Explanation of our Research for Patients and the Public
At the Oxford Biomedical Research Centre, research is divided into 14 areas or “themes,” which between them cover all the major medical specialties. The work carried out here is called “translational research” which means it focuses on ensuring the translation of new findings into improved patient care.
The main “Research” section of this website contains detailed information about all these themes, but much of it is written in technical language by and for researchers. The aim of this section of the site is therefore to summarise the work being done in each theme to make it accessible to patients and the wider public who are not healthcare or research professionals.
The 14 research themes at the Oxford Biomedical Research Centre
• Biomedical Informatics and Technology – improving care by using information technology
• Cardiovascular – conditions that affect the heart and blood vessels
• Dementia and Cerebrovascular Disease – conditions such as stroke and its outcomes, such as confusion
• Functional Neurosciences and Imaging – using advances in brain science to better understand how the brain works, and to help patients
• Genomic Medicine – using genetic technology to understand and treat disease
• Immunity and Inflammation – developing ways to measure the course and treatment of diseases of the immune system
• Prevention and Population Care – improving public health through disease prevention, earlier diagnosis and better management
• Surgical Innovation and Evaluation – establishing ways to develop and test new and less traumatic surgical techniques
• Translational Physiology – improving healthcare by using computers, telephones and other information technology
Summaries of the research themes
Biomedical Informatics and Technology
Improving healthcare by using computers, telephones and other information technology
This theme has projects underway in two main areas: telehealth, where technology such as mobile phones can be used to deliver healthcare information or help patients look after their own health themselves, and data fusion, in which computer systems are used to monitor patients more accurately. Both types of technology will be important in future: they will help patients, help healthcare professionals make the right decisions about treatment and management and help keep healthcare costs down, such as by reducing the length of time people stay in hospital.
For people living with long-term conditions such as diabetes, heart failure or chronic obstructive pulmonary disease, being able to monitor their own health can help them to better understand it, as well as improve how they manage aspects of it such as blood sugar, blood pressure or weight. Telehealth also enables patients to interact with healthcare professionals when help or advice is needed, without an emergency visit to the GP or hospital. Our telehealth team is currently carrying out studies with people who have diabetes, including one designed specifically to help pregnant women with the condition, or who had it in a previous pregnancy. It is hoped that telehealth, which allows patients to self-monitor, will improve both their health and quality of life.
Five data fusion studies are underway, in trauma, pregnancy, emergency care, cancer surgery and a process called haemodialysis in which the work of the kidneys to “clean” the blood is artificially replaced if the need arises.
Each of the five studies will develop new computer-based methods to measure patients’ heart rate, breathing rate, oxygen level, blood pressure and temperature, with the aim of identifying patterns in or combinations of these that indicate that the patient is getting worse. This sort of “early warning system” will enable healthcare workers to identify – and hopefully deal with – problems, more reliably and earlier than they can at present. Such an approach should reduce the risk of complications such as cardiac arrest – when the heart suddenly stops pumping blood around the body – or admission to intensive care.
The aim of the Blood theme is to ensure much better outcomes for patients with blood disorders. We are working on three types of cancer that affect the blood or the bone marrow where blood is made – lymphoma, leukaemia and myeloma – as well as disorders of red blood cells that carry oxygen around the body. We are also trying to find better ways to use bone marrow transplants, which can cure some blood disorders, and to develop safer and better ways to transfuse blood to patients who need transfusions.
We actively involve patients in our work through groups of those with specific diseases such as lymphoma or leukaemia, working with organisations like the Lymphoma Association and the UK MDS Patient Group. Team members are actively involved with these patient groups and seek their input in deciding on the key areas where progress is most needed. Having identified this, we use a mix of techniques, including laboratory-based science and clinical trials, to find out as much as possible about our patients and how they will respond to treatments.
The Cancer theme is working to make cancer treatments more effective through a number of approaches and jointly with several other groups in Oxford and further afield. Collaboration of this sort is especially important when patients are needed to join clinical trials to test medicines.
We are investigating possible new targets for cancer treatments and whether there are better treatment combinations than those currently used. This work involves finding ways to speed up tests to see which genes – the codes inside cells that determine how they behave – are affected by cancer treatment.
Alongside this, we are looking at drugs that can boost the ability of radiotherapy to combat cancer, and, using new methods to “look” inside the body, see how tumours respond to treatment.
With a particular interest in melanoma (skin cancer) sarcoma (a rare cancer that develops in the body’s supporting or connective tissue, such as muscle, bone or cartilage) and lung cancer, our researchers are collecting tumour samples and studying their protein and genetic make-up with a view to linking with details on how treatment has worked for particular patients and hence what new treatments might also work.
We are especially interested in a fast-growing new treatment approach called “personalised medicine.” It is known that different patients can respond in very different ways to the same treatment, and finding out more about this can help ensure that it is “tailored” to best suit each individual.
An area where this is of particular interest is finding ways to stop new blood vessels growing within tumours, and so hopefully stop tumour growth and spread. While drugs already exist that do this, they do not work for all patients. Our team is trying to understand why, both by genetic testing tumour samples and by seeing inside – imaging – tumours while treatment is given. One line of interest is whether blocking the blood supply to tumours – which reduces their oxygen supply – causes some tumours to adapt to low oxygen and so carry on growing as before. The challenge is to try and block not only the blood supply but somehow stop this ability to adapt to low oxygen, at the same time as giving drugs to stop blood vessel growth.
A new Oxford lab is dedicated to developing tests for patients having cancer treatment. By joining forces with other cancer research and treatment groups, our teams are helping get more patients involved in clinical trials more quickly, and so find out whether new treatments work, for which patients, and so be made available to them.
Conditions that affect the heart and blood vessels
The work of our theme is aimed at finding new ways to diagnose and treat diseases of the heart and blood vessels. To do this, we are using sophisticated new methods, for example based on imaging – being able to “see” inside the body – and also by trying to find out more about individuals’ genetic make up.
- Improving diagnosis and treatment of emergency conditions of the heart and blood vessels, such as heart attacks and stroke, in work done at a unique centre dedicated to this – the Acute Vascular Imaging Centre (AVIC)
- Finding out more about how to diagnose and treat inherited problems of the heart and blood vessels by using new methods based on the genetic codes that determine how the body works. We are also trying to find out how best to predict people’s risk of developing such conditions, and then testing how well new treatments work
- Identifying patients at increased risk of developing problems with their heart valves, and seeing whether these can be prevented with new treatments.
Five “sub-themes” underlie these projects and work closely together where relevant:
- Acute vascular syndromes (the emergency conditions referred to above)
- Inherited cardiovascular conditions
- Valvular heart disease (where the valves that control the direction of blood flow through the heart do not work properly)
- Cardio- and neuro-vascular imaging development (the methods to “see” inside the body mentioned above)
- Vascular surgery (used to treat problems of the blood vessels, arteries and veins)
We work closely with patients in several ways, including on study steering groups, and plans are underway to further develop such partnerships. We also have websites for some studies designed specifically for patients – see for example the study on heart valve disease.
Dementia and Cerebrovascular Disease
Conditions such as stroke and its outcomes, such as confusion
This theme has a strong track record of success in preventing diseases of the blood vessels that can lead to conditions such as stroke or dementia. We are now doing further work aimed at finding out how best to identify older people at risk of these conditions, and how to prevent and treat them.
We can study large numbers of very different types of patients, using world-class techniques in imaging – “seeing” into the brain and blood vessels – where the underlying problems may be. We also have a large collection of brains donated by people for research after their death, which are used to better understand the changes that occur with these conditions.
The four main areas of work are:
- Improving early recognition of people at risk of stroke or dementia and getting better at predicting who these people are likely to be
- Testing ways to improve prevention of dementia and stroke in the short term, with a particular emphasis on using existing methods more effectively
- Investigating the way in which other illnesses or conditions may reduce blood flow to and within the brain and so make stroke or dementia worse or more likely to happen
- Using new tests to study genes – the “codes” that tell the body how to function – and look at the way in which genes linked to dementia and stroke are also linked to the extent of damage in the brains of those affected.
Several of the studies within the theme involve researchers working closely with patients in order to measure and control blood pressure and other risk factors for stroke and dementia. This close involvement of patients in research is considered to be crucial to the development of treatments and strategies that will work in routine clinical practice.
The Diabetes theme focuses on understanding more about what causes diabetes, and how to treat it, making life better for patients.
The two main types of diabetes are called type I and type 2. Type 1 is rare and often starts when people are teenagers and the body cannot produce insulin, the hormone that controls blood sugar levels. Type 2 is much more common, accounting for up to 95% of all cases, and usually starts when people are older. It is often linked to being overweight or obese and is caused by too little insulin being made, or cells in the body being unable to react to it.
Diabetes is regarded as a “disease epidemic”: there are over 371 million sufferers worldwide, 3 million of these in the UK, where diabetes is nearly four times as common as cancer, causes around 24,000 deaths each year and accounts for 10% of the NHS budget – about £1 million – every hour. The main reason the cost is so high is that diabetes causes complications; indeed, it is now the biggest single cause of amputation, stroke, blindness and serious kidney failure in this country.
Our team is tackling the root causes of both type 1 and 2 diabetes, focusing primarily on the islet cells in the pancreas where insulin is made, but which (for a range of reasons) have stopped working properly.
Three main areas of work are underway to identify and test new and, hopefully, more effective methods for diagnosis and treatment: studies to test whether new drugs or devices are safe and help patients; experiments using islet cells taken from people and studied in the laboratory to find out more about how they work and help develop better ways to transplant them as a potential cure for diabetes; studies to find out more about the genetic control of islet cells and whether this knowledge can improve how patients are treated and how well they do longer term.
Functional Neurosciences and Imaging
Using advances in brain science to better understand how the brain works, and to help patients
This theme is working to gather together in one centre the people and skills needed to use the very newest technology to develop better treatments and care for those with brain diseases. By using state of the art ways to “see” inside – image – the brain, and record brainwaves, researchers can see how it works. In this way we are gaining new understanding of what goes wrong with the electrical and chemical circuits that underlie brain activity and aim to develop better treatments and also help to identify which patients will benefit from which approaches.
We are especially interested to investigate the following:
- Whether it is possible to use signals from the brain or other brain-related measurements to guide how best to directly stimulate the brain to treat some long- term conditions
- Whether it is possible to stimulate the brain, without having to access it directly, and encourage it to make new connections and so help recovery from disease or injury
- As mentioned above, whether imaging can help identify which patients will do best if treated with drugs or surgery
If you would like to get involved with any of the above research, please see the participate in our research page on this website.
Translating genetic research into patient benefit
Many diseases are caused by changes (called mutations) in a person’s genetic material, or DNA. Detecting these mutations has traditionally been technically difficult, time-consuming and costly. As a result, there are many inherited disorders for which no genetic cause is known, or, for diseases where genetic factors have been identified, no test is routinely available. However, technologies are now emerging which make it dramatically faster and cheaper to analyse an individual’s genetic make-up. It is this work which forms the main focus of our theme.
We aim to:
- use new DNA sequencing technology to find disease-causing genes by looking for mutations in patients
- design new diagnostic genetic tests that are helpful for doctors and patients, and cost-effective for use in the NHS
Developing new tests for inherited diseases
For patients with inherited genetic diseases of no known cause, we can sequence the entire genetic code with the aim of identifying the mutated gene or genes responsible for their condition. If successful, this provides a diagnosis for the patient and information to help doctors choose the right treatment or advise the patient about the risk of passing on an inherited condition if they have children. Such knowledge can also aid development of drugs to treat others with the same condition.
Improving testing in cancer
Most cancers contain mutations which aren’t seen in the patient’s healthy cells and which may drive tumour growth. We developed a test for routine NHS use (launched March 2013) where 46 known cancer-causing genes are tested at once. We are now working to evaluate a 150-gene test in our laboratory. For each of these genes, treatment is either already available or being tested in clinical trials. If a patient has them, they can be offered either a drug or the opportunity to take part in a trial. We are also looking for particular patterns in the genetic code which indicate that some cancer treatments (such as particular chemotherapy agents) are not effective for certain people, or might cause them very serious side effects. With this knowledge, treatment programmes can be modified to suit the individual.
In-vitro fertilisation (IVF) screening
We know that in IVF, genetic changes are frequently responsible for miscarriage. Our researchers have developed a new test to select healthy embryos at a very early stage, giving women a better chance of a successful pregnancy.
Immunity and Inflammation
Developing ways to measure the course and treatment of diseases of the immune system
This theme is focused on developing ways to predict how patients with many different sorts of illnesses will respond to new types of treatment, and also to carry out trials of such treatments. Conditions of interest include autoimmune diseases (where the body’s immune system sets up a reaction to the body itself) such as inflammatory bowel disease, rheumatoid arthritis and ankylosing spondylitis; skin diseases including psoriasis and atopic dermatitis; immunodeficiency syndromes, where the body’s defence against infections does not work efficiently; neuro-inflammation, where antibodies attack specific parts of the brain; and chronic viral infections such as hepatitis and HIV.
We are also working with the Vaccines theme to develop vaccine-like treatments for HIV and hepatitis and the Infections theme to improve diagnosis.
Our scientific and technical activities take place at different sites, including a new laboratory – the Translational Immunology Laboratory – in the John Radcliffe Hospital. Here, state of the art facilities allow detailed study of how cells involved in disease and in fighting against disease, and theme members also support others wanting to use such techniques.
We would be keen to involve patients and the public in steering committees for development of research protocols across these different diseases. If you are interested to help us, please contact the theme liaison lead: Dr Consuelo Anzilotti; email@example.com; Tel: +44 (0)1865 7433.
The Infectious Diseases theme works to find out more about bacteria and viruses – bugs – aiming to control and better manage them and so improve people’s health. We are using new ways to understand and handle information about how the behaviour of such bugs is controlled by genes, focusing on how infection is passed on and treated, how infectious diseases are diagnosed and disease outbreaks identified and controlled..
For individuals, this means understanding which infections are caused by which bugs, and what may be special about them so that the right treatment can be given, fast. In hospitals and within whole communities, it means for example looking at the genetic code of the same bug type from different patients to see where infections were picked up or if there is an outbreak.
We our focusing on studying three bugs that are the main cause of infection(s) that people get when in hospital: Staphylococcus aureus (including MRSA), Clostridium difficile (C.diff) and Norovirus. We are also using computer databases to investigate patterns of infectious disease among patients attending Oxfordshire hospitals and GPs.
In order to ensure research projects are most relevant to patients, we have identified 150 members of the public and patients who would like to get involved and are working with them to meet researchers and generate useful ideas and activities.
Our work to investigate bugs that cause infectious disease while tracking infection sources and movement in hospitals, has led to our being at the forefront of a joint national Health Innovation Challenge Fund project with fellow experts in Cambridge and London. Research here aims to transform routine diagnosis, management and control of infectious disease in the coming years.
We are also working hard to reduce the over-use of antibiotics: this will help prevent bugs becoming resistant to them, reduce the risk of infections and save money for the NHS.
Prevention and Population Care
Improving public health through disease prevention, earlier diagnosis and better management
This theme aims to ensure that research discoveries are used to provide better healthcare, with a focus on areas where treatment is provided by either – or both – primary care (GPs) and hospital-based specialists. Of particular interest are conditions such as stroke, heart disease and kidney disease, and the connections between them, which make major demands on the healthcare system at high cost.
We are working with colleagues across Oxford to add investigation of patients with kidney disease to existing studies on stroke and heart disease. We are also working on a clinical trial with other universities to see whether an established treatment for high blood pressure and heart failure can be used in patients with kidney disease.
A further area of interest centres around two projects looking at how best to treat patients with heart failure, with the aim of finding out whether there are better ways to:
- provide hospital-based care
- enable hospital specialists, GPs and community services to work together better
- enable formal and non-formal types of care to work together
The third area aims to draw together findings from work across our theme to see how accurately risk of illness, and future events, can be predicted. One expected outcome of this work is that it will contribute to how medical practice and policy are developed nationally.
The importance of our work is clear: heart disease, stroke and kidney disease cause serious ill health and finding better ways to tackle them is vital.
Surgical Innovation and Evaluation
Establishing ways to develop and test new and less traumatic surgical techniques
This is a relatively new theme, launched in April 2012. We aim to set up research projects that encourage development and detailed testing of new types of surgery, specifically those which are less disruptive to the patient.
As part of this, we are setting up a new Surgical Intervention Trials Unit (SITU) which will develop and study new approaches and methods, including devices that can ablate – destroy – small areas of body tissue. This is used, for example, when disrupted activity within the heart causes ill health (atrial fibrillation) and needs to be treated. We are also working on a process called organ reconditioning, in which donor organs can be made suitable for use in transplants. As well as this work in the SITU, we aim to develop new techniques in imaging – “seeing” inside the body – and taking measurements from within the body, to help better test new surgical methods in the future.
Our overall vision is therefore to set up a research programme that does not work within one particular disease, but across several different areas, and enables new treatment approaches to be taken from the very first stages to large-scale testing. In time, we should become a national centre for testing advances in surgery.
Developing and applying technology to better assess how the body works in health and disease
Launched in April 2012, this theme aims to combine new techniques that use imaging – methods to “see” inside the body and its cells – alongside other forms of measurement to improve how health can be monitored and illness treated.
We are taking two approaches to develop new methods, as well as ensure that experimental advances are used to benefit patients:
1. Developing and applying monitoring methods to address medical problems that are not yet well enough treated, such as:
- sophisticated imaging to assess lung function
- analysis, using lasers, of breathing efficiency in very ill patients
- direct imaging of how the body’s tissues use oxygen
- imaging of how cancer cells make and use energy
2. Studying related problems for which new technologies might offer new treatments, with a focus on:
- what happens when the body or parts of it are deprived of oxygen
- how sleep can be disturbed by breathing problems
We are also working with a group of patients with severe and long-term lung disease to see whether they can be better helped by new treatments.
The Vaccines theme is developing new vaccines against several different major infections that cause serious illness or death, and we are currently carrying out clinical trials to test these.
Of special interest are the microbes – tiny organisms – that cause meningitis, flu, pneumonia, tuberculosis, hepatitis and HIV/AIDS.
There are also specific questions being investigated in relation to these areas. For example, in meningitis, we are interested to find new and better ways to deliver the vaccine and so stimulate the body’s immune system to fight the disease, while in flu we are aiming to create a vaccine that works against all different types (strains) of the virus. Alongside this work, we are looking at how people’s age and the state of their immune system affects how they respond to vaccines. We hope this will allow us to find out whether, by giving vaccines in different ways, we can make them work better in very young or very elderly people.