Visceral fat is an intra-abdominal adipose tissue stored around several organs, including the stomach, the intestines and the liver.
Visceral Obesity is a major risk factor for developing several diseases, such as hypertension, type 2 diabetes, cancer, as well as dementia and some inflammatory diseases.
Accurate measurement of visceral fat remains tricky. Keeping track of your Body Mass Index (BMI) and waist circumference are not the best ways to tell if you are losing visceral fat.
The new online tool Visceral Fat Calculator provides an accurate and easy assessment of visceral fat deposits in adults.
This innovative tool is the result of a successful collaboration between Research and Development teams of the Luxembourg Institute of Health (LIH) with Dr Hanen Samouda and the Centre Hospitalier de Luxembourg (CHL) with Dr Frédéric Dadoun.
Obesity is a growing disease in Europe
Over more than half of adults in the EU have obesity and overweight, according to Eurostat.
Obesity is a chronic multifactorial disease, probably due to a combination of several factors.
An increase in visceral fat of more than 130 cm² defines Visceral Obesity, which also comes with a series of health complications that can be fatal. Visceral fat depots might increase in people having normal weight, overweight or obesity.
Usual measurement of obesity, validated by the World Health Organisation, is based on the BMI assessment. Yet, the index does not distinguish between fat mass and fat free mass and is therefore a poor diagnostic tool for general obesity.
Visceral Fat Calculator: an accurate, simple and readily available tool
The Visceral Fat Calculator is based on an innovative anthropometric model has been validated as the most accurate indicator of cardiometabolic risk, as well as cardiovascular, cancer and all-cause mortality, when biomedical imaging data is not available.
Using this online tool, users enter their gender, age, weight, height, and waist and thigh measurements. Based on these parameters, the tool calculates the amount of visceral fat, providing an indication of the presence or absence of visceral obesity.
How are depression in diabetes, diabetes distress, and diabetes burnout characterised? Why is it critical to distinguish one from the other? A new study, led by Dr Gloria Aguayo with the contribution of Dr Guy Fagherazzi from the Luxembourg Institute of Health in cooperation with researchers from the CUNY School of Medicine in New York,…
How much do urban environments have an impact on our active and healthy behaviours, chronic diseases and healthy ageing? Dr. Camille Perchoux is a young research associate in the Luxembourg Institute of Socio Economic Research (LISER). She focuses on urban health. A health geographer Camille Perchoux describes herself as a health geographer. Indeed, her research…
Generating insights and evidence from real-world clinical data at scale is a major challenge. Yet, it has the optential to support patients, clinicians, payers, regulators, governments, and the industry in understanding wellbeing, disease, treatments, outcomes and new therapeutics and devices. The Luxembourgish National Cancer Registry (RNC) at the Luxembourg Institute of Health (LIH) joined the consortium…
People with type 1 diabetes can experience psychological health issues related to their disease. Diabetes distress, diabetes burnout & depression are frequently reported.
Yet, it is still complex, for both patients and healthcare professionals, to put the right name on their psychological complications.
How are depression in diabetes, diabetes distress, and diabetes burnout characterised? Why is it critical to distinguish one from the other?
A new study, led by Dr Gloria Aguayo with the contribution of Dr Guy Fagherazzi from the Luxembourg Institute of Health in cooperation with researchers from the CUNY School of Medicine in New York, is addressing the concepts of distress, exhaustion and depression in type 1 diabetes.
The first and most comprehensive scoping review
Psychosocial issues are among the most common complications associated with and affecting type 1 diabetes. Depression and diabetes-related distress are frequently described and associated with poorer metabolic outcomes. Diabetes burnout has recently emerged. Yet, it is unclear whether these concepts are entirely distinct or whether they overlap.
“Unraveling the concepts of distress, burnout, and depression in type 1 diabetes: A scoping review” is the first and most comprehensive study summarising how the three concepts are used in papers examining depression, diabetes-related distress and diabetes-related burnout in people living with type 1 diabetes.
Areas of overlap among the three concepts
One sentence is common for the three concepts “Detachment from support systems”.
Overlapping between depression (blue) and diabetes distress (green) is in seven more sub concepts: “Fear”, “Feeling guilty”, “Feeling of failure”, “Lonely”, “Loss of energy”, “Negative mood” and “Poor concentration”.
Overlapping between diabetes distress (green) and diabetes burnout (salmon) is in five more sentences/words: “Anger”, “Burned-out”, “Frustration”, “Overwhelmed” and “Powerlessness to manage diabetes”. Twenty-two (73%), 17 (57%) and five sentences (45%) do not overlap in depression, diabetes distress and diabetes burnout, respectively.
Clarifying the underlying concepts of three psychological problems
Depression is a widespread psychological comorbidity in type 1 diabetes, although it is not specific. This condition is assessed using a variety of questionnaires, which increases the heterogeneity of the concept and increases the likelihood of overlap.
Diabetes distress is also common yet specific, and despite some overlap with depression, it seems to be an independent and different concept.
As diabetes burnout is emerging as a concept in type 1 diabetes, while being commonly mentioned in studies of diabetes distress, and presenting overlapping sub-concepts, there is a need to better conceptualise it to differentiate it from diabetes distress.
Towards better recognition and treatment
When depressive symptoms are detected using a self-reported instrument, clinicians should be aware that because of the possible overlap with diabetes distress, this diagnosis should also be evaluated.
The same situation may occur when diabetes-related distress is detected, in which case a diagnosis of diabetes-related burnout should also be screened.
Early differentiation of these concepts will allow for better recognition and treatment of the psycho-social problem with the right approach.
“Next steps are to perform data-driven analyses of qualitative studies and expert opinion with the objective of further refine these concepts. Another step should be to further analyse diabetes burnout and its differentiation from diabetes distress in clinical studies.”
Dr Gloria Aguayo, Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health
Accurate measurement of visceral fat remains tricky. Keeping track of your Body Mass Index (BMI) and waist circumference are not the best ways to tell if you are losing visceral fat. The new online tool Visceral Fat Calculator provides an accurate and easy assessment of visceral fat deposits in adults. This innovative tool is the…
Bringing together about 150 international scientists, clinicians, healthcare professionals and policymakers from 17 nations, the 45th edition of the Group of Cancer Epidemiology and Registration in Latin Language Countries (GRELL) conference takes place in Luxembourg in a fully virtual format. Organised in Luxembourg for the first time by the National Cancer Registry of Luxembourg (RNC)…
A Research Luxembourg team has published an overview on the use of voice monitoring in Digital Health. A voice reveals a lot about a person’s health: Does it sound strong? Does it sound weak? Is it hoarse? Are there indications of pain or fatigue? Modern digital technologies have recently made it possible to detect the…
Where we live and where we go as the result of our daily activities affect our health.
How much do urban environments have an impact on our active and healthy behaviours, chronic diseases and healthy ageing?
Dr. Camille Perchoux is a young research associate in the Luxembourg Institute of Socio Economic Research (LISER). She focuses on urban health.
A health geographer
Camille Perchoux describes herself as a health geographer. Indeed, her research expertise expends on her multi-disciplinary background in epidemiology and geography. Building on these two research fields, her research focus is on the social and spatial determinants of health behaviours and population health.
In her research, she investigates the impact of urban environments on active and healthy behaviours, chronic diseases and healthy ageing. Indeed, physical environmental characteristics, and social aspects of neighbourhood constitute urban structures of opportunities that enhance or constrain individual’s health related behaviours such as leisure physical activity, active transport, or adopting a healthy diet in daily life, which are key determinants of mental and physical health.
In order to more comprehensively assess people place interaction, and understand people decision making process in adopting (or not) health behaviours, Camille Perchoux and her colleagues in LISER are increasingly relying on GPS trackers to understand where people go, accelerometers to estimate their amount of energy expenditure and related transportation modes, and additional mobile sensors to accurately measure either personalised exposure to environmental factors or health related markers.
“This multidisciplinary research thematic is at the crossroads of public health policy, transport policy and land use as well as urban planning.”
Dr. Camille Perchoux
The promotion of strategies for adopting and maintaining healthy and active lifestyles is a public health priority to curb the cardiometabolic diseases, among others, and related severe impact on well-being.
In this regard, her research tends to identify socio-demographic and environmental levers that can provide element of decision-making to support the implementation of intervention at the individual level and their environment.
Research as a natural career path
While Camille Perchoux was a master student in geography, at Provence university, she had the chance to study the geography of malaria during two successive internships in Brazzaville, Congo, and in Dakar, Senegal.
“[During my master] I had the opportunity to do some field work, develop a survey, sample and survey the participants, work with researchers from public health and geography, and disseminate the results to the local stakeholders. After such an enriching experience of the different tasks that make up the daily work of a researcher, research was the only work I could picture myself doing at the end of my master degree.”
Dr. Camille Perchoux
After completing her Master’s degree, she joined a multidisciplinary research team to conduct a dual PhD thesis in public health – epidemiology at Sorbonne university – Pierre et Marie Curie Paris 6 (France), and at Montreal university (Canada). During her PhD, she examined the residential and non-residential neighbourhood environments that individuals experience as the results of their daily activities and may influence their health behaviours, with a case study on recreational walking.
Indeed, while more traditional approaches focused exclusively on the effect on residential neighbourhood characteristics on health, a significant innovation of this work was to highlight and quantify how individuals’ daily mobilities and daily activities outside their residential neighbourhood may also contribute to shape their health.
Then she joined the Centre de Recherche en Nutrition Humaine Rhône-Aples (CRNH-RA) in 2015 where she continued developing a strong taste for multidisciplinary work, being part of the ACTI-Cités consortium that embraces a team of epidemiologists, nutritionists and geographers to examine the socio-ecological determinants of active transportation in France. She also joined the DEDIPAC knowledge hub, a multidisciplinary consortium of 68 research centres from 13 countries across Europe, reflecting on the determinants of diet, physical activity and sedentary behaviours.
Camille Perchoux joined LISER in 2016 as a postdoc researcher before being prompted permanent researcher two years later.
Why Luxembourg as a research destination?
Camille Perchoux moved to Luxembourg as LISER was conducting a very innovative study on place effects on health based on map-based questionnaires, sensors and GPS trackers. It was “the perfect opportunity for me to grow as an independent researcher in the fields of neighbourhood and health.”
“Luxembourg applies the highest international standards of research, while the rather small size of the country facilitates the discussion and collaboration between researchers from different disciplines but also between researchers, political actors and stakeholders. Such dialogue between key actors in research and policy, and citizen is key in addressing complex societal challenges such as designing healthy and liveable cities while producing research with a high societal impact.”
Dr. Camille Perchoux
An FNR CORE 2020 grantee
Dr. Camille Perchoux is the principal investigator of the FNR CORE 2020 MET’HOOD project on the “Time-varying residential neighbourhood effects on cardiometabolic health”. Cardio-metabolic diseases are one of the leading causes of premature death worldwide.
“The MET’HOOD project is a joint collaboration between LISER and Luxembourg Institute of Health. It embraces a multidisciplinary team of urban geographers, epidemiologists, nutritionists, and sports scientists, with the support of local stakeholders in public health and urban planning “
Dr. Camille Perchoux
MET’HOOD explores the relationships between the socio-economic and physical environmental characteristics of residential neighbourhoods, behavioural cardiometabolic risk factors such as diet and physical activity, and the metabolic syndrome, over a nine-year period in Luxembourg.
Based on a country-wide, population based longitudinal study, this project will provide solid evidence on how urban density, transport infrastructures, foodscape characteristics and neighbourhood active-friendly characteristics have changed over the last decade in Luxembourg, and how such changes may have resulted in changes in the cardiometabolic health of the population.
About living in Luxembourg
After moving every six months during her PhD in between France and Canada, and then discovering the city of Lyon during her post-doctoral fellowship, Camille Perchoux was eager to discover a new country and a new culture.
“I believe that Luxembourg provides a great opportunity to benefit from natural spaces, in particular nature is accessible by bike and foot, while concentrating the assess of a capital city in terms of diversity to engage in social and leisure activities. Also, being exposed daily to such a great cultural and linguistic diversity provides me a strong sense of belonging to a European community.”
Why do certain systems suddenly start functioning in unpredictable and drastically different ways? Daniele Proverbio is a doctoral researcher at the Luxembourg Centre for Systems Biomedicine (LCSB) at the […]
Real-world clinical data has the potential to transform our understanding of health, disease and treatment. Yet, it is currently dispersed across multiple institutions and countries, stored in different formats and systems, and subject to different rules, challenging policy restrictions and technology considerations. This makes it very difficult to fully exploit its potential to the benefit of European patients.
Generating insights and evidence from real-world clinical data at scale is a major challenge. Yet, it has the optential to support patients, clinicians, payers, regulators, governments, and the industry in understanding wellbeing, disease, treatments, outcomes and new therapeutics and devices.
The Luxembourgish National Cancer Registry (RNC) at the Luxembourg Institute of Health (LIH) joined the consortium of the European Health Data & Evidence Network (EHDEN). The LIH team secured a cross-disciplinary grant for a duration of 12 months to accelerate the standardisation of clinical data.
Accelerating the harmonised large-scale analysis of health data
The LIH team will set up and implement IT tools and processes, such as those developed by the international Observational Health Data Sciences and Informatics open science collaboration, that will turn the data into the so-called OMOP (Observational Medical Outcomes Partnership) common data model – a model that will allow patient data to be captured in the same way across different institutions.
“Joining the EHDEN consortium is an excellent opportunity for the RNC to proactively demonstrate its commitment to evolving its data structure towards more streamlined and harmonised health data formats, ultimately contributing to facilitating the use of clinical and epidemiological cancer-related data to improve patient outcomes.”
Dr Claudine Backes, Principal Investigator and coordinator of the project.
EHDEN aims to accelerate the harmonised large-scale analysis of health data in Europe and reduce the time that it takes to provide an answer in real-word health research. Specifically, its goal is to build a federated data network allowing access to the data of over 100 million EU citizens in a harmonised and standardised common data model. This will enable the smarter management and sharing of research methodologies, therefore improving collaboration and expanding education in open science.
The EATRIS Luxembourg Node, coordinated by Luxembourg Institute of Health (LIH) and its Integrated Biobank of Luxembourg (IBBL), as well as the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg, was rewarded for its achievements in terms of translational research. The award recognised the remarkable efforts of the Luxembourg Node members with regard to…
The Luxembourg Institute of Health (LIH) and the Centre Hospitalier de Luxembourg (CHL) announce the launch of “SCOL” (Study of Continuous Oral Levodopa), a unique international clinical trial aiming to assess the safety, tolerability and efficacy of the new DopaFuse System for the continuous oral delivery of levodopa to better treat the symptoms of Parkinson’s…
The first wave of the COVID-19 outbreak resulted in strict pandemic control measures in Luxembourg and other countries. While these measures expectedly had an impact on the mental health of Luxembourg residents, little data is available on the longitudinal evolution of population mental health measures during lockdown and during the gradual relaxation of the lockdown…
Bringing together about 150 international scientists, clinicians, healthcare professionals and policymakers from 17 nations, the 45th edition of the Group of Cancer Epidemiology and Registration in Latin Language Countries (GRELL) conference takes place in Luxembourg in a fully virtual format.
Organised in Luxembourg for the first time by the National Cancer Registry of Luxembourg (RNC) at the Luxembourg Institute of Health (LIH), the meeting features several prominent speakers, providing an opportunity to discuss the latest developments in the field of cancer epidemiology with a particular focus on COVID-19 and cancer, as well as childhood and adolescent cancers.
National and international prominent speakers in Luxembourg
The three-day event gathers prominent speakers, who are addressing some of the key clinical challenges related to cancer.
Some of the national and international speakers and moderators include:
A Research Luxembourg team has published an overview on the use of voice monitoring in Digital Health.
A voice reveals a lot about a person’s health: Does it sound strong? Does it sound weak? Is it hoarse? Are there indications of pain or fatigue? Modern digital technologies have recently made it possible to detect the smallest changes in the voice. But now, more research is needed to make the results of this voice monitoring usable for medical and diagnostic purposes.
From research to clinical practice
To this end, a team at the Luxembourg Institute of Health (LIH) led by Dr. Guy Fagherazzi, director of the Department of Population Health and head of the Deep Digital Phenotyping Research Unit, has written a review on the topic of “vocal biomarkers”. In this paper, the research team describes the state of the art of voice analysis for health purposes and the evaluation of speech recordings with the help of artificial intelligence. The scientists have also described a pipeline in which the corresponding techniques can be coordinated and used for all the way up to medical applications. They have thus created an important basis for systematically advancing voice analysis in the field of digital health and making it ready for use in clinical practice. The publication “Voice For Health: The Use Of Vocal Biomarkers From Research To Clinical Practice” was published on April 16th in the journal “Digital Biomarkers“.
In the age of analogue medicine, a person would go to the doctor when he or she felt unwell. The doctor would perform an examination, make a diagnosis and prescribe a treatment for the patient. Until the next visit to the doctor, there was a period during which no one knew the patient’s exact state of health. But times are changing, as Dr. Guy Fagherazzi says: “We can now also use digital technologies to monitor a patient’s condition between two visits to the doctor – and intervene if his or her condition should deteriorate.” According to Fagherazzi, a key to this is the human voice. “If a person’s state of health changes, this immediately affects the voice,” the scientist says. The changes may be barely perceptible to the human ear. But digital technologies and artificial intelligence can measurably detect them as useful markers for diagnostic and medical purposes.
Evaluating voice recordings with artificial intelligence
At LIH, this is an important new field of research. There are several projects addressing this topic, which hope to make digital voice analysis usable for combating COVID-19, among other things. “The first thing we did was to assess how far research in this field has already come,” says Fagherazzi. Together with his team and colleagues from the University of Luxembourg and the Luxembourg Institute of Science and Technology (LIST), he conducted a comprehensive literature review. The researchers learned which techniques are suitable for recording voices and how the data can be collected and stored. They compiled current methods for processing and evaluating voice recordings with the help of artificial intelligence, and identified which vocal biomarkers – which characteristics of the voice – can already be used to diagnose diseases and determine the state of health.
Describing the current health status is, however, only half the journey the LIH researchers decided to embark on. “We have also described in our paper how the different techniques need to be brought together and developed so that the use of vocal biomarkers becomes relevant for clinical practice,” Fagherazzi says.
“We will now be taking these steps into practice within the framework of various clinical projects running at LIH and its cooperation partners”
Several projects in the framework of the COVID-19
Two of these projects are related to COVID-19: in Predi-COVID, COVID-19 patients and their relatives are being systematically examined in order to identify biomarkers and risk factors associated with disease severity. In CDCVA, a project led by the University of Luxembourg and LIST in association with LIH, approaches are being researched to detect COVID-19 using cough and voice analyses. A third project, called CoLive Voice, will soon be launched to collect voice samples from volunteers all over the world. The goal of CoLive Voice is to advance voice-based diagnosis and symptom monitoring for a wide range of diseases, from cancer and diabetes to mental health and Parkinson’s disease.
Through all these projects, Fagherazzi hopes not only to gain new insights into digital voice monitoring, but also to ensure proximity to clinical practice:
“Vocal biomarkers will only become useful if we have this connection with clinics.”
For the future, he has three groups of key stakeholders in mind. The first is doctors who will be able to use voice analysis to monitor the condition and symptoms of their patients remotely, even when they are at home. The second is people who want to monitor their own current state of health using an app and voice samples. And the third group is pharmaceutical companies that can use the new techniques to capture better real-life data on the condition of their participants and on the tolerability and efficacy of new active substances in clinical trials. “We have now published a key paper,” Fagherazzi says. “But,” he adds with a wry smile, “more than anything else, the paper is the basis for a lot of work that now lies ahead of us”.
The collection of tumour samples from various Luxembourg hospitals has enabled to launch several research projects, including European and international ones, which already present very promising results.
Initiated in 2011 by the University of Luxembourg and the Integrated Biobank of Luxembourg (IBBL) as a concerted action against colorectal cancer (CRC), the collection of tumour samples from various Luxembourg hospitals has enabled to launch several research projects which already present very promising results for the treatment of colorectal cancer patients.
Prof. Serge Haan and Dr. Elisabeth Letellier from the Department of Life Sciences and Medicine (DLSM) at the University of Luxembourg who launched the project in 2011 explain in more details the importance of such a collection.
How did the collection start?
In 2010, we gathered with Dr. Jos Even from the Laboratoire National de Santé (LNS) and the scientific management team from the IBBL to investigate colorectal cancer by setting up a high-quality tissue collection from colon cancer patients in Luxembourg. IBBL, in the context of its mission of serving the Luxembourg research community, decided to make this collection one of its strategic initiatives. The project started with the support of the Fondation Cancer and the Luxembourg National Research Fund (FNR).
Over the years, the collection has grown significantly with the launch of several research projects and the support of many partners such as the Laboratoire National de Santé (LNS), the Centre d’Investigation et d’Épidémiologie Clinique (CIEC/LIH), the Centre Hospitalier Emile Mayrisch (CHEM).
What is the current status of the collection?
Over the past years, we have established an ongoing collection of tumour tissue samples from CRC patients, assembling high quality samples of over 170 patients. This collection contains a multitude of sample types, such as serum, plasma, immune cells, stool and tumour tissue and normal counterparts from the same patients. Clinical parameters are available for all samples (age, gender, tumour location, survival, diet surveys, therapies, etc.), allowing for studies, which can generate highly valuable translational findings. Pre-analytical factors, such as the cold and warm ischemic time, the Bristol score, as well as dietary questionnaires are collected along with the samples.
We have a follow-up for these patients every year up to 5 years and clinical data is collected for more than 10 years. As the progression of CRC takes over 10 years, samples and data (survival, treatment etc.) covering 10 years are required to have a clinical relevant collection. This is why establishing such a cohort is a future-oriented project which will yield a lot of important translational findings in the domain of gastrointestinal cancers over the next years.
What is its value?
The collection allows generating results that can be translated into a clinical setting. Importantly, this cohort has a unique added value, based on (i) complete sets of sample types, (ii) full preanalytical documentation and characterisation, (iii) longitudinal follow-up samples, (iv) extended clinical data annotations, (v) quality control measurements. As we collect the tumour cells as well as the different cells of the tumour microenvironment, we can generate “small tumours” in the lab which nicely recapitulate the original tumour. These models allow us to study the mechanisms underlying tumour initiation as well as progression but also the development of novel drugs that not only target the tumour cells but also its microenvironment. This is crucial as the past years have clearly demonstrated that the tumour microenvironment plays a key role in tumour progression. Building up these complex tumour models from a patient’s material allows to develop drugs that are specific for this patient. In essence, it fosters personalised medicine.
Over the past years, we have acquired extensive knowledge in the exploitation of the results generated with the samples of the cohort. For example, by using our CRC cohort, we have identified promising biomarkers with a strong prognostic value in early CRC stages. One of our recently identified biomarkers has led to the filing of a patent on novel biomarkers for cancer diagnosis, prediction, or staging. Together with the IBBL, we obtained a Proof of Concept funding from the FNR to test one of the identified biomarkers for clinical use.
What is the future of the collection?
We have already initiated in collaboration with different groups at the University but also the Luxembourg Institute of Health (LIH) and international partners several research projects which are using the samples from the cohort or the cultures derived from them. As an example, IBBL was invited to join a European project, partly based on the value of our collection. These tools are important to generate high translational results. In addition, we have established a biobank at the University which contains 3D spheroid cultures, organoids, as well as cells of the tumour microenvironment such as fibroblasts. This biobank can be used by researchers to perform mechanistic studies as well as drug profiling or biomarker studies.
We would like to expand this cohort and involve more hospitals as for example the Hôpitaux Robert Schuman, Centre Hospitalier de Luxembourg and Centre Hospitalier du Nord. Our future aim is to include this cohort into the National Cancer Plan and further develop it as a national cohort that can be used by all researchers in Luxembourg and abroad.
11 project partners from academia and industry located all across Europe have joined forces in a project called PHOENIX to create an “Open Innovation Test Bed” for nano-pharmaceuticals and it will all be coordinated in the Grand Duchy by Luxembourg Institute of Science and Technology (LIST).
PHOENIX is an innovation project funded by EU’s Horizon2020 Framework Programme and it aims to provide services for the development, characterisation, testing, safety assessment, scale-up, GMP production and commercialisation of nano-pharmaceuticals to the market, making them available to SMEs, start-ups, research laboratories and interested users.
The project is coordinated by Dr Tommaso Serchi at LIST and supported at MyBiotech near Saarbrücken for the Scientific Coordination by Dr Nazende Günday-Türeli. PHOENIX will have a duration of 48 months starting on 1 March 2021 with a total budget of €14.450 million and a requested EU contribution of €11.1 million.
What are nano-pharmaceuticals?
They are drugs that use nanotechnology (the use of matter on an atomic, molecular, and supramolecular scale for industrial purposes) in some form. This could be in the sense that the drugs themselves are nanomaterials. For example, contrast agents are used in the form of nanoparticles rather than a molecule because nanoparticles are more stable and can stay longer in blood. Another example could be that the nanoparticle is used as a capsule to encapsulate the drug and protect it while enhancing adsorption and distribution.
Nano-pharmaceuticals have the potential to drive the scientific and technological uplift, offering great clinical and socioeconomic benefits to society in general, industry, key stakeholders and patients. Nevertheless, affordable and advanced testing, manufacturing facilities and services for novel nano-pharmaceuticals are main prerequisites for successful implementation of these advances to further enhance the growth and innovation capacity.
The implementation of an Open Innovation Test Bed
The establishment of current good manufacturing practice (cGMP) in nano-pharmaceutical production on a large scale is the key step to successfully transferring nano-pharmaceuticals from bench to bedside (from lab to industrial scale). Due to the lack of resources to implement GMP manufacturing at site, the upscaling and production of innovative nano-pharmaceuticals is still challenging to main players of EU nanomedicine market, start-ups and SMEs. To allow successful implementation of the nano-pharmaceuticals in the nanomedicine field, there is an urgent need to establish a science and regulatory-based Open Innovation Test Bed (OITB).
The PHOENIX project aims to enable the seamless, timely and cost-friendly transfer of nano-pharmaceuticals from lab bench to clinical trials by providing the necessary advanced, affordable and easily accessible PHOENIX -OITB which will offer a consolidated network of facilities, technologies, services and expertise for all the technology transfer aspects from characterisation, testing, verification up to scale up, GMP compliant manufacturing and regulatory guidance.
PHOENIX-OITB will develop and establish new facilities and upgrade existing ones to make them available to SMEs, starts-up and research laboratories for scale-up, GMP production and testing of nano-pharmaceuticals. The services and expertise provided by the OITB will include production and characterisation under GMP conditions, safety evaluation, regulatory compliance and commercialisation boost.
The 11 partners that form the PHOENIX consortium
Luxembourg Institute of Science and Technology (LIST) – Research and Technology Organisation (RTO) from Luxembourg – Project coordinator.
MyBiotech – Small Medium Enterprise (SME) from Germany – Project Scientific Coordinator.
Nanomol Technologies SL, SME from Spain.
LeanBio SL, SME from Spain.
BioNanoNet Forschungsgesellschaft mbH (BNN) – RTO from Austria.
Agencia Estatal Consejo Superior de Investigaciones Científicas (CSIC – two distinct institutes take part in the action CSIC-INMA and CSIC-ICMAB) – RTO from Spain.
Institute for Medical Research and Occupational Health (IMROH) – RTO from Croatia.
Research Center Pharmaceutical Engineering GmbH (RCPE) – RTO from Austria.
Luxembourg’s new business health technologies incubator will open in spring 2021. Hosted at the House of Biohealth in Esch-Belval, it will offer 350 m2 of laboratory space to start-ups and spin-offs during their first 2-3 years of operation.
The opening of the new healthtech incubator was announced by Minister of the Economy Franz Fayot on 21 January 2021. “The health technology sector is a pillar of our economic diversification strategy,” said the minister. “Offering suitable infrastructure for hosting relevant companies in the healthtech sector is an asset in terms of attractiveness and sustainability for the national economic ecosystem.”
Accelerating economic impact
The health technologies incubator will contribute to accelerating the economic impact of investments made to develop public research in biomedicine in Luxembourg. In addition to fully equipped laboratories, hosted companies will also be able to benefit from professional support in the field of business development.
The incubator is part of the House of Biohealth, a hosting facility with office and lab space for both established companies and start-ups in the fields of biotech, cleantech and ICT. The House of Biohealth currently hosts 9 companies and two public research laboratories that are part of the Luxembourg Institute of Health (LIH) and the Luxembourg Centre for Systems Biomedicine (LCSB). Around 450 people work in various areas such as diagnostics, medical devices and digital health.
Once the healthtech incubator has been opened, the House of Biohealth with be able to host up to 600 researchers on close to 9,500 m2 of laboratory surface and 5,500 m2 of office space.
“The House of Biohealth will be able to respond even better to the specific needs of start-ups and spin-offs, which can benefit from specific support to move successfully from the world of research to the world of business.”
Employment and investments in Research, Development and Innovation (RDI) are growing steadily.
Close to 5,000 highly qualified individuals are employed in research and development. This is equivalent to 13,4 persons per 1000 jobs. Another unique feature of Luxembourg’s economic landscape is the high percentage of service-based companies that are actively pursuing RDI activities. Indeed, more than 65% of service-based companies are involved in research, development and innovation activities (the average across sectors being 65%), whereas the share of industrial companies is 63%.
Over the past two decades, Luxembourg has developed into an internationally recognised hub for science. An important driving force behind this development is Parkinson’s research. The Grand Duchy is now one of the leading locations for this field of research. This can be attributed in part to the FNR-sponsored project NCER-PD, the National Centre for Excellence in Research on Parkinson’s Disease. NCER-PD is so successful that, in 2019, the FNR gave the green light and six million euros for the second funding period.
Parkinson’s is a disease of the nervous system, characterised by the premature aging of brain cells that produce the chemical messenger dopamine. Among other things, dopamine controls motor function, and thus the targeted and voluntary movement of arms, legs and other parts of the body. Parkinson’s patients therefore tend to lose the proper coordination of their movements, which also become slow. They can have difficulty swallowing. The ability to make facial expressions diminishes. Many Parkinson’s patients develop tremors, the muscle shaking characteristic of the disease. Their sense of smell and sleep patterns can also be disrupted.
Not all Parkinson’s cases are the same
The symptoms of Parkinson’s disease are highly diverse and differ from one person to another.
“We now know that not all Parkinson’s cases are the same,” says Prof. Rejko Krüger, the coordinator of NCER-PD, referring to the many symptoms of this disease. “It has become clear that we are dealing with not only different constellations of symptoms, but also different causes and many different triggers of Parkinson’s as well.”
These can be genetic risk factors or certain environmental influences, for example. In a small percentage of Parkinson’s patients, the disease can be traced back to mutations in a single gene. Researchers have so far identified 20 genes whose mutations can lead to Parkinson’s.
Research for earlier diagnosis and better treatment
There is still no cure for Parkinson’s, nor is there any way to prevent or stop the disease. Yet, there are drugs and other therapeutic methods that can treat its symptoms well enough for many patients to live for many years with the disease. NCER-PD is helping to continually improve the treatment of symptoms, but the most important goal for the researchers is to find ways to treat Parkinson’s at its root.
NCER-PD is centred around a so-called patient cohort: a group of people who have consented to have their state of health regularly monitored by specialists over the span of many years. The participants give samples of body fluids such as blood or urine. They also take part in clinical examinations that analyse movement sequences and test their attention, memory, vision, speech and sense of smell.
1600 participants in the cohort
The cohort includes people with and without Parkinson’s disease. The regularity of the comprehensive examinations allows the researchers to obtain a precise overview of how each volunteer’s health status develops over time. From this, they aim to identify early warning signs to help diagnose Parkinson’s disease in its early stages, even before symptoms appear. They are studying, with scientific rigour, the long-term effects of certain treatments on the health of Parkinson’s patients. They are also learning what might be effective preventive measures.
The NCER-PD team and its many partners from Luxembourg’s research, clinical and ambulatory care sectors have been recruiting volunteers for the cohort since 2015, with great success. At the end of 2019, more than 800 patients and just as many healthy people had already given their consent. “We need these numbers,” says Krüger, “to ensure we can make representative and scientifically valid statements.”
Excellent review of outstanding scientific results
The monitoring of the cohort lays the foundation for the scientific work of the NCER-PD researchers and the publication of their results in respected scientific journals. NCER-PD’s track record is outstanding, as evidenced by an excellent rating from an international review panel last year. As a result, the Fonds National de la Recherche is providing another six million euros for NCER-PD until 2023.
This funding will allow the regular check-ups to continue for registered participants and to be offered to newly diagnosed patients as well. “We are furthermore planning two new risk cohorts,” says Krüger: “With them, we want to identify early symptoms of future Parkinson’s cases so that we can take preventive action when it is needed.”
Recognising early symptoms for prevention
The researchers already have the first clues as to what could be early signs; now they want to increase the level of confidence. They are looking for volunteers who have a specific sleep disorder, namely REM sleep behaviour disorder. These people talk or shout loudly in their sleep, sometimes also kicking and punching so harshly that even their partners suffer.
People with REM sleep behaviour disorder have a higher likelihood of developing Parkinson’s disease later in life. With the help of this first risk cohort, the NCER-PD researchers now want to gain a better understanding of this correlation.
For the second risk cohort, the scientists are approaching people who have a very specific mutation in the “GBA” gene. Every third person with a mutated GBA gene develops Parkinson’s disease. In the new study, the participants will be offered tests using MRI scans. This non-invasive imaging method allows researchers to visualise structural changes in the brain.
“We want to find out whether such changes already exist in people with the GBA mutation before Parkinson’s symptoms appear,” Krüger explains. “These would be very good early warning signs that would indicate the need for early therapy, and would thus clear new paths towards prevention.”
Researchers from NCER-PD were already are able to find early indicators of Parkinson’s disease using biochemical and mathematical methods. In cooperation with Saarland University, they identified molecules in blood samples from Parkinson’s patients that indicate the disease at a very early stage. These are called biomarkers.
“We already have many biomarkers in sight,” Rejko Krüger reports: “Now we are narrowing the list of potential molecules down to those candidates that can actually be used in future clinical diagnoses.”
Treatment methods in focus
During the second funding period of NCER-PD, the Parkinson’s researchers want in particular to make significant progress in the treatment of the disease. An important part of this will be clinical trials in vitro: new active substances will be tested in the laboratory on cells derived from tissue samples provided by patients who have a specific genetic predisposition to Parkinson’s disease. Promising substances from these experiments will then be developed further in clinical trials, with the aim of making them safe and effective for use in clinical practice.
Prof. Krüger underlines the importance of teamwork and thanks everyone involved for the results achieved so far: “NCER-PD’s success is based on the fact that, in Luxembourg, people from different institutions are collaborating in a spirit of strong mutual trust. Furthermore, we have a scientific infrastructure that meets the highest standards. This means we have a great opportunity in Luxembourg to lay the foundations for personalised, tailored Parkinson’s therapies.”