2019 IARS Mentored Research Award Recipient Interview: John Whittle, MBBS, PhD, GChPOM, FRCA, FFICM

Abstract Presentations:

1. Poster #77: Assessing Postoperative Cardiac Risk: The Role of Metabolic Flexibility in Perioperative Patients Evaluated through CPET – presented by Pietro Arina, MD, Specialist Doctor in Anaesthesia and Critical Care Medicine, at Poster Presentation A, Friday, May 17, 10:00 am – 11:00 am, Columbia AB, Hyatt Regency Seattle

2. Impaired Substrate Utilisation during Cardiopulmonary Exercise Testing is Associated with Reduced Aerobic Fitness in Patients Undergoing Preoperative Assessment for Elective Cancer Surgery – presented by Nicholas Tetlow, MSc, Clinical Exercise Physiologist and Honorary Research Fellow, at the Oral Abstract Session: Perioperative Abstracts, Saturday, May 18, 6:17 pm – 6:25 pm, Columbia C, Hyatt Regency Seattle

3. Poster #82: Tissue Saturation Index Maximum Recovery as a Novel Marker of Cardiorespiratory Fitness in Surgical Patients – presented by Adam Beebeejaun, BMBS, FRCA, Specialist Registrar in Anaesthesia and Perioperative Medicine, at Poster Presentation E, Sunday, May 19, 10:00 am – 11:00 am, Columbia AB, Hyatt Regency Seattle

Experience as a critical care physician and anesthesiologist helped John Whittle, MBBS, PhD, GChPOM, FRCA, FFICM, to recognize that the critical care team could do better for patients in identifying who was at risk of developing complications and unraveling the underlying mechanisms behind those risk factors. This topic, specifically subclinical autonomic function, became the focus of his doctoral thesis and later developed into a grant proposal on focused exercise training to improve vagal tone before surgery, which won him a 2019 IARS Mentored Research Award (IMRA). Now an associate professor of Perioperative Medicine at the University College London, Dr. Whittle has taken those early research results and expanded their reach into new research focused on making a bigger impact on perioperative care of patients. His current work is targeted at determining whether metabolic inflexibility might be a mechanism underlying the relationship between low cardiorespiratory fitness and the development of postoperative complications. The findings of this work will be revealed during three abstract presentations during the 2024 Annual Meeting, presented by IARS and SOCCA. His research team members (Pietro Arina, MD, Nicholas Tetlow, MSc and Adam Beebeejaun, BMBS, FRCA), who have played an integral part in the success of this research, will present the results on his behalf. Below, Dr. Whittle reflects on what drew him to this area of research, the impact of the IMRA on his career and research, and the influence his current work might play in perioperative anesthesia.

1. For this research, you are…

Principal Investigator

2. What drew you to this area of research? Has it evolved since your initial research project?

I was drawn to research in perioperative medicine through my experiences as a critical care physician and anesthesiologist. I felt we could do better for our patients in terms of identifying who is at risk of developing the complications we see on the critical care unit through understanding the underlying mechanisms behind known risk factors. This knowledge could then be applied to patient care by directing optimization and supporting shared decision making. My doctoral thesis was focused on subclinical autonomic function and this evolved into the subject of my IARS Mentored Research Award grant proposal where I aimed to use focused exercise training to improve vagal tone before surgery. Over the course of this research, it became apparent that metabolic inflexibility might be a mechanism underlying the relationship between low cardiorespiratory fitness and the development of postoperative complications. This has become the focus of my current work.

3. What are the goals you most want to accomplish in your work with this research project?

I hope that through uncovering physiological risk factors and mechanisms underlying the development of postoperative complications, we can move closer to personalized perioperative care. I am mostly focused on uncovering modifiable risk factors in perioperative time frames in order to allow us to target perioperative optimization.

4. What is the potential impact of your research on the field of anesthesia and patient care?

Exercise and nutritional interventions are gaining traction in the perioperative period. I hope that through targeting these interventions to individuals that might benefit most and by optimizing the intervention to the individual patient’s risk profile we can reduce avoidable harm by preventing significant perioperative complications. In order to do this, we will need to rethink the focus of the perioperative pathway, putting the patient at the center.

5. What are the benefits of presenting your research at the IARS Annual Meeting?

The IARS Annual Meeting is the premier meeting of its type for dissemination and discussion of academic and translational research topics in anesthesiology and perioperative medicine. The networking and ideas exchange is second to none and provides plenty of take-home messages!

6. How did the 2019 IARS Mentored Research Award affect your research and professional trajectory?

This award was invaluable for supercharging my transition to independence as a researcher. The financial support in addition to the mentored nature of the award allowed me to develop new skills and set up an independent research group. IARS was extremely supportive in allowing me to work across two institutions in two countries. As a direct consequence of the award, I have been able to contribute to the development of one of the only two perioperative research themes in the UK sponsored by the UK National Institute of Health Research.

7. How are your current research projects influenced by your initial IMRA research project?

I have continued to focus on the mechanistic determinants linking cardiorespiratory fitness as the biggest predictor of perioperative complications and developed my thinking around how exercise testing can be used to uncover physiological reserve. Autonomic function remains one of the key targets to modulate in the perioperative period, but focus on metabolism and immunometabolism as modifiers of autonomic function among other positive benefits allows access to a host of potential interventions including targeted nutrition that are realistic in the perioperative timeframe. I have also been able to understand the potential benefits of machine learning techniques in unpicking the complexity of perioperative data and am now exploring their application across the translational spectrum.

8. Is there anyone else you wish to acknowledge as part of this research team?

Adam Beebeejaun and Nick Tetlow as research fellows have been extremely hard working, intelligent colleagues and integral to the delivery of my research aims and pulling together our nascent research group. Pietro Arina has done sterling work on development of machine learning techniques in the area of our labs focus and has made progression to precision medicine approaches closer in reach.

9. Outside of your research, what might someone be surprised to learn about you?

I play the clarinet and met my now wife in an amateur orchestra in London when I was a doctoral candidate.