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The links between different long-term health conditions will be explored in new research funded with a £2.5million grant from the Medical Research Council.

A female doctor does a blood pressure test on an elderly patient © Shutterstock

A team from NDORMS is joining co-investigators from UEA, Barcelona and Leicester in a new study led by the University of Exeter. The research is aiming to uncover new links between long term conditions that could lead to better drug treatments and more focused treatments. These new links could include a more complete understanding of which cells in the body are most critical to the presence of two or more conditions in the same patient.

While medical science has made huge strides in understanding individual conditions, in practice, many older people experience two or more overlapping conditions, known as multimorbidity. In some cases, having one condition, such as diabetes, increases the risk of developing another condition, such as heart disease, yet for other conditions, little is known on why risk is increased and how best to treat multiple conditions in combination.

Lead Investigator Professor Tim Frayling, from the University of Exeter, is part of the newly-formed GEMINI (Genetic Evaluation of Multimorbidity towards INdividualisation of Interventions) collaborative, which seeks to fill this knowledge gap and improve treatment. He said: "We're really delighted to receive this substantial funding that will help us make much-needed progress in understanding the causes of multi-morbidity. Modern medicine has had many successes at treating people for individual conditions such as heart disease but we now need to understand more about the reasons why some people live into older age with only one or two conditions whilst others suffer from many long term illnesses. Our research will help make progress in understanding, why, for example, people with osteoarthritis are at greater risk of type 2 diabetes, and many other combinations."

The team will study patient GP record data to define conditions present in more than one per cent of people over 65 years, and will study patients who have these conditions. They will also use millions of DNA sequence changes – the genetic information we inherit from our parents - to identify which conditions share broad biological mechanisms. They will use a smaller number of genetic variants to identify the specific mechanisms involved. The techniques are based on the principle that inherited DNA sequence changes are "fixed" for life and so provide a way of assessing whether particular risk factors cause diseases, much like a traditional randomized experiment.

GEMINI collaborator Dr Sara Khalid, Senior Research Associate in Biomedical Data Science, NDORMS, University of Oxford, said: "I'm delighted to be part of this exciting research. It's a fantastic opportunity to understand reasons for some of the diverse ways in which we all age: some people develop multiple conditions whilst others live long into old age relatively healthy or with just one condition."

Professor Jack Bowden, of the University of Exeter, who is part of the GEMINI team, said;: "We will use genetics to test whether one disease leads to a second disease, or whether a shared risk factor leads to both. These risk factors will include well known candidates such as obesity and more detailed measures of biology, such as how genes are switched on and off in different cells and tissues."

A key element of the research is to collaborate with patients and carers affected by the conditions, to understand how they are affected and what matters most to them. Mary Mancini, a patient who is collaborating on the research, said: 'I'm very pleased that GEMINI has been awarded funding from the Medical Research Council. I can't wait to start work with this multi-disciplinary and multicultural team, who I am sure will successfully deliver the project."

For more information, visit the MRC website on multimorbidity.

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