'FROM DISCOVERY TO RECOVERY'
My areas of research focus largely on the processes that mediate inflammation and repair in inflammatory lung disease. I am particualrly interested in the role of the matrix metalloproteinases (MMPs) in both initiating and perpetuating the process of tissue damage, but also mediating a reparative process allowing recovery. Broad spectrum MMP inhibition has been an unsuccessful therapeutic strategy in a number of inflammatory diseases. We aim to profile the expression of these proteases at different stages of disease and identify which initiate the damage and which regulate the repair process at the given time points. Ultimately the aim of this work is to allow targetted MMP inhibition at specific stages of disease, initially to reduce inflammation, and at later time points to promote normal epithelial repair and inhibit fibrosis.
My clinical specialties are tuberculosis and cystic fibrosis. Both are characterised by chronic infection leading to inflammation and extensive tissue damage. High protease activity has been well-described in tuberculosis, and along with Cliff Taggart and Danny McAuley I am investigating the capacity of anti-proteases to modulate inflammatory damage but also mycobacterial survival. In Cystic Fibrosis we have established models of direct infection of the lung parenchymal and inflammatory cells with typical CF pathogens (in particular Pseudomonas aerugionsa) and are investigating the regulation and effects of MMP secretion in response. We have a further clinical study about to begin examining in vivo exprssion of these proteases and investigating the mechanism that induce airway remodelling or destruction in this disease.
Along with Danny McAuley I work on proteases and inflammatory mediators in acute lung injury (ALI). We have established in vitro models and a human in vivo model of acute lung inflammation and have used these to test potential novel therapuetics in ALI that target inflammation and MMP production (including statins and Keratinocyte Growth Factor), and have progressed these to early clinical trial stage. We have further projects looking at the role of RAGE and Oncostatin M in mediating inflammatory lung disease, and are also investigating the capacity of endogenously produced anti-protease molecules to modulate these responses (particularly SLPI and elafin) in collaboration with Cliff Taggart. We have further collaborations with Birmingham, Edinburgh, UCL, Galway and San Francisco in ALI.
Finally I have an interest in the process of aberrant tissue remodelling that leads to cutaneous fibrosis. Many of the processes that regulate fibrosis in the lungs are common to other organs. I am currently supervising a clinical fellow investigating the mechanisms of skin fibrosis in scleroderma.
External academic engagement
Member of Northern Ireland HSC R&D clinical fellowship evaluation/interview panel 2015 onwards
October 2015 Hosted visit from Professor Stephen Gordon of the Wellcome Trust Malawi unit
December 2013 Hosted visit from Dr Paul Elkington, University of Southampton
Peer review for several medical journals regularly including Thorax, Critical Care Medicine, American Journal of Physiology, American Journal of Respiratory Cell and Molecular Biology, Journal of Immunology
Invited talk at VA San Franciscio 2009
Invited talk at Northern Ireland Update on TB to HSC 2013
National Guidelines - writing or implementation
Member of the NTM infection control guideline-wiriting group for the UK CF Society
Northern Ireland Implementatoin group of NICE TB guidelines
Teaching for NIMDTA to clinical trainees and general practitioners
Teaching within BHSCT to non-medical staff on infection control around tuberculosis
Teaching within BHSCT to medical students
External Research Collaborations
Prof John Simpson (Newcastle University)
MMP activity as a biomarker of ventilator associated pneumonia
Prof Andrew Fisher (Newcastle University)
MMPs in the reconditioned human lung
Prof John Laffey (NUIG)
Matrix metalloproteinases (MMPs) in ventilator associated lung injury
Mesenchymal stromal cells in ARDS
Dr David Thickett (University of Brimingham and University of Warwick)
Epithelial to mesenchymal transition as a mechanism of fibrosis in ALI
Vit D deficiency and outcomes in treatment of tuberculosis
Prof Michael Matthay (University of California, San Francisco)
Protective role of KGF and anti-microbial peptides in LPS induced acute lung injury
Mesenchymal stronal cells and ARDS
Dr Carolyn Calfee (University of California, San Francisco)
The effect of cigarette exposure in predisposing patients to ARDS.
The role of e-cigarette exposure in predisposing patients to ARDS.
Dr Mark Griffiths (Imperial College London)
Iron-binding molecules and ALI
UK national EVLP lung consortium, using ex vivo perfused lungs to understand and treat lung inflammation and injury
Prof Chris Denton (University College London)
Role of epithelial to mesenchymal transition in mediating cutaneous fibrosis in scleroderma
Prof Danny Altmann (Imperial College London)
Serological immune responses to Burkholderia species in CF patients
Expert reviewer for MRC and National Institute for Health Research (NIHR)
Peer review grants for MRC, British Lung Foundation, local Trust and West Midlands Charitable Funds
Contribution to national meetings
Chaired scientific sessions at the annual BTS winter meeting 2009, 2010,2015
Chaired scientific sessions at ECFS meeting (European CF Society) 2012
Organisation/chairing of UKALI meetings bi-annually (national, UK and Ireland, body of researchers working on ARDS)
Co-organisation of the 3rd Annual ARDS meeting (international meeting of ARDS investigators) in Belfast 2015
Co-organising REMERGE annual meeting June 2016
Winner of British Thoracic Society Young Investigator Award, 2005
Accepted as Fellow of the Royal College of Physicians of Edinburgh October 2011
Elected to the Association of Physicians Feb 2015