Research

Description of Research

My ongoing research focuses on transfusion transmitted infections aiming to improve our understanding of current risks and preparedness for emerging pathogens. I recently led the work in identifying occult hepatitis B infection as a blood transfusion risk in England and have done pioneering work to investigate the undeclared use of pre-exposure prophylaxis among syphilis infected blood donors. I am also engaged in diagnostic and molecular virology, and supporting the investigations into how next generation sequencing could be used to enhance the effectiveness of microbiological screening. This work is done within the Blood and Transplant Research Unit in Genomics to Enhance Microbiology Screening at the University of Oxford (BTRU-GEMS) but aiming to develop further collaborations with the University of Turku.

My second aim is to obtain a better understanding of enterovirus infection: firstly, to predict the emergence of these viruses, and secondly, to identify why some individuals encounter a severe form of infection while others remain completely asymptomatic. These small RNA viruses evolve rapidly through either mutations or recombination events, influencing their replication capability, transmissibility and potential escape from host immune responses. While we monitor their genetic evolution carefully, we currently lack tools to predict which changes will impact their transmissibility or pathogenicity. Furthermore, the severity of enterovirus infection caused by similar genetic variants seem to be vary between individuals. For example, coxsackievirus B3 infection can remain asymptomatic or initiate acute infection of cardiac tissue and, in some cases, establish a long-term persistent infection that can lead to serious disease sequelae, including dilated cardiomyopathy. We will investigate whether the disease severity is affected by the host genetic background perhaps mediated through varied immunological responses affecting virus clearance, persistence and immunopathology. We plan to apply varied tools for these investigations, including comparative analysis of transcriptomics, proteomics and metabolomics of plasma, cerebrospinal fluids and respiratory samples obtained from individuals with varying severity of infection, and analysis of tissue or blood derived viral genomes. The findings will also contribute towards a better diagnosis of enterovirus infections, and potentially open new innovative avenues for prevention and treatment.

These investigations will be supported by the established European Non-Polio Enterovirus Network (ENPEN) as a source of long-standing collaborative expertise, virus isolates, sequences and hospital-based surveillance data. ENPEN was established in 2017 and now composes scientists from over 70 institutions in Europe. With ENPEN, we are currently collaborating also with the European Centre for Disease Control (ECDC) and WHO European office.

Current topics

Blood safety related research:

  • Understanding occult HBV infection and developing better biomarkers for blood donation screening
  • Emerging infections as blood safety treat – with special focus on rat hepatitis E virus, Usutu virus and TBEV
  • Microbiological risks following the introduction of individualized blood donor assessment with special focus on syphilis and PrEP use
  • Is syphilis a blood safety risk, or simply a marker of risk?
  • Considerations for bacterial screening of blood donations
  • Impact of parvovirus B19 to blood donation and recipient safety

ENTEROVIRUS related research:

  • Comparison of enterovirus data reported to the WHO Regional Office for Europe via the acute flaccid paralysis (AFP), additional enterovirus and environmental surveillance system along with that collected by the European Non-Polio Enterovirus Network (ENPEN) [Collaborative study with WHO Europe]
  • Severe neonatal hepatitis associated with echovirus 11 infection: retrospective clinical, epidemiological and genetic investigations in Europe, 2018-2023 [Collaborative study with ECDC]