New annexe at Botnar marks decade of success

Research groups are moving into the new £11m annexe of the Botnar Research Centre at Oxford University. The annexe essentially doubles the size of the centre located on the site of the Nuffield Orthopaedic Centre in Headington.

Last year the centre celebrated its 10th anniversary. It's a celebration that is certainly justified, as that decade has seen an extraordinary growth and flowering of research in the centre, which focuses on musculoskeletal diseases such as arthritis and osteoporosis.

This is not always a high-profile area of research and the scientists involved certainly feel it loses out on funding to other areas more in vogue, like cancer or heart disease. Yet there is great clinical need here with a large burden of disease, pain and disability affecting the quality of life of many people, particularly with an ageing population.

The potential for developing improved treatments that will make a difference to the lives of large numbers of people with arthritis and osteoporosis is certainly there. Researchers in the Botnar centre develop and test not only existing technologies such as joint replacements but also novel tissue engineering implants which aim to treat early disease, maintain mobility, and keep many of us pain free for much longer in our lives.

Yet despite the field of orthopaedics in general facing some difficulties, it is an area of research that has actively grown at Oxford University.

'Generally speaking, this area of research has suffered in the last 10 years,' says Professor Andy Carr, head of the University's NDORMS department, Director of the Botnar Research Centre and a practising orthopaedic surgeon. 'It's remarkable that we've been able to grow in the way we have.'

The Botnar Research Centre currently houses the vast majority of the research going on in the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, or NDORMS. Until the centre came along 10 years ago and provided new impetus and opportunities, the department was one of the smaller parts of Oxford medicine with perhaps 20 researchers, Professor Carr explains. There will be around 220 University researchers working in the Botnar, once the new annexe of the building is fully occupied.

'I think there are three reasons for this expansion,' says Professor Carr. 'There is a huge need for advances in this area with an ageing population no longer dying from heart disease or cancer as they perhaps did, but now experiencing more arthritis and disability in later life. There was the brave step of the University, which decided to invest in this area when others were pulling out. And there has been the extraordinary philanthropy of first Lord Nuffield, secondly the Nuffield Orthopaedic Centre appeal and Botnar family, and thirdly the Kennedy Trust.'

The money to build the Botnar Research Centre in 2002, and then the equally large annexe last year, was achieved through an appeal at the Nuffield Orthopaedic Centre (NOC), now part of the Oxford University Hospitals NHS Trust, with the Botnar family being a substantial benefactor.

2012 was also the 75th anniversary of an academic department in this area at Oxford, with Lord Nuffield endowing a chair in orthopaedic surgery in 1937. There is an unlikely link between these benefactions too, Professor Carr notes. Lord Nuffield was a car manufacturer, who founded Morris Motors in Oxford, and the Botnars founded Datsun UK, importing Datsun (now Nissan) cars into the UK for the first time.

The Botnar centre is a real partnership between the NOC and the University, not just in the way funds have been raised but also in practice.

The point of it was to bring the University's bone, joint and arthritis research together in a purpose-built building on the hospital site – it's just across the car park from the main NOC building. It allows truly multidisciplinary science right where patients are, offering a partnership between University research and teaching and the work that goes on in NHS clinical practice.

NOC patients are asked whether they want to participate in research projects as a matter of course – it's part of the culture in both institutions. For example, Professor Carr says, 'over 90% of people undergoing operations at the NOC consent to donating tissue samples that are then stored and made available to researchers. We couldn’t do the research we do without it. It's a remarkable resource.'

This 'biobank' of stored tissue samples and associated data allows researchers to investigate the biological pathways underlying disease.

'But the real advantage of having aspects of a University department embedded in a hospital,' Professor Carr says, 'is that when we make a discovery, we can ask patients if they would be willing to participate in a clinical trial to discover whether there is clinical benefit for patients.'

Given the participation rates, it's clear that most patients see aiding research as a positive thing to being involved in. But Professor Carr believes there are direct benefits for them too: 'There is good evidence that if you're being treated in a research-intensive hospital that you are generally seen to do better.' He explains that there may be a range of reasons for this: it may be that the hospital culture is one of high standards, or it attracts staff that are engaged in their work, or that patients might be the first to benefit from novel treatments with improved results.

The department's achievements suggest this approach is working. Successes include the development and introduction of novel joint replacements that are now used in operations worldwide. The Oxford Knee and Oxford Shoulder are particular types of artificial joints that were invented here and are used in patients with severe or advanced arthritis.

NDORMS also played a big role in introducing patient-focussed measures of how successful orthopaedic surgery has been. After all the difference these treatments make to a patient's daily life is the most important outcome, rather than only recording how quickly a joint replacement fails. Given that 5% people over 65 have a joint replacement, this is of value for huge numbers of people.

Oxford scores are now used worldwide for assessing joint operations. Professor Carr says: '130,000 people a year are monitored in the UK alone using our scores, and they have transformed our understanding. Many other countries also use the Oxford Scores. Rather than just waiting for joint to fail, we ask the patient whether the pain has gone away, whether they are able to drive a car, go up stairs, live independently. These are the things that are really important to people later in life. We can also pick up issues or problems with new designs of joint implants much earlier than might otherwise be the case.'

As well as clinical research moving into the new annexe to the Botnar Research Centre, this year will also see the move of the Kennedy Institute of Rheumatology from their existing base in London to a new building across the road from the NOC in the University's Old Road Campus. This follows the institute's decision to move and join Oxford University in August 2011.

The Kennedy Insitute has great expertise in arthritis and inflammatory disease, most notably when researchers there discovered novel biological therapies for rheumatoid arthritis. These antibody therapies have transformed management of the condition. The future for NDORMS will see three streams of work all linked together, says Professor Carr:

The Kennedy Institute will concentrate on the basic discovery science in the biological pathways underlying disease, science that is directly relevant for developing new treatments.

The Botnar centre will continue to see more growth in its research based on access to tissue and blood donated by patients, and will also house those running and managing large trials to test the efficacy of new treatments.

And the NOC will house clinical trial units where patients can receive new treatments.

'We've created a critical mass,' believes Professor Carr. 'It is a complete package of research that is transforming this area of science. There’s nothing like it elsewhere in the UK or Europe. There’s great potential for the future.'

So what would count as success for Professor Carr's department in the next 10 years? 'I would like for a number of genuinely new therapies to reach the point of getting into the clinic,' he says, 'that we are geared up to discover amazing things, to train the best new researchers and create new therapies that work.'