When Lesley Anderson threatened to quit her PhD after being tasked with collecting toenail clippings, she never dreamed that 20 years later she’d be stockpiling them again.
Back then, she was researching causes of oesophageal cancer at Queen’s University in Belfast. This involved visiting people at home to cut their two big toe nails, which were then sent off for analysis.
But when a patient revealed the length of his unkept nails, she found herself trimming all 10 – an experience she made clear to her PhD supervisor she was unwilling to repeat.
Fast forward 20 years, the now Professor Anderson is once again seeking toenail clippings – this time for a study into the causes of a group of blood cancers, known as myeloproliferative neoplasms (MPNs).
Patients from across the UK and Ireland are taking part in the MOSAICC study, which is being supported by Aberdeen-based charity Friends of ANCHOR.
Although the cause of most MPNs are unknown, research has shown genetic traits or things people have been exposed to during their lifetime – such as where they live or work – may play a part.
Now Prof Anderson and the team are looking for more definitive causes and believe toenails could be key.
“Toenails can deliver an understanding of exposure in a measured way,” she said. “I can ask patients questions but often it’s very difficult to remember some of the historic detail. The fact we can measure something in a biological sample that your body is getting rid of anyway is really helpful.”
Big toenails take approximately a year to grow from root to tip, giving researchers a good insight into what a patient was exposed to around the time of their diagnosis.
Prof Anderson, chair of health data science at the University of Aberdeen, said: “We’re comparing patients with MPNs to controls without MPNs to identify what the causes might be.
“They might be genetic, or lifestyle factors such as weight or smoking, or occupational or chemical exposures. The MOSAICC study looks across the whole realm of a patients’ life.”
Aberdeen and Inverness are the only two sites in Scotland currently recruiting for MOSAICC, with a further 19 sites open around the rest of the UK and Ireland. More sites are to open in 2024.
To avoid a repeat of Prof Anderson’s own experience from her PhD days, participants are being asked to send in their cuttings, along with a saliva sample. The clippings will be cleaned, ground down and placed in a mass spectrometry machine at the university’s Rowett Institute, which will identify exposure to trace elements.
Participants will also be asked to provide a blood sample at their local hospital, and will be taken through a questionnaire by the research team, covering topics such as lifestyle, smoking, drinking, family history and circumstances, physical activity and a full job history.
Even the type of fire used at home and substances, such as paint, will be considered as a possible exposure factor.
Prof Anderson, who admitted she “hates feet”, believes the clippings are an accurate way of identifying exposure to trace elements that might be linked to MPNs and ultimately, helping to develop preventative measures and treatments.
The study has been a decade in the making, with the original pilot examining if the factories and shipbuilding industries in Southampton and Belfast could be playing a part in MPN cases.
The wider UK study was due to open in March 2020, but was hit by Covid.
In total, the research team need to recruit 650 cases to ensure a broad representation of the country.
Anyone aged over 18 who has been diagnosed with an MPN in the last two years should speak to their consultant if interested in taking part.
She said: “We need a distribution of cases and controls because we’re looking at potential for occupational exposures, and occupations vary across the country – from those working in farming and jobs of the past, like mining.
“Occupational exposure is important because there are things that can be put in place to prevent it.
“A few of our sites are successfully recruiting, and even overrecruiting, but that means we’ll get pockets with many more patients from London and not so many from Aberdeen and there’s a big difference between the exposures people from London and Aberdeen are going to have.
“It’s critical we get as many as we can from each of the different sites.”
Friends of ANCHOR has awarded more than £33,250 to the MOSAICC pilot study, which will be used to develop a larger piece of research and open the door to further funding avenues.
For more information on the study, e-mail firstname.lastname@example.org