Memorandum by the Wellcome Trust
INTRODUCTION
1. The Wellcome Trust is pleased to be given
the opportunity to respond to the House of Lords Select Committee
on Science and Technology on the subject of Scientific Aspects
of Ageing, and welcomes the setting up of the Sub-Committee
to consider how science and technology can help an ageing population
live a healthier and more active life.
2. The Trust is aware that medical advances
and demographic transitions are having radical effects on population
ageing. The estimated increase in world population over 65 years
of age to 1.2 billion by 2025[13]
presents a major public health challenge, especially for low and
middle income countries that are also struggling with the double
burden of disease—infectious and non-infectious diseases.
In some developed countries the proportion of older persons is
approaching 20 per cent, partly as a result of low fertility rates
but also because of longevity. However, with advancing age comes
adverse health and a debate on research and technology, as well
as a public health approach to help improve people's prospect
of a healthy and active life expectancy is opportune.
SUMMARY
3. A significant proportion of the research
funded by the Wellcome Trust is directly or indirectly related
to ageing. Using a broad set of key words to define ageing related
research we estimate the Trust has funded approximately £547
million of research in this area from 1994 to 2004: 16 per cent
of the total research funded by the Trust in this period.
4. However, in its main programmes, the
Trust has never given a specific priority to ageing related research
so this funding reflects those research grants that have been
awarded in competition with a wide range of other disciplines
and in all likelihood will have many overlaps with them.
5. Therefore, in undertaking the work to
complete this response, we found that there is a wide range of
research that is related to ageing but a sub-set of this might
be more narrowly focussed on, for example, conditions that affect
the elderly. In order to discuss priorities and the co-ordination
of funding it will be important to have a more focussed definition
of the area. With regard to cancer, this is one of the tasks that
the National Cancer Research Institute (NCRI) undertook when deciding
on how to discuss prioritisation in that area. This model might
be an appropriate one for the Committee to consider with regard
to ageing research.
6. However, discussions with a limited number
of Trust-funded scientists have highlighted specific areas that
might benefit from greater attention. For example there appears
to be a need for multidisciplinary teams in universities, bringing
public health, clinical gerontologists and biological researchers
together. This approach, together with wider use of medical care
technology, could assist an ageing population live a healthier
and more active life.
ABOUT THE
WELLCOME TRUST
7. The Wellcome Trust is an independent,
biomedical research-funding charity established under the will
of Sir Henry Wellcome in 1936. Its mission is to foster and promote
research with the aim of improving human and animal health.
8. In the financial year ended 30 September
2003, the Trust's total charitable expenditure was over £500
million, the majority of which was to fund research in the UK.
SCIENTIFIC ASPECTS
OF AGEING—RESPONSE
FROM THE
WELLCOME TRUST
9. The Trust does not have a special initiative
on ageing research but it does fund research in many biomedical
areas that are related, directly or indirectly, to ageing. For
an insight into funding in these areas, we searched our databases
for keywords and subject areas that cover some of the main diseases
and disorders normally associated with advancing age. In addition
to "ageing" or "longevity", cognitive function,
joint diseases, stroke, cell biology and cell cycle are amongst
the areas searched (see Annex 1); in total the Trust funded grants
in the region of £547 million over the decade 1994-2004,
representing about 16 per cent of the total funding portfolio.
In addition, substantial investment has been made in medical imaging
technology, infrastructure support, and genomic analysis of ageing
bringing the total to £877 million (26 per cent) over the
same period.
10. For the majority of the research that
it supports the Trust operates a responsive mode funding mechanism.
However, in addition to this there are a number of strategic initiatives
that have been launched and those which relate to ageing have
been listed below.
11. The Health Consequences of Population
Change Programme (http://www.wellcome.ac.uk/hcpc). This five-year
initiative was launched in 2001 and established a £65 million
fund to support several key areas aimed at research into the effects
of demographic shifts and socio-economic changes on public health
in the developing world including the ageing population.
12. The Cognitive Systems Foresight
Project (http://www.wellcome.ac.uk/en/l/biosfgunkste.html).
This is an area of multidisciplinary research highlighted by the
Trust for funding, jointly with the UK Research Councils. Cognitive
systems are natural or artificial information processing systems,
including those responsible for perception, reasoning, decision-making,
communication and action. Cognitive systems research is therefore
an area that could have implications for assisting ageing and
frail populations.
13. The UK Biobank (http://www.ukbiobank.ac.uk).
The Trust is a major funder (together with the MRC and the Department
of Health) of the UK Biobank, which will be the world's largest
resource (500,000 individuals, between the ages of 45 and 69)
for the study of the role of genes and the environment (or nature
and nurture) in health and disease. Many diseases and disorders
of old age (cancer, cardiovascular, diabetes, Alzheimer's, joint
diseases, cognition/dementia, and quality of life) will form the
basis of this resource to uncover the genetic and environmental
factors that lead to these conditions. This combination of information
from participants will create a powerful resource for biomedical
researchers. It will enable them to improve our understanding
of the biology of disease and develop improved diagnostic tools,
prevention strategies and tailor made treatments for disorders
that appear with advancing age. The pilot phase of volunteer recruitment
is about to commence and will take five years to complete.
14. The concept of prospective longitudinal
studies is to have the baseline measures in place, including biological
samples, before the onset of disease. The primary goal is to provide
research to enable the application of genomics technologies for
patient management and intervention strategies rather than therapy.
15. As mentioned above the Trust has not
previously highlighted ageing research as a specific priority
and so we felt it was not appropriate for us to answer some of
the specific questions regarding how ageing research is co-ordinated
or prioritised. However, it is hoped the following general comments,
arising from consultations with a limited number of Trust-funded
scientists, will be useful to the inquiry:
— In general, basic research into disease
mechanisms should be supplemented with a broader public health
agenda to provide health protection and healthier lifestyle promotion
together with primary/secondary prevention. A broader evidence
base is needed since the number of older people participating
in clinical trials is not representative of their number in the
population. Since life expectancy is closely linked with social
class, more research into social factors (such as access to health
care, education) and the underlying reasons for this link is probably
needed, but for which there is limited funding.
— Elucidating the role of genes and
non-genetic factors (for example, environment, diet, exercise);
research into disease mechanisms, pathogenesis and ageing mechanism(s)—for
example, cell senescence, neuronal cell death, the role of telomerase,
proteomic research/technology, are promising areas given the advances
in genomic research and technology.
— Research into dementia (Alzheimer's,
Parkinson's as examples), and motor neuron disorder, and model
systems such as mutations in fruit flies (Drosophila) and
worms (C. elegans) could provide molecular models into
human ageing, which have not been fully exploited.
— The use of non-human primates to
understand cognitive functions and test treatments for dementia
is likely to increase. There are alternatives which could be used
such as transgenic rodents genetically modified to have human-like
nervous systems. However, the development of these models and
in vitro (non-animal) alternatives could benefit from more targeted
funding.
— While stem cell research (or therapeutic
cloning) is a relatively young area and such therapies appear
distant, the benefits could be high for future generations. The
UK now leads in this burgeoning field given the recent ruling
by the Human Fertilisation and Embryology Authority to allow scientists
to clone human embryos. In this regard research using embryonic
stem cells, understanding their differentiation and maintenance,
in particular neuronal stem cells, could be exploited for research
into cognitive function.
— Public health aspects of diet and
exercise have an impact on healthy ageing. The World Health Organisation
has been advocating a "life course approach" (http://www.who.int/hpr/ageing/index.htm)
to reduce disability and delaying the onset of chronic diseases
by the promotion of a healthy lifestyle, avoiding or reducing
risk factors associated with some of the most common disabilities.
— Calorific restriction using animal
modes could provide insights into the role of metabolic processes
in ageing.
— Loss of muscle strength, bone loss
and joint diseases; new technologies, such as tissue engineering,
could focus on wound healing—especially bone fractures resulting
from falls and accidents.
— In the field of population genomics,
there is a high degree of international co-operation through EU
initiatives and other organizations, eg the Public Population
Project in Genomics (P3G, see http://www.p3gconsortium.org) which
is an organization that aims to foster collaboration between researchers.
— Research into an ageing population
covers basic, medical and social sciences. Capacity building for
a multidisciplinary approach is needed and researchers should
take advantage of existing networks, such as P3G, to establish
collaborations and multidisciplinary teams.
— A recent study (http://www.wellcome.ac.uk/en/l/awtpub.html)
commissioned by the Wellcome Trust on Public Health Sciences:
Challenges and opportunities, concluded that a national strategy
is urgently needed to foster research into major public health
problems in the UK. It is likely that research into ageing populations
will fall within this category.
13 WHO World Health Report, 1998, UN Population Division,
World Population Prospects (The 1994 Revision). Back
|
