My research interests are in vascular imaging, using CT, MRI and nuclear methods. I apply biomechanical, mathematical methods and AI to refine risk on top of imaging and demographic factors. I work across disease states, including stroke, ischaemic heart disease, peripheral vascular disease, aortic aneurysm, rheumatoid arthritis and pulmonary hypertension. Anywhere where there are arteries!
My research is/has been supported by HEFCE, the Wellcome Trust, the British Heart Foundation, the Evelyn Trust, the Academy of Medical Sciences, EPSRC and the NIHR Cambridge Biomedical Research Centre.
I have raised over £6 million in research grant income since becoming a principal investigator in 2009, including the establishment of the EPSRC Centre for Mathematics in Healthcare in Cambridge as Clinical PI (£2.1M, 2016, renewed 2020). I also serve on the HDRUK-Cambridge Executive Committee as of June 2019.
I have many high impact publications, including in The Lancet, Circulation, The Journal of the American College of Cardiology and Nature Communications. I have an H index of 49, with 9573 total citations. I have supervised or co-supervised 8 research fellows through successful PhD, MPhil and ACF projects, gaining substantive external funding in each case from either the Wellcome Trust or British Heart Foundation.
I have been commissioned to write editorials and reviews by Nature Cardiovascular, Circulation Research, Arteriosclerosis, Thrombosis and Vascular Biology, European Heart Journal Cardiovascular Imaging, Journal of the American College of Cardiology and the Journal of Nuclear Medicine.
I have delivered plenary lectures at major conferences within the last 5 years, including the American Heart Association, the American College of Cardiology, the European Society of Cardiology, European Atherosclerosis Society, International Atherosclerosis Society, The Society of Nuclear Medicine, the European Association of Nuclear Medicine and the British Cardiovascular Society.
After medical training in the UK and Australia, my PhD at the University of Cambridge described the first use of FDG PET for atherosclerotic plaque imaging and was funded by a British Heart Foundation Clinical Research Fellowship.
I was awarded a British Heart Foundation International Fellowship to work with Professor Zahi Fayad at Mount Sinai Medical Centre in New York. I was a British Atherosclerosis Society Young Investigator in 2003, and the Society of Nuclear Medicine Young Investigator in 2006. Collaborative work between my group and colleagues at Edinburgh University describing vascular NaF PET imaging for predicting heart attack has won the 2011 RSNA Young Investigator Prize and the 2012 Parmley prize from the American College of Cardiology. My PhD students have been successful at winning national and international research awards, including the 2018 Parmley prize from the American College of Cardiology for work describing a new way of quantifying vascular inflammation.
I was a member of the Programme Committee of the British Cardiovascular Society from 2009-2015 and a member of the European Society of Cardiology Working Group of Nuclear Cardiology and CT since 2007. I am a member of the SHAPE scientific advisory board, the MRC-MHRA PET Imaging Advisory Committee and the HDRUK Cambridge centre.
I was a 2017 British Science Association Media Fellow, during which time I worked as a Science Correspondent at The Guardian. See a full list of the articles I published there.
Insights into the pathophysiology and risk of clinical events in vascular disease using imaging
In atherosclerosis, inflammation, neovascularisation, hypoxia and calcification are drivers of plaque destabilisation and clinical events such as myocardial infarction and stroke. Conventional x-ray angiography does not provide information about the extent of these processes in the arterial wall, and as a consequence is a poor predictor of future events.
The aim of our research is to use non-invasive imaging to answer four related questions. Firstly, can we quantify the degree of arterial inflammation? Secondly, can we track the effects of therapy on arterial inflammation? Thirdly, can we use imaging to inform about the biology of arterial disease, and finally, can imaging improve our predictions about the risk of future clinical events?
Using PET/CT imaging, we can measure the glucose analogue fluorodeoxyglucose (FDG) where it accumulates in plaque macrophages. This allows us to identify symptomatic lesions causing TIA and stroke. We have demonstrated that arterial FDG uptake correlates with the number of cardiovascular risk factors and with the presence of inflammatory biomarkers of inflammation such as CRP and MMP9. Arterial FDG measures are also highly reproducible. Recent work has also revealed that inflamed plaques on PET imaging have larger lipid cores on MR and ultrasound imaging (suggesting vulnerability).
To image coronary artery inflammation, there are several hurdles to overcome, including coronary and respiratory motion and the avid accumulation of FDG by myocardial cells (swamping any potential coronary artery FDG uptake). To overcome these challenges, we are testing several novel PET imaging agents in both clinical and pre-clinical models of vascular disease.
As part of the second aim, we have completed several multi-centre clinical trials of novel anti-atherosclerosis agents (with GSK, Roche, Merck and Genentech). In this work, we use FDG PET/CT as a surrogate marker of vascular inflammation. in this way, we can obtain early readouts of drug efficacy with far fewer subjects than would be needed in a Phase 3 study.
For the third aim, we have applied FDG PET imaging to quantify vascular inflammation in several diseases including rheumatoid arthritis, pulmonary hypertension, COPD and aortic aneurysm (see above) all of which have an excess of unexplained cardiovascular deaths.
We also participating in prospective, multi-centre outcome-driven studies to determine the role of non-invasive imaging, biomarkers, genetic and clinical risk factors in predicting cardiovascular events.
I am the Clinical PI of The EPSRC Mathematics in Healthcare Centre – with partners in Medicine, Oncology, Radiology, Biochemistry, Neuroscience and Industry and led from the Department of Mathematics and Statistics.