The 'CARDIOvascular-Immune-Mediated Inflammatory Diseases (CARDIO-IMID) UK Network'
Lead Research Organisation:
University of Manchester
Department Name: School of Biological Sciences
Abstract
Objective: To improve the outcomes of people with Immune-mediated inflammatory diseases (IMID) who are at risk of/have cardiovascular (CV; heart and vessels) involvement, by bringing together the UK's expertise in CV and IMID research, raising awareness, improving methods of diagnosis and monitoring and increasing research in the field.
Background: Over a million people in the UK are affected by IMIDs in which abnormal behaviour of the immune system causes inflammation of the joints, skin and internal organs. The most common IMID is rheumatoid arthritis, but also includes systemic lupus erythematosus and rare diseases such as systemic sclerosis. People with IMIDs are 3-4 times at higher risk of dying compared to the general population, with CV involvement one of the major causes.
Unmet needs: We do not have standard methods to diagnose CV involvement in people with IMIDs, which can delay diagnosis. We do not know how to identify and monitor patients most at risk of CV disease (CVD). Clinical trials of people with IMIDs do not evaluate for CVD, so we do not have good evidence on which treatments improve CV outcomes. Key imaging methods that detect CVD are CV magnetic resonance imaging (CMR) and PET-CT. CMR is safe and very accurate but CMR measures have not been tailored to people with IMIDs. PET-CT is an effective tool to identify inflammation, but its access is variable. Also, it is not clear which patients with abnormalities may develop actual problems later.
Aims: We will establish a national network, the "CARDIO IMID UK Network" and have already identified 29 centres across England, Scotland, Wales and Northern Ireland. The Network will bring together CV and IMID experts and allow us to:
1. Bring together doctors and researchers from the CV and IMID fields and patient groups to improve education and training, and develop a national research strategy. This will lead to pathways of care tailored to people with IMIDs and better methods of diagnosis and treatment.
2a. Develop a database platform to securely store, manage and analyse clinical and heart investigation data from people with IMIDs and CV involvement across the centres so that we can conduct studies in the future.
3b. Establish a patient registry of existing and new people with IMIDs and CV involvement. This will be an invaluable resource to better understand the features of CV involvements across different IMIDs and inform future studies to improve diagnosis and test therapies.
3. Bring in uniform methods for CMR and PET-CT scanning and diagnosis so people with IMID across the UK are assessed in a way that is comparable across centres.
4a. Link the above registry with national initiatives such as the NIHR Bioresource for IMID that collects samples from people with different IMIDs
4b. Conduct a pilot study in which clinical, imaging and blood marker data obtained from a subgroup of patients recruited to the registry will establish capability to do this on a larger scale and inform the design to discover markers to help diagnose and develop new treatments
5.Establish collaboration with industry to enable inward investment and sustainability of the partnership beyond the duration of the grant; and the development of studies to target the unmet needs of this IMID population at risk of CVD.
We have crucial support from key partner groups including (i) existing national IMID networks which will identify patients and develop research projects (ii) the NIHR-Versus Arthritis Musculoskeletal Translational Research Collaboration, a network of academic experts in IMIDs and novel research to tailor therapies (iii) the NIHR-BHF Cardiovascular Partnership, a national collaborative of CV researchers, which has supported the convening of the CARDIO IMID UK Network community
If successful, the MRC-funded 'CARDIO-IMID UK Network' will be one of the largest national interdisciplinary initiatives that will have a major impact on people with IMIDs.
Background: Over a million people in the UK are affected by IMIDs in which abnormal behaviour of the immune system causes inflammation of the joints, skin and internal organs. The most common IMID is rheumatoid arthritis, but also includes systemic lupus erythematosus and rare diseases such as systemic sclerosis. People with IMIDs are 3-4 times at higher risk of dying compared to the general population, with CV involvement one of the major causes.
Unmet needs: We do not have standard methods to diagnose CV involvement in people with IMIDs, which can delay diagnosis. We do not know how to identify and monitor patients most at risk of CV disease (CVD). Clinical trials of people with IMIDs do not evaluate for CVD, so we do not have good evidence on which treatments improve CV outcomes. Key imaging methods that detect CVD are CV magnetic resonance imaging (CMR) and PET-CT. CMR is safe and very accurate but CMR measures have not been tailored to people with IMIDs. PET-CT is an effective tool to identify inflammation, but its access is variable. Also, it is not clear which patients with abnormalities may develop actual problems later.
Aims: We will establish a national network, the "CARDIO IMID UK Network" and have already identified 29 centres across England, Scotland, Wales and Northern Ireland. The Network will bring together CV and IMID experts and allow us to:
1. Bring together doctors and researchers from the CV and IMID fields and patient groups to improve education and training, and develop a national research strategy. This will lead to pathways of care tailored to people with IMIDs and better methods of diagnosis and treatment.
2a. Develop a database platform to securely store, manage and analyse clinical and heart investigation data from people with IMIDs and CV involvement across the centres so that we can conduct studies in the future.
3b. Establish a patient registry of existing and new people with IMIDs and CV involvement. This will be an invaluable resource to better understand the features of CV involvements across different IMIDs and inform future studies to improve diagnosis and test therapies.
3. Bring in uniform methods for CMR and PET-CT scanning and diagnosis so people with IMID across the UK are assessed in a way that is comparable across centres.
4a. Link the above registry with national initiatives such as the NIHR Bioresource for IMID that collects samples from people with different IMIDs
4b. Conduct a pilot study in which clinical, imaging and blood marker data obtained from a subgroup of patients recruited to the registry will establish capability to do this on a larger scale and inform the design to discover markers to help diagnose and develop new treatments
5.Establish collaboration with industry to enable inward investment and sustainability of the partnership beyond the duration of the grant; and the development of studies to target the unmet needs of this IMID population at risk of CVD.
We have crucial support from key partner groups including (i) existing national IMID networks which will identify patients and develop research projects (ii) the NIHR-Versus Arthritis Musculoskeletal Translational Research Collaboration, a network of academic experts in IMIDs and novel research to tailor therapies (iii) the NIHR-BHF Cardiovascular Partnership, a national collaborative of CV researchers, which has supported the convening of the CARDIO IMID UK Network community
If successful, the MRC-funded 'CARDIO-IMID UK Network' will be one of the largest national interdisciplinary initiatives that will have a major impact on people with IMIDs.
Technical Summary
The ambition of this partnership is to establish the first CARDIOvascular-Immune-Mediated Inflammatory Diseases (CARDIO-IMID) UK Network that is world-class to improve cardiovascular disease (CVD) outcomes in people with IMID. IMID precision medicine consortia have not captured CVD, despite it being the major cause of death. Specific evidence-based strategies for the prevention, diagnosis and therapy of CVD (from atherosclerosis to myocardial disease) are lacking. There are no diagnostic criteria tailored to IMIDs. Studies employing advanced CV imaging have been modest-sized, with varied methodology, limiting translation of findings and design of prospective studies and intervention trials. The proposed network will connect the current 29 centres and:
1. Establish a UK-wide network of CV and IMID clinicians and researchers. Scientific meetings, education and training will raise awareness, promote development of cardio-rheumatology services and a national research strategy to accelerate basic, translational and clinical studies.
2. Establish a cloud-computing platform for high quality clinical and imaging data acquisition, analysis, and sharing to support multi-centre studies
3. Establish a national registry of patients across the IMID-CVD spectrum to understand risk factors, prognosis and prediction and enable data linkage to obtain longer-term outcomes.
4. Agree on and implement diagnostic criteria and harmonised CV MRI and PET-CT imaging protocols
5. Link the registry with key national bioresources, NIHR Bioresource IMID and rare diseases, to investigate cross-disease immunopathogenic and cardiometabolic pathways
6. Develop data science and machine learning to identify novel biomarkers of IMID-CVD
7. Establish strong academic-industry engagement to identify novel therapeutic assets and methods and attract inward investment.
This initiative will deliver high-quality biomedical research studies and targeted therapeutic CVD trials to improve CV outcome
1. Establish a UK-wide network of CV and IMID clinicians and researchers. Scientific meetings, education and training will raise awareness, promote development of cardio-rheumatology services and a national research strategy to accelerate basic, translational and clinical studies.
2. Establish a cloud-computing platform for high quality clinical and imaging data acquisition, analysis, and sharing to support multi-centre studies
3. Establish a national registry of patients across the IMID-CVD spectrum to understand risk factors, prognosis and prediction and enable data linkage to obtain longer-term outcomes.
4. Agree on and implement diagnostic criteria and harmonised CV MRI and PET-CT imaging protocols
5. Link the registry with key national bioresources, NIHR Bioresource IMID and rare diseases, to investigate cross-disease immunopathogenic and cardiometabolic pathways
6. Develop data science and machine learning to identify novel biomarkers of IMID-CVD
7. Establish strong academic-industry engagement to identify novel therapeutic assets and methods and attract inward investment.
This initiative will deliver high-quality biomedical research studies and targeted therapeutic CVD trials to improve CV outcome
