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Dr Mehta is a clinical academic undertaking international research into the children’s disease cystic fibrosis whilst working 50% of his time as a consultant paediatrician with a neonatal medicine/paediatric cardiology interest. His focus is on EU-wide patient care, health outcomes, rare disease policy and better informed policy making.
He has tried to improve the welfare of Europeans who suffer because their diseases are very rare in a given hospital setting. This area is a priority for the EU through their forthcoming Rare Disease Directive that will require the NHS to plan care for all rare disease patients (UK to launch end 2013).
Past work: Dr Mehta implemented the first comprehensive UK-wide CF patient registry of ~ 7000 patients across 60 NHS CF clinics between 1995 and 2006 and recently developed the first 30,000 patient, 35-country pan-European demographic CF registry, with EU FP6 funding (2006-2009). My translational science focuses on two areas: (1) discovery of a new pathway in CF disease through collaborations in eight He is an editor of Royal Society of Medicine’s CF Clinical Update Journal (2011-) He developed the European Demographic CF Registry (2006-2009) and now acts as Scientific Lead on European Registry Executive of the European CF Society (2010-).
UK CF Database protocols are used by others to improve NHS efficiency: For example, Registry data from UK CF Centres are used by the CF Trust for (i) NHS resource allocation (patients banded by disease severity – banded between £5K & £40K p.a.) (ii) CF-Centre audit by NHS-commissioner-led peer review and (iii) EMA approved phase-IV studies are followed by the registry for new CF drugs.
Citations: Lancet cover (2007)/editorials/podcasts(2007/10); commentaries in leading specialist journals such as Pediatrics and in annual Scottish and UK audit reports for Government to calculate costs/centre re-imbursement (1995-2006); 23 peer-reviewed research publications impacted beyond academia by describing, inter alia, remote monitoring of toxic drug doses specified by the Committee on Safety of Medicines, reduced therapies following neonatal screening, cited by CDC Atlanta in Newborn Screening Recommendations Reports: and therapeutic windows to address the worse outcomes for CF females with diabetes (guidelines of the American Diabetes Association, doi: 10.2337/dc10-1768, 2010).
European CF Registry impacts: The published research findings created part of the evidence base that, after recent comment on disparities of care from the European Commission, are helping facilitate the lobby to drive the implementation of a recent decision by the European Council of Ministers to ratify the European Rare Disease Directive This has led to unsolicited invitations to influence European policy debate as follows:
Policy Appointments to Advisory Board of the EPIRARE Consortium of meta-registries funded by EU DG Sanco. Further impact on policy is on-going through membership of in two key ECFS committees and EURORDIS/EPIRARE (2012) to intensify lobbying at the European Commission, the European Council of Ministers and with MEPs to implement the policy changes needed to improve outcomes.
Political Presentations of the findings at the European Parliament (2009, 2010, 2013 on file Peter Liese MEP Bonn and in CF Europe office files and MEP Bart Staes Office ) and;
Keynote Address Invitations from CF Europe to influence CF care policy in Italy/Slovakia/Serbia (2013); Chaired an Irish Governmental Panel for rare disease research funding (Health Research Board, Dublin 2013).
In the period since 2008, these impacts can be classified into the following groups:
Impacting public policy and services. Through the European Commission, European Parliament and committee work in DG Sanco, EURORDIS, the European Cystic Fibrosis Society (ECFS) and CF-Europe.
Impacting health and welfare. The beneficiaries are health service / regulatory authorities across rare diseases by demonstrating the poor quality of CF health in low-income EU member states drawing the attention of their respective governments through the Commissionv and at the European Parliament in November on CF days (2009, 2010; 2013;CF-Europe web site). Quantifying disparities in care between member states creates a benchmark for disease survival (current political addresses in the Balkans (2013) and Slovakia (2013). These invitations follow transactions with 20 MEPs after presentations in 2009 to alert their national governments about their relative performances. Translations of the Lancet work into native languages (e.g. Polish, Slovakian) facilitated lobby activity (evidence available in the CF-Europe and Polish and Slovakian CF Association files).
Impacting rare disease practitioners and services outside CF. Other rare diseases share the same implementation challenges; countries such as Argentina, Brazil, Mexico, India etc. who are at the start of their rare disease implementation strategy. The European Rare Disease Organisation (EURORDIS) highlighted the utility of the Dundee rare disease protocols through the award of a EURORDIS prize (Krakow meeting, 2010) and the appointment as EURORDIS Registry Tutor (2011-12) where AM led a symposium for 16 country representatives to advise on the implementation of a registry applicable to any rare disease (Annual Eurordis meeting, Brussels 2012: where AM delivered templates for consent with confidentiality, procedures for quantitative data handling). AM’s RD blogs led to his invitation to join the scientific board of a new Findacure Foundation for Fundamental Diseases (see Guardian news, august 2013), who wish to conjoin rare disease researchers with altruistic funders in order to improve research and care across the rare disease spectrum.
Impacts on society. The evidence has been presented in a user-friendly manner (most recently at the Italian National CF delegate meeting in Rome, September 7th 2013). This impact includes patient-friendly European registry audit reports (2012; www.ecfs.eu) and AM-initiated patient poster campaigns across Europe explaining the origins of current CF medicines to patients to improve recruitment into clinical trials (from 2010; available from I Fajac and the ECFS office in Leuven: https://www.ecfs.eu/ctn/my-current-medication).
Background: CMO-Donaldson’s report (2009, ‘rare is common’) commented that millions suffering from rare diseases (RD) remain inadequately treated because healthcare is hospital-centred where RD-patients are too few for large-scale evidence generation. Registries underpinning research are an important part of the solution, and in cystic fibrosis (CF), no comprehensive UK- or Europe-wide clinical registry existed prior to my team’s work (a post-doctoral scientist Dr E. Sims and MD student J McCormick. Throughout, project manager G. Mehta supervised/trained UK-European hospital administrative staff including the EU CF Society registry group).
Screening for Cystic Fibrosis: The prior research demonstrating benefit vs. cost of new born CF screening (Lancet 2007) was incorporated into international screening guidelines of European Governments (e.g. Sweden 2010, Netherlands (2009-10), Germany), CDC Atlanta (US) and those of the European CF Society (ECFS, 2009). My parallel research demonstrating poorer outcomes for female patients with CF diabetes was cited in the clinical care guidelines if the American Diabetes Association (doi: 10.2337/dc10-1768, 2010) and recently, in the Lancet (2010), we reported better CF patient survival in established vs. new EU member states.
UK CF Database (1995-2007; UKCF-Trust Registry thereafter): ~2 million UK-carriers of the CF genetic defect randomly generate thousands of geographically-dispersed CF patients. My team designed and implemented the UK-CF-Database (UKCFD), engineering robust data protection & management protocols ensuring anonymity that drove the research described herein. 7000 CF patients (>40 CF-clinics) were registered at handover to the UK CFTrust. The underpinning research publications facilitated the case to Government for neonatal CF screening by calculating cost-benefit ratios demonstrating less intense drug therapy for a given FEV1 in screened cohorts. The UKCFD was also applied by others to remotely measure CF-drug toxicities (gut/kidney). In 2007, the UKCFD-data and structure/protocols were embedded into a new registry; now used in NHS commissioning. This registry matches patient disease severity against CF-centre reimbursement for ~10,000 UK patients in 2013 and, its design tracks new, expensive therapies (>£100K p.a. per-patient).
CF Pathogenesis: In CF science, a key unanswered question is the pathway by which the CF gene, through defective encoding of the normal version of its protein (called CFTR), causes disease in the human cell membrane. My work proposes a new pathway that lies at the interface of phospho-histidine and phospho-serine, that has implications for cell growth, cell specialisation and nutrient uptake in cells (see Annesley S et al. 2011). My collaborators and I hypothesised that the missing amino acid Phe508, deleted from the normal CFTR protein, did not just destroy the misfolded Phe508delCFTR (as is well established), but additionally, pressed a new ‘switch’. This proposed switch is being researched through collaborations in Italy, Portugal and Hungary in 2014 where new grants have been funded for postdoctoral staff scientists to unravel this complex scenario.
UKCF Database: Rolling grants (value over £1M) to University of Dundee (1993-2007) from both the Scottish Government through top-slicing of the NHS budget via the National Services Division (~30K per annum, recurrent) and from interleaved project grants (£100k per annum; 1993-2007) from the UK Cystic Fibrosis Trust that underpinned the development of the UK CF Database European CF Registry: European Commission FP6 EuroCareCF (€1.75M, Coordinator DN Sheppard, Bristol) with University of Dundee leading on project management (2006-7) and European Registry workpackage (2006-2010; €423,128); European Coordination Action for Research in Cystic Fibrosis (EuroCareCF).
Current EU-wide Network Activities/Grants:
See also recent grants awarded with Dr S Land on epithelial polarity.
New grants have been awarded to visiting staff from Lisbon and Milan in 2014 for postdoctoral science links between kinases NDPK CK2 and autophagy and also on the fate of CFTR.
Implementing new EU-wide software for data collection.
In addition to the members in group alumni, Dr Mehta now focuses on supervision/examination of external students across the EU: For example:
- LISBON (2013); MANCHESTER (2014). BUDAPEST (2014).
- My previous Ph.D. student, Dr LJ Marshall, and post-doctoral scientists, Dr R Muimo and Dr M Kerbiriou, have been appointed to University lectureships in Aston, Sheffield and Brest respectively.
- My last International Wellcome MD student, Dr G Sijumbila, returned as a lecturer to Zambia.
- My former postdoctoral researcher, Dr E Sims, is CEO of a healthcare consultancy in Norwich.
- My former Ph.D. student, Dr C Riemen, is a healthcare manager in Hamburg.
- Three of my previous students are now NHS Consultants (Drs J McCormick, R Shellard and R Smith).
Lectures and conferences
Since 2005 Dr Mehta has been invited to give >50 lectures/seminars (>40 international invitations) with ~20 invitations in epidemiology (>15 international) and 31 invitations in basic science (23 international
- EU Parliament, three speeches of disparities of CF care over 5 years (latest in 2013)
- Disparities in CF Care Keynote Lectures (Serbia/Slovakia) 2013
- Symposium Convenor/Moderator/Co-chair & Speaker CK2 & CFTR, at European CF Society
- Frontiers in CF Science each year between 2006 and 2012.
- Speaker/Chair/Co-chair on NDPK, CK2 and CFTR, 8th & 9th International NDPK Conferences
- Seminars on CK2 and CFTR, Universities of Pittsburgh and North Carolina, 2010
- Invited opponent 2 hour lecture on CF screening, Karolinska Institute, Sweden, 2010
- Invitation to lecture at International Neonatal Update Conference, London 2010
- Magistral lecture European Registry, Croatian Cystic Fibrosis Association, Zagreb, 2007
- Protein kinases and ion channel function in CF. EMBL Heidelberg, 2007
Peak Flow Meter
BBC Radio Four: Explanation of the Peak Flow Meter
I organise and teach a 4-week Student Selected Component (SSC) on the path from cystic fibrosis (CF) science to clinical disease. I teach small groups in year 4 on paediatric cardiology twice a month. I lecture years 1 and 3 on perinatal adaptation, paediatric cardiology and hypoglycaemia / metabolism. I am also an examiner in clinical medicine for years 3, 4 and 5 where my focus is on marking case scenario scripts and project work from year 4 students. I lecture annually to GP trainees on the Child Health Surveillance Course (excellent ratings, every year). I teach postgraduate trainees in neonatal medicine.
A Dundee family afflicted with an extremely rare form of cancer may benefit from new research initiated by a University of Dundee clinical academic.