Year in Review
Northern Sydney Local Health District
Bridging Medical Research and Health
Research delivering world-leading care Year in Review 2023
Contents
The Kolling Institute – Who We Are
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Overview from the Chair
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Academic Director Insights
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Kolling Institute Governance Committee
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Network
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2023 – A Year at a Glance
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Priority Research Area Achievements
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Musculoskeletal Research
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Cardiovascular and Renal Research
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Neuroscience and Pain Research
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Cancer Research
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Emerging Leaders
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Research Enablers
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The Impact of Community Support
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Acknowledgement of Country I would like to acknowledge the Traditional Custodians of the Northern Sydney Local Health District region, the Dharug and Guringai peoples. Their spirit can be found across the land and we honour the memory of their ancestors and Elders, past and present. As we endeavour to serve the health needs within the community, we recognise the importance of the land and the waterways, as an integral part of people`s health and wellbeing.
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THE KOLLING INSTITUTE Leading translational
research to tackle our biggest health challenges As the oldest medical research institute in New South Wales, the Kolling Institute continues to build on its reputation as a hub of high-quality research that has real-world impacts on the health and wellbeing of our community. Together with our joint venture partners, the University of Sydney and Northern Sydney Local Health District, our researchers are driving a wealth of discovery science and translational projects that are focused on improving community wellbeing at every age. We foster world-leading research that is tackling some of the biggest health challenges of our time, within a culture of local, national and international collaboration. As well as a focus on our three priority research areas – musculoskeletal conditions, neuroscience and pain, and cardiovascular and renal disease – the Kolling Institute is home to transformational research into cancer. Many of our researchers also work as clinicians, driven by their clinical observations and desire to improve the lives of their patients. Many are world leaders in their fields, bringing unrivalled experience and a track record of success in research that is translated from the bench to the bedside. This track-record of real-world clinical research outputs supports the training of today and tomorrow’s leaders. The institute’s location at Sydney’s Royal North Shore Hospital ensures researchers broad access to patient groups and state-of-the-art infrastructure. Our teams have been at the forefront of scientific progress for more than 100 years and continue to break new ground with novel health research that can make a real difference to our community.
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Our teams have been at the forefront of scientific progress for more than 100 years and continue to break new ground with novel health research.
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Overview from the Chair
It’s a pleasure to reflect on a year of progress, commitment and high-quality research, in my role as chair of the Kolling Institute Governance Committee.
I am tremendously proud of our team of Kolling Institute researchers, whose skill, expertise and unwavering commitment to a healthier community is demonstrated by the many stellar achievements showcased in this review. Our teams have maintained their commitment to research excellence, securing large scale funding, receiving high-profile awards including Australia Day Honours, and publishing a significant number of impactful studies. A large number of our researchers were also recognised in the prestigious Stanford University study, recognising the top two per cent of scientists in the world. In 2023, our research outputs included more than 140 Kolling-led research projects, 106 recognition awards and 537 publications. Those figures are evidence of the encouraging progress being made across all our priority research areas, with tangible steps being taken in terms of research impact, collaborations and improvements in clinical care. We continued to make good progress implementing the Kolling Institute’s five-year Research Strategy, which is supporting our researchers to expand their impact and develop their expertise. Our research enablers, which offer targeted help, provided collaborative opportunities, operational efficiencies and increased funding for our priority research areas. They also delivered significant new funding for equipment and infrastructure. The four enablers include Clinical Trials and Translation, Data and Informatics, Research Infrastructure and Support Services and Workforce and Culture. Our research teams have forged significant new collaborations nationally and across the globe, working with researchers from countries including the USA, Denmark and Spain on projects to tackle some of the biggest health challenge of our time.
Amazingly, we are even reaching beyond Earth into space, supporting research and collaborations that will inform developments in space life sciences where human health, performance, and wellbeing are at the forefront of new discovery. It is wonderful to see the way in which the Kolling continues to foster a new generation of researchers. Some of the exciting work being done by our early and mid-career researchers was showcased at the first Kolling Symposium in November. I’d like to acknowledge the leadership and dedication of Professor James Elliott in his first full year in the role as the institute’s Academic Director. He has continued to build on the wonderful work being achieved at the Kolling and is leading the institute to an even brighter future. We are ever grateful for the ongoing support provided by our joint venture partners – the University of Sydney and the Northern Sydney Local Health District. This support, which has included substantial funding for infrastructure and technical assistance, is key to our research being translated into real-world impacts. Finally, I’d like to thank the NORTH Foundation, the University of Sydney’s Advancement team and our many other philanthropic partners, whose support enables us to conduct research that greatly improves the health and wellbeing of our community.
Michael Nugent Chair Kolling Institute Governance Committee
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Academic Director Insights
Compiling this research review on the Kolling Institute’s achievements in 2023 has been a great joy, as it has highlighted our continued progress to drive research that can improve the lives of our community. Thanks to the dedication and expertise of our many research teams and support staff, this review showcases the many tangible improvements in research activity, collaboration and translations we have made throughout the last year. Our researchers have been awarded an impressive 84 grants, with a collaborative value of more than $43 million for projects over the next five years. Highlights have included NHMRC grant funding for collaborative research into the links between osteoarthritis and heart disease, new research into biomarkers that could identify ‘silent’ cardiovascular disease and investigations into cells that may have potential to control chronic pain. As well as progress across our three priority research areas – musculoskeletal, cardiovascular and renal, and neuroscience and pain – it is encouraging to see our cancer researchers continuing to make excellent progress towards furthering a personalised approach to cancer treatment. It is wonderful to see our international collaborations growing strongly – our researchers published more than 530 papers in 2023, stemming from partnerships across an impressive 90 countries (up from 67 countries in 2022). We are now working with researchers across the globe, in countries including the US, Brazil, Nigeria, India, South Korea, Malaysia, Mexico and Finland. Demonstrating our commitment to disseminating research, our researchers delivered 122 international presentations, and presented at 63 conferences around Australia. We were also thrilled to see two of our leading researchers recognised on the Australia Day Honours roll in 2023. Geriatrician Professor Sue Kurrle AO was honoured for her research into dementia and cognitive decline, and interventional cardiologist Professor Gemma Figtree AM was recognised for a career devoted to identifying the key mechanisms driving heart attack susceptibility.
Professor Carol Pollock AO also received the prestigious Alfred Newton Richards award for her outstanding research in the field of nephrology. Looking to the future, the Kolling has an exciting opportunity to contribute to a new initiative aimed at helping everyone in our community live their healthiest lives. A partnership between the Kolling, the Northern Sydney Local Health District, the University of Sydney, and the University of Technology Sydney, presents an opportunity for a futurist Centre for Functional Wellbeing within and beyond the local health district. The centre’s objectives are to improve our understanding of pre, peri and post-traumatic health, to tackle the complex issues of ageing and develop a personalised measure of functional wellbeing. Drawing on our interdisciplinary workforce and research interests, this exciting initiative complements the Kolling Institute’s strong focus on conducting research that can improve community wellbeing at every age. As we reflect on our achievements and look to future developments, I would like to express my gratitude to our joint venture partners and to all my colleagues at the Kolling who are central to our success, and who continue to make the institute a centre of world-leading research. Professor James Elliott Academic Director Kolling Institute
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Kolling Institute Governance Committee
Michael Nugent
Anthony Schembri AM
Adjunct Professor Anthony Schembri is the Chief Executive of the Northern Sydney Local Health District overseeing a $2 billion budget and a workforce of 13,000 people. His career spans leadership in various healthcare services, board appointments, hospital social work roles and holds adjunct professorial roles at University of Technology Sydney, Macquarie University and University of Sydney. Previously, he led St Vincent’s Health Network Sydney for nearly a decade and served in diverse community roles. Anthony received the Premier’s Community Service Award in 1998 and was named a Member of the Order of Australia in 2019 and received an Honorary Doctorate of Letters from UNSW Sydney in 2023. He holds multiple qualifications and is a Fellow of the Australasian College of Health Service Managers, with 30 years of social work service.
Michael Nugent is Chairman of the Governance Committee of the Kolling Institute. He was previously Chief Executive Officer and an 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
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.
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.
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Robyn Ward AM
Mark Rees
Professor Mark 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.
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.
Irina White
We would like to thank Professor Mark Rees and Associate Professor Chris Dennis for their significant contribution to the Kolling Institute Governance Committee. They have stepped down from the committee recently and we would like to express our thanks for their valuable strategic support and guidance.
Irina White 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 Hospital
Blue Mountains District ANZAC Memorial Hospital
NEPEAN HOSPITAL
The Westmead Institute for Medical Research
South West Academic Centre (Dareton)
WESTMEAD HOSPITAL
Central Sydney (Patyegarang) Precinct
Northern Sydney (Arabanoo) Precinct Western Sydney (Baludarri) Precinct Rural Health Precinct
Training site / 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.
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UNIVERSITY CENTRE FOR RURAL HEALTH (NORTHERN RIVERS)
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
Mona Vale Hospital
Kolling Institute
Melanoma Institute Australia
ROYAL NORTH SHORE HOSPITAL
CONCORD REPATRIATION GENERAL HOSPITAL
Ryde Hospital
ROYAL PRINCE ALFRED HOSPITAL
Sydney Eye Hospital
Centenary Institute
Sydney Dental Hospital
CAMPERDOWN CAMPUS
D
Canterbury Hospital
SUSAN WAKIL HEALTH BUILDING
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Kolling Institute researchers achieved a significant impact in 2023, extending their research activity and reach. Substantial progress was made with our discovery science through to our translational work, directly broadening our understanding of health conditions and diseases, and providing crucial data for improved models of care. The key research outputs point to an escalation of activity and a strengthening of the institute’s influence on a local, national and international scale. In collaboration with national and international partners, Kolling researchers were successful in obtaining more than $43 million in grant funding for projects over the next five years. A year at a glance 2023
Recognition Awards 106
Research Projects 142
Publications 537
Clinical Research 107
Higher Degree Candidates 106
Discovery Science 35
International 6
Grant Awards 84
Presentations 185
National 78
National 63
International 122
International Collaborations In 2023, Kolling Institute researchers partnered with researchers across 90 countries, up from 67 countries in 2022 (excluding Australia).
Europe
Asia
North America
Africa
South America
Australia
This map is based on SciVal geographical collaboration data. It reflects the total number of publications produced by Kolling Institute researchers with international co-authorship. The location of the bubble indicates the country of the co-author, while the size of the bubble corresponds to the number of publications. Data for the 2023 Year In Review was obtained from researchers and publicly available resources. 12
Key events Showcasing our life-changing research
New research on issues ranging from knee arthritis to neck pain guidelines to the development of a biomechanical robotic arm were among the innovative projects showcased at the first Kolling Symposium in November.
“It’s during big events like this where we promote the ground-breaking work being undertaken at the Kolling, and where we have the chance to meet with and learn from like-minded investigators from other teams,” he said. There was also a strong focus on the consumer role in research, with presentations from consumer representatives who discussed their personal perspectives and health experiences. “They provided crucial feedback on how to further involve consumers in our research community and future strategic initiatives,” he said.
The one-day symposium, which attracted close to 100 attendees, focused on the key themes of collaboration, innovation and wellbeing across three domains: pre-clinical, translational, and impact. A diverse group of early to mid-career clinician and basic science researchers from the Kolling gave presentations about their work covering a broad range of health issues. Academic Director Professor James Elliott said the presentations highlighted the significant multidisciplinary achievements being delivered across the institute.
Kolling Symposium researcher presentations included:
Binu Katari, Dr John Mach, Dr Jessica Cao, Dr Mounir Boudali, Associate Prof Sarah Glastras and Professor James Elliott
» Dr Katharine Kott – Detecting coronary artery disease in the absence of traditional risk factors » Dr Barbara Lucas – Ultra-early trial of parent- administered physiotherapy in the neonatal intensive unit for infants at high risk of cerebral palsy or motor delay » Dr Jocelyn Bowden – Optimising knee arthritis management in primary care » Dr Ana Paula Carvalho-E-Silva and Dr Chris Papic – An overview of new Australian whiplash guidelines » Dr Ali Gholamrezaei – A mobile health intervention to improve self-efficacy in opioid tapering in people living with chronic pain
» Dr Natassia Rodrigo – The intersection of metabolic dysfunction and maternal obesity on pregnancy outcomes » Dr John Mach – Medicine safety and functional wellbeing for older people: understanding mechanisms and identifying biomarkers for healthy ageing » Dr Mounir Boudali – The Kolling Orthopaedic Biomechanics Robotic Arm (KOBRA)– biomechanical testing 2.0 » Dr Jessica Cao – A novel protein that attenuates kidney fibrosis through blocking leukocyte infiltration.
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A YEAR AT A GLANCE 2023
At the event, the successful recipients of the 2023 Kolling Awards were announced. Eight researchers received awards across five categories. “Each of these award winners is driving substantial improvements in their individual areas of expertise, and I’m pleased that we’re able to direct the spotlight onto their significant achievements through the Kolling awards program,” Professor Elliott said. The symposium ended with a provocative panel discussion about the translation of innovative research into clinical practice and how to measure impact – not only through the lens of a healthcare provider, but from the perspective of the person receiving – if not helping to design – the research and pathway to translation. 2023 Kolling Award recipients » Clinical research : Dr Vicki Duong and Dr Sumit Sahni » Discovery research : Professor Jose Antonio Lopez-Escamez » PhD completion : Dr Natassia Rodrigo » PhD supervision : Associate Professor Claire Ashton-James and Dr Ryan Davis » Professional staff : Shihani Stoner and Quoc Nguyen
A gesture of thanks for Noel Raey who has volunteered at the Kolling for a decade
It’s during big events like this where we promote the ground-breaking work being undertaken at the Kolling, and where we have the chance to meet with and learn from like-minded investigators from other teams.
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A YEAR AT A GLANCE 2023
All systems go: research supporting future space missions
Professors James Elliott, Gordon Cable, Jule Hides and Dr John Cherry
From clinical advances to improve the healthcare of astronauts to technological research, a special colloquium co-ordinated by the Kolling Institute and Australian Society of Aerospace Medicine showcased expertise across Australia’s space medicine community.
Professor Elliott has contributed his expertise in musculoskeletal health to the Johnson Space Centre in Houston, Texas to help reduce injury and improve the health and performance of astronauts. He said physical changes to the spine during spaceflight predisposed astronauts to symptomatic spine pain and nearly half of cases presenting to NASA’s musculoskeletal care team involve spine pain. He said the learnings were two way: the Australian space medicine community was keen to see medical progress as a result of upcoming space explorations. “It’s anticipated that some of the lessons learned in space will deliver benefits back on earth and help to drive improvements in terrestrial-based health outcomes. “For instance, the new knowledge around the deconditioning of astronauts in space could help doctors back home managing patients with deconditioning after long periods in hospital, where mobility is limited with rapid reductions in strength are realised.” Dr John Cherry, a director from the Australasian Society of Aerospace Medicine, said Australia is in a strong position to support long duration human spaceflight missions. “We are world leaders in rural and remote healthcare, with experience delivering care in some of the most extreme and isolated environments on earth,” he said. “The Australian Antarctic Program for example has developed specialised training and technology to enable a generalist doctor to provide high quality medical, surgical, anaesthetic and dental care to an isolated team.
The two-day event involved national and international experts including representatives from the Australian Space Agency, the CSIRO, Boeing and the Australian Antarctic Program. Kolling Academic Director Professor James Elliott said the colloquium showcased some of the extensive research expertise supporting Australia’s contemporary space industry. “We have a tremendous depth of medical, technological and research expertise in this field,” he said. “Australian clinicians and researchers have been collaborating with international space agencies for years. Our clinical and research experiences have helped inform developments in space life sciences as our international partners recognise our unique scientific expertise. “Some research has specifically focused on clinical advances to improve the healthcare support to astronauts. Our technological sector is also well placed to offer specialised support, with a consistent track record of driving innovation. “Australian experience has driven advances in radiation protection, wearable sensors and compression suits worn by astronauts to limit the musculoskeletal effects of microgravity.” Presenters at the colloquium discussed the specific medical, dental and psychological needs of astronauts as well as Australian designed space suits and opportunities for the space medicine community to contribute to NASA’s Artemis exploration of the moon, and ultimately, Mars.
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Musculoskeletal Priority Research Area
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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
Co-chaired by Professor Chris Little and Professor Manuela Ferreira Our scientists 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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MUSCULOSKELETAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY
Bad knees might cause broken hearts
Exciting research was launched investigating a ground-breaking approach to reduce osteoarthritis-associated heart disease. Kolling Institute researcher Professor Chris Little is leading the project after receiving a highly competitive National Health and Medical Research Council Ideas grant of close to $1 million. Professor Little and Dr Cindy Shu from the Raymond Purves Bone and Joint Research Lab will collaborate on the novel study with Kolling heart disease researcher Dr Anastasia Mihailidou and Professor Anthony Ashton from the Lankenau Institute for Medical Research in the USA. Professor Little welcomed the significant funding, saying it followed years of specialised work in this field. “We’re very excited about this research and we’re hopeful it may make a big difference,” he said. “We have known about the link between osteoarthritis and heart disease for many years, with those experiencing osteoarthritis twice as likely to develop heart disease as those without the painful joint condition. “We had thought the conditions were linked because they shared the same risk factors like age, obesity and a lack of exercise, but our research has showed for the first time, that there might be a biological connection where the joint disease might actually be causing heart disease. “Our team found that if we induced osteoarthritis in one knee of a mouse that was otherwise fit, young and healthy, within 16 weeks that mouse had evidence of heart disease. “We then went onto show that if you take serum from these mice or a patient who has diseased joint tissue from a knee injury like a cruciate ligament tear, that serum caused heart cells to become sick. “We were able to identify a group of factors (micro-RNAs) that were released into the blood from the joint tissue that were causing this.”
Dr Anastasia Mihailidou
The new research project, funded through the NHMRC, will now investigate which specific micro RNAs are contributing to the development of heart disease. “If we can define which factors released into the blood are the most important, we may be able to help develop a new diagnostic tool for heart disease and potentially stop osteoarthritis contributing to cardiovascular disease,” Professor Little said. “Our research could lead to both a diagnostic test as well as a therapeutic target. It could change the health advice around risk factors for heart disease. “Our grant success highlights the breadth of expertise we have at the Kolling and the impact of collaboration, where we have researchers specialising in different fields coming together to identify new avenues to research. “It’s certainly one of the great things about working in the Kolling. “I would like to acknowledge the crucial preliminary work undertaken by Dr Cindy Shu, and the earlier financial support from the Raymond E. Purves Foundation and the Hillcrest Foundation through Perpetual Philanthropy.”
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Researchers have shown for the first time, that there might be a biological connection where the joint disease might actually be causing heart disease.
Professor Chris Little and Dr Cindy Shu
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MUSCULOSKELETAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY
New research challenges our understanding of tendon suitability for knee reconstructions
With an increasing number of people suffering anterior cruciate ligament (ACL) injuries, researchers at the Kolling Institute published new research suggesting a broader range of tendon grafts could be successfully adopted by surgeons undertaking knee reconstructions. The research, which is the second-largest human tendon study ever published** is prompting calls for tissue banks to review current age restrictions and the range of tendons approved for grafts. The findings came as Australia continued to record one of the highest rates of ACL injuries in the world. Interestingly, these injuries are not limited to professional athletes, but impact all age groups, particularly children in the five to 14 years age range. Study lead PhD student Dylan Ashton said if you were to rupture your ACL today and opt for surgical treatment, your orthopaedic surgeon would most likely use your hamstring tendons as a graft to reconstruct your ACL. “This approach however, can cause additional pain and create functional deficits. It can also be difficult to source enough healthy tendon in younger patients, and those who have re-ruptured their ACL,” he said. “These issues have increased the popularity of using tendon allografts, which are sourced from deceased human tissue donors. “Currently there are strict limitations around the type of allografts used, and age limits where tissue banks will only accept donors up to the age of 65 years. “We expect our research findings will prompt a review of these restrictions. “We mechanically assessed the strength of nine tendons from the lower leg, three commonly used as allografts, and six new candidates.
Dylan Ashton and Associate Professor Elizabeth Clarke
“As part of our research, we investigated the impact of donor age, sex, height and weight on the biomechanical properties of the graft. “Importantly, we found that donor age was not associated with weaker tendons, even when including donors into their nineties - and the strength of the new tendons was higher than the strength of tendons which are commonly used as allografts.” Murray Maxwell Biomechanics Laboratory Director, Associate Professor Elizabeth Clarke, said the findings were important as it meant there could be a much broader range of tendon options available to surgeons and their patients, and this could directly improve outcomes for those who experienced increasingly common ACL injuries. ** Ashton DM, Blaker CL, Hartnell N, Haubruck P, Hefferan SA, Little CB, Clarke EC. Challenging the Perceptions of Human Tendon Allografts: Influence of Donor Age, Sex, Height, and Tendon on Biomechanical Properties. Am J Sports Med. 2023 Mar;51(3):768-778. doi: 10.1177/03635465221143385
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Combined digital interventions improve recovery following knee replacement surgery
“For many people there is little post-operative care once a patient leaves rehabilitation, but our research indicates that delivering follow-up care with a combined digital package may give patients the support and encouragement they need to get back on their feet with confidence. “This approach could be particularly important for rural and remote communities as the program has the potential to extend access to care and improve equity. “We would also like to see future studies consider patient preferences and abilities. “Some participants, especially those who were older were hesitant to use unfamiliar devices. Overall however, the approach was well-accepted.” The study was published in the prestigious JAMA Network Open journal.
For the thousands of people who undergo a total knee replacement each year, a new technological approach could hold the key to a better recovery following surgery. Researchers from the Kolling Institute conducted a randomized clinical trial** investigating whether a digital technology package delivered remotely was effective in reducing pain and improving mobility after a knee replacement. Dr Vicky Duong, from the Osteoarthritis Research Team, said total knee replacement surgery was an increasingly common surgery for advanced, end-stage osteoarthritis. “We know however, that one in 10 people report dissatisfaction two years after surgery,” she said. In response to this trend, the team launched a clinical trial involving more than 100 people, where they measured the impact of a combined digital program involving fortnightly health-coaching sessions, a Fitbit activity tracker and an exercise mobile app. Dr Duong said the approach was found to aid recovery, and patients had improved pain and greater mobility three months after surgery compared to those who only received usual care. “Encouragingly, this positive trend was mirrored at six and 12 months,” she said. “We also found improvements in function, activity participation and quality of life as a result of the digital program. “Participants indicated that the online health coaching sessions particularly helped them maintain a consistent rehabilitation program. ** Duong V, Robbins SR, Dennis S, Venkatesha V, Ferreira ML, Hunter DJ. Combined Digital Interventions for Pain Reduction in Patients Undergoing Knee Replacement: A Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2333172. doi: 10.1001/jamanetworkopen.2023.33172
Dr Vicky Duong
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Cardiovascular and Renal Priority Research Area
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Northern Blood Research Centre
Translational Cardiology Research Lab
Cardiovascular & Hormonal Research Lab
Preventative Cardiology and Heart Failure
Ageing and Pharmacology Lab
CARDIOVASCULAR AND RENAL PRIORITY RESEARCH AREA
Cardiovascular Discovery Group
Cardiac Membrane Biology Lab
Cardiology Clinical Trials Unit
Renal Clinical Trials Unit
Renal Research
Cardiovascular Magnetic Resonance Group
North Shore Vascular Surgery
Endocrinology
Co-chaired by Professors Carol Pollock AO and Gemma Figtree AM Our internationally respected teams are at the forefront of research into heart and kidney disease. They continue to make strong progress into the development of ground-breaking treatments for kidney disease. Researchers are also broadening our understanding of the genetic influences in heart disease and improving diagnostic testing for the disease.
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CARDIOVASCULAR AND RENAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY
Researchers saving those with silent heart disease
For many years we’ve understood that heart disease is linked to unhealthy habits and underlying health issues, but our researchers at the Kolling Institute are pioneering a new approach to identify and treat those with the disease without the traditional risk factors In Australia, a heart attack occurs every nine minutes, often with a tragic outcome or lifelong consequences. Many of these attacks are associated with smoking, high blood pressure, diabetes and high cholesterol, where arteries have been damaged and obstructed by plaque. But our researchers are turning their focus to a group of patients who have developed silent cardiovascular disease, without any warning signs. This group accounts for an alarming 25 per cent of people who have had a heart attack without any of the standard modifiable risk factors. Internationally recognised researcher and Royal North Shore Hospital interventional cardiologist Professor Gemma Figtree AM said there had been an increase in patients like this over the last 10 years, and worryingly, many fared poorly after initial hospital treatment. “A greater number of them died within 30 days of the initial heart attack compared to patients with traditional risk factors, and women were disproportionately affected,” she said. “This group has, until now, not been the focus of research or disease management, but we are working to gain a better understanding of how the disease develops in these patients and how we can capture them early and save lives. “It’s estimated 1.3 million people worldwide die each year due to heart attacks without the usual risk factors. These patients have no current way of accessing effective treatment for their underlying plaque as it silently develops.”
In response to these challenges, Professor Figtree is spearheading a new approach and working with physicians, scientists and industry experts to support this group. Researchers are developing a series of blood tests to identify biomarkers of the underlying disease itself in its silent phase, and confirm whether they point to potential new therapeutic targets. They said that if a marker could identify even 50 per cent of people with plaque independently of the risk factor profile, it would allow intervention with effective treatments that stabilise plaque and dramatically reduce the number of heart attacks. Professor Figtree said this would be a crucial step forward, revolutionising heart attack prevention. “Most current medications for heart disease target the known risk factors like high cholesterol and high blood pressure, however we are working to develop medications which could benefit all those at risk of heart disease, not just those with the obvious risk factors,” she said. “It’s important that this cohort, which has been largely invisible until now, is given the focus they need. “We know the
development of new drugs can take many years, but we’ve seen with the success of the COVID-19 vaccines that progress can be made in a short period of time, and we’re convinced that by bringing together the best minds from across the globe, we’re in a strong position to effect
change and reduce preventable deaths.”
https://www.scientia.global/professor-gemma-figtree-a- quest-for-zero-heart-attacks/
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It’s estimated 1.3 million people worldwide die each year due to heart attacks without the usual risk factors. These patients have no current way of accessing effective treatment for their underlying plaque as it silently develops.
Researchers from the Kolling Institute’s Cardiovascular Discovery Group
Professor Gemma Figtree with Dr Steve Vernon
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CARDIOVASCULAR AND RENAL PRIORITY RESEARCH AREA – A SNAPSHOT OF ACTIVITY
Kolling researchers leading the fight against diabetes
With a concerning rise in the number of people developing Type 2 diabetes, our researchers at the Kolling Institute are offering an effective way forward to reduce the impact of the serious disease. Type 2 diabetes is the fastest growing chronic disease in the world, and if the current trend continues, it’s anticipated close to three million Australians will be living with the disease by 2025. It often occurs in those who are aged over 40 years, overweight or if there’s a genetic predisposition, but increasingly doctors are seeing young adults and adolescents with the condition. Sadly, many people may have Type 2 diabetes, and not realise it until the condition is well advanced.
Kolling researcher and Royal North Shore Hospital endocrinologist Associate Professor Sarah Glastras said Type 2 diabetes was a crippling condition which could increase a person’s chance of kidney failure, heart attack and stroke. “There is no cure but it can be put into remission with lifestyle changes, with evidence suggesting that losing weight can help you manage your diabetes and return to normal blood sugar levels,” she said. “It is an encouraging time with a range of new drugs, innovations and clinical trials in the pipeline which will offer tools and strategies to manage diabetes. “In the next 12 months, there will be new combined medications which we expect will help with weight loss and the maintenance of glucose levels. “These drugs will have the potential to halt the march of diabetes.” For many people, a combined approach of exercise, diet and medication would achieve significant results, she said. “I often tell my patients you can’t change your age or your genes, but we do have control over what we eat and how much exercise we do. Exercise is crucial to improving the body’s metabolism.” Research is pointing to the benefits of a personalised diet program tailored to your individual gut microbiota. “Importantly, there also needs to be greater access to these promising new medications, and a greater focus on the condition. “Unlike cancer and heart disease, diabetes often doesn’t receive the attention and funding it deserves. There is a stigma associated with obesity and diabetes, a belief that people have brought it on themselves, neglecting the fact that it is a genetically driven disease.”
Associate Professor Sarah Glastras
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Researchers develop urine test based on kidney cell colour and AI to diagnose chronic kidney disease
Researchers from the Kolling Institute and the Australian Centre of Excellence for Nanoscale Biophotonics at the University of New South Wales have developed and continue to improve a urine test which provides accurate information for early diagnosis. This novel test is based on assessing colour properties of kidney cells exfoliated from the kidney into urine. An individual’s disease status is determined by observing colour patterns with artificial intelligence-based analysis. Encouragingly, this exciting new technology avoids the risk of an invasive biopsy procedure. Head of the Kolling’s Renal Research Laboratory Professor Carol Pollock said this approach provides clear information about kidney pathology by examining kidney cells in urine through a “liquid biopsy”. “Having the ability to diagnose chronic kidney disease with a simple urine test represents a major step forward,” she said. “It means patients with chronic kidney disease or those who have a high risk of disease can receive timely management.” Project co-lead Associate Professor Sonia Saad said the non-invasive test would also provide information on the effectiveness of drugs and other treatments over time. “We look forward to applying our test for wider use within the nephrology setting, such as monitoring complications in patients who receive a kidney transplant.” PhD student Dr Henry Wu welcomed the chance to apply artificial intelligence to their research. “It’s been rewarding to help develop this important diagnostic test and progress the use of AI within the nephrology field.”
Dr Henry Wu
We may soon have a convenient and painless approach to diagnose chronic kidney disease following research by the team from the Kolling Institute’s Renal Research Laboratory. Chronic kidney disease is an emerging global health issue, currently affecting more than 11 per cent of Australians and 13 per cent of the worldwide population. By 2032, it’s estimated up to 125 million people will have the condition. Chronic kidney disease is a progressive disease which eventually leads to kidney failure. It is fatal without dialysis or a kidney transplant. Currently, a kidney biopsy is required to confirm a diagnosis, but this procedure brings inherent risks such as bleeding and pain. A non-invasive approach to diagnose chronic kidney disease is critically needed. There are some blood and urine tests available which can detect advanced stages of the disease, but early detection through these means remains challenging.
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Neuroscience and Pain Priority Research Area
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Clinical Pharmacy
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
John Walsh Centre for Rehabilitation Research
Allied Health
Co-chaired by Professors Paul Glare and Sarah Hilmer AM This priority research area includes a diverse group of clinician 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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NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY
World leading Meniere’s disease expert joins the Kolling
In a sign of the growing neuroscience expertise at the Kolling Institute, internationally recognised Meniere’s disease expert Professor Jose Antonio Lopez Escamez relocated from Spain to the institute in 2023. Professor Lopez Escamez launched a new international research program into the disease, extending his body of work in Europe. Meniere’s disease is a rare disease of the inner ear that causes vertigo, sensory neural hearing loss and tinnitus. Professor Lopez Escamez will continue to collaborate with international partners in Europe, the US and the Centre for Genomics at the University of Granada, as well as new Australian-based partners. He established the Meniere’s Disease Neuroscience Laboratory at the Kolling Institute, where he is investigating the cellular and molecular basis of the disease, as well as the genetic factors contributing to severe tinnitus. His team is also working to identify molecular targets for personalised treatment. Professor Lopez Escamez said his research focused on the influence of family heritage in Meniere’s disease and new genes linked to the disease. His current project aimed to broaden understanding of the genetic and inflammatory basis of the disease and tinnitus by combining multi-omic data and 3D cellular models, he said. “I am pleased to be starting this exciting international program to extend our understanding of the disease by studying new families with Meniere’s disease in Australia and East Asia. It’s hoped our work will ultimately help many people experiencing this condition.” Professor Lopez Escamez came to the Kolling Institute with a wealth of experience. He founded the Otology and Neurotology Group in Spain and
is an international leader in the neurotology and genetics of Meniere’s disease and tinnitus. His research has been disseminated through major international meetings including the Association for Research in Otolaryngology, and he is the recipient of several prestigious awards including the Frontiers Spotlight 2018 Award. He is one of many from the Kolling ranked among the top two per cent of researchers in the world according to the latest Stanford University study, and he has published more than 150 papers in top scientific journals in several categories including audiology, genetics and heredity, medicine, clinical and experimental and otorhinolaryngology.
Professor Jose Antonio Lopez Escamez
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