key: cord-0982664-ci7j70hu
authors: Moore, Edward
title: Medical relevance of UK-funded non-human primate research published from January 1997 to July 2012
date: 2014-07-03
journal: J R Soc Med
DOI: 10.1177/0141076814530686
sha: 2de3df4bc6bfab602038165ccb45368768071956
doc_id: 982664
cord_uid: ci7j70hu

In 2012, the Bateson Review of research using non-human primates (NHPs) recommended the commissioning of a working group to identify and follow-up the results of UK-funded NHP research of potential benefit for human health (Recommendation 4), but the Medical Research Council (MRC) has postponed implementation of the recommendation. Information on results and potential benefits of NHP research therefore remains unavailable. To fill this gap in knowledge, this study identified all published NHP research studies funded by the MRC, Wellcome Trust and Biotechnology and Biological Sciences Research Council (BBSRC) from January 1997 to July 2012 and assessed full texts for medical relevance. In total, 284 papers were identified, of which 51 (18%) involved invasive NHP research, compared to 176 (61%) which used NHP tissue and cell lines, indicating a shift in research emphasis from invasive whole animal to cell-based research. Of these studies, 98 (35%) were medically relevant, of which 22 had potential therapeutic or public health applications. The relatively low proportion of medical studies together with the small number of applied studies raises questions over the level of investment in medical research and the effectiveness of knowledge transfer from basic to applied research. Implementation of the Bateson Review’s Recommendation 4 would address these questions.

In 2006, a working party led by Professor Sir David Weatherall recommended that UK funders of NHP research undertake a 10-year review of their sponsored research. 1 In response, the Medical Research Council (MRC), Wellcome Trust and Biotechnology and Biological Sciences Research Council (BBSRC) commissioned a review of all their funded NHP research studies from January 1997 to December 2006. The Review Panel, led by Professor Sir Patrick Bateson, recommended, inter alia, that 'Science policy-makers together with the public sector, private sector and charitable funders of research should commission a working group to develop proposals for a mechanism (outputscanning) to identify research results with potential to deliver improvements to healthcare or other significant benefits to society, and to assess the extent to which the potential benefits are achieved' (Recommendation 4). 2 The MRC has indicated that this recommendation 'is not currently being taken forward, as we have prioritised work on other recommendations in the Bateson Review'. Consequently, factual information on NHP research results and their medical relevance remains unavailable to the public and wider medical profession. This study provides this information.

The Royal Society of Medicine (RSM) Library search services team was commissioned to undertake a literature search encompassing all NHP research sponsored by the MRC, Wellcome Trust and BBSRC published in UK scientific or medical journals indexed by Medline from January 1997 to July 2012.

Access to full texts was sought using Europe PubMed Central, Internet search engines, Athens and the RSM Library e-journal resource in turn, failing which access was purchased through the RSM Library. Full texts were scrutinised for medical relevance.

. Medical: aimed at a specific human disease or health problem; . Veterinary: aimed at a specific animal disease or health problem; . Biological: NHP research excluding medical and veterinary studies.

This identified 286 study abstracts. One study comparing types of ultrasound equipment and one funded by the Medical Research Council of Australia were excluded. Access to the remaining 284 full texts was gained using Europe PubMed Central (155 studies), Internet search engines (75), Athens (42) and the RSM Library e-journal resource (8) . Access to the remaining four was purchased through the RSM Library.

Research funders were identified in study abstracts. Funding of biological, medical and veterinary research by the UK funders, alone and in combination, is shown in Table 1 .

Forty-six studies were also funded by the US National Institutes of Health (30 studies, of which three were co-funded by Howard Hughes Medical Institute), Cancer Research UK (8), British Heart Foundation (3), UK Department of Health (2) or Telethon of Italy (3) . In 95 studies, researchers acknowledged additional support from grants, fellowships, studentships, gifts of research materials from fellow scientists, and sponsorship from charities, universities, the pharmaceutical industry and national and local governments in the UK, Europe, the USA, Africa, China and Australia. Of 55 studies based outside the UK, 27 were in Europe, 18 in the USA, three in China, three in Africa, two in Australia and one each in Thailand and Japan.

Research was grouped into invasive and non-invasive whole animal and cellular research. Invasive whole animal studies involved either marmosets or macaque monkeys and, in one study, baboons. Non-invasive research also concerned gorillas, bonobos, chimpanzees and gibbons. Cellular research utilised NHP tissue and COS-1, COS-7 and Vero cell lines derived from the African green monkey (Cercopithecus aethiops); 40 of these studies also involved invasive research in rodents, cattle, goats, sheep, poultry or fish ( Table 2 ).

Invasive whole animal studies focused on neurobiology (22 studies), reproduction (10), vision (9) and pharmacology (2) . Non-invasive studies concerned neurobiology (19 studies), evolutionary biology (12), behaviour (5), genomics (5), vision (5), physiology (3) and reproduction (1). Cellular studies focused, inter alia, on protein metabolism (46 studies), gene expression and function (36), endoplasmic reticulum function (6), phosphorylation (6), signal transduction (6), calcium metabolism (5), microtubule metabolism (5), the Golgi apparatus (5), calcium channel function (4), cell membrane function (4), phagocytosis (4), receptor trafficking (3), cell movement (2), cell adhesion (2), stress granule formation (1) and oxidative stress (1).

This provides a chronological list of references to the 80 cellular studies.

Invasive whole animal studies focused on infection by Plasmodium knowlesi (1 study), simian immune deficiency virus (1) and an outbreak of Mycobacterium intracellulare in a captive colony of wild baboons (1).

Cellular research focused on disease pathogenesis (5 studies), control of infection (2) and vaccine development (3).

Invasive whole animal studies focused on chronic obstructive pulmonary disease (2 studies), measles (1), gene transfer (1) and testing a neurosurgical procedure (1). Non-invasive studies concerned HIV infection, HIV vaccines, hepatitis C, animal models of trypanosomiasis, evolution of malaria, obesity and gender-related behaviour (1 each). Cellular studies focused mainly on genetic disorders, infectious disease and cancer. Table 3 presents the 98 medical studies by research subject and area of medical relevance.

Pathogenesis research. This focused on alpha 1-antitrypsin deficiency, Alzheimer's disease, Bardet-Biedl syndrome, cardiovascular disease, chronic obstructive pulmonary disease, craniosynostosis, cystic fibrosis, diabetes Type 2, familial encephalopathy with neuroserpin inclusion bodies (FENIB), frontotemporal dementia with Parkinsonism linked to chromosome 17 (FTDP-17), Frasier syndrome, fragile Xassociated tremor ataxia syndrome (FXTAS), hereditary sensory and autonomic neuropathy Type 5 (HSAN5), Huntington's disease (HD), myoclonus dystonia syndrome, oculopharyngeal muscular dystrophy, Parkinson's disease, popliteal pterygium syndrome, retinitis pigmentosa, retinoschisis, schizophrenia, Treacher Collins syndrome, Van der Woude syndrome, Williams-Beuren syndrome and Wolfram syndrome.

. Davies et al. 3 investigated the effect of trehalose in cell and transgenic mouse models of the late onset autosomal disease oculopharyngeal muscular dystrophy. The drug reduced aggregate formation and toxicity of mutant protein in cell models and oral administration attenuated muscle weakness in mice: 'As one can identify almost all cases at risk, this disease is amenable to pre-symptomatic treatment . . . Trehalose would be particularly attractive for this strategy, given its safety and suitability for long term use.' . Sarkar et al. 4 demonstrated that combined treatment with lithium and rapamycin in a drosophila fly model of HD enhanced macroautophagy of aggregate-prone proteins, providing proof-of-principle of this combination as a potential treatment for HD. . Ravikumar et al. 5 showed that inhibition of the endosomal protein Rab5 enhanced polyglutamine toxicity in cell and fly models of HD, whereas overexpression attenuated toxicity: 'A possible therapeutic approach for HD and other proteinopathies would thus be to enhance Rab5 activity'. . Vamathevan et al. 6 investigated the role of positive gene selection in the higher incidence in humans of diseases including epithelial cancer, Alzheimer's disease and auto-immune diseases: 'Understanding the evolutionary history of disease genes can also significantly impact the choice of pre-clinical animal models in the drug discovery process'. . Wang et al., 7 in an international collaborative study, presented the first diploid genome sequence of an Asian individual (YH). They identified several genotypes which conferred an increased risk for YH of tobacco addiction and Alzheimer's disease. They considered that 'personal genome sequencing may eventually become an essential tool for diagnosis, prevention and therapy of human diseases'. . Underwood et al. 8 

. Lamden et al. 14 investigated the effect of penicillin on Chlamydia trachomatis DNA replication and found that the antibiotic blocked binary fission but 'did not prevent chromosomal or plasmid DNA replication'. . Stabler et al. 15 

Clostridium difficile infection and its increasing virulence: 'These studies facilitate pinpointing the genetic and phenotypic attributes that may explain the emergence of the hypervirulent 027 strain and contribute in general to our understanding of the evolution of bacterial virulence'. . Salisbury et al. 16 found that Salmonella Virchow infection of chickens can occur without overt clinical signs: 'The asymptomatic colonization of chickens indicates an increased ability of S. Virchow to enter the food chain undetected'.

Pathogenesis research. This focused on malaria, trypanosomiasis and toxoplasmosis.

Studies of therapeutic or public health relevance . Biagini et al. 17 considered how newfound knowledge of parasite transport physiology could be turned into a strategy for drug delivery in malaria.

. Kennedy 18 argued in favour of the continued use of animal models of human African trypanosomiasis, despite their limitations. . Wilson and Coulson 19 reviewed the strategies used by the schistosome in combating the immune response: 'the animal models suggest that targeting multiple functions is more likely to achieve worm elimination, thereby requiring administration of a cocktail of antigens'. They concluded: 'On a personal note, after nearly 30 years research on schistosome vaccines, we still hope that a magic bullet akin to the Taenia onchosphere antigens will be found by serendipity. Experience tells us that more likely, the laudable goal will require a ''long march''.' . Liu et al. 20 

Plasmodium falciparum malaria by identifying and characterizing Plasmodium spp. DNA sequences in faecal samples from wild-living apes: 'Importantly, all currently available human P. falciparum sequences comprised a single lineage nested within the G1 clade of gorilla parasites. This finding indicates that human P. falciparum is of gorilla origin and not of chimpanzee, bonobo or ancient human origin.'

Pathogenesis research. This focused on cancers of the breast, prostate and ovary; leukaemia; neuroblastoma; tumour suppression; hypoxia regulatory factors and chromosomal changes.

. Chu et al., 21 in their study of the effects on apoptosis of phosphatidylinositol 4-kinases, concluded that, for certain breast cancers: 'targeted inhibition of PI4KIIIb represents a potential chemotherapeutic strategy to treat such malignancies'. . Dart et al. 22 investigated the relationship of the corepressor protein prohibitin and the androgen receptor (AR) in prostate cancer and concluded that 'altering AR activity via increasing levels or activity of corepressors is a valid therapeutic strategy for advanced prostate cancer'.

Pathogenesis research. This focused on obesity and gender-related behaviour.

Studies of therapeutic relevance . Buckley et al., 23 in their investigation of airway relaxation in response to inhaled prostaglandin E 2 , found that in human beings it was the EP 4 receptor which mediated airway relaxation and proposed that 'EP 4 selective compounds could potentially be the next generation of bronchodilators'. . Pereira et al. 24 reported on their preliminary research and use of deep brain stimulation in patients with Parkinson's disease in whom symptoms of gait freezing and postural instability predominate.

This provides a chronological list of references to all 98 medically relevant studies.

The study findings provide insights into three aspects of UK-funded NHP research.

Overall, only 51 (18%) of the studies involved invasive research on living NHPs, compared to 176 (61%) which made use of NHP tissue and cell lines. The writer could find no comparable data from previous years, but it is submitted that this represents a change in research emphasis from invasive whole animal studies to cell-based molecular and genetic research. In particular, the change means that basic medical and biological research now share common ground in respect of cellular research methods and materials, offering the opportunity for coordination of biological studies of normal cell function with medical studies of cell function in disease. The reduction in invasive NHP studies should reduce harm to animals and will hopefully lead to a reduction in the level of opposition to NHP research and aggression towards researchers, as well as encouraging charitable support. The shift in research emphasis is also relevant to the ethical debate: overall, 193 (68%) of the studies were non-invasive in NHPs or other animals and therefore in accord with the Beauchamp and Childress principle of non-maleficence 25 and the medical axiom of 'First do no harm'.

At 35%, the proportion of medical studies was low compared to biological studies (61%). This, however, is broadly in line with the findings of the Cooksey Review of 2006, which cited the UK Clinical Research Collaboration analysis showing that around two-thirds of public and charitable funding of health research was invested in basic science projects. The Review considered that current funding levels for basic science should be maintained, but recommended: 'that future increases in funding should be weighted towards translational and applied research until a more balanced portfolio is achieved'. 26 Both Government and research funders will be aware of the recommendation and investment in medically relevant NHP research will hopefully rise to a level equivalent to that of basic biological research.

The level of translation from basic to applied research is a touchstone of research effectiveness and provides an assessment of return on research investment. The small number (22 including three reviews) of applied medical studies was therefore a cause for concern. If this is a fair representation of translation of basic research from earlier years, it suggests that research results may not always have been taken forward into applied studies, echoing the Bateson Review Panel's finding that 'some evidence was provided of the translation of fundamental science into applied science and practical application, but in many cases too little consideration was given to effective knowledge transfer'. 2 On the other hand, the low level of translation may have been due, at least in part, to legitimate negative research findings. There is insufficient information on which to draw conclusions. Whatever the reasons, in order to determine the true level of translation, it is important that all studies of potential value for human health are identified and followed up. Implementation of the Bateson Review's Recommendation 4 would meet this need.

The shift in research emphasis from invasive whole animal to cellular research brings medical and biological science into a complementary relationship, which will hopefully lead to better understanding of disease aetiology, and improved diagnosis, prevention and treatment, particularly of chronic disease. It also presents an opportunity for researchers and research funders to engage in a more open relationship with the public.

With the growing research opportunities in molecular biology and genetics, the need for coordination of biological and medical research may increase. The need for identification and follow-up of studies of potential importance for human health will remain.

This paper raises questions over the level of investment in medically relevant NHP research, the effectiveness of knowledge transfer from basic to applied research and the coordination of biological and medical research. Implementation of the Bateson Review's Recommendation 4 would address these questions.

Competing interests: EM has an interest in cost-benefit analysis of NHP research.

Ethical approval: Not applicable Guarantor: EM Contributorship: EM

The Use of Non-human Primates in Research

Review of Research Using Non-human Primates. London: Medical Research Council

Trehalose reduces aggregate formation and delays pathology in a transgenic mouse model of oculopharyngeal muscular dystrophy

A rational mechanism for combination treatment of Huntington's disease using lithium and rapamycin

Rab5 modulates aggregation and toxicity of mutant huntingtin through macroautophagy in cell and fly models of Huntington disease

The role of positive selection in determining the molecular cause of species differences in disease

The diploid genome sequence of an Asian individual

Antioxidants can inhibit basal autophagy and enhance neurodegeneration in models of polyglutamine disease

High efficiency gene transfer to the central nervous system of rodents and primates using herpes virus vectors lacking functional ICP27 and ICP34

Mapping the minimal regions within the ORF73 protein required for herpesvirus saimiri episomal persistence

Targeting viral infection by microRNA inhibition

Anti-infective activity of apolipoprotein domain derived peptides in vitro: identification of novel antimicrobial peptides related to apolipoprotein B with anti-HIV activity

HIV vaccines: current status worldwide and in Africa

The effect of penicillin on Chlamydia trachomatis DNA replication

Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium

Salmonella Virchow isolates from human and avian origins in England-molecular characterization and infection of epithelial cells and poultry

Malaria parasite transporters as a drug-delivery strategy

Animal models of human African trypanosomiasis-very useful or too far removed?

Immune effector mechanisms against schistosomiasis: looking for a chink in the parasite's armour

Origin of the human malaria parasite Plasmodium falciparum in gorillas

Differential effects of the phosphatidylinositol 4-kinases, PI4KIIa and PI4KIIIb, on Akt activation and apoptosis

Manipulating prohibitin levels provides evidence for an in vivo role in androgen regulation of prostate tumours

EP4 receptor as a new target for bronchodilator therapy

Deep brain stimulation of the pedunculopontine nucleus in Parkinson's disease. Preliminary experience at Oxford

A Review of UK Health Research Funding. London: HM Treasury

Acknowledgements: The author thanks Hazel Jeffers for helpful comments on the text, Joan Fleming for proof reading and Irene Robertson for typing the manuscript.Provenance: Not commissioned; peer-reviewed by Ian Olver