London Aortic Mechanobiology Working Group

What we do

The vision of our research group is to improve the diagnostic and treatment process of patients with thoracic aortic aneurysms at risk of a life-threatening type A aortic dissection.  Our research brings together advanced imaging technology with tissue biomechanics, genomics, metabolomics and computational modelling.

Why it is important

Guidelines for the management of proximal thoracic aortic aneurysms are limited to size criteria only, and our understanding of which aneurysms are more vulnerable to suffer from acute dissection/rupture is very limited. Most clinical studies tend to be anecdotal, poorly controlled and lack the scientific backing to make ground-breaking conclusions that may change clinical practice.

Biomechanically, acute aortic events occur due to tears occurring spontaneously in the aortic intima/media, leading to formation of a false lumen, which propagates under the aortic pulse pressure to dissect. The failure of the aortic tissue at the dissection entry site occurs as a result of the haemodynamic loads (from blood flow) exceeding its strength

The current gold standard treatment is surgical replacement of the aneurysmal aorta to ward off the life-threatening complications, although it is reserved for at-risk patients owing to the significant burden of surgery. Endovascular management of the proximal thoracic aorta also shows promise, although is not yet established.

How it can benefit patients

Our research aims to create patient-specific computational models to predict how enlarged thoracic aortas will behave over time and assess the risk of aortic dissection.

Our work provides vital data that will be applied to clinical decision support software systems utilising patient specific algorithms that can be used in the hospital setting. This will be vital for patients coming through the multi-disciplinary team in predicting acute aortic events and making important decisions regarding treatment and its timing.

Summary of current research

Our current studies recruit patients with enlarged thoracic aortas.

Patients undergo pre-operative 4D flow MRI. Using computational fluid dynamics and direct measurements from 4D flow images, patient-specific blood-flow profiles are generated

• Pre-operative blood for targeted genomic testing metabolomics. As well as identify commonly associated genes with TAA, we hope to identify metabolic phenotypes that can potentially act as biomarkers of vulnerable TAAs
• Explanted aneurysm from theatre. This is subjected to regional tensile strength and failure testing. This is coupled with the aforementioned haemodynamic parameters to generate a finite element model to simulate aortic wall biomechanics and predict aortic wall rupture.
• Aneurysm tissue is also analysed histologically using computational pathology methods
• The group is in the process of developing deep learning algorithms working with artificial intelligence experts for medical image analysis and complex neural networks

Other research interests of the group include:

• Quality of Life after Aortic Surgery
• Misdiagnosis of Acute Aortic Syndrome

Our researchers