NSLHD’s Safety and Quality Newsletter provides information on new and upcoming activities, programs and initiatives within the district that aim to improve the safety of our patients and the quality of our care.
Page 3
Significant new funding for heart and kidney disease
World first clinical trial to help those with spinal cord injuries
Page 5
Dynamic robot to improve hip and knee replacements
Discovery into reality
WWW.KOLLINGINSTITUTE.ORG.AU
MESSAGE FROM THE ACADEMIC DIRECTOR
professional experience. It is so important that this group of emerging leaders is supported and thrive at the Kolling. We are implementing a host of initiatives to ensure our early-mid- career colleagues are provided every opportunity to extend their experience, develop their expertise and broaden their networks. We have continued to see good engagement with our Kolling Seminar Series and it’s great to see our researchers benefit from exposure to a diverse collection of health and scientific experts. We are already co- ordinating an exciting line-up of events for 2023. As we map out our 2023 priorities in line with our Research Strategy, there will be a stronger focus on collaboration, not just within the Kolling, but with our health and university partners, and with national and international collaborators. I am convinced that this will help drive further success and deliver a wealth of new opportunities for all of us. I’m sure it will increase our impact and lead to innovations and tangible improvements in the healthcare provided, not just nationally but globally. There is a real sense of momentum at the Kolling presently, and I would like to thank everyone across our institute for their part in our progress and our continued success.
commitment to research and patient care. It is wonderful to see their terrific work and substantial impact acknowledged. Read on for more details. It is pleasing to see that world-leading research projects are consistently born at and led by Kolling researchers, including a new trial co-ordinated by Professor Ashley Craig from the John Walsh Centre for Rehabilitation Research. Ashley’s study will investigate a novel approach to support those with life-changing spinal injuries, and mitigate some of the significant health challenges experienced by those with this condition. Our infrastructure capabilities have also been strengthened with the commissioning of the Kolling’s Orthopaedic Biomechanics Robotic Arm. KOBRA, led by Associate Professor Liz Clarke and Professor Bill Walter, represents a significant step for orthopaedic and biomedical engineering research, new surgical techniques and medical technologies. We are fortunate to have such impressive technology and collaborative interdisciplinary partners to support our work. Thank you Liz and Bill. We are all very excited to see what new innovations KOBRA reveals. It has been heartening to see an increasing number of early and mid-career researchers coming to the Kolling and broadening their
This is the first newsletter since I stepped into the role of Academic Director of the Kolling Institute in August and it is tremendously encouraging to see the wealth of research progress across the organisation. While it has been a challenging few years thanks to Covid, it’s clear our research endeavours are going from strength to strength. We have a large collection of basic, clinical trial and translational projects underway, demonstrating the depth of experience and expertise at the Kolling. Encouragingly, a diverse range of new research is being launched and our team is continuing to secure significant funding. In recent weeks for example, Professors Gemma Figtree and Carol Pollock both received sizeable NHMRC Investigator Grants, which will drive research into heart and kidney disease. This funding provides dedicated research time and security, broad opportunities for many researchers, and a favourable environment for producing long-term, significant improvements to the health of our community. The Kolling has also been in the spotlight recently with prestigious national and international awards presented to some of our team. I would like to congratulate Professors Chris Little and Sarah Hilmer who have been recognised for their outstanding
2
KOLLINGNEWS | OCTOBER 2022
Our research expertise recognised with multi-million dollar grants
Professor Carol Pollock’s program of research will work to reduce the personal and societal impact of kidney disease. Carol is a renal medicine specialist at RNSH and an internationally respected academic at the Kolling Institute. Chronic kidney disease currently affects over 13 per cent of the global population and 10 per cent of Australians. End-stage kidney disease is escalating and directly costing the Australian economy around $1.8 billion a year. Professor Pollock says despite our treatment strategies, a progressive loss of renal function is inevitable. Our program will involve three main components, including an assessment of new strategies to prevent or slow the development of kidney disease for which we currently have some positive preliminary data. These include ibody therapeutics, and the delivery of mesenchymal stem cells. We will also expand our program promoting the regenerative capacity of kidney fibroblasts, and finally, we will thoroughly analyse the models involved kidney disease that spontaneously recover from kidney injury compared with the models that progress to irreversible fibrosis. “I’m really thrilled to have secured this funding to undertake our work and develop our research which we hope will have transformational benefits for patients with kidney disease,” she said. “While early-stage research requires several years to translate to clinical benefit, we are well placed at the Kolling to speed-up improvements in patient care.
We would like to congratulate Professors Carol Pollock and Gemma Figtree who have received significant National Health and Medical Research Council Investigator Grants. Despite a tremendously competitive field, both clinician/researchers have been awarded $2 million to progress their world-leading research and improve long-term patient outcomes. The announcement highlights the experience and expertise at the Kolling Institute, with Professors Pollock and Figtree joint leaders in our Cardiovascular and Renal Priority Research Area. Professor Figtree’s research will investigate innovative solutions to reduce heart attacks for those without the typical risk factors. Professor Figtree, an interventional cardiologist at RNSH, said approximately one-quarter of first-time heart attack patients do not have any of the typical risk factors of coronary artery disease, and yet they have developed what is regarded as silent coronary artery disease without any symptoms. Gemma and her team will use this group to extend their understanding of the disease and identify markers relevant to all patients at risk of a heart attack. Her program will drive the discovery of new biomarkers for the early detection and treatment of coronary artery disease. “I am enormously grateful to the NHMRC for this support. It will help my team follow exciting leads towards clinical translation, and help develop a new way of detecting coronary artery disease and preventing heart attacks,” she said.
Professor Gemma Figtree
Professor Carol Pollock
“For a clinician researcher, the Kolling Institute, a partnership between the University of Sydney and the Northern Sydney Local Health District, provides the ideal environment to take basic research to clinical trials. “Our Renal Research Laboratory has researchers from diverse professional backgrounds and this will facilitate the successful delivery of the research. “Importantly, we are also well supported by partners in the biotech and pharma industries to accelerate our research into practice. “The security that five years funding brings is welcomed by my exceptional scientific staff and I would also like to acknowledge the philanthropic support we have received. “I am grateful for the untied funding that has allowed me and my laboratory to develop preliminary data, which has in turn paved the way for these funds.”
3
WWW.KOLLINGINSTITUTE.ORG.AU
Innovative trial aims to reduce the impact of serious spinal cord injuries
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 if rhythmic breathing can help people with a disrupted nervous system as a result of their spinal cord injury. It will assess whether the 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. “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.
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 are launching 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 Spinal cord injury, Mind and HeART or (SMART) study has been made possible by $3 million in combined funding from the NSW Ministry of Health and the University of Sydney. The research project, to be run at Royal North Shore Hospital, will see participants 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
“The hope is this will in turn deliver wide ranging benefits for the brain, the gut, the heart, sleep and a host of other physical functions. “We are keen for at least 100 people to join our study and potentially help establish a new and effective, evidenced-based approach to care.” How to participate Researchers are now recruiting for the study and are encouraging those interested in taking part to contact them. Please email smart.trial@ sydney.edu.au or call 0420 378 157 .
John Walsh Centre for Rehabilitation Research team
4
KOLLINGNEWS | OCTOBER 2022
Associate Professor Elizabeth Clarke and Professor Bill Walter
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. this capability where they can test joints through a broad range of life-like manoeuvers, like hip flexing, squatting, walking and throwing. 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.” The robot has been made possible following a collaboration between the Northern Sydney Local Health District, the University of Sydney, the Kolling Institute, the NSW Investment
“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. 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
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
Boosting Business Innovation program and the RNSH Staff Specialist Trust Fund.
5
WWW.KOLLINGINSTITUTE.ORG.AU
Researchers closer to better pain management strategies
Dr Karin Aubrey and Dr Yo Otsu
“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.
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.
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. This valuable progress has been recognised internationally with publication in the Journal of Physiology, a leading scientific journal. 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
6
KOLLINGNEWS | OCTOBER 2022
Outstanding career recognised with national accolade We would like to congratulate Kolling Institute researcher Professor Sarah Hilmer who has been elected a Fellow of the prestigious Australian Academy of Health and Medical Sciences. look forward to contributing to the activities of the academy, particularly supporting younger researchers.
“Mentorship for health and medical researchers is a priority for me in my roles at Royal North Shore Hospital, the University of Sydney and the Kolling.” Sarah has worked as the Head of Clinical Pharmacology and as a geriatrician at Royal North Shore since 2005. Her research and clinical expertise is respected both nationally and internationally. Sarah leads a research program in ageing and pharmacology at the Kolling Institute and has contributed widely to the management of medication. She said she has been tremendously fortunate to have worked across clinical practice, research and policy,
Professor Hilmer is part of a select group of researchers who have been admitted to the academy, which works to advance health and medical research across Australia. She has joined the highly-respected organisation in recognition of her important contribution to healthcare and research. Sarah has welcomed the election, saying it was not expected. ‘I was surprised and honoured to be elected a fellow of the Australian Academy of Health and Medical Sciences,” she said. “I have great respect for the work of many of the current fellows and I
Professor Sarah Hilmer
with a wonderful network of mentors, colleagues and mentees. It’s been a good year for Sarah who was also awarded an AM for her service to clinical and geriatric pharmacology as part of this year’s Queen’s birthday honours.
Kolling researcher recognised with prestigious international award
“I am very proud to have been made a Fellow of International Orthopaedic Research,” he said. “While I have received the award, it’s actually a reflection of the wonderful work that has been done by all the researchers in my group over the years.” “It is an honour to be nominated by one of the International Combined Orthopaedic Research Societies (ICORS) – and in my case, the US Orthopaedic Research Society. “ICORS member organisations are represented across the world. They have a crucial role advancing orthopaedic and musculoskeletal research by promoting basic, translational, and clinical research worldwide.
Professor Chris Little has received a highly coveted award for his outstanding commitment to orthopaedic research. Professor Little has been elected a Fellow of International Orthopaedic Research at a key international conference in Edinburgh Scotland. The award is only presented every three years, with around 20 people across the globe receiving the accolade. Fellows are recognised for their leadership, service, achievement and dedication to the field of orthopaedic research. Chris has welcomed the recognition, while acknowledging the support he’s received.
Professor Chris Little
“This is an important part of progressing valuable research across the globe and improving long-term health outcomes.”
7
WWW.KOLLINGINSTITUTE.ORG.AU
Researchers investigate if stem cells can reverse osteoarthritis damage
Professor Hunter 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
Our researchers are seeking participants for 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.
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.” Further information about the Sculptor study is available at: www.tinyurl.com/sculptor-trial If you are interested in joining the trial, email sculptor.trial@sydney. edu.au or call 02 9463 1855 .
Royal North Shore Hospital rheumatologist and Kolling
researcher Professor David Hunter is leading the two-year trial which is recruiting around 400 participants
over 40 who have painful osteoarthritis in their knees.
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.
8
KOLLINGNEWS | OCTOBER 2022
Researchers to study link between cardiovascular disease and sleep apnoea
With a disturbing number of people losing their lives to heart disease each year, researchers have launched the first study of its kind using MRI technology to broaden our understanding of the link between cardiovascular disease and sleep apnoea. The project has been made possible following funding from the Ramsay Research Grant Program, and will involve clinician researchers from NSLHD and the University of Sydney. It follows the latest figures showing cardiovascular disease is the leading cause of death worldwide, killing one Australian every 12 minutes. This makes the research important and timely, especially given that obstructive sleep apnoea is also increasing, and is now affecting around a billion people. Known as the silent killer, this chronic disease causes low oxygen levels, sleep disturbance and dangerous pressure inside the chest.
Professor Peter Cistulli (centre) and research team
Royal North Shore Hospital respiratory and sleep medicine
specialist Professor Peter Cistulli will lead the study, collaborating with RNSH Head of Respiratory and Sleep Medicine Dr Ben Harris, and leading experts in cardiac imaging Professor Martin Ugander and Dr Rebecca Kozor. Professor Cistulli said obstructive sleep apnoea has been linked to the development of cardiovascular disease, including hypertension, heart attack, atrial fibrillation and stroke – but there have been no randomised controlled trials confirming a causal link between the two.
“Our CardioSleep Program will be unique, uniting three major disciplines of cardiology, respiratory and sleep medicine, and radiology to develop a precision medicine approach. This would define which patients are at greatest risk and require personalised treatment,” he said. “We hope our project will provide definitive evidence of the relationship between sleep apnoea and
and informing future treatment approaches. “We would like to see this valuable research program drive a new approach, and one which will dramatically reduce the number of number of people who lose their lives prematurely with a combination of sleep apnoea and cardiovascular disease.”
cardiovascular disease, closing our existing gaps in knowledge
9
WWW.KOLLINGINSTITUTE.ORG.AU
Dr Henry Wu and Associate Professor Sonia Saad
Researchers develop test to identify the severity of kidney disease
Project co-lead Associate Professor Sonia Saad said that being able to assess kidney pathology in a non- invasive way brings a host of benefits. “It will enable clinicians to examine the effects of new drugs on the kidney and monitor kidney pathology over time. This will provide valuable information on the effectiveness of treatments.” PhD student Dr Henry Wu has welcomed the chance to be involved in the project. “It’s been rewarding to have been part of the development of this important new technology. We would like to see it applied broadly across clinical practice given the health and economic benefits of this approach,” he said.
Encouragingly, researchers from the Kolling Institute and the University of New South Wales have now developed biomedical technology to provide accurate information around early diagnosis and prognosis, without the risks of an invasive biopsy procedure. Head of the Kolling’s Renal Research Lab Professor Carol Pollock said this exciting new technology provides clear information about kidney pathology by examining kidney cells in urine. “Having the ability to diagnose patients with a simple urine test represents a significant step forward for those with chronic kidney disease,” she said. “Importantly, this enables early intervention and effective management.”
We may soon have a safer approach to diagnosing and measuring the progression of chronic kidney disease following new research by the team from the Kolling Institute’s Renal Research Laboratory. The condition is a global health issue, which now affects more than 13 per cent of the worldwide population. Chronic kidney disease is a progressive disease that leads to end-stage kidney failure, which is fatal without dialysis or a kidney transplant. Currently there are tests to detect advanced stages of the disease, but early detection is not possible. Biopsies are performed to confirm a diagnosis of chronic kidney disease, but this approach brings with it inherent risks such as bleeding, pain and hospitalisation.
10
KOLLINGNEWS | OCTOBER 2022
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 is investing $2.5 million in the A3BC for Kids project which is involving researchers from the Kolling Institute and the University of Sydney in collaboration with the Australian Paediatric Rheumatology Group. Kolling researcher and RNSH 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
A broad range of biological, environmental and health information will be collected from participants throughout the study. These data and biospecimens will form part of the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC) biobank-registry collection. This may lead to new treatment guidelines and support tools to truly personalise medicine for the individual. For the first time, researchers led by the Kolling Institute’s Dr Manasi Mittinty, will also investigate how children and their families navigate the mental health impact of juvenile idiopathic arthritis. This research will assess coping mechanisms, treatment responses and children’s well-being.
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. The CHAMPION clinical trial is recruiting more than 300 children from every major paediatric rheumatology treatment centre across Australia. It will taper the medications to determine who can come off these drugs and how best to withdraw them once the disease is controlled.
(02) 9926 4500 Kolling@sydney.edu.au www.kollinginstitute.org.au @KollingInstitute @KollingINST Latest News from the Kolling Institute
Jointly supported by:
11
WWW.KOLLINGINSTITUTE.ORG.AU
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12Made with FlippingBook - professional solution for displaying marketing and sales documents online