How Manchester is leading the world in a new era of genomics

The world’s leading practitioners in genomics – a field of biology that will be key to delivering precision and personalised medicine – are now shaping a community of experts in Manchester. Award-winning health writer and Guardian contributor, Rachel Pugh, investigates the opportunities for local patients and international investors alike.

Intent on saving the life of seriously premature baby Hugo Corry-Wilson, medical staff working in the neonatal intensive care unit at Manchester’s St Mary Hospital faced the possibility that in giving the antibiotic gentamicin to halt a dangerous infection, they might also cause irreversible damage to his hearing.

Four years on, a ground-breaking bedside test developed in the city can identify which babies have the biomarker for gentamicin-induced deafness, so that a different antibiotic can be used in these cases within an hour.

The test on neonates will start to be used in November for six months at St Mary’s and at Liverpool Women’s Hospital, in the hope that it can be rolled out to other hospitals across the UK once all the approvals are in place.

Leading the gentamicin research, Professor Bill Newman, Professor of Translational Genomic Medicine in The Manchester Centre for Genomic Medicine at The University of Manchester, said: “Successful implementation of the gentamicin test would be a first in the integration of a rapid decision making, genetic-based diagnostic in the UK NHS.”

Hugo (born at 24 weeks and six days), was one of the lucky ones. The four-year-old – now happy, healthy and with normal hearing – was later discovered to be without the genetic predisposition for gentamicin damage. Other infants are not so fortunate.

Hugo’s mother Rachel has committed herself to giving something back to the unit at St Mary’s, participating in research and focus groups to speed the biomarker test into neonatal units.

“When you’re in the position we were in, time is of the essence,” Rachel explains. “The staff at the hospital saved my son’s life so many times and we’re incredibly grateful. The decision to treat him with gentamicin had to be made quickly to do so.

To have a test that could check for this sensitivity; to help find the right treatment for every baby so they could be treated quickly and easily without detrimental, life-long side effects, would be an immense step in reassuring parents who are already coping with so much.

This gentamicin biomarker test is one of a battery of ground-breaking projects in the genomics and life sciences sector in Manchester. In layperson’s terms, genomics is helping us to understand and identify biomarkers in our blood. These are characteristics that can be objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological responses to a therapeutic intervention. The goal is precision medicine to meet the individual needs of the patient and, ultimately, personalised care.

The project and others are supported by the Diagnostics and Technology Accelerator (DiTA) created by the Manchester University NHS Foundation Trust (MFT) to power evidence generation for commercial biomarker and MedTech research.

Manchester is already a UK flagship for life sciences. The sector contributes more than £10.8 billion a year to the UK economy and was identified in the Northern Powerhouse Independent Economic Review as one of the North of England’s key strengths and opportunities.

Health Innovation is also identified as one of Greater Manchester’s strengths and opportunities in the Greater Manchester Local industrial Strategy, which states the region’s intention to “lead the UK and the world in the roll-out of innovative new health and care solutions”.

Biomarker research in Manchester is driven by a concentration of world-leading researchers who work together to turn ideas into solutions. The Stoller Biomarker Discovery Centre carries out research to identify biomarkers and the Manchester Molecular Pathology Innovation Centre (MMPathIC) translates biomarkers into clinically usable tests to speed up diagnosis and identifying the best treatment.

Both of these centres operate under the umbrella of the Manchester Precision Medicine Institute and work with other groups including the Manchester Cancer Research Centre and the Cancer Research UK Manchester Institute.

Professor Tony Whetton, Director of the Stoller Biomarker Discovery Centre and Manchester Precision Medicine Institute at The University of Manchester, is a leader in biomarker research through his long-term studies of leukaemia.

He said: “Currently, many diseases are treated with a ‘trial and error’ approach, where doctors prescribe a drug which will be effective in some patients, but not in others. Patients who do not respond (or stop responding) to the first drug tried will be moved from drug to drug, until one is found which works for that individual patient.

“The Stoller Biomarker Discovery Centre aims to find protein markers in the blood that could be used to stop patients being given treatments which won’t improve their condition. These markers will be developed to ensure doctors can prescribe the right treatment for the right patient as early as possible.”

The centre currently focuses on two main research strands – inflammatory disease (including arthritis) and cancer, which benefits from the unparalleled opportunity for translational research offered by The Christie, one of Europe’s leading cancer centres.

Among the many research programmes underway in Manchester is one to look at markers of risk of ovarian cancer in women who initially go undiagnosed but later develop the disease. An algorithm is being developed to measure the risk of ovarian cancer in the population. Many women now die because their disease is too far advanced by the time they develop symptoms.

Key to the success of the Stoller Centre is the partnership with MMPathiIC, which takes groundbreaking research findings and puts them into clinical use, so that patients can benefit from innovation as swiftly as possible.

One test being trialed at Manchester Royal Infirmary (MRI) and Wythenshawe Hospital is to determine whether people are taking their medication to lower their blood pressure. Patients frequently report they are taking it but sometimes fail to do so, risking heart attack. Researchers estimate that this biomarker test could reduce the number of heart attacks by 50% in 10 years’ time, saving the NHS £250m a year.

MRI is also trialing a simple blood test which can save both suffering and money by predicting whether a specific rheumatoid arthritis patient will respond to inexpensive but effective methotrexate treatment, rather than going straight onto expensive biologics, which are manufactured in a living system, such as a microorganism, plant or animal cells. Methotrexate is produced more cheaply through chemical synthesis. Other research is looking for biomarkers for heart failure in women being treated for breast cancer with anthracycline, a class of drug which is used in cancer chemotherapy. While the drug is very effective, it can cause heart damage in some patients.

Director of MMPathiIC, Professor Tony Freemont, believes a unique set of circumstances have created the perfect environment in Greater Manchester for turning ‘blue sky thinking’ into biotech advances.

• A single Greater Manchester health and social care system created through the devolution of its £6 billion annual budget, which promotes integrated solutions and good governance.
• The existence of Health Innovation Manchester, (HInM) which accelerates innovation into practice and at scale, by creating close and intricate collaborations between the NHS, academia and industry
• A history of innovation including the only fully e-enabled NHS trust in England and global digital exemplar hospital (Salford Royal NHS Trust)
• An infrastructure to carry out real-time, digitally-enhanced, randomised controlled trials established by the pioneering Salford Lung Study.

“We are in an amazing position here in Manchester – which is not available to the NHS – to run tests on the basis of savings in 10 years’ time,” Professor Freemont explains. “To be able to do that is so exciting. Being able to shift relatively small amounts of money round the system, knowing that you can help people in the future, means that you do not have to worry about the current politics.”