Born in 1953, I was brought up in Ealing, West London. In 1964 I won a scholarship to Latymer Upper School, Hammersmith. After completing A levels in Biology, Physics and Chemistry I entered St Thomas’ Hospital Medical School in London from which I graduated BSc (Anatomy 2:i), MB, BS in 1970.
I trained in General Medicine in Portsmouth and Leicester, passing the MRCP (UK) examination in 1983. I then entered into pathology training in the University of Manchester, passing the MRCPath examination in Histopathology in 1986. I have since been made FRCP(E)(1990), FRCP (1995) and FRCPath (1996). I have specialised in Osteoarticular (bone and joint) pathology since 1983 (when I was awarded an ARC Clinical Lectureship) and was given a personal chair in 1993.
In 1984 I was awarded an MD for work on the migration of lymphocytes into diseased tissue. I was the first person to show vascular specialisation for promoting lymphocyte entry into disease tissues.
I am Professor and Honorary Consultant (at CMFT since 1986) with a large diagnostic histopathology practice in bone and joint disease. I report about 2,000 specimens per annum and am a recognised expert in the diagnostic pathology of joints, metabolic bone disease and fracture. My clinical research focuses on two aspects of my clinical work:
• Synovial fluid microscopy as a test for the early and accurate diagnosis of joint disease. I have written a book, several chapters in leading Rheumatology and Cytology texts, and in excess of 25 peer-reviewed publications on this subject.
• Bone histomorphometry in the diagnosis, prognosis and management of renal osteodystrophy and other metabolic bone disorders. I have written several book chapters and more than 50 peer-reviewed papers on this subject.
My basic scientific and clinical research is focused in the broad area of molecular pathology and, in particular, the development and application of molecular pathology techniques to human skeletal tissues to obtain a better understanding of the molecular mechanisms underpinning disease.
Most of the work I have undertaken over the last 20 years or so has focused on an understanding of the pathology of the degenerate intervertebral disc, the origins of discogenic back pain, and regenerative medicine and materials engineering approches to reversing these debilitating conditions.
The work on back pain has led to the formation of a University "spin-out" company "Gelexir Healthcare plc" which is now capitalised to progress to "first in man" studies of a novel injectable nano material to restore the function of the intervertebral disc.
I am also Director of MMPathIC (Manchester Molecular Pathology Innovation Centre), an MRC/EPSRC Molecular Pathology node with £4M of funding from MRC/EPSRC (£2.9M), UoM (£800,000) and CMFT (£300,000) to take novel molecular pathology and molecular pathology related engineering discoveries into clinical use in partnership with industry. This builds on my research in molecular pathology, and experience gained as Founder and Director of Gelexir, and serving for 6 years on the NICE MTAC Committee.
I am also a Co-I on the Manchester NIHR MSK BRU, and Co-I on grants from EPSRC to devlop novel biomateria;ls.
I have authored or co-authored about 300 peer reviewed publications, >50 reviews, ≈30 book chapters, and 1 book. I have supervised 37 MD/PhD students. I am a member of the College of Experts of the MRC and EPRSC and editorial board member of 4 journals.
I am a keen tower bell ringer, including being Training Officer for the Shropshire Association of Church Bell Ringers, and a collector of brass threepenny bits.
1) Basic Science - Basic molecular pathology and regenerative medicine. I am a member of the Tissue Injury and Repair Theme in the School of Biomedicine.
2) Clinical practice-based research – Primarily diagnostics. I am research theme leader for the Molecular Diagnostics in the NIHR Manchester Musculoskeletal BRU, and lead on Industry Interactions.
Over the years, my group has pioneered the development of those molecular pathology techniques required to understanding disease mechanisms at the cellular level in human hard tissues (eg. bone, cartilage). Examples include being the first to use: in-situ RT PCR to detect low copy number transcripts (eg. IL-1 and oestrogen receptors) in bone, and in-situ zymography to identify active matrix degrading enzymes in osteoarthritic cartilage.
Currently our primary research focuses on identifying molecular mechanisms underlying discogenic low back pain and designing novel therapies using regenerative medicine techniques (eg. tissue engineering, stem cell manipulation, gene therapy). Key discoveries include showing that: Imbalances in the IL-1 superfamily drive the intervertebral disc (IVD) pathology underlying back pain; IL-1Ra delivered by gene therapy reverses the cellular dysfunction causing this pathology; autologous mesenchymal stem cells can be differentiated into IVD cells.
In addition, because it is difficult to reproduce the disease conditions of IVD degeneration in animal models, we have advanced understanding of the factors precipitating IVD degeneration and preclinical evaluation of novel therapies, by developing novel tissue culture bioreactor systems that mimic the human disease situation in a controlled environment.
In my role as Professor of Osteoarticular Pathology, I have been responsible for changing clinical practice through research in two particular areas:
• Defining the impact of adynamic bone disease in renal failure patients and reclassifying renal osteodystrophy to facilitate clinical decision-making.
• Defining the scope of synovial fluid microscopy in early management of arthritis.
I teach on the medical MB ChB, Pathology BSc, dental and FLS undergraduate programmes; on the MSc in Clinical Rheumatology and the NowNANO core knowledge programme.