The cornea on the front surface of the eye is our window to the world. If transparency is compromised, visual impairment and even blindness can occur. There are 10 million people worldwide who are blinded by scarring of the cornea and are denied a sight saving corneal graft due to insufficient donor tissue availability. The ability to 'grow' components of a cornea in the laboratory would represent a very significant scientific and medical advance that could improve quality of life. As a first step towards this goal, we are working to address a condition called limbal epithelial stem cell (LESC) deficiency of the cornea, which causes painful, blinding corneal surface failure. An estimated 240 new cases of LESC deficiency occur annually in the UK. We have cultured and transplanted sheets of LESCs to improve vision in patients with chemical burns. However, many patients have very difficult to manage diseases requiring treatment with a substrate to aid cell survival, in our case human amnion. This approach can significantly improve quality of life and productivity in the workplace (patient personal communications) however, we have found the long-term therapeutic benefit to be variable. In part, we suspect, because cultured LESC sheets do not restore the normal LESC microenvironment or 'niche' destroyed by disease. Using a novel tissue engineering approach we have recently made simple constructs of the human corneal surface using protein, epithelial cells (including LESCs) and the fibroblasts that support them. Novel technology (Real Architecture for 3D Tissues - RAFT) is used to make a fibroblast-seeded collagen construct with surface toplology that mimics the in vivo stem cell niche, then corneal epithelial cells are seeded on the surface. Our data are very promising, the epithelial cells grow successfully and produce an epithelium. RAFT constructs are reproducible and have significant advantages over human amnion for LESC culture. Amnion is biologially variable and often (40% of cases) does not support the growth of healthy LESCs. We now wish to a) asses the physical and functional properties of RAFT and b) perform safety and efficacy studies so that we may proceed to first in man studies at Moorfields Eye Hospital (MEH) following this project. We already know that RAFT is strong enough to be handled and that text can be read through it. Here we will test actual mechanical strength as this must be sufficient to withstand surgery. Transparency will also be measured as RAFT should ideally be at least as transparent as the amnion we aim to replace if not better. The key driver behind this proposal is the need to establish if RAFT is safe to use and if it can improve the surface of a cornea with LESC deficiency. Without this information we cannot test RAFT in humans. Here we will work with colleagues to assess RAFT safety and efficacy in an established model of LESC deficiency. Our techniques and methods for producing RAFT constructs, presenting them to the surgeon in an accessible device and measuring clinical outcome in our model will be rigorously validated. If during this pre-clinical testing RAFT constructs can restore corneal transparency and maintain a healthy ocular surface, our data will be used to develop regulatory compliant standard operating procedures for the production of RAFT for future testing in man. This project is therefore essential to progress our research findings into clinical practice. If the project goes as planned, IoO have the experience and capacity to manufacture RAFT constructs in the 'Cells for Sight Cell Therapy Research Unit'. This new state of the art cleanroom facility, led by the applicant, is used to produce cell therapies for patients. If the project is successful, IoO and MEH will design a phase I/II safety and efficacy clinical trial to compare RAFT with LESC cultured on amnion.

Umbilical cords are traditionally discarded after childbirth as medical waste. However, over the past few decades it has become apparent that the cord contains a small amount of immature blood cells with powerful properties to repair the human body. Cord blood is now frequently used instead of bone marrow to treat childhood blood cancers (leukaemia). Cord blood cells can also be grown to generate very large numbers of red blood cells or platelets for transfusion, or, if processed differently to create immune system cells. More recently cord blood has been proven effective, or is being clinically trialled, for a wide range of serious conditions such as organ failure, childhood brain damage or diabetes. Despite national cord blood collection and banking programmes since the early 1990's, the success of these new clinical applications will lead to unsustainable demand on already strained stocks of cord blood. In this Fellowship I intend to develop tools to help manufacture large quantities of medicinally valuable cord blood cells from the small samples retrieved at child birth. This will form the basis of a manufactured blood related bio-products industry. We will use a new technology to grow the cells in small vessels under very controlled conditions. These vessels will let us quickly and efficiently test different physical conditions (such as oxygen and acidity) and novel chemical additives on the growth of the blood cells. We will use engineering approaches to control the cells' environment in novel ways, and understand the relationships between the cells' development. We will demonstrate the conditions and systems that are necessary to grow these cells to large and clinically useful numbers. We will also understand how tolerant the manufacturing process is for repeated production of safe and effective cells. My proposed research will help the clinical community deliver a new cohort of treatments for serious diseases to patients in the UK as well as help develop an important new economic activity in the UK in the development of these new types of cell based therapies.

SummaryContinued improvement in the nation's health depends upon the efficient development of affordable replacement human tissue and related therapies; an acute shortage of willing organ donors and the shortcomings of conventional therapies leads to the preventable death of many patients each year. The next healthcare revolution will apply regenerative medicines, creating biological therapies or substitutes for the replacement or restoration of tissue function lost through failure or disease. However, whilst science has revealed the potential, and early products have shown the power of such therapies, there is now a need for the long term supply of people properly trained with the necessary skills to face the engineering and life science challenges before the predicted benefits in human healthcare can be realised. Because the products arising from this technology differ significantly from those made by mainstream pharmaceutical companies, training programmes currently available are poorly equipped to meet the demand for increasing numbers of appropriately trained personnel. We estimate that the number of engineers with the necessary skills to interact `on the same level' with cutting edge bioscientists and clinicians is very small, perhaps no more than 100 nationally; in such a small community 50 newly trained PhD's will have a very large impact. Here we propose a new UK based DTC in Regenerative Medicine integrated across three Universities with highly complementary expertise where students will be trained in the core skills needed to work at the life science/engineering interface and then engaged in strategic research programmes designed to address the major challenges in the field. This will ensure that the necessary people and enabling technologies are developed for the UK to lead in this rapidly growing worldwide marketplace.

This proposal bids for £4.5M to both evolve and renew the Loughborough, Nottingham and Keele EPSRC CDT in Regenerative Medicine. The proposal falls within the 'Healthcare Technologies' theme and 'Regenerative Medicine' priority of the EPSRC call. This unique CDT is fully integrated across three leading UK Universities with complementary research profiles and a long track record of successful collaboration delivering fundamental and translational research. Cohorts of students will be trained in the core scientific, transferable, and translational skills needed to work in this emerging healthcare industry. Students will be engaged in strategic and high quality research programmes designed to address the major clinical and industrial challenges in the field. The CDT will deliver the necessary people and enabling technologies for the UK to continue to lead in this emerging worldwide industry.The multidisciplinary nature of Regenerative Medicine is fully captured in our proposal combining engineering, biology and healthcare thereby spanning the remits of the BBSRC and MRC, in addition to meeting EPSRC's priority area.

In the 1980s it began to be possible to produce potentially unlimited quantities of human proteins by placing the gene defining them in a simple organism such as yeast. From this grew a new kind of medicine capable of treating conditions such as severe arthritis, haemophilia, growth deficiency, and some cancers that previously had no satisfactory treatments. As well as having great clinical value the resulting technology has become the basis of a new and fastest growing part of the pharmaceutical industry, described as biopharmaceuticals. Because the molecules involved are proteins, they are orders of magnitude larger and more complex than conventional drugs such as aspirin and their processing is much more demanding. They are also so complex that they cannot in general be characterised with precision except in relation to the methods by which they are made. That means the capacity to precisely define such processes is critical to clinical safety and commercial success. Full scale trials of the processes are so costly they can only be conducted once clinical promise is established but, given the number of factors governing processing of even first generation products, there have often been hold-ups so extensive as to delay availability to patients. UCL has pioneered micro scale methods that are sufficiently good at predicting efficient conditions for large scale performance that far fewer and better focussed large scale trials suffice. That resolves part of the problem but an even greater challenge is now emerging. The early biopharmaceuticals were in general the easiest ones to produce. The final scales were also relatively modest. Now, the next generation of biopharmaceuticals are more complex materials and with rising demand the scales are far larger so that processes push the boundaries of the possible. The combined complexity of the product and the process with so many variables to consider means that the managers need better systematic means of supporting their decisions. Already the cost of developing a single biopharmaceutical can exceed 0.7 billion and take 10 years. With more advanced biopharmaceuticals these figures tend to rise and yet the world's governments are facing a healthcare cost crisis with more older people. They therefore exert pressure on companies to reduce prices. Because the public wishes to have medicines that do not pose risks, regulations become ever more stringent so they are a major factor in defining the bioprocess. This also adds to the need for managers to have sector-specific decisional-support aids well grounded in the detailed engineering of the processes. Finally, it is now possible to apply molecular engineering to proteins and vaccines to enhance their therapeutic properties but this can also cause serious bioprocessing problems. The research vision developed with detailed input from UK industry experts will apply these methods as the foundation for another step change whereby much faster and lower cost information can be gathered and integrated with advanced decisional techniques to give managers a better foundation on which to base their policies. The academic team from leading UK universities provides the necessary continuum of skills needed to assess the ease of manufacture of novel drugs, the costs of processing and of delivery to patients. We will work with companies to test the outcomes to ensure they are well proven prior to use on new biopharmaceuticals. This will cut costs so that all the patients who might benefit can receive them and at the earliest possible date achieved within the severely restricted budgets now available to the NHS.