Blog posts

Nurturing hope: Understanding Dilated Cardiomyopathy and transforming heart failure prospects

As the leading cause of heart failure in young individuals, dilated cardiomyopathy presents a unique set of challenges and implications. It is an intrinsic heart muscle disease that is the most common reason for needing a heart transplant. The origins of this condition are diverse, spanning genetic predispositions, external triggers that subject the heart to undue stress, or often, a combination of both. Dr Brian Halliday, a Clinical Senior Lecturer and British Heart Foundation Intermediate Fellow at the National Heart and Lung Institute sheds light on this disease and how medical advancements have enabled some patients to go into remission.

Heart failure can be a devastating diagnosis. The prognosis has been shown to be worse than many of the most common cancers. The words themselves often create a sense of doom for patients.

Dilated cardiomyopathy is the most common cause of heart failure in young people and the most common reason to need a heart transplant. It is an intrinsic heart muscle problem where the heart becomes baggy and weak. It may be due to genetic susceptibility, extrinsic acquired triggers that put the heart under stress, or a combination of the two. At the National Heart and Lung Institute, we have a particular interest in dilated cardiomyopathy.

The heart of a patient with dilated cardiomyopathy
The same patient’s heart after undergoing remission

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The Compressed Air Bath and its Therapeutic Uses in Mid-Victorian Britain

The Wharfedale hydropathic establishment and hotel (Ben Rhydding) with surrounding grounds. Etching, ca. 1860. Wellcome Collection. Source: Wellcome Collection.
The Wharfedale hydropathic establishment and hotel (Ben Rhydding) with surrounding grounds. Etching, ca. 1860. Wellcome Collection. Source: Wellcome Collection.

What happens when industrial technology meets nature? A French invention of the 1830s, the compressed air bath capitalised on the allure of ‘pure countryside air’ to treat a range of respiratory problems. Dr Jennifer Wallis, Medical Humanities Teaching Fellow, explores the fascinating history of these baths and their therapeutic uses in mid-Victorian Britain.

During the summer holiday season, many of us will have taken a break to recharge our batteries. Whether it’s gazing out over a clear blue sea or hiking through a forest, connecting with nature is often a key component of our holidays.

Tourists in the 19th century sought a similar experience. They yearned to escape the crowded city or the routines of home to immerse themselves in a new environment. The era is most associated with the seaside resort, which grew in popularity as the railway network expanded. But many Britons were also choosing to follow in the footsteps of their eighteenth-century ancestors by visiting spa towns like Malvern. Spa towns were renowned for their health benefits, from the freshness of the air to the energising effect of the mineral waters. Hotels and resorts sprung up in spa towns to cater for the health-seeking hordes.

One such resort was the Ben Rhydding Hydropathic Establishment in Ilkley, Yorkshire. It cashed in on a contemporary interest in hydropathy, a treatment regime based on baths and showers. Ben Rhydding offered its visitors a variety of activities to supplement these treatments: bowling greens, dances, and guided walks of local beauty spots. It also offered a rather unusual experience for the health-seeking tourist, one that used air rather than water: a compressed air bath.

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Team Science Leads the Way – But Hero Science Still Looms Large

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

When it comes to tackling the world’s biggest health challenges, teamwork makes the dream work for Professor Wiebke Arlt, Director of the MRC Laboratory of Medical Sciences (LMS). Here, she discusses why it’s time that contemporary science shifted from a hero science to a team science approach – one based on productive collaboration rather than wasteful competition.

Going it alone is often glorified as the breakthrough way of achieving major milestones. However, if you look closely, most of these are achieved in a team effort and not by single individuals. Our perception of heroes rather than teams is often driven by the narrative and not the facts: when I was a child, I learnt that Edmund Hillary was the first to climb the highest mountain in the world, Mount Everest. Now I know that Hillary achieved this feat together with the Nepalese mountaineer Tenzing Norgay. Reading up on it, I discovered that they didn’t walk up the mountain on their own, but they were part of a large expedition team that worked together to achieve the goal. Hillary and Norgay were the second pair to be deployed as part of a systematic team approach to conquering the mountain.

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Embracing Ubuntu in Higher Education: The Power of Togetherness

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

Ubuntu (ooh-bun-too) is a concept, a philosophy, a way of living in Africa. It highlights the interconnectedness of all individuals and encourages people to recognise their shared humanity. Here, Dr Sungano Chigogora, Senior Teaching Fellow in Epidemiology in the School of Public Health, explores the spirit of Ubuntu and why it should be at the heart of teaching and learning.

In Central and Southern Africa, Bantu means ‘people’ or ‘humanity’ to hundreds of millions of individuals whose languages have common ethnolinguistic roots. To them, Ubuntu is a core characteristic of humanity that extends beyond the individual, and recognises not only their humanity, but how they belong to a deep community in which they can participate, share, and grow. As observed by the late Archbishop Desmond Tutu, “Ubuntu is very difficult to render into a Western language. It speaks to the very essence of being human. … to give high praise to someone we say … ‘he or she has Ubuntu’. This means that they are generous, hospitable, friendly, caring, and compassionate” (Tutu, 1999).

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Closing the Gender Health Gap: A Call for Sex and Gender Equity in Biomedical Research Policies

When it comes to healthcare, there are clear and stark inequalities between women and men. Marina Politis, Alice Witt, and Kate Womersley explain how, at its root, this gender health gap derives from a research and data gap, and how the MESSAGE project is working to improve accounting of sex and gender dimensions in medical research.

Everyone aspires to receive gold standard treatment when seeking medical care. What if, however, this standard, was only ever set out to be gold for one group of people? Much of our medical evidence base has been based on a male norm, with women underrepresented at all stages of the research pipeline. Subsequently, when a woman suffers an out-of-hospital cardiac arrest, she is less likely to receive bystander CPR than a man. Once in the hospital, she continues to be less likely to receive optimal care than her male counterpart.

The gender health gap in cardiovascular disease – poorer outcomes women experience due to the “male default” in health research and healthcare – is just one of many conditions for which there are disparities between women and men. From dementia to diabetes, and osteoporosis to obesity, sex and gender differences and similarities remain neglected in UK and international research.

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Getting to the Heart of the Matter: Sex Differences in Cardiomyopathy

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

Could variation in the architecture of men and women’s hearts explain why their risk of cardiomyopathy differs? Dr Paz Tayal, Clinical Senior Lecturer in Cardiology at the National Heart and Lung Institute is investigating this with the aim of improving outcomes for patients affected by this disease of the heart muscle. Dr Tayal also discusses the ‘juggle struggle’ of balancing work and family life, and the importance of truth telling in academic medicine.

As winter sets in, I start to pack away the summer dresses and bring out the woolly jumpers and sturdy boots. When I do this, I will not be going into my husband’s closet to find things that fit me, nor indeed will I be wearing his shoes.

That seems obvious right, because we are different sizes.

We don’t think twice about that, yet in medicine, we are only just beginning to realise that male and female patients might need to have tailored ways to diagnose and treat disease.

Even in health, male and female hearts are not the same. At birth, the hearts of male and female babies are about the same size. However, at puberty, male hearts have a faster period of growth compared to female hearts. Whilst this eventually settles down, throughout adult life the mismatch persists, and the female heart remains smaller.

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The Fleming Centre: Driving the fight against antimicrobial resistance.

Prof Ara Darzi, Chair, The Fleming Centre Initiative 

In the relentless pursuit of global health, few adversaries loom as large as antimicrobial resistance (AMR). AMR poses a pervasive threat to both different disease areas and public health as a whole. It has the potential to undermine modern medicine, as previously treatable common infections and injuries may once again become life-threatening. As the gravity of this crisis intensifies, The Fleming Centre will stand at the forefront of a burgeoning global movement to combat AMR. On World Antimicrobial Awareness Week,  Professor Ara Darzi, Chair of The Fleming Centre Initiative, writes about the pivotal role this centre will play in the fight against AMR and the far-reaching impact it promises to deliver.  

AMR poses a significant threat to global health, making it one of the most pressing challenges of our time. Drug-resistant infections occur when the bacteria responsible for the adaption and evolution of infections, gain the capacity to withstand drugs intended to kill them. The overuse and misuse of antimicrobial drugs, such as antibiotics and antifungals, in both humans and animals is only accelerating this process. As a result, AMR has been linked to more than one million deaths worldwide each year; a sign common infections are becoming increasingly difficult to treat as the medicines we all rely on become less effective. With people across the globe already dying from drug-resistant infections, the threat of more drugs losing their potency, will put more lives at risk.  

Deaths attributed to AMR every year
Source: Wellcome Trust (https://wellcome.org/sites/default/files/wellcome-global-response-amr-report.pdf)

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The one with a Nobel prize winner

Hadi Sallah, PhD student in John Tregoning's lab, working on RNA vaccines.
Hadi Sallah, PhD student in John Tregoning’s lab, working on RNA vaccines.

Dr John Tregoning, Professor in Vaccine Immunology, recounts his experience of working with Dr Katalin Karikó, Nobel Prize winner and the tenacious force behind the mRNA vaccines that helped change the course of the COVID-19 pandemic. Their recently published study investigates how RNA modifications impact the body’s immune response to infection, with the hopes of aiding the development of more effective mRNA vaccines.

Science is collaborative, we work with lots of different people to understand the world around us. Working with other people is one of the joys of the job. In our recently published study, Reducing cell intrinsic immunity to mRNA vaccine alters adaptive immune responses in mice, we had the privilege of working with Dr Katalin Karikó, joint winner of the 2023 Nobel prize in Physiology or Medicine.

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Why not eliminate HTLV-1 while eliminating HIV-1? We need HTLV-1 PEP/PrEP clinical trials.

Dr Goedele Maertens and Dr Fabiola Martin

HTLV-1 PrEP Open Letter to Gilead & ViiV 

Human T Lymphotropic/Leukaemia Virus-1 (HTLV-1) is a sexually transmitted infection (STI) closely related to human immunodeficiency virus-1 (HIV-1). HTLV-1 causes chronic infection, can be transmitted from mother to baby and is associated with significant disease burden and mortality, preceded by years of suffering and poor quality of life for victims.   

Therefore, HTLV-1 is one of the 2030 elimination targets of the World Health Organization’s global STI elimination strategy.  

Although there is currently no drug or vaccine available to cure HTLV-1, we now know that the very same drugs that effectively treat patients with HIV or prevent people from getting HIV-1, called HIV PrEP, also prevent the transmission of HTLV-1 in our laboratory testing (Reviewed in Bradshaw and Taylor, Frontiers in Medicine 2022). We believe that these compounds are likely to block the transmission from mother to child. 

It is well known that many HIV PrEP clinical trials are conducted in countries where HTLV-1 is common. So, by adding in HTLV-1 testing to these HIV-PrEP trials we could measure if the HIV PrEP drugs also prevent HTLV-1 transmission. The beauty of such an outcome would be that these HIV-1 drugs are already licensed to be used in humans.  

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Tackling syncope – a significant diagnostic challenge for many

Syncope–a transient loss of consciousness–occurs in 42% of people by the age of 70. Professor Richard Sutton, Emeritus Professor of Clinical Cardiology, discusses this common medical problem, and how he has pioneered a “true but still insufficiently small interest” in it.

I have been Emeritus Professor of Clinical Cardiology at Imperial since 2011. Prior to that, I had trained in Cardiology at St George’s Hospital, the University of North Carolina, and the National Heart Hospital in London, becoming Consultant Cardiologist at Westminster Hospital in 1976. There I focused on cardiac pacing as a subspecialty. From a clinical perspective, cardiac pacing eradicated syncope (transient loss of consciousness) in patients with conduction tissue disease of the heart. So, I sought to extend the role of pacing into related syncope conditions.

My primary interest therefore became the symptom of syncope. I began this in the late 1970s, and formed a close relationship with Worthing Hospital which carried a heavy load of older patients, many of whom presented syncope. I founded an outreach clinic at Worthing which led to the receipt of many challenging patients with syncope in whom there was no obvious cause.

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