Chief investigator:    Prof Mohammed Abu Hilal
Study Coordinator:  Christoph Kummerli
 
Without a spleen we run the risk of developing overwhelming (life-threatening) infections. Often the spleen is removed following pancreatic surgery and as a result lifelong antibiotics and vaccines are prescribed for patients. 

The aim of this study is to perform re-implant part of the spleen (26% of the original volume) in patients who lose their spleen during pancreas surgery and to investigate the performance of the re-implanted spleen with the antibody response to a Salmonella Typhi vaccine. Antibodies are measured before and after vaccination and a difference in antibodies will tell us how well the implanted spleen is performing.  In the long-term, the aim is to preserve the splenic function.

Patients are divided into three groups: spleen-preservation surgery (control group), splenectomy with splenic implantation (intervention group) and without (control group).

Since commencing the project the following centres have been recruiting appropriate patients:

• University Hospital Southampton, UK 
• Virginia Mason, Seattle, USA
• Poliambulanza, Brescia, Italy
• Birmingham University Hospital, UK
• Morriston Hospital, Swansea, UK

A further centre is in the process of setting up at the Miami Cancer Institute at Baptist Health, Miami, USA.

At the time of writing this report 28 patients have been recruited.  Progress in reaching the target of 45 by October 2020 might be impacted by the Covid-19 pandemic.  However, patients with low malignant cancer can now also be included. 
 
A further update report will be provided in 6 months time.  LAPR&D has committed to maintain its funding of this project despite the challenges presented by Covid-19.
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Picture: Christoph Kummerli (Study Coordinator) being presented with the research grant by Charity Chairman Kelvin Davis

LAPR&D pledge to continue to support vital research during the Covid-19 Pandemic  – LAPR&D has three important research projects underway at the present time (please see the Research section of this website for details).  However, they have all been impacted to differing degrees by the worldwide Covid-19 pandemic.  In some cases this is as a result of an inability to recruit patients due to non-critical operations being postponed or as a result of our researchers being utilised to support the fight against Coronavirus.  However, LAPR&D Chairman Kelvin Davis committed charity funds to the future of these projects and said “these projects remain vital to improve the life chances of those facing the challenges presented by liver and pancreatic cancer.  I have agreed that funding already promised towards these projects remains in place and project timescales will be extended where projects have been impacted by the Covid-19 pandemic. 

We wish all our researchers and charity supporters well over these difficult months ahead.  Our fundraising events will be postponed but we hope to be back with our exciting events once it is safe to do so.  In the meantime if you wish to donate please use the “donate” buttons on either our Facebook page or website.”

Almost eighty guests and supporters attended the annual curry night at Kuti's in Southampton (www.kutis.co.uk) last Monday to celebrate the work of the charity.  Guests enjoyed the superb food and wonderful hospitality of Kuti and his team.  "It is no wonder this venue won the Tiffin Cup,  making Kuti's the Best Indian Restaurant in the UK, they certainly put on a great show for our supporters" said Charity Patron, Kelvin Davis.   This contributed to our valued followers having a most memorable evening, judging by the feedback received from guests.  

The opportunity was also taken by Christoph  Kummerli (pictured with Charity Patron Kelvin Davis) to introduce the latest research project to be funded by LAPR&D.  As well as supporting Christoph and his fellow research student Alma Moekotte for 2 years,  the charity is also funding the RESTORE trial.  The trail will test the viability of restoring the spleen function when it is removed during surgery, often as part of pancreatic cancer surgery.  Christoph explained "the spleen performs an important function in purifying blood and is a key functions in immune response to fight infection.  When a patient loses their spleen during surgery, they require regular vaccination and a lifelong commitment to antibiotics to replicate the important function of the spleen.  This research project will test the viability of reimplanting part of the healthy spleen into a pocket that we form inside the patient to see if it will recover and begin to reperform it's functions". 

The trail will take 6-12 months and will be supervised by Professor Primrose at Southampton University Hospital with Professor Hilal performing the role of Chief Investigator. 

Guests also bought charity Christmas cards and lapel badges to contribute towards a superb £1,755 raised on the evening and further volunteers came forward to assist the charity with their future work.

​A further grant application to extend the liver stem cell research programme already supported by LAPR&D is also under consideration.

Our joint founder Professor Mo Abu Hilal performed his last operation in Southampton on 30 September - a liver resection - before taking up a new post at the Poliambulanza Hospital in Brescia, Italy.  Mo has been instrumental in guiding the charity's research  programme and will continue to provide input as an Honorary member.  The work of the charity will continue under the professional guidance of Dr. Nadeem Tehami who we will introduce to you shortly.  In the meantime we wish Mo every success in his new post and thank him for his support and kindness over many years since the charity's formation in 2012.

​Following the extension of funding for this project by LAPRD last year, Mogib Khedr (LAP researcher pictured) has conducted 172 experiments involving human samples and 78 experiments involving cell lines and liver stem cells.

Mogib is has made important strides using a novel method to grow liver and liver stem cells. This unique method means that these cells can now live and function for up to two weeks in the laboratory. The technique allows the generation of mature liver cells (from stem cells) and this will enable researchers to test if the cells are able to tolerate anti-cancer treatment. This research has successfully optimised conditions suitable for stem cells, liver cells and most recently cancer cells. Preliminary results of this interesting practice have been recognised and were presented to the national conference ‘The British Association for the Study of the Liver (BASL) Annual Meeting, York 2018’.

In addition to the research above the team have also been working with the Faculty of Engineering at Southampton University to use ultrasonic waves to create a complex structure of cells. The aim of this is to replicate cells normal conditions in the human body where cells would interact with each other and be in an organised 3D form.  This technique allows us to imitate tumours seen in the human body and test anti-cancer drugs more accurately.  This has been published and the full article can be found https://doi.org/10.1063/1.5082603.

Exciting future research will look at patients with liver tumours undergoing surgical intervention. The research will study the role of stem cells during liver regeneration.

This current research project is fully funded by LAPRD until 2020.

Following the overwhelming feedback from our Facebook poll in November 2018 that the charity should focus on its research programme associated with improving the life chances of Liver and Pancreatic cancer patients the charity has approved a "ten point plan" to deliver the programme.  The plan includes:
 
1.  Better communicate the uniqueness of our charity and  projects nationwide - this will focus on our research  programme;

2. Leverage Southampton Hospital Charities for media  relations and communications of key messages and results - initially this will involve meeting with hospital charity representatives to identify where they can provide support;

3.  Improve corporate leaflet – issue new 3 folder flyer;

4.  Target large local companies for corporate sponsorship;

5.  Establish relationships with organisations that raise  awareness - add links to our social media and website;  

6.   Split the role of patron and chairperson; 

7.   Nominate event manager for fund raising activities and set-up formal events bank account and email address;

8.    Strengthen Committee and expand number of volunteers supporters beyond existing   group;

9.    Identify person who manages /updates website, issues emails and social media and

10. Implement monthly donor scheme

If you are able to offer any support for any of these roles or objectives then please do get in touch.  We will keep you updated on progress with these actions during the year.

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A huge thank you to Tina Hiscox who raised £6962 at the last charity lunch, held alongside the Southampton Boat Show at the Grand Café Southampton on 20th September.  The event included games of bingo, superb auction prizes as well as a wonderful lunch. Our thanks also go out to the Grand Café Southampton team (www.grand-cafe.co.uk) for their support and Jenny Slowen the Bingo caller and compere for the day.

Tina is already planning the next event which will be Lunch with Elvis on March 28th 2019 - watch this space for details but in the meantime save the date!

The General Data Protection Regulation (GDPR) came into force in the UK on 25 May 2018.  The GDPR, which replaces the Data Protection Directive (95/96/EC), aims to strengthen the security and protection of personal data.  The LAPR&D, as a fund operating under the auspices of the Southampton Hospital Charity,  complies with their policy under the GDPR to ensure that we follow the requirements of the GDPR.
  
Charity policy:
Southampton Hospital Charity is committed to the principles inherent in the GDPR and particularly to the concepts of privacy by design, the right to be forgotten, consent and a risk-based approach.  In addition, we aim to ensure:
 
·         transparency with regard to the use of data;
·         that any processing is lawful, fair, transparent and necessary for a specific purpose;
·         that data is accurate, kept up to date and removed when no longer necessary;
·         that data is kept safely and securely.
 
The charity has adopted an opt in/legitimate interest policy and will review data held on an annual basis.  
 
As a part of University Hospital Southampton NHS Foundation Trust the charity policy is in line with that of the Trust.
 
Fundraising group commitment;
As a fundraising group of Southampton Hospital Charity, we adhere to the principles of the GDPR by:
·         being transparent with our supporters with regards to the use of their data;
·         by processing your data in a lawful, fair, transparent and necessary way for the specific purpose you have gained their data for;
·         that any data that we hold is accurate, kept up to date and removed when no longer necessary;
·         that any data we hold is kept safely and securely.
 
The Charity’s privacy and legitimate interest statements can be found here:
www.southamptonhospitalcharity.org
www.schcharity.org.uk
 
Please contact Suzie Simmons,                                         
Head of fundraising                                           
Southampton Hospital Charity                         
023 8120 5221
Suzie.simmons@uhs.nhs.uk  
​if you have concerns or queries regarding the policy.

​LAPR&D are delighted to announce the extension of the Liver Stem Cell project, which will enable the project to continue to the next phase since phase 1 was approved in 2015.

The project will be continued under the supervision of Professors Abu Hilal and Salim Khakoo at the University of Southampton Hospital with LAPR&D continuing as the significant funder.
             
Professor Hilal explained that during the original project many of the objectives i.e. to grow and maintain functioning liver cells outside of the body and allow for early experimentation of new drugs on functioning livers with much reduced risks to patients have been met.  Our researcher, Mogib Khedr, has  conducted 127 proper experiments involving human samples
 and 69 experiments involving cell lines and liver stem cells and successfully isolated stem cells and succeeded in making liver cells grow in laboratory.  This research has been published in The Journal of Cell Proliferation and the full article can be found here https://doi.org/10.1111/cpr.12482.  Good progress has also been made to identify a way to grow the cells in three dimensions and an ultrasound device has been validated for hepatic cell line.

In additional Liver stem cells have been grown in a clay gel material and can be encouraged to form mature liver cells.

However, further work is required to validate the model so that drugs can be tested.  This will require an in depth characterisation of newly formed cells at the functional and the genetic level.
As an experimental study which has been started from scratch on a very novel topic with very little available data the achievements we had so far have been great and much above the average achievement levels in experimental studies.  Funding for the next phase of this research will ensure that we have managed to put secure foundations to this project and produce strong data to enable us to progress to the use of liver stem cells in the clinical practice. 

The project team have very clear ideas and believe that in the next 2 years (the term of this project extension) they will be able to capitalise on the work done so far so that further grant support can be attracted.

The approved extension will:

        1.   Use an ultrasound device to fabricate cancer cell micro-tissue which can be used for    anti-cancer drug screening and/or drug toxicity testing.
        2. Characterise the liver tissue formed from liver stem cells and validate this model in  laboratory animals.
         3.  Test the applicability of use of  ultrasound wave device in culture of liver stem cells and promoting the formation of mature liver tissues from them.
         4.  Testing the ability of implanted human stem cell (in clay gel) for compensation of liver functions in laboratory animals.

The project extension is funded by £40,450 of LAPR&D funding and will run until June 2020.  Progress updates will be provided via the News section of our website.

The RESTORE trial - also referred to as Autogenic Splenic Implantation - is being undertaken by Alma Moekotte – Research  Fellow at the University Hospital, Southampton under the supervision of Prof Mohammed Abu Hilal.

This new research is being supported with from LAPR&D, research fees from the Spire Hospital Southampton and a senior investigator grant from the National Institute for Health Research (NIHR) which was awarded to Professor Primrose, who is a key research member on this project.

The spleen is located at the tail end of the pancreas (see photo).  If someone has a tumour in the body or tail of the pancreas, the pancreas, or part of it, will be resected (cut out).  Often the spleen will be removed as well because the blood supply to the spleen is situated very close to the pancreas and sometimes goes through the pancreas.  In that case it is not always possible to divert the blood vessels that go to the spleen, from the pancreas so they have to be removed with the pancreas.  As a result the spleen will not receive any blood and will eventually die.  For this reason the spleen must be resected as well.  Sometimes it is possible to divert the vessels that support the blood supply and keep the spleen alive.

The spleen plays an important role in clearing bacterial infections.  Without a lifelong course of antibiotics & regular vaccinations there is a risk of severe infectious complications.  As a result of these consequences, several investigators have tried to re-implant pieces of the resected spleen.  The procedure is relatively simple:  The resected spleen is cut into pieces, about one third of these pieces are placed back into the abdomen, the body will create new small blood vessels to supply these pieces with blood.  As a result the new pieces of spleen will regenerate and become new splenic tissue.
​
However, the question is - will the splenic function be restored?  Or are these new pieces of spleen not functional at all?  This research project will try to answer this question.

The research will follow patients who have undergone spleen auto-transplantation.  After 6 months  participants will be vaccinated with the Salmonella vaccine.  Before and 1 month after the vaccination, we will measure the amount of Anti-bodies against salmonella in the blood.  This gives us an idea whether the new pieces of spleen are able to make enough antibodies to clear an infection. The Salmonella vaccine is chosen because it mimics the specific encapsulated bacteria that are dangerous in patients without a spleen.  Of course the vaccine is harmless to the patient.  We hope this research will lead to a new way of restoring the splenic function and therefore patients no longer require daily antibiotics and regular vaccinations.

The project will start shortly.  The protocol is written and we are waiting for ethical committee clearance.
​
Further updates will be provided on our website.
 
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