The £20m set of Blood and Transplant Research Units (BTRUs) - co-funded by the National Institute for Health and Care Research (NIHR) and NHSBT - are aimed at providing new technologies, techniques or insights that will benefit donation, transfusion, and transplantation. The NIHR BTRUs are partnerships between universities and NHSBT.

Many of the work strands in the new units could result in new technologies and practices that can then be delivered at scale by NHSBT, helping to save and improve even more lives.

Much of the work will be aimed at reducing health disparities and improving access to new treatments. For example, one BTRU will seek to expand and gene edit cord blood donations, to try and improve access to stem cell transplants for black, Asian and minority ethnic communities. Another will seek to create universal donor type O kidneys, which could reduce waiting times to transplant in minority communities.

The University of Nottingham is part of the NIHR BTRU in Donor Health and Behaviour - partnered with the University of Cambridge, working in collaboration with the University of Nottingham and the University of Oxford.

The evidence based underpinning blood donation is underdeveloped. This research aims to improve the safety and efficiency of blood donation through more detailed research. The BTRU will conduct research to address major challenges identified by NHSBT, such as finding ways to encourage a more ethnically diverse range of people to donate blood, developing new methods for recruiting and retaining donors, promoting safe and effective donation practices and identifying risks of adverse health effects of blood donation.

The unit will also train researchers and PhD students, support Patient and Public Involvement and Engagement activities and ensure that research findings are translated into benefits for donors and NHSBT.

Example of work included will include:

• Aligns the blood donor base to better match demand for transfusions, particularly for diseases affecting ethnic minorities (e.g. sickle cell disease).
• Exploits modern tools in computing and medicine to optimise the donor base and improve planning.
• Promotes safe and effective donation practices.

The application of behavioural and psychological sciences to understand the complexities of why people decide to donate blood and remain as a donor is critical. This BTRU in blood donor health and behaviour offers a unique opportunity in the UK to develop a sustained programme of research to better understand blood donors, enhance the equality and diversity of blood donors, and help develop new systems and policies to meet the health needs of the diverse UK population.

The other units are:

NIHR BTRU in Precision Cellular Therapeutics - partnered with the University of Oxford, working in collaboration with the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust.

The aim is to develop new kinds of cell therapies for blood disorders and blood cancer, and improved systems for following up patients receiving treatment to better support their care.

There is a wide range of work in the package but examples include:

• Transplants work in blood cancer patients because some of the donor immune cells attack and eliminate the cancer. However the transplanted cells can also attack normal body organs in the patient and cause a complication called graft versus host disease (GvHD). The team will seek to identify and clone the receptors that enable the T cells to target the cancer cells. The ultimate aim of this research is develop a novel clinical trial, with NHSBT, via its cell therapy manufacturing infrastructure, expanding these cancer specific T cells for use in patients while reducing the toxicity due to GvHD seen in patients.
• There is a shortage of suitable cell donors for minority communities. Cord blood units from babies may be a match but not have enough cells to be successful in adults. The team will seek to expand and gene edit the stem cells in cord blood, so they could be used with increased safely in a wider range of adults. NHSBT will support the translation of this research through to early phase clinical trials, providing process development, manufacturing and quality control expertise. This initiative will drive wider access to cord blood transplant.
• It is important that patients from all communities benefit from cell therapies. The team will seek to better understand how patients access the newer cell therapies and how they perceive the benefits of treatment. The team will develop new digital technologies that improve care by enhancing interactions between the patients and their doctors and nurses.

NIHR BTRU in Data Driven Transfusion Practice - partnered with the University of Oxford, working in collaboration with the University of Leeds, Queen Mary University of London, with Guys and St Thomas NHS Foundation Trust, and further hospitals.

Blood transfusions save lives but must be used appropriately and like all medical interventions they carry a risk. Around 20-25% of blood transfusions are given outside of clinical guidelines. Data-driven approaches, using actual data at all steps in the transfusion chain, can offer ways to improve transfusion practice.

There are a wide range of innovative projects in the package but examples include:

• Work with hospital teams across the country to develop a linked electronic pathway between hospitals and from donors to patients receiving blood, to monitor and improve clinical use of transfusion.
• Work with primary care on data to develop a risk assessment tool for targeted anaemia screening and treatment before the patient needs to come to hospital, reducing the need for transfusions.

NIHR BTRU in Organ Donation and Transplantation - jointly partnered with Newcastle University and the University of Oxford.

The aims of the BTRU are to increase the number of organs available, improve long-term outcomes and improve quality of life after transplant.

There is a wide range of work in the package but examples include:

• Trial the use of enzymes to remove blood group A and B antigens from donated organs during machine perfusion, to create universal donor O type organs. This could transform clinical practice and especially benefit ethnic minority groups who currently have reduced access to transplantation due to high prevalence of blood group B.
• Increasing the use of donated organs through image analysis. The unit will further develop an app which can rate the likely performance of an organ based on its appearance – for example, how much fat there is on a donated liver – giving a prediction of the transplant outcome.
• Reducing the risk of longer term rejection in kidney transplants. Kidneys need matching by tissue type as well as blood type, but research has shown there can be variation in compatibility down to the molecular level. This increases the risk of rejection and the need for immunosuppressants, which have potentially damaging side effects. The team has developed an algorithm to improve tissue matching at the molecular level and will now work with NHSBT to incorporate it into the UK Living Kidney Sharing Scheme.

NIHR BTRU in Genomics to Enhance Microbiology Screening - partnered with the University of Oxford, working in collaboration with University College London and the UK Health Security Agency.

The GEMS programme will evaluate and provide solutions for current threats to the microbiological safety of blood, organs and derived products used to treat patients. The team will see how new, large scale genetic testing methods – collectively known as High Throughput Sequencing - can detect and often fully genetically characterise infectious agents present in patient and donor samples.

There is a wide range of work in the package.

• Literally hundreds of different sorts of viruses live in us, collectively known as the human virome. The team will use deep genome sequencing methods to assess their presence and better understand any health risk from their transmission during blood transfusion of organ or stem cell transplant and how these potential risks can be mitigated.
• Blood donors provide a valuable cross-section of the adult population with which to pick up early signs of emerging infections in the UK. The team will use a donation bioarchive to test anonymised samples for novel pathogens using High Throughput Sequencing. The project will additionally link with UKHSA surveillance programmes, potentially developing larger early warning systems in areas where viruses are detected.

The BRTUs are funded by £16m from the NIHR and £4m from NHSBT, with research goals set to meet NHSBT’s requirements, to be delivered between 2022 and 2027. The products could be manufactured at the NHSBT including major new centres such as the new cellular therapies laboratories and the forthcoming Clinical Biotechnology Centre.

Dr Gail Miflin, Chief Medical Officer for NHSBT, said: “By collaborating with academia, these five new Blood and Transplant Research Units will help us to deliver on our mission to ‘save and improve even more lives’ and drive innovation to inform future clinical practice and improve patient outcomes.

“For example, the supply-demand gap for solid organs continues to grow. We will explore the use of organ perfusion technologies to maintain and enhance the quality of organs, improve organ preservation and increase organ utilisation. This will enable more patients to receive the transplant they need.

“And by building and analysing new data sets to track and demonstrate the impact of our interventions will lead to better understanding and improved outcomes. We already do this well for solid organs, but do not currently understand the outcomes for people who receive blood or stem cells. We will work with partners to build integrated data sets for these patients, focusing on the multi-transfused, especially those with sickle cell disease where a clear health inequity exists.

“To maximise the value and impact from our research, we will accelerate the translation of innovation into practice. The NIHR BTRUs will be an important vehicle for this in the longer term.”

Story credits

More information is available from Professor Eamonn Ferguson at the University of Nottingham eamonn.ferguson@nottingham.ac.uk

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