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(Pilot) Parenteral interventions to support families of children with neurodisability in low resource settings 16 Nov 2015

I plan to conduct cross sectional surveys in five demographic surveillance sites across sub-Saharan Africa, to identify cases of active convulsive epilepsy (ACE). This cohort will be used to determine the prevalence of ACE and the extent of the number of people not receiving treatment (treatmetn gap) in these sites, identify the causes (particularly parasitic diseases that could be prevented) and establish cohorts of people with epilepsy, from which the magnitude and causes of excess mortality a ssociated with epilepsy can be determined. In addition, a community based intervention will be tested through a randomised cluster trial in one of the sites, to reduce the treatment gap and improve the quality of life of people with epilepsy in this area.

Amount: £28,916
Funder: The Wellcome Trust
Recipient: University of Oxford

(Pilot) A Pilot Study of Improving Outcomes in Teenage Pregnancy Using a Combined Tailored M- Health Program and Motivational Interviewing Intervention 16 Nov 2015

Mortality among pregnant teenagers in South Africa (SA) is very high: institutional Maternal Mortality Ratio (iMMR) of 67.1 deaths per 100,000 live births in teenagers; with 71.7% of deaths resulting from four causes: hypertension (22.8%); non-pregnancy related infections (21.1%) (HIV/AIDS-related, such as TB or pneumonia); obstetric haemorrhage (14.2%); and medical and surgical disorders (13.6%). Risk factors for these include poor antenatal clinic (ANC) attendance, lack of adherence to antiretroviral therapy, poor compliance to treatment for tuberculosis, inadequate management of preeclampsia, and slow referral of high risk pregnancies to secondary and tertiary centres. Changing the health-related behaviour of pregnant teenagers, using an m-health intervention combined with motivational interviewing (MI), could reduce the prevalence of these risk factors and, thus reduce mortality. This pilot study will test the feasibility, user acceptability and preliminary efficacy of an enhanced version of MomConnect - an m-Health program developed by our partners, the Praekelt Foundation and the SA National Department of Health (NDOH).The enhancements include adding tailored content to the SMS messaging platform; and an MI counselling intervention (4 sessions) delivered face to face by trained healthcare workers. The SMS messages will be tailored by age (13 - 19 years), motivational variables, appointment adherence, language and culture. Messages will be designed, pretested, and refined through formative evaluation procedures, under direction of our health communications expert. The revised program, Teen-MomConnect, will integrate both the enhanced SMS messages and the MI counselling for each pregnant teenager. For example, the MI counsellors will have access to the survey question responses, as well as ANC appointment-keeping status obtained via the cell phone. The MI clinical behavioural counselling training and implementation will be designed by, and pilot tested with health workers, who will deliver the counselling. Starting from week 12 of their pregnancy, the teenagers will receive 4 MI sessions delivered face to face (or via cell phone) at the ANC by a healthcare worker. The study has two phases. Phase 1 aims to develop, test, refine, and then pilot the major program enhancements (SMS and MI) to MomConnect. Phase II is the pilot field test and its aims are:1) to demonstrate whether pregnant teenagers can be recruited and retained in the study; 2) whether the causes of 71.7% of mortality in pregnant teenagers can be measured, 3) to establish uptake rates (both SMS use and completion of MI visit) for the enhanced Teen-MomConnect intervention; 4) evaluate if the integrated motivational behavioural face to face counselling, and the tailored health SMS intervention, impact pregnant teenagers ANC attendance (primary outcome), and the other risk factors for teenage maternal mortality. For the Phase II field pilot study, 200 pregnant teenagers will be recruited through clinics, schools and community organisations - 100 will be randomised to the behavioural intervention of Teen-MomConnect plus MI; and 100 will be given "usual care" with MomConnect alone. The study will take 18 months to complete at a cost of £150,000.The results of the pilot will be used to design a randomised controlled trial (RCT) to test the effectiveness of the Teen-MomConnect in a fully powered cohort of pregnant teenagers. The RCT will also include a cost effectiveness analysis. The products from this grant will include the Teen-MomConnect App and SMS messages; an MI training program for health workers; research instruments that have been designed and validated for the larger RCT; recruitment and retention protocols and a partnership between an international collaboration of scientists, Praekelt Foundation and the NDOH. This grant application has received the support of the NDOH who have issued a letter of support.

(Pilot) Bridging the Mental Health Treatment Gap through Tele-psychiatry - 'REACH' a Formative Research Project from Goa, India. 16 Nov 2015

The main objectives of REACH are to determine the:1. Feasibility of delivering psychiatric consultation services via tele-psychiatry to patients with mental health problemsidentified in primary care. Vast number of patients in India access health care at the primary level however availability ofmental heath care is poor in these settings. This is largely due to lack of trained mental health manpower. Further thehealth personnel at primary level are poorly trained to identify and treat mental health issues. It will not be possible tobridge this mental health treatment gap in the near future hence this innovative use of tele-psychiatry viavideoconferencing is being considered. Though telepsychiatry has been used in some settings it remains to be seen if it can be integrated into the primary health system, which if found to be possible would have significant impact on mentalhealth care delivery in India. We aim to demonstrate that it is feasible to integrate such services into routine primary healthcare.2. Acceptability of tele-psychiatry services to various stakeholders including the delivery agents, patients, and their familymembers. One of the challenges would be engaging the end user and the peripheral health team in delivering care in asafe and acceptable manner. Besides feasibility and acceptability there are other concerns in delivering such a servicesuch as issues of privacy, confidentiality, record-keeping, ethical and legal implications as well as duty of care andhandling of emergencies. The study will delve into these issues through in-depth interviews with all stakeholders.3. Preliminary impact of psychiatric consultation services delivered via tele-psychiatry on various outcomes in patients with mental health problems identified in primary care. We will recruit patients identified with Depression, Alcohol use disorders and Severe Mental Illness; before-after assessments of symptom burden and disability levels will be done to determine the impact of the tele-psychiatric consultations. We hope to demonstrate that providing mental health care through telepsychiatry has a positive effect on the outcomes.

Amount: £17,998
Funder: The Wellcome Trust
Recipient: University of Bath

(Pilot) Improved Breastfeeding Support to Treat Acute Malnutrition amongst Infants under 6 months (IBAMI) 16 Nov 2015

This research aims at comparing the congruence between the current secondary school health education curriculum in Kenya, with curriculum roll-out experiences of teachers and students and the health education needs of secondary school students. To address this I will: conduct a document review to outline the current reproductive health education policy, curriculum and resources available for delivery in Kenya; use qualitative methods, mainly focus group discussions and in-depth interviews to des cribe student and teacher experiences of the reproductive health education curriculum; and participatory video to explore the health education needs of secondary school students. Videos produced by students detailing their own narratives and needs in relation to reproductive health education will be shown to audiences comprising fellow students, teachers and education stakeholders in order to elicit responses and reflections. Mismatches between curriculum aims, student experiences and student ne eds will identify recommendations for policy change in health education and contribute to curriculum development.

Microfluidic Platform for Investigating the Kinetics of Extracellular Vesicle Induced Metastatic Niche Formation 21 May 2018

Extracellular vesicles (EVs) are believed to be important messengers in the progression of metastatic cancer that prime distant organs for tumour cell colonisation. However, due to an inadequacy of relevant tools, we have a poor understanding of how EVs distribute to, diffuse into and remodel organs into metastatic niches. The goal of this project is to develop novel microfluidic platforms for performing real-time continuous quantification of EV kinetics over multiple days in physiologically-relevant microenvironments. Towards this end, I propose three aims: Develop Microfluidic Metastatic Niche Platforms to explore the interaction of extracellular vesicles with liver tissue and vasculature. Investigate the kinetics of EV distribution, uptake and diffusion in liver and vasculature compartments of Microfluidic Metastatic Niche Platforms. Explore the influence of EV kinetics (distribution, uptake and diffusion) on the ability of cancer cells to attach, invade and proliferate in Microfluidic Metastatic Niche Platforms. The results of this project will enhance our understanding of metastatic cancer progression and will contribute valuable data for numerous follow-up studies aiming to inhibit or even prevent the development of metastatic niches.

Amount: £99,951
Funder: The Wellcome Trust
Recipient: Imperial College London

Mechanisms and pharmacodynamics of antifungal agents for cryptococcal meningitis. 30 Sep 2018

Cryptococcal meningitis (CM) is an infection of the brain and surrounding tissues (the meninges). It is caused by a yeast called Cryptococcus and is responsible for approximately 180,000 deaths annually (26). The most effective drug is amphotericin B (AmB) which needs to be given for 2 weeks and causes dangerous side-effects. A modified formulation, liposomal amphotericin B (LAmB), may be easier to administer to patients because it can be given as a single dose, and appears to be as effective as 2-weeks of conventional AmB (12, 15, 23). This observation raises a number of questions: 1) What is the optimal dosing strategy for LAmB? I will measure drug levels and describe their relationship with reduction in Cryptococcus levels. 2) How does one dose of LAmB exert a prolonged effect? i will image the movement of LAmB in mouse brains and meninges to assess how long LAmB stays in these regions. During treatment for CM, the rate of decline of yeast in spinal fluid is highly variable (24, 25, 27). Therefore, another question is: 3) Do different groups of yeast vary in teir response to treatment? I will collect samples of Cryptococcus and characterise their survival ability in various conditions.

Amount: £0
Funder: The Wellcome Trust
Recipient: University of Liverpool

Clinical Characterisation of a Broad Spectrum of Genetic Variation in the General Population 30 Sep 2018

Inborn errors of metabolism (IEM) are severe and extreme changes in metabolism caused by mutations in a single gene. Recent large-scale human studies have shown that genes causal for IEM are associated with nutrients, or ‘metabolites’, in the blood. However, whether these associations cause disease or adverse health outcomes is unknown. In this project, I will use IEM genes identified in these studies to link genetic variation to clinical features in a large human population. To do this, I will assemble a list of IEM genes of interest that were identified in the literature and in large population datasets. I will then test for associations between the variants I find in these genes and a wide range of clinical features found in open-access population datasets. As the IEM genes used in this study have been associated with blood metabolites previously, linking variants in these genes to clinical features will shed light on the molecular mechanisms underlying genes and disease in the general population. Understanding how genetic variation affects disease will help identify novel therapeutic targets and enable health professionals to better manage disease risk.

Amount: £0
Funder: The Wellcome Trust
Recipient: University of Cambridge

LMIC Travel Scholarships for Global Climate and Health Forum 30 Sep 2018

The Global Climate and Health Forum is a one-day, high-level convening of global climate and health leaders designed to mobilize stronger health sector engagement in and commitments to climate action. The Forum will bring together 250 leaders from national and local governments, health systems, public health agencies, civil society, and international organizations to build the community of climate and health professionals, strengthen collaboration across sectors, and raise the health voice for climate action. The Forum will be held at the University of California, San Francisco on September 12th, 2018. The Forum is an affiliate event of the Global Climate Action Summit, and co-hosted by the UCSF Global Health Group, Health Care Without Harm, Global Climate and Health Alliance, and US Climate and Health Alliance. In order to make the Forum a truly global event, it is imperative that the Forum includes speakers and participants from low- and middle-income countries who are leading climate mitigation, adaptation, and resilience work in the most vulnerable regions and communities. Funding from the Wellcome Trust will be used to support five travel scholarships for participants from the global South, including all registration, travel, accommodation, and event-related expenses.

Structure and mechanism of the Ino80 chromatin remodelling complex 28 Nov 2017

Compaction of the genome into chromatin helps to protect the genetic material but also causes problems in regard to access for essential processes such as transcription, replication and repair. Chromatin remodelling complexes alter the state of chromatin through a number of processes that includes chemical modifications of nucleosomes and sliding their position on DNA. Nucleosome sliding is catalysed by a number of protein complexes, one of which is the multi-subunit INO80 complex. INO80 contains an ATP-dependent translocase motor, that is common to all nucleosome sliders, but also a variety of other subunits, most of which have unknown roles. Furthermore, not only does it require two INO80 complexes interacting with a single nucleosome to promote sliding, but the complex also has an ability to "sense" the presence of other nucleosomes to space them evenly on DNA indicating interactions with multiple nucleosomes. The mechanism for this process is poorly understood, particularly at a molecular and structural level. INO80 is highly regulated in several distinct ways, including chemical modifications, small molecule effectors and subunit interactions but none of these are well understood. Finally, how the various subunits, many of which are ATPases in their own right, contribute to INO80 activities is also unclear.

Amount: £1,701,911
Funder: The Wellcome Trust
Recipient: Imperial College London

Growth and secretion by Campylobacter jejuni under anaerobic conditions 31 May 2018

Campylobacter jejuni is the leading cause of bacterial gastroenteritis and thus poses a significant health risk. The bacteria is part of the natural microbiome of the chicken caecum where it appears to function as a non-invasive commensal but in the human intestine the organism becomes invasive and pathogenic. The Ó Cróinín group have recently reported that DNA supercoiling plays a key role in inducing this invasive phenotype and that relaxation of DNA supercoiling is associated with an increase in invasion and the appearance of an invasion associated secretive. This group have also unpublished data which reveals that DNA supercoiling allows the bacteria to survive and grow under anaerobic conditions which normally do not support growth. Given the anaerobic nature of some areas of the human intestine this could indicate that relaxation of DNA supercoiling could be critical in allowing this bacteria to both secrete virulence factors as well as to survive and grow under anaerobic conditions. The aim of this study is thus to investigate and characterise the effect of DNA supercoiling on the ability of the bacteria to grow under anaerobic conditions as well as to compare the secretion of proteins by microorganisms grown under anaerobic and microaerophilic conditions

Amount: £0
Funder: The Wellcome Trust
Recipient: University College Dublin

Suppression of adaptive immunity by Salmonella 28 Nov 2017

Dendritic cells (DCs) have a crucial role in the development of adaptive immunity to bacteria. DCs transport the intracellular pathogen Salmonella from intestinal Peyer’s Patches to mesenteric lymph nodes where they present bacterial antigens to CD4+ T cells using MHCII molecules. DCs also secrete cytokines that stimulate recruitment and activation of T and NK cells. Salmonella is a globally important intracellular pathogen that survives in DCs and interferes with the processes of DC migration, cytokine production/sensing and T cell activation. The overall goal of this application is to understand mechanisms by which Salmonella interferes with these processes. Recently we identified an effector of the SPI-2 type III secretion system (SteD) that reduces the number of mature MHCII molecules on the surface of DCs. A significant component of the planned work is to understand its mechanism of action in detail. We will use candidate-based and unbiased screens, along with molecular cell biological approaches to characterize mechanisms involved in suppressing DC migration, production of IL-12 and IFN-gamma-stimulated host cell signaling. Collectively, this research will advance the field by providing novel insights into different mechanisms by which a bacterial pathogen subverts the development of adaptive immunity.

Amount: £2,170,670
Funder: The Wellcome Trust
Recipient: Imperial College London

Intra-Africa Mobility Initiative on Science, Language and Culture 30 Sep 2018

The Alliance for Accelerating Excellence in Science in Africa (AESA), Wellcome Trust (WT) and the Institut Pasteur International Network propose a researcher mobility program which would support African researchers (who share our ambition) to break down language and cultural barriers that impede greater African research collaboration in the biomedical and health sciences.Over the next 5 years, we aim to support at least 50 researchers to undertake mobility favoring the enhancement of their scientific careers while also increasing the understanding and interconnections of the African research community within different cultural and linguistic environments. Where language is the barrier we will look for flexible ways of providing support and funding language training. The program will aim to; Strengthen scientific collaboration between Anglo and Francophone speaking African scientists Build language skills/capabilities in English and French among African scientists Improve cultural understanding between English and French speaking African scientists The program will build out from the DELTAS and H3Africa researcher communities and the Institut Pasteur network, Our indicator of success will be; By December 2020, 50 African researchers will have experienced the mobility program and report positively on breaking down language and cultural barriers to research.

Amount: £198,662
Funder: The Wellcome Trust
Recipient: African Academy of Sciences

Investigating the Structure of FcγRIIa and its Interactions within the Membrane 30 Sep 2018

Human Fcgamma receptors (FcgammaRs) are proteins found on the surface of immune cells. They bind to antibodies, which are produced by the body, in response to infection. Some antibodies produced recognise their own tissues and are found in many diseases, including rheumatoid arthritis and lupus. It has been shown that genetic changes in the FcgammaRs are found more frequently in rheumatoid arthritis sufferers compared to healthy individuals. This project will focus on FcgammaRIIa, which is present on cells which are responsible for the destruction of many antibody-bound objects. Through a combination of cutting edge techniques, spanning physics, biology, immunology and medicine, we will uncover fundamental information within this field. This information would aim to inform the production of effective therapies to treat diseases such as arthritis, which put a huge strain on the NHS every year.

Amount: £0
Funder: The Wellcome Trust
Recipient: University of Leeds

Design and testing of allele specific gene editing tools. 31 May 2018

The Type II Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) is a programmable RNA guided endonuclease, which is effective at gene editing in mammalian cells. These highly specific and efficient RNA-guided DNA endonucleases may be of therapeutic importance to a range of genetic diseases. The CRISPR/Cas9 system relies on a single catalytic protein, CRISPR associated protein 9 (Cas9), which can be guided to a specific DNA sequence anywhere in the genome by the substitution of a 20-nucleotide sequence, complimentary to the particular target, within a single RNA molecule (sgRNA).A number of computer programs have been developed to predict the sgRNA that cuts the intended target most efficiently with the least off-targetting. I aim to identify, design and characterise sgRNA molecules that could be used to target mutant corneal dystrophy genes by using molecular biology techniques such as in silico identification of mutations in corneal dystrophy genes suitable for CRISPR/Cas9 gene editing with in vitro testing of selected guides, design of sgRNA to target the identified mutation and comparison of sgRNA design and off-target prediction tools.

Amount: £0
Funder: The Wellcome Trust
Recipient: Ulster University

C. elegans – a model system to study causation in the microbiome-gut-brain axis 06 Sep 2018

Metagenomic approaches are generating a long list of health and disease states associated with the microbiome (the microbes inhabiting our digestive tract) but without mechanistic understanding. The challenges arise from the enormous complexity of the microbiome, including genetic, environmental and dietary variations, microbe-microbe interactions, and the cost associated with studying the microbiome using murine models. If the field is to move beyond association, simple, well-controlled and cost-effective models allowing unbiased high-throughput studies are needed. The nematode C. elegans is a genetically tractable model, ideally suited for mechanistic and causative studies of host-microbiome and microbe-microbe interactions shaping host physiology and metabolism. Aims: 1) Establish an experimental microbiome in C. elegans based on strains from the human microbiome associated with health, disease and ageing 2) Generate fluorescent labelled bacterial strains and perform real-time imaging of gut colonisation 3) Characterise the effects of the experimental microbiome on the microbiome-gut-brain axis during ageing The experimental microbiome in C. elegans will be an important contribution to the field, complementing existing models. It will allow me to establish important collaborations, form a basis for my future research and address one of the most important questions of modern biology: the effects of the microbiome on host physiology.

Amount: £99,905
Funder: The Wellcome Trust
Recipient: Queen Mary University of London

A structural investigation into the action of and resistance to ribosome-targeting antibiotics 30 Sep 2018

Antibiotics are crucial to modern medicine, allowing treatment of life-threatening bacterial infections and making many surgeries like transplantations possible. However, pathogenic bacteria are rapidly evolving to resist their effects. Protein synthesis is one of the main antibiotic targets in bacterial cells. I will use structural biology techniques, principally cryoEM and single particle image processing, to understand how both novel natural products and clinical antibiotics bind to the ribosome to bring about their inhibitory effects on protein synthesis. Furthermore, I will investigate the cause of toxicity of certain ribosome-binding antibiotics by examining how they bind to the mammalian mitochondrial ribosome. Finally, I will use a combination of cryoEM and protein X-ray crystallography to elucidate how certain ribosomal-protecting proteins form complexes with the ribosome in order to bring about antibiotic resistance. On an individual level, these studies will allow an assessment of the viability of novel natural products as suitable clinical antibiotics. More generally, they will contribute to our knowledge of how different classes of antibiotics target the ribosomes of pathogenic bacteria, and how these bacteria evolve resistance. This knowledge will help the development of methods to rationally design new ribosome-targeting antibiotics that are able to overcome or circumvent resistance.

Amount: £0
Funder: The Wellcome Trust
Recipient: University of Leeds

Supramolecular peptide nanotechnology for antimicrobial therapies 04 Dec 2017

Antimicrobials remain the main means to treat and control bacterial infections, but their efficacy is now compromised due to overuse in humans, animals, agriculture, with bacteria developing resistance that renders certain antibiotics ineffective. Infections due multi-drug resistant (MDR) bacteria have emerged as one of the most significant global threats to human and animal health in the 21st century. Thus, the development of new antibiotics, or better ways to deliver existing antibiotics more effectively, is an urgent priority. Polymyxins are "old" antibiotics that have re-emerged as the last resort for treating infections caused by MDR Gram-negative bacteria. There are two polymyxins in clinical use, polymyxin B and polymyxin E (colistin), but their low stability, unpredictable pharmacokinetics and nephrotoxicity still raise significant concerns. We hypothesize that nano-engineered carriers will be able to restore and/or enhance the efficacy of polymyxins against MDR Gram-negative bacteria by improving their pharmacokinetic profiles, compared to standard mono and dual antimicrobial formulations, whilst minimizing the risks of adverse systemic effects. We will develop and optimize novel self-assembled nanocarriers for the controlled delivery of polymyxins and assess their potential to treat more effectively bacterial-related infections. This data will make the basis for future grant applications under the AMR initiatives.

Amount: £99,986
Funder: The Wellcome Trust
Recipient: Queen Mary University of London

The role of MINK1 in homoeostasis of the intestinal epithelium 30 Sep 2018

Surgery and chemotherapy, which preferentially kills dividing cells, are the main treatments for colon cancer: a common disease in the developed world. To develop better treatments requires defining the molecular events that cause tumours to grow so that these specific aberrations can be bypassed. Mutations in a gene called Adenomatous polyposis coli (Apc) are the most common molecular change identified in colon tumours. The Näthke lab recently discovered that APC protein (encoded by the Apc gene) binds to and regulates the abundance of another protein (MINK1) with roles in cell division and movement. This raises the possibility that faulty control of MINK1 by mutated APC could explain why cells in colon tumours divide excessively and migrate aberrantly. I will investigate the function and control of MINK1. Using cells grown in dishes and also cells that form mini-gut structures called organoids, experiments will be designed to determine whether and how MINK1 is required for Apc mutations to cause cancer, and how MINK1 affects the structure of the gut lining. These issues will also be addressed in mice whose guts lack the Mink1 gene. Results will help to decide whether human colon cancer can be treated by new drugs that target MINK1.

Amount: £0
Funder: The Wellcome Trust
Recipient: University of Dundee

Modelling synaptic and intrinsic plasticity in the somatosensory cortex 04 Dec 2017

Somatosensory plasticity is as key ingredient of sensorimotor learning; a better understanding of the plasticity mechanisms involved would yield insights for neuroprosthetics, motor rehabilitation, and chronic pain. In the somatosensory cortex, changes in the hand representation have been described under stimulation paradigms lasting only a few hours. Conversely, other evidence shows that cortical representations are stable over long periods of time. These disparate results raise the question of whether different plasticity mechanisms, operating on different timescales, might be involved. Recent advances in neuroimaging techniques have allowed us to observe and track plasticity in the human brain, leading to novel insights into the timescale and extent of sensorimotor learning. However, inferring specific plasticity mechanisms from these data has been challenging, as observed cortical changes are often compatible with multiple mechanisms. Here, we focus on two forms of plasticity: synaptic plasticity, which determines which specific inputs will excite a cortical neuron, and intrinsic plasticity, which determines the neuron’s overall responsiveness. We propose a computational framework that will track the effects of these two mechanisms on sensory cortical representations and make predictions that can be empirically tested using existing fMRI paradigms.

Amount: £99,605
Funder: The Wellcome Trust
Recipient: University of Sheffield

Human Challenge Studies in Endemic Settings: Ethical and Regulatory Issues 30 Sep 2018

This study will investigate the key ethical and regulatory considerations regarding human challenge studies (HCS) in endemic settings—and to examine the ethical processes (e.g., in the design, review, and conduct) involved in such studies to date (with a focus on recent HCS involving diarrheal disease in Thailand and malaria in Kenya and Tanzania). Our approach to this project will include two main data gathering processes: (1) review of relevant literature, and (2) qualitative research, involving in-depth interviews of those involved in the conduct and ethical review of recent HCS in endemic settings (focusing especially on HCS involving diarrheal disease in Thailand and malaria in Kenya and Tanzania) and other relevant stakeholders.

Amount: £99,407
Funder: The Wellcome Trust
Recipient: Monash University