Bridging Medical Research and Health
Celebrating our Research Success
The Kolling Institute’s Year in Review 2022
Northern Sydney Local Health District
Contents
The Kolling Institute – Who We Are
4
Overview from the Chair
6
Academic Director Insights
7
Kolling Institute Governance Committee
8
Network
10
2022 – A Year at a Glance
12
Priority Research Area Achievements
14
Neuroscience and Pain Research
14
Musculoskeletal Research
22
Cardiovascular and Renal Research
30
Kolling Research Enablers
39
The Impact of Philanthropic Support
40
Acknowledgement of Country We acknowledge the traditional custodians of the lands on which our services are located, the Guringai and Dharug peoples, and we honour and pay our respects to their ancestors. We acknowledge and pay our respects to all Aboriginal and Torres Strait Islander peoples and to Elders past and present. We acknowledge that past, current and future Aboriginal and Torres Strait Islander peoples are the continuing custodians of this country upon which we live, work and meet and that it is from their blood, courage, pride and dignity that we are able to continue to live, work and meet on this ancient and sacred country.
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THE KOLLING INSTITUTE Driving world-leading translational research
At the Kolling Institute, we have brought together a large, talented team to help diagnose, prevent and treat disease, and improve the care our community receives. Our research is focused on improving community wellbeing at every age. Backed by our joint venture partners, the University of Sydney and the Northern Sydney Local Health District, our researchers are investigating some of the biggest health challenges of our time from heart and kidney disease to musculoskeletal conditions, chronic pain and neurodegenerative disorders. We are driving a wealth of basic, clinical trial and translational projects, with a diverse range of new research consistently launched.
As the oldest medical research institute in New South Wales, the Kolling Institute has a long established reputation of high quality research and unrivalled experience. Our teams have been at the forefront of scientific progress for more than 100 years. Our researchers have a track record of success, a unique breadth of skills and knowledge and globally recognised expertise. Located on Sydney’s Royal North Shore Hospital campus, our researchers have broad access to patient groups and state of the art infrastructure. This ensures our teams are well placed to directly embed scientific and medical progress into patient care. Our researchers are supported by a robust strategic framework which is strengthening our ability to achieve game-changing research and importantly, improve the care we all receive.
Our institute is governed by our approach to inclusivity.
At the Kolling, we foster a sense of belonging, where everyone feels valued, accepted, and supported to thrive at work. By embracing diversity and inclusion, we are supporting genuine participation and collaboration, and enhancing our workplace.
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Kolling Institute Year in Review 2022
Our researchers have a track record of success, a unique breadth of skills and knowledge and globally recognised expertise.
5
Overview from the Chair
As chair of the Kolling Institute Governance Committee, I have been fortunate to witness the steady improvements at the Kolling in recent years, and particularly in 2022. Our large and experienced team of researchers is well placed to expand its research activity and increase its impact on the national and international stage.
I am tremendously proud of our unique group of researchers, and consistently impressed by their unrelenting commitment to quality research, new models of care and better health outcomes. In some cases, these improvements can be life-changing. Many of our researchers are juggling clinical and research responsibilities, while making substantial inroads in their individual areas of expertise. In 2022, it was pleasing to see the consistent progress with the implementation of the Kolling’s five-year Research Strategy. This progress has only been possible with the support of a large number of people who have shared their time and experience to help secure the Kolling’s future success. The strategy leverages the collective strengths of our joint venture partners the University of Sydney and the Northern Sydney Local Health District, who both share a vision for excellence in translational research. I would like to extend my thanks to Deb Willcox, former NSLHD Chief Executive, who in collaboration with Professor Robyn Ward, Executive Dean and Pro Vice-Chancellor (Medicine and Health) at the University of Sydney, pioneered new ways to strengthen the long-standing partnership and build on our culture of trust and transparency to enable strategic use of resources and improved funding for researchers. The Kolling kicked goals in so many areas over the year, from new infrastructure improvements to substantial grants and prestigious accolades. Researchers were supported with better structures, a stronger culture of collaboration, as well as practical support and training. All these components have increased opportunities for scientific progress and research impact. In 2022, there was a changing of the guard with Professor Carolyn Sue stepping down from her role as Executive Director of the Kolling Institute and Professor Jim Elliott appointed the Kolling’s first
Academic Director. I would like to thank Carolyn for her remarkable contribution to the institute over more than two decades, and particularly over the last five years as Executive Director. The Kolling benefitted from a smooth transition to a new leader and I would like to acknowledge Professor Elliott’s commitment to the implementation of the research strategy and the Kolling’s ongoing success. As a globally respected researcher, Jim has brought tremendous knowledge, experience and expertise to his new role, and we look forward to him building on the wonderful work already achieved. As we mark the end of a successful year, I would like to express my gratitude to our joint venture partners for their continued support. Without the financial and institutional backing of the University of Sydney and the Northern Sydney Local Health District, the Kolling and its researchers would not be in the strong position they are today. Michael Nugent Chair Kolling Institute Governance Committee
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Kolling Institute Year in Review 2022
Academic Director Insights
As we reflect on our many achievements in 2022, it has been encouraging to see the progress throughout the Kolling Institute. Our researchers reached so many milestones, from the implementation of our research plan to significant impact across the research priority areas.
We saw tangible improvements in research activity, healthcare outcomes, policy and global reach, and these gains were not isolated to a small group of researchers but were made across the institute. To give you a snapshot of our impact, our researchers are developing the first tools to detect early kidney disease, improving hip and knee replacements, guiding the use of multiple medications and devising national rehabilitation programs. Our teams are identifying new genetic risk factors for heart disease, launching a world-first clinical trial for those with spinal cord injuries, and driving innovative research for those with pain and disabling musculoskeletal challenges. There has been heartening progress with our cancer research and the largest study in Australia into the treatment of juvenile arthritis. The expertise and experience of our research team did not go unnoticed, and a share of our researchers received prestigious national and international awards. These were remarkable awards, recognising the truly outstanding contribution our researchers are making to lift standards of care and the health of our community. In 2022, we continued to welcome significant funding from a range of sources including the National Health and Medical Research Council. More than $4 million was awarded to Professors Gemma Figtree and Carol Pollock to progress our research into heart and kidney disease. This was just some of the large-scale funding awarded to our teams. It is crucial that our researchers are supported with world-leading technology and it was pleasing to see large-scale funding invested in new infrastructure within the Kolling. The program of works will continue and includes a biomechanics robot and a Digital Spatial Profiling System, which is regarded as one of the most exciting technological advances globally in the investigation of tissues. In 2022, we saw an increasing number of early and mid-career researchers coming to the Kolling. It’s so important this group of emerging leaders is
supported and thrives at the Kolling, and we will be implementing a host of initiatives to ensure this younger cohort is given every opportunity to extend their experience and professional skills. The Kolling Institute’s partnership with the Northern Sydney Local Health District and University of Sydney’s Faculty of Medicine and Health means students and researchers benefit from being embedded within a large health precinct ecosystem. The unique research culture of the precinct broadens opportunities to directly incorporate scientific discoveries into practice, without being bound by traditional siloes. Building on the progress in 2022, we will continue to focus on collaboration, not just within the Kolling, but with our health and university partners, and with national and international collaborators. I’m convinced this will drive further activity and deliver new opportunities. There is a real sense of momentum at the Kolling, and I would like to thank the large number of people who have contributed to our progress and research success. Professor Jim Elliott Academic Director Kolling Institute
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Kolling Institute Governance Committee
Michael Nugent
Lee Gregory
Michael Nugent is Chairman of the Governance Committee of the Kolling Institute. He was previously Chief Executive Officer and an
Lee Gregory has worked in health and the public sector for more than 20 years. He was
appointed Interim Executive of Northern Sydney Local Health District in September 2022, bringing to the role his extensive experience as a senior health executive. Lee has a deep commitment to the NSW public health system and prior to his appointment as Interim Chief Executive, Northern Sydney Local Health District, he held a number of senior executive and leadership positions within NSW Health. These include Director Finance, Northern Sydney Local Health District, General Manager, Hornsby Ku-ring-gai Health Service and most recently Executive Director Operations, Northern Sydney Local Health District.
Executive Director of Goodman Fielder, one of Australia’s largest food companies. Prior to that, Michael was the Managing Director of Elders Agribusiness. Michael has held many director and managerial roles across a range of industries, including food, agriculture, services, transport and infrastructure. These roles delivered extensive experience and skills in strategy formulation, the marketing of consumer and industrial products and services, research and development, manufacturing, corporate governance and risk management.
Chris Dennis
Helen Zorbas AO
Associate Professor Christopher Dennis is the Executive Medical Director of Northern Sydney Local Health District, with responsibility for strategic oversight of research and medical governance across the District. Prior to this, Chris was Head of the Northern Clinical School in the Sydney Medical School, Faculty of Medicine and Health, University of Sydney for over seven years. He has extensive teaching experience at undergraduate and postgraduate levels. Chris is also a Consultant Respiratory Physician at Royal North Shore Hospital. He was Head of the Department from 1997 to 2007 and continues to have an active role as a clinician today. Chris has been a member of the National Examining Panel of Royal Australasian College of Physicians since 1998.
Dr Helen Zorbas was Chief Executive Officer of Cancer Australia, the Federal Government’s national agency for cancer control from 2010-2019. Prior to this, Helen was CEO of the National Breast and Ovarian Cancer Centre for seven years. Helen has directed national cancer initiatives to improve evidence-based practice, policy and health service delivery. Her clinical experience spans almost 40 years as a GP and a specialist breast physician in both public and private healthcare settings. Helen has chaired and held positions on a number of key national government, cancer and health committees including Chair and Member of the Board, Cancer Institute NSW. In 2013, Helen was appointed an Officer of the Order of Australia (AO) in recognition of her distinguished service to public health through the delivery of improved information and services to cancer patients and their families and contributions to research and clinical trials.
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Kolling Institute Year in Review 2022
Robyn Ward AM
Mark Rees
Professor Robyn Ward AM FAHMS joined the University of Sydney in July 2018 as the inaugural Executive Dean of the Faculty of Medicine and Health. She was the former Deputy Vice-Chancellor (Research) and Acting Executive Dean of the Faculty of Medicine of the University of Queensland. Professor Ward is an academic leader, cancer researcher and medical oncologist. She chairs the Commonwealth Medical Services Advisory Committee, and serves on the Council and Executive of the Australian Academy of Health and Medical Sciences. In 2013, Robyn was made a Member of the Order of Australia (AM) for significant service to medical research and patient care in the field of oncology.
Professor Rees completed his PhD at the University of Wales College of Medicine in 1994 and has had academic positions at Cardiff, Auckland and Swansea universities. His academic interests lie in the genetic basis of medical disorders with a focus on neurology, mental health and cardio-respiratory disease. Professor Rees is the former Founder and Director of the Wales Epilepsy Research Network and a Fellow of the Royal College of Pathologists and Fellow of the Learned Society for Wales. In 2019, Mark joined the University of Sydney as Deputy-Executive Dean of Research Partnerships for the Faculty of Medicine and Health. He is focused on expanding research collaborations between the University and affiliated medical research institutes.
Irina White
Irina commenced as Committee Secretary, Kolling Institute Governance Committee in 2019. Prior to this, Irina was employed in a number of the state’s largest industry sectors: electricity, rail and education. She served as Company Secretary to the Boards of Endeavour Energy, Integral Energy, Rail Corp, Rail Infrastructure Corporation, State Rail Authority and Rail Services Australia. Her past experience also included membership of executive leadership teams and a variety of senior executive positions such as General Manager Corporate Services, Group Manager Corporate Governance, General Manager Human Resources and Director Communications and Marketing. She is a fellow of the Governance Institute of Australia and member of the Australian Institute of Company Directors.
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The Kolling Institute is part of a large collaborative network
North West Academic Centre (Bourke)
SCHOOL OF RURAL HEALTH (DUBBO/ ORANGE)
Orange Health Service
BROKEN HILL UNIVERSITY DEPARTMENT OF RURAL HEALTH
Children's Medical Research Institute
THE CHILDREN’S HOSPITAL AT WESTMEAD
Blacktown
Blue Mountains District ANZAC Memorial Hospital
The Westmead Institute for Medical Research
NEPEAN HOSPITAL
South West Academic Centre (Dareton)
WESTMEAD HOSPITAL
Central Sydney (Patyegarang) Precinct Northern
(Arabanoo) Precinct (Baludarri) Precinct
Western
Rural Health Precinct i Training s te / Hospital site Medical Research Institute
*Map is not to scale and for illustrative purposes only. Due to size constraints, not all FMH sites have been able to be included.
10 Kolling Institute Year in Review 2022
UNIVERSITY CENTRE FOR RURAL HEALTH ( )
Grafton Base Hospital
Hornsby Ku-ring-gai Hospital
The Kolling Institute is located on Sydney’s Royal North Shore Hospital campus. It is part of the Northern Sydney Local Health District and the University of Sydney Faculty of Medicine and Health Northern Sydney (Arabanoo) Precinct. This health precinct is one of Australia’s leading education and research centres, and recognised for enhancing quality of life across all health conditions. University, health and industry partners are collaborating in new ways in a unique ecosystem, enabling greater impact in healthcare outcomes, policy, and global reach. On a local level, researchers benefit from dedicated support for research performance, infrastructure and career development. With a primary focus on functional wellbeing, the Northern Sydney (Arabanoo) Precinct aims to maximise physical, mental and social health at every stage of life.
The ANZAC Research Institute
Kolling Institute
Mona Vale Hospital
Melanoma Institute Australia
ROYAL NORTH SHORE HOSPITAL
CONCORD REPATRIATION GENERAL HOSPITAL
ROYAL PRINCE ALFRED HOSPITAL
Ryde Hospital
Sydney Eye Hospital
Centenary Institute
Sydney Dental Hospital
CAMPERDOWN CAMPUS
D
SUSAN WAKIL HEALTH BUILDING
Canterbury Hospital
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2022 – A year at a glance
Kolling Institute staff profile Academic and technical research staff represent the majority of full time equivalent staff working at the Kolling Institute. 55 per cent of staff are in this group. The student population is also well represented at the Kolling at 32 per cent. Overall, the Kolling has a greater representation of females at 56 per cent compared to 44 per cent of males.
2022 Kolling FTE Staff Profile 249
FTE Gender Distribution 249
4%
8%
38%
44%
24%
56%
9%
17%
Academic Research Staff (95) Technical Research Staff (43) Admin support staff (22) HDR Students (59)
Male (109)
Female (140)
Honours, Masters and other students (20) Other Staff (Visiting researchers) (10)
Grants awarded In 2021/2022 Kolling Institute researchers applied for 121 research grants. They were successful with 41 applications, which represented 53 per cent of the 78 grants awarded. These grants delivered $10,839,535 in funding.
Publications In 2022, Kolling researchers produced more than 670 publications across a diverse range of disciplines. A significant number of publications focused on musculoskeletal disorders, pain, genetics, ageing, depression and hypertension. Publications also investigated the complications, outcomes, risk factors and quality of life associated with
Grant outcomes by Higher Education Research Data Collection (HERDC) funding 121
120 150
121
0 30 60 90
Successful Pending
75
49 41 37
Unsuccessful Grand Total
29
29
17
11
7 9 11
2 5 7
1
1
1
1
1
Cat 1
Cat 2
Cat 3
Other
Unknown Grand Total
Funding categories
Successful grants awarded by HERDC Category 78
Successful grants awarded by HERDC Category 78
1%
7,785,364
19%
Cat 1 Cat 2 Cat 3 Other
Cat 2 Cat 1 Cat 3 Other
8%
2,056,678
disease, including cardiovascular and renal disease.
72%
855,812
141,681
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Public engagement and education As a dynamic joint venture research partnership, the Kolling Institute strives to provide knowledge and raise awareness of its research activities and achievements. Internal and external initiatives are adopted to achieve this, and in 2022, a range of events were co-ordinated to profile research activity including the institute’s seminar series and the priority research area showcases. A collection of town hall meetings were staged throughout the year which provided an opportunity to highlight significant milestones. In 2022, the Kolling Institute introduced Good Clinical Practice (GCP) and research integrity training sessions to improve individual skills and support the development of high quality research.
Seminar Series
Town Halls
Research Priority Area Showcases
Training and Education Sessions
Collaboration There is a strong culture of collaboration across the Kolling Institute with researchers creating a wealth of national and international partnerships. In 2022, our teams collaborated with partners in North America and the United Kingdom. There was also significant collaboration across South East Asia, South Korea, Japan, Singapore and Bangladesh.
Europe
Asia
North America
Africa
South America
Australia
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RESEARCH HIGHLIGHTS Neuroscience and Pain Priority Research Area
This priority research area includes a diverse group of researchers who are driving progress in the areas of pain, neurodegenerative disorders, ageing and other conditions that impact the mind, brain and nervous system. Their world-class research is focusing on improvements in clinical practice as well as the use of medications.
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In 2022, this group, co-chaired by Professors Paul Glare, Lisa Harvey, and Sarah Hilmer led large-scale research projects into depression, the quality use of medicines, whiplash, spinal cord injuries, Parkinson’s disease, pain pathways and the management of pain. Their work investigated conditions which cost the Australian community billions of dollars a year in direct medical expenses and lost productivity. Over the past 12 months, researchers from this priority research area attracted a diverse range of funding. Both their experienced and up-and-coming research leaders were recognised with prestigious national and international awards. Achievements across the Neuroscience and Pain Priority Research Area » NHMRC Centre of Research Excellence $2.5 million » Improving hospital outcomes for frail patients across different disciplines » Research investigating Esketamine in treatment resistant depression $700,000 » MRFF Scheme: Dementia, Ageing and Aged Care $5 million » MRFF Transforming Residential Aged Care Through Evidence-based Informatics » MRFF Models of Care to Improve the Efficiency and Effectiveness of Acute Care Grant: Reshaping the management of low back pain in emergency departments » More than $500,000 to the John Walsh Centre for Rehabilitation Research for projects to support those with a traumatic brain injury and spinal cord injuries » Sydney Health Partners Geriatric Medicine Clinical Academic Group $85,000 » Ramsay Health Care Grant to investigate digital intervention for rib fracture pain » Professor Sarah Hilmer elected fellow of the Australian Academy of Health and Medical Sciences » Professor Ian Cameron Life Fellowship of the Royal Australasian College of Physicians » Professor James Middleton International Spinal Cord Society Medal » Trudy Rebbeck promoted to Professor and awarded University of Sydney VC award for outstanding research supervision » Dr Ryan Davis 2022 Mito Foundation Award for Excellence in Mitochondrial Research » Dr Manasi Mittinty - Advanced Global Clinical Scholar Research Fellow, Harvard Medical School » Professor Gin Malhi re-elected as President of International Society for Bipolar Disorders and as Editor-in-Chief of Bipolar Disorders
» Higher degree completions: Dr Brendan Ng, Dr Trang Tran and Dr Harry Wu » National awards to early-to-mid career researchers Dr Lisa Kouladjian O’Donnell, Dr John Mach, Kevin Winardi, Gizem Gemikonakli, Mai Duong and Dr Neda Assareh
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Research teams across the Neuroscience and Pain Priority Research Area
Back Pain Research Group
Pain Management Research Centre
Ageing and Pharmacology
Neurogenetics
Neuromuscular Imaging
Academic Psychiatry and CADE Clinic
NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA
The Curran Ageing Research Institute
Sutton Arthritis Research Lab
Meniere's Disease Neuroscience Group
Bill Walsh Translational Cancer Research Lab
Osteoarthritis Research Group
John Walsh Centre for Rehabilitation Research
Allied Health
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NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY Researchers closer to better pain management strategies
Researchers at the Kolling Institute have taken an important step towards the development of safer, non-addictive pain medications by increasing our understanding of spinal cord pain signalling. The findings follow the latest figures indicating more than 20 per cent of the population experience chronic pain, impacting their ability to work, care for families and generally function. Dr Karin Aubrey said many people currently rely on opioids, like morphine and codeine to reduce their pain. “We know however, that these medications have serious side effects and in many cases offer only limited help,” she said. “Our team, including senior researcher Dr Yo Otsu, is committed to advancing our understanding of how pain signals travel through the body, so that we can use this information to develop safe, new medications. “This unique study used advanced techniques to unravel the spinal pain control circuit, and determine how opioids affect a key descending pain pathway. Interestingly, this pathway can enhance and reduce spinal signalling.
“Our spinal cords are an incredible information highway, responsible for relaying sensory, motor and pain information to the brain. “The connections that make up the circuits of the spinal cord are all jumbled together and it’s difficult to unravel them and map how each connection contributes to controlling pain signals in the spinal cord. “In this study, we’ve identified how a particular point in the spinal pain circuit is controlled by opioids, giving us a clearer picture of how a good pain medication might work. “We currently have a reasonable understanding of the brain and pain circuits, but there is still so much more to discover. “Each one of us has about 86 billion cells in our brains called neurons, which is approximately half the number of stars in the Milky Way. Essentially our heads are a small galaxy. “This gives some context to the complexities of the brain and pain circuits, and the challenges involved in making significant scientific progress and advances in treatments. “We are encouraged by the progress we’ve made and the deeper understanding we now have around the spinal cord pain signalling and potential targets for new therapies. “Our findings have broadened our understanding of how the spinal cord pain circuit is organised and affected by opioids.” This project was made possible with the support of the Ernest Heine Family Foundation and the Pain Foundation. This research was published in the Journal of Physiology.
Dr Karin Aubrey and Dr Yo Otsu
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NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY
Research confirms your age and sex influence the impact of medications
Trang Tran, Professor Sarah Hilmer and Dr John Mach
A new study by researchers at the Kolling Institute will directly guide the use of medications by older Australians after it identified the profound adverse effects of taking multiple medications. The study follows the latest figures which show around 50 per cent of Australians over 75 years take five or more medications every day to treat multiple chronic illnesses. The trend is leading to an increased risk of geriatric syndromes, including functional and cognitive impairments. Concerned by the growing number of adverse issues, Professor Sarah Hilmer and her team from the Laboratory of Ageing and Pharmacology used a preclinical model to assess the impact of multiple medications on various physical activities performed in a day-night cycle. Importantly, the study examined the effect of common medications widely used by older adults in Australia and internationally. Trang Tran, the PhD student who led the paper said the research identified significant adverse impacts, including a reduction in physical movement such as walking speed and behavioural changes similar to a drug-induced delirium prior to sleep.
“Interestingly, some of the impacts were greater with females than males, confirming that gender can influence outcomes, particularly the effect of medications on physical and cognitive performance,” she said. “We hope it will provide detailed, evidenced-based information to help clinicians understand the global effects of multiple medication use and individual susceptibility.” Members of the nursing community have welcomed the research, with clinical nurse consultant Allyson Waird, from the Aged Care, Delirium and Dementia units at Royal North Shore and Ryde Hospitals, saying the new findings provide valuable information. “The clinical importance of unsettled, agitated or aggressive behaviours by patients, especially later in the day, should never be underestimated,” she said. “Such behaviours may be due to a number of factors, not the least of which is medications, and should always be investigated.” “Our research represents an important body of work which we hope will highlight the need to consider age and sex when prescribing or managing multiple medication use in patients.”
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NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY Researchers identify the best ways to ease chronic pain
With large numbers of people across the community looking for effective and lasting ways to treat pain, our researchers at the Kolling Institute are driving nationally significant projects to reduce a reliance on opioid medication and promote proven alternative options. The research by our team from the Pain Management Research Centre follows the latest figures which indicate around 20 per cent of the population experience chronic pain and a large share of those are still relying on opioid treatment to reduce the impact of their pain. Centre Director and RNSH specialist Professor Paul Glare said despite the wide use of opioids, we now know they are not an effective, long-term option for most people, and cause a wealth of adverse side effects including addiction issues. “Opioid use is directly linked to an increase in mortality, and now accounts for more deaths than car accidents,” he said. “Our research is focusing on the best ways to reduce opioid use considering the complex challenges with medication withdrawal and patient fears that their pain will become unmanageable. “Our research indicates that cognitive behavioural therapy is the most effective option to reduce pain, and patients are three times more likely to be able to stop their opioid use if they adopt the self-management strategies promoted through the cognitive based therapies. “With the number of people experiencing chronic pain continuing to escalate, it’s crucial that we’re able to provide the very latest evidenced- based data around the treatments that work and help people manage their pain. It can make a life-changing impact.” One part of the research program is assessing the effectiveness of digital technologies to support those with chronic pain while reducing their reliance on opioids.
Associate Professor Claire Ashton-James says with demand for support at an all-time high, they are investigating the value of a technological approach which can be delivered to a large number of people at any time of the day. “Our research has initially focused on how patients would like to engage with the programs, and one key trend has shown us that the community would prefer to receive consistent SMS messages, rather than tap into an App,” she said. “It’s important that we seek consumer input early to ensure our strategies will be effective and broadly adopted. “Our research has led to the development of carefully-scripted messages, videos and patient testimonies. “We anticipate these resources will complement the care provided by clinicians and we are undertaking a clinical trial to test their effectiveness in providing additional support. This trial is being funded by the Ernest Heine Family Foundation and we hope the strategies will directly assist those living with constant pain.”
Professor Paul Glare
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NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY
Innovative approach to reduce the impact of serious spinal cord injuries
A simple yet smart approach may hold the key to greatly improved health for those with life-changing spinal cord injuries. Researchers from the Kolling Institute’s John Walsh Centre for Rehabilitation Research launched a project to assess whether a specific breathing technique can improve many of the challenges faced by people with a spinal cord injury, like chronic pain, life threatening unstable blood pressure, fatigue and poor mood. The project, being run by clinician researchers at Royal North Shore Hospital, will see participants randomly allocated to two groups. One group will continue with their usual care, while the other will undergo a 10-week specialised program involving guided breathing practice using computer feedback of heart rate function, and psychological strategies like mindfulness and visualisation techniques. Study lead Professor Ashley Craig is looking forward to the unique project, with more than 300 adults suffering a spinal cord injury in NSW every year. “Spinal cord injuries can have a devastating impact, with a broad range of short and long-term health issues, including some which can be life-threatening like unstable blood pressure,” said Professor Craig, Professor of Rehabilitation Studies at the University of Sydney and the Kolling Institute. “Clinicians currently rely on a host of pain management and treatment approaches, but our team is keen to measure the benefits of this innovative breathing technique to determine if it could be an effective addition to existing treatment strategies. “Yoga enthusiasts have long used rhythmic breathing to achieve tranquillity of the mind, and we now know that the way we breathe regulates our nervous system, in turn affecting our blood pressure and our ability to recover from stress.
“Our study aims to determine how rhythmic breathing can help people with a disrupted nervous system as a result of their spinal cord injury. It will assess whether the rhythmic breathing and importantly, the feedback of heart function can improve the functioning of the nervous system. “A disrupted nervous system can be likened to a car without brakes, with limited moderation of the effects of the nervous system.
Professor Ashley Craig (second from right back row) with the John Walsh Centre for Rehabilitation Research team
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“Our approach will involve a specific type of breathing to regulate heart function to a point where it influences neural function and the autonomic nervous system. “This will in turn deliver wide ranging benefits for the brain, the gut, the heart, sleep and a host of other physical functions. “This technique will naturally require practise, similar to any physical exercise program.
“Importantly, researchers will measure the benefits for blood pressure regulation, and whether the technique can reduce fatigue and dizziness, while improving endurance and performance. “We are keen for as many people as possible to join our study and potentially help establish a new and effective, evidenced-based approach to care.”
The Spinal cord injury, Mind and HeART or (SMART) study has been made possible with a $3 million grant from the NSW Ministry of Health and the University of Sydney.
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RESEARCH HIGHLIGHTS Musculoskeletal Priority Research Area
Our researchers in this priority research area are global leaders in the discovery, development and delivery of breakthroughs for musculoskeletal conditions. They conduct research from bench to bedside and beyond, designing and testing interventions that could speed recovery and decrease the burden of musculoskeletal pain globally.
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This priority research area includes a large number of experienced researchers with expertise in discovery and implementation research. In 2022, this group, co-chaired by Professor Manuela Ferreira and A/Professor Elizabeth Clarke, achieved significant gains through clinical trials and biomedical research, while also driving advances in public health and policy. This group welcomed large-scale funding in 2022, as well as a collection of high-profile awards and accolades. Their research not only broadened our understanding of the underlying causes of musculoskeletal diseases, but provided high-quality data to influence models of care and future treatment options. Achievements across the Musculoskeletal Priority Research Area » NHMRC Investigator Grant $2.6 million awarded to Professor Manuela Ferreira » MRFF $2.5 million for research led by Professor Lyn March into juvenile arthritis » MRFF funding to support research led by Professor David Hunter into better management of osteoarthritis » $600,000 in industry partnership funding to support multiple projects and » Sydney Health Partners Musculoskeletal Academic Group awarded $100,000 » Professor Chris Little elected a Fellow of International Orthopaedic Research » Associate Professor Elizabeth Clarke President-elect of the International Society for Biomechanics » Associate Professor Elizabeth Clarke elected member of the World Council of Biomechanics » Dr Cindy Shu awarded Researcher Exchange and Development within Industry fellowship researchers across the priority research area » More than $450,000 in philanthropic funding
» Dylan Ashton Cooperative Research Australia Early Career Research award » Dr Emma Ho awarded the Sydney Musculoskeletal Flagship Inaugural Research Fellowship » Dr Jill Eyles awarded Sydney Health Partners Inaugural Translation Research Fellowship » Launch of the high-tech Kolling Orthopaedic Biomechanics Robotic Arm
» Professor Ferreira invited to join the World Health Organisation working group to develop international evidence-based clinical practice guidelines for the management of low back pain » Professor David Hunter elected editor-in-chief of the Osteoarthritis and Cartilage Scientific Journal » Higher Degree completions and awards: Dr Emma Ho, Dr Carolina Gassen, Dr Lingxiao Chen and Dr Vicky Duong » International PhD scholarship awards: Alessandra Marcelo, Riyaas Mohammed
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Research teams across the Musculoskeletal Priority Research Area
Neuromuscular Imaging Research Lab
MUSCULOSKELETAL PRIORITY RESEARCH AREA
A3BC
Raymond Purves Bone & Joint Research Lab
Back Pain Research Team
Sutton Arthritis Research Lab
Ageing and Pharmacology
Murray Maxwell Biomechanics Lab
Department of Rheumatology
Osteoarthritis Research Team
Orthopaedics Surgery Department
Allied Health
Pain Management Research Centre
Neurogenetics
John Walsh Centre for Rehabilitation Research
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MUSCULOSKELETAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY
Researchers investigate if stem cells can reverse osteoarthritis damage
Researchers commenced a large-scale clinical trial pioneering the use of stem cells to treat and potentially cure osteoarthritis. The disease is now one of the leading causes of disability in the world, affecting around three million people in Australia alone. Royal North Shore Hospital rheumatologist Professor David Hunter is leading the two-year trial which is recruiting around 400 participants over 40 who have painful osteoarthritis in their knees. Clinical trial sites have been established at Royal North Shore Hospital and the Menzies Institute in Hobart. Participants will receive three injections over a 12 month period, with researchers assessing levels of pain, physical activity and quality of life throughout the trial. Professor Hunter, a world-leading researcher based at the Kolling Institute, said we are evaluating whether stems cells can alleviate symptoms, and importantly, modify the underlying disease. “We believe stem cells likely have the capacity to regulate inflammation, and hopefully through that process allow the joint to repair itself,” he said. “What we’re hoping to do is reduce inflammation in a part of the knee joint known as the synovium, and by doing so, reduce the symptoms of osteoarthritis. “We will also be examining whether the stem cell therapy can slow and even reverse the progression of the disease.” The study follows some small trials which indicated stem cell therapy may reduce inflammation and help the body repair cartilage. These earlier studies found that injecting stem cells into the affected joint not only reduced the pain, but repaired the damage caused by osteoarthritis.
“We know there is tremendous interest in stem cell therapy and many products on the market, but to date, there has been no strong evidence to confirm this approach is effective. “It’s really important that we have high-quality trials like this one to produce the evidence we need around efficacy and safety. “We may then be in a better position to offer those managing the condition a range of treatment options, on top of the existing approach of weight loss and exercise.” If you are interested in joining the trial, email sculptor.trial@sydney.edu.au or call 02 9463 1855.
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MUSCULOSKELETAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY Sophisticated new robot driving innovation in joint surgery
A $400,000 robot which may hold the key to significant improvements in hip and knee replacements is now operational at the Kolling Institute. Known as KOBRA or the Kolling Orthopaedic Biomechanics Robotic Arm, the new technology delivers an advanced testing facility, while greatly increasing research capabilities. It is the largest of its kind in Australia and one of just two SimVitro robots in the country. Director of the Kolling’s Murray Maxwell Biomechanics Lab Associate Professor Elizabeth Clarke has welcomed its installation, saying it represents a significant step for orthopaedic and biomedical engineering research, new surgical techniques and medical technologies. “KOBRA will be used to simulate complex human movements on joints. This is a new way of working and very few other machines have this capability where they can test joints through a broad range of life-like manoeuvers, like hip flexing, squatting, walking and throwing. “We expect to use the robot in the testing of implants, particularly for hip and knee replacements, to gauge how the implants will function and to help ensure the movement is as life-like as possible,” Associate Professor Clarke said. The orthopaedic biomechanics robotic is not only expected to advance hip and knee replacements, but is also likely to assist surgeons working to repair chronic shoulder instability. Large numbers of patients are presenting with this injury and the information provided by the robot will help to improve the quality of research and optimise surgical approaches. Professor Bill Walter, Royal North Shore Hospital orthopaedic surgeon and Professor of Orthopaedics and Traumatic Surgery at the University of Sydney has witnessed advances in surgical techniques over many years.
He said the next improvements will be delivered through new technologies provided by robots like KOBRA. “We have seen that previous innovations have come through new materials and design. The next innovations however in joint replacement surgery will be delivered through improved biomechanics of the artificial joints.” “It’s tremendously encouraging to see this world-leading technology coming to the Kolling. It will assist researchers, engineers and surgeons, and ultimately lead to improved surgical techniques, better placement of implants and good long-term health outcomes for our community.”
Associate Professor Elizabeth Clarke and Professor Bill Walter
26 Kolling Institute Year in Review 2022
MUSCULOSKELETAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY Back pain treatments shouldn’t neglect the mind
Professor Manuela Ferreira, Lingxiao Chen and Emma Ho
New research by a team from the Kolling Institute has found the best treatment for chronic low back pain doesn’t just focus on the physical, but combines physiotherapy treatments with those focusing on the mind. The study, involving Emma Ho, Professor Manuela Ferreira and Lingxiao Chen, analysed evidence from almost 100 trials worldwide involving over 13,000 patients. It found a combination of physiotherapy alongside psychological interventions, like behavioural therapy and pain education, produced the best outcomes for physical function and pain intensity. The researchers say these results could help improve the clarity of guidelines to better support patients and clinicians in making treatment decisions. Lead author Emma Ho said we know that adults with chronic low back pain not only experience physical disability, but often also suffer psychological distress including anxiety, depression or fear of pain from movement.
“Clinical guidelines recommend a combination of exercise and psychosocial therapies for managing chronic low back pain, however very little is actually known about the different types of psychological therapies available and their effectiveness,” she said. “This often leaves doctors and patients unclear about the best choice of treatment. “This uncertainty motivated us to conduct the study and we are pleased to say we now have a clearer picture of the most effective psychological interventions for people with chronic low back pain. “Our in-depth analysis looked at a broad range of interventions such as counselling and cognitive programs, and we found behavioural therapy and pain education alongside traditional physiotherapy offered the best results and reduction in pain,” she said. Researchers from Australia and Canada were involved in the collaborative research project, with the results to inform healthcare guidelines not just in Australia but internationally as well.
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MUSCULOSKELETAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY
Championing precision medicine for children living with arthritis
The largest study in Australia into the treatment of juvenile arthritis may pave the way for a unique approach to care for those with the disabling condition and dramatically improve outcomes. The Medical Research Future Fund will invest $2.5 million in the A3BC for Kids project which will involve researchers from the Kolling Institute and the University of Sydney in collaboration with the Australian Paediatric Rheumatology Group. Kolling researcher and Royal North Shore Hospital Head of Rheumatology Professor Lyn March said the centrepiece of the project, a large-scale clinical trial represents an important step towards improved care and more efficient use of medicines. “Juvenile idiopathic arthritis affects over two million children worldwide. It is the most common chronic inflammatory musculoskeletal condition in children, and can lead to blindness and life-long disability,” she said. “The condition is more common in girls than boys and may affect a child’s bone development and overall growth. Sadly, there is no known cause or cure.” Current treatments involve the use of disease modifying and biologic medications which target particular immune pathways. Professor March said these medications help, but they come with risks as they dampen the immune system, leaving some children vulnerable to infection, which can be very serious. “International clinical and research experts agree we need to use these medications more effectively, but there is no high-quality data indicating when or how to take children off these drugs when their condition is under control,” she said.
Professor Lyn March
The CHAMPION clinical trial will recruit more than 300 children from every major paediatric rheumatology treatment centre across Australia. It will involve tapering the medications to determine who can come off these drugs and how best to withdraw them once the disease is controlled. A broad range of biological, environmental and health information will be collected from participants throughout the study, which will form part of the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC) biobank-registry collection.
28 Kolling Institute Year in Review 2022
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RESEARCH HIGHLIGHTS Cardiovascular and Renal Priority Research Area
There was significant activity across the Cardiovascular and Renal Priority Research Area in 2022. Supported with large-scale funding, our internationally respected teams were at the forefront of research progress into heart and kidney disease.
30 Kolling Institute Year in Review 2022
Our teams, led by Professors Carol Pollock and Gemma Figtree, made exciting inroads into the development of a ground breaking diagnostic test for early kidney disease, and broadened our understanding of the genetic influences in heart disease. This focus on heart attack susceptibility is expected to guide new treatments and save lives. Our teams led valuable research extending our knowledge of diabetes, and also identified the link between obesity severity and adverse outcomes for pregnant women and their babies. 2022 represented a year of significant research impact for this priority research area.
Achievements across the Cardiovascular and Renal Priority Research Area
» NHMRC Investigator Grant to Professor Carol Pollock $2 million » NHMRC Investigator Grant to Professor Gemma Figtree $2.02 million » Professor Figtree awarded the following grants commencing in 2022: » NSW Health, Cardiovascular Research Capacity Program, Senior Researcher Grant $750,000 » MTP Connect - MRFF Targeted Translation Research Accelerator for Diabetes and Cardiovascular Disease $750,000 » Vonwiller Foundation – Digital Sciences Initiative $1 million
» Heart Foundation Vanguard Grant $150,000 » Heart Research Australia Project Grant $80,000
» Associate Professor Xin-Ming Chen awarded NHMRC Ideas Grant $880,000 » Successful NHMRC/University of Sydney equipment grant for the new cryostat $83,000 » Dr Hooi Hooi Ng and Dr Giannie Barsha awarded Heart Research Australia project grants » Dr Hooi Hooi Ng awarded a NSW Cardiovascular Research Network Innovation Grant and a Diabetes Australia Research Program Grant » Professor Carol Pollock received the International Society of Nephrology’s Alfred Newton Richards award for outstanding research » Dr Steve Vernon awarded a Heart Foundation Postdoctoral Fellowship » Dana Kim commenced a PhD linking cardiology and renal expertise in renal imaging » Dr Natassia Rodrigo and Dr Di Wu awarded their PhD » Establishment of CAD Frontiers initiative – Professor Gemma Figtree
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