Making an impact in Northern Ireland: from polio to pill safety, from blindness to bone health | Action Medical Research

Touching Lives - February 2008

Making an impact in Northern Ireland: from polio to pill safety, from blindness to bone health

Action Medical Research began in 1952 as the National Fund for Poliomyelitis Research, with the aim of fighting the feared polio virus. Much of this early work was conducted in Northern Ireland (NI), and the Charity has maintained a strong track record here ever since.A few examples of the pioneering partnership of Action Medical Research and NI researchers include: halting the spread of polio in the UK, improving guidelines for drug treatment in children, checking the safety of steroid use in newborn babies, fighting the progression of diabetic retinopathy and helping bone fractures heal.

Halting the spread of polio in the UK

Action Medical Research originated as the National Fund for Poliomyelitis Research. During the 1950s and ’60s the Charity targeted all its resources to supporting polio research across the UK, including the work of Professor George Dick at Queen’s University, Belfast. Professor Dick, held in high standing in the scientific community, led his team to conduct some of the most important work on polio vaccines of this time. Action Medical Research supported the group’s investigations into the development and safety of the live vaccine, and allowed examination of immunity in NI populations. Charity funds, both in NI and across the rest of the UK, were invested in much needed equipment, fellowships, treatment centres, polio committees, polio surveys and the establishment of laboratories. The research funded by the Charity helped pave the way for the use of the oral ‘sugar cube’ vaccine in the UK, introduced in 1962. Since then polio has been eradicated in the UK, and worldwide levels have plummeted, with the number of endemic countries at a historic low.

Improving guidelines for drug treatment in children

Many medicines prescribed for children have never been tested in this young age group. A study of European hospitals, including one in the UK, found that around two-thirds of child patients received an unlicensed or ‘off-label’ drug prescription.Trials undertaken to determine the safety of drugs are often carried out in adults only, with prescribing for minors based on scaled down adult doses, which are not necessarily appropriate. A team headed by Professor James McElnay from Queen’s University Belfast and involving collaboration with the Royal Belfast Hospital for Sick Children and Alder Hey Hospital in Liverpool developed a system to address this issue.They used blood samples taken from children as part of their routine clinical management to examine the clinical effects of the drugs they were receiving, and are using the information to help provide much needed dosage guidelines for unlicensed drug use in this age-group. Action Medical Research funded the work and drove the associated campaign ‘Children are not little adults’, which began in 2000 and gained widespread support from many bodies. The campaign raised awareness of the need for better testing of drugs for children and for improved prescribing guidelines. Significant progress in this respect has been made in the UK.The British National Formulary for Children was launched in 2005, providing a practical information source for health professionals involved in drug therapy for children. In addition, in December 2006, the European parliament approved new legislation on paediatric medicines that encourages improved drug treatment in children.

Checking the safety of steroid use in newborn babies

Premature babies often have respiratory problems despite increased use of helpful treatments. Babies who need assistance with breathing, such as ventilator treatment, may go on to develop chronic lung disease (CLD). Steroids were introduced to treat CLD in the 1980s.They reduce the time on a ventilator and, if given early after birth, reduce the chances of developing CLD. However, studies suggested their use was associated with long term side effects, including cerebral palsy and poor development.There were unanswered questions…did the timing of steroid use matter? Would a lower dose still be effective but not lead to side effects? Would giving the steroid by inhaler directly into the lungs be effective without side effects? During the 1990s and early 2000s, a team led by Professor Henry Halliday at Queen’s University and the Royal Maternity Hospital in Belfast tried to answer some of these questions by conducting a large, multi-centre clinical trial. It compared results when giving steroids to premature babies early or later after birth and when giving them by injection or inhalation.They also followed up some of the babies’ development at age seven.They found, along with others, that early treatment was more effective in preventing CLD but more likely than later treatment to be associated with cerebral palsy. Inhaled steroids were probably not as effective, but may prove safer.These findings have helped establish the balance between the risks and benefits of steroids for premature babies. Clinical guidelines now advise against giving early steroids but allow them to be given later, in a lower dose, in babies with severe CLD who cannot be weaned from the ventilator.This is important to help guide doctors in their management of these tiny, vulnerable babies.

Tackling the progression of diabetic retinopathy

Diabetic retinopathy, a complication of diabetes, is one of the leading causes of blindness and visual impairment in the UK.Therapeutic options are limited, partly because the cause of the condition is not clearly understood. Recent research by a Belfast-based group, directed by Professor Alan Stitt and funded by Action Medical Research, investigated the physiology of the retina, the light-sensitive layer at the back of the eye.They have successfully demonstrated that if the light-sensitive cells of the retina use less oxygen, this may protect against disease progression. They also showed that a drug commonly used for heart conditions may reduce the oxygen demands of the retinal cells and therefore help prevent further damage.This could have important implications for people with diabetes as new treatment strategies are developed with the aim of stopping the progression of this sight-threatening eye disease.

Helping bone fractures heal

Bone fractures affect hundreds of thousands of people in the UK every year.They can take many months to heal causing much suffering and having a significant economic impact. A team led by Dr Glenn Dickson, Head of the Tissue Engineering Research Team of the Trauma Research Group at Queen’s University of Belfast School of Medicine and Dentistry, has looked at ways to improve bone healing in two separate Action Medical Research studies conducted in the late 1990s and early 2000s. The first showed that non-steroidal anti-inflammatory drugs (NSAIDs), often used for pain relief after trauma or operations, can inhibit fracture repair by suppressing normal inflammatory responses.The second study investigated the possibilities of a pioneering form of therapy involving the injection of bone-forming cells into the fracture site to form bone.The first study will help clinicians in their decisions on how to use NSAIDs during fracture healing, while the second gives insight into a potential new approach to treating bone repair.

Sustaining our support in Northern Ireland

Since 1990 Action Medical Research has invested more than £1 million in projects based in Northern Ireland.The Charity is currently funding two new research projects in this region. The first is being performed by Professor Alan Stitt of the Centre for Vision Science, Royal Victoria Hospital and Queen’s University Belfast. Professor Stitt led the diabetic retinopathy work described earlier, and in this project his group is investigating the causes of age-related macular degeneration, also one of the leading causes of blindness in the UK.The second project is being conducted by Dr Karen McCloskey of the Medical Biology Centre at Queen’s. Her team is looking to further our understanding of urinary incontinence to help find ways to prevent the distressing symptoms of this condition.

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