Get the latest news from across Northern Sydney Local Health District.
Windfall for spinal cord injury research Page 4
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Common medications could reduce severe COVID-19 symptoms
Research into link between osteoarthritis and heart disease
Discovery into reality
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MESSAGE FROM THE EXECUTIVE DIRECTOR
COVID-19 continues to define this year, influencing our work, our research activity and our families. I have been tremendously encouraged by the efforts of our teams to progress their research endeavours despite the altered and at times, challenging arrangements. It has also been pleasing to see how quickly some of our Kolling researchers have responded to the global pandemic, and established COVID-19 related trials. Our researchers are driving national and international studies, broadening our understanding of this devastating virus and working to improve patient outcomes. The trials are focusing on early warning tools, the impact on patients with cardiovascular disease, and the use of blood pressure medications to reduce severe COVID symptoms. We are seeing important new collaborations, with researchers working with teams across the country and overseas. This is widening the scope of the research activity and strengthening results. Importantly, Kolling representatives are a key part of the District’s COVID-19 Clinical Research Group, looking at emerging treatments, the prevention of COVID in high risk groups, and biomarker research for diagnosis.
All these measures will help support our community through this pandemic. At the Kolling, we have also taken steps to support our researchers during this time, with a new professional development webinar series. These sessions are an important way to improve connectivity with our teams, and to help researchers through these altered arrangements. It’s been gratifying to see the numbers of researchers benefiting from this new initiative. COVID has led to changes within the Kolling building with the District’s executive team relocating to level 14. The move was required to meet the demands of a possible surge in COVID-19 patients. Levels five and six of the Douglas building have been refurbished to provide more than 50 additional beds. The Kolling was accommodating the teams managing the contact tracing and community care of COVID patients. These teams have now moved out of the building and are continuing to provide a crucial role supporting the community. Consultation around the Kolling Institute’s new research strategy stepped up recently, ahead of the finalisation of the strategic document. It will set the direction of the Kolling for
the years ahead, while strengthening our reputation as a world-leading institute driving research progress and improvements in healthcare. The new research strategy will help us develop new partnerships and attract additional investment. A key component of the strategy is the provision of the research enablers. These will be instrumental in delivering: • Collaborative opportunities • Operational efficiencies • Improved facilities and services to support Kolling Institute researchers • And, increased community awareness of our research activities Important new committees will be established to support the implementation of the research strategy, with a range of disciplines to be represented. As we celebrate the Kolling’s 100th anniversary this year, I’d like to thank Royal North Shore Hospital’s archivist Cate Storey for her special contribution to this newsletter and her wonderful insights into the history of the Kolling – the oldest research institute in New South Wales. We discover some of the personal experiences which inspired the establishment of this unique organisation.
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Research to help reduce smoking in pregnancy
A large scale review has found the number of women smoking during pregnancy in NSW has halved, and yet there are still some concerning trends prompting calls for targeted campaigns. Researchers from the Kolling Institute and the University of Sydney, analysed smoking rates in all pregnancies in NSW over a 22 year period from 1994 to 2016. The Women and Babies Research team found the overall smoking rates during pregnancy have more than halved from 22.1 per cent in 1994 to 8.3per cent in 2016, with less than one in ten women smoking during pregnancy at the end of the study period. The numbers fell from 19,850 women to 7,820.
A/Professor Tanya Nippita and Professor Jonathan Morris
“These trends are concerning and contributing to poor but avoidable health outcomes, such as stillbirth, neonatal death, low birth weight and preterm birth.” Associate Professor Tanya Nippita said around 8000 pregnancies each year are exposed to maternal smoking, and researchers would like to see that figure drop substantially. “Armed with our research data, we believe the greatest reduction in smoking during pregnancy is likely to come from interventions targeting the four regions with the highest rates,” she said. “Tailored programs represent the best use of resources, with the potential to achieve the best results. “This is an important example of strong research data translating to improved public health outcomes.”
Director of Women and Babies Research, Professor Jonathan Morris, said the reduction in numbers was positive and reflected the success of anti-smoking initiatives such as plain packaging and mandatory health warnings. “The decrease however, was the lowest among younger mothers, under 25, and women from a lower socio economic background,” he said. “The data indicated the highest rates of smoking were clustered in just four areas, including Hunter New England, South Western Sydney, Western Sydney and Western NSW. “Over half the women who smoked during pregnancy lived in one these four regions, and up to 21 per cent of women in these areas continued to smoke while they were pregnant.
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Professor Lisa Harvey and Bob Flegg
Kolling teams win funding for vital spinal cord injury research An Australia-wide trial is set to get underway with hopes it may lead to life-long improvements for those who experience a spinal cord injury. interventions for those with spinal cord injuries. walking on a treadmill with overhead suspension and electrical stimulation.
“It’s hoped the trial will provide evidence of the effectiveness of this intervention and its potential to make an immediate and life-long difference to people with a spinal cord injury. “Once we have that evidence, this approach could be incorporated into clinical practice and rolled out on a large-scale across Australia. “We’re very hopeful the treatment will lead to better outcomes for those with a spinal cord injury, improving their ability to live independently, and participate in work and leisure.”
“Researchers will assess the effectiveness of early and intensive physiotherapy on neurological recovery and function in people with a recent injury,” she said. “The type of physiotherapy we are looking at will be directed below the level of the injury to take advantage of the plasticity of the spinal cord, and its ability to self-repair soon after injury. “The treatment will aim to help partially paralysed muscles work again through a range of specific exercises, including
Led by Professor Lisa Harvey from the Kolling Institute’s John Walsh Centre for Rehabilitation Research, the study represents a collaboration between the University of Sydney and every spinal injury unit in Australia. The State Government is investing $2.5 million in the project, with the University of Sydney contributing $500,000. Professor Harvey said the innovative approach is one of the most promising
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Professor Jim Elliott
Professor Ashleigh Craig
Nervous system control to improve outcomes The Spinal Cord Injury Research Grants program is also investing $2.5 million in a world-first trial, led by Professors Ashley Craig and James Middleton from the John Walsh Centre and researchers from the University of Sydney, Macquarie University, UNSW and the University of British Columbia. Professor Craig said spinal cord injuries can lead to significant problems such as highly unstable blood pressure and dysfunctional nervous system control. These can in turn cause sleep disorders, confusion and depression, and in some cases, sudden death.
High tech approach may hold key to progress for those with specific injury Prof Craig will join Profs Jim Elliott and James Middleton on a project to develop virtual reality technology to assist those with incomplete spinal cord injuries to improve their sense of touch and feeling. The project follows a recent breakthrough which found 50 per cent of people with complete spinal cord injuries still had preserved nerve fibres. This meant that even though they couldn’t feel when someone touched their toe, their brain
“This research will focus on an approach to restore nervous system function, by encouraging those with spinal cord injuries to self-regulate their autonomic nervous system activity,” he said. “Your nervous system is absolutely crucial for a healthy life, influencing almost every body and brain function, including blood pressure, heart rate, breathing and sleep. “The trial will focus on teaching those with spinal cord injuries to control their brain and heart function by observing feedback on a computer screen. “We are confident this innovative therapy will be successful, increasing life expectancy and quality of life, including improved vitality, sleep and mental health,”
was still receiving the message. Prof Elliott said this project brings together innovation in scientific
understanding of neurological changes with spinal cord injuries, and cutting-edge clinical applications of virtual reality.
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Associate Professor Meg Jardine and Professor Carol Pollock
Common, easily accessible medication could reduce severe COVID-19 symptoms
A group of blood pressure medications may hold the key to better outcomes for those with COVID-19, marking a significant breakthrough in the treatment of the virus. An exciting new study, involving researchers from across Australia and India, will investigate whether existing blood pressure medications can reduce the risk of severe disease as well as the duration of severe symptoms. Researchers from Royal North Shore Hospital will support a team led by Associate Professor Meg Jardine from The George Institute for Global Health. Professor Carol Pollock, who will lead the trial at RNSH, said the CLARITY study will involve up to 600 patients over the next year. “The trial will investigate whether a class of drugs called angiotensin receptor blockers can improve outcomes for COVID-19 patients, by interrupting the virus’ entry into the body’s cells,” she said. “We’ll also be looking at whether these medications can protect patients against lung injury from COVID-19, a common outcome for those with severe symptoms.
“These existing blood pressure medications have already shown to reduce inflammation, and we’re hopeful they’ll reduce the risk of severe COVID disease and guide future treatment advice.” Blood pressure medications have been used widely in the treatment of various chronic diseases for more than 30 years, and are affordable and easy to access. “If found to be effective, these medications could be rapidly incorporated into the routine clinical care of COVID-19 patients, long before a vaccine is ready.” Prof Pollock said. “This would represent a major breakthrough in the management of these patients, so we’re very keen to see the initial results of the trial. “The project involves a tremendous national and international collaboration, and it’ll give Australia the opportunity to deliver really significant global benefits.” The trial has received $1.4 million from the Federal Government’s Medical Research Future Fund.
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Professor David Hunter
Dr Xia Wang
Which jobs put you at risk of developing a disabling knee condition?
A global review has identified the jobs most likely to lead to knee osteoarthritis, prompting calls for greater measures to reduce the painful condition. More than 70 studies, involving nearly a million people were analysed as part of the biggest review of the knee condition. The international study brought together teams from the Universities of Sydney, Oxford and Southampton. Researchers found construction workers, cleaners, miners, farmers
Professor David Hunter, from the Kolling’s Institute of Bone and Joint Research, said they also identified the activities which increased the risk of joint disease, like excessive kneeling, squatting, standing, lifting and climbing stairs. “This large scale review was important to highlight the direct link between specific jobs and knee osteoarthritis, a leading cause of loss of work and disability worldwide.” he said. “One in eight people currently have the condition, and that number is expected to jump by 50 per cent in the next 15 years.”
Lead author Dr Xia Wang, also from the Institute of Bone and Joint Research said knee osteoarthritis can lead to invasive surgery including total knee replacements. “We hope this research will lead to additional measures to reduce the occupational hazards across a broad range of jobs,” she said. “We also hope it will promote the steps individuals can take to reduce their risk, such as reducing their weight, improving the strength of the muscles around the joint, and reducing the load on the joint when working.”
and surprisingly stay-at-home parents were all more likely to develop osteoarthritis.
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Dr Cindy Shu
Vital research to look at the link between osteoarthritis and heart disease
Generous funding from the Raymond E Purves Foundation will support innovative research to identify how osteoarthritis causes cardiovascular disease. $100,000 will go towards Dr Cindy Shu to continue her valuable project to better define the link between osteoarthritis and heart disease, and inform improved treatment. Nearly 2.5 million Australians currently suffer from osteoarthritis, with the disabling condition contributing to pain and loss of independence, and directly costing the healthcare system at least $3.75 billion. There is no cure for the condition, and existing treatments have limited benefits.
Dr Shu said researchers believe the impact of this disease goes much further, and is responsible for a two-fold increase in the risk of heart disease. “Studies have shown osteoarthritis is an independent risk factor that can’t be explained by the known causes of heart disease like diet, hypertension and lack of exercise,” Dr Shu said. “This suggests the current approaches to reducing cardiovascular disease risk through weight loss for instance, won’t effectively alter the risk of heart disease from osteoarthritis. “There is an urgent need to better define the pathophysiology of the osteoarthritis-heart disease link, and to identify new, effective treatments.
“It’s hoped this approach will not only help reduce chronic pain, but the incidence of heart disease and its devastating impact on individuals and the community. “We greatly appreciate the significant funds and support from the Raymond E Purves Foundation to allow this crucial research to continue. “We hope it will broaden our understanding of this common and painful condition, and its potentially deadly effect.”
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Research may lead to early warning test for COVID-19
Co-ordinated COVID-19 Research Response Kolling Institute researchers are a key part of a new Northern Sydney Local Health District COVID-19 Clinical Research Group. Associate Professor Clifton-Bligh said the group was formed because there was a need to co-ordinate our clinical research response in a strategic, whole-of-health service way.
“It’s really pleasing to be involved in such an important study, and we hope it will assist early diagnosis of the virus and future treatment options. “We hope it will potentially help a large number people across Australia.” Head of Neurogenetics and Executive Director of the Kolling Institute Professor Carolyn Sue will form part of the research team. “We have used this smell test before to assess patients with other medical conditions and found it easy to do and interpret,” she said. “This new application of the smell test is an exciting way to combine our past expertise with new research collaborations to help solve COVID-19 related health problems for our patients and the general community.” The study team is looking to recruit patients who’ve tested positive to COVID-19 and are being monitored through the Royal North Shore Virtual Hospital or have been admitted to RNSH with mild-moderate COVID-19 illness. The study will involve a structured questionnaire followed by the smell test, based on the University of Pennsylvania’s Smell Identification Kit.
Associate Professor Rory Clifton-Bligh
For many people with COVID-19, the first sign they had the virus was a loss in their sense of smell. Now a team from the Kolling Institute and Royal North Shore Hospital will investigate the correlation between the virus and early symptoms. Study lead Associate Professor Rory Clifton-Bligh said a loss of smell has emerged as a common symptom of COVID-19 infection, but the current data is relying on subjective, self- reported information. “This study will objectively assess loss of smell with people who have tested positive to COVID-19,” said A/Professor Clifton-Bligh, head of Endocrinology at RNSH. “We will be using a validated test kit for smell identification. Depending upon our findings, it may then be possible to develop a rapid screening test.
The six broad areas of focus include:
• Emerging treatments for COVID-19
• Prevention of COVID-19 in high risk groups, including health care workers • Biomarker research for diagnosis and prognosis • Epidemiology of disease outbreaks in Northern Sydney Local Health District • Health services data collection and research • The impact on non-COVID-19 related activities (both in healthcare and in research)
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Matthew Gray and Professor Ravinay Bhindi
Kolling researcher drives national COVID-19 study For many people with heart disease there’s an increased level of anxiety around the implications of COVID-19, but it’s hoped a new study led by Europe suggesting that cardiac patients are particularly vulnerable,” Professor Bhindi said.
“This is a really important national study which we believe will assist the large numbers of people with cardiovascular disease in Australia.” Matthew Gray, who was diagnosed with heart disease two years ago has welcomed the research. “It’s a timely, landmark study which will help fill the gaps in knowledge, and assist GPs and clinicians to better manage people with heart disease who develop Covid,” he said. “As a result of the research, there’ll be reliable information which will directly help me mange my health.” The AUS-COVID study is receiving financial support from the Northern Sydney Local Health District and the Ramsay Hospital Research Foundation.
“This leads to increased anxiety for patients and it means general practitioners and clinicians are not thoroughly informed about the implications for this group. “The study will provide timely advice to help clinicians allocate resources and identify patients most likely to deteriorate and therefore require a higher level of care. “It will also help identify the patients unlikely to deteriorate, who can be safely discharged. “Importantly, the AUS-COVID study will provide information on the safety of continuing common cardiac medications for patients with COVID-19.
Royal North Shore Hospital will guide future treatment and improve health outcomes.
Head of Cardiology Professor Ravinay Bhindi launched the
AUS-COVID study, which will involve more than 800 patients in over 20 hospitals across Australia. The Kolling Institute researcher said the study aims to provide clinicians and health services with the valuable information they need to lower complications for COVID-19 patients with cardiovascular disease. “There is a lot we just don’t know about COVID-19, although there is some early data from China and
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Professor Chris Little
Dr Trish Dwight
Professor Carol Pollock
Support for innovative research
Three valuable research projects have received a boost with the Hillcrest Foundation donating significant funds through the Perpetual IMPACT Philanthropy Program. The Cancer Genetics team received $75,000 to help uncover genetic drivers for rare neuroendocrine tumours.
$75,000 will also go towards osteoarthritis research aimed at improving treatments for the currently incurable disease. Osteoarthritis is the number one cause of chronic pain worldwide, with 25 per cent of patients unable to carry out activities of daily life. Professor Chris Little from the Raymond Purves Bone and Joint Research Lab said osteoarthritis is often incorrectly seen as an inevitable consequence of the wear and tear of aging. “We know this is not the case, and like any other disease, osteoarthritis is an active biological process,” he said. “The more we learn about the cellular and molecular processes that cause joint breakdown and pain, the more we’ll be able to identify potential treatments to halt or even reverse the impact of this condition. “The generous funding from the Hillcrest Foundation will support our vital pre-clinical discovery research, a crucial step in the development of new treatments.”
Professor Carol Pollock has received funding for her project to help reduce kidney fibrosis. “This research aims to identify new targets in the structure of the kidney that promote kidney scarring,” Professor Pollock said. “We will then aim with our partners to develop treatments to limit the development of kidney disease. “One in ten people in Australia have signs of kidney disease, and yet 90 per cent of those are unaware of its presence or devastating impact. “End stage kidney disease costs Australia more than $12 billion each year, a significant financial burden. “Our research could have wide reaching benefits for individuals and the broader community, and we thank the Hillcrest Foundation for their support of this important work.”
Investigator Dr Trish Dwight said these tumours, known as pheochromocytomas and paragangliomas affect a small
percentage of the population, but can have a devastating impact, including a lower quality of life. “The management of patients and their families is highly dependent on genetic testing, and while we know which genetic drivers influence about 70 per cent of these cases, we don’t know the genetic factors in about 30 per cent of cases,” Dr Dwight said. “This much-needed funding will help us identify those markers and deliver far reaching benefits for patients and their families.”
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Professor Rob Baxter
Well earned recognition Former Kolling Institute director Professor Rob Baxter received an Order of Australia medal in the Queen’s Birthday honour roll for his significant service to medical research, endocrinology and tertiary education. Professor Baxter has more than 20 years’ experience in breast cancer research, with expertise in cell biology, endocrinology and metabolic regulation. He has been a Professor in the Sydney Medical School since 1992 and was Director of the Kolling from 1994 to 2011.
Professor Baxter has led a long standing program of pre- clinical breast cancer research within the Kolling, and hopes this award will highlight this area of research. “My research into cell and tissue growth led me from the endocrinology of normal childhood growth, to cancer research, studying the abnormal growth of breast cancer cells,” he said. “I hope this award will give greater recognition to our efforts to improve treatment, and overcome chemotherapy resistance for women with triple-negative breast cancer. “Our current pre-clinical studies are aiming to develop a targeted therapy for this type of breast cancer, which typically affects women at a younger age, and is more difficult to treat than other breast cancers.”
Professor Baxter said he was surprised to receive the award.
“I greatly appreciate the recognition and hope that community support for basic and pre-clinical research will be reflected in an improved funding environment,” he said.
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Dr Emma Smith
Gout cases risingworldwide The prevalence of gout - a form of arthritis characterised by severe pain, redness and joint tenderness has increased across the world at an alarming rate. That’s according to Kolling Institute researcher Dr Emma Smith, who was the senior author of a research paper analysing the condition from 1990 to 2017. The paper, published in Arthritis & Rheumatology, found there were more than 41 million cases of gout in 2017, representing an increase of over five per cent from 1990. Dr Smith said her analysis showed gout was more common in males and in older individuals, and generally higher in developed regions and countries. “We also found high body mass index and impaired kidney function were risk factors for gout, and we expect the number of cases will continue to climb,” she said. “The increasing trend of gout burden is likely to continue, with the global ageing population on the rise. “Greater efforts are needed to reduce the burden of gout through early diagnosis and treatment, and better awareness of the risk factors.”
Dr Kai Fu and Professor David Hunter
New research challenges long-held views about high heels and joint pain New research has produced a surprising result, indicating high heel shoes may not be a problem for those with hip osteoarthritis. The condition is a very common joint disorder, contributing to tremendous pain for many older people and significant disability. Researchers from the Kolling Institute and the University of Sydney adopted an innovative approach, and evaluated the link between wearing shoes with higher heels and hip pain in those with symptomatic hip osteoarthritis. They also investigated whether the length of time in high heels influenced the pain. Florance and Cope Chair of Rheumatology Professor David Hunter said it had been difficult in the past to measure the symptoms of hip osteoarthritis, with hip pain fluctuating so greatly and traditional research methods not able to adequately measure short-term risk factors. “Our research team adopted a new approach, using an internet-based study of participants with hip osteoarthritis, and recruiting more than 250 people for the study,” Professor Hunter said. PhD student Dr Kai Fu, who helped drive the research project, said we found more than 54 per cent of people had experienced pain in the last 90 days, and those who had worn heels over 2.5 centimetres high in the last day had lower levels of pain. “In fact, they were 50 per cent less likely to have experienced pain,” he said. “Perhaps surprisingly, those who had worn heels for more than six hours the previous day also reported lower levels of pain. This group was 70 per cent less likely to have had pain. “These results suggest that heels up to 5 centimetres could be worn without increasing the risk of hip pain. “The findings challenge long-held views that high heels exacerbate all musculoskeletal complaints, but we would like to see further research to clearly determine the ideal heel height before more definitive conclusions can be drawn.”
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In the beginning – one hundred years ago Catherine Storey Honorary Archivist, Royal North Shore Hospital One hundred years ago, in 1920, a group of distinguished citizens of NSW devised ‘a scheme of the utmost importance to NSW, and to the Commonwealth.’ The world had just emerged from World War 1 and the Spanish flu pandemic of 1919, with a massive loss of life. Research into the common diseases of mankind was seen as a means to reverse this appalling human toll. The original prospectus proposed the establishment of the Institute of Pathological Research (the forerunner to the Kolling Institute), under the Royal North Shore Hospital of Sydney Act of Incorporation, 1910. An appeal was launched for the necessary funds to provide the facilities; facilities for the routine hospital pathology alongside the research activities. The hospital Board advertised for a resident pathologist, and the minutes of the Board show that unfortunately, there was only one applicant – a woman! Dr Emma Buckley, a well-qualified young Sydney University graduate (who resigned when she married
Dr Emma Buckley (centre)
in 1922) accepted the position. Before the Institute, the pathology technician took all routine pathology tests by ferry across the harbour to the Board of Health in Macquarie Street and returned with the previous day’s results. These commonly included urine samples and throat swabs testing for diphtheria. But now the hospital set aside a small ex-workman’s cottage Oakleigh, within the grounds to serve as a laboratory. In this, the first home of the Institute, three rooms were allocated for bacteriology, physiological and biochemical testing. This little cottage would be home to the Institute until the Charles Kolling Memorial Laboratory opened in 1931. The Hon Dugald Thomson donated the first £100. When Thomas Rofe, a member of the hospital board provided a cheque for £5000, matched with funds from the NSW Government, the Institute of Pathological Research was ready to proceed. His personal connection explained here. My wife and I have had the misfortune to lose our only son from diabetes which has long threatened his life…I have since felt that if it had been the special business of some qualified scientist to study that particular disease…some means might have been found to check diabetes.
Oakleigh College
Thomas Rofe, 1920
(02) 9926 4500 Kolling@sydney.edu.au www.kollinginstitute.org.au @KollingInstitute @KollingINST Latest News from the Kolling Institute
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