Invest in ME Research have been working towards establishing an examination and research facility for ME in Norwich, Norfolk, UK, utilising the knowledge, expertise and facilities within and around the Norwich Research Park – which includes the University of East Anglia, the Institute of Food Research (transforming to Quadram Institute), Earlham Institute (formerly The Genome Analysis Centre) and the Norfolk and Norwich University Hospital.
The charity published its proposal for a UK Centre of Excellence for ME in 2010. Supporters launched the Let’s Do It for ME campaign in 2011 to help raise funds for the research. The translational biomedical research strategy got underway in 2013.
A detailed description is available on the Invest in ME Research CofE microsite.
People with ME need early and correct diagnosis, proper treatment and advice. The status of services for people with ME and their families in the UK has been poor with little knowledge of current biomedical research being applied and possible treatments not being made available to patients or healthcare staff.
This has resulted in ME patients having no service and there being little progress in attracting new researchers or clinicians to study the disease.
The dangers for people with ME having no proper clinical examination and no access to possible treatments is that the disease can develop into more severe forms with significant loss of functioning. There is also the danger of mis- or missed diagnosis – a common problem with people thought to suffer from ME.
The charity’s’ proposal for a Centre of Excellence for ME will require key elements to be put in place or developed to enable the aetiology of the disease to be understood and advances to be made in finding the cause of this disease by developing treatments for patients.
These would consist of – full examinations, clinical diagnosis, translational biomedical research, a research database (including biobank(s) to allow for more research opportunities and support) and improved education and training of healthcare staff with standard and up-to-date protocols being used.
Figure 1 shows the elements of the model with patient care and treatment at the centre of the model.
The proposal is located around the Norwich Research Park in Norfolk. This area contains world-class facilities with a leading university (the University of East Anglia), leading research institutes and a modern flagship hospital (the Norfolk and Norwich University Hospital) – all of which complement the necessary biomedical research which would take place.
REFERRALS & CLINICAL EXAMINATIONS
This proposal would make use of the existing infrastructure where patients are initially seen by GPs and referred to a consultant. It is assumed that the local primary care would initially filter ME patients via GPs using appropriate guidelines and having performed necessary tests, as normally happens to exclude other conditions.
GPs in the area with a special interest in ME would be used to assist and be trained in diagnosis and treatment of ME. Once having ensured that a patient is a likely candidate for referral to an ME consultant then that referral would be made. The service would require early and correct examination and referral to the consultant
The examinations of people with ME would be performed by the ME consultant at the Centre – in the hospital. Referrals to the university hospital would be via existing methods from GPs. An important issue is for early and correct diagnosis to be determined. The consultant would perform a full clinical examination of the patient using a standard clinical protocols. For home-bound patients who are unable to visit the hospital then home visits would be built into the model.
DIAGNOSIS & TREATMENT
The diagnosis would be confirmed by the ME consultant (using the international standard Canadian Consensus Guidelines or its evolutionary replacement), and, once patients have been formally diagnosed as having ME, administer possible treatments. If consent is obtained the patient may then also be entered for inclusion and participation in biomedical research into the disease at the centre.
Using a standard diagnostic and clinical protocol the service would allow a model of care and appropriate care packages for people with severe presentations and to establish and co-ordinate a clinical network and disseminate best practice across that network.Follow-up examinations would be scheduled so that patients are provided with a service and possible treatments and results from any treatments are fed back into a database which is administered between the university hospital and the university research faculty.
TRANSLATIONAL BIOMEDICAL RESEARCH
It is important that the consultant is linked with the research taking place in the Research Park.
A parallel but complementary element will be for translational biomedical research to be started by the university in association with other complementary research organisations.
The university would undertake biomedical research into ME using cohorts of patients from those being examined at the university hospital and provide possible recommendations for treatment.
The university research would be used for more rapid provision of possible treatments for patients whilst at the same time building up the research database for ME/CFS and allowing fostering of new areas of cooperation with other biomedical research facilities.
The research being proposed by the university would be of the most advanced possible – using virology and immunology as the key for examining patients. An important aspect of the biomedical research is that properly defined and distinct patient cohorts are defined and maintained.
The research would be oriented toward translational biomedical research, which allows results from research to be applied toward treatments for ME patients.
Allied to this would be biomedical research projects – the first of which would examine the possible link between ME and gut inflammation.
The Centre of Excellence is intended to establish the cause(s) of ME and develop treatments. Research would also be focused on international collaboration in biomedical research.
RESEARCH DATABASE REPOSITORY
These initial and ongoing projects would enable a research repository to be established for use in further research. This research repository will assist epidemiological studies, enhance research potential and provide patients with proper records of treatment. Similarly a bio/tissuebank would be established/augmented using a registry and standard up-to-date protocols for collection.
A research protocol will be established to outline all the study procedures, including data collection and planned data analysis.
Invest in ME Research has been facilitating and supporting a strategy of international collaboration in research into ME which the charity believes is the most effective and quickest route to finding solutions to this disease.
The charity is funding research and joined with the Alison Hunter Memorial Foundation of Australia, and with Bond University and University of East Anglia, in convening the Clinical Autoimmunity Working Group in London in May 2012 to raise awareness of ME, and promote collaboration, innovation and the foundations for a clearer strategy of biomedical research into ME.
Invest in ME Research has organised 11 international ME conferences and 6 biomedical research colloquiums and is a founding member of European ME Alliance.
The foundations are therefore already in place to advance science and provide the promise of better treatment and possible restoration of function and lives back to a section of the community who have received very little help in the past.