Scotland’s CMO on cutting-edge sepsis gene research

Gene research to reduce sepsis death risk “absolutely” part of realistic medicine agenda, CMO says

Thursday 18th April 2019

The most senior doctor in Scotland has thrown her weight behind new research that could allow doctors to use a patient’s genes to tailor sepsis treatments, claiming the scientific advance “opens up a huge range of possibilities”.

Sepsis deaths in Scotland have fallen by 21% since 2012, in part because of support provided to clinicians by the Scottish patient safety programme to deliver six simple interventions in acute settings.

It’s vital the condition is treated as soon as possible, as it can advance quickly. Currently, a range of antibiotics is often deployed to treat each patient in the hope that one will work.

Change is afoot however, thanks to a group of researchers at the University of Edinburgh’s Roslin Institute who are aiming to tailor treatments to a patient’s genetic make-up.

More tailored treatments that could reduce the number and type of antibiotics used to tackle sepsis is a pursuit that sits well with the realistic medicine agenda of Scotland’s Chief Medical Officer, Dr Catherine Calderwood, who visited the research team to launch the Scottish Government’s latest sepsis awareness raising campaign.

An ardent advocate of realistic medicine in Scotland, Dr Calderwood told's Sarah Nimmo the research being carried out “absolutely fits” with a desire to make care more person-centred and less harmful or wasteful.

The work Dr Bailie and his team at the Institute are undertaking stems from the knowledge that some people are more susceptible to getting sick and developing sepsis than others, and that once sick, an individual’s chance of dying is in part determined by their genes.

If the genetic markers that indicate an individual’s susceptibility can be pinpointed, the hope is that treatments can be tailored and therefore more effective.

Dr Calderwood said: “We are actually taking someone’s genetic make-up and establishing whether they are someone who will respond to a treatment or actually who won’t respond, then we won’t give them unnecessary treatment if they are known to be somebody who will not benefit from that.

Whereas we can also further target people with a particular treatment or antibiotic. We already do it in some forms of cancer but in this situation what the research here is going to look at is whether not only are you susceptible to the treatment and therefore more likely to survive, but also which treatment is going to be best for you.

“So, it is absolutely realistic medicine because we are avoiding over-treatment or unnecessary treatment, which will of course avoid harm and side effects.”

We have work ongoing in sequencing the whole human genome so we will know a lot more than we do – we already target colorectal and breast cancer treatments, and we have some types of heart disease where we are looking at people’s genetics to tailor treatment, but this opens up a huge range of possibilities.”

The latest sepsis awareness campaign, launched today, focuses on the importance of being able to recognise the condition through five early signs.

Dr Calderwood continued: “We know following the [last] campaign [in 2018] that three quarters of the Scottish population know what sepsis is, but they don’t necessarily know the individual symptoms of what distinguishes a really significant infection that means they should seek immediate help, or whether they are alright to stay at home.”

So those symptoms and awareness of symptoms is why this campaign is different. That includes symptoms of a very high or low temperature, uncontrolled shivering, confusion, passing less urine than normal, and at the later stages having cold or blotchy hands and feet. Having two of those symptoms would make us want to see someone seek medical help.

Whether that is their GP who maybe has already seen them for an infection, or if they are very unwell they should phone NHS 111 for advice or go straight to A&E.”