Select Committee on Science and Technology Minutes of Evidence


Memorandum by the Medical Research Council

  1.  The Medical Research Council welcomes the opportunity to provide a submission to the Select Committee in its Inquiry on issues relating to human infectious disease in the UK.

INTRODUCTION

  2.  MRC is the principal public sector funder of basic and applied research relevant to medicine. The Council's mission is to:

    —  encourage and support high quality research with the aim of maintaining and improving human health;

    —  train skilled people, and advance and disseminate knowledge and technology to help meet national needs for health, quality of life and economic competitiveness; and

    —  promote public engagement with medical research.

  3.  Thus the Council's contribution to preventing and diagnosing infectious diseases involves funding relevant basic research, facilitating knowledge transfer to the NHS and industry, contributing towards the required supply of skilled people, and raising public awareness of and support for new scientific developments.

  4.  The Council invests in research and training through research grants, mainly to scientists based in higher education institutions, through support for research in its own research institutes and units, and through personal awards for research training and career development.

INFECTIONS AND IMMUNOLOGY RESEARCH PORTFOLIO

  5.  In 2001-02, the MRC spent approximately £46 million directly on infections research. The portfolio ranges from basic molecular studies to clinical work, and includes a large amount of work relevant to international health issues, such as Malaria, as well as research into conditions common in the UK. A good proportion of the basic research is on mechanisms of pathogenesis or host-pathogen cellular interactions during infection: the work covers a variety of protozoa, bacteria and viruses. In addition, the World Influenza Centre at the MRC National Institute for Medical Research plays an international role in the WHO Global Influenza Surveillance Network. The Centre is responsible for evaluating antigenic changes as influenza viruses evolve. It also advises WHO biannually on influenza vaccine composition and identifies the emergence in the human population of novel influenza A subtypes which have the potential to cause major pandemics, as in 1918, 1957 and 1968. These different types of research complement and underpin the surveillance and diagnostic work carried out at the PHLS/HPA and the equivalent bodies in Scotland.

  6.  The Council published a Highlight Notice in Antibiotic Resistance in 1999 and among other work, we have funded two proposals to investigate the potential of bacteriophage for treating infection and a proposal, jointly funded with the Defence Science and Technology Laboratories, to examine the effect of antimicrobial peptides in a bacterium often found in patients with cystic fibrosis. This Highlight Notice remains in operation because we recognise that there is still a particular need for research in this area to aid understanding. We continue to welcome applications in this field, in particular epidemiological studies and social sciences proposals into public attitudes and behaviour (relating for example to disease transmission) that MRC's advisers have identified as specific areas where work is needed.

  7.  Vaccine R&D is underpinned by and builds on basic research in immunology, which seeks to understand the mechanisms and interactions of the immune system. Examples of immunology research include support for the MRC/University of Birmingham Centre for Immune Regulation which spans basic and clinical work, as well as a variety of programmes, cooperative groups and personal fellowships. The MRC Human Immunology Unit in Oxford, in collaboration with the International AIDS Vaccine Initiative, is co-ordinating trials in the UK and Kenya of an HIV subunit vaccine. Finally MRC contributes £1.5 million per annum to the Edward Jenner Institute for Vaccine Research alongside our co-funders GlaxoSmithKline, the Biotechnology and Biological Sciences Research Council and the Department of Health.

  8.  Linkage of surveillance to a strong research base pays dividends. For instance, work towards understanding the significance for the public of bovine spongiform encephalopathy took a crucial step forward with the identification of new variant Creutzfeldt-Jakob Disease (CJD). That the new variant was recognised promptly and confirmed with a high degree of certainty owed much to a combination of a well-established surveillance programme (at the Health Departments' CJD Surveillance Unit, Edinburgh) and strong collaborative links to centres of research excellence nationally and internationally (particularly through the EU Framework Programmes). CJD surveillance and long term epidemiology continue to be underpinned by close association with internationally competitive, research council funded—(and other) programmes of clinical and experimental research applying a range of approaches such as biological chemistry, neuroscience and statistical modelling to issues such as diagnosis, natural history, transmission and control.

RESEARCH IN PRIMARY CARE

  9.  The Council is also supporting a number of research projects in primary care. For example, MRC has funded a programme of research looking at diagnosis and treatment in primary care of young children with symptoms of respiratory infection. In addition, a clinical trial has recently been completed looking at alternative treatment of acute coughs in children, including immediate antibiotic treatment and wait-and-see or delayed treatment. The results will be reported in due course. MRC also supports research training in the field. For instance, a clinical fellow is investigating GP (and patient) attitudes to treating infectious conjunctivitis, in preparation for a clinical trial. A further multi-centre clinical trial is examining the value of H pylori eradication for dyspepsia in primary care.

HARNESSING RESEARCH RESULTS: THERAPEUTIC VACCINATION AND DIAGNOSTICS

  10.  Follow through into application to improve health and prevent disease is important. The MRC has successfully licensed an innovative therapeutic vaccine technology to combat tuberculosis infection to Sequella Inc, a US company which is dedicated to developing novel mycobacterial vaccines. In studies using experimentally infected mice, this DNA vaccine significantly accelerates the clearance of TB from the lungs of the infected mice. Although still at the preclinical stage, this therapeutic vaccine is expected to enter clinical trials in the near future. Another DNA vaccine, this time for therapeutic treatment of HIV infections, is undergoing pilot evaluation at the MRC Human Immunology Unit.

  11.  Another example of dissemination of technology developed by the MRC, is the development of a novel diagnostic kit designed to detect infection by Human Herpes Simplex Virus type II (HSV-2). This diagnostic tool has been developed by Omega Diagnostics Ltd, an independent, privately-owned British company based in Scotland. Existing diagnostic tools for detection of HSV-2 infection are often not able to distinguish between infection with this harmful, sexually transmitted virus from the closely related but relatively benign HSV-1 that most people are latently infected with. The new kit eliminates false positive results.

RESEARCH TRAINING

  12.  In 1998, the Council was approached by the Royal College of Physicians and Royal College of Pathologists, who wanted to work with MRC to strengthen UK research capacity in clinical bacteriology and clinical virology. The Council subsequently introduced a joint training scheme with the Colleges aimed at encouraging clinicians to undertake research training in clinical infection and medical microbiology. These awards are targeted at academic clinicians at the start of their research careers. So far, two of these joint clinical training fellowships have been awarded, in addition to others funded through the Council's own clinical research training scheme. The Council is currently in discussion with the Royal College of Physicians about introducing a joint award at the next level of clinical research career development.

THE FUTURE

  13.  Human infectious diseases present a diverse range of problems which change from decade to decade, as pathogens evolve in response to medical treatments, and which pose new health problems wherever environment, behaviour, or poverty offer new opportunities.

  14.  Breakthroughs will come both from the persistent, creative application of new and more productive post-genome approaches, and from taking a more integrative approach to complex problems.

    —  Analysis of newly available genome sequences of bacteria, viruses and parasites will allow rapid identification of target molecules for new drugs, will help understand how pathogens are evolving, and will show how they cause disease.

    —  There are important opportunities for strengthening vaccine science, building on basic research into immunity. As well as identifying better vaccine components to elicit effective immunity against diseases, we hope for further progress in understanding how best to stimulate immune responses using DNA, modified recombinant micro-organisms or other novel biochemicals, how to maintain immune memory better, and how to achieve more effective vaccination in vulnerable groups, such as older or ill people.

    —  Antibiotic resistance is a steadily increasing problem. Widening the range of research approaches could help give more precise knowledge about the evolution and spread of resistance, its relationship to resistance in the natural environment, and the consequences of human behaviour and policies. Work on alternative antibiotics, vaccines, and other therapies needs to continue. The recent elucidation by the MRC Laboratory of Molecular Biology of the structure of the bacterial ribosome, a target for antibiotics, is a significant step forward.

    —  The advent of transplantation as a treatment for organ failure has highlighted the problem of cross infection between humans of hitherto unknown microorganisms and hastened the discovery of hepatitis C virus. For the future, the possibility of cross-species infection occurring after xenotransplantation has been raised by work we have supported that has shown human cell lines can be infected with porcine endogenous retroviruses.

  15.  There are still significant gaps in our knowledge of the factors influencing immunity and progression of disease, such as how early health and nutrition, or childhood infection, can affect development of the immune system, how chronic infections are maintained, and the role of infection in inflammatory disease.

  16.  World-wide, we also need to strengthen links between basic science, epidemiology, evaluative trials, and social sciences, and links with health surveillance systems, to ensure progress in reducing infectious illness. Especially in poorer countries, but also in the developed world, a better understanding of why some people are more at risk than others, and why some people benefit more from treatment or preventive policies, will help develop more effective clinical and public health practices, as well as highlighting some new areas where more research may be needed. Such work can often be advanced by developing mutually beneficial partnerships with developing world countries.

October 2002


 
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