Jane Cleal, University of Southampton, Southampton, UK

https://doi.org/10.36866/pn.111.21

10 May 2018, University of Southampton, Southampton, UK

Preterm birth, defined as birth before 37 weeks of gestation, is a global problem, responsible for over a million deaths each year. While progress has been made over the last 20 years to reduce the number of preterm births, this has been limited by poor understanding of the physiology of human childbirth and a lack of investment into potential therapeutics.

In her GL Brown Prize Lecture, Rachel Tribe discussed spontaneous preterm birth. Preterm birth is described as a syndrome as it is caused by multiple pathologic processes: multiple pregnancy, infection, placental abruption and stress. However, there is still no established early pregnancy screening test or effective treatment for preventing or inhibiting preterm labour.

Rachel is using a multidisciplinary approach to help unravel the complexity of spontaneous preterm syndrome. She described an impressive range of research that spanned the pipeline – from molecules to clinical impact.

This includes basic science in both animal and human tissue to identify novel uterine smooth muscle targets for the development of tocolytic therapies (for the treatment of preterm labour). Rachel and her team have identified KV7 channels as a key regulator of uterine contractility in term and preterm myometrium (a layer of uterine muscle). Specifically, channels comprising the KV7.4 isoform seem to be the most important in the uterus, and there is potential to repurpose existing drugs for use in preterm labour.

A major focus of Rachel’s work is also exploring the early pregnancy events that lead to preterm labour. The working hypothesis is that an early maternal inflammatory response is associated with differences in the resident vaginal microbiome that leads to cervical shortening and preterm birth. She has identified key ethnic differences in the vaginal environment and host response which has led her team to pursue a precision medicine approach to early pregnancy prediction of preterm birth that considers maternal ethnicity as well as pregnancy history and other socio- economic factors.

Rachel explained how, by working closely with a clinical team led by Andrew Shennan and co-supervising clinical and midwifery PhD students, their research data has informed the development of a mobile phone app. This ‘QUiPP’ app quantifies the risk of preterm birth by combining knowledge of obstetric history with quantitative fetal fibronectin (fFN) (a protein that acts as a biological ‘glue’ at the chorio-decidua interface) and transvaginal ultrasound measurements of cervical length. The QUiPP app is currently being used on an ad hoc basis by clinicians in the UK, Europe, USA and Australia to inform management in high-risk preterm birth clinics, and recently the team have launched an implementation study (EQUIPPT) across 13 UK centres.

The lecture was extremely well received, attracting around 100 attendees from all career stages and therefore playing an important role in promoting the physiological sciences and The Physiological Society. As Rachel has been an active member of The Physiological Society since 1996 and a Trustee since 2013, Early Career Researchers (ECRs) were particularly interested in meeting with her after the lecture to discuss her work and the role of The Physiological Society in supporting her career. The Society’s support includes the opportunity to meet and network with physiologists, training workshops and support to attend conferences, all of which are vital for the ECRs in developing their career.

In 1975, The Physiological Society established the GL Brown Prize Lecture in memory of the physiologist Sir George Lindor Brown. This is an annual series of lectures aimed at a younger audience in order to stimulate an interest in physiology. Rachel Tribe, the 2016–2017 awardee, is
a Fellow Member, and Reader of Women’s Health at King’s College London. She trained as a physiologist at the University of Sheffield and gained her PhD at UMDS, London. She leads an active research team of scientists and clinicians, with her work focusing on translational research aimed at tackling the complications of preterm birth and pregnancy-associated conditions.

At the University of Southampton, we were privileged to be one of the selected Institutions to host the lecture, as Rachel’s work is of great interest to many researchers in our institution. This was the last of the six lectures Rachel presented across the UK (Cambridge, Cardiff, Dublin, Manchester, Edinburgh, Southampton), travelling 2085 miles to do so!

Congratulations to the 2018 winner of the GL Brown Prize, Andrew Parker, University of Oxford, UK. His talk will be entitled ‘Seeing in depth with the brain: the physiology of the third dimension’.