Professor Angela Vincent has made an outstanding contribution to the field of neuroimmunology through her research. Her work on autoimmune diseases, and the identification of specific auto-antibodies that cause several previously unexplained neurological diseases, is world leading.

While Angela’s work has largely been conducted in laboratories, she has always been aware of the human aspect to her research. Everything she’s done has been fuelled by an innate sense of curiosity about the diseases she heard about from colleagues. 

Angela is adamant about the importance of patients in all her discoveries. She explains that her desire to understand what is happening “beneath the skin” was what led her away from practicing medicine and into research. For her, everything starts with a patient and develops from there. 

A single patient made all the difference

This approach to her work is perhaps best demonstrated by the story behind one of her biggest professional achievements: the finding that maternal antibodies can be pathogenic to the development of the fetus in some circumstances.

Angela reveals that this line of research began with a single patient: “There was a mother who’d had four children, three of whom were stillbirths or survived for only a few hours, and one who was born alive but had joint contractures. This is due to a loss of movement during pregnancy. It’s a well-known condition and usually it’s genetic, or it’s because they’re twins and don’t have enough room to move. There can be other reasons for it, but those are the most common.”

“It turned out that this woman, unbeknownst to her at the time of her pregnancies, had myasthenia gravis. This is a disease of the nerve-muscle synapse caused by antibodies to the transmitter protein, acetylcholine receptor; the patients become weak and fatigue very easily.  Once she was treated for myasthenia by therapies that reduce the levels of the harmful antibodies, she had a healthy child.”

This observation naturally led Angela to ask further questions: “Something about her myasthenia was causing the developmental problems in the babies in-utero. We showed, fairly simply, that she had antibodies that completely inhibited the function of the fetal form of the acetylcholine receptor.”

“IgG antibodies cross the placenta during pregnancy, which is a good thing because it protects the baby from illnesses. But, in this case, these potentially very harmful antibodies were crossing the placenta and paralysing the babies so they couldn’t move and had these joint contractures,” she explains. This was associated with underdeveloped breathing and swallowing muscles that threatened their lives outside the womb.

Until this research, it was not known that neurodevelopmental disorders may, in some cases, be caused by maternal antibodies.

This is just one of several examples where Angela can single out an individual patient and their clinical story as making the difference to her success.

These stories are also why she advises anyone who wants to work in medical research to study medicine first. “I would say stick to medicine, make the most of it, get really interested in a topic in your chosen field and write up case reports for patients. It’s about that one patient where you think, ‘That’s really interesting, can we investigate what is going on?’ Those have been the lead for almost every so-called discovery that I’ve made,” she asserts.

Angela is modest about her research: “In my field, I wouldn’t call any of these breakthroughs. You make an observation. I’ve always tried to investigate things further but in a very simple, inexpensive way,” she states.

From Westminster Hospital to world renown

It seems especially fitting to honour Angela’s achievements in 2019, given that this marked the 300th anniversary of Westminster Hospital. It was here that she undertook her initial medical degree, graduating from Westminster Hospital Medical School in 1966.

The institution subsequently merged with Charing Cross Hospital Medical School, which in turn became part of the Imperial College School of Medicine. Imperial is really proud to welcome alumni of its constituent colleges and medical schools into the Imperial community and celebrate their achievements. Angela is a wonderful example of this and we’re proud to share her story and celebrate her success.

Her research career began in earnest when neuroscientist Ricardo Miledi FRS took her on as an MRC Researcher in the Biophysics department at UCL. He conducted important work on neuromuscular and synaptic transmission. As Angela explains, the five years she spent working with Ricardo formed the backbone of the next 20 years of her research.

When you speak to her about all she has achieved, you are struck by an overwhelming sense of modesty. One concept that Angela repeatedly comes back to is luck. “I was incredibly lucky,” she says, when asked what it was like to be working in a field that was developing so rapidly in the 1970s and ‘80s.

During her time at UCL, she began working on research related to myasthenia gravis, a disease that causes extreme muscle weakness and fatigue. This period, and particularly her time working with Ricardo Miledi, had a significant influence on the path her career took. At this time, he asked her to do a couple of things that she describes as “incredibly fortunate”.

One of Angela’s first opportunities came when Ricardo asked her to write a news and views article in Nature on a paper that had come out on acetylcholine receptors. She authored the article and had it published under her name at a very early stage in her career.

The scientific journal then asked Ricardo to attend a meeting in New York about myasthenia gravis, to write another news and views article. “Ricardo didn’t really like travelling or going to meetings. He did his own thing,” Angela explains. When the meeting in New York came up, he turned to her and said: “Why don’t you go?”

Of course, Angela went. “I met all the principle people who had just started working on myasthenia and who had really begun to make all the breakthroughs,” she says.

“They all wanted to talk to me because I was working in the best lab for neuromuscular junction physiology in the world - and also because they wanted their work to be mentioned in the news and views article,” she adds with a laugh.

“It was a very exciting thing to write because there was lots of new data. It really began to show that this disease was antibody mediated and that was the first neurological disease of that kind.”

The Neuroimmunology Group is born

She had already begun to collaborate with neurologist John Newsom-Davis, through his collaboration with Ricardo. John was director of the Batten intensive care unit, where he was responsible for patients with myasthenia gravis. He asked Angela to join him at the Royal Free Hospital in London to do further research into this condition.

Angela then helped John set up the first Neuroimmunology Group. Initially this was based at the Royal Free Hospital in London before moving to the University of Oxford in 1988.

After John's retirement in 1998, she led the Group and established the Oxford Neuroimmunology Service, which she led until 2016. It provides a laboratory service for the serum diagnosis of myasthenia gravis and now a number of other diseases identified.

Angela has also published more than 500 peer-reviewed papers in some of the most prestigious medical and scientific journals in the world. She has been associate editor and sat on the editorial boards of many of these journals, including Journal of Neuroimmunology, Muscle & Nerve, Brain, and Neurology.

In addition to conducting research, Angela also lectured at the University of Oxford on neuromuscular physiology and immunology. In 2016, eight years after her official retirement, she was named Emeritus Professor of Neuroimmunology in the Department of Clinical Neurology and Weatherall Institute of Molecular Medicine at the University of Oxford.

She hasn’t ever found being a woman presented an issue in her career, but she sees great value in men and women collaborating in a research environment. “I’ve always thought that, especially when it came to being on committees, it was important not to have women just for the representation of women, but because they have different ways of seeing things,” she says.

Throughout her career, Angela has been motivated by her curiosity and enjoyment in taking things forward, as well as working with younger people building research careers of their own. She also revealed that she feels a sense of obligation to make a difference where she can.

"I always felt I was very fortunate. I had a relatively privileged background. Most of the world has to work very hard to survive and all I’ve had to do is work jolly hard to try and do something useful, and that’s the least I can do. I always tried to make it clear to my children that one worked because one had certain abilities, and to not do so would be wrong."

Angela has won numerous awards for her work, including the Duchenne-Erb Award (2009) and Klaus Joachim Zülch Prize (2018), and the World Federation of Neurology Medal for scientific contributions to neurology (2017). In 2009, she was the first woman and non-neurologist to receive the Association of British Neurologists Medal. She was elected to the Academy of Medical Sciences in 2002 and to the Royal Society in 2011. This is the first award Angela has ever nominated herself for, and she’s very grateful to Prof Paul Matthews for his recommendation and delighted to receive this very special honour. 

Imperial’s contribution to the 300^th anniversary celebrations of Westminster Hospital was what prompted her to enter. “I thought it was a good time to celebrate Westminster. 2019 was the 300th anniversary of Westminster hospital. It was very appropriately celebrated by both Imperial and the Chelsea & Westminster. The celebrations really made us Westminster alumni feel like part of Imperial,” she says.

Professor Angela Vincent graduated from Westminster Hospital Medical School in 1966. She was a winner of the Distinguished Alumni Awards in 2020.