The NIHR BRC at NDORMS
The NIHR Biomedical Research Centre, Oxford (OxBRC) is based at the Oxford University Hospitals NHS Foundation Trust and run in partnership with the University of Oxford.
The OxBRC is a collaboration between the University and NHS organisations that brings together academics and clinicians to translate scientific breakthroughs into potential new treatments, diagnostics and medical technologies that benefit patients, improve the delivery of care by the NHS and support the wider economy.
The OxBRC will fund innovation across 15 research themes, with NDORMS leading on the musculoskeletal and inflammation themes.
The Musculoskeletal Theme
The new musculoskeletal (MSK) strategy focuses on integrated care pathways from the perspective of patients, and can broadly be divided into two main clinical areas: acute care and planned care.
The Musculoskeletal (MSK) Acute Care sub-theme, led by Professor Matthew Costa, follows patients through pre-hospital, emergency department, trauma inpatients and back into the community through rehabilitation, with strong guidance from the MSK Trauma patient and public involvement and engagement (PPIE) group.
The MSK Planned Care sub-theme, led by Professor Laura Coates, is researching referral pathways into and out of secondary care, integrating surgical, medical and rehabilitation interventions with community services. Our researchers work closely with the new Open Arms PPIE group.
These two clinical sub-themes are supported by three cross-cutting, methodological sub-themes:
- The Clinical trials and technology appraisal sub-theme, led by Professor David Beard, is using cutting-edge trials methodology to evaluate new devices and surgical interventions.
- The MSK big data sub-theme, headed by Professor Daniel Prieto-Alhambra, uses routine and registry data to explore new ways to identify and treat MSK disease.
- The Biomaterials and drug delivery sub-theme, led by Professor Eleanor Stride, is bringing novel biomaterial interventions into clinical use and testing new drug delivery systems to benefit patients with musculoskeletal diseases.
Inflammation across tissues
Diseases are traditionally managed within specific medical specialities, which often relate to parts of the body: rheumatology, dermatology, gastroenterology and so on. However, patients with disease in one organ often experience similar problems in another, suggesting a more holistic cross disease approach may be more effective. A patient with systemic lupus erythematosus, for example, may have to visit a number of medical specialists as they have symptoms in many organs.
Immune Mediated Inflammatory Diseases (IMIDs) are a common and growing problem for the NHS. They are often treated in very similar ways (combination therapy) with very similar drugs (steroids and anti-TNF biologics). This has led our patient partner groups to ask: if these diseases share so much in common, why are they not investigated in a common manner?
Through initiatives like the Human Cell Atlas, we know that some types of cells are found across all organs, while others are specific to an organ. We aim to identify a common set of cells that would allow us to target inflammation across all organs; as well as those cells that are unique to each organ.
The Inflammation across tissues theme, led by Professor Chris Buckley, are testing the hypothesis that unravelling the common cellular and molecular basis of inflammation across four distinct but clinically related tissues in children and adults will lead to a new tissue-based, cellular understanding of inflammation. This will:
- Allow 'basket trials' over a range of IMIDs, where a drug is tested against two or more diseases.
- Link the cellular processes that underpin different diseases to new or repurposed drugs
- Enable us to carry out research studies to assess quickly how effective drugs are in tackling different diseases.
- Advance the concept of 'precision pathology' – using the right drug for the right IMID at the right dose.
The Inflammation across tissues theme is supported by three sub-themes.
- The Cohorts sub-theme is looking at clinical cohorts, both paediatric and adult, across seven diseases that reflect the full spectrum of autoimmune and auto inflammatory disease, covering a number of organs (skin, gut, joints, liver). Examples include the Arthritis Therapy Acceleration Programme (A-TAP) and the True Colours online tool.
- The Genes, microbiome and Informatics sub-theme, is concerned with using genetic research to diagnose and predict IMIDs that are caused by variations in a single gene (Monogenic disorders). It includes investigating inflammatory bowel disease (IBD) in children using the the Paediatric Inflammatory Bowel Disease (PIBD) BioResource, and the Inflammatory Arthritis Microbiome Consortium.
- The Tissue biology sub-theme concerns the collection, transport, storage and processing of IMID tissue samples – vital for validating our approaches. We already have excellent processes as part of the partnership between Oxford and Birmingham within A-TAP.
Other major collaborations include the Cartography consortium, with Janssen; a new Inflammation and Advanced Cellular Therapy (I-ACT) trials team Working with colleagues in Birmingham; while ensuring that patient partners play a major role in the overarching approach of our theme.