23–24 May 2012 NEC Birmingham, UK www.medtecuk.com The UK’s Only Medical Device Innovation & Manufacturing Event Where Tomorrow’s Innovation Meets Next Generation Manufacturing. For more information and to register, please visit: A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT Professor Molly Stevens discusses the new developments in regenerative medicine PHOTOS: PRIVATE INNOVATIONS IN MEDICINE No. 1 / March 2012 Diagnostics and healing New innovations in wound care and how they are making a difference to patients THE FUTURE’S BRIGHT Barbara Thompson Saxophonist and star of the BBC documentary Playing Against Time discusses her life with Parkinson’s
Transcript
23–24 May 2012NECBirmingham, UK
www.medtecuk.com
The UK’s Only Medical DeviceInnovation & Manufacturing Event Where Tomorrow’s Innovation MeetsNext Generation Manufacturing.
For more information and to register, please visit:
A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT
Professor Molly Stevensdiscusses the new
developments in regenerative medicine
PHOTOS: PRIVATE
INNOVATIONS IN MEDICINE
No. 1 / March 2012
Diagnostics and healingNew innovations in
wound care and how they are making a
difference to patients
THE FUTURE’S BRIGHT
Barbara Thompson Saxophonist and star of the BBC documentary Playing Against Time discusses her life with Parkinson’s
2 · MARCH 2012 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT
UK at the heart of medical innovations
Welcome to Innovations in Medicine, a report celebrating the UK’s position as a global hub for research and development in the field of medicine and healthcare.
‘People come to us from all over the place because trauma knows no boundaries’
Daren EdwardsClinical nurse specialist in plastic surgery, The Royal London Hospital
WE RECOMMEND
PAGE 5
INNOVATIONS IN MEDICINE 1ST EDITION MARCH 2012
Managing Director: Christopher EmbersonEditorial Manager: Faye Godfrey
Responsible for this issue:Project Manager: Jessica PaceyPhone: 020 7665 4405E-mail: [email protected]
Distributed with: The Independent, March 2012Print: The Independent
Mediaplanet takes full responsibility for the contents of this supplement
We make our readers succeed!Britain has a long and proud history of medical innova-tion. Underpinned by our outstanding science, technol-ogy and bioengi-
neering expertise in our life scienc-es industries, universities and hos-pitals, our national contributions have been massive. Each of these sectors has, over the past 50 years, been responsible for innovations of extraordinary significance.
Life sciences industries
1The life sciences industries have been responsible for ma-
jor advances in diagnostic imaging and pharmaceuticals. Godfrey Housman developed the first com-puterised tomography (CT) scan-ner and Jim Black the first beta-blockers for hypertension and an-gina. He went on to develop the
first selective H2 blockers to treat peptic ulcers. And, of course, a group at Pfizer’s Sandwich Labora-tory were responsible for the dis-covery of sildenafil (Viagra).
Academic research
2Academia in Britain has also played a critical role in inno-
vation. John Vane’s work on angio-tensin converting enzyme (at the Institute of Basic Science, London) paved the way for a novel group of drugs that, by inhibiting the action of this enzyme, are widely used for the treatment of hypertension and heart failure. The discovery, by Marc Feldmann and Ravinder N Maini (at the Kennedy Institute of Rheumatology, London), of so-called “tissue necrosis factor”, a promoter of the body’s response to inflammation, paved the way for their subsequent development of “anti-TNFs” for the treatment of
rheumatoid arthritis and other in-flammatory diseases.
The National Health Service
3The British National Health Service has also been responsi-
ble for major innovations. Harold Ridley, a consultant ophthalmolo-gist at St Thomas’ Hospital in Lon-don, developed the first interocular
lenses to replace those removed during catarract surgery. In vitro fertilisation was first successfully carried out by Patrick Steptoe (at Oldham) with the embryologist Robert Edwards (at Cambridge). And the orthopaedic surgeon John Charnley, working at Wrightington Hospital near Wigan, developed the first hip replacements.
The innovative imperatives of our medical scientists, technolo-gists and bioengineers continue, as shown by the discoveries highlight-ed in this supplement. They will con-tinue to bring major benefits to pa-tients as well as to the UK’s economy.
The Royal Society of Medicine’s medical innovations programme provides a plat-form for entrepreneurs, innovators and researchers to showcase their work. The next Innovations Summit will take place on 30 June 2012. For more information visit www.rsm.ac.uk/innovations
Sir Michael Rawlins, president-elect, Royal Society of Medicine and chair of the National Institute for Health and Clinical Excellence
CHALLENGES
MARCH 2012 · 3A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT
INSPIRATION
I can recall vividly the moment I fi rst noticed something was not right.
I was playing at Andrew Lloyd-Web-ber’s summer festival and we were re-hearsing the theme from Variations which introduced the South Bank Show every week.
A phrase on the fl ute that I had played dozens of times before, was not falling under my fi ngers like it usually did. I shrugged my shoulders and just assumed that I was out of practice. This was clearly a warning sign, but I didn’t think anything of it.
I was also writing a lot of music at the time, and started to notice that my right hand was getting increas-ingly stiff . I had no shaking or trem-or and not knowing any diff erent, reasoned it must be a trapped nerve.
After seeing several specialists — in-cluding doctors in homeopathy — I was eventually diagnosed with ‘mild’ Parkinson’s. But my husband and I had no idea what it was, so looked it up in a medical dictionary when we got home from the hospital. I wasn’t worried at all.
However, when we started reading up about the condition, we were hor-rifi ed. Soon after being diagnosed, we went along to a support group where we met other Parkinson’s patients — in truth, this only made me feel worse and frightened for the future. It was a sobering experience.
Wide-ranging symptoms
Knowing nothing about the condi-tion, we had to embark on a learning
HOW I MADE IT
Barbara ThompsonJazz saxophonist, fl autist and composer, Barbara was awarded the MBE in 1996 for services to music. During her long career, she worked closely with Andrew Lloyd-Webber on musicals, including “Cats” and “Starlight Express”. She has written many classical compositions, as well as music for fi lm and television, including “A Touch of Frost”, where millions will have heard her haunting saxophone on the main title theme. Barbara has appeared on over 50 albums and released 18 under her own name. Less well known is that Barbara was diagnosed with Parkinson’s disease in 1997. In February this year, Barbara’s fi ght to keep composing and performing was the subject of a 75-minute BBC documentary, “Playing Against Time”.
curve to better understand what was in store. We discovered that no two cases are alike and that Parkinson’s works in mysterious ways, right at the centre of everything you do both physically and mentally.
Medication that’s good for one per-son might not be so good for another. There are “shakers” (those exhibiting uncontrolled movements) and “freez-ers” who are simply very stiff until
medication frees them up, but there is every combination in between and uncontrolled movement can be in-duced by the medication itself, in anybody. The central problem is how to deliver the drug you need at the pre-cise time and in the minute quanti-ties necessary. That is where much of the current research is centered. There is also a lot of work going on with drugs that will regrow the dam-aged dopamine producing cells in the brain that cause the condition.
Music has been my savior. At the time of writing it’s unclear whether I will ever be able to tour again. Ob-sessed by music and performing, I have been fortunate to be able to ad-just my work to fi t in with my Parkin-son’s schedule.
‘The central problem is how to deliver the drug you need at the precise time and in the minute quantities necessary’
■ Parkinson’s is a degenerative
neurological condition with no cure.
Around 127,000 people in the UK live
with Parkinson’s — every hour some-
one is told they have Parkinson’s.
■ But there is hope. Break-
throughs in the past 10 years mean
a cure is closer than ever.
■ Strides are being made in stem
cell research. Skin cells turned into
nerve cells lost in Parkinson’s may
offer better ways to test drugs and
possibly a way to treat people with
their own cells.
■ Most Parkinson’s is not inherited.
But the discovery of changes in ge-
netic risk factors helps us to under-
stand the causes of Parkinson’s.
■ Exercise is important for eve-
ryone but may have extra benefi t to
people with Parkinson’s to help man-
age symptoms. Research suggests it
may even help slow Parkinson’s.
■ Parkinson’s UK funds 90 re-
search projects worth £15m and its
biggest focus over the next three
years is fi nding a cure.
■ Parkinson’s Awareness Week (16
– 22 April 2012). Find out more or do-
nate by visiting www.parkinsons.org.
SOURCE: PARKINSON’S UK
HOPE FOR THE FUTURE
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Roughly 200,000 people at any one time will suffer from a chronic wound, and their treatment will ac-count for around two to three per cent of the NHS budget.
Getting the right treatment to the right patient at the right time is a high priority for many trusts, which not only want to heal wounds and alleviate distress but also want to save budget and free up resources for other patients. Chronic wounds are typically found on the leg
or foot of patients with poor circu-lation or diabetes, although they can be caused by many things in-cluding venous disease, pressure, surgery and trauma.
To be considered “chronic” a wound will have no signifi cant signs of healing over a month or so, requiring specialist care.
Specialist dressings
In one in three cases of non-healing chronic wounds, the naturally occur-ring enzymes (proteases) responsible for removing damaged tissue are not deactivated when they should be. This means new healthy tissue does not get a chance to become established.
There are specialist dressings for such wounds but they are more ex-pensive than standard dressings and, to date, have not always been used ap-propriately, according to Jacqui Fletch-er, senior lecturer at the wound heal-ing unit at Cardiff University.
“We have the dressings widely available but they can be up to fi ve times as expensive as other dress-ings,” she says.
“So the problem has been people have either used them all the time, when they’re only right for around a third of cases, or they’ve been put off using them altogether. We now have a test kit which looks like a match case. You take a swab out, expose it to the wound and then place it inside the reader. If you get a reading that there is elevated protease activity, you know there is a good case for us-ing a protease modulating dressing.”
Demonstrating need
The breakthrough, Fletcher explains, is that nurses and doctors now have a means of showing whether or not a more expensive dressing would help and so trusts can rest assured they are being used more appropriately.
It is important because a wound dressing will typically be replaced every other day, or a couple of times per day if the wound is wet, and so the cost of inappropriately used dress-ings can soon mount up.
Jacqui FletcherSenior lecturer, Cardiff University wound healing unit
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MARCH 2012 · 5A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT
Medical advances often provide im-provement to the lives of patients. When the status of patents change for existing medical devices, there can often be a flurry of activity as companies are able to add their own innovations to previous discoveries.
This has certainly been the case for new advances in negative pres-sure wound therapy which now of-fers several advantages to suitable patients. The treatment has been around for more than a decade and works by sealing a wound with an airtight dressing and then using a small pump to apply negative pres-sure to the wound area underneath.
This drains excess fluid produced by the wound but also, crucially, en-courages the flow of blood into the ar-ea and speeds up the healing process,
explains Daren Edwards, clinical nurse specialist in plastic surgery at the Royal London Hospital. “The big advance now, though, is the pumps are single-use and really small — about the size of a mobile phone,” he says.
“It means we can release patients the same day or the day after they’ve had treatment. All they need to do is keep the pump tucked into a pock-et and then the dressing can be re-moved a week later.”
Homeward bound
Edwards reveals most patients can ben-efit from the treatment with the most usual exception being when the wound bleeds excessively or is malignant.
The mobility aspect is particularly useful for a centre to which patients are referred, such as the Royal Lon-don Hospital.
“People come to us from all over the place because trauma knows no boundaries,” he says.
“It means they naturally don’t want to be in hospital any longer than they need to and so that’s the beauty of sending people home with a small pump. They can go and rest up at home, where they want to be, and we have ca-pacity spared up to treat new patients. It’s a classic win-win situation.”
Daren EdwardsClinical nurse specialist in plastic surgery, the Royal London Hospital
■ New dressing technology
is enabling patients to
go home while they heal,
improving quality of life and
freeing up capacity to treat
new cases.
TREATMENT
DRESS TO IMPRESSNew innovations in wound care are helping those with chronic wounds to heal faster PHOTOS: SHUTTERSTOCK
“It was really frustrating, the nurses were changing my dress-ing and bed sheets four times per day because of the amount of fluid coming from it,” he recalls.
“I was so lucky that a tissue vi-ability nurse at the Lister Hospital found out about negative pressure wound therapy and thought it was worth giving it a go. The change was remarkable. I didn’t have to keep having dressings removed, I could shower and I was discharged within a week. It was so wonderful to be able to go home.”
After being hospitalised for more than half a year, Tony was fi-nally on the road to recovery and able to get back to work and in-dulge in his twin passions of fish-ing and flying model aeroplanes.
6 · MARCH 2012 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT
The layers of cartilage in joints prevent bones rubbing against one another but they naturally wear with age and can suffer dam-age through accidents and sports injuries. Without a ready supply of blood to help cartilage regen-erate, healing can be slow and is unlikely to return the joint to full, painless mobility.
Hence surgeons have been using a relatively new technique to grow cartilage cells in the laboratory and then implant them in the affected joint so they can go on to form car-tilage and repair damage.
According to Phil Chapman-Sheath, consultant orthopaedic sur-geon at the Southampton Univer-sity Hospital, a key recent advance
has been in growing, selecting and storing the cells used.
“The technique of harvesting cartilage cells from the patient and then growing more cells in the lab-oratory before putting them back in the joint has been around for several years now,” he says.
“The really big breakthrough has come with a technique which now allows the laboratory to pick out the cells which show the best char-acteristics for forming healthy car-tilage. That’s a massive advance be-cause before you’d grow a few mil-lion cells and put them back in to the joint but, if they weren’t the most healthy cells, they might just sit around and do nothing.
“Crucially, they can also be frozen when they’re at their best. Previous-ly, the cells would be suitable for just a day or so and so it was very restrictive when it came to scheduling surgery.”
Repair kit
Chapman-Sheath likens the lat-est technique to repairing a punc-ture on a bicycle. A small patch of organic material is placed over the missing or damaged piece of carti-lage and the laboratory-grown cells are injected underneath. The patch is then stitched and superglued around its edges to stop the cells slipping away.
“It’s a little like a divot on a golf course,” he suggests. “You can get another piece of grass from else-where to replace it but then you’re just robbing Peter to pay Paul. If, in-stead, you seed the area you can en-courage new growth.”
The technique, he points out, is most suited to young, active peo-ple who are willing to avoid impact sports for up to a year after the oper-ation. It is harder to encourage car-tilage repair in older patients and for young professional sports peo-ple, the prospect of a year on the bench is too much.
Phil Chapman-SheathConsultant orthopaedic surgeon, Southampton University Hospital
MARCH 2012 · 7A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT
The body is amazingly adept at re-freshing bone material to ensure that, for most people, bones remain strong and healthy. Hence broken bones can normally be expected to heal well in time.
The problem comes, though, when breaks are particularly severe or parts of a bone are missing after surgery or a major trauma. There is only so much the body can do unaided and so researchers have developed innova-tive materials which can boost a pa-tient’s natural ability to heal.
Clever scaffolding
Molly Stevens, professor of bio-medical materials and regenera-tive medicine at Imperial College has helped develop a bioactive material which she compares to a “builder’s scaff old” around which new bone can build.
“The material basically acts as scaf-folding for new bone to build around to fi ll in gaps that are too large for the
body to heal by itself,” she says.“Although people often think
of children when they talk about stem cells, you still have stem cells at an older age, it’s just you don’t have so many. So the cells are there and they’re able to form new bone; it’s just they don’t have the abil-ity to span large gaps. They can cope with breaks and fractures but if someone loses a part of a bone through, say, having a tumour re-moved, that’s where our bioceram-ic material can help.”
Bone on demand
Professor Stevens reveals that her research is moving towards hu-man clinical studies of a new tech-nique to grow new bone on de-mand on a healthy bone which could then be harvested and used to replace missing bone through a small operation.
At present, bone is sometimes removed from a patient’s hip to be used to fi ll in gaps in other bones. However, patients can experience long-term pain and so the Imperial College laboratory is hoping grow-ing new, additional bone for clini-cal situations, where it is needed, will alleviate the issue.
ADVANCES
RESEARCH AND DEVELOPMENTProfessor Molly Stevens discusses innovation in bone repair and what Imperial College is hoping for in the futurePHOTO: PRIVATE AND TIGENIX
Bridging the gap: giving broken bones a helping hand
The use of a patients’ own bone stem cells together with
an appropriate synthetic scaff old and / or with donor bone, to create a living cell or material composite is an exciting possibility that will be realised within the next fi ve years, I believe. The ultimate aim is to use skeletal stem cells with synthetic scaff olds to develop into bone tis-sue tailored to the needs of individ-ual patients, without requiring do-nor bone or painful harvesting of bone from the recipient.
■ Is the UK well placed to make
major advances in medicine?
We have considerable strengths in stem cell bi-
ology from embryonic through to adult stem cells. However, UK Science is in danger of being left behind if we do not build on fund-ing for translational biomedicalresearch at the basic science as well as clinical level and, critically, reduce and simplify the regulatory burden.
QUESTION & ANSWER
Professor Richard Oreffo, chair of Musculoskeletal Science and co-founder of the Centre for Human Development, Stem Cells and Regeneration at Southampton University
