The Graham Hughes Lupus Research Unit
The Lupus Research Unit, set up in 1985 with private grant support, was the result of a move to St Thomas’ Hospital by Professor Graham Hughes and his colleagues, in order to initiate a research laboratory specialising in connective tissue diseases, specifically lupus. The ‘dream’ behind the formation of the lupus unit was to provide a truly specialised international centre where research (both laboratory and clinical) was regarded as integral to management.
Research in our unit has been generously supported by The St Thomas Lupus Trust and more recently the Hughes Syndrome Foundation. Research at the Lupus Unit is based around a translational programme of research with the aim of understanding the mechanisms of immunologically mediated thrombosis, vascular damage, pregnancy loss and late pregnancy complications.
Scientific achievements of the unit include the European League Against Rheumatism (EULAR) prize in 1990 (awarded to Dr Munther Khamashta) and in 1993 the International League Against Rheumatism (ILAR) prize awarded to Professor Hughes and his team for their research on clinical and basic aspects of the antiphospholipid syndrome.
The unit’s strength comes from our international links. During the past 20 years we have had more than 250 international research fellows joining our unit. An average of 10 overseas research fellows (mostly Rheumatology, Haematology and Internal Medicine trainees) join our Unit annually. Due to the multi-disciplinary programme of research into connective tissue diseases, our unit attracts both national and international students into PhD studentships and clinical research fellowships.
This year is the 25th anniversary of the annual very popular post-graduate course “Ten Topics in Rheumatology” which attracts more than 200 delegates from both UK and abroad and which is organised by our unit. Furthermore, our unit over the years has organised five international research meetings and has become the centre for standardisation of international antiphospholipid antibody measurements.
From 1985 the Lupus Research was an independent Unit managed initially by the Rayne Institute Committee (1985-1995) and subsequently by the Special Trustees of St Thomas’ Hospital (1996-2003). Management of the Rayne Institute was transferred to King’s College School of Medicine in 2003. In 2010 the Lupus Research Unit was allocated to the Division of Women’s Health, King’s College London School of Medicine, under Professor Lucilla Poston as Head of Division and Dr Munther A Khamashta, Head of Lupus Research. Following this move, the Lupus Research Unit changed its name to The Graham Hughes Lupus Research Unit (Division of Women’s Health) in recognition of its founder Prof Graham Hughes.
GSTT employs one of only four Obstetric Physicians in the UK (Nelson-Piercy) and her research interests include particularly venous thromboembolic disease and the use of low molecular weight heparin in pregnancy, the treatment of hyperemesis gravidarum, the management of systemic lupus erythematosus and antiphospholipid syndrome in pregnancy and obstetric cholestasis.
There is also a tertiary level service for pregnant women with cardiac disease and renal disease. She has convened an RCOG Study Group on renal disease in pregnancy, developed evidence based peer review guidelines for the RCOG green top guideline on thromboprophylaxis in pregnancy. Nelson-Piercy was a member of the Centre for Maternal and Child Enquiries (CMACE) Obesity Consensus Standards Group. She is also the Royal College of Physicians representative and central assessor for maternal deaths due to heart disease for the Confidential Enquiry into Maternal Deaths, UK and writes the chapter on cardiac deaths in pregnancy for the CMACE Saving Mothers Lives Report. Nelson-Piercy chairs the Steering Committee of the UK Obstetric Surveillance System (UKOSS), researching rare disorders in pregnancy.
Two large multicentre studies researching obstetric cholestais have been coordinated by MFRU (Shennan, Nelson-Piercy, Tribe, Poston) on ‘Markers for the identification of Obstetric Cholestasis’ and ‘Prevalence and Pathophysiology of Obstetric Cholestasis’. This resulted in changes to RCOG guidelines, several high impact peer reviewed papers and a patent application for a biomarker test. The MFRU (Chappell and Briley) is now recruiting to the national multicentre RCT (Pregnancy Intervention Trial in Cholestasis (PITCH) study. In collaboration with two other UK academic centres, an application for funding to the HTA Clinical Evaluation and Trials Board has been shortlisted for a fully powered intervention trial in obstetric cholestasis to follow on from the successful pilot study.
- New oral anticoagulants for the treatment of patients with thrombotic antiphospholipid syndrome: a prospective pilot randomised controlled trial of warfarin versus dabigatran or rivaroxaban. Arthritis Research Uk. 2010, submitted.
- Comparison of practices regarding lupus pregnancy between a dedicated lupus pregnancy clinic and a general lupus clinic, and establishment of pregnancy clinic for Rheumatic Diseases at the University Hospital in Heraklion Crete. EULAR fellowship. July 2010
- Rituximab in Lupus Nephritis. This is a large multi-centre study in collaboration with Spanish colleagues (Dr. Ramos-Casals) to evaluate the outcome of patients with Lupus Nephritis treated with Rituximab. This will be the largest study in the world literature with more than 140 patients. Recruitment is now completed and the data is being analysed
- Systemic LUpus Erythematosus Cost of Care In Europe Study (LUCIE). GSK sponsored project. This is a large European (UK, Germany, France, Italy and Spain) study started in September 2010 of which Dr. Khamashta is the lead investigator.
- Systemic Lupus International Collaborating Clinics (SLICC). Through SLICC we have established an international registry of newly diagnosed SLE patients in order to provide a large diverse cohort of patients for a prospective, longitudinal study to address the issue of atherosclerosis in SLE. So far 1650 patients have been recruited of which 50 patients are from the Lupus Research Unit.
- MORMED: Multilingual OrganiK Information Management in the Medical Domain – European Commission No: CIP-ICT-PSP 250534. Amount awarded €1.111.000. From 2010-2012. MORMED proposes a multilingual community platform combining social software applications with automatic translation capabilities. It will be piloted upon the community interested in lupus involving researchers, medical doctors, general practioners, patients and patients support groups.
- Long Term Outcome of children born to SLE patients - Lupus Outcome Research Fund. Amount awarded £95,000. From 2006-2010. To date 100 mothers with lupus have been recruited into this study from St Thomas Hospital.
- Mitochondrial dysfunction and oxidative stress in atherothrombosis associated with systemic autoimmune diseases. Genomic and proteomic analysis. FIS Spanish Ministry of Health PS09/01809. Amount awarded €103.000. From 2009-2011.
- Characterisation of monocyte population in patients with autoimmune disorders (Postdoctoral Research Associate) - Louise Gergel Foundation. Amount awarded £140.000. From 2009-2011.
- Fluvastatin and other antioxidant drugs in the prevention of thrombosis and atherosclerosis in antiphospholipid syndrome: analysis of cellular and molecular mechanisms – Junta de Andalucia. Proyecto de Excelencia P08-CV1-04234. Amount awarded €252.924. From 2008-2012.
- Genetic alterations of innate immunity and prothrombotic factors as predictors of subclinical atherosclerosis and cardiovascular disease in patients with primary Sjogren’s syndrome – Spanish Ministry of Research and Development No: PI080103. Amount awarded €145.010,00. From 2009-2011.
- Immunogenetic susceptibility and metabolic alterations as etiopathogenic factors of chronic pain in patients with Sjogren’s syndrome in comparison with primary health care patients – Fundacio Le Marato, Barcelona, Spain. Amount awarded £120,000. From 2007-2010.
- Seronegative Antiphospholipid Syndrome project. This is a cohort study of case series of patients with Antiphospholipid Syndrome with or without antiphospholipid antibodies (sero-negative APS) describing the clinical manifestations, course of the disease and prognosis of both conditions. Furthermore, serum and plasma samples are being collected for a detailed laboratory testing, looking for novel new assays for the diagnosis of this Syndrome.