30 years on from his arrival at St Mary's Hospital, virologist Professor Graham Taylor reflects on leading vital clinical research at Imperial.
Professor Graham Taylor is a Professor of Human Retrovirology at Imperial College London and is internationally recognised as a leader in the clinical research and management of HTLV-1 and its associated diseases.
At the beginning of his career, he trained in General Internal Medicine in the West Midlands and South Wales before being appointed as Chief Medical Officer for the Solomon Islands in the late 1980s. Here, he began working with patients with tropical spastic paraparesis (TSP), also known as HTLV-1 associated myelopathy (HAM), before establishing a research programme in HTLV-1.
Professor Taylor joined the St Mary’s Hospital Medical School in August 1992 (then part of Imperial College London, later merging into the Imperial College School of Medicine) as a clinical research fellow for the Delta trial, a groundbreaking HIV research study which paved the way for effective combination antiretroviral therapy (ART). Early in his Imperial career, Professor Taylor helped to establish a dedicated HTLV clinic at St Mary’s Hospital and the HTLV European Research Network (HERN). In addition to developing diagnostics and optimising treatments for HTLV patients, Professor Taylor continues to lead research into the safe management of HIV infection in pregnancy.
30 years on from arriving at St Mary’s, we spoke to Professor Taylor about breakthroughs in HIV research, the ongoing challenges in tackling HTLV and rapidly setting up a COVID testing facility at Imperial in the early days of the pandemic.
What motivated you to take up your first position at St Mary’s Hospital in 1992?
I wanted to gain research experience in HIV, and I started at St Mary’s as a Clinical Research Fellow. At the time, people were just starting to study anti-HIV therapies. The main study I was involved with – Delta – was fantastic because the study design showed that people who took combined antiretroviral therapy lived longer and were less likely to develop AIDS.
I also arrived at St Mary’s with an interest in a virus called HTLV-1, which I’d come across in my work in the Solomon Islands. In the early eighties, many researchers who had been working on this virus switched their focus to HIV. This was understandable, but it worried me that nobody was working on HTLV.
Working with Professor Jonathan Weber, we knew from our links with other London hospitals and the blood service that there were cases of HTLV in the community. In around 1993, we decided to set up a clinic for HTLV patients. We wanted to understand the different outcomes of HTLV infection, as these were largely unknown to us at the time.
Having worked in HIV and HTLV research for over 30 years, what have been the biggest landmark moments for you?
"My research has always tried to follow the clinical problem of the time" Professor Graham Taylor Professor of Human Retrovirology
When I was starting out, we didn’t have anti-HIV therapies and there was a lot of debate about the benefits of the first of these therapies, called zidovudine. At the time, we had two wards full of patients with HIV and related complications and once you developed AIDS, the prognosis was very poor. However, after the results of the Delta study were reported, we quickly moved on to studying the impact of combining three antiretroviral therapies (triple therapy). We saw that the effects of this approach were really powerful, and it completely changed everything. You could clearly see the impact in the data from Public Health England – the number of people developing AIDS and dying of HIV dropped off dramatically. It was amazing to see that reduction.
I also set up a new clinic system for HIV patients, which was really exciting. We set up an adult component of the HIV service within the paediatrics department, so that children and their parents could receive treatment at the same time. We also started to see pregnant patients in this clinic and elsewhere, so we applied the same model and established an HIV clinic in the antenatal department. Moving from monotherapy to triple therapy completely changed what we could do and how we approached pregnancy – there was a new hope. We’ve now almost eliminated mother-to-child transmission of HIV. Currently, my job is more focused on understanding how therapies affect mothers and their babies, and whether there are additional benefits or risks. In this way, my research has always tried to follow the clinical problem of the time.
However, if we compare the HIV journey to that of HTLV, the progress has been so much slower. We have made some important advances, despite not having the level of funding and resources we need.
Why do you think HTLV research has not received the necessary resources and support over the years?
It’s a question I ask myself a lot because I don’t understand the longevity of the neglect. We know enough about the virus to know that it’s important for those people who are infected with it - it has major complications in a significant number of people. We know how it’s transmitted, and we know how to prevent transmission. In the UK, we screen blood and tissue donors for HTLV, but not in any other setting - why is that? I think there’s a misconception that HTLV doesn’t cause that much disease, and that it’s not very common. But, of course, if you don’t look for something, it's always going to appear uncommon.
As part of our current HTLV research, we are trying to understand how cancers occur, the timeframe for this, and what’s happening at the cellular level. By studying people who we already know are at risk of developing cancers, we can learn more about how to identify high-risk patients and better understand the impact of the virus. We’re trying to make up for lost time, but we’re learning a lot. Hopefully, we’ll be in a position soon where we can start trials focused on the prevention of these cancers.
Back in 2019, you wrote about the key steps needed to tackle HTLV ahead of the World Health Organization (WHO) Global Consultation in Japan. What progress has been made since that time?
Advances have definitely been made. Following the global consultation, the WHO recognised HTLV as an organism of concern and it's been incorporated into their work on bloodborne viruses and sexually transmitted diseases. We really want to see more thinking around how HTLV can be factored into other research and initiatives being established for hepatitis B, HIV, syphilis and so on. It’s not necessarily about having a dedicated programme for HTLV, but considering how HTLV could benefit from work happening in other areas, and what gains could be made with very little additional cost.
The fact that HTLV has gained greater recognition within WHO is a big step forward. And yet, we’re still facing problems, especially around introducing screening for the virus in different settings.
However, there is a lot to be excited about as well. We’ve developed tools here at Imperial that help us to assess a patient’s risk of developing disease. This allows us to reassure those who are at low risk, and to step in and identify ways of helping high-risk patients. Much of this is because of the work done by Professor Charles Bangham’s lab and by Dr Aileen Rowan.
What I love most about working at Imperial is how we’ve been able to deliver the benefits of our research straight back to the patients who supported us by providing samples. It’s a very tight circle between the lab and the clinic, and we want to look at how we can expand that further.
At the outset of the COVID pandemic, you established a gold-standard testing facility within the Molecular Diagnostic Unit (MDU) at the St Mary’s Campus in a matter of weeks. What was your experience of this project?
Every step of the way, it was an amazing story. Within days of being asked, members of the lab set up an assay that worked, and our colleagues in the Trust and North West London Pathology supported us in validating it. Researchers whose work had been disrupted by lockdown volunteered their skills and time to help out. The Estates, IT, Safety and HR teams turned things around so quickly to allow us to get the lab up and running. Professor Paul Freemont’s team and their repurposed high-throughput robotic platform were vital to enabling us to scale up our efforts.
Without the contributions of all these teams and individuals, it wouldn’t have been the unbelievable success story that it was.
Within just a few weeks, we were testing samples for the Trust and for different COVID research programmes. We were able to pilot an in-house testing scheme for staff and students quite early on, and this was fully rolled out in December 2020. By November 2020, we were supporting the NHS Test and Trace programme.
What’s the best example of change you’ve seen at Imperial?
A really positive change was when we scrapped exams for our 3rd year Intercalated BSc medical students. In doing this, we’ve been able to give students the chance to gain more experience in writing and reviewing papers, and analysing data. We've lengthened their research projects and all in all provide skills for life in academic medicine.
How do you see things changing in your area of research within the next five years?
With our ongoing work in HTLV, we’ll be setting up new channels of research in neuroinflammation and understanding mother-to-child transmission. We’ll also be thinking about how the MDU - the diagnostic arm of the Section of Virology - can fit into the research agenda of the Department of Infectious Disease and support additional research in the near future. We’re in a great position now to grow and develop further, both within the Section of Virology and the Department more broadly.
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