Southampton researcher Philip Calder, as part of a panel of experts, has produced new European guidelines for medical teams on how to prevent malnutrition in intensive care patients. Good nutrition is important for all of us, but for patients on the intensive care unit (ICU) it can tip the balance to ensure their recovery and survival. Professor Philip Calder has been part of a two year long effort by a multi-national panel of experts to produce new European guidelines for ICU medical teams, based on the latest evidence. These guidelines, published online by the European Society for Clinical Nutrition and Metabolism (ESPEN), will help to improve the nutrition of critically ill patients all across Europe. Challenging care Meeting the nutritional needs of patients in ICU can be extremely difficult. The simple act of eating can pose a big challenge to these patients. Patients in ICU may have difficulty chewing and swallowing, may have had major surgery on their gut or be entirely comatose. This means that while some patients may be able to eat normally, others need to be tube fed or even get their nutrition infused directly into their veins. Not only that, but depending on why they were admitted to ICU, some patients can have extra specific nutritional requirements. Patients with severe burns, for example, lose a lot of fluid through their skin, taking with it key minerals that need to be replaced. “These patients are very complicated,” explains Professor Calder. “They may need surgery, complex combinations of medications and external support for several organs to maintain function. If the patient is very frail or malnourished, these interventions are not going to work very well.” Reviewing the evidence ESPEN is a learned society that brings together doctors, dieticians, pharmacists, nurses and scientists with an interest in nutritional support of patients. It develops clinical guidelines for the medical community across the whole of Europe. Professor Calder was part of a panel of experts from ten different countries, which responded to questions from the medical community by reviewing and summarising the latest evidence. An online system was then used to gather feedback and agreement with these statements from relevant professionals. Finally, the text was discussed in specially arranged workshops, after which the guidelines were published online. Altogether, the whole process took about two years. Southampton’s involvement in this process equips ICU teams across Europe with the latest evidence and advice they need on nutrition to give critically ill patients the best chance possible.

Doctors in Southampton are leading a world-first trial of a new nose drop containing a type of modified ‘friendly’ bacteria that could help prevent meningitis and other infections. It was developed by Professor Robert Read, director of the NIHR Southampton Biomedical Research Centre and Dr Jay Laver, senior research fellow in the experimental human challenge group at the University of Southampton. Together they have inserted a gene into a harmless form of bacteria to help it remain in the nose and cause an immune response, with the first person given the drop at the NIHR Southampton Clinical Research Facility last week. It is hoped the enhanced ‘friendly’ bacteria, known as Neisseria lactamica (Nlac), will protect against its close cousin, Neisseria meningitidis (N.meningitidis), the strain responsible for causing a severe type of meningitis. Around 10% of adults carry N.meningitidis in the back of their nose and throat with no signs or symptoms. However, in some people it can invade the bloodstream and cause life-threatening bacterial infections including meningitis and blood poisoning, known as septicaemia. Meningitis occurs in people of all age groups but affects mainly infants, young children and the elderly. Meningococcal meningitis, which is a bacterial form of the disease and is responsible for 1,500 cases a year in the UK, can cause death in as little as four hours from the onset of symptoms. In a previous study, Prof Read's team found inoculating adults with unmodified Nlac resulted in it settling harmlessly in the nose of a third of recipients and prevented them carrying N.meningitidis at the same time. They hope genetically enhancing the bacteria with a ‘sticky’ surface protein from N.meningitidis will increase its ability to reside in the nose and generate a strong immune response that protects against the meningitis-causing bacteria. “We have already shown that placing Nlac in the nose of healthy adults caused no harm to the volunteers - the bacteria settled and it caused an immune response which prevented the acquisition of harmful bacteria in a number of patients,” said Prof Read, who is an honorary consultant at University Hospital Southampton NHS Foundation Trust and professor of infectious diseases at the University of Southampton. “By enhancing Nlac with a gene which we know helps bacteria stick to human body cells in larger numbers, we can increase the number of people who carry this friendly bacteria in their nose and thus block out N.meningitidis which can cause invasive meningococcal disease." He added: "If successful, this would offer the potential to prevent the spread of infection or the ability to rapidly control an outbreak as meningococcal meningitis cannot develop in the absence of N.meningitidis. “It would also mean we would then have a future therapy that we can adapt to combat other diseases caused by bacteria that breed in the nasal pathway such as pneumonia and ear disease.” The study is being run in collaboration with Public Health England and funded by the Medical Research Council. For more information on taking part in the study, email uhs.recruitmentCRF@nhs.net or call 023 8120 3853.

Researchers in Southampton and the US have created an app that can predict a child’s risk of asthma through six simple yes or no questions – and without the need for blood tests. Known as the Personalised Asthma Risk Score (PARS), it has the potential to help prevent the condition in some children by identifying those at moderate to high risk who could benefit from interventions. It was developed by clinicians at Cincinnati Children’s Hospital Medical Center in Ohio in partnership with colleagues at Southampton General Hospital and can be used by clinicians and families. They are asked to answer questions about eczema, wheezing, race, allergies and parental asthma history, with the tool available in chart form, online and as a smartphone or tablet app. It then gives a score between zero and 15 which categorises a child as having a low, moderate or high risk of developing asthma by the age of seven through a percentage calculation. The development has been unveiled in a study published online by The Journal of Allergy and Clinical Immunology which was funded by the National Institutes of Health in the US. PARS was found to be 11% more effective than the currently-used system, the Asthma Predictive Index (API), in identifying those who go on to develop the condition. In addition to using parental asthma, wheezing unrelated to colds and eczema as factors, as in the API, PARS also incorporates wheezing before the age of three, single and multiple allergy history and race in its calculation. The researchers analysed PARS against the data of 762 infants born between 2001 and 2003 in Cincinnati and Northern Kentucky and 1,456 born and enrolled between 1989 and 1990 from the David Hide Asthma and Allergy Research Centre on the Isle of Wight. “The ability to accurately predict which children will develop asthma continues to be a challenge for clinicians,” said Professor Hasan Arshad, a consultant in respiratory medicine at University Hospital Southampton NHS Foundation Trust and co-author of the study. “PARS has the potential to be an important innovation as it uses information routinely collected at assessment, does not require blood testing and has an improved ability to predict asthma development in children with fewer risk factors. “This is significant as wheeze is common in early childhood and identifying children at risk of asthma development is the first step in developing interventions to prevent childhood asthma.” Dr Ramesh Kurukulaaratchy, a consultant in respiratory medicine at UHS and part of the study team, added: “A common question that parents face is whether or not their wheezy child will go on to have asthma. This simple tool should help clinicians answer that question with much greater confidence than before. “Importantly, what we have shown in this study is that it can be used reliably for populations in the USA as well as the UK, suggesting it has wide applicability.” The PARS tool is available at pars.research.cchmc.org.

An NIHR funded ‘soft’ laser therapy pioneered in the UK by doctors in Southampton to help prevent side effects in patients receiving treatment for head and neck cancer could now be offered nationwide. The National Institute for Health and Care Excellence (NICE) has now recommended low level laser therapy (LLLT) as a way of healing tissue in the mouth and throat while a patient undergoes chemotherapy and radiotherapy. The technology was introduced by Dr Shanmugasundaram Ramkumar, a consultant clinical oncologist at Southampton General Hospital, who described it as a “potential breakthrough” ahead of an initial project in 2014. LLLT, which is also known as cold laser therapy, is a drug-free treatment that reduces pain and inflammation by stimulating damaged cells using a laser/LED light beam. It is more commonly used to treat musculoskeletal problems such as tendon, bone and nerve damage. Each therapy session takes around 15 to 20 minutes and is delivered three times a week for six weeks during radiotherapy and chemotherapy treatment. Around 80 to 100% of people with head and neck cancer treated with chemotherapy and radiotherapy suffer from severe soreness in the mouth and throat, dry mouth and swallowing problems as a result of their treatment. This complication, known as oral mucositis (OM), can also affect taste and speech and cause excessive secretions of saliva, which leads to nausea, vomiting and breathing difficulties. Currently, most patients are treated with a combination of pain killers and anti-sickness drugs and many require frequent hospital appointments or admissions to control their symptoms or provide nutritional support via nasal or stomach feeding tubes. “OM is a serious acute side effect for patients undergoing chemotherapy and radiotherapy for head and neck cancer and the standard treatment options on the NHS do not fully address the problems these patients suffer from,” explained Dr Ramkumar. “It causes very unpleasant complications such as painful dry mouth, swallowing difficulties and sickness but, in the worst cases, it can interrupt radiotherapy treatment and potentially increase the risk of regrowth of tumour cells.” He added: “I am delighted at NICE’s decision to recommend LLLT for patients with OM as it could now ensure better outcomes, improved quality of life and better treatment compliance for many more patients, as well as reduced medication and inpatient costs. “It gives us all great satisfaction to have led the introduction of this treatment option for OM from early-stage studies through to a major multicentre national trial and NICE recommendation and we look forward to the technology being adopted more widely for patients across the UK.” LLLT for OM is currently part of a wider £1.2 million study, led jointly by University Hospital Southampton NHS Foundation Trust (UHS) and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, which involves 380 patients at 10 sites across the UK and will run until 2019. The study is funded by the National Institute for Health Research (NIHR). In addition, UHS has established a treatment pathway and facilities to deliver LLLT as a routine treatment for radiotherapy and chemotherapy induced oral mucositis outside of clinical trials. The NICE guidance on LLLT for preventing or treating OM is available online.

Researchers at the University of Southampton have developed a new digital way of analysing X-ray images of lungs that could herald a breakthrough in diagnosing Chronic Obstructive Pulmonary Disease (COPD) and other lung diseases. The team devised a method for numerically describing the three-dimensional structure of the lung using topology – a mathematical technique to study complex shapes. By combining CT scans, high-performance computing and algorithms, they computed the three-dimensional numerical characteristics of the entire bronchial trees in 64 patients from four groups: healthy non-smokers, healthy smokers, patients with mild COPD and patients with moderate COPD. Understanding COPD COPD is a complex lung condition involving the airways (bronchi) and the lung tissue (alveoli) which results in a progressive loss of lung function. It affects more than 200 million people worldwide, who are often middle-aged or older adults and mainly those who have had significant exposure to cigarette smoke. It is the fourth leading cause of death worldwide. The team analysed the structure and size of the bronchial tree, the length and direction of its branches and the comparative changes in shape during deep inhalation and full exhalation. It was found that, typically, a larger more complex tree indicates better lung function and a smaller distorted tree indicates poorer lung function. The method accurately distinguished between the different groups of patients, the characteristics of their lung function and the different stages of their condition and was also able to identify characteristics not detectable to the naked eye. Changing practice The team hopes that repeating this method across a larger database of images and combining it with other data could lead to the real-world development of a valuable clinical tool for the early diagnosis and monitoring of conditions like COPD and asthma. This would provide a more accurate way of identifying the severity of an individual patient’s condition. “This method is a major advance in our ability to study the structural abnormalities of COPD, a complex disease that affects so many people and, sadly, results in significant morbidity and mortality” explained Professor of Medicine of the NIHR Southampton Biomedical Research Centre, Ratko Djukanović. “The image analysis method is the first to apply the field of topology in lung diseases, and one of only a handful of studies of this kind in medicine. Southampton is a great place for collaborative research of this kind, so we’re looking forward to developing this method for use in routine clinical care.” Lead researcher in this collaboration between mathematicians and clinical scientists and Professor in Mathematics, Jacek Brodzki said “Until now, the severity of lung conditions has been assessed by using a spirometer – a device which measures the force and amount of air a patient can exhale – and standard, two-dimensional CT images.” “The images are assessed by experienced specialists in examining and interpreting CT imagery, using relatively simple measures of lung density and bronchial wall thickness.” “Our study shows that this new method can expand on established techniques to give an accurate range of information about the lung function of individuals. This could eventually aid decisions about the treatment of patients with serious lung conditions.”

Clinical trials couldn’t take place without people volunteering to take part. All doctors depend on volunteers to better understand the safety and efficiency of new treatments – without them there could be almost no research. However, researchers often struggle to recruit volunteers and over recent years there has been a overall decline in the number of people taking part in clinical trials. Little is known about why people choose not to take part in research, even when approached by their doctor or nurse. Now, researchers from the NIHR Southampton Biomedical Research Centre have worked with almost 300 women to better understand the main barriers and reasons to not take part in pregnancy-related clinical trials. Identifying the barriers to taking part This latest study, published in the Social Science and Medicine journal, involved surveying 296 women who declined to participate in two Southampton pregnancy-related randomised controlled trials. Both trials required pregnant women to take daily vitamin D tablets throughout their pregnancy to see if it had a positive effect on their and their baby’s health. They also had to attend two extra ultrasound appointments and the baby received a scan just after birth to measure bone mineral density. One study also involved a phone call during pregnancy from the research nurse and a home visit one month after birth. Dr Strömmer and her team developed a questionnaire that asked women to give their reasons for not taking part in the trials. The list included ‘I don’t want to take pills during my pregnancy, I don’t want my baby or me to have a bone density scan, I am too busy, I don’t want to take part in any research’ as well as the opportunity to give free-text answers. “Previous research has shown that of 122 clinical trials, covering 18 clinical areas, only 31 per cent had reached their target number,” explained Dr Sofia Strömmer, a psychologist based at the MRC Lifecourse Epidemiology Unit in Southampton. “We want to understand the underlying reasons for people choosing not to participate in clinical trials – even relatively straightforward trials, such as our two vitamin D supplement studies – so we can look to address it. “Studies that don’t get enough volunteers might not record enough results to show a benefit or detriment to using a new therapy. Only when research is tested fully, and on a representative cross section of society, can we get the best possible results to inform us,” Dr Strömmer continued. A lack of trust Overall, the study concluded that there is a lack of trust in those who chose not to take part in the clinical trials. It identified that, despite what women were being told about the trial, those who declined to take part were worried that they or their baby could be at risk and felt that coming in for extra appointments wasn’t possible to fit into their lives. This is compared to those who agreed to take part and believed that the research would cause no harm and were able to fit the appointments into their lives. Breaking down barriers Following the study, Dr Strömmer has developed number of recommendations to encourage more people to participate in clinical trials and improve participation rates. Focussing on building trust, one recommendation is to set up a review-style platform for participants to provide feedback and rate their clinical trial experience. “We hope that feedback and reviews from people who have taken part in clinical trials will give potential participants an independent source of information, rather than hearing from a doctor, nurse or researcher. “Investing time in open and honest discussions around the risks and benefits of taking part in research, improving the visibility of research teams, and better advertising study safety and ethical conduct, are also key to building trust between potential participants and clinical teams. “We believe these recommendations could be implemented relatively easily into our pregnancy trials and protocols, and could make a real difference in empowering and enabling women to feel heard and supported – and therefore raise participation rates in clinical trials,” Dr Strömmer concluded.

Researchers in Southampton are studying the timeline of lung disease in a younger smoking population to better understand how and when it develops, with the hope to improve treatment and outcomes for future patients. Professor Tom Wilkinson, a respiratory specialist at University Hospital Southampton NHS Foundation Trust, and his team are looking for young adult smokers, aged 30-45, to study the long-term effects of breathing cigarette smoke. The study, which will monitor the lung function of the participants over three years, will increase the researchers’ understanding of when a person begins to develop smoking-related lung problems, including chronic obstructive pulmonary disease (COPD). Lung-related problems COPD is an umbrella term that covers several progressive lung diseases like emphysema, chronic bronchitis and non-reversible asthma. Over 1.2 million people in the UK currently live with COPD, which is most commonly diagnosed when a person is in their 60’s. The main cause is smoking, with the likelihood of developing COPD increasing the more frequently and the longer you smoke. People can also develop the condition following long-term exposure to harmful fumes or dust, or because of a rare genetic problem that means their lungs are more vulnerable to damage. There is currently no cure for COPD but treatment can help slow the progression of the condition and control symptoms. COPD develops slowly over a number of years but it is not currently known at what point the disease develops, as most people do not have any symptoms until significant lung damage has occurred. This study hopes to understand when COPD first begins so that treatments can be developed to prevent the disease and improve treatment and outcomes for future patients. Monitoring the participants The study, which is funded by the British Lung Foundation and taking place at the NIHR Southampton Biomedical Research Centre, will involve six monthly checkups to monitor each participant’s lung function over a period of three years. “Regular lung function testing will allow us to pin-point when function begins to decline – which can help identify the onset of COPD,” explains Professor Wilkinson. “We will follow up and track the lung function of all participants over time so we can understand at what point the changes occur and when the disease starts. “It’s about understanding and developing treatments that may be available to prevent the disease, as opposed to treating it after it is diagnosed.” If you are a smoker aged 30-45 and would like to be involved in the study, please contact 023 8120 4479 or email COPDResearch@uhs.nhs.uk for more information. Participants will also be offered advice and support on how to quit smoking.

In March we (the Wessex Public Involvement Network - #WessexPIN) organised an ‘Exploring the Impact of Public Involvement’ workshop. Caroline, the PPI Officer for Research, shares her thoughts on the day and their upcoming Tweetchat. The importance of the topic Involving patients and the public in the research process has become part of the research culture. As a PPI facilitator, there is no doubt in mind that PPI can make a positive difference to research. I would like to ensure the PPI activities I support have the maximum impact, but to do this I need to understand what works best, for whom, and in what circumstances. The workshop Our speakers had the huge challenge of introducing us to impact and giving us insights into how we can monitor impact. There was a general agreement that while impact means different things to different people, impact always means a change in the real world. We also heard how poor quality of PPI reporting weakens the PPI evidence base, and I am certainly interested in learning how researchers within my own organisation report on PPI. In the afternoon we had a workshop where we explored some questions which will be discussed in more detail as part of our Wessex PIN tweetchat (Mon 23rd April, 8pm #PPIimpact). We hope this event will widen the conversation to include more groups from across the UK, and maybe even further afield! Why not join us? Reflections The next steps will be to really focus on generating some meaningful actions to start demonstrating impact, both in my own organisations and in the activities of the Wessex PIN. I will certainly be using Sarah Thomas’ advice to have a clear purpose to our impact work and to recognise that we are unlikely to ‘measure’ impact but we can look for indicators and evidence. My first step will be to host a meeting with our organisations public contributors to discuss some of the learnings from the day and to generate some actions for the next 6 months. So, watch this space! The Wessex Public Involvement Network is a unique regional collaboration of NIHR organisations to share PPI resources and expertise. The workshop was kindly sponsored by the NIHR Southampton Biomedical Research Centre and Clinical Research Facility.

Looking at how tuberculosis (TB) bacteria interacts with our immune system, researchers in Southampton believe a more effective vaccine could be developed to better fight respiratory TB in adults. TB is a bacterial infection that’s spread by inhaling tiny droplets from the coughs or sneezes of an infected person. Typical symptoms include tiredness and fatigue, a high fever, weight loss and a persistent cough that usually brings up phlegm which may be bloody. TB is a serious condition – and is responsible for more deaths worldwide than any other infectious disease – but it can be cured if treated with the right antibiotics. To help protect against TB in the UK, the BCG vaccine is given on the NHS when a child or adult is thought to have an increased risk of coming into contact with TB. It contains a weakened strain of TB bacteria which help builds immunity and encourages the body to fight the disease if infected with it. However, the BCG vaccine offers limited effectiveness against respiratory TB, which is the most common form of the disease in adults. Discovering how we fight TB New research, carried out in Southampton and published in the prestigious journal Proceedings of the National Academy of Sciences, has revealed the specific part of Mycobacterium tuberculosis, the bacteria that causes the disease, that is recognised by our immune system. This new discovery greatly improves our understanding of how the immune system naturally fights TB and could be used to develop a more effective vaccine to prevent it. Better understanding our immune system “In the past, developing an effective vaccine has been a challenge as the TB-causing bacteria has developed a number of tricks to avoid being identified and eradicated by our immune system, allowing it to live safely within our bodies,” said Dr Salah Mansour, lead author for the study. “By understanding how the body recognises and naturally fights the TB-causing bacteria,a vaccine could be developed to fast-track this process and prevent the disease taking hold.” Looking at blood and infected lung tissue samples from TB patients allowed the team to show that specialised immune cells detect specific parts of the bacteria’s cell wall, known as mycolates. “We created a computer simulated model to show how the immune system uses mycolates to boost the production of specialised T cells, which are special defender cells found in our bodies that protect us from infection, to target and kill the TB-causing bacteria”, explained Dr Mansour. “The hope is that this new knowledge will boost TB vaccine development, helping to more effectively prevent this deadly disease and save many more lives.”

Researchers in Southampton are working with women across the region to raise awareness of the link between alcohol consumption and breast cancer and develop a new app to help reduce the risk of developing the disease. Breast cancer is the most common type of cancer in the UK, with one in eight women likely to be diagnosed at some point in their lifetime – but around 25% of cases could be prevented through simple lifestyle changes, including reducing the amount of alcohol people drink. Raising awareness Whilst it’s widely recognised that smoking can cause cancer, a recent study by the Southampton team showed that less than 20% of women were aware that drinking alcohol increases your risk of developing breast cancer. Researchers in Southampton are leading a pioneering project to raise awareness of the link between breast cancer and alcohol by incorporating alcohol awareness into routine breast clinics and mammogram screening appointments, and developing a web-based app. Dr Julia Sinclair and Dr Ellen Copson, both clinical academics working at University Hospital Southampton NHS Foundation Trust and at the University of Southampton, are leading the ‘Abreast of Health’ study which aims to give women the tools to record the amount of alcohol they consume and receive feedback. “Many women are unaware that the risk of developing breast cancer increases with every unit of alcohol consumed. We want to empower women to know what they are drinking and to allow them to make more informed choices,” said Dr Sinclair. “Also, strengths of alcohol and sizes of glasses have increased and lots of people say ‘I only have one glass of wine which is one unit, isn’t it’, but that’s often a large glass or about 250ml at 14% which will be three to four units of alcohol – so people are often drinking far more than they think,” she continued. A new app for breast cancer Previous research shows that people are more receptive to health advice and are more likely to make positive changes when they face significant health events – such as being investigated for a possible illness. So, when women come to a breast clinic appointment after they’ve found a lump (95% of whom will be given the all clear), it’s a really good time to provide advice and say ‘here are some things you could do to maximise your breast health for the future’. Knowing this, the Abreast of Health team are using breast screening and clinic appointments to understand what information is needed and what tools, such as an app, will help women to reduce their alcohol consumption. Dr Sinclair said: “We’re using these conversations to help develop a new app specifically designed for this audience as most apps available at the moment are designed for people at higher risk of drinking or who are alcohol-dependent. “We’d like to develop something that will work as a long-term motivational tool to reduce alcohol consumption and help reduce the risk of breast cancer amongst women.” Success so far The 18-month programme, which is being funded by the Medical Research Council, is already proving successful having recruited over 800 women so far – making it the best cancer recruiting study in England in 2017. For more information, please visit the study website.

Our critical care research team has been awarded £2.3 million for a new scheme providing pre-surgery exercise sessions for cancer patients in the local community, at gyms and cancer support centres, to improve their recovery after surgery. The WesFit study, run by Dr Sandy Jack in partnership with the Wessex Cancer Alliance, the Wessex Cancer Trust and the council, has been awarded £2.3 million to use exercise to improve patients’ wellbeing before, during and after cancer treatment. This follows research by the NIHR Southampton Biomedical Research Centre’s critical care team, led by Professor Mike Grocott, which has shown that a tailored exercise programme for cancer patients can improve physical fitness and outcomes from surgery. In their latest study, known as WesFit, the team is looking to roll out the scheme on a larger scale, expanding from a clinical setting into the wider community. Exercise as medicine Patients who are physically fitter recover from surgery better, and previous research by the team has found a six-week exercise programme based at the hospital has been extremely successful with small groups of cancer patients. So far, patients who completed this exercise training have returned to pre-treatment levels of fitness, or even improved and gained a healthier lifestyle. In comparison, those who didn’t complete training found that their fitness levels dropped after chemotherapy or remained relatively similar to pre-treatment. Moving into the community Now that it has been shown to have such beneficial effects, the team are looking to scale up the exercise programme to see if it can be introduced as an NHS service for cancer patients. WesFit is a unique partnership that will see the researchers work with gyms and cancer support centres to roll out a larger scale study across Wessex. The study aims to look not just at the effects of exercise on the physical health and fitness of the cancer patients, but also their quality of life during treatment and recovery. Participants will either have exercise training on a bike three times a week, psychological support, or a combination of both. The exercise programme will be delivered by personal trainers who are qualified to support cancer patients. If successful, the researchers hope that the programme could become a widely available NHS service to help cancer patients prepare for surgery by getting fit.

Pairing antibiotics with a drug that helps break down bacterial defences could make them more effective against hard-to-treat infections in patients with a rare lung disease. Primary ciliary dyskinesia, or PCD, is a rare genetic condition that results in ineffective cilia, tiny hair-like structures that keep the airways of our lungs clear from mucus and debris. This makes those with PCD prone to lung infections. New research, published in The European Respiratory Journal, has shown that the cells lining the lungs of PCD patients are not only more susceptible to infection, but has also revealed why these infections can be harder to treat with antibiotics. The bacteria Haemophilus influenzae, the most common cause of lung infections in PCD patients, surround themselves in a protective slime known as a biofilm. The researchers showed that combining antibiotics with a drug that disrupts biofilms, PYRRO-C3D, improved antibiotic performance in lung cells taken from PCD patients. Boosting antibiotic treatment Antibiotic resistance is a growing problem worldwide, resulting in ‘superbugs’ that can’t be treated with standard antibiotics. This antibiotic resistance threatens to turn the clock back to a time when infections associated with surgery, disease or childbirth were untreatable and deadly. One of the main ways to combat the rise of antibiotic resistant strains of bacteria is to minimise the use of antibiotics. This research suggests PYRRO-C3D could do exactly this, by allowing smaller but more effective doses of antibiotics to be given to PCD patients with a lung infection. Helping PCD patients The team used tissue samples from the lungs of 15 people with PCD and 19 people without. Cells from the samples were then cultured in a dish with Haemophilus influenzae bacteria. After three days, PCD patients’ cells had considerably more bacteria than those from participants without the condition. Their was also more biofilm present, meaning that antibiotics were less effective when added tothese cellsso when an antibiotic was added it was less able to kill the bacteria. However, adding the drug PYRRO-C3D broke down the biofilm, boosting the ability of the antibiotic to kill the bacteria. This raises the possibility that PCD patients might benefit from PYRRO-C3D use alongside antibiotics to better treat the lung infections they are particularly prone to.