Genetics, Rheumatology, Infection, Immunology and Dermatology
Our Genetics, Rheumatology, Infection, Immunology and Dermatology Clinical Academic Group (CAG) promotes academic input into the delivery of state-of-the-art clinical services, fuels investigative clinical research, and promotes the translation of basic science discoveries.
Through enhancing research; forging new connections and collaborations; fostering new initiatives; and hosting outside experts, Genetics, Rheumatology, Infection, Immunology and Dermatology (GRIID) aims to engender the excitement of research-based medicine.
The GRIID CAG’s clinical remit embraces ambulatory services for severe chronic inflammatory diseases of skin, joints and connective tissues; musculoskeletal services; clinical services for infectious diseases and sexual health; infection prevention and control teams at Guy’s and St Thomas' and King’s College Hospital NHS Foundation Trusts; services for the largest HIV cohort in the EU; a regional clinical genetics service; nationally-funded services for rare complex genetic disorders such as Epidermolysis Bullosa, Xeroderma Pigmentosa, and Bardet Biedl syndrome; and tertiary clinical activities from over 100 Primary Care Trusts within the St John’s Institute of Dermatology and the Louise Coote Lupus Unit.
The CAG provides support for complex multidisciplinary services within other specialities including renal, paediatric and adult allergy, neurology, respiratory, women and children’s services, haematology and orthopaedics, and comprehensive regional and supra-regional skin cancer services.
The CAG also embraces clinical diagnostic services for Guy’s and St Thomas’ NHS Foundation Trust genetics, virology, microbiology and specialised dermatology laboratories.
As part of the groundbreaking 100,000 Genomes Project, King’s Health Partners, together with collaborating organisations, is home to an accredited and pioneering Genomic Medicine Centre. This is part of a national programme that will focus on cancer and rare diseases, and will enable ground-breaking research to decode 100,000 human genomes, a scale not seen anywhere else in the world.
Our CAG contributes to the education of around 2,200 students inclusive of all phases on the MBBS programme. We have a range of postgraduate taught programmes including MSc/PG Diploma in Rheumatology; MSc in Immunology; MSc in Clinical Dermatology and MSc in Advanced Practice. There is supervision and student support for over 50 PhD students in training at any one time.
We host and contribute to a variety of professional training programmes, such as the long running ‘Conquest of Skin Disease Course’ developed for GPs, an annual Ano-Genital and Mucosal dermatology course.
Most recently, we led a successful bid to deliver an MSc in Genomic Medicine funded by Health Education England and in full partnership with St George’s University School of Medicine.
Key achievements in education include:
- Members of the CAG are actively involved in delivering two summer schools aimed at pupils from local ‘Widening Participation schools’ namely Reach Out for Healthcare Science Programme 2014 (funded by Health Education South London). This week long summer school is aimed at raising aspirations of one hundred 14 year old pupils and promoting the range of careers within the healthcare science sector
- An app has been created called ‘Infections’ that provides the workforce with information regarding a whole host of guidelines relating to infection such as: empirical antimicrobial treatment; antimicrobial prophylaxis; infection prevention and control and many more.
The GRIID CAG is home to internationally recognised experimental medicine research programmes, harnessing and developing cutting-edge molecular, cellular, organismal and genetic approaches directed toward key questions in HIV resistance, psoriasis, atopy, melanoma, Xeroderma pigmentosum, cutaneous T-cell lymphoma, prostate cancer, leukaemia, breast cancer, Type 1 diabetes, skin gene therapy, and immune-monitoring. Our researchers have been in the vanguard of developing bio-banking techniques, and have established one of the largest infectious disease bio-banks in Europe; host the National Institute for Health Research (NIHR) Bio-resource at the King's College London and Guy's and St Thomas' NHS Foundation Trust Bio-medical Research Centre; and have established a dermatology bio-resource covering both skin cancer and medical dermatology, with one of the largest acne genetics bio-resources in the world with over 8,000 samples.
Recent clinical research successes include:
- Partners in a £4.9M MRC Stratified Medicine Programme in Psoriasis (PSORT): this 4 year project, in collaboration with the Universities of Glasgow, Liverpool, Manchester, Newcastle and Industry partners, will develop a personalised medicine programme and predict treatment response for patients with moderate to severe psoriasis
- Dermatology has also received £3M of National Institute for Health Research (NIHR) Programme Grant funding to investigate treatment response and patient adherence in paediatric eczema, palmoplantar pustulosis and xeroderma pigmentosum
- The HIV unit is carrying out pioneering research investigating candidate drugs for HIV Pre-exposure prophylaxis. It is part of the Biomedical Research Centre (BRC) HIV CURE programme which has been awarded two MRC Developmental Clinical Studies grants in 18 months and will commence recruitment to a high profile HIV vaccine study funded by International Aids Vaccine Initiative (IAVI) and the Bill and Melinda Gates foundation
- The Sexual and Reproductive Health department at Guy’s and St Thomas’ NHS Foundation Trust has three clinics that see 1700 patients a week. Over 200 patients a week are diagnosed with a common Sexually Transmitted Infection (STI) including Chlamydia, Gonorrhoea (GC), Trichomoniasis, Syphilis and HIV. All patients with an STI are invited to tell sexual contacts using an anonymous partner notification tool that is linked to hypothecated appointments. Up to 40% of sexual contacts are found to have an STI.
The GRIID CAG has attained national accreditation as an Arthritis UK Research Experimental Treatment Centre, establishing an early phase facility within Guy’s Clinical Research Facility that in partnership with Quintiles is developing on-site first-in-man clinical trials.
The GRIID CAG is 1 of 11 centres in England to lead phase 1 of the NHS England 100k Genome Project. At least 80 percent of rare diseases (that collectively affect about 3% of the population) are genomic with half of new cases found in children. Knowledge of the whole genome sequence will provide invaluable clues to the cause of some rare diseases and help point the way to new treatments. As most rare diseases are inherited, the genomes of the affected individual (usually a child) plus two of their closest blood relatives will be included to pinpoint the cause of the condition.
Moreover, working with partner NHS trusts and with Genetics Outreach Clinics in south east and south London, there is the opportunity to merge patients’ genetic information with their phenotypic medical data, thereby gaining unique insight into how the course of disease progression relates to an individual’s genes and environment.
The Immunobiology programme “Therapeutic use of gamma-delta T cells in cancer” has been selected for the “King’s Accelerator” programme and is gathering much private sector interest. Meantime, the CAG’s immune-monitoring capabilities have benefited from a major grant from Cancer Research UK to develop, in collaboration with University College London's modalities in patient profiling that can be rolled out to other Cancer Centres.
Recruitment to clinical research studies across the CAG
The GRIID CAG remains one of the largest recruiters of NIHR-badged studies within King's Health Partners with a year-on-year increase in activity for the last 3 years. This reflects an increase in interventional studies in line with the GRIID strategic objectives for 2014/2015 (interventional studies carry greater weighting to reflect their complexity). Particularly noteworthy are interventional studies in sexual health developing a rapid point of care test in Chlamydia.