Transforming the management of cancer and chronic disease

The University of Glasgow is home to the £3.4m MRC / EPSRC Molecular Pathology Node (GMP), the largest of its kind in the UK.

The GMP brings scientists, pathologists and clinicians together to develop and perform new tests that better diagnose patients and guide treatment in cancer and chronic diseases eg. inflammatory diseases such as rheumatoid arthritis, and cardiovascular and metabolic diseases such as diabetes, heart disease and stroke. 

The molecular diagnostics and approaches developed by GMP will drive beneficial change in clinical practice for patients worldwide. The GMP was established in partnership with industry and the NHS, and is supported by the Medical Research Council (MRC) and the Engineering and Physical Sciences Research Council (EPSRC). 

Glasgow is ideally positioned to host a Molecular Pathology Node having both long term clinical strengths in pathology and molecular diagnostics and an organisational structure where multidisciplinary Research Institutes are perfectly positioned to utilise and support the GMP.

At the heart of the Precision Medicine Ecosystem

Molecular pathology is a major tool in precision medicine. Tiny samples of blood or tissue are taken from the patient and analysed for levels of large molecules, such as proteins and DNA. The results, in combination with imaging and clinical data, allow personalised treatment of disease for patients. 

The Node is a crucial component of Scotland’s Precision Medicine Ecosystem, a strategic umbrella organisation which oversees Scotland's world-changing precision medicine research and work. The University (with support from the Scottish Government, Research Councils, major charities and industry) has invested over £100 million at the Queen Elizabeth University Hospital (QEUH) creating an epicentre for Precision Medicine. Being located at the QEUH puts the GMP at the heart of the ecosystem, to nurture close working relationships, sharing of staff and expertise and strategic alignment with initiatives such as the Stratified Medicine Scotland-Innovation Centre (SMS-IC), the Imaging Centre of Excellence (ICE) and the Clinical Innovation Zone (CIZ).

Training

With a vision of creating the next generation of leaders, the GMP provides training for Molecular Pathology, in order to facilitate pathologists, clinical scientists and those in related health professions to acquire essential knowledge, skills and professional attributes.

The GMP offers training in molecular pathology, genetics, informatics and stratified medicine, helping address national skill shortages. The GMP contributes to a workforce capable of developing, interpreting and applying the results of novel molecular diagnostics (eg. geneticists, pathologists, clinical and other scientists, informaticians and clinicians and across hospital practice and primary care).

The increased capacity and expertise provided by their MSC, doctoral level and CPD training will enable improved clinical practice in molecular pathology in the UK and beyond.  

Case study: Increased opportunities for pathologists at Queen Elizabeth University Hospital 

A recent MSc student with special interests of cardiovascular and head and neck pathology has been promoted to consultant pathologist, and is already applying the teachings to her clinical and academic practice. 

"One of my particular interests is human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma and I used assessment tasks to learn more about testing strategies for HPV in this tumour type. My knowledge directly contributed to clinical care in our department as we implemented the updated TN Classification of Malignant Tumours (TNM8), the internationally accepted standard for cancer staging. As a result, I was asked to lecture on this subject to surgical trainees on the Head and Neck Surgery course." 

With the support of the GMP she has been instrumental in establishing the Scottish cardiovascular tissue biobank. And is also contributing to a number of translational studies as co-investigator.

Industry partnerships

"The Node will enable scientists, pathologists and clinicians to collaborate with industry partners in developing new diagnostic tests" Professor Dame Anna Dominiczak

The GMP is committed to bring industry, academia and the NHS closer together, providing an environment for the rapid development of precision medicine health solutions. Current GMP industry partnerships include working with:

• Aridhia - medical informatics and data analysis.
• BioClavis - novel transcriptomic/genomic platform technology.
• Illumnia - next generation sequencing.
• Leica Biosystems - developing molecular pathology diagnostic systems.
• Sistemic - novel diagnostic systems and biomarkers.
• ThermoFisher - developing genetic testing and precision medicine instruments.

Case study: Development of ‘supply side’ economic model to inform decisions around diagnostic research and design

Inflammation experts from the GMP are developing a test to predict whether patients are likely to respond to respond to two types of biologic drugs in Rheumatoid Arthritis. Blood samples were taken from patients taking part in a clinical trial and the genomic profile of patients who responded and did not respond compared. This allowed the development of a ‘signature’ which can predict response. As it was developed from data from the patients in the clinical trial the next stage in the project will be to validate the signature (to see whether it works) in a different population of patients.

Alongside this project health economists have been working to help the development team in deciding how the test might best be used.  Much health economics is used by organisations such as National Institute for Health and Clinical Excellence (NICE) or the Scottish Medicines Consortium to decide whether drugs or tests are cost-effective for use in the NHS.  When that health economics work is undertaken there is usually good evidence about the performance of the drug or test and it is clear how the drug or test will be used.  When a test is still in development there are various ways it may be used (for example, on diagnosis or after trying one drug) and the test design is still changing.  The health economics can be designed to help the development team decide when the test should be used to provide best value for money.  Simple models can also inform the development team how accurate the test needs to be in order to provide good value for money.