New RCSI light technology can improve surgical outcomes

Professor Donal O’Shea, Professor and Head of Department of Chemistry, RCSI

A technology that can light up cancerous cells during surgery promises better post-operative outcomes for patients.

The new technique precisely defines the boundaries of a cancer using chemistry, imaging technology and artificial intelligence by lighting up cancer tissue that is attached to a fluorescent agent.

It has been shown in previous research that artificial intelligence is highly effective – often more effective than human experts – when it comes to analysing medical images.

The research effort was led by Prof Donal O’Shea, Department of Chemistry at the Royal College of Surgeons in Ireland (RCSI) and published in the latest edition of Chemical Science.

The surgeons can use the technology to see lit up cancer issue through specialised cameras or microscopes, O’Shea said, and will not have to rely so heavily on their own experience when making decisions as to what tissue needs to be removed.

Tumours 

Currently, a surgical team can get access to a variety of different images of a patient’s tumour from technology such as CT scans, or MRI scans. These can help to locate the tumour and its size in advance, but in theatre, the surgeon is on her own.

“Quite often, depending on the tumour, they may be doing it by touch, by trying to feel the different tissues, by their experience, by visually looking at different tissues,” O’Shea said.

The new technology’s real benefit, he said, is that it can help the surgeon make decisions ‘on the spot’ as the operation takes place, and not have to rely so much on their experience alone.

“The way this works is that you would shine light on the [cancer] tissue, and if the fluorescent agent is in the tissue it will emit, or shine, light back at you at a different wavelength,” O’Shea said.

“It means you can take, or capture images, whether pictures or movies, from this fluorescent light which is being emitted from the tissue,” O’Shea said.

“When it is done clinically, or in the laboratory, there are special devices that shine the light, and essentially, there are cameras to capture the image,” O’Shea added.

The new technology can benefit the approximately 60 percent of people with solid cancer tumours – in the lung, breast, or prostate for example – who undergo surgery for their removal.

Success 

The success of these operations depends on how effectively the solid cancer is removed and how much healthy tissue remains.

“In most surgeries there isn’t a huge margin of healthy tissue,” O’Shea said. “If you can imagine it is in brain cancer, it is very, very small margins. In breast cancer similarly, there may not be a large amount of tissue that a surgeon wants to take.”

“It’s the surgical team’s decisions they are making in real time during the operations as to, do we take this portion of the tissue, or that portion of the tissue.”

The researchers aim to also use the technology to help surgeons identify whether a solid cancer has spread in a patient.

“If there was metastasis in a nearby lymph node perhaps we could detect that with our imaging agent during the surgery,” O’Shea said.

Prof O’Shea is collaborating with Prof Ronan Cahill, a colorectal surgeon in the Mater University Hospital and IBM Research in Dublin to get the technology into clinical trials in three years.

 

 

 

RCSI scientists develop drug that stops killer sepsis

(L-R) Professor Steve Kerrigan and Dr Sinéad Hurley from the School of Pharmacy, Their pre-clinical trial has shown that the drug, called InnovoSep, has potential to stop all sepsis-causing bacteria from triggering organ damage in the early stages of the condition. (Credit: Maxwell Photography)

The almost 3,000 deaths from sepsis in Ireland could be prevented through the use of a new drug that stops the bacteria responsible in its tracks.

That’s according to scientists based at the Royal College of Surgeons in Ireland who have announced that a drug called InnovoSep, which was first developed to treat cancer, has demonstrated it can treat sepsis in preclinical trials.

Sepsis is caused when common bacteria  such as S. aureus or E. coli that live on the skin, eyes, or inside or nose, eyes or ears enter the blood where blood vessels have been damaged or exposed due to a cut, injury or infection.

Once in the blood, bacteria are, within seconds, transported around the body via the bloodstream, reaching  the vital organs, such as heart, liver and lungs, where, left untreated, they will cause organ failure and death.

“When the bacteria enter the blood it causes damage, and once we start to get damaged blood vessels we get blood vessels that are leaky,” explained Steve Kerrigan, Associate Professor of Pharmacology at RCSI.

“The way this drug works is, it stops the blood vessels getting damaged. This could be used to prevent somebody who’d be at high risk of developing sepsis, or prevent people who already have sepsis from getting worse,” Prof Kerrigan said.

It takes just 12 to 24 hours from the time bacteria enter the bloodstream for someone to die from sepsis-induced organ failure due to sepsis. The treatment is to use antibiotics, and survival depends on how fast the drugs are given.

The symptoms of sepsis are like the flu, with high temperature, rapid heart rate, low blood pressure, but the difference is that the symptoms advance in hours rather than over a number of days. In cases of suspected sepsis people are advised to immediately attend hospital A&E rather than visit the GP.

The rate of of sepsis is increasing at rate of about 10 percent per year, worldwide, a trend also being seen in Ireland. There are about 15,000 sepsis cases per annum here with some 3,000 deaths across all age groups.

Scientists do not yet understand why the number of sepsis cases are growing so rapidly around the world, but they suspect that antibiotic resistance, where bacteria find ways to survive antibiotic attack, is at the root of the issue.

The team at RCSI, led by Prof Steve Kerrigan, set out to find a drug that could prove effective against sepsis. They decided to investigate drugs that had been developed for other diseases but had failed to progress fully through clinical trials. This led them to InnovoSep, a drug developed to treat cancer.

The performance of the drug in preclinical trials were exciting,  and better than any other drugs that have been tested to treat sepsis, said Prof Kerrigan.

“It stops sepsis before it gets going,” explained Prof Kerrigan. “In a lot of the previous drugs, whey they have failed is because the horse has already bolted.”

It can take decades and hundreds of millions of euro to take a drug from the discovery stage and get it to market. But, because Innovosep has been trialled as a cancer drug, it could be available in five years, at a fraction of the cost.

The preclinical trials of InnovoSep were supported by the Enterprise Ireland Commercialisation Fund. The intention now, said Prof Kerrigan, is to conduct human trials of the drug in Ireland, and funding is being sought to do this.

Transition Year students get ‘real life’ doctoring experience at RCSI

RCSI

Iolanda Tiedt, final year medical student, RCSI, pictured in the TY MiniMed Programme clincal skills lab with Kate Brennan, aged 15, from St Mary’s Newport, Co Tipperary (Credit: Maxwell’s Photography, Dublin)

Transition Year students interested in a medical career have this week been getting invaluable experience into the ‘real life’ work of a medical doctor.

Some 150 students from 90 schools across Ireland have been seeing how medicine really works thanks to an initiative by the Royal College of Surgeons in Ireland (RCSI).

The highlight of the week-long programme, which finishes today, 17th January, was the opportunity to see a live operation performed.

The operation they witnessed took place at Beaumont Hospital. Aside from surgery, other areas of medicine covered included psychiatry, anatomy, epilepsy and genetics.

Leading medical professionals from RCSI and Beaumont Hospital were involved.

These include Professor Marie Cassidy, State Pathologist and Professor Arnold Hill, Consultant breast, endocrine and general surgeon at Beaumont hospital.

‘The TY MiniMed programme is a great opportunity for students to experience what it is like to train as a medical professional,” said Professor Hill.

“This is the 7th year of the programme and demand for the programme outweighs the number of places available,” Prof Hill added.

“Students will have an opportunity to use innovative technology and learn from some of Ireland’s top healthcare professionals from RCSI and Beaumont Hospital, giving them an excellent insight into careers in medicine, science and research,” Prof Hill concluded.

Protein injections reduce hereditary lung disease

Copy of AAT in health and disease

Hereditary emphysema affects thousands of Irish people (Image provided courtesy of the Royal College of Surgeons in Ireland) 

The lives of 12,000 Irish people affected by a hereditary lung condition can be improved by injecting a protein into the blood, according to new research by scientists at RCSI and Beaumont Hospital.

The hereditary form of emphysema, also called Alpha 1, is the most severe form of the lung disease, and it arises when someone is lacking the protecting protein called Alpha-1 Antitrypsin, or AAT.

Alpha-1 is much more common in Ireland than in most other countries. After cystic fibrosis, it is the most common fatal inherited lung condition in Ireland.

Up to 1 in 25 Irish people carry the gene for the disease, which 12,000 people here affected by the most severe form of Alpha 1 and up to 200,000 affected by the less severe form.

A lack of AAT causes an increase in white blood cell proteins in the blood, explained Professor Gerry McElvaney of RCSI, joint lead researcher on the project.

These proteins are recognized as ‘foreign’ by the body leading the immune system to respond to the ‘invasion’ by producing harmful oxidants.

The researchers found that purifying Alpha 1 protein from the blood – a process known as ‘augmentation therapy’ – and giving it intravenously can alleviate the disease.

“This research gives new hope for a better quality of life for sufferers of this chronic condition and may also be applied to other autoimmune associated diseases such as rheumatoid arthritis” Prof McElvaney added.

In 2004, the Alpha One Foundation initiated the first national screening programme for Alpha-1. To date, more than 11,000 individuals have been tested and 28% were found to be at risk from the disease.

The World Health Organisation recommends that everyone with Chronic Obstructive Pulmonary Disease (COPD) or emphysema should be tested for Alpha-1.

For more information on how to get tested for Alpha-1, see www.alpha1.ie or contact the National Centre for Alpha-1 at Beaumont Hospital (alpha1@rcsi.ie).

Their research findings were published in this month’s edition of Science Translational Medicine. The other joint lead reserachers on the project were Dr David Bergin and Dr Emer Reeves.