This Clinical Trials Day, hear from some of the people behind our work at Protas.
Tell us a bit about yourself.
I’m a doctor by training. I qualified in 2000 and have worked in the NHS as a kidney consultant since 2011.
It was the opportunity to get into research working on a heart disease trial led by Prof Sir Martin Landray that brought me to Oxford University’s Clinical Trial Service Unit (CTSU).
I thought I’d work in clinical trials for just a few years, but I was truly bitten by the bug and today I am Professor of Renal Medicine and Clinical Trials at CTSU. I have split my time between Oxford and the NHS – but moving forward as Chief Scientist of Protas I will spend half my week with the Protas team.
I have worked on many trials over the years, particularly focusing on cardiovascular disease, kidney disease and diabetes. They are so powerful, often fun, sometimes very hard work.
Being involved with the RECOVERY Trial was a game changer because it showed how we can do things differently, quicker and more efficiently. It showed what could be done, and Protas is founded on these principles.
What drew you to Protas?
I was fortunate enough to see the beginnings of Protas through working with Martin and Professor Sir Rory Collins at Oxford.
CTSU has spent over two decades working out ways to do clinical trials in a sensible, streamlined way, but there are so many more trials that need to be done and CTSU can’t do them all.
The big issue is the industry is going in the wrong direction, with things getting too expensive and complex.
That’s why Protas was set up. It has had decades of knowledge put into it, alongside the capacity and flexibility to change the course of things at scale.
I’m also drawn to the diversity of trials we’ll be able to run at Protas. As a kidney doctor, many patients I see often have other issues, such as cardiovascular disease, liver problems and lung problems. If a patient has kidney disease and develops cancer, the treatment is often going to be determined by the kidney disease.
My role is to be a generalist and the work I do at Protas will support the ways in which patients with complex needs can be treated.
What plans do you have for the Science team?
First of all, I’ll be looking to expand the team so that we have the capacity to deliver on multiple, concurrent clinical trials.
What’s going to be key is helping Protas to identify which trials we are going to do, where we can have the biggest impact, and making sure that we have the expertise in place to inform the design of those trials.
That will involve finding the experts in the conditions that we are looking to do trials in, and together deciding what state of the art looks like currently and where new treatments will fit into that.
Further down the line, in addition to designing and running trials, particularly in collaboration with Tim Peakman’s Clinical Operations team, it’ll be about how we handle and cope with the amount of data coming out of trials, ensuring we have the systems in place to process the data and get the results we need to change practice.
What’s the proudest work of your career so far?
The easy answer for me is the day I got to go to Buckingham Palace to receive an MBE for services to global health through my work on the RECOVERY Trial. I never thought anything like that would happen for me in research.
I couldn’t talk about that without mentioning the hundreds of other people all around the UK who were equally deserving. There was a team of 20-30 people at Oxford, 180 participating hospitals who were seeing patients every day, carrying out difficult and dangerous work. I’m so proud to have worked with them.
One other moment for me was actually one of the smallest trials I have worked on.
The 3C study aimed to test new ways to improve kidney transplants. Kidney transplantation is an effective treatment for people whose kidneys no longer function sufficiently to keep them alive. However, kidney transplants don’t last for ever and rejection is common.
The trial was something I’d wanted to do from the moment I joined CTSU and I’m so grateful for CTSU’s support in making it happen.
All transplant centres in the UK took part, with 850 trial participants, which is quite big for a study in kidney transplants.
I worked on the trial for seven years, with the results coming out in 2013. The first results found that we could halve the instances of kidney rejection, which was a remarkable outcome.
Public interest in clinical trials has increased since the pandemic. How do we maintain this momentum?
The need for research was very obvious to people during the pandemic.
Every day, the news was telling us the solution to getting out of the pandemic was research. It was thrust on us – but people understood.
We have some excellent examples of clinical trials from COVID-19, such as the vaccine trials and RECOVERY. We were able to show how people’s participation in these trials led to the change we needed. If we hadn’t had people taking part and hadn’t found a vaccine, we’d be in a much worse situation that we are now.
Now we need to help people realise the same goes for other diseases. There are diseases like cardiovascular disease and cancer that are ruining people’s lives. We need to show that the solution is the same.
When recruiting to other trials, I’m always struck by the reasons people take part. There is a strong sense of altruism in the community and most of the time people get involved in trials because of how it could help others.
We can reassure people that when good trials are done well, there is nothing to fear. Their participation is vital to changing lives.
If you could run one large-scale, randomised clinical trial, what would it be and why?
This is a great question, it certainly got me thinking!
As mentioned, I’m excited about the diversity of trials we can explore at Protas. But if I had to choose one, I would love to run a trial to better understand the benefits of lowering blood pressure.
High blood pressure is something that causes many diseases we know about, such as heart and stroke. And we know that lowering your blood pressure has huge health benefits. However, there could be other benefits to lowering blood pressure (for example, preventing dementia or kidney disease) that we just don’t know about yet.
Trials are difficult to do and they require a huge number of participants, but there’s so much more to find out. We could get answers to some really important questions, so for that reason it would be my top choice.