UK Research Collaborative means business

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by Simon McGrath

stephen-holgate.jpg

Prof Stephen Holgate

The new UK CFS/ME Research Collaborative has had its first meeting and it very much looks like it means business. They have plans to rev up the research agenda and raise funds - and they have key players on board too.


The Players

The CMRC is chaired by Stephen Holgate, MRC professor of Immunopharmacology at Southampton, with Dr Esther Crawley as vice chair. There are then five charities and five further researchers to complete the Executive Board.

So far Professors Julia Newton (Autonomic system & fatigue), Hugh Perry (Neuropathology), Paul Little (Primary Care Research), and Peter White (Psychiatry) have been appointed, with one more to follow. I don't know the views of all the researchers, but that looks to me like a greater emphasis on the biomedical than the biopsychosocial.

Hugh Perry is a particularly interesting member as his research is on links between inflammation, the brain and disease. He was on the former MRC ME/CFS Expert group and is Chair of the MRC's Neuroscience and Mental Health (funding) Board. That's a very useful person to have onside.

The five charities are the ME Association (Dr Charles Shepherd), Action for ME (Sonya Chowdhury, chief executive), the CFS Research Foundation (Clive Kerfoot), Association for Young People with ME (Mary-Jane Willows) and ME Research UK (Dr Neil Abbott/Sue Waddle).

There are several official Observers too, which helpfully includes the three main funders of research in the UK: The Medical Research Council (MRC), the National Institute of Health Research and The Wellcome Trust. The MRC were represented by Joe McNamara, Programme Manager for the Population Science and Public Health Board, who went out of his way to offer support to the group, including resources for a planned AGM. The other funding Observers, along with the researcher Executive members, sent apologies, but are expecting to be present at future meetings.

Also as Observers are BACME, representing clinicians, and Ed Sykes for the Science Media Centre (SMC). The presence of the SMC is very much part of the broad church approach, as they have promoted a biopsychosocial view of ME/CFS up till now. However, Charles Shepherd did raise concerns with Ed Sykes about the way the SMC has presented ME/CFS research, so it does represent an opportunity for a dialogue.

The Collaborative would also like to have parliamentary input and this will be discussed with the All Party Parliamentary Group.

Action for ME are providing the secretariat for the CMRC, which has been funded by one of their donors who has been very impressed by the work of the CMRC. Administrative support is not usually seen as an exciting thing to fund, but I think that's a smart move by the donor.


Why it's critical for the ME Association to be in the Collaborative
Charles Shepherd explains why the MEA is taking a seat at the top table of the CMRC to argue for more biomedical research and clinical trials:
"The CMRC is a very big (and potentially extremely powerful) tent with prominent people from a whole spectrum of opinion on causation and management of ME/CFS actively involved ... part of the research agenda has to involve sitting down and discussing/debating with people you may not always agree with.
Would it be better for people with ME/CFS if we were not forming part of the Executive (remember the charities have five seats here - as do the researchers) of a multidisciplinary research organisation that involves almost all the established UK ME/CFS research groups, as well as new/young researchers, people from the MRC, NIHR, other major funding bodies, politicians from the APPG on ME at Westminster, and (in due course) the pharmaceutical industry? We would be letting down our members if we opted out."
Fulll version at the ME Association
Getting down to work: Funding and more

The Collaborative is setting up four 'Workstreams' to get things done. Little was said about three of them - Publicity & Awareness, Increasing Capacity, and Organisation (presumably more will emerge on this in future) but there were some significant developments regarding funding priorities.


Funding priorities: severely-affected and sub-grouping

The Collaborative wants to stimulate more funding for research and support a strategic approach for future funding. Stephen Holgate has said that fundraising will be a priority. It's quite possible that the UK Research Collaborative - backed by almost all the ME charities and all the main researchers - could pull in new and wealthy donors. Parkinson's research was revolutionised by a donation of £5 million - wouldn't it be nice if something like that came out of this initiative? (I do like to dream).

The MRC has already identified four priority areas including immune dysfunction and neuropathology, but the Collaborative has now also prioritised severely-affected patients and epidemiology (including sub grouping/phenotyping). Great to see the severely-affected (and severely-neglected) getting attention in research. The Board even discussed having ‘severely affected’ as a separate workstream, but it was better as a research priority to ensure that activity was cross-cutting and that the focus is on increasing funding to enable more research into this area.

Obviously this new approach brings the risk of the CMRC competing with individiual charities for funds so those involved are approaching this with some caution. Signing up to the research priorities "would in no way undermine the charities’ independence with regard to their own research activities". And it was agreed that all charities would provide a summary of their research priorities by the end of June to identify where the differences and alignments exist. Action for M.E. are asking for views to inform their research strategy as well as the priorities they will put forward to the Collaborative - you can take the AfME survey here.

As well as specific areas for research, the Collaborative might look at studentships, joint fellowships and bursaries to increase access to research in the field for early career researchers.

On the subject of research funding, both the ME Association and ME Research UK are both hoping to win for up to £2,000 in 'The Big Break'.


Dealing with the first spat

Given its 'Big Tent' make up, there are bound to be disagreements in the CMRC - and it looks like the first one has already taken place over the launch press release:
Some of the charities received negative feedback regarding some aspects of the press release and the notes to editors prepared by Bristol University. It was acknowledged that there are differences in some areas such as prevalence rates and that we need to produce information that best reflects the range of positions for future use [my note: this probably also refers to background notes included with the press release emphasing the role of psychological factors]. Sonya Chowdhury has coordinated a teleconference for the charities to discuss this and to prepare a draft for approval by the Board. It was reiterated that there was not an expectation that independent positions should be compromised.

I think the significance of this is not in the specifics of the press release, but in the fact that the problem was recognised - rather than swept under the carpet - and is apparently being dealt with constructively. If the CMRC is to succeed, I suspect there will need to be a lot more of this constructive work in future.


Big Pharma takes an interest

An unnamed pharmaceutical company has expressed an interest in working with the Collaborative and will be asked to show "what value they would create and what they could contribute to support the workstreams, especially with a focus on funding" ( :), my italics).


Annual conference

There will be an annual event for researchers which could provide a combination of learning and development through showcasing research projects, as well as time to develop collaborations on new projects.

So: the Research Collaborative looks like it's going to make an impact. Charles Shepherd described it as "a very big and potentially extremely powerful tent". Sonya Chowhury is positive too: "As a group, we are committed to action; to making a real difference and enhancing work in the research field ... It’s such an exciting time at the moment and it’s essential that we work collaboratively to leverage the potential and create even more capacity than we would by working on our own".

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Prof Hugh Perry (an executive member of the UK research collaborative) gave an interesting and reassuring presentation at the recent Australian conference. Amongst other things, he discussed the UK Research Collaborative's research intentions, the MRC's intentions in relation to ME, and the MRC's current funded research projects.

I'm really impressed with Hugh Perry, but I hadn't come across him before his association with the research collaborative. I happened to look him up the other day, for some reason, and came across the following which I found very impressive, and relevant to ME/CFS (It's his Southampton Uni webpage that describes his academic speciality - It's probably been posted previously, but I have a short memory):
http://www.southampton.ac.uk/biosci/about/staff/vhp.page#research

Anyone following the developments of the UK Research Collaborative would probably be interested in reading the section about Prof Hugh Perry's presentation in Dr Ros Vallings' report of the Australian conference. (Tom Kindlon posted it as a Tweet.) It's contains lots of interesting info:
https://twitter.com/TomKindlon/status/409762381439725568
Long Tweet:
http://www.twitlonger.com/show/n_1rt43lk

I've extracted the info about Perry's presentation:
Hugh Perry (Southampton, UK) gave the inaugural Alison Hunter Memorial Foundation address. However he began his address pointing out that neuro-immunology has a large role to play in the understanding and research associated with ME/CFS. He reiterated how much Christine Hunter (AMHF) had raised so much the awareness of the illness.

The first part of his talk explained the Medical Research Council (MRC) mission. The MRC has been established for 100 years. The mission is to encourage research, produce skilled researchers, disseminate knowledge and bring dialogue to the table. ME/CFS research has been supported since 2003. A strategy document was produced in 2008 – leading to an expert group incorporating external researchers for collaboration. The idea was to bring in new people, new research and new technologies. One of the big challenges was the unmet clinical need (up to 600,000 sufferers in the UK). Grants were initially low as there was no clear pathology and no targeted therapies. Treatment has been geared towards support and symptom control. There is need to define phenotypes and sub-phenotypes and embrace new technology. He then outlined a prioritization of topics for research: Autonomic dysfunction, cognitive symptoms, fatigue, immune dysregulation, pain and sleep. There is a need to bring in external expertise. In the medium term there is need to encompass comorbidity and chronicity, susceptibility and resilience, mitochondrial function, use of well characterized cohorts and development of intervention (eg cytokine inhibition). In the longterm there should be development of imaging technologies, assessment of genetic risk and review of neurobiological changes (eg cerebral activity). The MRC is currently funding new research looking into the mechanism of ME/CFS (1.6 million pounds). There needs to be partnership with new researchers to qualify for grants, and a focus on one of the 6 topics listed above. So far the following awards have been made: Mitochondrial function, Autonomic dysfunction, Biological fingerprints of fatigue, Slow-wave sleep and daytime function, persistent fatigue induced by interferonα (a new model for ME/CFS). The MRC role is to support excellent and innovative research. There is increased emphasis on translation, and increased commitment to develop research for application to new therapies. This needs a “bottom-up” researcher –led approach. This has led to the establishment of the UK ME/CFS Research collaborative launched in April 2013, associated with Dr Stephen Holgate. This brings together funders and ME Charities. The MRC acts as an observer. The aim is to collaborate the ME charities and to increase awareness with the research community. The key to success is that research should drive the agenda, the “bottom-up” approach and the engagement of researchers outside the field. This has led to the First UK CMRC Research conference to be held in Bristol in September 2014.

The second part of the address focused on the Impact of Systemic Inflammation on the Brain. He described how diseases “talk” to the brain, and how infection makes you feel “sick”. Inflammation changes behavior. These symptoms can be the same as those experienced by those with ME/CFS. This highly organized strategy is critical to survival if living in the wild. Systemic inflammation activates selective brain regions. Infection causes a localized inflammatory response, with release of pro-inflammatory cytokines, which then communicate with the brain. The cytokines act on the endotheliail cells, which in turn affect the macrophages in the brain (microglia) – and microglia play a key role in immune/brain communication. This is tightly regulated by the brain/micro-environment. The microglia may become dysregulated, escaping from CNS control, and this leads to massive pathology and symptoms equivalent to microglial activation. The activated microglia may proliferate, leading to neuro-degeneration. The microglia may be primed by decline (eg Alzheimer’s disease). Macrophages are primed by exposure to ɣinterferon and then triggered by infection, which is the secondary stimulus. In a younger population the microglia can be primed by the environment – living in dirty conditions (animal model) predisposes the brain to give a more robust response to infection, which can lead to microglial activation for months. Smoking and obesity lead to higher levels of cytokines and this in turn leads to more activation of the microglia as if a peripheral disease exists. Lifestyle, systemic infection and genetics all prime the microglia.


The final conclusion/hypothesis was that systemic infection and inflammation, that normally leads to sickness behavior in an individual with a healthy brain, is a homeostatic mechanism with no long term consequences, is distorted and maladaptive in an individual with primed microglia. The question is to find “inhibitors” to penetrate the brain and downregulate the microglia.
 
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After that positive observation, now to a negative reflection.
I've been thinking about the S&K ME/CFS Society's recruitment to the research collaborative.
They are well known for dogmatically promoting the cognitive-behavioural model of illness, and supporting the cognitive-behavioural proponents.
I reckon they might be the only local group in the country who is well known for taken a strong and rigid stance about this.
So is it simply a coincidence that they've been recruited, or was there a purposeful drive to get a patient group on board who would side with the cognitive-behavioural proponents?
I can't help having strong feelings that it was the latter.
I do find this development quite irritating, and not at all positive.
 
Prof Hugh Perry: "Treatment has been geared towards support and symptom control."

I hope this is a telling insight into the thinking behind Profs Hugh Perry and Stephen Holgate re CBT/GET.

Edit: i.e. It implicitly suggests that CBT/GET are not curative and do not address the underlying disease mechanism or cause of illness.
 
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Prof Hugh Perry (an executive member of the UK research collaborative) gave an interesting and reassuring presentation at the recent Australian conference. Amongst other things, he discussed the UK Research Collaborative's research intentions, the MRC's intentions in relation to ME, and the MRC's current funded research projects.

I'm really impressed with Hugh Perry, but I hadn't come across him before his association with the research collaborative. I happened to look him up the other day, for some reason, and came across the following which I found very impressive, and relevant to ME/CFS (It's his Southampton Uni webpage that describes his academic speciality - It's probably been posted previously, but I have a short memory):
http://www.southampton.ac.uk/biosci/about/staff/vhp.page#research

Anyone following the developments of the UK Research Collaborative would probably be interested in reading the section about Prof Hugh Perry's presentation in Dr Ros Vallings' report of the Australian conference. (Tom Kindlon posted it as a Tweet.) It's contains lots of interesting info:
https://twitter.com/TomKindlon/status/409762381439725568
Long Tweet:
http://www.twitlonger.com/show/n_1rt43lk

I've extracted the info about Perry's presentation:
I wonder could Stephen Holgate have asked him to speak for him?
 
I wonder could Stephen Holgate have asked him to speak for him?
I would be surprised - Hugh Perry is quite a big player in his own right, and he was talking about his core research area, the link between inflammation and the brain.

Professor V Hugh Perry @ Southampton Uni | Research interests:
Inflammation in the CNS and its contribution to Neurological Disease
The inflammatory response evolved to protect organisms against injury and infection. Following an injury or infection a complex cascade of events leads to the delivery of blood-borne leucocytes to sites of injury to kill potential pathogens and promote tissue repair. However, the powerful inflammatory response has the capacity to cause damage to normal tissue and dysregulation of the innate or acquired immune response is involved in different pathologies.

It has long been known that Multiple Sclerosis is an inflammatory disease of the brain but it is now recognized that inflammation may contribute to diseases such as stroke, traumatic brain injury, HIV-related dementia, Alzheimer's disease and prion disease. The recognition of an inflammatory component in the pathology of these different diseases has come from the development of new techniques and reagents for the study of inflammation biology in brain pathology.

It is now known that the resident macrophages of the central nervous system (CNS), the microglia, may exist in many different states of activation and contribute to the outcome of neurological disease in diverse ways. The goal of my research group the CNS Inflammation Group is to discover how inflammation contributes to the outcome of neurological disease. This information may help in the development of therapies to treat acute and chronic neurodegenerative conditions, which at present are largely untreated
 
Prof Hugh Perry: "Treatment has been geared towards support and symptom control."

I hope this is a telling insight into the thinking behind Profs Hugh Perry and Stephen Holgate re CBT/GET.
In what way, Bob? Sorry you lost me.
I must have missed your question.

By saying that current treatments are geared towards 'support and symptom control', it suggests that he is not of the opinion that CBT/GET are curative or that they address the underlying disease mechanism or cause.
 
one problem with that response is that it indicates a lack of awareness over the problems with misleading claims about the curative nature of thee interventions.
Perhaps, or perhaps he just doesn't want to explicitly attack any colleagues?
Whichever, it's still good to see that he is aware of the limitations of CBT/GET.
 
That's a bad sign too imo!

Attacking dodgy colleagues is the most worthwhile thing to be done in CFS research!
I understand why researchers might not want to launch explicit attacks on other researchers, and make themselves enemies within their community.
And the psych-lobby always seem to get the upper-hand when when in battle, so making explicit attacks could cause major problems for the whistle-blower (for want of a better phrase), and it would probably be futile anyway.
The psych-lobby use smear tactics, and get people removed from their positions, and they get funding withdrawn.
(Remember Jonathan Kerr?)
 
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Attacking dodgy colleagues is the most worthwhile thing to be done in CFS research!
Robust debate is a feature of some very strong life science areas :). On the other hand, what matters most is getting high quality, relevant research going and both Hugh Perry and Stephen Holgate are being very helpful there. So saying that what's needed is a focus on causal molecular pathways, and that current approaches amount to symptom control, may be poor spectator sport but I think it does show they understand the issues and are moving things in a new and more helpful direction.
 
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