Blizard Institute - Barts and The London

Professor Charles Knowles, MBBChir (London Hospital Medical College), PhD (University of London), FRCS, FRCS (Gen Surg)

Charles

Professor of Surgery, Deputy Director of Research and Director of National Bowel Research Centre

Centre: Centre for Neuroscience, Surgery and Trauma

Email: c.h.knowles@qmul.ac.uk
Telephone: +44 20 7882 8757

Profile

Professor Knowles is Deputy Director of the Blizard Institute and Honorary Professor of Experimental Therapeutics at UCL. He is the Director of the National Bowel Research Centre, and Chair of the several research committees including those of European Society of Coloproctology, Association of Coloproctology of Great Britain and Ireland and International Continence Society. He is also Chair to UEG-led international working groups in anorectal physiology and GI neuromuscular diseases. He serves as a member of the Rome IV committee for anorectal disorders and is on a global expert panel for Medtronic. He has authored over 180 peer reviewed publications as well as contributing several book chapters to major international colorectal and general surgical texts. He also holds an Honorary Consultant appointment at Barts Health NHS Trust.

Professor Knowles undertook his preclinical training at Cambridge University and then moved to the London Hospital Medical College, qualifying in 1992. Prior to specialist training, he undertook research based at Barts & the London and, funded by the Royal College of Surgeons of England, leading to the degree of PhD at the University of London in 2000. He entered the Specialist Register in 2005 as a general and colorectal surgeon. In 2006, he was appointed Senior Lecturer in Colorectal Surgery on the basis of a prestigious award from HEFCE.

Senior President of Barts and the London Student Running Club.

Teaching

  • Lecturer on the final MB revision and preparation for practice courses: Barts & the London SMD
  • Lecturer on MSc, Intercalculated BSc and higher surgical training courses locally and internationally
  • Lecturer on Cass University (nursing) coloproctology masterclass course
  • Co-author or editor of 4 books related to examination technique, revision style and knowledge base
  • Author of chapters in core surgical texts in the UK (Bailey and Love) and USA (American College of Surgery textbook)
  • Internal and external (Imperial College) surgical examiner annually
  • Student Mentor (years 3-5) and Academic Scheme Mentor: Barts & the London SMD
  • Approved Educational Supervisor to ST programme at Homerton Hospital
  • Local lead for Academic Clinical Fellowships and prev. national surgical advisor to Walport scheme
  • Representative on the NE Thames London Deanery Specialist Training & Academic Steering Committees
  • National trainee surgical research network pilot steering group member
  • Senior advisor (and founder) or the London Surgical Research Group (trainee led)

Topics for PhD supervision:

  • A randomised mixed methods pilot (phase II exploratory trial) of sacral and percutaneous tibial nerve stimulation for faecal incontinence (N Thin)
  • Role of hypermobility and connective tissue disease in disorders of GI function (A Fikree)
  • Study of central afferent neural mechanisms of sacral nerve stimulation (E Carrington)
  • A translational study of voltage-gated sodium channels in visceral afferent signalling (G Boundouki)
  • Further development of human visceral afferent recordings (C McGuire)
  • CONtrol of Faecal Incontinence using Distal NeuromodulaTion (CONFIDeNT) study (E Horrocks)

Research

Research Interests:

His main clinical interests are in the surgical management of:

  1. Functional colorectal disorders e.g. chronic constipation and rare GI neuromuscular diseases
  2. Pelvic floor disorders including prolapse and faecal incontinence
  3. Other complex proctology e.g. anal fistula

His main research interests are:

  1. Evaluation of new technologies for the treatment of chronic gastrointestinal (GI) diseases with a focus on neuromodulation and cell therapies
  2. Development and evaluation of GI diagnostics for deeper phenotyping and treatment stratification;
  3. Pathology and management of rare gastrointestinal neuromuscular diseases
  4. Development of new trial methodology for evaluation of complex interventions with a focus on surgery

 

Overview

Professor Knowles is possibly unique as a surgeon with a major focus on neurogastroenterology. His research includes clinical trials of a variety of therapies (several UK and European), experimental medicine (study of disease in human tissue with a focus on fresh GI tissues) and diagnostic / therapeutic innovation (several first-in-man studies). In addition, he works closely with QMUL statisticians in developing designs of trials for the future of surgical research.

Recent and ongoing research projects

  • Current clinical trials

    • NIHR CapaCiTY studies (3 x RCTs in chronic constipation)
    • NIHR EME SUBSONiC study (RCT of sacral neuromodulation for faecal incontinence)
    • Industry funded study of autologous muscle-derived cells in treatment of faecal incontinence (Cook Myosite)

    Experimental medicine

    • New histopathological disease phenotypes in GI neuromuscular disorders
    • In-vitro human visceral afferent recordings with relevance to visceral pain and inflammation
    • Effects of ageing on neuromuscular structure and function in human colon
    • Relationships between human glia and enteric neurons in maintaining stable enteric nerve populations
    • Phenotyping striated muscle cells with relevance to autologous regenerative therapies

    Diagnostic / therapeutic innovation  

    • First-in-man studies of porous microspheres for fistula-in-ano, new patented fistula instruments for fistula-in-ano, vastus muscle pedicle interposition for parastomal and incisional hernia
    • Evaluation of new tests of anorectal and colonic function with leadership of international diagnostic protocol and disease classification
    • First-in-man studies of bidirectional bioelectronics for pelvic disorders

    Methodology / Health Science

    Development and piloting (in surgery) of:

    • Individual level stepped wedge designs in RCTs
    • Enhanced cohort designs with new analytical methods

Publications

Key Publications

Broad J, Kung VWS, Palmer A, Elahi S, Karami A, Darreh-Shori T, Ahmed S, Thaha MA, Carroll R, Chin-Aleong J, Martin JE, Saffrey MJ, Knowles CH, Sanger GJ. Changes in neuromuscular structure and functions of human colon during ageing are region-dependent. Gut, 2018; 68(7):1210–23. 

McGuire C, Boundouki G, Hockley JR, Reed D, Cibert-Goton V, Peiris M, Kung V, Broad J, Aziz Q, Chan C, Ahmed S, Thaha MA, Sanger GJ, Blackshaw LA, Knowles CH, Bulmer DC. Ex vivo study of human visceral nociceptors. Gut, 2016; 67(1):86–96.

Grossi U, Carrington EV, Bharucha AE, Horrocks EJ, Scott SM, Knowles CHDiagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defaecation. Gut, 2016; 65(3):447-55.

Botha C, Farmer AD, Nilsson M, Brock C, Gavrila AD, Drewes AM, Knowles CH, Aziz Q. Preliminary report: modulation of parasympathetic nervous system tone influences oesophageal pain hypersensitivity. Gut, 2015; 64(4):611-7.

Knowles CH, Horrocks EJ, Bremner SA, Stevens N, Norton C, O'Connell PR, Eldridge S; CONFIDeNT study group. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet, 2015; 386(10004):1640-8.

All Publications