Dr Michael Robson
We run an established Renal training programme across Guy’s and St Thomas’ NHS Foundation Trust (GSTT), King’s College Hospital NHS Foundation Trust (KCH), St George’s Healthcare NHS Trust (SGH) and Epsom and St Helier University Hospitals NHS Trust (ESTH). This incorporates patient populations from a wide range of socio-economic and ethnic backgrounds. General nephrology training is given at all sites, with specific training in transplantation at GSTT and SGH. GSTT has one of the largest transplant programs in the country and trainees are exposed to both HLA and ABO incompatible transplantation. They are also exposed to pancreas transplantation. Specialist clinics available across all centres includes lupus, vasculitis, glomerular disease, renal disease in sickle cell and renal disease in pregnancy.
Trainees in integrated academic training posts may be placed at any of these centres during the clinical part of their training in order to gain a wide range of clinical experience. However, since their research time at KCL is totally protected, this does not have an impact on their research training. Their clinical training is therefore as diverse and thorough as their research training. During their clinical training, trainees will be exposed to the many clinical research projects and clinical trials that are in progress and which cover both nephrology and transplantation. Regular training days are organised with trainees released from clinical duties in order to attend. Our programme is underpinned by effective clinical and educational supervision, effective communication between clinical and educational supervisors (ESs), and protected time for educational supervision.
A key aspect of the program in renal medicine is the protection of research time. Trainees are completely free to focus on their research during research blocks. For ACFs there is a very strong drive to obtain a 3-year clinical training fellowship as shown by our track record. ACFs are strongly encouraged to plan their time before the research block in order to maximise the gain from this period of time. For CLs, as much flexibility as possible is offered. The needs of the trainee are given priority when scheduling clinical and academic time.
The research component of the programme will be based within the Faculty of Life Science & Medicine, King’s College London. Within or allied to the MRC Centre for transplantation there are several major research programmes in nephrology, transplantation and basic science. These include research on complement, coagulation, inflammation, immune biology, T cell differentiation and regulation, B cell biology as well as cell and protein therapeutics. Basic immunology, renal science, and transplantation biology at King’s is linked with clinical research teams at GSTT NHS Trust and King’s College Hospital.
The development of new therapies is a major research interest with several aspects:
- Cell therapy: The first in human trial using naturally occurring regulatory T-cells as adoptive therapies to counter allograft rejection in renal transplantation has completed. A program is also under development for the treatment of Crohn’s disease. A third trial using Tregs in highly sensitised patients should also be underway soon.
- Protein therapeutics: Novel therapeutic proteins that target complement and coagulation inhibitors to the cell surface have been developed. A complement inhibitor is an MRC funded clinical trial (Empirikal) and coagulation inhibitors are in preclinical studies.
- Optimising immunosuppressive therapy: The NIHR EME funded Outsmart trial aims to optimise the level of immunosuppression, using HLA antibodies as a biomarker, in transplant patients.
- Small molecule and nucleic acid inhibitors: Translational studies in kidney disease are assessing the benefit of new anti-inflammatory and anti-fibrotic therapies. The NIHR EME funded PAVE trial is assessing the potential for locally delivered paclitaxel to prevent restenosis in the arteriovenous fistula (blood vessel) used for haemodialysis.
Potential projects may include basic science and preclinical studies developing therapeutic interventions and molecules. In addition, in all our clinical trials patient samples have been collected. These provides a rich resource to facilitate studies aimed at biomarker discovery to guide treatment, and at understanding mechanisms of effect. There is substantial research funding from NIHR, research councils and major charities.