News

Car travel contributes to air pollution, a major cause of heart and lung diseases including asthma attacks. Beyond this, it limits children's opportunities for physical activity, hindering their development and mental health, and increasing their risk of obesity and chronic illnesses.

Despite UK guidelines recommending a daily average of 60 minutes of moderate-to-vigorous physical activity for school-aged children and adolescents, less than half (45%) of children aged 5-16 met these levels in 2021. One in three children aged 10-11 in the UK are overweight or obese.

In April 2019, London introduced the ULEZ to help improve air quality by reducing the number of vehicles on the road that do not meet emissions standards. According to Transport for London, the central London ULEZ reduced harmful nitrogen oxides by 35% and particulate matter by 15% in central London within the first 10 months of its introduction.

In a study published today in the International Journal of Behavioral Nutrition and Physical Activity, a team led by researchers at the University of Cambridge and Queen Mary University of London examined the impact of the ULEZ on how children travelled to school. The research was part of the CHILL study (Children’s Health in London and Luton).

The study examined data from almost 2,000 children aged six to nine years attending 84 primary schools in London and the control area, Luton. 44 schools were located with catchment areas within or bordering London’s ULEZ, and these were compared to a similar number in Luton and Dunstable (acting as a comparison group). The inclusion of the comparison site enabled the researchers to draw more robust conclusions and increased confidence in attributing the observed changes to the introduction of the ULEZ.

The researchers collected data from the period June 2018 to April 2019, prior to ULEZ implementation, and again in the period June 2019 to March 2020, the year after implementation of the ULEZ but prior to COVID-19-related school closures.

Among those children in London who travelled by car prior to the introduction of the ULEZ, four in 10 (42%) switched to active modes, while one in 20 (5%) switched from active to inactive modes.

In contrast, only two in ten (20%) children in Luton swapped from car travel to active modes, while a similar number (21%) switched from active to car travel. This means that children in London within the ULEZ were 3.6 times as likely to shift from travelling by car to active travel modes compared to those children in Luton and far less likely (0.11 times) to switch to inactive modes.

The impact of the ULEZ on switching to active travel modes was strongest for those children living more than half a mile (0.78km) from school.  This was probably because many children who live closer to school already walked or cycled to school prior to the ULEZ and therefore there was more potential for change in those living further away from their school.

The study’s first author, Dr Christina Xiao from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, said: “The introduction of the ULEZ was associated with positive changes in how children travelled to school, with a much larger number of children moving from inactive to active modes of transport in London than in Luton.

“Given children's heightened vulnerability to air pollution and the critical role of physical activity for their health and development, financial disincentives for car use could encourage healthier travel habits among this young population, even if they do not necessarily target them.”

Joint senior author Dr Jenna Panter from the MRC Epidemiology Unit, University of Cambridge, said: “The previous government was committed to increasing the share of children walking to school by 2025 and we hope the new government will follow suit. Changing the way children travel to school can have significant effects on their levels of physical activity at the same time as bringing other co-benefits like improving congestion and air quality, as about a quarter of car trips during peak morning hours in London are made for school drop-offs.”

After ULEZ was introduced in Central London, the total number of vehicles on the roads fell by 9%, and by one-third (34%) for vehicles that failed to meet the required exhaust emission standards, with no clear evidence of traffic moving instead to nearby areas.

Joint senior author Professor Chris Griffiths from the Wolfson Institute of Population Health, Queen Mary University of London, said: “Establishing healthy habits early is critical to healthy adulthood and the prevention of disabling long term illness, especially obesity and the crippling diseases associated with it. The robust design of our study, with Luton as a comparator area, strongly suggests the ULEZ is driving this switch to active travel. This is evidence that Clean Air Zone intervention programmes aimed at reducing air pollution have the potential to also improve overall public health by addressing key factors that contribute to illness.”

Due to the introduction of COVID-19 restrictions in late March 2020, the study was paused in 2020/2021 and results are only reported for the first year of follow-up. However, as both London and Luton, the study areas, were similarly affected, the researchers believe this disruption is unlikely to have affected the results. The study has restarted following up with the children to examine the longer-term impacts of the ULEZ. This will identify if the changes they observed in the year following the introduction of the ULEZ persist.

The study was conducted in collaboration with Queen Mary University of London, Imperial College, University of Bedfordshire, University of Edinburgh, University of Oxford and University of Southern California and funded by the National Institute for Health and Care Research Public Health Research (NIHR), NIHR Applied Research Collaboration North Thames, and Cambridge Trust. 

Reference
Xiao, C et al. Children’s Health in London and Luton (CHILL) cohort: A 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children’s travel to school. IJBNPA; 5 Sept 2024; DOI: 10.1186/s12966-024-01621-7

Four in ten children in Central London who travelled to school by car switched to more active modes of transport, such as walking, cycling, or public transport, following the introduction of the Ultra-Low Emission Zone (ULEZ), according to new research. In the comparison area with no ULEZ, Luton, only two in ten children made this switch over the same period.

Changing the way children travel to school can have significant effects on their levels of physical activity at the same time as bringing other co-benefits like improving congestion and air qualityJenna PanterMatt BrownULEZ signs (cropped)

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YesLicence type: Attribution

The research also suggests that people who are taking lipid-lowering drugs such as statins to lower their cholesterol levels should remain on them, even if their cholesterol levels have fallen, as stopping treatment could increase their risk of atherosclerosis.

Atherosclerosis is one of the major causes of heart and circulatory disease. It involves the hardening and narrowing of the vessels that carry blood to and from the heart. It is caused by the build-up of abnormal material called plaques – collections of fat, cholesterol, calcium and other substances circulating in the blood.

Atherosclerosis is largely considered a disease of the elderly and so most screening, prevention and intervention programmes primarily target those with high cholesterol levels, generally after the age of 50.

But in a study published today in Nature, a team led by scientists at the University of Cambridge shows that high cholesterol levels at a younger age – particularly if those levels fluctuate – can be even more damaging than high cholesterol levels that only begin in later life.

To study the mechanisms that underlie atherosclerosis, scientists often use animal modes, such as mice. The mice will typically be fed a high fat diet for several weeks as adults to see how this leads to the build up of the plaques characteristic of the condition.

Professor Ziad Mallat and colleagues at the Victor Phillip Dahdaleh Heart and Lung Research Institute at the University of Cambridge decided to explore a different approach – to see whether giving mice the same amount of high fat food but spread over their lifetime changed their atherosclerosis risk.

“When I asked my group and a number of people who are experts in atherosclerosis, no one could tell me what the result would be,” said Professor Mallat, a British Heart Foundation (BHF) Professor of Cardiovascular Medicine.

“Some people thought it would make no difference, others thought it would change the risk. In fact, what we found was that an intermittent high fat diet starting while the mice were still young – one week on, a few weeks off, another week on, and so on – was the worst option in terms of atherosclerosis risk.”

Armed with this information, his team turned to the Cardiovascular Risk in Young Finns Study, one of the largest follow-up studies into cardiovascular risk from childhood to adulthood. Participants recruited in the 1980s returned for follow-up over the subsequent decades, and more than 2,000 of them had received ultrasound scans of their carotid arteries when they were aged around 30 years and again at around 50 years.

Analysing the data, the team found that those participants who had been exposed to high cholesterol levels as children tended to have the biggest build of plaques, confirming the findings in mice.

“What this means is that we shouldn’t leave it until later in life before we start to look at our cholesterol levels,” Professor Mallat said. “Atherosclerosis can potentially be prevented by lowering cholesterol levels, but we clearly need to start thinking about this much earlier on in life than we previously thought.”

The mouse studies showed that fluctuating levels of cholesterol appeared to cause the most damage. Professor Mallat says this could explain why some people who are on statins but do not take them regularly remain at an increased risk of heart attack.

“If you stop and start your statin treatment, your body is being exposed to a yo-yo of cholesterol, which it doesn’t like, and it seems this interferes with your body’s ability to prevent the build-up of plaques,” he added.

The reason why this is so damaging may come down to the effect that cholesterol has on specific types of immune cells known as ‘resident arterial macrophages’. These reside in your arteries, helping them to clear damaged cells and fatty molecules known as lipids, which include cholesterol, and stopping the build-up of plaques.

When the team examined these macrophages in their mouse models, they found that high cholesterol levels – and in particular, fluctuating cholesterol levels – changed them physically and altered the activity of their genes. This meant that the cells were no longer protective, but were instead detrimental, accelerating atherosclerosis.

The research was funded by the British Heart Foundation.

Reference
Takaoka, M et al. Early intermittent hyperlipidaemia alters tissue macrophages to boost atherosclerosis. Nature; 4 Sept 2024; DOI: 10.1038/s41586-024-07993-x

Our risk of developing atherosclerosis – ‘furring’ of the arteries – can begin much earlier in life than was previously thought, highlighting the need to keep cholesterol levels low even when we are young, new research has discovered.

Atherosclerosis can potentially be prevented by lowering cholesterol levels, but we clearly need to start thinking about this much earlier on in lifeZiad MallatSolStock (Getty Images)Teenagers eating pizza by the river

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Yes

These are among the conclusions of Time to Care: findings from a nationally representative survey of experiences at the end of life in England and Wales, a new report funded by end-of-life charity Marie Curie and produced by King’s College London’s Cicely Saunders Institute, Hull York Medical School at University of Hull, and the University of Cambridge.

Time to Care aims to describe the outcomes, experiences, and use of care services by people affected by dying, death, and bereavement in England and Wales. It is the final report from the Marie Curie Better End of life programme.

The report found one in five dying people had no contact with their GP in the last three months of life.

Half of people surveyed (49%) said their dying loved one visited A&E at least once in their final three months of life, and one in eight people who died in hospital had been there less than 24 hours. 

Half of respondents (49%) in the study were also unhappy with at least one aspect of the care the person who died received and of those one in eight people made a formal complaint. Fewer than half of respondents said they had a key contact person to co-ordinate their care. This meant responsibility for care fell on informal carers (family and friends), who often felt unprepared and unsupported.

Professor Stephen Barclay, from the Department of Public Health & Primary Care at the University of Cambridge, a researcher on the project and a practicing GP, said: “GPs, Community Nurses and the wider Primary Care Team have a central and often under-recognised role in the care of people approaching and at the end of their lives. But they are under enormous pressure with increasing workloads, diminishing workforces and inadequate investment over recent years.

“Increasing numbers of people have been dying in the community during and following the COVID-19 pandemic, at home or in care homes. This important survey, undertaken at a time when the NHS was beginning to recover from the worst of the pandemic, reveals how clinical teams in all settings are struggling to meet the needs of this vulnerable patient group.

“The out-of-hours period, which comprises two-thirds of the week, is particularly difficult for patients and their families. Across the UK, GPs and Community Nurses want to provide excellent palliative and end of life care, but the necessary ‘time to care’ is currently often squeezed. The new UK Government’s focus on care close to home is welcome. This report highlights the need for a radical repurposing of NHS funding to resource primary care for that ambition to be achieved.”

The research report is based on a survey sent by the Office for National Statistics in 2023 to a nationally representative sample of people who had registered the death of a family member in the prior six to 10 months. Only non-sudden causes of death were included. Responses were received from 1179 people, making this the largest nationally representative post-bereavement survey in England and Wales for a decade.

Professor Katherine Sleeman, from King’s College London and lead researcher on the project, said:  “This study reveals patchy and inconsistent provision of care for people approaching the end of life. While there were examples of excellent care - including in the community, in care homes, and in hospitals - the overall picture is of services that are overstretched, and of health and care staff lacking the time they need to consistently provide high-quality care. This means that dying people miss out on treatment and care for their symptoms, and families are left feeling unprepared and unsupported which has lasting emotional repercussions into bereavement.

The researchers say the findings are concerning, considering the ageing population and the expected increase in palliative care needs across the UK. By 2048, there will be an additional 147,000 people in the UK who need palliative care before they die, an increase of 25%.

“Without a corresponding increase in capacity of primary and community care teams to support these people as they approach the end of life, the quality of care is likely to further suffer,” said Professor Sleeman. “It has never been more important to ensure high-quality palliative care for all who need it.”

Annette Weatherley, Marie Curie Chief Nursing Officer, added: “The findings are shocking.  Too many people are dying in avoidable pain, struggling with breathlessness and other debilitating symptoms because of the difficulties they face accessing the end-of-life care they need from overstretched GPs and other health and care workers.

“Without urgent action, gaps in access to palliative and end of life care will only grow.

“It is a critical time to improve palliative and end of life care. People at the end of life should be able to have the very best possible care. There is only one chance to get it right at the end of life.  Yet, as the evidence shows, too many people are being failed by a system faced with extreme financial and workforce pressures.  It’s time for Governments to step up and fix care of the dying.”

Professor Stephen Barclay is a fellow at Emmmanuel College, Cambridge.

Adapted from a press release by Marie Curie

One in three dying people in England and Wales was severely or overwhelmingly affected by pain in the last week of life, with bereaved people reporting how difficult it was to get joined-up support from health and care professionals at home.

This report highlights the need for a radical repurposing of NHS funding to resource primary care for that ambition to be achievedStephen BarclayAlexander GreyExperimental coloured image of two hands touching

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YesLicence type: Public Domain

A cancer drug that unlocks the anti-inflammatory power of the immune system could help to reduce the risk of future heart attacks, according to research part-funded by the British Heart Foundation. By repurposing an existing drug, researchers hope it could soon become part of routine treatment for patients after a heart attack.

The findings will be presented at the European Society of Cardiology Congress in London by Dr Rouchelle Sriranjan, NIHR Clinical Lecturer in Cardiology at the University of Cambridge.

High levels of inflammation in blood vessels are linked to an increased risk of heart disease and heart attacks. After a heart attack, the body’s immune response can aggravate existing inflammation, causing more harm and increasing risk even further. However, NICE guidelines don’t currently recommend the use of any anti-inflammatory drugs to reduce future risk.

Now, a team of researchers, led by Dr Joseph Cheriyan from Cambridge University Hospitals NHS Foundation Trust, have found that low doses of an anti-inflammatory drug called aldesleukin, injected under the skin of patients after a heart attack, significantly reduces inflammation in arteries.

The researchers are currently following up patients to investigate the longer-term impact of this fall in inflammation. To date, in the two and a half years after their treatment, there have been no major adverse cardiac events in the group that received aldesleukin, compared to seven in the group that received the placebo.

Professor Ziad Mallat, BHF Professor of Cardiovascular Medicine at the University of Cambridge who developed the trial, said: “We associate inflammation with healing – an inbuilt response that protects us from infection and injury. But it’s now clear that inflammation is a culprit in many cardiovascular conditions.

“Early signs from our ongoing trial suggest that people treated with aldesleukin may have better long-term outcomes, including fewer heart attacks. If these findings are repeated in a larger trial, we’re hopeful that aldesleukin could become part of routine care after a heart attack within five to 10 years.”

Aldesleukin is already used to treat kidney cancer, as high doses stimulate the immune system to attack cancer cells. The Cambridge team previously found that doses one thousand times lower than those used in cancer treatment increased the number of regulatory T cells – a type of anti-inflammatory white blood cell – in patients’ blood compared to a placebo.

In the current trial at Addenbrooke's and Royal Papworth hospitals in Cambridge, 60 patients admitted to hospital with a heart attack or unstable angina received either low dose aldesleukin or placebo. Patients received an injection once a day for the first five days, then once per week over the next seven weeks. Neither the participants nor their doctors knew whether they had received the drug or placebo.

At the end of treatment, Positron Emission Tomography (PET) scans showed that inflammation in the artery involved in patients’ heart attack or angina was significantly lower in the group treated with aldesleukin, compared to those who received the placebo.

The anti-inflammatory effect of aldesleukin appeared even more striking in the most inflamed arteries, leading to a larger reduction in inflammation levels in these vessels and a bigger difference between the two groups by the end of the study.

Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and consultant cardiologist said: “Thanks to research, we have an array of effective treatments to help people avoid heart attacks and strokes and save lives. But, even after successful heart attack treatment, unwanted inflammation in the coronary arteries can remain, which can lead to life-threatening complications.

“A treatment to reduce inflammation after a heart attack could be a game-changer. It would help doctors to interrupt the dangerous feedback loop that exacerbates inflammation and drives up risk. This research is an important step towards that treatment becoming a reality.”

The study was predominantly funded by the Medical Research Council, with significant support from the BHF and National Institute for Health and Care Research Cambridge Biomedical Research Centre (NIHR-BRC).

Originally published by the British Heart Foundation. 

Repurposed cancer drug helps to calm inflammation in arteries.

Sebastian Kaulitzki/Science Photo Library via Getty ImagesIllustration of human heart

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Yes

Plans for Cambridge Children’s Hospital can move ahead following the news that the Outline Business Case for the project has been signed off by the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care. The project has been given the green light to begin the detailed process of appointing a contractor, to build the ground-breaking new facility in 2026.

The ministerial backing means that the Project’s Outline Business Case, the second stage of the business case process, has now been fully approved by the Department of Health and Social Care, NHS England and HM Treasury. It was approved in principle in September 2023, subject to a capital affordability review by NHS England and the Department for Health and Social Care’s Joint Investment Committee. That review took place in April 2024 and resulted in a recommendation to Ministers to endorse the decision.

In a show of further confidence in its plans, the Outline Business Case was signed off by the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care in August 2024. This approval recognises that the hospital will meet the needs of patients and staff across the East of England and that the project has the appropriate funding streams in place, to deliver the specialist children’s facility.

The hospital is being co-designed with the help of children, young people, families and healthcare professionals across the region to ensure the new hospital will meet the needs of patients, families and staff.

Dr Rob Heuschkel, Clinical Lead for Physical Health at Cambridge Children’s Hospital said:

“We are absolutely delighted that we can now move forward to enter contracts with a construction partner, so we can finally start to see work happening on site.

“A huge amount of work has gone into finalising the designs and getting us to this point, and I want to thank our healthcare staff, young people and their families from across the region who have been contributing valuable feedback and helping us shape our plans, right from the very start.

“The East of England is the only region in the UK without a specialist children’s hospital, and we look forward to changing that very soon.”

The approval comes as a programme of groundworks preparing for the build was completed in July, and new access roads have now been installed where the new five-storey, 35,000sqm hospital will be located, opposite the Rosie Maternity Hospital, on Robinson Way and Dame Mary Archer Way.

In the coming weeks, people will be able to see hoardings installed around the site of Cambridge Children’s Hospital, the first hospital truly designed to bring mental and physical health care together for children and young people.

Dr Isobel Heyman, Clinical Lead for Mental Health at Cambridge Children’s Hospital said:

“This really is fantastic news and an exciting moment in our journey to build a truly integrated children’s hospital for the East of England.

“The current model of mental health care is inadequate. Many children with physical ill-health also have significant mental health needs, and vice versa.

“Cambridge Children’s Hospital offers a solution. By delivering holistic care for children, young people, and their families, this not only reduces stigma, but the revolutionary model of care really does act as a blueprint for the NHS and the future of healthcare.”

The fundraising Campaign for Cambridge Children’s Hospital has now passed the halfway mark and the project remains on track to meet its £100m philanthropy target.

The hospital will also house a University of Cambridge research institute, focused on preventing childhood illness and early intervention across mental and physical healthcare.

Professor David Rowitch, Clinical Lead for Research at Cambridge Children’s Hospital said:

“By bringing clinicians and patients together with University of Cambridge investigators and industry partners, we aim to shift the medicine paradigm from traditional reactive approaches, to one based on early detection, precision intervention and disease prevention.

“Co-locating research efforts inside Cambridge Children’s Hospital will mean we can detect disease early or even prevent it altogether, personalise health care and prescribe treatments more appropriate for children and their individual health needs.

“We’ll also be able to foster collaborations to advance the power of advanced diagnostics, digital and telehealth technology to support healthcare professions from a distance, to deliver care closer to people’s homes, wherever they live in our region.”

The Cambridge Children’s Hospital project is a partnership between Cambridge University Hospitals NHS Foundation Trust (CUH), Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), and the University of Cambridge.

Work now continues on the final stage of the business case for Cambridge Children’s Hospital – the Full Business Case.

Major milestone for first specialist children’s hospital in the East of England.

A montage of concept designs for Cambridge Children's Hospital Cambridge University Health PartnersArtist's impression of Cambridge Children's Hospital

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Yes

The findings are published today in The Lancet Diabetes and Endocrinology.

Global meat production has increased rapidly in recent decades and meat consumption exceeds dietary guidelines in many countries.  Earlier research indicated that higher intakes of processed meat and unprocessed red meat are associated with an elevated risk of type 2 diabetes, but the results have been variable and not conclusive.

Poultry such as chicken, turkey, or duck is often considered to be an alternative to processed meat or unprocessed red meat, but fewer studies have examined the association between poultry consumption and type 2 diabetes.

To determine the association between consumption of processed meat, unprocessed red meat and poultry and type 2 diabetes, a team led by researchers at the University of Cambridge used the global InterConnect project to analyse data from 31 study cohorts in 20 countries. Their extensive analysis took into account factors such as age, gender, health-related behaviours, energy intake and body mass index.

The researchers found that the habitual consumption of 50 grams of processed meat a day - equivalent to 2 slices of ham - is associated with a 15% higher risk of developing type 2 diabetes in the next 10 years. The consumption of 100 grams of unprocessed red meat a day - equivalent to a small steak - was associated with a 10% higher risk of type 2 diabetes.

Habitual consumption of 100 grams of poultry a day was associated with an 8% higher risk, but when further analyses were conducted to test the findings under different scenarios the association for poultry consumption became weaker, whereas the associations with type 2 diabetes for each of processed meat and unprocessed meat persisted.

Professor Nita Forouhi of the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, and a senior author on the paper, said: “Our research provides the most comprehensive evidence to date of an association between eating processed meat and unprocessed red meat and a higher future risk of type 2 diabetes. It supports recommendations to limit the consumption of processed meat and unprocessed red meat to reduce type 2 diabetes cases in the population.

“While our findings provide more comprehensive evidence on the association between poultry consumption and type 2 diabetes than was previously available, the link remains uncertain and needs to be investigated further.”

InterConnect uses an approach that allows researchers to analyse individual participant data from diverse studies, rather than being limited to published results. This enabled the authors to include as many as 31 studies in this analysis, 18 of which had not previously published findings on the link between meat consumption and type 2 diabetes. By including this previously unpublished study data the authors considerably expanded the evidence base and reduced the potential for bias from the exclusion of existing research.

Lead author Dr Chunxiao Li, also of the MRC Epidemiology Unit, said: “Previous meta-analysis involved pooling together of already published results from studies on the link between meat consumption and type 2 diabetes, but our analysis examined data from individual participants in each study. This meant that we could harmonise the key data collected across studies, such as the meat intake information and the development of type 2 diabetes.

“Using harmonised data also meant we could more easily account for different factors, such as lifestyle or health behaviours, that may affect the association between meat consumption and diabetes.”

Professor Nick Wareham, Director of the MRC Epidemiology Unit, and a senior author on the paper said: “InterConnect enables us to study the risk factors for obesity and type 2 diabetes across populations in many different countries and continents around the world, helping to include populations that are under-represented in traditional meta-analyses.

“Most research studies on meat and type 2 diabetes have been conducted in USA and Europe, with some in East Asia. This research included additional studies from the Middle East, Latin America and South Asia, and highlighted the need for investment in research in these regions and in Africa.”

InterConnect was initially funded by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602068.

Reference
Li, C et al. Meat consumption and incident type 2 diabetes: a federated meta-analysis of 1·97 million adults with 100,000 incident cases from 31 cohorts in 20 countries. Lancet Diabetes Endocrinol.; 20 August 2024

Adapted form a press release from the MRC Epidemiology Unit

Meat consumption, particularly consumption of processed meat and unprocessed red meat, is associated with a higher type 2 diabetes risk, an analysis of data from almost two million participants has found.

Our research supports recommendations to limit the consumption of processed meat and unprocessed red meat to reduce type 2 diabetes cases in the populationNita ForouhiRichard BellFull English breakfast

The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

YesLicence type: Public Domain

Researchers have identified a drug already used for cancer patients, that, when applied to current gene therapy protocols can improve blood stem cell function threefold.

One trillion blood cells are produced every day in humans, and blood stem cells are the only cell types in our body capable of producing all blood cell types over our lifespan, giving them immense regenerative potential.

Blood stem cell gene therapy is a ground-breaking treatment that currently provides the only cure to more than ten life-debilitating genetic diseases and has already saved the lives of more than two million people with blood cancers and other diseases.

These therapies take blood stem cell samples from patients, where their genetic defect is corrected in a dish before being delivered back to the patient. However, limitations persist in blood stem cell therapies because of the shelf life of the cells outside the body. When removed from their environment in the human body and cultured in a dish, most blood stem cells lose their function. The exact timing and cause of this function loss has not previously been well understood.

Now, scientists in the Laurenti Group and others at the University of Cambridge’s Cambridge Stem Cell Institute (CSCI) and Department of Haematology have pinpointed a timeline for the blood stem cells under the current gene therapy protocols, which typically take place over three days. After the first 24 hours in a dish, more than 50% of the blood stem cells can no longer sustain life-long blood production, which is before therapy would even begin in a clinical setting.

During those first 24 hours, the cells activate a complex molecular stress response in order to adapt to the dish. By studying this stress response, the team identified a solution. Through repurposing a cancer growth blocker drug (Ruxolitinib), already in use for cancer treatments, they were able to improve stem cell function in a dish by three times its former capabilities.

The group is now aiming to modify current gene therapy protocols to include this drug, providing patients with the highest number of high-quality blood stem cells and improving their outcomes.

The study is published today in the journal Blood.

Professor Elisa Laurenti at the University of Cambridge Stem Cell Institute, and senior author of the study, said: “This is really exciting because we are now in a position where we can begin to understand the huge stress that these stem cells sense when they are manipulated outside of our body. Biologically it is really fascinating because it affects every aspect of their biology. Luckily, we were able to identify a key molecular pathway which governs many of these responses, and that can be targeted by a drug which is already in use and is safe to use.

“I hope our findings will enable safer treatments for gene therapy patients. Our discovery also opens up many possibilities to better expand blood stem cells ex vivo and expand the set of disease where we can use blood stem cells to improve patients’ lives.”

Dr Carys Johnson at the University of Cambridge Stem Cell Institute, and first author of the study, said: “Although we expected that removing these cells from the body and culturing them on a plastic surface would alter gene expression, the extent of change we found was surprising, with over 10,000 genes altered and a significant stress response detected. It was also striking to discover that the majority of blood stem cells are functionally lost during gene therapy protocols, before transplantation back to the patient.

“We have identified a key bottleneck where function is lost and clinical culture could be improved. I hope that our work will drive advancements in culture protocols to better harness the power of blood stem cells and improve the safety and efficacy of clinical approaches.”

Reference

C.S. Johnson, M.J. Williams, K. Sham, et al. ‘Adaptation to ex vivo culture reduces human hematopoietic stem cell activity independently of cell cycle.’ Blood 2024; DOI: 10.1182/blood.2023021426

Story written by Laura Puhl, Cambridge Stem Cell Institute.

Researchers have discovered a way to extend the shelf life of blood stem cells outside the body for use in gene therapy, providing patients with better options and improving their outcomes.

We were able to identify a key molecular pathway...that can be targeted by a drug which is already in use and is safe to use.Elisa LaurentiPhilippe Delavie from Pixabay

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Severe brain injury can leave individuals unable to respond to commands physically, but in some cases they are still able to activate areas of the brain that would ordinarily play a role in movement. This phenomenon is known as ‘cognitive motor dissociation’.

To determine what proportion of patients in so-called ‘disorders of consciousness’ experience this phenomenon – and help inform clinical practice – researchers across Europe and North America recruited a total of 353 adults with disorders of consciousness, including the largest cohort of 100 patients studied at Cambridge University Hospitals NHS Foundation Trust.

Participants had mostly sustained brain injury from severe trauma, strokes or interrupted oxygen supply to the brain after heart attacks. Most were living in specialised long-term care facilities and a few were living at home with extensive care packages. The median time from injury for the whole group was about eight months.

Researchers assessed patterns of brain activation among these patients using functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). Subjects were asked to repeatedly imagine performing a motor activity (for example, “keep wiggling your toes”, “swinging your arm as if playing tennis”, “walking around your house from room to room”) for periods of 15 to 30 seconds separated by equal periods of rest. To be able to follow such instructions requires not only the understanding of and response to a simple spoken command, but also more complex thought processes including paying attention and remembering the command.

The results of the study are published today in the New England Journal of Medicine.

Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences at the University of Cambridge said: “When a patient has sustained a severe brain injury, there are very important, and often difficult, decisions to be made by doctors and family members about their care. It’s vitally important that we are able to understand the extent to which their cognitive processes are still functioning by utilising all available technology.” 

Among the 241 patients with a prolonged disorder of consciousness, who could not make any visible responses to bedside commands, one in four (25%) was able to perform cognitive tasks, producing the same patterns of brain activity recorded with EEG and/or fMRI that are seen in healthy subjects in response to the same instructions.

In the 112 patients who did demonstrate some motor responses to spoken commands at the bedside, 38% performed these complex cognitive tasks during fMRI or EEG. However, the majority of these patients (62%) did not demonstrate such brain activation. This counter-intuitive finding emphasises that the fMRI and EEG tasks require patients to have complex cognitive abilities such as short-term memory and sustained concentration, which are not required to the same extent for following bedside commands.

These findings are clinically very important for the assessment and management of the estimated 1,000 to 8,000 individuals in the UK in the vegetative state and 20,000 to 50,000 in a minimally conscious state. The detection of cognitive motor dissociation has been associated with more rapid recovery and better outcomes one year post injury, although the majority of such patients will remain significantly disabled, albeit with some making remarkable recoveries.

Dr Judith Allanson, Consultant in Neurorehabilitation, said: “A quarter of the patients who have been diagnosed as in a vegetative or minimally conscious state after detailed behavioural assessments by experienced clinicians, have been found to be able to imagine carrying out complex activities when specifically asked to, is sobering. This sobering fact suggests that some seemingly unconscious patients may be aware and possibly capable of significant participation in rehabilitation and communication with the support of appropriate technology.

“Just knowing that a patient has this ability to respond cognitively is a game changer in terms of the degree of engagement of caregivers and family members, referrals for specialist rehabilitation and best interest discussions about the continuation of life sustaining treatments.”

The researchers caution that care must be taken to ensure the findings are not misrepresented, pointing out, for example, that a negative fMRI/EEG result does not per se exclude cognitive motor dissociation as even some healthy volunteers do not show these responses.

Professor John Pickard, emeritus professorial Fellow of St Catharine's College, Cambridge, said: “Only positive results – in other words, where patients are able to perform complex cognitive processes – should be used to inform management of patients, which will require meticulous follow up involving specialist rehabilitation services.”

The team is calling for a network of research platforms to be established in the UK to enable multicentre studies to examine mechanisms of recovery, develop easier methods of assessment than task-based fMRI/EEG, and to design novel interventions to enhance recovery including drugs, brain stimulation and brain-computer interfaces.

The research reported here was primarily funded by the James S. McDonnell Foundation. The work in Cambridge was supported by the National Institute for Health and Care Research UK, MRC, Smith’s Charity, Evelyn Trust, CLAHRC ARC fellowship and the Stephen Erskine Fellowship (Queens’ College). 

Reference
Bodien, YG et al. Cognitive Motor Dissociation in Disorders of Consciousness. NEJM; 14 Aug 2024; DOI: 10.1056/NEJMoa2400645

Adapted from a press release from Weill Cornell Medicine

Around one in four patients with severe brain injury who cannot move or speak – because they are in a prolonged coma, vegetative or minimally conscious state – is still able to perform complex mental tasks, a major international study has concluded in confirmation of much smaller previous studies.

When a patient has sustained a severe brain injury, there are very important, and often difficult, decisions to be made by doctors and family members about their careEmmanuel StamatakisWitthaya Prasongsin (Getty Images)Male patient in a hospital bed - stock imageAcknowledgements

The multidisciplinary Cambridge Impaired Consciousness Research Group, led by Emeritus Professors John Pickard (Neurosurgery) & David Menon (Anaesthesia) and Drs Judith Allanson & Emmanuel A. Stamatakis (Lead, Cognition and Consciousness Imaging Group), started its research programme in 1997, partly in response to emerging concern over the misdiagnosis of the vegetative state. This pioneering work has only been possible by having access to the world class resources of the Wolfson Brain Imaging Centre, the NIHR/Wellcome Clinical Research Facility at Addenbrooke’s Hospital, the MRC Cognition and Brain Sciences Unit (Professors Barbara Wilson & Adrian Owen), the Royal Hospital for Neuro-disability (Putney) and the Central England Rehabilitation Unit (Royal Leamington Spa).

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Yes

New, repurposed and combined treatments could soon transform prostate cancer outcomes, with DNA repair research informing promising clinical trials at Cambridge.

Around one in 200 people in Europe every year will suffer concussion. In the UK, more than 1 million people attend Emergency Departments annually with a recent head injury. It is the most common form of brain injury worldwide.

When a patient in the UK presents at an Emergency Department with head injury, they are assessed according to the NICE head injury guidelines. Depending on their symptoms, they may be referred for a CT scan, which looks for brain injuries including bruising, bleeding and swelling.

However, CT scans identify abnormalities in fewer than one in 10 patients with concussion, yet 30-40% of patients discharged from the Emergency Department following a scan experience significant symptoms that can last for years and be potentially life-changing. These include severe fatigue, poor memory, headaches, and mental health issues (including anxiety, depression, and post-traumatic stress).

Dr Virginia Newcombe from the Department of Medicine at the University of Cambridge and an Intensive Care Medicine and Emergency Physician at Addenbrooke’s Hospital, Cambridge, said: “The majority of head injury patients are sent home with a piece of paper telling them the symptoms of post-concussion to look out for and are told to seek help from their GP if their symptoms worsen.

“The problem is that the nature of concussion means patients and their GPs often don’t recognise that their symptoms are serious enough to need follow-up. Patients describe it as a ‘hidden disease’, unlike, say, breaking a bone. Without objective evidence of a brain injury, such as a scan, these patients often feel that their symptoms are dismissed or ignored when they seek help.”

In a study published today in eClinicalMedicine, Dr Newcombe and colleagues show that an advanced form of MRI known as diffusion tensor imaging (DTI) can substantially improve existing prognostic models for patients with concussion who have been given a normal CT brain.

DTI measures how water molecules move in tissue, providing detailed images of the pathways, known as white matter tracts, that connect different parts of the brain. Standard MRI scanners can be adapted to measure this data, which can be used to calculate a DTI ‘score’ based on the number of different brain regions with abnormalities.

Dr Newcombe and colleagues studied data from more than 1,000 patients recruited to the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study between December 2014 and December 2017. 38% of the patients had an incomplete recovery, meaning that three months after discharge their symptoms were still persisting.

The team assigned DTI scores to the 153 patients who had received a DTI scan. This significantly improved the accuracy of the prognosis – whereas the current clinical model would correctly predict in 69 cases out of 100 that a patient would have a poorer outcome, DTI increased this to 82 cases out of 100.

dti_images_web.jpg

Whole brain diffusion tensor tractography showing healthy patient (left) and patient at two days (centre) and six weeks (right) after severe traumatic brain injury (Credit: Virginia Newcombe)

The researchers also looked at blood biomarkers – proteins released into the blood as a result of head injury – to see whether any of these could improve the accuracy of the prognosis. Although the biomarkers alone were not sufficient, concentrations of two particular proteins – glial fibrillary acidic protein (GFAP) within the first 12 hours and neurofilament light (NFL) between 12 and 24 hours following injury – were useful in identifying those patients who might benefit from a DTI scan.

Dr Newcombe said: “Concussion is the number one neurological condition to affect adults, but health services don’t have the resources to routinely bring back every patient for a follow-up, which is why we need a way of identifying those patients at greatest risk of persistent symptoms.

“Current methods for assessing an individual’s outlook following head injury are not good enough, but using DTI – which, in theory, should be possible for any centre with an MRI scanner – can help us make much more accurate assessments. Given that symptoms of concussion can have a significant impact on an individual’s life, this is urgently needed.”

The team plan to look in greater details at blood biomarkers, to see if they can identify new ways to provide even simpler, more practical predictors. They will also be exploring ways to bring DTI into clinical practice.

Dr Sophie Richter, a NIHR Clinical Lecturer in Emergency Medicine and first author, Cambridge, added: “We want to see if there is a way to integrate the different types of information obtained when a patient presents at hospital with brain injury – symptoms assessment, blood tests and brain scans, for example – to improve our assessment of a patient’s injury and prognosis.”

The research was funded by European Union's Seventh Framework Programme, Wellcome and the National Institute for Health and Care Excellence.

Reference
Richter, S et al. Predicting recovery in patients with mild traumatic brain injury and a normal CT using serum biomarkers and diffusion tensor imaging (CENTER-TBI): an observational cohort study. eClinMed; 8 Aug 2024; DOI: 10.1016/j.eclinm.2024.102751

Offering patients with concussion a type of brain scan known as diffusion tensor imaging MRI could help identify the one in three people who will experience persistent symptoms that can be life changing, say Cambridge researchers.

Concussion is the number one neurological condition to affect adults, which is why we need a way of identifying those patients at greatest risk of persistent symptomsVirginia NewcombeCallista Images (Getty Images)Diffusion tensor imaging (DTI) MRI of the human brain - stock photo

The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Writing in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, the team from Cambridge Public Health argue that substantial challenges including the risk-benefit ratio, limited eligibility and high cost of roll-out will limit any benefits of these treatments.

Alzheimer’s disease is often quoted as causing 70% of the 55 million cases of dementia worldwide, though the definition of what constitutes the disease is hotly debated. One characteristic of Alzheimer’s is the build-up of clusters of misfolded proteins, one of these being a form of amyloid, leading to plaques in the brain. The cascade hypothesis, a dominant theory in the field, suggests that this triggers a series of processes which together lead to dementia symptoms.

Advances in developing treatments to reduce symptoms and slow down the progression in the early stages of Alzheimer’s has been slow. However, there has been recent excitement surrounding amyloid immunotherapy agents, drugs that harness the immune system to remove amyloid pathology.

Two completed phase III randomised controlled trials of amyloid immunotherapy reported statistically significant reductions in the rate of cognitive and functional decline compared to the placebo.

But as the Cambridge team point out, the effect sizes were small – small enough that a doctor would struggle to tell the difference between the average decline of a patient on the drug and another on placebo, after 18 months. The drugs were also associated with significant adverse events, including brain swelling and bleeding; during the phase III trial of one agent, donanemab, there were also three deaths attributed to the treatment.

Crucially, there is little known about the long-term effects of the drugs beyond the 18 month trial periods. Long-term placebo-controlled trials, which would be needed to see if there is any clinically meaningful slowing of decline, are unlikely to be feasible where drugs are already approved.    

Despite this, the US Food and Drug Administration has licensed two such drugs. The European Medicines Agency (EMA) has recommended rejecting one (lecanemab) predominantly on the grounds that the small effects seen do not outweigh the risk from side effects; it is reviewing the other. The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) is expected to take a decision on both drugs imminently.

Edo Richard, Professor of Neurology at Radboud University Medical Centre in Nijmegen, The Netherlands, and co-author, said: “If these drugs are approved by regulators in the UK and Europe, and become available, it is understandable that some people with early Alzheimer’s will still want to try these drugs, given their despair living with this dreadful disease. But there is a lot of hyperbole around the reporting of these drugs, and significant effort will be needed to provide balanced information to patients to enable informed decisions.”

Press coverage of the drugs has implied they are suitable for anyone with a diagnosis of Alzheimer’s. However, while the trials included those with ‘early symptomatic Alzheimer’s disease’, it excluded those with other conditions that may have been contributing to their symptoms.  Evidence suggests that the people in the trials represent less than 8% of those in the community with early Alzheimer’s disease. Those in the trials were up to 10 to 15 years younger than those typically presenting to health services with early symptoms.

Lead author Dr Sebastian Walsh, NIHR Doctoral Fellow in Public Health Medicine at Cambridge Public Health, University of Cambridge, added: “If approved, the drugs are likely to be relevant only for a relatively small cohort of Alzheimer’s patients, so potential recipients will need to undergo a range of assessments before being given access to the drugs. Plus, effect sizes seen in the trials are very small and the drugs will need be administered as early in the disease process as possible, when symptoms are mild – and people in these phases of disease can be hard to identify.”

The resource requirements for rolling out such treatments are likely to be considerable. Even if approved for only a small proportion of Alzheimer’s patients, a much broader group of people will need to be assessed for eligibility, requiring rapid specialist clinical assessment and tests. The authors question whether this is the best use of these resources, given the strain health systems are already under. Support would also be required for the large number of Alzheimer’s patients (potentially as many as 92%) found to be ineligible. Those found to have insufficient amyloid to be eligible may then require follow-up assessments to determine eligibility in the future, with the further implications for services this would entail.

Professor Carol Brayne, Co-director of Cambridge Public Health, said: “Even in high-income countries, rolling out such types of treatments at scale is highly challenging, but most dementia occurs in low- and middle-income countries. Health systems in these countries are highly unlikely to have the resources required to offer these new drugs, even to a very narrow group.

“Other compelling evidence suggests that attention to inequalities and health experience across people’s lives could have greater impact on the rates of dementia in populations. Most dementia is more complicated than a single protein.”

The team concludes that based on current evidence, it is far from clear whether amyloid immunotherapy can ever significantly reduce suffering caused by dementia at scale in the community, and we must continue to explore other approaches.

Professor Brayne added: “With an ageing population, we urgently need effective ways to support people living with dementia, but while the current amyloid immunotherapies may show a glint of promise for very selected groups, it’s clear these drugs will not address dementia risk at scale.”

Reference
Walsh, S et al. Considering challenges for the new Alzheimer’s drugs: clinical, population, and health system perspectives. Alz&Dem; 6 Aug 2024; DOI: 10.1002/alz.14108

Cambridge researchers have cast doubt on whether new amyloid immunotherapy drugs will have the desired effect of significantly reducing the impact of Alzheimer’s disease.

While the current amyloid immunotherapies may show a glint of promise for very selected groups, it’s clear these drugs will not address dementia risk at scaleCarol BrayneSteven HWG (Unsplash)Woman sitting in a wheelchair

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YesLicence type: Public Domain

Professor Baron-Cohen is a British clinical psychologist and professor of developmental psychopathology at the University of Cambridge. He is the director of the university's Autism Research Centre and a Fellow of Trinity College.

The honorary fellowships were granted at a ceremony at the RSM’s central London home. 

Speaking at the ceremony, Professor Baron-Cohen said: “Although I’m receiving this honour, I’m really here because of the work of the team of researchers at the Autism Research Centre at Cambridge. I want to thank them for all their hard work into both basic science into trying to understand the cause of autism but also applied research to evaluate what kinds of support might help autistic people and their families.”

The Society also bestowed honours upon Baron Adebowale CBE, Major General Timothy Hodgetts CB, Professor Martin McKee CBE, Professor Dame Robina Shah and Professor Irene Tracey CBE.

Adapted from a news story by the Royal Society of Medicine.

Professor Sir Simon Baron-Cohen has been awarded an honorary fellowship of the Royal Society of Medicine, in recognition of his contribution to health, healthcare and medicine.

Although I’m receiving this honour, I’m really here because of the work of the team of researchers at the Autism Research CentreSimon Baron-CohenRoyal Society of MedicineProfessor Henrietta Bowden-Jones, Professor Simon Baron-Cohen, Professor Roger Kirby

The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

The study, published today in Nature Communications, showed that the incidence of arterial thromboses, such as heart attacks and strokes, was up to 10% lower in the 13 to 24 weeks after the first dose of a COVID-19 vaccine. Following a second dose, the incidence was up to 27% lower after receiving the AstraZeneca vaccine and up to 20% lower after the Pfizer/Biotech vaccine.

The incidence of common venous thrombotic events – mainly pulmonary embolism and lower limb deep venous thrombosis – followed a similar pattern.

Research led by the Universities of Cambridge, Bristol and Edinburgh and enabled by the British Heart Foundation (BHF) Data Science Centre at Health Data Research UK analysed de-identified health records from 46 million adults in England between 8 December 2020 and 23 January 2022. Data scientists compared the incidence of cardiovascular diseases after vaccination with the incidence before or without vaccination, during the first two years of the vaccination programme.

Co-first author Dr Samantha Ip, Research Associate at the Department of Public Health and Primary Care, University of Cambridge, said: “We studied COVID-19 vaccines and cardiovascular disease in nearly 46 million adults in England and found a similar or lower incidence of common cardiovascular diseases, such as heart attacks and strokes, following each vaccination than before or without vaccination. This research further supports the large body of evidence on the safety of the COVID-19 vaccination programme, which has been shown to provide protection against severe COVID-19 and saved millions of lives worldwide.”

Previous research found that the incidence of rare cardiovascular complications is higher after some COVID-19 vaccines. For example, incidence of myocarditis and pericarditis have been reported following mRNA-based vaccines such as the Pfizer/Biotech vaccine, and vaccine-induced thrombotic thrombocytopenia following adenovirus-based vaccines such as the AstraZeneca vaccine. This study supports these findings, but importantly it did not identify new adverse cardiovascular conditions associated with COVID-19 vaccination and offers further reassurance that the benefits of vaccination outweigh the risk.

Incidence of cardiovascular disease is higher after COVID-19, especially in severe cases. This may explain why incidence of heart attacks and strokes is lower in vaccinated people compared with unvaccinated people, but further explanations are beyond the scope of this study.

Professor William Whiteley, Associate Director at the BHF Data Science Centre and Professor of Neurology and Epidemiology at the University of Edinburgh, said: “The COVID-19 vaccination programme rollout began strongly in the UK, with over 90% of the population over the age of 12 vaccinated with at least one dose by January 2022.

“This England-wide study offers patients reassurance of the cardiovascular safety of first, second and booster doses of COVID-19 vaccines. It demonstrates that the benefits of second and booster doses, with fewer common cardiovascular events include heart attacks and strokes after vaccination, outweigh the very rare cardiovascular complications.”

The research team used de-identified linked data from GP practices, hospital admissions and death records, analysed in a secure data environment provided by NHS England.

Co-last author Dr Venexia Walker, Research Fellow at the University of Bristol, said: “Given the critical role of COVID-19 vaccines in protecting people from COVID-19, it is important we continue to study the benefits and risks associated with them. The availability of population-wide data has allowed us to study different combinations of COVID-19 vaccines and to consider rare cardiovascular complications. This would not have been possible without the very large data that we are privileged to access and our close cross-institution collaborations.”

Reference
Ip, S et al. Cohort study of cardiovascular safety of different COVID-19 vaccination doses among 46 million adults in England. Nat Comms; 31 Jul 2024; DOI: 10.1038/s41467-024-49634-x

Adapted from a press release from Health Data Research UK

The incidence of heart attacks and strokes was lower after COVID-19 vaccination than before or without vaccination, according to a new study involving nearly the whole adult population of England.

This research further supports the large body of evidence on the effectiveness of the COVID-19 vaccination programme, which has saved millions of lives worldwideSamantha IpPaul_McManusVial of the AstraZeneca COVID-19 vaccine

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YesLicence type: Public Domain

Today sees the launch of the Early Cancer Institute at Cambridge. Its mission is deceptively simple: to detect cancer early enough to cure it.

The team say that while these experiences can be very positive, that is not always the case. Mindfulness teachers and students need to be aware that they can be a side-effect of training, and students should feel empowered to share their experiences with their teacher or doctor if they have any concerns.

Mindfulness-based programmes have become very popular in recent years. According to recent surveys, 15% of adults in the UK have learnt some form of mindfulness. They are often practised as a way of reducing stress or coping with depression and anxiety. There is anecdotal evidence that practising mindfulness can lead to alterations of the senses, self, and body boundaries, some even similar to those induced by psychotropic drugs.

From September 2015 to January 2016, the University of Cambridge conducted a randomised controlled trial to assess the effectiveness of mindfulness training as a way of coping with the stress of examinations and found that it can help support students at risk of mental health problems.

Dr Julieta Galante from the Department of Psychiatry at the University of Cambridge, who led the trial, said: “There’s been anecdotal evidence that people who practice mindfulness experience changes in how they perceive themselves and the world around them, but it’s difficult to know whether these experiences are a result of mindfulness practice or whether people who are more prone to such experiences are also more likely to practise mindfulness.

“Because we’d been running a randomised trial of mindfulness practice with several hundred students at Cambridge, we realised this offered us an opportunity to explore this question further.”

The team behind the trial followed up with participants a year later to investigate whether they had experienced any of the altered states of consciousness being reported anecdotally. The results are published today in PLOS ONE.

Participants were asked to complete a questionnaire that explored 11 ‘dimensions’ such as: spiritual experience; blissful state; disembodiment; and unity. In experiences of unity there is a sense that borders dissolve and everything, sometimes including the sense of time, is perceived in an integrated way. Disembodiment experiences often consist of a floating sensation or a dissolution of body boundaries, which may facilitate strong unity experiences.

In total, 670 participants took part in the randomised trial. Around a third each from the mindfulness trial and the control arm went on to complete the questionnaire about experiences of altered states of consciousness.

The researchers found that people who had received the mindfulness training were twice as likely as those in the control group to experience unity and disembodiment.

When the researchers explored the relationship between the total hours of formal mindfulness practice and the presence and intensity of experiences of altered states of consciousness,  they found that the more people practised, the more likely they were to have an experience of unity, disembodiment, or of a blissful state.

Participants who reported having meditated in the six months prior were asked if altered states of consciousness happened during meditation. Based on this sub-sample of 73 participants, 43% reported unity experiences during meditation, 47% blissful states, 29% disembodiment experiences, and 25% insightfulness experiences.

Dr Galante said: “Although we can’t say definitively, our results at least suggest the possibility that mindfulness training causes these experiences of unity and disembodiment. It aligns with other studies showing that people who practice mindfulness training are more likely to describe experiencing a sense of relaxed self-boundaries and broadening their spatial awareness beyond the physical body.”

Dr Galante, who practices mindfulness, has herself experienced these altered states of consciousness.

“I’ve benefited a lot personally from meditation and mindfulness and I’ve also had many of these experiences,” she said. “They were intense, and at first I found it difficult to share them with my meditation teacher. I didn’t know if they were normal or desirable or if they were a sign of problems with my mental health.”

While many experiences of altered states of consciousness are likely to be interpreted as pleasant, this may not always be the case, and Dr Galante says that it is important for teachers and their students to be aware that they may arise and be open to talking about them.

She added: “The most common and intense experiences tend to be those that do not have intrinsically unpleasant characteristics. Some, such as bliss, can feel extremely pleasant. But some experiences, such as disembodiment or altered sense of self could be perceived as unpleasant, or startling, even alarming, especially if you’re not expecting them.

“It’s important that people who are offered mindfulness are told about the possibility that they may come across these experiences.  That way, if they do experience them, they shouldn’t be disconcerted. There may be nothing wrong with their experience, but it may be useful for them to check in with their mindfulness teacher, and if the experience was negative, to also consider discussing it with their doctor.”

The research was supported by the University of Cambridge Vice-Chancellor’s Endowment Fund, the University Counselling Service and the National Institute for Health Research (NIHR) Applied Research Collaboration East of England programme.

Reference

Galante, J & Montero-Marin, J et al. Altered states of consciousness caused by a mindfulness-based programme up to a year later: results from a randomised controlled trial. PLOS ONE; 17 July 2024; DOI: 10.1371/journal.pone.0305928

Mindfulness training may lead participants to experience disembodiment and unity – so-called altered states of consciousness – according to a new study from researchers at the University of Cambridge.

I’ve benefited a lot personally from meditation and mindfulness and I’ve also had many of these experiences. I didn’t know if they were normal or desirableJulieta GalanteDingzeyu Li Woman sitting on sand at sunset meditating

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YesLicence type: Public Domain

The findings highlight the urgent need for monitoring and support for the mental health of young people diagnosed with type 1 diabetes.

According to the charity JDRF, there are 8.7 million people living with type 1 diabetes around the world, including over 400,000 people in the UK. It is a chronic, life-threatening condition, usually diagnosed in childhood, that has a life-long impact.

Currently, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions, because their pancreas no longer produces insulin itself, although recent developments in artificial pancreas technology are helping transform this care.

Previous studies have shown potential links between childhood-onset type 1 diabetes and a number of mental health disorders in adulthood. However, it is not clear whether these links can be best explained by the impacts of living with the condition and its treatment, or whether underlying common biological mechanisms may be implicated, for example the impact of unstable blood sugar levels on the developing adolescent brain.

To help answer this question, a team of researchers turned to data from over 4,500 children with type 1 diabetes on a national register in the Czech Republic and from large-scale European DNA studies.Their findings are published today in Nature Mental Health.

From the national register data, the researchers found that children diagnosed with type 1 diabetes – compared to children without the condition – were over twice as likely to develop a mood disorder and more than 50% more likely to develop an anxiety disorder. They were also more than four times more likely to develop behavioural syndromes including eating and sleep disorders

Conversely, children with type 1 diabetes were at a much lower risk of developing psychotic disorders, such as schizophrenia – almost half the risk compared to their peers.

The findings are consistent with the results from two other national register studies in Sweden and in Denmark, suggesting that the results would likely apply to other countries, too, including the UK.

The team used a statistical technique known as Mendelian Randomisation to probe causal links between type 1 diabetes and these various psychiatric disorders, but found little evidence in support of a common underlying biological mechanism.

Tomáš Formánek, a PhD student at the University of Cambridge and the National Institute of Mental Health, Klecany, Czech Republic, said: “Although we found a concerning increase in the risk of mental health problems among people living with type 1 diabetes, our study – and others before it – suggests this is unlikely to be the result of common biological mechanisms. This emphasises the importance of prevention and sustained attention to the mental health needs of children and young people with type 1 diabetes.”

The researchers say that mental health problems in later life may be a result of children with type 1 diabetes being forced to make significant changes to their lives, with a constant focus on monitoring their food intake and a need to check blood sugar levels and administer insulin injections. This often leaves these children feeling excluded from social events and singled-out by peers, teachers and even family members.

Dr Benjamin Perry from the Department of Psychiatry, University of Cambridge, said: “We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. This can include extreme frustration with blood sugars and feelings of isolation and can lead to burnout, hopelessness, and a feeling of lack of control. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives.”

Professor Peter Jones, also from the Department of Psychiatry, University of Cambridge, added: “Our findings emphasise the urgent need to support children diagnosed with type 1 diabetes, look out for signs of mental health problems and offer timely, expert help. That way, it may be possible to help these children early, before these problems fully take root.”

The research was supported by the National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridgeshire and Peterborough NHS Foundation Trust and the Ministry of Health, Czech Republic, with additional funding from Wellcome and the UKRI Medical Research Council.

Reference
Formánek, T et al. Childhood-Onset Type 1 Diabetes and Subsequent Adult Psychiatric Disorders: A Nationwide Cohort and Genome-wide Mendelian Randomization Study. Nature Mental Health; 17 July 2024; DOI: 10.1038/s44220-024-00280-8

Children diagnosed with type 1 diabetes are at significantly higher risk of a number of mental health issues, including mood and anxiety disorders, a study from a team in the UK and the Czech Republic has found.

We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult livesBenjamin PerrykyotokushigeTeenager With Type 1 Diabetes Takes at Home Test

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