

Emma Greenwood, Cancer Research UK’s director of policy, said: “It’s unacceptable that so many people are diagnosed late. Although survival has improved, it’s not happening fast enough. More referrals to hospital means we urgently need more staff. The Government’s inaction on staff shortages is crippling the NHS, failing cancer patients and the doctors and nurses who are working tirelessly to diagnose and treat them.

“By 2035, one person every minute will be diagnosed with cancer but there’s no plan to increase the number of NHS staff to cope with demand now or the growing numbers in the future. Saving lives from cancer needs to be top of the agenda for the new Government and it must commit to investing in vital NHS staff now to ensure no one dies from cancer unnecessarily.”

An underpowered workforce is not the sole reason for late diagnoses. Other factors include symptoms being hard to spot, GPs having too little time to investigate people thoroughly, low uptake of screening programmes or the cancer being advanced when detected.

But right now, staff shortages are affecting every part of the pathway. According to work commissioned by Cancer Research UK, it is estimated that by 2027, the NHS needs:

An additional 1700 radiologists – people who report on imaging scans – increasing the total number to nearly 4800
To nearly triple its number of oncologists – doctors specialising in treating patients with cancer – a jump from 1155 to 3000
Nearly 2000 additional therapeutic radiographers – people who give radiotherapy to cancer patients – increasing the total to almost 4800

By 2035, more than 500,000 people will be diagnosed with cancer in the UK, compared with nearly 360,000 today. With an ageing population, more tests will need to be carried out to diagnose more cancers and diagnose them earlier.

Dr Giles Maskell, Cancer Research UK’s radiology expert, said: “We can feel the bottleneck tightening in the NHS – the pressure is mounting on diagnostic staff. We don’t have nearly enough radiologists in the UK right now and far too many patients are waiting too long for scans and results.

“NHS staff are working as hard as they can, but we won’t be able to care for the rising number of cancer patients unless the resources are found to train more specialist staff. Extra scanners are welcome, but they will achieve nothing without staff to run them and experts to interpret the scans. It’s like buying a fleet of planes with no pilots to fly them.”

Lack of government action on staffing undermines ambition to diagnose cancer early

Boosting the power of cancer immunotherapy treaments

27th August 2019

Scientists may have found a way to pull down the protective wall that surrounds tumours, potentially re-exposing them to the killing power of the immune system and immunotherapy treatments.

The study was part funded by Cancer Research UK and published in EBioMedicine.

Drs Francis Mussai and Carmela De Santo who are based at the University of Birmingham studied immune cells, called myeloid-derived suppressor cells (MDSCs), taken from the blood of 200 adults and children newly diagnosed with cancer before they had started treatment.

These cells send out a barrage of chemical signals that shield tumours cells from the immune system and the effects of treatment, and prevent the activation of T cells that can kill tumour cells.

When MDSCs are present in higher numbers, the outlook for patients is worse as their cancer can become resistant to treatment and is more likely to spread to other parts of the body.

Researchers showed that an antibody drug that is already available for leukaemia, was able to destroy these immune cells, which protect the solid tumour from the immune system.

Dr Francis Mussai, lead author of the study and Cancer Research UK Clinical Scientist Fellow at the University of Birmingham, said: “Treatments that work with the immune system to kill cancer often fail because it can be difficult for our body’s defences to get access to the tumour cells. Our research indicates that giving this antibody drug alongside immunotherapies could dramatically increase the number of patients benefitting from the latest innovations in treatment.”

Previously, researchers in another group had found a way to break the protective layer around tumours in mice by using antibodies that attach to the MDSC cell surface, marking it for destruction by the immune system. But translating this into clinical trials has been challenging because researchers have been unable to find a drug target that’s present on human MDSCs.

In this latest study, the team used blood samples taken from patients and showed that a protein called CD33 is present on the surface of MDSCs across a wide range of cancers.

By using an antibody drug called gentuzumab ozogamicin that targets CD33, which is already used to treat acute myeloid leukaemia, the researchers were able to kill the MDSCs in the samples and restore the ability of T-cells to attack the tumour cells.

The researchers also showed that active MDSCs prevented CAR-T cells from working. But when they added the antibody drug, it boosted the activity of the CAR-T cells.

“This is the first time we’ve been able to effectively target the immune cells that form a barrier around solid tumours,” added Dr Mussai. “If this approach works in patients it could improve treatments for many different types of cancer, in both adults and children. We envision our approach will have the most impact in CAR-T therapy, which despite showing lots of promise in blood cancer, so far it’s had limited success in solid tumours.”

Dr Emily Farthing, research information manager at Cancer Research UK said: “Although this is early research, it’s increased our understanding of the way tumours interact with the immune system, and has given us a tantalising insight into how we could make immunotherapies work for more patients in the future. But we are still a long way off in getting this treatment to patients. The next step will be to learn more about the side effects of the antibody drug, and how it works in the body.”

In addition to treating a range of cancers, the findings could also be applicable to treating HLH (hemophagocytic lymphohistiocytosis) and MAS (macrophage activation syndrome) – where the body reacts inappropriately to triggers, such as infections. These disorders are extremely rare and as a result there are few treatments available, particularly to children with HLH.

The team are now planning a clinical trial to test the safety and activity of the antibody drug in people with HLH and MAS. The trial will also include people with solid tumours.

Boosting the power of cancer immunotherapy treaments

Collaborating to better understand difficult to treat diseases

MSD and the Francis Crick Institute in London have entered into a collaboration to understand the causes of motor neurone disease and better understand difficult to treat diseases.

“In the clinic, it’s devastating when I have to tell a patient they have motor neurone disease,” says Dr Rickie Patani, a research group leader at the Crick and UCL and consultant neurologist at the National Hospital for Neurology and Neurosurgery.

“Through fundamental research, we want to understand the basic biology underpinning the disease. Just knowing what’s happening can offer some comfort to patients, even when there aren’t treatments around the corner. I am excited to start our new collaboration with MSD, which we hope will give us a comprehensive understanding of the earliest events that cause Motor Neurone Disease. This is a unique science-led partnership, driven by our shared commitment to helping patients in the long term.”

The new collaboration will build on previous work from Dr Patani’s group, which identified key mechanisms that can kill motor neurons in patients.

Fiona Marshall, Vice President, Head of Neuroscience Discovery and Head of Discovery Science at MSD UK said: “We are delighted to be working with Rickie and his colleagues at the Crick and I am hopeful that this collaboration could produce ground-breaking research which will ultimately change how we treat a broad spectrum of diseases in the future. This collaboration is a great example of the opportunities that can arise from a thriving life science community when doors and minds are open.”

The multi-disciplinary project crosses traditional boundaries between clinical, academic and industry research, with Dr Patani as a practising neurologist working alongside Crick, UCL and MSD scientists. The unique approach is possible thanks to matched funding from the Medical Research Council, one of the Crick’s founding partners.

This latest agreement builds on MSD’s commitment to establish a research presence in London, which will enable stronger collaboration with UK and European research organisations. Earlier in the year, a group of MSD researchers started working at the Crick, ahead of their move to a new London site.

Veronique Birault, Director of Translation at the Crick, said: “We are very excited that MSD are back undertaking research in the UK, and will be working with us on discovery science. There is so much we don’t know about neurodegeneration, and working together from such an early stage will help us to build knowledge and understanding from the ground up. By combining our expertise, we hope to truly advance the field and potentially offer hope for future generations.”

Collaborating to better understand difficult to treat diseases

‘Typical’ heart attack symptoms more likely in women than men

22nd August 2019

Women who have heart attacks experience the same key symptoms as men, quashing one of the reasons given for women receiving unequal care.

Research funded by the British Heart Foundation puts into question a long-held medical myth that women tend to suffer unusual or ‘atypical’ heart attack symptoms, and emphasises the need for both sexes to recognise and act on the warning signs.

Incorrectly assuming that women having a heart attack suffer different symptoms to men could lead to misdiagnosis, delayed treatment and less intensive medical interventions being offered. Previous BHF-funded research has shown the resulting differences in care for women were estimated to have contributed to at least 8200 avoidable deaths in England and Wales in the last decade.

In this latest study, published in the Journal of the American Heart Association, researchers at the University of Edinburgh recorded the symptoms of people attending the Emergency Department (ED) at Edinburgh Royal Infirmary who had a blood test called a troponin test. This test is used when doctors suspect a person is having a heart attack, and measures a protein released by damaged heart cells during a heart attack.

Between 1 June 2013 and 3 March 2017, doctors in the ED ordered the troponin test for 1941 people. Of these people, 274 were diagnosed as having a type of heart attack known as an NSTEMI (90 women and 184 men). This is the most common type of heart attack, and occurs when the coronary artery is partially blocked.

Chest pain was the most common symptom for both men and women, with 93% of both sexes reporting this symptom. A similar percentage of men and women reported pain that radiated to their left arm (48% of men and 49% of women).

More women had pain that radiated to their jaw or back and women were also more likely to experience nausea in addition to chest pain (33% vs 19%).

Less typical symptoms, such as epigastric pain (heartburn), back pain, or pain that was burning, stabbing or similar to that of indigestion, were more common in men than women (41% in men vs 23% in women).

Previous research has suggested that women and men report different heart attack symptoms. However, the symptoms were often recorded after a heart attack diagnosis was confirmed, which may introduce bias. This study aimed to avoid this by asking an independent research nurse to interview and record the symptoms of all patients arriving at the ED with a possible heart attack before they were given a diagnosis.

The authors now say that further research is needed in larger and more diverse populations to confirm their findings.

Early diagnosis of a heart attack is essential for treatment and survival. BHF-funded research has previously shown that women having a heart attack are up to 50% more likely than men to receive the wrong initial diagnosis and are less likely to get a pre-hospital ECG.

Amy Ferry, cardiology research nurse at the University of Edinburgh and first author, said: “Our concern is that by incorrectly labelling women as having atypical symptoms, we may be encouraging doctors and nurses not to investigate or start treatment for coronary heart disease in women.

“Both men and women present with an array of symptoms, but our study shows that so-called typical symptoms in women should always be seen as a red flag for a potential heart attack.”

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “Heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. We need to change this harmful misconception because it is leading to avoidable suffering and loss of life.

“In the UK, three women die of coronary heart disease every hour, many of them due to a heart attack. We know that women tend to wait longer before calling 999 after first experiencing heart attack symptoms. But that delay can dramatically reduce your chance of survival.”

'Typical' heart attack symptoms more likely in women than men

Research suggests antibiotic use is linked to increased risk of bowel cancer

Antibiotic use is linked to a heightened risk of colon suggests research published online in the journal Gut.

The findings suggest a pattern of risk that may be linked to differences in gut microbiome (bacteria) activity along the length of the bowel and reiterate the importance of judicious prescribing, say the researchers.

The researchers wanted to find out if this might affect bowel and rectal cancer risk, and how and drew on data submitted to the nationally representative Clinical Practice Research Datalink (CPRD) between 1989 and 2012.

This contains the anonymised medical records of around 11.3 million people from 674 general practices – around 7% of the UK population.

The researchers collected prescribing information for 28,930 patients diagnosed with bowel (19,726) and rectal (9254) cancers during an average monitoring period of 8 years, and for 137,077 patients, matched for age and sex, who did not develop these cancers.

Antibiotics had been prescribed to 70% (20,278) of patients with bowel and rectal cancers and to 68.5% (93,862) of those without. Nearly six out of 10 study participants had been prescribed more than one class of antibiotic.

Those with bowel cancer were more likely to have been prescribed antibiotics: 71.5% vs 69%. Exposure levels were comparable among those who developed rectal cancer (67%).

The association between bowel cancer and antibiotic use was evident among patients who had taken these drugs more than 10 years before their cancer was diagnosed.

Patients who developed bowel cancer were more likely to have been prescribed antibiotics targeting anaerobes, as well as those targeting aerobes, which do – than patients without cancer.

But patients with rectal cancer were less likely to have been prescribed antibiotics targeting aerobic bacteria.

Cancer site was also associated with antibiotic use. Cancer of the proximal colon was associated with the use of antibiotics targeting anaerobes, when compared to people without cancer.

But antibiotic use was not associated with cancer of the distal colon – the last part of the bowel.

After taking account of potentially influential factors, such as being overweight, smoking, and moderate to heavy drinking, cumulative use of antibiotics for a relatively short period (16+ days) was associated with a heightened risk of bowel cancer, with the impact strongest for cancers of the proximal colon.

The reverse was true for rectal cancers, where antibiotic use exceeding 60 days was associated with a 15% lower risk compared with no use.

When the analysis was restricted to patients who had been prescribed only one class of antibiotic, as opposed to none, penicillins were consistently associated with a heightened risk of bowel cancer of the proximal colon. Ampicillin/amoxicillin was the penicillin most commonly prescribed to these patients.

By contrast, the lower risk of rectal cancer was associated with prescriptions of tetracyclines.

This is an observational study, and as such, cannot establish cause, and the researchers were not able to capture potentially influential lifestyle factors for all the participants, nor hospital treatment, which may have affected overall cancer risk.

Nevertheless, the findings suggest ‘substantial’ variation in the size and pattern of antibiotic effects along the length of the bowel, they say, concluding: “Whether antibiotic exposure is causal or contributory to colon cancer risk, our results highlight the importance of judicious antibiotic use by clinicians.”

Research suggests antibiotic use is linked to increased risk of bowel cancer

C. diff adapting to spread in hospitals

16th August 2019

Clostridium difficile is evolving into two separate species, with one group highly adapted to spread in hospitals, according to UK researchers.

Researchers at the Wellcome Sanger Institute, London School of Hygiene & Tropical Medicine and collaborators identified genetic changes in the newly-emerging species that allow it to thrive on the Western sugar-rich diet, evade common hospital disinfectants and spread easily. Able to cause debilitating diarrhoea, they estimated this emerging species started to appear thousands of years ago, and accounts for over two thirds of healthcare C. difficile infections.

Published in Nature Genetics, the largest ever genomic study of C. difficile shows how bacteria can evolve into a new species, and demonstrates that C. difficile is continuing to evolve in response to human behaviour. The results could help inform patient diet and infection control in hospitals.

Often found in hospital environments, C. difficile forms resistant spores that allow it to remain on surfaces and spread easily between people, making it a significant burden on the healthcare system.

To understand how this bacterium is evolving, researchers collected and cultured 906 strains of C. difficile isolated from humans, animals and the environment. By sequencing the DNA of each strain, and comparing and analysing all the genomes, the researchers discovered that C. difficile is currently evolving into two separate species.

Dr Nitin Kumar, joint first author from the Wellcome Sanger Institute, said: “Our large-scale genetic analysis allowed us to discover that C. difficile is currently forming a new species with one group specialised to spread in hospital environments. This emerging species has existed for thousands of years, but this is the first time anyone has studied C. difficile genomes in this way to identify it. This particular bacteria was primed to take advantage of modern healthcare practices and human diets, before hospitals even existed.”

The researchers found that this emerging species, named C. difficile clade A, made up approximately 70% of the samples from hospital patients. It had changes in genes that metabolise simple sugars, so the researchers then studied C. difficile in mice, and found that the newly emerging strains colonised mice better when their diet was enriched with sugar. It had also evolved differences in the genes involved in forming spores, giving much greater resistance to common hospital disinfectants. These changes allow it to spread more easily in healthcare environments.

Dating analysis revealed that while C. difficile Clade A first appeared about 76,000 years ago, the number of different strains of this started to increase at the end of the 16th Century, before the founding of modern hospitals. This group has since thrived in hospital settings with many strains that keep adapting and evolving.

Dr Trevor Lawley, the senior author from the Wellcome Sanger Institute, said: “Our study provides genome and laboratory based evidence that human lifestyles can drive bacteria to form new species so they can spread more effectively. We show that strains of C. difficile bacteria have continued to evolve in response to modern diets and healthcare systems and reveal that focusing on diet and looking for new disinfectants could help in the fight against this bacteria.”

Prof Brendan Wren, an author from the London School of Hygiene & Tropical Medicine, said: “This largest ever collection and analysis of C. difficile whole genomes, from 33 countries worldwide, gives us a whole new understanding of bacterial evolution. It reveals the importance of genomic surveillance of bacteria. Ultimately, this could help understand how other dangerous pathogens evolve by adapting to changes in human lifestyles and healthcare regimes which could then inform healthcare policies.”

Reference

Kumar N et al. Adaptation of host transmission cycle during Clostridium difficile speciation. Nature Genetics, 2019; DOI: 10.1038/s41588-019-0478-8

Researchers identify key mechanism linked to neuropsychiatric lupus

15th August 2019

A breakthrough study by a SUNY Downstate Health Sciences University research team in the US has identified a specific antibody target implicated in neuropsychiatric symptoms of lupus.

These symptoms, including cognitive impairment, mood disorders, seizures, headaches and psychosis, are among the most prevalent manifestations of the disease and occur in as many as 80% of adults and 95% of children with lupus.

The study, Neuronal BC RNA transport impairments caused by systemic lupus erythematosus antibodies, was published in the Journal of Neuroscience.

The study identified antibodies that are directed at regulatory brain cytoplasmic RNAs (BC ribonucleic acid) that are unique to lupus patients. Because these antibodies are unique in the brains of lupus patients, the study suggests that this is at the root of neuropsychiatric symptoms seen in these patients.

“Prior to this study, we poorly understood why lupus affects the brain in the way in which it does and causes neurocognitive symptoms,” said Principle Investigator Henri Tiedge, PhD, Distinguished Professor, The Robert F Furchgott Center for Neural and Behavioral Science at SUNY Downstate. “Because we could not treat the cause, the only alternative was for physicians to treat the symptoms with anti-inflammatory drugs, immunosuppressives and other therapies, depending on the how the brain was being affected.”

According to Dr Tiedge, the discovery gives new insight into both how and why many lupus patients suffer from these symptoms, and, just as important, may well provide the basic understanding necessary for scientists to pursue effective treatments.

Researchers identify key mechanism linked to neuropsychiatric lupus

Joint lubricating fluid plays key role in osteoarthritic pain

A team at the University of Cambridge has shown how, in osteoarthritis patients, the viscous lubricant that ordinarily allows our joints to move smoothly triggers a pain response from nerve cells similar that caused by chilli peppers.

Osteoarthritis tends to occur later in life and has been largely considered as a degenerative disorder in which pain is produced by damage and wear and tear to bone and cartilage. However, in recent years it has become clear that osteoarthritis is not restricted to cartilage damage, but is a failure of the entire joint, with inflammation – the body’s response to stress and injury – being a major contributor to the pain experienced by patients. A recent collaboration between the two pharmaceutical companies Pfizer and Eli Lilly has found that their anti-inflammatory drug, tanezumab, produced pain relief for osteoarthritic patients in a Phase III clinical trial.

When inflammation occurs during osteoarthritis, the body produces an increased number of cells within and around the joint. These cells release inflammatory substances into the synovial fluid, the lubricant that allows joints to move smoothly. During osteoarthritis, synovial fluid becomes less viscous and these inflammatory substances come into direct contact with sensory nerve cells in the joint, producing the sensation of pain.

In a study published in the journal Rheumatology on 13 August 2019, researchers at the University of Cambridge and Addenbrooke’s Hospital, part of Cambridge University Hospitals, examined whether synovial fluid produced during osteoarthritis is capable of directly exciting sensory nerves supplying knee joints – those nerves responsible for transmitting pain signals.

“Osteoarthritis can be a very painful condition, but we only know a little about what causes this pain,” says Sam Chakrabarti, a Gates Cambridge Scholar. “We wanted to investigate what was happening in the joint and to see whether it was the lubricant that ordinarily keeps these joints moving that was contributing to the pain. Studies such as these are important in helping us develop better treatments.”

The researchers obtained synovial fluid from consenting osteoarthritis patients at Addenbrooke’s Hospital and from post-mortem donors with no known joint disease. They then incubated knee sensory nerves isolated from mice in either healthy or osteoarthritis synovial fluid and recorded the activity of these nerves.

The team found that when incubated with osteoarthritic synovial fluid, the knee nerves were more excitable. The nerves also showed an increase in the function of TRPV1, a molecule that detects the hotness of chilli peppers (TRPV1 is also activated by heat, which is why chillis tastes hot). Although the presence of inflammatory chemicals in osteoarthritis synovial fluid has been known since 1959, this is the first evidence that synovial fluid can directly excite sensory nerves and hence is an important contributor to an individual’s experience of pain.

“This is the first time we have been able to use synovial fluid from human osteoarthritis patients to excite sensory nerve cells, making it more clinically-relevant than mouse studies alone, and so will hopefully help translating treatments from bench to bedside,” says Dr Ewan St John Smith from the Department of Pharmacology at the University of Cambridge.

“In the future, this set up can be used to identify the specific components of synovial fluid that cause pain and then to test if and how a drug will be useful in arthritic pain. Since synovial fluid is regularly collected from arthritic patients as part of their treatment regime, our technique can be easily set up in laboratories throughout the world to understand and help to identify a cure for arthritic pain.”

Dr Deepak Jadon, Director of the Rheumatology Research Unit at Cambridge University Hospitals, adds: “This study highlights how much we can learn with the help of our patients, as well as the importance of collaboration between clinicians and basic scientists.”