Profile: Amy Foulkes
Amy Foulkes is a dermatologist and MRC fellow based at the University of Manchester. She told Katherine Nightingale why she is passionate about personalising treatments for the skin disease psoriasis.
Amy Foulkes never wanted to do science for the sake of it. When she was younger, she wanted to work in disease control. “I thought I wanted to work with dangerous infectious diseases in a lab,” she says.
She chose to intercalate immunology into her medicine degree at the University of Nottingham, but a few months of investigating immune cells in the lab without a clear sight of how this would help people made her reconsider her plans to go into research. Then during her house officer rotation in Edinburgh, she spent time in various hospital units that had a research focus. “They really fuelled me on in thinking about evidence-based medicine and then I got a job in my dream area — dermatology — in Newcastle, in a very research-focused department. I started to think about research again.”
It was at one of the big clinics focusing on psoriasis that Amy started to think about personalised medicine, also known as stratified medicine — grouping patients depending on how they respond to a treatment and treating them according.
“We had a lot of patients with psoriasis as well as other diseases, and we had to figure out which drug would suit the patient.Thankfully, in dermatology we have a lot of treatment options but it’d be good to use them in a more targeted way.”
Amy’s MRC fellowship, which is based at the University of Manchester but also offers her access to expertise and facilities at the University of Liverpool, gave her the opportunity to do just that.
Psoriasis is a common skin condition which affects around 2 per cent of the UK population. It’s an autoimmune condition in which skin cells grow and shed more quickly than usual. In its most common form, patients have red, scaly patches of skin. It is associated with depression and a poorer quality of life, comparable with that of diabetes or cancer patients.
Injectable treatments for psoriasis are expensive — around £10,000 a year for each patient — and can have serious side effects, so doctors must consider carefully whether they are an appropriate treatment. They are also effective only in some cases, and it’s possible that genetics is a factor in this.
“If you treat a group of patients who all have the same severe psoriasis you will find that there is huge variability between how they respond to treatment,” says Amy. “Therefore if we could find a specific way of prescribing these treatments, rather than a best guess, it will save patients unnecessary treatments and side effects, as well as saving money.”
Amy is currently recruiting patients from clinics at Salford Royal NHS Foundation Trust and the Royal Liverpool and Broad Green University Hospital into her study. The idea is to recruit up to ten patients who have been prescribed each injectable treatment for psoriasis. Amy takes samples such as blood and skin before they start treatment and then monitors whether the treatment works.
Once all the patients have been recruited she will analyse their genetic material and see if there are differences between the people who responded to treatment and those who didn’t. If she can identify genetic differences, most probably in genes that have already been found to be associated with psoriasis, it would be a first step towards stratified medicine for psoriasis.
Once the genetic signatures have been validated in a larger population of patients, a test could be developed that is used to guide drug prescription.
An unusual aspect of Amy’s fellowship — one of 12 funded by the MRC — is the close interaction that it affords with companies. The fellowship programme was established with four industrial partners, two pharmaceutical companies and two contract research organisations (which carry out clinical trials on behalf of pharma), from the start.
“In one sense, they are like mentors. When else would I be able to email the clinical vice president of a company and say: ‘Help’? I can, and that’s incredible.” On a general level, the partners can provide advice on aspects such as study design.
Amy’s also going to observe early-phase clinical trials at Manchester-based contract research organisations ICON. “On a personal level, we have opportunities that we wouldn’t have in a standard research fellowship. As well as project-specific help, we also gain knowledge that we can take with us through our careers. Being involved with industry mean you learn from a large sector of both the economy and science.”
Another positive of the fellowship is that she and her counterparts receive regular teaching in clinical pharmacology. The overall intention of the fellowship, says Amy, is to produce well-rounded clinician scientists who understand industry.
Now that Amy has found a patient-focused area of research, it looks like she’ll be staying put. “I want to improve patients’ health and stay involved in clinical research. If you were to ask me in what format I’d do that, I don’t yet know, but working through a university or the NHS or industry — they’re all possibilities.”
“I’ve come to see clinics as so much more. They are wonderful places where people are receiving treatment, but they are also a resource for improving health in the future.”