Meet the researcher: Professor Fai Ng
In our fifth ‘Meet the researcher’ post, we talk to Wan-Fai Ng, Professor Professor of Rheumatology at Newcastle University and Consultant Rheumatology at the Freeman Hospital, part of Newcastle Hospitals NHS Foundation Trust. He is a world-renowned expert in Primary Sjogren’s Syndrome; an autoimmune condition that can cause dryness in the eyes, mouth and skin, as well as joint pain, swelling and inflammation.
Professor Ng is also Deputy Lead for the NIHR Newcastle Biomedical Research Centre’s (BRC) Musculoskeletal Disease research theme.
More recently, Professor Ng became the Director of the NIHR Newcastle Clinical Research Facility; a collection of sites across Newcastle Hospitals and Newcastle University that deliver high-quality, cutting-edge, experimental medical research.
What drew you to the field of rheumatology?
I was very interested in immunology when I was in medical school (immunology = the branch of medicine that focussed on our immune system and the conditions that we can get if our immune system does not function properly). After I completed my general medical training at Cambridge University, I decided to do a PhD in immune tolerance in transplantation. I then had some experience in the rheumatology unit at Hammersmith Hospital and I quite enjoyed it, so I ended up switching my speciality.
And what then specifically led you to address Primary Sjogren’s Syndrome?
It was serendipity really! After completing rheumatology training, I took a position as Clinical Senior Lecturer at Newcastle University. One of my NHS colleagues was planning to retire and he passed his cohort of Sjogren’s Syndrome patients to me. Around the same time, the Medical Research Council had just also announced a call to set up a research patient cohort and, fortunately, I received the funding. From there, I built my research programme around Sjogren’s Syndrome. I started with around a hundred Sjogren’s patients, but now I have around six hundred, from all around the North East, Northern Ireland, and Scotland. The number of referrals I get is growing rapidly.
What is your current research focus?
Right now, I am focussing on two main areas: fatigue and personalised medicine. Sjogren’s is an autoimmune inflammatory condition, often known for its association with dry mouth and dry eyes. However, from my contact with patients, it has become apparent that their main unmet need is fatigue. If we can manage this, it would really improve things for patients. I don’t think the conventional inflammatory processes are enough to explain patient symptoms and experiences of Sjogren’s, so I am trying to understand what other physiological processes are involved, with the aim of developing personalised medicine.
What role do patient cohorts and other partners play in your research?
Patient cohorts are key for me; they’re the foundation of my entire research programme. My Sjogren’s patients have provided clinical data for my lab-based research, but also have made it possible for me to run many clinical trials. Facilities like the BioResource have made it possible for me to collaborate with different partners, both in academia and industry. Importantly, the patient cohorts also help me keep my feet on the ground. They help me appreciate the unmet needs so that we can develop ways to support them. Giving patients the chance to get involved helps them manage their condition and take ownership of the research journey. This is very empowering, especially when there is no treatment available.
I am also a trustee of the British Sjogren’s Syndrome Association and a medical board member of Sjogren’s Europe. These are ways I feel I can give back to patients, beyond my clinical service.
What role does industry play in your research?
It is huge. I am always keen to work with industry partners and have had very fruitful collaborations in the past. Work with industry has included lab-based research, clinical research, support with clinical trials and experimental medicine studies. Industry partners provide a very different set of expertise and resources which academia, the government and charitable funders don’t have. They play such a big role in developing research and ultimately, in delivering therapies for patients. I think the COVID-19 vaccine study is a very good example of this.
What role do professional relationships play in shaping your work?
Collaboration is very important. Even early in my career I felt that I didn’t need to be leading on every single research project that I was involved in. Working like this helped me in setting up the Sjogren’s cohort. Developing a registry like this involves lots of different recruitment centres and I needed to be able to encourage the collaborative mindset that made this happen. This allowed me to acquire a diverse portfolio of funders to support the registry.
What do you think has helped you get to where you need to be today?
I think it is important to have confidence and perseverance, because when I started this research, fatigue wasn’t really a popular topic, yet now it is more recognised. This isn’t all my effort, but I’ve certainly made a substantial contribution to raising the profile. A lot of this is down to building my confidence. I see patients day in, day out, so know that fatigue is an important area for them. Yet when I first started talking to industry, a lot of people didn’t believe this. I see a lot more research in this area now, but a lot of others still prefer to focus on the more well-known symptoms, such as dry mouth. It isn’t about one topic being right and the other being wrong, but I wanted to focus on what I truly believed in.
You’re connected to both the NIHR Newcastle BRC and the Newcastle Clinical Research Facility (NCRF); how valuable is this for your research?
It is hugely important. The NIHR Newcastle CRF is a research delivery platform. We are there to support the research journey from scientific discovery, to a stage where discoveries can be tested in a wider context once the therapy is considered safe and efficient. We link with lots of infrastructure funded by the NIHR, but one of the closest links is with the Newcastle BRC. The BRC funds scientific discovery into potential therapies, so the CRF is the logical next step to bringing those ideas further. For example, we can take ideas developed by the BRC that are likely to succeed and bring them to the CRF for an experimental medicine study or and early phase clinical trial. We work with our local BRC (Newcastle), but we would also work with similar requests from other BRCs across the country, or industry. It is all about how we can connect better.
One of the areas we work with the Newcastle BRC is through joint PPI (Patient and Public Involvement), and with this we can make sure things are connected in this area. We have also jointly funded a Care of Elderly Research Fellow who is based in the Clinical Ageing Research Unit and this role is to support research and into Ageing Syndromes and teaching.
What are the benefits of working in Newcastle and doing research here, and for the wider North East region?
As well as being a nice place to live, Newcastle is a great place to do research, as we have a relatively stable population. Even if people leave the region, they tend to come back. This means we can get a better understanding of the natural history of diseases because you can follow up with the same people. We also know that the North East is one of the more deprived regions of the country, with a large, underserved population. I think we are already pioneering a lot of ways to connect with underserved groups in the North East, but there is always more we can do to reach out, especially with those who have not traditionally been part of research conversations. Generally, I think people are working very well together in Newcastle; from hospitals to universities, there are so many connections. However, it is now up to us to capitalise on those connections to go further. For example, how can innovation help us reach people who geographically isolated? Many of the excellent facilities we have are based in the city centre, which may be too far to go for some people.
What do you think is the best way to address this is?
One of the ways we could support this would be making the most of a mobile workforce. We have had to carry out remote consultations because of the pandemic, and through these visits we have been able to attract some people to take part in studies. We know this might not work for every trial, but the idea would be that we can go out to participants and conduct some activity during home visits. Another thing would be the Newcastle Health Innovation Partners. This is quite exciting and unusual as it involves the City Council and shows how we can all work together. Reaching people widely needs a multi-pronged approach, and even involving the younger population in studies, which will ultimately benefit older people too.
What do you think the biggest breakthrough will be in your areas of medicine?
Over the last 14/15 years as a Consultant, I have begun to believe more and more in the power of holistic medicine. In rheumatology, the role of immunology has brought about a huge number of important discoveries, but I also think there is room for more understanding around other biological processes. I think the immunological understanding of rheumatology has gone a long way, but a breakthrough may come from research into non-immunological approaches. I believe there is a lot of untapped potential in our own psychological and emotional understanding when it comes to preventive medicine.