49 Hands Across the Divide is the work of local Sculptor Maurice Harron. The bronze statues standing on separate columns with outstretched hands depicts a theme of reconciliation. This monument was unveiled dring July 1992 by the Environment and Economy Minister for Northern Ireland Mr Robert Atkins. This impressive landmark stands as a welcoming feature as you approach the city centre. Open all year.

Courtesy of CAIN / cain.ulst.ac.uk

Anne Cody counts Good Friday, 1998, as an important milestone in the delivery of new treatments to Irish cancer patients. The date she refers to is Friday, April 10, the historic day when the British and Irish governments signed the 'Good Friday' or 'Belfast' Agreement, heralding an end to armed conflict in North Ireland.

That agreement, brokered in part by the United States, went beyond political power-sharing. As part of the deal, President Bill Clinton demonstrated a willingness intervene on seemingly peripheral details, such structures for all-island cooperation on health research. "The island of Ireland has one of the highest cancer incidence and mortality rates in the Western world," explains Cody, who heads the Research Infrastructure and Special Initiatives Unit at the Health Research Board in Dublin. "When Bill Clinton became aware of this abysmal record, he put in a call to the National Cancer Institute, asking if they would help."

The result was the Cancer Consortium, a tripartite agreement between the US National Cancer Institute (NCI) and the departments of health in Northern Ireland and the Republic of Ireland. "A major goal of the consortium is to improve patients' access to new therapies by strengthening the capacity of cancer centers in Republic and Northern Ireland to conduct cancer clinical trials," Cody explains.

Among the initiatives it supports is the All Ireland Cooperative Oncology Research Group (ICORG), a network modeled on the NCI's cooperative clinical trials group. "The cancer-related funding from the North-South agreement was crucial for our development," acknowledges ICORG chair John Kennedy, an oncology consultant for Dublin's St. James's Hospital. "It enabled us to transform from a small, voluntary group and take the next step towards a vigorous, well structured all-island organization, now triple the size."

Over the past ten years, ICORG has opened 71 research protocols and brought new research treatments to more than 2,600 Irish cancer patients. As an organization it is emblematic of a growing movement in both the north and south of Ireland to build new infrastructure for translational research.

Easy as ABC

Another landmark on Northern Ireland's translational research landscape is Queen's University Center for Cancer Research and Cell Biology (CCRCB). The new building is located next to the Northern Ireland Clinical Cancer Center at Belfast City Hospital, allowing scientists and clinicians to work together to improve outcomes for patients.

The CCRCB hosts more than 300 international researchers. Former US Senator George Mitchell, who was a Special Envoy to Northern Ireland from 1995 to 2000 and is now Chancellor of the university, officially opened CCRCB in November 2007. "This new center places Northern Ireland in the front line of the worldwide crusade to tackle cancer," he notes. "Cancer does not recognize boundaries or geographical frontiers."

Beyond fighting cancer, Northern Ireland is taking a broader view on translational research, using innovation support as one tool to stimulate bench-to-bedside collaboration, explains Bernie Hannigan, pro-vice chancellor of research and innovation at the University of Ulster, and a director of the Northern Ireland Health & Social Care R&D office.

"An example is the ABC initiative," says Hannigan, referring to the so-called Academic-Business-Clinical Research Innovation facility, currently under construction in Derry in the northwest of Ireland. The center is aimed at stimulating the development of new products and treatments by bringing staff at Altnagelvin Area Hospital and the University of Ulster together, and making these linkages accessible to the local life sciences industry. "This is an obvious physical example of bringing everyone together on one site," she says.

Meanwhile, in Belfast during January 2008, Northern Ireland's Ministers for Health and Enterprise came together to launch the European Center for Connected Health (ECCH). The new center, funded to the tune of €58 million ($90 million US) over the next three years, aims to use new technologies for improving the quality of life for people with chronic conditions such as diabetes or respiratory diseases.

The new center has a commitment to translating research findings into clinical application in the short term. That goal is exemplified by a plan to provide at least 5,000 people in Northern Ireland access to a remote monitoring service for chronic conditions such as diabetes or respiratory diseases conditions by 2011.

"This is the start of something big," says Paul McCoy at Invest Northern Ireland (Invest NI), the government agency charged with supporting business development in Northern Ireland. "Companies like IBM, Oracle, Medtronics, and Philips are taking an increasing interest in 'connected health' and the blend of information and communications technologies, medical devices, and monitoring for management of chronic care that ECCH promises to deliver."

Thousands of pilot programs testing these kinds of monitoring systems are underway around the world, he says, "but real outcomes have been few and far between. Northern Ireland is now saying there have been enough pilots; 5,000 is a significant number, demonstrating real leadership."

Infrastructure Growth

A hundred miles down the road in Dublin, the development of new translational research facilities is also gathering pace. Trinity College Dublin is joining forces with St. James's Hospital and Tallaght Hospital to form the Trinity Academic Medical Center. The medical school at University College Dublin will operate with St Vincent's Hospital and the Mater Misericordiae Hospital as Dublin Academic Health Care. Elsewhere in the Republic, universities in Cork and Galway are embarking on similar building plans in cooperation with regional hospitals.

Much of this is happening under the watch of the Dublin Molecular Medicine Center (DMMC), which is soon to become Molecular Medicine Ireland (MMI), a not-for-profit company being established by the country's five main medical schools. "The goal is to work together to achieve better-quality outcomes for patients," says Ruth Barrington, CEO of DMMC.

The organization has already brought about advantages of scale in areas such as the development of a multi-institutional biobank for prostate cancer. "The DMMC provided an umbrella for the medical schools and associated hospitals to work together, and we believe MMI can do that for Ireland across a range of disease areas in a very ethical, transparent, noncommercial way," Barrington says.

DMMC is also providing funding for medical graduates at registrar level to undertake a new PhD clinical scientist training program, and it is hosting the Irish arm of the European Clinical Research Infrastructures Network (ECRIN), which is an EU-funded initiative focused on integrating national clinical research facilities into a pan-European infrastructure.

North and South Together

"Things are starting to move quickly," says Sharon Higgins, head of the Dublin-based industry lobby group, the Irish Medical Devices Association (IMDA) and a member of BioMedIreland, a north-south network established to enhance cooperation and collaboration across the island's life and health-technology sector. "We now have four clinical research centers on the island of Ireland, with further facilities on the way. If we work together, this island can offer huge advantages as a location for bench-to-beside research," says Higgins.

"The North and Republic are approaching translational research from very different starting points," Higgins continues. In Northern Ireland, the life science industry largely comprises companies that have evolved from research-based startups, which, by their very nature, involve collaboration between researchers and clinicians.

In contrast, the Republic's strength has been the ability to attract major international players in the life science industry. Nine of the world's top 10 pharmaceutical companies and 15 of the world's top 25 medical technology companies have invested in Ireland. Because operations have traditionally been focused on manufacturing, there was little need for companies to reach out and network with clinical practitioners, says Higgins.

There are signs that this situation is changing, however. Invest NI's counterpart in the South, IDA Ireland, is trying to foster links between healthcare workers, scientists, and industry. One prime example is a flagship project involving GlaxoSmithKline, explains Barry Heavey, IDA's science and technology advisor. "The collaboration is focused on the discovery of new therapies to treat Alzheimer's disease and making future clinical trials more efficient," he says. It brings together 22 full-time employees comprising medical professionals, PhD students, and postdoctoral scientists from GlaxoSmithKline's UK-based Neuroscience Center of Excellence for Drug Discovery, with the Trinity College Institute of Neuroscience, in Dublin, and the National University of Ireland, Galway.

IDA could seed similar projects on a case-by-case basis, Heavey says, by introducing life science companies to research teams in areas where there are strong 'bench-side' capabilities, and then bringing the necessary critical mass of clinical expertise onboard.

To get industry seriously excited, however, he says that the clinicians need to come together themselves through networks such as the All Ireland Cooperative Oncology Research Group. "ICORG functions very effectively as a network and has an executive that understands where industry and drug therapy [are] going," he says. "We would like to see the model being replicated in other disease areas where Ireland has strong basic science capabilities, for example, neuroscience, immunology, cardiology, and vascular problems associated with diabetes."

Bringing clinical practitioners together, in a manner Heavey would like, is just one feature of the ICORG template. The organization's deeper significance perhaps lies not in the fact that it helps bridge the bench-to-bedside divide, but rather that it crosses a historically deeper chasm - the north-south Irish border.

With Northern Ireland and the Republic each facing gaps in their translational research capabilities, such all-Ireland cooperation could provide a route for both parts of the island to progress and bring benefits to patients more quickly, argues Hannigan. "The pharmaceutical companies are located in the Republic. What they need is an excellent health services infrastructure, which we have in the north. So, if we work together, we could really sell the Island of Ireland as a location for clinical trials."