How did your interest in hearing loss come about?
I first did my medical training in Ireland and then moved into specialist training in London and Oxford. During this time, I had the opportunity to go on fellowships to the States: to the House Institute in Los Angeles and to the University of California in San Francisco. These fellowships are what really sparked my interest in the whole field of inner ear research and what it could do. At that time, we were involved in cochlear implants, which were considered experimental and would never be used in clinical practice. But of course, this has proven incorrect, and they’ve surpassed our original expectations. I’ve always been a glass-half-empty person. While I can see the wonderful things that have been done in the field, I’m always looking at what we can’t do and the limitations. While cochlear implants have been transformative for profoundly deaf people, and have greatly changed their lives, there are a lot of things they don’t do.
Many individuals with hearing loss are not candidates for that treatment and still have considerable communication difficulties in their day-to-day lives. I was particularly touched by the effect of deafness on very young children. How they grew up without language, spoken language, and how their whole life is compromised by their hearing loss. So, what we could do to remedy the situation has always interested me.
What was your journey to Rinri?
My work in the USA was a very stimulating experience as it was a year out of clinical practice. Clinicians of course, and young surgeons, are very interested in developing the clinical sides of their career, perfecting their surgery and getting up with their clinical skills. That’s a very, very important aspect. But I was given the opportunity to do some research during my training which sparked my special interest in how research could actually be translated into clinical practice. This is often called a bench-to-bedside journey: taking things from the laboratory and making them actually useful to patients. The big challenge was cochlear implants. At the time these were very controversial and experimental. It was risky and could not be applied in daily clinical practice, but that has been proved wrong. I would very much hope that cell therapies for hearing loss will have a similar journey.
Rinri has produced some fantastic research, such as the surgical access to the inner ear, can you tell us a bit more about your next piece of research?
The next research piece is about fine-tuning access to the inner ear. It’s very complex, it is tiny and has many twists and turns. We’re looking at ways where we can access the hearing nerve, perhaps more directly than has been the case before. When you put stem cells in, you have to be on target and can’t go off, as they won’t have their biological effect. So we’re exploring new ways to access the hearing nerve directly in humans. We think we’ve found some interesting new approaches that will allow us to do that and open up the real opportunity for stem cell delivery. It’s been a very positive experience, and we’re pleased with the data from our experiments. It’s not just an academic interest, it will actually shape what Rinri does. This is what’s exciting about it. We go into the laboratory with a preconceived view of how we might do things, but of course, I’ve had to change my view as there are probably better ways of doing it than I had envisaged. The beauty of discovery medicine is allowing the science to influence the result.
The future of Rinri is looking very exciting with upcoming clinical trials, can you tell us more?
It is exciting, it’s putting your toe in the water in a serious way! You have to at some point, actually do the clinical work. One of my friends in the USA was a great pioneer in ear surgery and used to talk about vocalists (people who talk about doing research) and instrumentalists (the people who do the research). He asked me if I was a vocalist or instrumentalist. Are you just going to be talking about these things or actually do them? That’s the great thing about Rinri, is that they’re actually taking these ideas to the clinical coalface and testing them. It’s not an easy job and a very difficult proposition. It needs a lot of reflection, thought and compliance with regulatory frameworks, which are becoming increasingly more convoluted by the day.
As stem cells are living cells, and are being injected, regulation around this practice is very tight. It’s challenging to navigate these obstacles, but they can’t deter us and must work around the regulation. It can be frustrating, and the cost can spiral on these kinds of developments, sometimes even kill them off! So we’re very keen to progress within the regulatory framework and won’t cut corners. But we are optimistic that Rinri will be able to deliver results. The strength of Rinri is in its willingness to see this to fruition and to test it in person, which is so important.
Can you tell us how you fit within the Rinri jigsaw puzzle?
I have no executive function, and I have to say, I like it that way! I have no shares or financial interest in the fate of the company, so they’re completely free to ignore my advice. I don’t have any reason not to be frank with them. But I have advised Rinri for quite some time, and it’s always been a pleasure to do so. The bench-to-bedside journey is always fraught and it’s difficult. I remember chatting with Marcelo, and we were looking at and addressing the unknowns, and of course, there are a lot of unknowns on this journey. You have to be ready for them as this hasn’t been done before. In any first advanced study, there will always be things which crop up, unforeseen challenges, and so on. You just have to be ready. That’s the excitement of discovery medicine. So, a lot of all the work that Rinri is doing, and rightly so, is to try and cover every foreseeable risk to ensure it is addressed as best we can.
Are you hopeful for Rinri’s success?
Oh yes, absolutely! You have to go for success and Rinri are motivated by this. As I said, you always have the unknowns that might crop up at the back of your mind. There are very few pathways to discovery and to clinical application, and they are fraught with difficulty. Patients want it right first time. In the field of cochlear implementation, we’ve had our ups and downs, and we’ve had real moments of difficulty, but you really have to have the resilience to overcome these and see them as a learning opportunity. Move on and adapt as I say, come up with a better proposition – that’s the fun of it!
It’s really all about the patients isn’t it?
It is absolutely. You know, it’s not vision loss, something that everyday people can connect with so easily. If you ask people whether you prefer hearing or vision loss, people will immediately say I’d hate to lose my vision. But actually, hearing loss is so isolating, so debilitating and so invisible. It’s an invisible disability, it cuts you off from people. A younger person, child or infant faces huge barriers to their education curriculum, spoken language or socialising with their peers. It’s not the easiest of subjects but is a very intriguing and rewarding field.