For International Clinical Trials Day we are showcasing some of our exciting and cutting edge research.

NIHR Doctoral Fellow Dr Mary Ní Lochlainn’s upcoming clinical trial is looking at the relationship between protein intake, prebiotics, gut bacteria and muscle strength in over-60s.

Based in the Department of Twin Research & Genetic Epidemiology, King’s College London, she and her team are about to start a 12-week trial with twins, which will be carried out entirely from home with support from research nurses over Zoom. This is the first intervention trial the department has carried out entirely remotely.

What is your research about?

NIHR Doctoral Fellow Dr Mary Ní Lochlainn

My PhD research is about protein and skeletal muscle and the role that the gut microbiome might play in the relationship between these two. We know that older people need a higher dose of protein in their diet in order to get the same response in their muscles as a younger person – this is called anabolic resistance. My focus is on whether the microbes which live naturally in our guts can be targeted to help reduce muscle loss with age. We are only getting to grips on the various ways these bacteria influence our overall health.

Research on the gut microbiota is still relatively new. Researchers are looking at the role this bacteria has in our overall wellbeing. We know from animal studies that these bacteria clearly play a role in many processes in the body. For example, when you move bacteria from one animal to another, you can see changes in metabolism in the animal who receives it; this is called a faecal transplant. Clearly the bugs are having an effect. My interest is whether they have role in muscle physiology in aging.

How did your research come about?

I was always interested in healthy aging and preventing frailty. I am interested in extending healthy life-years, and minimising years spent with disability and dependence on others. We know that people are living longer and we want those people to be healthy and independent. I’ve been looking at ways in which we become frail, and one way is that we lose muscle. I was trying to look at something which could potentially target that. This area hadn’t been fully explored.

Some gut microbiome research had looked at athletes. It showed they have increased diversity in their gut bacteria. Athletes usually have healthy muscles and excellent cardiovascular health. We also know the gut microbiome change as patients get older. Some research had started to link muscle health with the bacteria in our guts. Maybe we could put the right bugs back in? Or harness particular bacteria to prevent muscle loss or frailty?

Why is your research important?

We’re seeing if we can improve the lives of older people. The population is aging. The proportion of older people in society is the highest it has ever been. With that comes problems with age-related conditions. We have longer life expectancy but we want healthy life years, rather than living with frailty and comorbidity. There isn’t enough research in this area. This is why this is important. We don’t know how to prevent muscle loss with age. There is no medication available to treat muscle loss or frailty. Apart from general health advice we don’t have a huge amount of things to offer and it would be fantastic if we could improve the treatment options available.

What do you predict from your research?

We are going to give our study participants either protein + prebiotic or protein + placebo. Our hypothesis is that the older people we give a prebiotic alongside the protein supplement will have a greater response in their muscles in terms of strength improvement versus those who have the protein supplement with just the placebo. The idea is that the prebiotic is modulating the gut microbiome. We hope to see that those who get the prebiotic will get stronger, showing that that gut microbiome is playing an important role.

How is it possible to research entirely remotely?

The questionnaires will be done entirely online. People will be posted out a kit, including the equipment for collecting biological samples (urine, faeces etc.). They will have an envelope to send everything back to our lab. Then physical measures will be done via video conference with a researcher on the other end of the video call. They will be able to take measurements over video like walking speed and grip strength. We hope to bring a small subset into the department to validate the measures and to make sure they’re being done accurately.

One advantage of conducting research remotely is that it increases access. Sometimes it’s difficult for older patients to travel, because of their medication routine, their need for specialised transport, or a whole range of other reasons. We know this is a barrier for older people accessing research.