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Dr Alan Whone

Dr Alan Whone

Dr Alan Whone
MBCHB, FRCP, PhD

Consultant Senior Lecturer in Movement Disorder

Institute of Clinical Neurosciences, Lev,
Learning and Research Building, Southmead Hospital BS10 5NB
(See a map)

+44 (0) 117 41 47816

Summary

Alan leads a programme of research in Parkinson’s disease and other movement disorders at the Bristol Brain Centre, Southmead Hospital. Since 2010 Alan has been Principal Applicant or Co-applicant on £5-million of peer reviewed grant funding (Parkinson’s UK, NIHR) and £1 million of industry or local charities research funding.

The research programme in Parkinson’s has two arms:
• Addressing unmet symptom needs, “helping people with Parkinson’s live better today” and;
• Addressing unmet disease modification needs, “giving people with Parkinson’s hope for the future”.
Studies to address unmet symptom needs include observational or clinical trial investigations of medicinal products or devices. Experiments to address unmet disease-modification needs are clinical trial and laboratory based (for further details see Research tab).

Investigations into Unmet Symptom Needs:

We wish to case impact the common, disabling and costly symptoms created by Parkinson’s axial manifestations (falls, postural instability, gait-freezing) and neuropsychiatric and or cognitive complications.

• Led by Emily Henderson and in collaboration with Professor Yoav Ben Shlomo, Alan and colleagues completed a successful investigator-led single-centre phase II clinical trial to assess if the cholinesterase inhibitor Rivastigmine could be repositioned, through its effect on increased attention, to reduce gait instability and falls in people with Parkinson’s without dementia. The primary endpoint, improvement in step time variability, and a secondary endpoint, a reduction in falls (40%), was reached. Alan was joint last author on the subsequent paper in Lancet Neurology, 2016. The study was funded as a Research Training Fellowship by Parkinson’s UK for Emily Henderson. An HTA has been awarded in 2017 by the NIHR for a confirmatory phase III multi-centre study where falls are the primary outcome and as part of which there will be an economic cost benefit analysis.
• Alan collaborates in studies led by Drs Coulthard and Grogan to understand cognitive changes in Parkinson’s and the role of dopamine in the formation of memory.
• NBT is one of the largest providers of Deep Brain Stimulation Surgery for Movement Disorders in the UK. Alan is Neurology lead for this service and integrated with this service is a programme of DBS research that involves both novel stimulation devices and novel targets for stimulation.
• With Professors Apps and Gilchrist, University of Bristol and Dr Boca, Dr Rolinski and Hannah Findlay, Alan is preparing an MRC Programme Grant to determine the effects of reward and training on motor adaptation, in Parkinson’s and prodromal Parkinson’s (REM Sleep Behaviour Disorder).
• In Bristol we have a unique digital health experimental facility known as SPHERE (Sensor Platform for Healthcare in a Residential Environment), which is a highly-instrumental living-lab (http://theinstitute.ieee.org/technology-topics/smart-technology/the-sphere-house-can-monitor-its-residents-health). Working with Professor Craddock, Director of SPHERE, Alan and Drs Morgan, Rolinski, Boca and Hannah Findlay are developing research to provide better outcome measures for trials of putative disease modifying agents in Parkinson’s.
• Since 2010 Alan has been Principa l Investigator on 8 further multi-centre investigator-led or commercial studies in Parkinson’s and currently we have 5 investigator or commercial trials in set-up.

Investigations into Unmet Neuroprotection/Neurorestorative Needs:

Currently there are no treatments to slow the progression of Parkinson’s and over 70% of patients eventually develop dementia and a high-burden of social care.

• Alan was Chief Investigator of a single-centre, investigator-led, randomised placebo-controlled – followed by open-label clinical trial, to assess the safety and efficacy of intermittent bilateral intraputamenal Glial Cell Line-Derived Neurotrophic Factor (GDNF) infusions administered via convection-enhanced delivery (CED) on a monthly basis via a skull-mounted port in Parkinson’s. 41 subjects were randomised and over 1000 brain infusions administered between 2012 and 2017. The double-blind phase completed April 2016 and the open label extension phase completed February 2017. In addition to assessing the putative neurorestorative effect of GDNF, these investigations were the first to demonstrate the tolerability and feasibility of an intermittent infusion methodology for bypassing the blood brain barrier and to show successful convection-enhanced delivery in Parkinson’s. Alan led the complex collaboration between the stakeholders that included: a Canadian biotech industry (MedGenesis), a high-tech industry (Renishaw), North Bristol NHS Trust, Cardiff University and the University of British Columbia and two charities - Parkinson’s UK and the Cure Parkinson’s Trust. Subsequently Alan has been collaborating with MedGenesis and Pfizer to take this forward to a phase III confirmatory multi-centre trial. For a talk on this trial delivered at the Royal Institution, London, at primary study start in 2013 – see https://www.youtube.com/watch?v=h3ZDxnwwbzc. For an update talk on this trial delivered at the Royal College of Surgeons, London, in late 2016, see:https://www.youtube.com/watch?v=XcZQEct4yCI
• Alan is currently collaborating with investigators at the Universities of Lund and Helsinki and the Karolinska Institute for a separate investigation of an alternative growth factor, CDNF, in Parkinson’s.
• Alan has previously collaborated with researchers in Bristol and the U.S. to investigate molecular changes in Parkinson’s at the cell culture level utilising skin collected from patients with genetic forms of Parkinson’s to look at both fibroblasts (published in Nature Medicine) and induced pluripotent stem cells. Similarly, Alan has previously investigated the potential neuroprotective effect of human bone marrow stem cells on cultured dopaminergic neurons through trophic factor release.

In the past 5 years Alan has given multiple invited research lectures including at The Royal Institution, London, The Royal College of Physicians, London, The Royal College of Surgeons, London, The Royal College of Physicians, Edinburgh, The National Hospital for Neurology, Queen Square, London, Cambridge University, and outside the UK at international meetings in Dublin, the U.S. and Japan.

Biography

Dr Alan Whone MB ChB FRCP PhD is Consultant Senior Lecturer in Movement Disorders Neurology at the University of Bristol and Honorary Consultant Neurologist at Southmead Hospital, North Bristol NHS Trust, Bristol, UK. 

Background:
Alan obtained his undergraduate medical degree from the University of Birmingham. Subsequently, he undertook general medical training in the West Midlands before specialty training in Psychiatry at the Maudsley Hospital, London, and in Neurology at Kings College Hospital, London, the Hammersmith Hospital, London, and Frenchay Hospital, Bristol. Alan obtained his PhD from Imperial College, London, after 4 years of clinical research into Parkinson’s disease and other movement disorders at the MRC Cyclotron Unit, London. During this period Alan was awarded a Wellcome Research Training Fellowship. His PhD research employed brain imaging using Positron Emission Tomography (PET) and was supervised by Professor David J Brooks and involved collaborations with Professor Robert Y Moore, University of Pittsburgh. Alan became an NHS Consultant Neurologist in 2008 before moving to his current University post in late 2012.  He was made a Fellow of the Royal College of Physicians in 2013 and is a member of the Movement Disorders Society and the Association of British Neurologists.

Clinical Services:
Alan leads a large regional Movement Disorders clinical service at the Bristol Brain Centre (BBC), Southmead Hospital. This service involves a multidisciplinary team dedicated to improving quality of life for people living with movement disorders. At the BBC, we encompass the full breadth of Parkinson’s disease, from prodromal states, to the point of diagnosis, to adjusting to early disease, to ameliorating motor and non-motor symptoms throughout the condition, to advanced therapies for motor complications, to end of life issues and palliative care.  Our clinic provides advanced treatments for Parkinson’s including, deep brain stimulation (DBS) surgery, Apomorphine subcutaneous infusions and Duodopa intestinal gel. We are a national designated centre for DBS and provide one of the largest DBS services for movement disorders (Parkinson’s, tremor, dystonia) in the UK (approximately 60 new implantations per year). Our service is the DBS provider for the South-West peninsula, South Wales, and southern Ireland, our Apomorphine service covers Bristol, South Gloucestershire and North Somerset and we are the Duodopa service provider for the South-West of England.
At the BBC, we also care for patients with atypical parkinsonian disorders and hyperkinetic movement disorders including tremor, tics, myoclonus, chorea and dystonia (for which we have a dedicated botulinum toxin programme).  The broader movement disorders team includes: 6 neurologists, 3 neurosurgeons, 5 Parkinson’s disease nurses, 4 DBS nurses, an Apomorphine nurse, a Duodopa nurse, 2 neuropsychiatrists, 2 neuropsychologists, neuro-physiotherapists, neuro-occupational therapists, speech and swallow therapists, dieticians, a neuro pharmacist, a uro-neurologist and 2 team administrators.

Leadership and Management:
• Since 2008 Alan has sat on the board of the DBS Advisory Group that guides the Welsh Health Specialised Services Committee (WHSSC)
• Between 2009-2011 Alan was the neurological advisor for and authored the Criteria Based Access requirements for DBS for Movement Disorders adopted by NHS England, see: https://www.england.nhs.uk/wp-content/uploads/2013/04/d03-p-b.pdf
• From 2011 to 2015 Alan led the movement disorder group in their bid to gain a one third share of the Bristol Brain Centre (BBC) which is a fully integrated clinical care and clinical research facility for the neurological areas of dementia, multiple sclerosis and movement disorders. From 2012 onward, through community fundraising and fundraising by the University of Bristol’s Development Office, £500,000 of the required £1.5 million was raised in collaboration with the movement disorders group. The BBC opened in 2015 and provides the physical hub for MOVE-hITs hub and spoke model for Parkinson's clinical services and research.  With our PPI group we directly fed into the furnishings and design of the new centre, thus optimizing what the Parkinson’s community most wanted from this venture. Novel components of the BBC include: A dedicated patient information room that has enabled space for an advice worker from Parkinson’s UK to host drop-in workshops running alongside our clinics; A café in the patient waiting area staffed by volunteers with Parkinson’s; A gym to host the PD Warrior program; Integrated open-plan office space for our multidisciplinary clinical team and research group; A meeting room with video-conferencing facilities used by our clinical group, our research group and the executive committee of the Bristol and District Branch of Parkinson’s UK and our in-development Parkinson’s garden.
• Between 2011and 2015 Alan was co-director of the Dementia and Neurodegeneration Research Network (DeNDRoN) for Parkinson’s for the South-West of England. During this period, the South-West of England became the highest patient recruiting region to National Institute of Health (NIHR) portfolio studies in Parkinson’s.
• Since 2013 Alan has been founding director of the Parkinson’s and Other Movement Disorders Health Integration Team (MOVE-hIT) for Bristol, North Somerset and South Gloucestershire (BNSSG). The Health Integration Team is a network organisation, covering the above mentioned geographic areas, that aims to improve the wellbeing of patients and families living with movement disorders by better linking together primary and secondary care clinical providers (including Neurology and Elderly Care services) across BNSSG, social services, public health, Bristol’s two universities, movement disorders charities, our movement disorders patient and public involvement group (PPI), industry and both national and local service commissioning. See: http://www.bristolhealthpartners.org.uk/health-integration-teams/parkinsons-and-other-movement-disorders-hit/more-about-move-hit/
• Since 2015 Alan has been a member of the Research Committee of the Cure Parkinson’s Trust.
• Since 2015 Alan has been President of the Bath and North-East Somerset Branch of Parkinson’s UK.
• In 2016 Alan was the first recipient of The Bristol Post’s Health and Care Outstanding Achievement Award, in recognition of his contributions to Parkinson’s clinical services and research in Bristol.
• In 2017 Alan was invited by British Prime Minister, Teresa May, to a small group reception at 10 Downing Street to celebrate 200 years since James Parkinson’s publication of, The Shaking Palsy.

Teaching

Alan supports a range of educational activities, both locally and nationally, to improve the understanding of Parkinson’s and other movement disorders by medical students, junior doctors, preclinical researchers, general practitioners, hospital consultants and allied health professionals. Alan was a clinical tutor for the medical school of the University of Bristol between 2011and 2014 and at the 2015 graduation ceremony was presented with the “Teacher of The Year” Award, by the Dean of the Faculty of Medicine post nomination by the student body. In 2016 Alan was presented with the award for “Registrar Trainer of the Year in a Non-Internal Medical Speciality”, for South-West England, by the regional post-graduate Dean.

In 2009 Alan founded the South West and South Wales Basal Ganglia Club, which until 2014, when it was incorporated into the MOVE-hIT research working-group, ran an annual educational meeting to bring together movement disorders preclinical and clinical researchers from across the region.

Alan has been a faculty member of the Parkinson’s Academy since 2009, a Department of Health recognised national post-graduate training programme in Parkinson’s, and regularly teaches on the national, Positive Steps, training courses. Alan frequently lectures to Parkinson’s UK patient groups across the country and, over the past 5 years has collaborated with presentations by the British Broadcasting Corporation, Independent Television, and national and local radio to increase public awareness of Parkinson’s.

Memberships

Organisations

Bristol Medical School (THS)

Other sites

Academic staff

Research groupings

Recent publications

View complete publications list in the University of Bristol publications system

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