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Medicine

Professor Peter Howarth BSc (Hons), MBBS, DM, FRCP

Professor of Allergy and Respiratory Medicine and Honorary Consultant Physician

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Professor Peter Howarth is Professor of Allergy and Respiratory Medicine and Honorary Consultant Physician within Medicine at the University of Southampton.

Professor Peter Howarth is Professor of Allergy and Respiratory Medicine and Honorary Consultant Physician with a clinical and research focus on asthma, particularly severe asthma, and allergy. He is Head of the Clinical Studies Forum in the Clinical and Experimental Science (CES) Research division within the Faculty of Medicine, coordinating clinical and translational human based research as well as clinical trials, lead for “Airways disease” within the CES research division and area lead for “Airways disease” within the NIH funded Respiratory Bioscience Research Unit in Southampton. Professor Howarth has funding from the MRC, National Institute of Health Research, EPSRC and Asthma UK as well as Industrial funding for his research that addresses the understanding and treatment of severe asthma. Much of this work makes use of direct airway sampling at bronchoscopy to obtain samples for the evaluation of the airway microbiome, airway inflammatory status, airway remodelling and to obtain samples for ex vivo cell culture studies. Such studies focus, in collaboration, on bronchial epithelial cells, airway mucosal fibroblasts and alveolar macrophages. These approaches have been used both to compare findings in severe asthma to that in healthy controls and mild asthma as well as to evaluate the impact of standard and novel therapeutic approaches to disease management. On-going work also includes biomarker evaluation and evaluation of novel approaches to lung imaging in airways disease.

Professor Howarth has supervised over 20 PhD and DM students (scientists and clinicians) and his research involves Local, National and International collaboration. He has participated in EU funded collaborative programmes, such as BIOAIR and GA2LEN, focusing respectively on severe asthma and allergic diseases, and is joint work package 4 lead for UBIOPRED, the EU/EFPIA funded IMI programme on severe asthma. Professor Howarth has published over 200 peer reviewed papers and lectured extensively at National and International specialist society meetings as an invited speaker.

Professor Howarth coordinates the MRC funded Wessex Severe Asthma Cohort, a well characterised group of over 300 patients with treatment resistant asthma, established to facilitate basic science and interventional studies in severe asthma. Professorr Howarth is joint lead for the Difficult Airways Service in Southampton, providing a secondary and tertiary referral service for treatment-resistant asthma, and established the Clinical Allergy Service providing a clinical Allergy and Immunology service for the Wessex region. This close patient involvement provides the basis for the translational research programme and the appreciation of the unmet clinical needs. Professor Howarth is regional advisor on allergy training and a member of the standing advisory committee for Allergy and Immunology at The Royal College of Physicians.

Professor Howarth has contributed to National, European and International (World Health Organisation) guidelines on the management of rhinitis and asthma. He has been on the council of The British Society of Allergy and Clinical Immunology, advisor on allergy to Asthma UK and has been chairman of the board of trustees of Allergy UK. He is currently President of Allergy UK and a trustee of AAIR.

Qualifications

B.Sc (Hons), Pharmacology, University of London (1973)
MB BS University of London (1976)
MRCP London (1979)
DM University of Southampton (1987)
FRCP (1993)

Appointments held

House Surgeon , The London Hospital, 1977

House Physician , The London Hospital, 1977-1978

SHO (Rotation) , Southampton Hospitals, 1978-1979

Registrar (Rotation) , Salisbury and Southampton, 1979-1981

Research Fellow/Lecturer , University Medicine, University of Southampton, 1981-1985

Senior Registrar , The London Hospital, 1985-1988

Senior Lecturer , University Medicine, University of Southampton 1988- 1998

Reader in Medicine , University of Southampton, Southampton General Hospital, 1998- 2012

Professor of Allergy and Respiratory Medicine , Faculty of Medicine, University of Southampton, 2012 –present

Research interests

My research is focused on the pathophysiology and pharmacology of airways disease This research is aimed at better understanding the pathophysiology of clinical disease expression, the impact of current and novel therapies on the disease process and the identification of biomarkers to aid in diagnosis, disease monitoring and in early phase clinical trials as surrogate end-points.

Current work streams

1) Characterising severe asthma and establishing a patient cohort for clinical intervention studies ( MRC funded Wessex severe asthma cohort )
2) Bronchoscopic airway sampling in severe asthma with focus on understanding the airway remodelling process ( MRC funded programme grant )
3) In vivo and in vitro investigation of the relevance of mechanical airway forces to epithelial mesenchymal signaling and changes in the extracellular matrix composition ( PhD students funded by Royal Navy and Thai government )
4) Airway wall imaging in asthma and COPD ( MRC and Respiratory Biomedical Research Centre [RBRC] funded projects )
5) Use of molecular microbiological techniques to evaluate respiratory microbiome ( collaboration with academics at King’s College, Sanger institute and University of Gent )
6) Evaluation of innate immune airway responses in asthma ( MRC Clinical Research Training Fellow )
7) Assessment of airway events underlying acute disease exacerbation in asthma ( collaboration with Synairgen )
8) Investigation of airway epithelial barrier integrity in asthma and its modification by intervention ( RBRC funded project and PhD student )
9) Contribution of samples from well characterised patients for genetic and other collaborative measures in asthma ( MRC funded severe asthma cohort and programme grant )
10) Clinical trials in asthma and rhinitis ( industrial collaborations and RBRC )
11) Biomarker detection ( EPSRC funded UOS interfaculty nanotechnology award and involvement in EU/EFPIA Innovate Medicines Initiative (IMI) UBIOPRED programme ).

Areas of development and implications

The bronchoscopic evaluation of airway remodelling changes before and after repeated experimental bronchoconstriction in asthma with allergen and methacholine has demonstrated the relevance of mechanical compressive forces within the airways to epithelial activation, mesenchymal signalling and fibroblast activation (NEJM 2011; 364: 2006-15). This has significant implications for the long term management of asthma and further prospective studies evaluating the effect of sustained bronchoprotection in preventing the progression of airway remodelling and decline in lung function in asthma are proposed. A controlled clinical trial evaluating the impact of recombinant Keratinocyte Growth Factor (KGF) on the epithelial repair response and downstream effects on markers of airway wall remodelling will complete by the end of the year.

The identification of an altered airway microbiome within the airways in treatment-resistant severe asthma (collaboration Dr Ken Bruce) and immune responses directed towards bacterial components (collaborations Professor Claus Bachert and Professor Robert Clancy) have opened up new avenues for therapy in treatment-resistant severe asthma and clinical trials are being planned for vaccine intervention against non-typeable Haemophillus influenzae (collaboration with Hunter Institute) and anti-IgE therapy in aeroallergen defined non-atopic asthmatics who have evidence of IgE against bacterial products. To better understand the basis for the altered microbiome in asthma and the relevance of this airway environment to the innate immune response, evaluation of epithelial and macrophage markers of activation are being studied in asthma of differing severity and under circumstances of stable and exacerbated disease. The relevance of disease-related changes in MiRNA to the altered activation profile is under study (collaboration Dr Tilman Sanchez-Elsner).

I am closely involved with WP3 (clinical recruitment and characterisation) and WP4 (bronchoscopic airway sampling) components the European collaborative IMI funded U-BIOPRED project and will have responsibility for the adult contribution to these WP programmes from Southampton. This will identify biomarkers of disease phenotype in severe asthma. Southampton initiatives I am involved with, e.g. silicon nanowire array sensor programme (EPSRC funded led by Professor Peter Ashburn) and impedance spectroscopy for blood cell analysis (Phillips funded led by Professor Hywel Morgan and Dr Judith Holloway) will provide avenues to point of care translation. In addition through MRC funded (programme grant) and RBRC funded work the value of imaging as a biomarker to define disease phenotypes is being investigated in asthma and COPD, evaluating not only external imaging but also endobronchial imaging with endobronchial ultrasound and probe-based Confocal Laser Endomicroscopy (pCLE) to evaluate the airway structure. A collaboration has developed with Dr Julian Moger (University of Exeter) and Professor David Shepherd (optoelectronics research centre, UOS) to assess whether additional probe based approaches to airway wall assessment could be developed, based on Microelectromechanical systems (MEMS) and Coherent anti-Stokes Raman scattering spectroscopy (CARS).

Department(s)

Clinical and Experimental Sciences

Affiliate Department(s)

Respiratory and allergy Research group

Postgraduate student supervision

Previous successful supervision of 16 higher degree candidates (8PhD and 8
DM)

Dr Christopher Grainge PhD 2011
Dr David Sammut PhD 2011
Dr Thom Daniels DM 2011
Dr Benjamin Green DM 2010
Mr Sanjiv Bhimrao DM 2010
Dr Philip Sanders PhD 2008
Dr Timothy Shaw DM 2007
Mr Rami Salib PhD 2005
Dr Paul Becket MD 2005
Dr Rachel Limbrey DM 2004
Dr William McConnell DM 2002
Dr Raja Rajakulasingham DM 1996
Dr Anthony Redington PhD 1996
Dr Laurie Lau PhD 1995
Dr Susan Wilson PhD 1994
Dr Stephen Montefort PhD 1993

Current supervision of 5 PhD students

Dr Wiparata Manuyakorn PhD
Dr Patrick Dennison PhD
Dr Tom Havelock PhD
Dr Nivenka Jayasekara PhD
Dr Hitasha Rupani PhD

Course coordinator for Airways module on Allergy MSc

Faculty of Medicine

Final year co-ordinator for BM5 Medicine
Head of Bursary sub-committee
member of MSc Allergy Curriculum Development, Examination and Assessment Sub-Committee
member of Postgraduate Education Management Committee
member of postgraduate student progress committee
member of BM5 final year steering group
OSCE examiner
Standards setting committee
BM finals marking sub-group

National and International responsibilities

BSACI guidelines committee for Rhinitis
Scientific committee of BIOAIR
WP 4 joint lead for IMI funded UBIOPRED programme

BM5
Final year: coordinator for medicine, participate in final year away days, have assisted in development of MEDUSA based instruction and standard setting for Mini-CEX assessments

BMedSc/MMedSci (4th year): student supervision of specific projects
Years 1 and 2: Lectures and clinical symposium coordination for Cardio Renal and Respiratory systems course

MSc in Allergy

Joint course coordinator for “Airways disease module” involved in delivering curriculum, student support, lectures, assignments and marking. Lecture on Foundation module.

Professor Peter Howarth
Faculty of Medicine, Room AB215, Mailpoint 801, South Academic Block, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD
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