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Our new centre is searching for solutions

Published on 07 October 2013
Source: Arthritis Today
Professor Tonia Vincent, director of the new centre, supervising a junior colleague.

Osteoarthritis affects eight million people in the UK, and treatments are limited to reducing painful symptoms. The new Arthritis Research UK Centre for Osteoarthritis Pathogenesis at the University of Oxford hopes to provide some solutions. Jane Tadman reports.

What would people with osteoarthritis like to see as a result of research into their condition?

That’s what the team at the new osteoarthritis pathogenesis centre asked patients before planning their new programmes of work.

Unsurprising, one of the patient priorities was reducing pain. However, there was also a firm understanding among patients that before research can lead to better treatment, a great deal more needs to be known and understood about the actual origin and development of the disease itself: the ‘pathogenesis’ of osteoarthritis, in other words.

The new osteoarthritis pathogenesis centre in Oxford, opening this year with funding of £5.5m over five years, is taking an unashamedly laboratory-based approach as its focus. Sixty five per cent of its research will be pre-clinical or basic science; the remaining 35% clinical, involving patients.

Despite this emphasis on basic science, each of the seven discrete work streams will ask clinical questions, and each group will contain at least one clinician (either a rheumatologist or an orthopaedic surgeon) among the chrondrocyte, bone, matrix and structural biologists.

Explains Dr Fiona Watt, a rheumatologist and senior lecturer newly appointed to the osteoarthritis centre: “Basic science is necessary, but the end goal has to answer clinically relevant questions. Patients we’ve talked to have an understanding that osteoarthritis is a disease that isn’t well-understood, and that we need to understand the basic process right from the start: why it starts, why it gets worse, why a joint is painful or swells, why it’s better some days than others.”

The new centre has been formed by the Kennedy Institute of Rheumatology (which moved from its former base in London this summer into a purpose-built centre at Oxford University) and includes the Botnar Research Institute, the Nuffield Orthopaedic Centre and the Functional MRI Centre at the University of Oxford, as well as links with the Medical Research Council Unit at nearby Harwell.

The principal aims of the centre will be to understand primary mechanisms in osteoarthritis with a view to developing novel disease biomarkers (indicators of disease risk) and to develop new therapies that both affect disease progression and reduce pain.

Centre director Professor Tonia Vincent, an honorary consultant rheumatologist, and Arthritis Research UK senior fellow with clinical and academic interests in osteoarthritis pathogenesis, believes the formation of the new centre will create the highest concentration of osteoarthritis researchers with the broadest range of expertise in Europe.

Explains Professor Vincent: “Although much of our work is pre-clinical, we aim to create a seamless transition, translating our lab-based discoveries into clinical benefit for patients. Our work has the potential to be moved into patients in a relatively short time. We also hope to create a national training resource for scientists and clinicians working within the osteoarthritis field.”
Dr Fiona Watt (right) examines osteoarthritis patient Danuta Bildziuk (left)

Each work stream will look at a different aspect of osteoarthritis development and ask important clinical questions, such as:

• What molecules drive osteoarthritis, and can they be blocked for therapeutic benefit?
• Does cartilage have the capacity to repair itself?
• Why do patients with osteoarthritis have pain?
• Can the surface of the joint be imaged (through targeted imaging techniques) to detect early disease?

While the centre is still strictly at the setting-up phase – staff only started to move into the new building in July – they have already identified some outcomes that can be delivered in between one and three years. They include:

• identifying biomarkers (indicators) of acute joint injury that may predict risk of subsequent OA
• validation of novel imaging biomarkers for detection of early osteoarthritis
• development of clinical tools that will improve the management of people with osteoarthritic pain.

The Kennedy Institute, formerly based in west London, had core funding from Arthritis Research UK until 2012 and became part of the University of Oxford in 2011. Several of the work streams at the new osteoarthritis centre, which is based in the new Kennedy Institute building on the Old Road Campus, will continue as before.

One of the new patient-focused work streams is the KICK study (Knee Injury Cohort at the Kennedy). Run by Dr Watt, this prospective cohort is recruiting individuals aged between 18 and 50 who have recently suffered an acute knee injury.

“We’re looking at groups of individuals who have significant risk of osteoarthritis. After a joint injury, around 50% of people will go on to develop premature osteoarthritis,” explains Dr Watt. “We want to understand the clinical and cellular responses that occur as early as a couple of weeks after the knee injury to see whether these can be used to predict who develops osteoarthritis, using a combination of imaging to detect changes in the joint and patient-reported outcome measures.”

Being able to predict who will develop osteoarthritis, either as a result of injury or just by getting older, is something that has long been aspired to. The KICK group is working in collaboration with Mr Andrew Williams, leading sports knee surgeon. Currently, around 70% of the cohort are professional sports people. Knowledge of their osteoarthritis risk post-injury will enable them to plan for the future. The study also hopes to identify novel targets for preventing or treating early disease.

Ian RoseIan Rose, aged 41, is a former Paralympic judo player who has five World Championship and nine European Championship medals, but he had to retire from the sport he played for 22 years before the 2012 London Paralympics after injuring his anterior cruciate ligament in training. Now a motivational speaker, Ian is in the KICK study, and is giving the centre his full support.

He knows he is at risk of developing osteoarthritis, but is keen to avoid it, and for other sports people to be more aware of the risks of injury. “Like a lot of top sports people, I’ve dedicated most of my life to achieving ‘excellence’ for my country, and one of the sacrifices we make is to be at increased risk of getting osteoarthritis,” says Ian. “We need to make sure that people continue to meet their sporting aspirations but without having to make that sacrifice, and to be able to stay well and healthy in their later years.”

Meanwhile, Sue Woollacott, from the centre’s patient advisory group, is hopeful for the future and that the centre will deliver. “What will patients get out of this research? We need new therapies to control pain adequately, and for that novel research strategies are needed,” she says. “I think the centre’s focus is very patient-oriented. We feel as patients that we will have a better life at the end of five years.”

Arthritis Today will keep readers up to date with the centre’s progress.

The Arthritis Research UK Centre for Osteoarthritis Pathogenesis has funding of £2.5 from the charity for five years, matched by £2.5m from the University of Oxford, and £500,000 from the Kennedy Trust. It will be officially launched later this year.

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