Get the latest news from across Northern Sydney Local Health District.
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Obesity link to complications for women and their babies
Research identifies a concerning lack of knowledge around heart risks
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Exciting new research to help treat those with a deadly blood cancer
Discovery into reality
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MESSAGE FROM THE EXECUTIVE DIRECTOR
all their efforts. This is one success story from our new Kolling research enabler committees, with the Research Infrastructure and Support Services Enabler closely involved in the funding application. It has been pleasing to see the progress with the Kolling Research Plan, and the comprehensive work that has been undertaken to define the key goals and next steps for the strategic framework. Some of the initiatives will involve broader research collaborations, stronger consumer engagement and an increase in research funding, and I’m sure that all of these measures will help to propel the Kolling as a centre for world-leading translational research, focused on improving the health of our community.
This month’s newsletter provides an insight into the scope of research taking place across the Kolling, and it demonstrates the depth of expertise and experience throughout our institute. Our research is continuing to attract the recognition it deserves through the latest funding announcements, high profile national awards and influential publications. You can read about some of those in this edition, along with details of some exciting clinical and pre-clinical trials. Encouragingly, we will be seeing a boost to our infrastructure following significant funding for a new Digital Spatial Profiling System. This means the Kolling will be one of the first institutes in New South Wales to introduce this world-leading technology, and we expect it will significantly extend our neuroscience and other research capabilities. Many people were involved in applying for the funds, including Professor Mark Molloy and the University of Sydney’s Core Research Facility, and I’d like to acknowledge
The importance of medical research has never been more evident. As we continue to address the challenges presented by the COVID pandemic, the Kolling is stepping up its research activity and increasing its influence nationally and internationally. It’s great to see that the institute is going from strength to strength, with a wealth of valuable research underway right across the organisation. One example of this is research just published by Professor Geoffrey Tofler and Associate Professor Tom Buckley around the early warning signs and risk factors of heart disease, especially for those playing masters soccer. This research is particularly timely given the tragic deaths of cricket hero Shane Warne and federal politician Kimberley Kitching. Importantly, the research is helping to direct the community’s focus to risk factors and how to respond to these risks, and I’m sure it will play a part in saving lives.
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KOLLINGNEWS | APRIL 2022
Research prompts calls for a better understanding of heart attack signs, especially during exercise
Other key findings include:
A new study has directed the spotlight to the risk of a cardiac event for those over 35 playing football, while also highlighting a concerning lack of knowledge around recognising the early signs of a heart attack. Conducted by researchers from Royal North Shore Hospital, the University of Sydney and the Kolling Institute, the study surveyed more than 150 masters age amateur soccer players involved in competitive and social games. The research is believed to be the first of its kind to assess cardiac knowledge and beliefs in this higher- risk amateur football group. Senior author Professor Geoffrey Tofler, RNSH cardiologist and University of Sydney academic said the study identified that one in five participants had one or more possible cardiac symptoms during a game in the prior year, but only a quarter of them sought medical attention. “Our research indicates a concerning trend and we hope that by raising awareness of heart health, we will be able to reduce the risk of a cardiac event such as a heart attack and sudden death,” he said. “We know that strenuous exercise can cause a temporary increase in cardiac risk, but being able to recognise the warning signs of an impending cardiac event will help lower those risks. “It’s important to act quickly on symptoms and if a cardiac arrest occurs, promptly begin CPR and have a readily accessible defibrillator.”
• Almost half of those surveyed had little or no confidence that they would recognise the signs of a heart attack. • In response to a hypothetical episode of chest pain while playing, less than half would leave the field immediately, while 49 per cent would stay on the field for 5-10 minutes to see if the pain eased, and others would play on. • Three quarters of participants said they would use the internet
Professor Geoffrey Tofler
for information about their symptoms before seeing a doctor.
• Less than 40 per cent were aware of the less typical signs of a heart attack. • One high-risk attitude was that nearly half of the participants indicated that if they thought they were having a heart attack, they would prefer someone to drive them to the hospital rather than have an ambulance come to their home. Co-author Associate Professor Tom Buckley said encouragingly, the participants agreed that CPR training was important and that defibrillators should be staples at football fields during all games. “These steps could make the difference between life and death for someone experiencing sudden cardiac arrest, as the survival rate decreases by seven to ten per cent for every minute without the use of CPR or defibrillation” he said.
Associate Professor Tom Buckley
“While the benefits of exercise still far outweigh cardiac risk overall, these measures may further increase the benefit to risk.” The study was conducted as a supervised student MD project by lead author, Dr Matthew Francis. To find out more about heart-attack causes, warning signs and what to do, visit the Heart Foundation resource page https://www. heartfoundation.org.au/conditions/ heart-attack
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Researchers identify link between obesity severity and adverse outcomes for pregnant women and their babies
There are calls for a greater focus on weight management following new research defining the relationship between obesity and pregnancy- related complications for mother and baby. The study follows an increase in obesity levels globally as well as a rise in prevalence during pregnancy. Today, more than 20 per cent of Australian women have obesity at the time of conception. Kolling Institute and University of Sydney researcher and Royal North Shore Hospital Endocrinologist Associate Professor Sarah Glastras said researchers know that obesity in pregnancy increases the risk of the mother developing gestational diabetes, gestational hypertension or high blood pressure, and pre- eclampsia. There’s also a higher risk of stillbirth as well as a caesarean section delivery. “Women with obesity are more likely to deliver a baby with congenital abnormalities, respiratory distress syndrome and have a large baby,” she said. “Our research has now given us a much clearer picture of the direct link between the severity of obesity and the risk of adverse impacts for both the mother and her baby.” Three classes of obesity were identified based on Body Mass Index with class one assessing women with the lowest severity of obesity. • The research found 21 per cent of women with class I obesity developed gestational diabetes, compared with 28 per cent with class III.
• Women with class I obesity had half the risk of developing pre- eclampsia compared class III. (2.8% versus 6.2%). • There was an increased risk of caesarean delivery, with a 40 per cent risk in class I, a 45 per cent risk in class II and 54 per cent in class III. This compared with the national average of 33 per cent. • 26 per cent of women with class I obesity had a large baby compared with 33 per cent in class III. • Stillbirth and birth defects were more common in women with more severe obesity. “Our study highlights the importance of weight management in women of child-bearing age, not just during pregnancy, but also at time of conception,” said Associate Professor Glastras.
Associate Professor Sarah Glastras
“Encouragingly, we also demonstrated that with good
obstetric care, we can mitigate some of the risks associated with obesity in pregnancy. “Our research not only provides individuals with an incentive to manage their own weight, but also offers health providers and policy- makers more evidence to support pre-conception weight management initiatives.”
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KOLLINGNEWS | APRIL 2022
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 Royal North Shore Hospital 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
“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.”
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.
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Exciting study to investigate new treatment for acute myeloid leukaemia
known as leukaemic stem cells, which have the ability to lay dormant and evade chemotherapy. They then reactivate and renew themselves to drive fresh cancer growth. “My team and I recently uncovered a mechanism which is crucial to the survival of leukaemic stem cells. This mechanism is only found in leukaemic stem cells, not in normal human stem cells, making it a promising target for a new treatments.” In this project, Dr Wang and her team will investigate how leukaemic stem cells are able to survive and renew. The team will then develop a treatment strategy to inhibit this unique mechanism in clinically relevant experimental models. “We are very excited by this approach targeting leukaemic stem cells, as this potential new treatment could eradicate acute myeloid leukaemia at its root," she said. “If our pre-clinical tests are successful, we hope to start clinical trials of this innovative approach in collaboration with clinicians and our longstanding industry partner.
The Cancer Council NSW announced funding for a new stem cell team at the Kolling Institute to examine a revolutionary approach to treatment for those with acute myeloid leukaemia. This aggressive form of blood cancer has a tragically poor survival rate, and while there has been tremendous progress for many other types of cancer in recent years, there have been very limited improvements in treatment for this deadly form of blood cancer. Internationally respected researcher Dr Jenny Wang will lead the promising new study following the Cancer Council NSW grant of $450,000. “We are thrilled to have received this generous funding for our project which we hope will lead to an effective, new therapy for this complex cancer,” said the University of Sydney researcher. “Chemotherapy is currently the first-line treatment for acute myeloid leukaemia. “There are however, high rates of relapse as this form of cancer is protected by a rare group of cells
Dr Jenny Wang
“This new funding represents an important step towards a greater understanding of this complex cancer and promising new treatment options to improve outcomes for those with this form of blood cancer.” Dr Wang returned to Sydney in 2011 from Harvard Medical School where she undertook postdoctoral research in cancer and stem cell biology. She subsequently established an independent stem cell laboratory at Children’s Cancer Institute/UNSW in 2013, before her recent transition to the Kolling Institute.
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KOLLINGNEWS | APRIL 2022
Research shows your age and sex influence the impact of medications
Trang Tran, Professor Sarah Hilmer and Dr John Mach
“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. “Whilst nurses are aware of addressing unmet needs as a person- centred strategy when caring for these patients, it is also imperative that medications be reviewed.” The study, which has been published in Scientific Reports, builds on Professor Hilmer’s internationally significant research fostering the safe use of medications across the hospital, aged care and community settings. The research represents an important achievement for lead author Trang Tran, who is a Vietnamese doctor who first came to Royal North Shore Hospital in 2017 as a Hoc Mai Fellow. Trang returned to Sydney to undertake her PhD at the Kolling, which she recently completed.
“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. “Part of the strength of this research is due to the consistent monitoring involved, with behaviour patterns recorded continuously for 23 hours in both night and day settings. “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. “It will provide 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 RNS and Ryde hospitals, saying the new findings provide valuable information.
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 physical activities. 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.
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Professor Mark Molloy
New cutting-edge technology coming to the Kolling The Kolling is set to be one of the first institutes in New South Wales to introduce new world-leading technology, boosting our cancer and neuroscience research capabilities. patients we serve,” said the Lawrence Penn Chair of Bowel Cancer Research. During its initial phase, the new equipment will be used in the study of cancers and neuroscience. This
is set to be extended to include investigators from numerous disciplines including molecular biosciences, bioengineering, plant biology and bioinformatics. The Kolling’s Executive Director Professor Carolyn Sue and her neuroscience team have welcomed the chance to utilise the new technology in their innovative research projects, especially their Parkinson’s disease research. It’s anticipated the new system will deliver broad ranging and long term benefits, with the next generation of research students expected to be trained in this technology.
“It will significantly extend our research capabilities and represents an important step towards new treatments. “The digital spatial profiling technology will allow researchers to divide tissues into spatial regions to study how proteins and genes are regulated within parts of the tissues. “Importantly, this will address the limitations of conventional gene and protein profiling methods that produce averaged data which fail to consider the discrete spatial organisation that occurs within tissues. “This will lead to new discoveries around the intricate biological processes that go wrong in diseased tissues, a key step towards finding new drug targets and treatments.”
The Digital Spatial Profiling System has been made possible following a $535,000 grant from the Australian Research Council LIEF scheme. The project is being co-funded by the University of Sydney’s Core Research Facility with a $250,000 contribution, and Macquarie University with a $50,000 commitment. Cancer researcher Professor Mark Molloy has welcomed the establishment of the microscopy system, which has been recognised as one of the most exciting technological advances in the investigation of biological samples globally. “This is wonderful news for our researchers, the Kolling, our partners and ultimately the community of
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KOLLINGNEWS | APRIL 2022
Research program supporting
injured workers wins top award Kolling researchers have taken out a highly-competitive, national award for an innovative program helping people get back to work after injury. Professor Michael Nicholas and Dr Manasi Mittinty from the Pain Management Research Centre were part of a team which received a National Safety Award of Excellence for their initiative targeting injured workers. The program was trialled with staff from Australia Post and involved early identification and intervention for workers at risk of delayed recovery following a work-related injury. Participants in the intervention arm of the trial were offered up to six sessions with a psychologist or counsellor, and a workplace rehabilitation provider to assist with barriers returning to work. This was in addition to the medical and physiotherapy care normally provided for such injured workers. Professor Nicholas said while the long-term follow-up is continuing, the benefits of this approach have been so clear that Australia Post has already implemented the program for injured workers across the country. “We have shown that by adopting this additional, targeted support, injured workers were getting back to their job in less than half the time of those receiving usual care,” he said.
Professor Michael Nicholas
announcement that he is to receive the International Association for the Study of Pain John D Loeser Prize for 2022. This award recognises the recipient’s distinguished lifetime achievement in the clinical science of pain and Professor Nicholas is the first Australian to receive the accolade. He has welcomed the honour, saying it reflects the standing of our work at the Pain Management Research Centre in pain education, research and clinical services.
“Workers felt the connection to positive people and the consistent reassurance were particularly helpful. “This is a wonderful example of robust research influencing healthcare models and health outcomes, and improving real-life workplace protocols. “Importantly, the benefits of this research will not just impact workers and their individual organisations, but will extend to the broader community as well.” There has been further recognition of Professor Nicholas’ contribution to healthcare with the
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Dr David Chan and Professor Nick Pavlakis
Researchers to join leading cancer care centres in exciting new trial
lutate treatment for instance, can only receive this care at Royal North Shore Hospital and one other site in New South Wales. “We expect this new approach will make a marked difference to their lives if they’re able to access comprehensive, tailored care close to home, and have confidence that they’re receiving the same care that they would in a larger, metropolitan centre. “Our research and clinical teams have helped to develop this care model and are looking forward to trialling this promising initiative.”
“This is a really important study which we hope will improve the experience of patients going forward and lead to a better model of care with additional resources,” he said. “The clinical trial will examine a multi- disciplinary, shared-care approach involving greater specialised support and follow-up. “Importantly, this tailored treatment could be adopted in both metropolitan and regional centres where access to specialised care is a significant challenge for patients with this uncommon and complex cancer. “We hope this new model could be broadly adopted with the support of clinicians, GPs and nurses. “Currently, some of our patients spend a large amount of time travelling hundreds of kilometres to receive the care, knowledge and advice they need. Patients requiring
Researchers from the Kolling Institute and Royal North Shore Hospital will help drive a new project investigating a revolutionary approach to care for those with neuroendocrine tumours. Cancer specialists Professor Nick Pavlakis and Dr David Chan will join the AUS-NET trial after a funding announcement by Health Minister Greg Hunt. The study will assess whether a new patient-specific care model improves health outcomes and quality of life for patients with the rare neuroendocrine cancers. Around 500 patients from five centres across Australia are set to be involved in the clinical trial and Dr Chan said the local team is thrilled to have been chosen to participate.
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KOLLINGNEWS | APRIL 2022
Kolling researcher to join prestigious Harvard Medical School postgraduate program Congratulations to Kolling Institute researcher Dr Manasi Mittinty who has been selected for the Advanced Global Clinical Scholar Research training at Harvard Medical School. Dr Mittinty is a medical trained researcher with the Pain Management and Research Centre and a University of Sydney lecturer. She has a keen interest in translation research and the connections between musculoskeletal conditions, pain science and neuropsychology. The one-year training program provides clinicians and clinician- scientists with advanced training in health care research. One of its key aims is to help participants develop cutting-edge translational research on a global scale. Places in the program are highly competitive with only established academics and leaders in their field selected. The program has previously attracted participants from more than 40 countries in high profile positions such as chief physicians,
Dr Manasi Mittinty
“This training will help me develop and lead transformative research to promote enhanced wellbeing for people living with arthritis and their families.” Manasi has received several prestigious awards including the Australian Post-graduate award and the Commonwealth funded Endeavour Post-doctoral Research
medical directors, fellows, scientists and medical specialists. Manasi has welcomed the opportunity to join the program. “I feel very excited and privileged to be selected from a global pool of scholars for this training. I look forward to learning from the distinguished faculty at Harvard Medical School,” she said.
Fellowship, and can now add this opportunity to her list of achievements.
(02) 9926 4500 Kolling@sydney.edu.au www.kollinginstitute.org.au @KollingInstitute @KollingINST Latest News from the Kolling Institute
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