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Kolling researchers lead world first trial
Funding for key national projects
Long term impacts of minor crashes
Discovery into reality
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MESSAGE FROM THE ACTING EXECUTIVE DIRECTOR
event. The seminars will have a focus on networking, collaboration and career pathways, and will provide a forum for researchers to discuss collaborative opportunities and offer peer support. The series will feature national and international speakers, as well as early and mid-career researchers. The implementation of our research strategy has been discussed in the many conversations I have had around the Kolling. It is safe
The neuroscience and pain priority research area, for instance, will bring together academics, clinicians and community members to focus on the complex issue of opioid prescription. A combined research approach, involving representatives from pharmacology, ageing, pain, neurosciences, and the community, will reduce this significant health challenge. Importantly, planning is underway for three research showcases over the coming months to direct the spotlight to our priority research areas of musculoskeletal, neuroscience and pain, and cardiovascular and renal research. The showcases will focus on the strengths and diversity across the three areas, and will provide an excellent opportunity to broaden awareness of our expertise and research activity in these areas. One initiative to flow from the research strategy is a new collection of seminars. The Kolling Research Seminar Series will commence on June 1, with physiotherapists Dr Sally Wootton and A/Professor Zoe Mckeough to present at our first
I have stepped into the role of Acting Executive Director during an exciting time for the Kolling immediately after the launch of our five-year research strategy. It is both an honour and a privilege to be acting in the position. I have welcomed the opportunity to meet with the priority research area and research enabler groups and to learn more about their plans for their respective groups. Our strategic committees have thrown their support behind the new strategy, and are working to establish measurable objectives, timelines and benchmarks for future reporting. It has been encouraging to see the considerable efforts and commitment to expanding our research success in a united fashion. A key part of the new strategy will see the development of new collaborations, both within the Kolling and with external partners, and I’m pleased to see some new partnerships are already emerging and becoming established. This
to say that these ‘early-days’ conversations have given me a
sense of confidence that our Kolling community is committed to actioning the research strategy. I believe effective, consistent, and cohesive language around the successful implementation of the strategy will not only prove positive, but will exceed all of our expectations of what a culture of success looks and feels like. Lastly, I am reminded of an African proverb…“If you want to go fast. Go alone. If you want to go far. Go together.”
will have a significant impact on our ability to enhance our multidisciplinary research capabilities.
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First large-scale trial of stem cell therapy for knee osteoarthritis Kolling researcher Professor David Hunter will lead one of the world’s largest clinical trials into the effectiveness of stem cell therapy for those with knee osteoarthritis. More than 400 participants will be recruited for the study which will see trial sites established at Royal North Shore Hospital and the Menzies Institute in Hobart. Professor Hunter, the Florance and Cope Chair of Rheumatology at the University of Sydney, said the two- year study represents the first of its type to test stem cell therapy for osteoarthritis. “We will evaluate whether stem cell injections can improve symptoms and slow the progression of the disease in people with mild to
moderate knee osteoarthritis,” he said. “Participants will receive three injections over a 12 month period, with researchers to assess levels of pain, physical activity and quality of life throughout the trial.” All participants will receive the same stem cell product, developed from cells from a single young healthy person. The study follows some small trials which have indicated stem cell therapy may reduce inflammation, and help the body repair cartilage. Professor Hunter said there is tremendous community interest and many stem cell products available, but to date, there has been no good, rigorous evidence to suggest these products are effective in this context. “It’s really important that we have high-quality trials like this one to produce the evidence that we need around efficacy and safety,” he said. “Osteoarthritis is steadily increasing in prevalence due to our ageing population and the high numbers of
people above a healthy weight.
“It’s important that we can offer those managing the condition a range of treatment options, on top of the existing conservative approach of weight loss and exercise.” The trial has been welcomed by 61 year old Tom Buttel who has experienced knee osteoarthritis for most of his life after a rugby injury in his teens. “Osteoarthritis has had a big impact on my life, causing considerable pain and limiting quite a few daily tasks,” he said. “I have found, however, that by maintaining my weight and adhering to a personally-tailored exercise program, I’ve been in a much better position to manage my condition. “I’m very excited by the trial and encouraged that it may be an important step towards a safe and effective treatment for people with osteoarthritis.”
Further information about the SCUlpTOR study is available at: tinyurl.com/sculptor-trial
Professor David Hunter and Tom Buttel who has lived with osteoarthritis for most of his life
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Professor Gemma Figtree with Dr Steve Vernon
Our researchers secure highly competitive national funding Two of our leading researchers will drive key Australian projects following a funding announcement from the National Health and Medical Research Council (NHMRC). of coronary artery disease - the most common form of heart disease which can lead to heart attacks. measure the effectiveness of this new test using genetic markers to predict heart health,” she said.
“If it proves effective, we anticipate the new early warning test will directly inform clinical guidelines and government policy. “It will help us identify those at risk of coronary artery disease so they can receive preventative treatment, similar to that received by those with the traditional risk factors. “We anticipate this approach will reduce heart attacks and prevent deaths.
She said our current assessment is based on the well-documented risk factors of smoking, hypertension, diabetes and high blood cholesterol. However, between 15 and 30 per cent of people who experience a heart attack don’t have these traditional risk factors, so a new early detection test, called a polygenic risk score has been developed. “As part of our research, we will be providing some robust data to
More than $1.4 million from the partnership grant program will go to Kolling researcher and RNSH interventional cardiologist Professor Gemma Figtree and her team for a study to reduce coronary artery disease. The world-first project will receive an additional $2 million from industry and health partners. Professor Figtree and her team will assess a new way to identify the risk
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Professor Marg Fry
“More than 30 NSW, Victorian and Queensland hospitals will be involved in the trial over the next five years, and if this approach proves effective, it’s likely to be adopted not only in Australia but internationally as well, across Fiji, Sri Lanka and Nepal. “We are anticipating a positive response, and expect the training will lead to a 20 per cent reduction in inpatient deterioration events and an increase in patients reporting a good ED experience.” she said.
more than eight million people attending Australia’s 287 emergency departments each year. “Emergency nurses are the first and sometimes only clinicians that patients see, so the quality of this initial assessment and ongoing treatment is vital. Patient safety is contingent on accurate assessment, intervention and escalation,” she said. “There is currently no standardised way that Australia’s 29,000 emergency nurses are taught to assess and manage their patients, so the research will examine the HIRAID system, a validated framework developed by the research team.
“It’s really aimed at prevention and identifying those at risk in the community, not just supporting those after a heart attack.” An NHMRC partnership grant of $1.5 million will also go to a study to improve the safety and quality of emergency nursing care. More than $3.6 million will be granted in total. The NSLHD’s Nursing and Midwifery Director of Research Professor Margaret Fry will help lead the national project, examining a standardised assessment and management approach for all emergency care nurses. Professor Fry said the evidenced- based system is needed with
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Dr Daniel Whiten
High tech project offers hope for Parkinson’s treatment Kolling researchers are set to lead a ground-breaking project to identify new drug therapies for those with Parkinson’s disease. will help our team translate our scientific progress into an effective treatment for Parkinson’s disease patients.
but we have identified a new pathway to restore cellular function in the brain, and this project will help us identify the compounds which can activate this pathway and reduce the impact of Parkinson’s disease. “The funding means we will now have access to highly specialised robotic screening at the Walter and Eliza Hall Institute, allowing us to test several hundred thousand compounds in a relatively short amount of time.
“Parkinson’s disease affects approximately one per cent of the population over 65, leading to a continual loss of neurons in the brain, and loss of function,” he said. “Currently, we are unable to slow or stop this process with medication,
The project has been made possible following Federal Government funding through the National Drug Discovery Centre. Senior Kolling researcher Dr Daniel Whiten has welcomed the announcement, saying the funding
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Professor Carolyn Sue
“Currently, all treatments are aimed at reducing the symptoms of the condition. This project however, will look to halt the symptoms and reduce the progression of the disease.” The large scale screening campaign will be carried out over the coming months.
Kolling, where we are able to directly transfer our breakthroughs in research into better treatment options for patients and ultimately better health outcomes.” Professor Sue said the project was a wonderful opportunity to work collaboratively with the National Drug Discovery Centre team at the Walter and Eliza Hall Institute. “This is a tremendously exciting project as it’s investigating new ways to treat Parkinson’s disease.
“This approach will give us the best chance of identifying the most effective compounds for new drug therapies. “I’m looking forward to working with Professor Carolyn Sue, Dr Gautam Wali and Professor Michael Kassiou from the University of Sydney on this exciting project. “It is an important step in the development of new treatments for Parkinson’s disease and highlights the translational strength of the
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Michael Nugent, Prof Carolyn Sue, Prof Robyn Ward, Irina White and Deb Willcox
New strategic framework for the Kolling It has been an important time for the Kolling following the launch of the institute’s five-year research strategy, which aims to broaden opportunities for high-quality translational research. A key component of the new strategy is the provision of research enablers, which will be instrumental in providing collaborative opportunities, modern platforms and infrastructure.
promoted as the vehicle for pursuing translational research priorities. “The Faculty of Medicine and Health and Northern Sydney Local Health District have now established the Northern Sydney Precinct unit, to provide dedicated local support for research performance, infrastructure and career development as well as grant management,” she said. “This will be a unique opportunity to explore new ways of pursuing our long-standing partnership, to deliver for our own communities, and to make our mark on the world stage.” NSLHD Chief Executive Deb Willcox said the research strategy will strengthen the Kolling’s reputation, both nationally and internationally, as a centre for translational research excellence. “With the Kolling located alongside Royal North Shore Hospital, researchers are embedded within a large health system,” she said. “This paves the way for strong collaborations between researchers and clinical teams, and efficiently delivers improvements to patient care and long term health outcomes.”
The research enablers will focus on the following areas: • Clinical trials and translation • Data and informatics • Research infrastructure and support services • Recruitment and retention Professor Elliott said the measures incorporated in the new strategy are aimed at assisting teams to increase the impact of their research. “They will provide a robust strategic framework, delivering new opportunities, access to high quality facilities and new partnerships both within and outside the organisation.” As a joint venture between the University of Sydney and the Northern Sydney Local Health District, the research strategy will see enhanced support from the joint venture partners. Professor Robyn Ward, Executive Dean and Pro Vice Chancellor of Medicine and Health at the University of Sydney said one of the key initiatives will see the Kolling
Three research priority areas were identified during the development of the strategy including musculoskeletal, neuroscience and pain, and cardiovascular and renal research. These areas represent some of the biggest health challenges of our time, and collectively cost the community billions of dollars a year with a health, personal, and economic burden. Acting Executive Director James Elliott said there is tremendous expertise across these disciplines within the Kolling, with many researchers world renowned in their fields. “Our research teams have a track record of success, a unique breadth of skills and knowledge and globally recognised expertise,” he said. “By focusing on these areas, we are moving to strengthen our ability to achieve game-changing research and ultimately improve the health of our local, national and international communities.”
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Age and sex influence the adverse effects of multiple medications There are calls for a carefully- considered, tailored approach to the prescription of multiple medicines with new research finding a person’s age and sex influence the impact of multiple medications. More than half of older Australians take five or more regular medications, with the higher number of medications directly linked to a higher chance of adverse reactions, like falls, confusion and frailty. Researchers from the Ageing and Pharmacology Laboratory at the Kolling Institute, led by Professor Sarah Hilmer, used an experimental model to measure the impact of multiple medications, including high risk drug classes. The research confirmed the multiple medications had an adverse impact, reducing independence in daily living, increasing anxiety and reducing physical function including grip strength, motor endurance and gait speed. Further analysis found the negative impacts were influenced by age and sex. The decline in independence and increase in anxiety were significantly greater in the old than in the young, while males were more likely to experience reduced grip strength than females. Professor Hilmer said this was an important body of research and the first study to rigorously assess the effects of age and sex on
Dr John Mach with Professor Sarah Hilmer
investigate the impact of a broader range of medications. “While males were more susceptible to the regimen we tested, females may be more susceptible to other drug classes,” he said. “Our study highlights the need for further investigations to ensure medication use across Australia is supported by scientific evidence.” Dr Harry Wu, who was also a co-first author, hopes the study will be the first of many to promote a more personalised approach to medication use. “It has been exciting to have the opportunity here at the Kolling to conduct this bedside to bench research, to help understand how to treat and monitor patients who take multiple medicines.”
susceptibility to the adverse impacts of multiple medications. “The research indicates that a one-size fits all approach to the prescription of multiple medications is not advised, and the differences in age and sex should be considered,” she said. “To get the best outcomes from medications, we need to practice personalised medicine. “It’s important to consider not only the person’s diagnosis, but also their age, sex, other medications, other diseases, genetic and environmental factors. “We would particularly like to see a more cautious approach when multiple medicines are prescribed for older people.” Co-first author Dr John Mach said further studies are needed to
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Research identifies long-term health impacts of minor crashes
“If you’re a patient with ongoing chronic pain following a whiplash injury, but no objective imaging finds anything wrong, people are frequently informed that nothing is wrong with them,” he said. “We now have a broader understanding of the condition and can assure patients their chronic pain is not all in their heads. “Additional treatment options could be considered including a more targeted approach to pain management and possibly help from a psychologist. “The findings highlight the potential value of changing standard imaging protocols to identify these individuals early and start accelerated treatment. “Not everyone needs an MRI scan after a whiplash injury from a motor vehicle collision, but this research has demonstrated the importance of additional screening in individual circumstances.”
“I was sent for MRI scans every few years, and was always told the scans were normal. “It wasn’t until a few years ago that a neurosurgeon investigated my case despite another normal MRI, and now they believe the whiplash I experienced all those years ago could have contributed to my symptoms. “My cognitive symptoms are now much improved and I appreciate the research spotlight on this area.” Professor Elliott said these latest findings are significant. “Whiplash-associated-disorders are the most common outcome for the 2.6 million Australians and four million Americans involved in a non- catastrophic motor vehicle collision every year,” he said. “Half of those injured recover rapidly, but the other half continue to experience long-term health issues, with neck pain the most common symptom. “Whiplash-associated-disorders are the fourth leading cause of disability. They represent a considerable financial burden, costing the Australian economy around a $1 billion a year, and the American economy more than $100 billion. “Within this context, there is an urgent need for new diagnostics and effective strategies to identify and mitigate the risk of chronic whiplash- associated-disorders.” Professor Elliott said the findings encourage health care providers treating these patients to dig deeper if the clinical signs and symptoms suggest a potential injury involving the spinal cord, and adjust treatment accordingly.
Treatment of whiplash injuries may be modified following research which has found even minor motor vehicle accidents can cause a long-term spinal cord injury. Researchers from the Kolling Institute along with scientists from Northwestern, Stanford and the University of Oklahoma conducted the longitudinal study involving participants who had been involved in a relatively simple rear-end motor vehicle collision.
Using advanced MRI imaging, the research team identified
profound changes in the health and integrity of spinal cord pathways of female participants who were still experiencing health issues one year after their crash. Acting Kolling Institute Executive Director Professor Jim Elliott said he believe these changes represent a more severe injury than what might be expected from a typical low-speed car crash, and would not normally be detected with conventional imaging scans. The research indicates these patients may have experienced an incomplete spinal cord injury, which could be linked to a range of associated health issues. The news has been welcomed by academic Jade Barclay who experienced decades of unexplained symptoms after a car accident when she was just 15. “It was a very tough time managing fluctuating disability, debilitating fatigue, tinnitus, nausea, as well as ongoing cognitive difficulties with speech, memory, and reading,” she said.
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Jade Barclay
A/Professor Paul Roach with Professor Dale Bailey
First Australian imaging technology to deliver research windfall An exciting project between the University of Sydney and the Northern Sydney Local Health District will see a $15 million, revolutionary scanner installed at Royal North Shore Hospital, greatly improving patient care and research capabilities. Australia’s first Total Body Positron Emission Tomography (TB-PET) scanner will produce faster and higher quality whole-body PET/CT scans, with less exposure to radiation than current scanners.
The high-tech scanner could improve treatment outcomes for a wide range of chronic diseases, including cancer, neuromuscular conditions and infectious diseases. “By identifying new disease targets and biomarkers, or evaluating new therapies, the scanner could greatly assist patients with an earlier diagnosis or access to more effective, personalised treatments,” Prof Meikle said. “Importantly, researchers from across the country and international collaborators will have access to the facility via the University’s Sydney Imaging core research facility. It will be the only one in the country with dedicated research capacity.” The machine, which will be a flagship of the National Imaging Facility, is expected to be operational by early 2022.
It will capture the whole body in a single scan, allowing doctors to diagnose, guide treatment and track patient’s progress more accurately. In addition to the direct clinical benefits, there will be wide sweeping benefits for research. Professor of Medical Imaging Physics Steve Meikle said the TB-PET scanner will capture dynamic, physiological information from all organs at the same time. “This will be incredibly useful as researchers seek to understand how chemical signals within and between organs regulate their function, and how these processes go awry in chronic diseases,” he said. “Crucially, it’ll allow researchers to evaluate the effects of new drugs on the whole body, including the targets they’re designed to interact with and non-target sites.”
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Professor Manuela Ferreira
Technology to bring relief to those with low back pain With many of us looking to adopt a healthier lifestyle, researchers say a new approach may not only deliver benefits for your heart and waistline but may reduce low back pain as well. Professor Ferreira said learning how to self-manage low back pain is particularly important, and the TEXT4myBACK study will remotely support people anywhere, at any time of the day. “It has been shown to help people with other chronic diseases, such as cardiovascular disease and diabetes engage in a healthier lifestyle.
investigate whether a lifestyle-based text message intervention can help people do just that. Two different formats of text message interventions are being assessed and participants will receive one of two interventions which differ in their frequency and content. The messages will contain educational information about low back pain and self-management strategies. The study will measure whether the text messages improve function and patient confidence in managing their symptoms. “We’re keen to measure the effectiveness of this new mobile health approach,” she said. “Text messaging is an easy, accessible and affordable intervention that can empower people with low back pain to better manage their own symptoms. It can be used to
The condition affects one in six Australians or four million people and is the leading cause of adult musculoskeletal pain worldwide. Researchers from the University of Sydney and the Kolling Institute have launched an innovative study to assist those with low back pain, and they’re urging those with the debilitating condition to join the trial. Professor Manuela Ferreira said research has shown us that low back pain is the number one cause of disability worldwide, greatly impacting social, family and work activities. “We know low back pain is the main reason Australians miss work and retire involuntarily,” she said. “Low back pain also contributes to a lack of physical activity, increasing the risk of other chronic diseases.”
“Text messages have helped people lose weight, stop smoking and increase their exercise participation levels. “The study is receiving a positive response, with participants able to join remotely, as long as they have access to a phone and internet coverage. “This is a great option for many Australians who do not have easy access to specialised care or support to receive evidence-based information on how to care for their spinal health.” To find out more, follow ibjr.sydney. edu.au/volunteer/text4myback/ To express interest in participating in the study, click on bit.ly/ TEXT4myBACK and complete the pre-screening survey.
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Research highlights the dangers of early births
Lobaba Idris experienced this with her twins Zayn and Layla who were born via planned caesarean at Royal North Shore Hospital at 36 weeks and four days old. In the last weeks leading up to the birth, Lobaba said every day was a relief. In 2019, Lobaba lost a baby at 21 weeks. “I was keen to stay pregnant for as long as I could, but I have an autoimmune disease that needed to be monitored, and my baby girl was much smaller than her brother,” she said. “We tried to wait until I was 37 weeks but she was so tiny we just knew it was the right time to have a c-section.” Layla was born at just over two kilograms and Zayn was over 2.6 kilograms. “Waiting as long as we did I think helped. The twins didn’t need to go into special care and could come home,” she said. Twins are known to be smaller than singleton babies, and the management of their growth poses
Doctors and researchers are increasingly concerned at the steady rise in premature twin births in New South Wales. Professor Jonathan Morris and his team from the Kolling’s Women and Babies Research group analysed over 14,000 twin pregnancies from 2003-2014, finding 49 per cent of twins were born premature before 37 weeks, and 69 per cent of all births were planned either by pre-labour caesarean or induction. “Previous research into singleton pregnancies has shown early birth placed an infant at increased risk of long-term developmental problems,” he said. “In the short-term, babies born early were more likely to need help with their breathing, be admitted to a neonatal intensive care unit, have jaundice, spend longer in hospital and be readmitted to hospital in the first year of life.” Professor Morris said while an early planned birth is sometimes necessary, the aim should be to prolong the pregnancy for as long as it is safe to do so.
unique challenges as the wellbeing of both twins has to be considered. “Use of singleton growth charts to plot the growth of twins are still being used without considering the different growth patterns which could occur in each twin pregnancy,” Professor Morris said. “This leads to healthy, well-grown twins being misclassified as growth restricted, and often results in unnecessary early birth, exposing these babies to problems associated with prematurity.” In partnership with the NORTH Foundation, Professor Morris and his team are raising funds to evaluate and develop fetal growth charts for twin pregnancies. To donate to the study, visit https://northfoundation.org.au/how- you-can-help/women-and-babies- research/
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A simple mix of treatments holds the key to better hand function The base of our thumb may just be a small part of our hand, but osteoarthritis in that area can have a significant impact, making the simplest tasks difficult. The condition especially affects post-menopausal women, with figures indicating up to a third of women over 70 have this type of osteoarthritis. Increasing numbers of people are experiencing the condition, and yet current treatments still leave patients with limited use of their hand. Researchers from the Kolling’s, Institute of Bone and Joint have completed a clinical trial finding a combined approach of education, a splint to support the thumb, hand exercises and a pain relief gel, were a promising lead in helping people regain hand function. More than 200 people, in two groups, were involved in the COMBO study, which assessed pain and hand function, grip strength, thumb base stiffness, and overall quality of life.
Findings: • After six weeks, there was increased hand function for people who undertook the treatments and exercises compared to the control group. • After 12 weeks, participants also reported a better quality of life and reduction in pain. Senior author Professor David Hunter said many older adults affected by thumb base osteoarthritis feel there is nothing that can be done for the condition. “This trial demonstrates clinically beneficial effects on hand function with readily available interventions,” he said. “It indicates a simple mix of treatments can improve range of hand motion and make daily tasks, like opening a door or picking up an object, easier.” The study, published in JAMA Internal Medicine, was led by the Kolling Institute’s Dr Leticia Deveza and Sarah Robbins. “Previous studies on combined treatments in thumb base osteoarthritis have provided conflicting results,” said Dr Deveza. “To our knowledge, ours is the first study to investigate a combination of treatments in thumb base osteoarthritis, and importantly, we’ve found a solution that could be of clinical benefit,” she said.
(02) 9926 4500 Kolling@sydney.edu.au www.kollinginstitute.org.au @KollingInstitute @KollingINST Latest News from the Kolling Institute
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Bridging Medical Research and Health
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