Metabolic health and regenerative medicine

We have explored metabolic impact of puberty and weight gain on child health ( Pinkney ) and pioneered the development of Apps and online resources for young people with diabetes ( Pinkney , Jones ). We also undertake important research supporting the psychosocial health of teenagers, such as those living with HIV (Hoard), living with cancer or other long-term health conditions such as endocrine conditions ( Norman ) and cleft lip and palate ( Norman ) or facing end of life ( Pearce ), or experiencing bereavement ( Stedmon ).

As part of the Dietetics, Human Nutrition and Health group, Professor Mary Hickson , Dr Avril Collinson and Dr Jenny Child have explored new ways of working to manage malnutrition and frailty and childhood allergy in GP surgeries. They have also explored how dietitians can successfully take on a first contact practitioner role.

The group also has a particular interest in the metabolism of iron and nitrate-nitrate, and has collaborated with colleagues in Dentistry to develop new products to promote a healthy oral microbiome.

Professor Jonathan Pinkney leads a large programme of obesity research, including the origins of weight gain and obesity, impact on health, diabetes, development of effective prevention strategies and treatment interventions. Trials in this area include PROGROUP (ImPROving GROUP treatment for people with severe obesity) ( Pinkney , Swancutt ), an NIHR funded, multicentre national study.

Lloyd and Pinkney have used personal narratives of obesity to elevate the views of service users and explore the relationship between subjective illness models and motivation to engage in treatment in people referred to tier three weight management services.

Dysfunctional metabolism is associated with medical disorders across the life course. Nutrition and lifestyle establish an appropriate energy balance that is crucial for metabolic health. When this energy balance is disturbed, chronic diseases may arise that affect people from cradle to grave (Pinkney, Hosking, Sheridan). Patients with acute critical illnesses are affected too, as metabolic health correlates directly with disease prognosis (Martin).

Our current work in these areas falls under a broad Metabolic Health Research umbrella that also covers nutrition ( Rees , Redfern ), diet ( Hickson , Bescos ) and exercise ( Breese ).

Our clinical and physiological work informs, and is informed by, fundamental research into the biochemical basis of metabolic and other diseases ( Affourtit , Carre ).

The Hepatology Research Group uses state of the art laboratory facilities based in the Derriford Research Facility and the world class clinical research strengths of the Faculty of Health and Plymouth Hospitals NHS Trust. We work in unison with the South West Liver Unit, at Plymouth Hospitals NHS Trust, providing a full range and secondary, tertiary and community Hepatology services to the South West region, including assessment for liver transplantation, TIPS and liver cancer therapy. The research team run several commercially sponsored clinical trials in hepatitis C therapy, non-alcoholic steatohepatitis (NASH), primary biliary cholangiopathy (PBC), alcoholic liver disease and liver failure amongst others, through the clinical research facilities of The Lind Research Centre at Derriford Hospital.

The broad themes of the hepatology research group are:

In 2020, the group opened an observational clinical trial at UHP to test biomarkers of outcome of patients hospitalised with COVID-19. Other research highlights include the identification, using next generation sequencing, of six genes expressed in the liver that had rare genetic signatures in the small number of people who appear resistant to the Hepatitis C Virus.

Like all living organisms, we humans need to extract energy from our environment to escape death and the cellular mechanisms by which this energy is transduced and conserved are thus critical to our survival. As the powerhouses of the cell, mitochondria play a key role in cellular bioenergetics and mitochondrial dysfunction has indeed been linked to a range of diseases.

Research in the Affourtit Lab aims to establish the role of bioenergetic failure in the Metabolic Syndrome, a cluster of medical disorders that collectively increase the risk of developing type 2 diabetes and cardiovascular disease. Current projects explore how mitochondria may mediate obesity-related defects in insulin secretion by pancreatic beta cells and in the insulin sensitivity of skeletal muscle.

Dr Charles Affourtit

The Dietetics, Human Nutrition and Health group researches the nutritional management of disease in childhood. Prominent projects include the CORE-KDT study which aims to identify a list of the most important outcomes to measure for children with epilepsy treated with the ketogenic diet. Research often uses seizure control and the side effects of a ketogenic diet as the main way of assessing ketogenic diet therapy (these are known as ‘outcomes’). However, we also think it is vital to consider outcomes that are important to the children receiving treatment and their parents. Other outcomes may include measurements of physical health, mental health and quality of life, to name a few.

The skeleton constantly remodels in response to changes in mechanical load, serum calcium and micro-damage. At a cellular level remodelling is performed by osteoblasts that secrete and mineralise new bone matrix and osteoclasts that resorb bone. Osteoblast and osteoclast activity is tightly regulated such that during each remodelling cycle osteoblast formation is temporally coupled to resorption ensuring there is little net bone loss. However, this balance is disrupted in many skeletal disorders such as post-menopausal osteoporosis, breast and prostate cancer.

Our work aims to understand the mechanisms leading to the disruption of bone cell activity and assess the beneficial impact of potential novel nutritional factors on tumour and bone cell function.

Dr Simon Fox