Rheumatology 2008 47(Supplement 1):i1-i3; doi:10.1093/rheumatology/kem337
© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Report on Arthritis Research Campaign sponsored meeting: Osteoarthritis Research Horizon Scanning—23/24 October 2006, University of Warwick
A. J. Silman
Arthritis Research Campaign, Chesterfield, UK.
Correspondence to: A. J. Silman, Arthritis Research Campaign, Chesterfield S417TD, UK. E-mail: a.silman{at}arc.org.uk
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Summary
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The UK Arthritis Research Campaign (ARC) organized a meeting
on 23/24 October 2006 with the aim of bringing together the
leading UK clinical and basic scientists in osteoarthritis (OA)
research. The principal goal was to identify key strategic research
target areas that would stimulate an increase in competitive
applications for research funding in these areas. In addition,
the meeting aimed to identify constraints to research in OA
and suggest solutions, with a particular focus on areas that
ARC could lead on. Thus the meeting also focused on the technologies,
infrastructure and skills needed to ensure a successful programme
of research.
The major outcome of the meeting was the identification of a number of research priority areas suitable for applications to response mode funding. In addition, a number of key activities that would facilitate high-quality research were considered appropriate for ARC central organization.
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Workshop programme outline
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The workshop was attended by 60 invited UK research active individuals
across all relevant areas of OA research. The workshop commenced
with ‘state of the art’ presentations in each of
the six chosen target areas:
- Epidemiology and genetics
- Biomarkers and assessment tools (including imaging)
- Disease mechanisms and pathogenesis
- Pharmaceuticals and novel therapies
- Orthopaedic surgery
- Pain management
Each presentation identified the areas of current research interest and the major gaps in knowledge. These provided the backdrop for the subsequent small group discussions for which purpose participants were then split into subgroups, for each of these areas.
Subgroup tasks
The major part of the meeting was then devoted to the subgroups who were charged with the following:
- Identify gaps in current research and prioritize emerging topics in order of importance based on:
- Patient/public health need
- Timeliness given state of scientific knowledge
- Tractability
- Where UK research can lead
- Consider constraints in addressing these gaps including:
- Availability of clinical material
- Skills shortages in relation to specific areas of scientific expertise
- Limited availability of technology due to costs and other factors
- Identify what kinds of research support from ARC (as well as from other funders) would be best suited to address (i) given (ii) e.g.:
- Project grants
- Long-term programme support
- Fellowship schemes
- Are other types of funding scheme needed?
At the final session, each subgroup presented their conclusions to the whole group leading to a wider discussion about the next steps. From these discussions emerged a list of research topics that could provide the focus of a number of new investigator-initiated funding applications. A number of centralized tasks were identified that ARC could organize for the benefit of the UK osteoarthritis community.
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Priority OA research topics
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The subgroups emerged with a large number of research topics
for priority. Some of these were tightly focused, others were
broader in scope. The results are listed in Appendix 1. It is
hoped that this list will stimulate research activity in the
areas outlined that would be appropriate for funding by ARC
as well as other funders.
Thus, these research areas have been identified by a group of experts in OA research as being appropriate for consideration as priorities for OA research. The ARC funding committees will not have funds specifically ‘ring-fenced’ for OA research although ARC hopes that this list will act as a stimulus to increase the number of fundable applications. Grant reviewers for relevant grants, as well as the funding committees, would be informed that ARC wishes to fund high-quality science in these areas of OA research. All applications will be peer reviewed for their scientific merits following current processes.
Research fellowships
The meeting identified a capacity gap in several areas of OA research and would wish to encourage fellowship applications in a number of specific areas of science to develop expertise in the UK. These are listed in Appendix 2.
Again ARC will not ring-fence-specific funds for fellowships in OA but reviewers and interview committees will be informed of these areas of interest.
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Centralized ARC activities
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Two recurring themes at the workshop were first the need to
maximize the use of clinical and biological resources available
nationally for OA research and second to harmonize the approaches
used in both clinical and laboratory-based research to permit
greater comparability between the studies. As a consequence
the following centralized activities were identified for ARC
to undertake.
Inventory of data sets and tissue collections
It was proposed to establish an inventory of clinical data sets, both cross-sectional and longitudinal, with details of the data items recorded. A similar exercise will be undertaken with regard to collections of tissues including cartilage samples, synovial fluids and other tissues and biological materials such as DNA. Such an inventory would also include the source of funding (ARC or other). The main purpose would be to enhance collaboration between groups. Access to the data or materials would be by direct contact with the investigators concerned but details of the scope of each collection and the contact person would be available from the ARC website. The aim would be to update this on an annual basis.
A separate inventory of transgenics will also be considered, which might be incorporated into the above or undertaken as a separate exercise
Working groups on standards in OA research
Two working groups will be established on (i) standards for clinical data collection and (ii) standards for collection and storage of biological samples, and once these reports were produced the standards would be published on the ARC website.
One of the major barriers to translational and clinical research is the lack of an agreed nomenclature and criteria for accurately defining the clinical OA phenotype and its correlates. Such an exercise should include:
- Definition of OA and its agreed subtypes
- Assessment methods for pain, function and quality of life
- Methods of imaging
- Appropriate standards for biomarkers
There is an extensive literature on many of these issues but by producing agreed guidelines in these areas, this will assist the OA community in planning future studies. There are also areas of inconsistency in the published material and an agreement between researchers would enhance the quality and comparability between studies.
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Appendix 1
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OA Horizons Research Scanning Meeting
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Priority topics for research
In October 2006, a 2-day meeting was held of UK experts in several
areas of osteoarthritis (OA), research. One of the key goals
was to identify areas of priority for research given the current
state of knowledge, the need to assess clinical problems, the
tractability of the topic and the status of the UK in these
areas. A number of such areas were identified that are listed
subsequently and ARC encourages applications in these areas,
though the list should not be considered exhaustive with regard
to OA research it is prepared to fund. Some of these topics
are very broad and others more focused and they are not mutually
exclusive.
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Epidemiology and genetics
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- Identification of novel genes through association studies
- Gene–environment interactions
- Confirmation, fine mapping and translation of genetic associations
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Imaging and molecular markers (all biomarker research will need to utilize agreed phenotype definitions)
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- Need to identify novel biomarkers both individually and in combination that will predict susceptibility to and progression of OA
- Need to validate existing biomarkers
- Integration results of imaging and molecular biomarkers
- Performance characteristics of biomarkers in epidemiological and clinical studies
- Biomarkers that improve an understanding of the relationship between bone and cartilage in OA
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Disease mechanisms and pathogenesis
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- Mouse genetic models to identify pathways and processes
- Gene array and proteomic screens
- Large animal models for specific testing of novel agents and cell therapies
- Understanding of age-related change in normal cartilage
- Delivery of genes to chondrocytes and stem cells
- Studies that inform relative role of bone, synovium and cartilage
- Understanding mechanisms of pain in OA
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Novel therapies
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- Investigations of potential new biologics including:
- Identification of new targets from in-vivo experiments
- Role of gene therapy and technological issues
- Role of cell therapies and technological issues
- Combination of novel therapies
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Conservative management
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- Targeting of patients for specific types of interventions
- Barriers to adherence to therapies
- Role of self-care vs professional care
- Long-term outcome studies (given short-term scope of randomized trials)
- Patient perspective on outcomes
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Orthopaedic surgery
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- How to improve outcome of current surgical therapies, including joint replacement:
- Clinical studies, e.g.:
Improving assessment tools both for targeting and outcome assessment
- Better targeting of patients for different surgical procedures
- Clinical research networking
- Laboratory based, e.g.:
- Causes of implant failure; biological and biomechanical
- Pre-clinical testing
- Safety and toxicity
- How to develop the next generation of surgical therapies:
- The relationship between biomaterials and biological environment in relation to implants (from nano- to macro-scale)
- Cell and biomaterial combination therapies
- Identifying role of prevention strategies following trauma (including surgical):
- Biomechanical
- Partial joint replacement
- Pathogenesis and surgery:
- Understanding the cause of OA by studies at the end stage
- Banking strategies for surgical specimens
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Appendix 2
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OA Horizons Research Scanning Meeting
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Priority topics for research fellowships
In October 2006, a 2-day meeting was held of UK experts in several
areas of OA research. One of the key goals was to identify areas
of priority for research given the current state of knowledge
and the constraints to satisfying these gaps. One of the key
constraints is a capacity gap in specific areas of expertise
and ARC wishes to encourage applications in these areas of science.
This list should not be considered exhaustive with regard to
OA fellowships ARC is prepared to fund.
Fellowship applications focused on OA are encouraged in the following areas:
- Animal models
- Neurophysiology and pain
- Biochemistry
- Histopathology
- Imaging
- Bioinformatics
- In vivo experimentalists
- ‘Omics’.
Disclosure statement: The author has declared no conflicts of interest.
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Summary
Workshop programme outline