It’s nearly impossible for us to imagine life without the National Health Service.
NHS midwives help us take our first breaths; GPs, nurses, doctors, and specialists care for us in times of sickness and vulnerability; and palliative care specialists work to help us die with dignity.
The NHS is free at the point of care, supporting people at every stage of their life. As a result, it is an incredible source of the data that drives research into human health and disease.
Today marks 75 years of the NHS. To mark this historic milestone, we’re highlighting some of the recent research and innovation at the Earlham Institute which directly benefits the NHS and patients.
Babies born pre-term have particularly immature immune systems, which makes them vulnerable to potentially life-threatening infections.
Identifying the bacteria responsible for an infection - and any signs of antibiotic resistance - is a key part of effective treatment. Doing this quickly can make all the difference but standard tests can take two or three days to give results - a long time for a tiny baby.
Dr Richard Leggett, Leader of the Earlham Institute’s Technology Algorithms Group, together with a team of collaborators, has developed a method to sequence and identify bacterial infections within hours.
“These infections need immediate treatment and often this means doctors prescribe a broad spectrum antibiotic,” he explains. “This might kill the infection - but it also disrupts the baby’s developing microbiome.”
Dr Leggett’s approach applies Oxford Nanopore Technology to rapidly sequence faecal samples, which are then analysed in near-real-time to reveal both the identity of the culprit and any resistance genes it may be harbouring.
This method has the potential to quickly guide treatment decisions, helping doctors to choose a targeted therapy and minimise any impact on the infant microbiome. His group is also looking at other patient groups who could benefit from similar approaches.
“One day - in the not too distant future - I can see this technology being used at bedsides for rapid diagnosis,” he says. “And it has the potential to have a really positive impact on patient outcomes.”
Daniel Brewer, Professor of Medical Bioinformatics and Genomics at Norwich Medical School, based at the University of East Anglia, has collaborated with researchers at the Earlham Institute over the past 6 years to advance our understanding of prostate cancer.
Prostate cancer is the second most diagnosed cancer in the UK, accounting for four in every 25 (14%) of all cancer cases and affecting one in six men during their lifetime.
“Prostate cancer can have a wide range of outcomes,” explains Professor Brewer. “For some tumours, we don’t need to do anything and the patient can simply be monitored from time to time, while others are much more aggressive and require immediate intervention.
“But the tools we use at the time of diagnosis are not optimal and can lead to overtreatment. This is a major challenge in the care of prostate cancer patients.”
He has a number of research interests, but his work with the Earlham Institute focuses on the links between aggressive prostate cancer and certain types of bacteria. The Institute’s cutting-edge technology has enabled more accurate sequencing of the bacteria and is helping to separate bacterial DNA in tumours from associated human DNA.
“The hope is that we can use molecular biology to improve patient care,” he says, “so that more people are saved and fewer suffer the side effects of unnecessary treatment.”
The Earlham Institute and Quadram Institute are located next to the Norfolk & Norwich University Hospital and UEA's Norwich Medical School where Prof Brewer is based.
A typical human gut hosts 200-300 different species of bacteria, generally living in a state of equilibrium – the microbiome. But what does your bacterial ecosystem say about you?
Dr Falk Hildebrand, who works jointly between the Quadram Institute and the Earlham Institute, has identified five so-called ‘enterosignatures’ in the human gut.
These represent different types of microbial guilds – groups comprising multiple species of bacteria which commonly co-occur and have complementary metabolisms.
Analysing 5,230 gut metagenomes from 13 countries, Dr Hildebrand found that combinations of these enterosignatures could describe western and non-western faecal metagenomes of all ages.
And, while some were associated with good health, others marked potential illness and disruption to the gut ecosystem.
“These enterosignatures could be used to identify healthy individuals, and also to identify microbial dysbiosis,” explains Dr Hildebrand. “This would be a really big step towards detecting and assessing gut diseases.”
One day - in the not too distant future - I can see this technology being used at bedsides for rapid diagnosis, and it has the potential to have a really positive impact on patient outcomes.
Dr Richard Leggett, Group Leader
Silvia Ogbeide, a PhD student in Dr Iain Macaulay’s group at the Earlham Institute, is investigating cancer evolution in the context of drug resistance.
Her research involves using biopsies from patients with advanced-stage colorectal cancer to generate patient-derived organoids - groups of cells that mimic the characteristics of the original biopsy. She then assesses their responses to candidate chemotherapy drugs, including their intrinsic drug resistance.
Resistance to chemotherapy drugs is a significant obstacle in the treatment of cancer. Currently, it takes several weeks of treatment to determine whether a cancer is resistant. This results in valuable time lost for the patient.
“The hope is to use this technique to identify drug resistance in tumours before initiating treatment,” she explains.
This project is part of a collaboration funded by the Cancer Research UK Accelerator Award. Institutes in Italy and the United Kingdom are working together to deliver tools to bring single-cell multi-omics analyses to clinical applications.
Collaborators include the Institute of Cancer Research in London, along with the Ospedale San Raffaele Centre for Omics Sciences, Human Technopole, and the University of Milano-Bicocca - all in Milan.
Today most people can expect to live into their sixties and beyond. In England, the percentage of people 65 and over is predicted to rapidly rise by 2030.
These numbers are set to put increased pressure on our NHS. Finding out more about healthy ageing is a priority.
Earlham Institute Group Leader Dr Edyta Wojtowicz is a molecular haematologist with a particular interest in platelet biology.
“Healthy ageing is not just about the number of years,” Dr Wojtowicz says. “It’s about how long we can stay healthy and active. How do we maintain good health as we age?”
Platelet production and function slows as we age. This leads to more difficulty healing and means older people take longer to recover from injuries. Platelets can also become too active with age, which can cause cardiovascular diseases.
Platelets are produced by a small pool of cells called megakaryocytes in our bone marrow. Dr Wojtowicz is studying how these cells produce platelets and how function is affected by our diets. Her work includes the impact of dietary intervention on hematopoiesis - the formation of blood cellular elements - and immune system function in health and disease.
And, as well as the work we are doing now we were able to directly help the NHS with its Covid response during the pandemic.
Healthy ageing is not just about the number of years, it’s about how long we can stay healthy and active. How do we maintain good health as we age?
Dr Edyta Wojtowicz, Group Leader
Thanks to its world-class expertise and infrastructure in genomics and microbiology, the Earlham Institute was able to play an important role throughout the height of the global coronavirus pandemic.
During the summer of 2020, the UK government was relying on nationwide COVID-19 testing to track the spread and severity of the pandemic. The return of students to universities in the autumn was a major concern.
The Earlham Institute collaborated with institutions across Norwich Research Park (NRP) to address this with the Norwich Testing Initiative (NTI), a pilot study looking at whether an asymptomatic testing programme could be effective for a large cohort, such as a university.
Collaborators on the NTI included the University of East Anglia and the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), along with the Quadram Institute and the John Innes Centre.
The pilot tested staff from the university and Park. It carried out more than 3,000 tests on around 800 Norwich Research Park staff and students. Turnaround time for results could be as low as nine hours, with the majority completed within 24 hours.
The Institute joined the Quadram Institute in loaning equipment to the NNUH for a new automated test. This increased the hospital’s testing capacity by a factor of seven.
The hospital never ran out of lab capacity or staff and could offer testing to its staff and the region when needed. This provided local testing for key workers, who otherwise would have had to travel to national test centres in Ipswich, Stansted, or Peterborough.
Following this success, the Department of Health and Social Care contracted the Earlham Institute and NNUH to provide loop-mediated isothermal amplification (LAMP) testing. They and their partners across the park built a local programme.
The Institute used some of its available lab space to set up a dedicated facility with a processing capacity of up to 35,000 samples a week, and also ran a Norwich Research Park volunteer drive with more than 200 volunteers.
In September 2020, the Earlham Institute partnered with the UEA to provide all of their staff and students on campus with COVID-19 self-swab tests, in a bid to stop asymptomatic transmission as the academic year started.
And, working in partnership with the NNUH, a dedicated laboratory at the Institute was set-up by Dr Karim Gharbi, including both Earlham Institute and NHS staff. This piloted the use of saliva tests for frontline NHS staff, gradually replacing the lateral flow tests previously in use.
