Kolling Institute Year in Review 2024

Northern Sydney Local Health District

Bridging Medical Research and Health

Innovative research advancing health and wellbeing Year in Review 2024

Contents

The Kolling Institute – Who We Are

Overview from the Chair

Academic Director Insights

Kolling Institute Governance Committee

2024 – A Year at a Glance

Signature Event

Research Achievements

Cardiovascular and Renal Research

Musculoskeletal Research

Neuroscience and Pain Research

Cancer Research

Research Enablers

Community Support for Emerging Research Leaders

Support from Philanthropic Partners

Acknowledgement of Country We 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.

THE KOLLING INSTITUTE – WHO WE ARE Delivering innovation and high-quality care for over a century As the oldest medical research institute in New South Wales, the Kolling Institute is in a unique position, built on 105 years of well-respected research. It continues to proudly support hundreds of dedicated scientists who are committed to tangible gains and improved community health and wellbeing. As a joint venture partnership, the Kolling Institute is supported by the resources and expertise of the University of Sydney and the Northern Sydney Local Health District. This places its investigators in a strong position to drive significant change in the delivery of healthcare. Our researchers pursue innovations spanning from discovery science to impactful, potentially life-changing projects. Each body of work aims to extend our understanding of complex health conditions and improve community wellbeing at every age. At the Kolling Institute, we are consistently producing world-leading research into some of the most significant health challenges, including heart and kidney disease, chronic pain and neurological conditions, as well as cancer, musculoskeletal and age- related conditions. A large share of our investigators are ranked in the top two percent of global experts in their field, and remarkably, this is not limited to a few areas, but right across the institute. The depth of experience and expertise places our institute in a privileged position. Our research success relies on our strong partnerships, and investigators are consistently expanding their local, national and international collaborations. Community input and engagement is another crucial part of our research impact. The institute’s location at Sydney’s Royal North Shore Hospital ensures our research community has direct access to patient groups and state-of-the-art infrastructure. These advantages help accelerate new models of care. Our teams have been at the forefront of scientific progress for more than 100 years. Today, they continue to build on that remarkable legacy, offering hope, greater knowledge and better health outcomes.

Our researchers pursue innovations spanning from discovery science to impactful, potentially life-changing projects.

Overview from the Chair

Having witnessed the steady growth and encouraging progress across the Kolling Institute in recent years, I am immensely proud of our researchers and their steadfast commitment to community health. As the Chair of the Kolling Institute Governance Committee, it is a pleasure to reflect on another year marked by impact, dedication and outstanding research. Our investigators have gone from strength to strength, extending their national and global reach. Our researchers secured coveted national and international awards, highly competitive grants and published over 600 insightful papers. All these signs point to an unwavering commitment to research excellence. Building on the funding success, researchers expanded their network of collaborators and steadily increased the number of papers they published. These trends pave the way for measurable advancements in the delivery of clinical care. The collaboration with AGRF, the Australian Genome Research Facility, for instance, will see a specialised team and cutting-edge technology located within the institute, and we expect this will help speed the translation of genomics research into clinical care. Our research enablers continued to play a crucial role at the Kolling Institute, providing direct support and education, and helping to secure vital investment in equipment and infrastructure. These committees encompass, Clinical Trials and Translation, Data and Informatics, Research Infrastructure and Support Services, and Workforce and Culture. The year marked the start of the review of the Kolling Institute’s Research Strategy, and I am pleased to see that many researchers have been involved in the workshops, surveys and discussions which are shaping the next five-year strategy. This strategic document will help deliver targeted support and ensure researchers are well placed to expand their influence and impact. A large number of events were staged throughout the year including the popular Kolling Symposium.

It was a valuable opportunity to hear about the significant progress across the institute, including the latest achievements with research into kidney and heart disease, bone and muscle conditions, cancer, and neurological diseases and disorders. It was also an opportunity to learn about the development of a unique wellbeing index in collaboration with community partners, and to hear from many of our emerging research leaders. The Kolling continues to foster this important group, offering new opportunities and a career pathway. Special thanks to Professor James Elliott for his leadership and dedication to the Kolling’s success, and for his exciting MuscleMap collaboration, which will benefit a wide range of people from athletes and the general population to astronauts regaining muscle strength after experiencing zero gravity in space. I would like to acknowledge our joint venture partners, the University of Sydney and the Northern Sydney Local Health District for their generous support. The provision of key services on top of the considerable financial backing ensure our innovative research is consistently translated into real-world outcomes. I would also like to thank the NORTH Foundation and the University of Sydney’s Advancement team for their collaborative efforts as our philanthropic partners. Your valuable support enables us to progress research that greatly improves the health and long-term wellbeing of our community. Michael Nugent Chair Kolling Institute Governance Committee

Academic Director Insights

As I reflect on the achievements throughout the last year, I would like to take the opportunity to acknowledge a year of impact, collaboration and growth across the Kolling Institute. Our teams continued to build on the gains in recent years and I am proud of the large body of high-quality, impactful research completed across the year. Our researchers are at the top of their game, with many consistently named among the best in their field in the world rankings. Few institutes can boast the large number of researchers in this prestigious group, with over 30 Kolling researchers ranked in the top two percent of global experts in their speciality. Work broadened across many areas, with the development of Australia’s first guidelines for physiotherapists caring for patients with spinal cord injuries, crucial steps towards gene therapy for Meniere’s disease and a kidney organoid to improve treatments for kidney disease. Researchers are closer to a new test to identify the risk of heart disease, tailoring pain solutions for multicultural communities and working to capture people with a high risk of frailty and likely to have a potentially devastating fall. It was pleasing to see the significant progress by our cancer researchers, including a breakthrough with investigations into leukaemia and the launch of the NORTH STAR VNP clinical trials and research centre, which promises to fast track access to the very latest cancer medications and clinical trials. Our key performance indicators were encouraging with researchers securing $12.6 million in highly-competitive grant funding. This figure may rise with the outcome of a large number of grants still pending. Our success rates with category 1 funding continues to track well above the national average. We continued to strengthen our international partnerships, with our researchers collaborating on publications with investigators from 130 countries in 2024. This represents a 60 per cent increase since 2021, and includes researchers from right across the world. I am pleased to report our research activity is expanding with 629 papers published in 2024, up

from 576 in 2023. It is wonderful to see consistent growth in this area, clearly demonstrating the commitment to publishing high-quality peer- reviewed papers. Our researchers continued to make their mark on the world stage with internationally respected investigator Professor Chris Little elected a Fellow of the Orthopaedic Research Society. The accolade acknowledges Chris’ achievement and contribution to the society and the field of musculoskeletal research over more than 20 years. In a sign of the strength of the Meniere’s disease research at the Kolling Institute, Professor Jose Antonio Lopez-Escamez received the Nylen-Hallpike Medal in Sweden. The highly-competitive award is granted to the world’s best vestibular researcher in basic science. With the review of the Kolling’s research strategy underway, I would like to thank all those involved as we work to refresh our strategy and build on the improvements realised in recent years. It is important that we have a robust strategic framework to ensure we are in the best position to progress our innovative multidisciplinary work and widen access to high quality care. I would like to acknowledge the efforts of all our researchers. Your commitment and unrelenting dedication have gone a long way towards our research success and improving the health of our community.

Professor James Elliott Academic Director Kolling Institute

Kolling Institute Governance Committee

Michael Nugent

Anthony Schembri AM

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.

Adjunct Professor Anthony Schembri is an accredited social worker and the Chief Executive of Northern Sydney Local Health District overseeing a $2.4 billion budget and a workforce of 13,000 people. His career spans leadership in healthcare, board appointments, hospital social work roles and includes 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 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 and Fellow of the Australian Institute of Company Directors.

Mary Collins Chebib

Naomi Hammond

Professor Mary Collins Chebib is a senior academic leader at the University of Sydney, serving as Head of School of Medical Sciences and currently interim Associate Dean (Research) for the Faculty of Medicine and Health. Professor Chebib’s leadership spans research strategy, academic development, and cross-disciplinary collaboration. They have led major initiatives including the creation of the Faculty’s Minimum Academic Standards. They supported the initiative of the Bachelor of Biomedicine and Health at Westmead, the expansion of the School’s research income to $40–$50 million, and the Sydney Biomedical Accelerator. With a focus on inclusive culture, strategic space planning, and research staff empowerment, Professor Chebib is committed to fostering environments where research thrives and impact flourishes.

Associate Professor Naomi Hammond is the Critical Care and Sepsis Australia Program Head at The George Institute for Global Health. She is also the Executive Director, Research for Northern Sydney Local Health District. Naomi holds several other appointments including NHMRC Emerging Leader Fellow; Conjoint Associate Professor at the Faculty of Medicine, University of New South Wales; Treasurer of the Asia Pacific Sepsis Alliance, and Chair of the Australian Critical Care Nurses Research Advisory Panel. Naomi’s research interests include fluid resuscitation, sepsis, fever management, knowledge translation and implementation research, health economics, and long-term outcomes post critical illness. Naomi has experience supervising and mentoring medical trainees, nursing staff, higher degree, and medical students in both the clinical and academic environment.

Nancy Baxter

Helen Zorbas AO

Professor Nancy Baxter is the Interim Deputy Executive Dean (Research Centres) in the Faculty of Medicine and Health, University of Sydney. She is a clinical epidemiologist, colorectal surgeon and health services researcher. Positions held before joining the University of Sydney include Head of the Melbourne School of Population and Global health at University of Melbourne, Associate Dean, Academic Affairs at the Dalla Lana School of Public Health, Professor of Surgery in the Department of Surgery and the Institute of Health Policy, Management and Evaluation at the University of Toronto, and Provincial Endoscopy Lead for Endoscopy at Cancer Care Ontario. Her main research interests are in the evaluation of patterns of cancer care particularly cancer screening, determining the long-term consequences of cancer care for survivors, and improving the quality and safety of surgery using linked health administrative data.

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.

Irina White

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.

A year at a glance 2024

Funding support

Grants submitted

$12.6 million in highly- competitive grant funding

19% success rate in category 1 funding on average

123 grants were submitted in 2024

$18 million

in grant funding averaged by the Kolling Institute since 2021

Publications

629 papers published in 2024 as research activity continued to expand, up from 576 in 2023.

Kolling researchers were involved in 119 research projects

A large share of the publications were in highly respected, peer- reviewed journals.

47 clinical trials

134 Researchers

Research activity

112 HDR (Honours, Masters, & PhD Students)

34 Other clinical research, including biobanks and surveillance studies

38 discovery (laboratory) science

Staff profile

104 Professional (admin, research support)

27 Visiting

377 in total

researchers and students

Strengthening collaborations Kolling Institute researchers continued to strengthen international partnerships, with researchers collaborating on publications with investigators from 130 countries in 2024.

This compares with 90 countries in 2023 and represents a 60 per cent increase since 2021.

 2024  2023

245 193

184 161

128 115

Europe

North America

Asia

35 22

Africa

37 33

South America

Oceania

Map indicates the number of collaborative publications by country. The information is provided by the SciVal publication data.

Our research success relies on our strong partnerships, and investigators are consistently expanding their local, national and international collaborations.

Caitlin Fenech

Signature event: Kolling Institute Research Symposium Kolling researchers take critical steps towards improved care A ground-breaking wellbeing index, rare cancer treatments, and new approaches to osteoarthritis were some of the topics discussed at the annual symposium.

Kolling Symposium 2024

“The event offered the chance to highlight some special awards for a group committed to increasing access to high-quality care, and improving the health and wellbeing of our broader community. “I would like to congratulate the 2024 Kolling Institute award recipients for their commitment to our research success.”

More than 150 people attended the event profiling the latest research into kidney and heart disease, bone and muscle conditions, and neurological challenges. Researchers discussed innovative heart valve devices, new technologies allowing the delivery of care to large numbers of patients, and the benefits of reducing multiple medications in older patients. The symposium brought together representatives of the Kolling Institute’s joint venture partners, the Northern Sydney Local Health District and the University of Sydney, researchers and a growing network of community partners. Academic Director Professor James Elliott said the event featured thoughtful presentations, panel discussions, poster presentations, and a debate on the impact of AI on healthcare. “The symposium provided an opportunity to hear how our researchers are extending our understanding of complex conditions and improving therapies and outcomes,” he said. “Our dynamic guest speakers included Professor Susan Morton, the Director of INSIGHT at the University of Technology, and Lifeline Australia ambassador and wellbeing advocate Matt Caruana who shared his personal experience and inspiring perspective.

Kolling Symposium participants

2024 Kolling Award recipients » PhD Supervision Award Associate Professor Sonia Saad Renal Research Laboratory » HDR Student Award Amanda Purcell Renal Research Laboratory » Discovery Science Award Category A Dr Nunki Hassan

Cancer Stem Cell and Biology Laboratory » Discovery Science Award Category B Dr Sumit Sahni Bill Walsh Translational Cancer Research Laboratory » Professional Staff Award Category A Susan Smith Raymond Purves Bone and Joint Research Laboratory » Professional Staff Award Category B Annette McCook Research Development Officer » Excellence in poster presentation Claire Wong Neurofibromatosis research » Excellence in oral presentation Dr Karan Rao Cardiology research

Associate Professor Sanaa Zaki

"Thank you to the many people involved in bringing this large-scale event together to highlight the remarkable and life changing work underway at the Kolling Institute," —Professor Elliott

Guest speakers: Wellbeing advocate Matt Caruana and Professor Susan Morton, the Director of INSIGHT at the University of Technology

Governance Committee members: Associate Professor Naomi Hammond, Professor Antoine van Oijen, Chair Michael Nugent and Academic Director Professor James Elliott

Cardiovascular and Renal Research

Northern Blood Research Centre

Translational Cardiology Research Lab

Cardiovascular & Hormonal Research Lab

Preventative Cardiology and Heart Failure

Ageing and Pharmacology

CARDIOVASCULAR AND RENAL RESEARCH TEAMS

Cardiovascular Discovery Group

Cardiac Membrane Biology Lab

Women and Babies Research

Renal Clinical Trials Unit

Renal Research

Cardiovascular Magnetic Resonance Group

Diabetes Clinical Trials

Endocrinology

Co-chairs Associate Professor Sonia Saad and Associate Professor Xin-Ming Chen

Our internationally respected teams are at the forefront of research into heart and kidney disease. They are developing ground-breaking treatments for kidney disease, while improving diagnostic testing and deepening our understanding of the genetic influences on heart disease.

CARDIOVASCULAR AND RENAL PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY

Kidney organoid to shake up care for the disease

Researchers at the Kolling Institute continued making encouraging progress towards personalised medicine for kidney disease, an approach which will mark a significant improvement in care. The team from the Renal Research Laboratory, led by eminent clinician researcher Professor Carol Pollock, developed a kidney organoid, which can be grown from a person’s blood cells or urine in just 10 days. The researchers are believed to be the first team to have developed a kidney organoid from urine. Professor Pollock says their ground-breaking approach will lead to tailored treatments similar to the individual cancer care offered to many patients. “These organoids will be used to test personalised therapies for kidney diseases, determining if a particular drug is effective or toxic for an individual,” said Professor Pollock who is a renal medicine specialist at Royal North Shore Hospital and internationally respected academic with the University of Sydney. “We will be able to test new therapies that come onto the market to assess whether they could reverse the damage in the kidneys or stop the progression of kidney disease. “We also expect to test whether drug combinations might be toxic to the kidney as we know that some drugs can injure the kidney. “In many cases, people with kidney disease take a lot of medications, and if somebody doesn’t respond well, we often leave them on that drug, and add another one. “We have a handful of medications that have been shown in clinical trials to be beneficial, and in some cases people are on most of these drugs.

“But with this new ability to test medications, we will be able to see what works and what doesn’t, reducing the trial-and-error approach in kidney disease management, and replacing it with a potentially life-changing personalised treatment.” Professor Pollock said the development of the kidney organoid is well advanced and they are refining how they would manage the testing. She anticipates its wider use is close. She said their work was an important area of research given the increasing prevalence of kidney disease. “More than 11 per cent of Australians have the condition which claims more lives each year than breast and prostate cancer combined. Kidney disease is a progressive disease which eventually leads to kidney failure and death, without dialysis or a kidney transplant,” she said.

Professor Carol Pollock

More than 11 per cent of Australians have the condition which claims more lives each year than breast and prostate cancer combined. Kidney disease is a progressive disease which eventually leads to kidney failure and death, without dialysis or a kidney transplant.

Dr Henry Wu from the Kolling Institute Renal Research Lab

CARDIOVASCULAR AND RENAL PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY

Running for game-changing research

Gemma is tremendously thankful to her donors who helped her raise more than $30,000. “Philanthropic funding is so important as it often supports early to mid-career researchers or early stage ideas, where there may not necessarily be all the data to succeed with a highly competitive national funding grant. It can be a crucial component in advancing medical research.” Professor Figtree hopes to secure further philanthropic funding for her research into heart disease, particularly the rising cases of coronary artery disease and heart attacks in patients without traditional risk factors such as high blood pressure, diabetes, high cholesterol and smoking. “I’m sure we can learn from some of our cancer colleagues about the drugs that can target specific biological pathways that are driving an individual’s susceptibility or resilience to common disease. “This could be particularly relevant for heart disease, with 25 per cent of heart attack patients developing ticking time bomb coronary plaque without the traditional risk factors. “We are developing new biomarkers in the blood to help detect early coronary artery plaque before a heart attack, enabling all patients to benefit from effective treatments. These markers are designed to be integrated into clinical pathways that take a stepwise approach to imaging using advanced CT coronary angiography. “This would have a game changing impact on reducing heart attacks – because, if we can detect the disease, we can treat it.” Imaging of coronary plaque also has an important role in providing a new pathway for novel drugs to prevent heart attack. Professor Figtree is leading an international consortium CAD Frontiers, to advocate for CT coronary angiography measures of coronary plaque to be measured as endpoints in clinical trials. This approach would dramatically reduce the cost and time required to develop much needed new coronary artery drugs without reducing the rigor.

Less than two years after a breast cancer diagnosis, Professor Gemma

Figtree completed the prestigious Boston Marathon while raising significant funds for cancer research. She crossed the finish line in under four hours as part of the talented team running for the internationally renowned Dana Farber Cancer Institute. Professor Figtree ran her first marathon after completing six months of chemotherapy, so to be accepted into the Boston event was a remarkable achievement. “I was really excited to have the opportunity to run in the marathon, but it was particularly an honour to run for the Dana Farber Cancer Institute,” she said. “For me to come through chemotherapy, and then qualify to run Boston was a major milestone in itself, and then to be able to run for one of the world’s best cancer research institute’s fundraising teams, was a perfect combination. “Running was a crucial part of my recovery, and there’s now increasing evidence around the benefits of exercise for cancer patients from reductions in recurrence, improved mental health and a reduction in the side effects of chemotherapy.”

Professor Gemma Figtree

Researchers find a combination of diabetes drugs offers valuable extra health benefits

The research found the combination of diabetes medications reduced the risk of chronic kidney disease progression by 33 per cent, and slowed the annual loss of kidney function by almost 60 per cent. It also found that using the two drugs together reduced the risk of major adverse cardiovascular events like a heart attack or stroke by 11 per cent, and hospitalisations for heart failure or cardiovascular death by 23 per cent. A/Prof Neuen, a nephrologist and Director of Kidney Trials at Royal North Shore Hospital, said it was important to look at the combined effect of the medications given the rapidly expanding use of drugs like Ozempic. “We know that these medications work well independently and now our findings support the use of a combined approach to further improve kidney and heart health for patients with diabetes,” said A/Prof Neuen, who is also a senior researcher at the Kolling Institute and The George Institute for Global Health. “Diabetes is a known risk factor for cardiovascular and kidney disease, with impaired glucose control causing damage to blood vessels in the heart and kidneys. “Many patients with diabetes live with cardiovascular disease or chronic kidney disease, with the prevalence increasing in the years following a diabetes diagnosis. “We anticipate our study will inform clinical guidelines for people with diabetes not just in Australia but globally as well.” The study was published in The Lancet Diabetes & Endocrinology.

Clinical Associate Professor Brendon Neuen

A major study, led by Associate Professor Brendon Neuen, found combining Ozempic with another widely used diabetes drug improved heart and kidney health. The research, which was the largest and most comprehensive study of its kind, analysed 12 landmark clinical trials involving around 73,000 patients with a range of health conditions including heart failure, diabetes, and kidney disease. It found that combining one type of diabetes medication (SGLT2) with medications including Ozempic was not only safe, but also offered additional protection against heart and kidney disease in patients with diabetes.

Musculoskeletal Priority Research

Neuromuscular Imaging Research Lab

MUSCULOSKELETAL PRIORITY RESEARCH TEAMS

A3BC

Raymond Purves Bone & Joint Research Lab

Orthopaedics Research

Sutton Arthritis Research Lab

Ageing and Pharmacology

Murray Maxwell Biomechanics Lab

Rheumatology Research

Osteoarthritis Research Team

Hand Surgery

Dermatology

Pain Management Research Centre

John Walsh Centre for Rehabilitation Research

Co-chairs Dr Annette Kifley and Associate Professor Michelle Hall Our scientists 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 to speed recovery and decrease the burden of musculoskeletal pain globally.

MUSCULOSKELETAL PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY

Kolling researchers instrumental in first Australian guidelines

It took three years and many hours of careful work, but two researchers from the John Walsh Centre for Rehabilitation Research developed the first clinical practice guidelines for physiotherapists to inform the care of people with life-changing spinal cord injuries. Physiotherapy is a key part of rehabilitation for people with a spinal cord injury, but there was no nationally consistent advice based on the best available evidence. The guidelines were driven by Associate Professor Joanne Glinsky and Professor Lisa Harvey, who worked with a team of physiotherapists, researchers, and people with a spinal cord injury across Australia and New Zealand. Professor Harvey said the recommendations provide up-to-date information on the most effective physiotherapy management. “Importantly, they are based on a rigorous evaluation of the available evidence, taking into account the opinions of clinical experts and people with a spinal cord injury,” she said.

“We started the process by identifying over 100 clinical questions of importance to physiotherapists and those living with an injury, and each question was ultimately answered by way of an evidenced-based recommendation or a consensus statement.” A/Professor Glinsky said they followed a very detailed and rigorous process with many meetings, discussions and reviews of the evidence. “It is this process that should give people confidence in the recommendations of the guidelines,” she said. Professor Harvey added that the work was only possible with the initial financial support from icare in NSW, and the support from organisations throughout Australia including the Transport Accident Commission, the National Insurance Scheme Queensland and the Lifetime Support Authority. “Their support for this important piece of work was critical to our success. We are tremendously grateful they shared our vision to create these first Australian recommendations.”

The guidelines can be viewed at www.SCIPTguide.org

The guidelines were driven by Associate Professor Joanne Glinsky and Professor Lisa Harvey, who worked with a team of physiotherapists, researchers, and people with a spinal cord injury across Australia and New Zealand.

Professor Lisa Harvey and A/Professor Joanne Glinsky

MUSCULOSKELETAL PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY

Helping astronauts tackle the health challenges of spaceflight

As the National Aeronautics and Space Administration (NASA) progresses its ambitious Artemis spaceflight program, Australian researchers including the Kolling Institute’s Academic Director Professor James Elliott have tapped into their scientific expertise to offer support. Professor Elliott attended an event at NASA’s Johnson Space Centre in Texas, which brought together leading clinicians and scientists from around the world to discuss ways to reduce the spine injuries experienced by astronauts. This group is exposed to a range of musculoskeletal conditions including spinal pain and muscle challenges due to the lack of gravity when in space. Professor Elliott said physical changes to the spine during spaceflight predispose astronauts to symptomatic spine pain and nearly 50 per cent of cases presenting to NASA’s musculoskeletal care team involve this type of pain. “The risk of spine pain during and after spaceflight raises operational issues and concerns for the long-term spine health of astronauts and others going into space,” he said. “We are looking forward to sharing our expertise to help reduce injury, and improve the health and performance of astronauts. “NASA has expressed an interest in our MuscleMap program, which is a revolutionary technique to assess whole-body skeletal muscle composition using high-resolution MRI. “More than 50 clinicians and researchers are contributing to our program representing physics, engineering, oncology, radiology and many more specialties.

Professor James Elliott at the NASA Johnson Space Centre in Texas

“We are generating a reference dataset of muscle composition across the lifespan to help diagnose pathology, gauge the effectiveness of interventions, and develop new health outcome measures. “We are using the latest AI technology to revolutionise the measurement of skeletal muscles. “The normative data sets, developed by the MuscleMap program, could be used to compare data sets from astronauts, so that when they return from outer space, and they’ve experienced zero gravity exposure, you will be able to see what’s happened to their muscle system and what has changed to their skeletal muscle composition. “The MuscleMap assessment tool will help improve their pain and performance when they’re in space, when they get home, and in preparation for future missions. “We are very excited to be involved with this cutting- edge research which we hope will directly support astronauts and their long-term health.”

Research driving the development of new implants and improving outcomes

Researchers at the Kolling Institute joined with international collaborators to develop a revolutionary implant for hip replacements. The ceramic implant, designed for hip resurfacing procedures, doesn’t require the long stem used in common hip replacements. This means surgeons are not removing the bone which they would generally remove for a hip replacement. Professor Bill Walter, a leading surgeon and investigator with the Murray Maxwell Biomechanics Lab, said that with this approach, the hip feels more natural and is a bit stronger, particularly for activities such as running and jumping. “Importantly, feedback from patients has informed the development of the device,” he said.

“Patients reported excellent pain and symptom relief, and 45 per cent of patients returned to high-level sports.” Female patients especially benefit from the procedure, marking a significant development for the surgery. “In the past, resurfacing has not worked well in female patients but with the ceramic on ceramic resurfacing, we’re getting very good results.” The ceramic device alleviates concerns around metal toxicity with the traditional implants. Currently about 50,000 hip replacements are performed in Australia each year, with resurfacing procedures representing less than one per cent. Professor Walter said that trend is expected to change, with up to 50 per cent of patients potentially eligible for resurfacing. Further research will examine the long-term results of the ceramic resurfacing implants.

Associate Professor Elizabeth Clarke and Professor Bill Walter

Neuroscience and Pain Research

Clinical Pharmacy

Osteoarthritis Research Team

Pain Management Research Centre

Ageing and Pharmacology

Neurogenetics

Neuromuscular Imaging Research Lab

Academic Psychiatry and CADE Clinic

NEUROSCIENCE AND PAIN PRIORITY RESEARCH TEAMS

The Curran Ageing Research Institute

Sutton Arthritis Research Lab

Meniere's Disease Neuroscience Group

Bill Walsh Cancer Research Lab

John Walsh Centre for Rehabilitation Research

Dermatology

Co-chairs Associate Professor Sanaa Zaki and Dr Ryan Davis At the Kolling Institute, we have a diverse group of researchers who are driving progress in the areas of pain, neurodegenerative disorders, ageing and other conditions that impact the mind, brain and nervous system. This includes Meniere’s disease, mental health conditions, spinal cord and brain injury. Our world-class research is focusing on improvements in clinical practice as well as the use of medications.

NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY

Crucial steps towards gene therapy for debilitating Meniere’s disease

The Kolling’s Meniere disease research team

Professor Lopez-Escamez said it was an exciting time for research in this area as we move into precision medicine with specific drugs and develop gene therapy for the next generation of patients with the disease, which causes vertigo and hearing loss.

Our researchers at the Kolling Institute are at the forefront of Meniere’s disease science, developing the first humanised model of the disease ahead of gene therapy. The specialised team is led by world-leading Meniere’s disease researcher and neuroscientist Professor Jose Antonio Lopez- Escamez, who relocated from Spain to the institute to pursue his ground-breaking work.

“We are making encouraging progress as we investigate the genetic basis of the disease, finding that many patients have a recessive inheritance where both parents are carriers of the disease but don’t have any symptoms,” he said. “When I was working as an ENT surgeon in Spain more than 10 years ago, the condition was largely neglected and not well understood, and many patients were not doing well. “Today, we are learning more about the disease and the broad range of influences, including immune-response inflammation, allergy and migraine.”

“Importantly, we must consider that people will have different genetic and immune backgrounds, and different associated conditions, like migraine. “It is not the same disease for all individuals and will present differently. “We don’t have a magic pill that is going to work for everybody with Meniere’s. For some patients some medication will work, one drug will be better, but for others there will be another way. “That’s why it’s important we know which subgroup of Meniere’s a patient has.”

Prestigious International Award Professor Jose Antonio Lopez- Escamez received the Nylen-Hallpike Medal at the Barany Society Conference in Sweden. The award is granted to the world’s best vestibular researcher in basic science over the last two years. It recognises the significance of the research underway at the Kolling and the University of Sydney’s position as a world-leading institution in vestibular medicine. “We are now investigating the genetic mutations involved in the disease in preclinical models in a crucial step towards the development of gene therapy. We believe this game-changing approach will be available within the next 10 years.

Professor Jose Antonio Lopez-Escamez

NEUROSCIENCE AND PAIN PRIORITY RESEARCH AREA A SNAPSHOT OF ACTIVITY

New research to improve care for frailty

records to measure the Frailty Index, and this will automatically and efficiently screen hospital patients for frailty. “Identification of frailty is the essential first step to providing frailty-informed health care. It will inform health services about the facilities, resources and staff required to meet the needs of people with frailty. “On an individual basis, it means patients will receive specialised, multidisciplinary care, including the Comprehensive Geriatric Assessment model of care, where patients are more likely to continue living at home and less likely to be in a nursing home up to a year after their stay in hospital.” The screening may be used for observational research or clinical trials of optimal therapies for people living with frailty. Professor Hilmer said the research project will bring models of care in line with international guidelines which strongly recommend that all older people are screened for frailty. “I am delighted to lead a strong, multidisciplinary, national and international team to develop the crucial technology we need for frailty screening of older people in hospital. “By automating frailty screening, health services and health professionals will be able to focus on providing optimal care tailored to the needs of frail older people, rather than spending precious time on manual screening.” The introduction of the automatic hospital screening will mark the first time the Frailty Index has been adopted in acute hospital care on such a large scale. The project has been developed following support from the Sydney Health Partners Geriatric Medicine Clinical Academic Group.

Professor Sarah Hilmer

Researchers secured $3 million to develop technology to identify frailty in older people in hospital, a crucial step towards improving care and long-term patient outcomes. The Kolling Institute’s Professor Sarah Hilmer is leading the large-scale study involving hospitals and universities across Australia as well as international investigators. Professor Hilmer said the five-year project will develop real-time frailty monitoring technology to help tackle one of the biggest challenges facing older people. “As we age, our risk of frailty increases, and we know that frail older people in hospital have a high chance of experiencing an adverse event, like confusion or a fall,” she said. “The technology we are researching will use existing data from the electronic medical

Culturally relevant pain solutions

After training as a musculoskeletal physiotherapist in India, Dr Saurab Sharma returned to Nepal to treat patients with musculoskeletal pain conditions but quickly found that Western practices to assess and treat pain didn’t translate well to his community. One issue was the internationally-recognised numeric pain rating scale, where zero indicates no pain and 10 is maximum pain. “Some people in Nepal struggle with it because they can’t compute numbers in their head,” he said, making it difficult for them to rate their pain accurately. “Also, not many people take surveys in their day-to-day life. For many, it’s the first time in their life.” Saurab also noticed a lack of local research. “There’s no research on musculoskeletal pain in my region, specifically back pain,” he says. To address this, he collaborated with Professor Mark Jensen, a prominent pain researcher, and later completed a PhD in New Zealand. Now Chief Scientist for Clinical Research at the Kolling’s Pain Management and Research Centre, Saurab emphasises the need for more pain research in low and middle-income countries, as well as culturally relevant interventions for diverse communities in Australia. Saurab’s work has focused largely on Nepal. He compared four pain scales and found that the numeric scale had the highest error rate and was disliked by patients. The “Faces rating scale,” which uses facial expressions to indicate pain intensity, had the best results and was preferred by patients. He has translated and validated 29 pain assessment tools for Nepal, but there’s still more work to be done. He also developed educational resources using local language and metaphors to describe pain and they have now been adapted for four countries and languages.

Importantly, he believes the West can learn from Nepal’s approaches to pain management. In countries with limited access to multidisciplinary teams, peer support groups in communities often play a vital role. “We could implement similar models here in Australia,” he suggests, proposing that individuals could be trained for a few days in evidence-based pain management and then support others in their community. To boost back pain research, Saurab formed a consortium of researchers, clinicians, and patients from 35 low and middle-income countries. “In many countries, there’s no local pain research. We don’t even know how back pain is managed.” In a recent study, he found that in majority of countries patients have to rely on pharmacotherapy and electrotherapy, neither of which is recommended. “Education and self-management are recommended by most global back pain guidelines but are rarely used,” Saurab notes. He’s now developing interventions to treat pain in Australia’s diverse communities, including Nepali, Chinese, Indian, and Vietnamese populations.

Dr Saurab Sharma, Chief Scientist for Clinical Research at the Pain Management and Research Centre

Cancer Research

Kolling researchers make promising breakthrough with leukaemia study

one cancer stem cell survives after treatment, the cancer can regenerate and come back,” she said. “Sadly, over 80 per cent of people will experience a relapse with their blood cancer.” The future for blood cancer treatment is expected to be stem cell-based treatment and A/ Professor Wang’s team has made significant progress over the last 10 years broadening our understanding of the biology of the stem cells driving blood cancers. Her Cancer and Stem Cell Laboratory team is using that knowledge to progress the development of an effective, stem cell-targeted cancer treatment. Leukemia stem cells have their own protective mechanisms that make them resistant to anticancer drugs. “Our new treatment approach however, works by disrupting the ability of the leukemia stem cells to self-renew. Specifically, it destroys the unique protective antioxidant mechanism of malignant stem cells” said A/Professor Wang. “Antioxidants have long been considered a type of healthy compound, due to their many benefits such as anti-aging and anti-inflammatory. However, we found that the antioxidant in cancer protects malignant stem cells against cancer therapy, leading to drug resistance and disease relapse. “Reducing the antioxidant level makes malignant stem cells sensitive to standard chemotherapy and effectively kills these cells. “Encouragingly, it’s anticipated this treatment approach could be applied to other cancers as well, improving outcomes for a much larger range of cancers.”

Researchers from the Cancer and Stem Cell Laboratory team led by Professor Jenny Wang

While there has been a great deal of encouraging progress with many cancer treatments over the last decade, the prognosis for people with acute myeloid leukaemia remains dismal, with only 27 per cent of patients surviving more than five years after treatment. Lead researcher Associate Professor Jenny Wang said we have seen a sharp rise in the number of people with the deadly form of blood cancer in recent years. There are now more than 135,000 people in Australia living with blood cancers, with 16 people losing their life to this disease every day. A/Professor Wang said blood cancers are particularly aggressive forms of cancer and very challenging to treat. “The majority of them are resistant to current chemotherapy treatments which means many people experience a relapse of their blood cancer. If even

Philanthropic funds launch crucial research into little-known cancer

Dr Stevenson, a surgeon and researcher, said he was incredibly grateful for the philanthropic support as it allowed him to conduct research which would otherwise be very difficult to get off the ground. “There have been some really significant improvements for some cancers like melanoma and breast cancer in the last 10 years, but concerningly, we have not seen the same kind of improvement in outcomes for those with oesophageal cancer,” he said. “Patients will generally undergo chemotherapy and radiotherapy before surgery, with some people responding much better than others. In some cases, the patients’ disease will worsen while on treatment, and occasionally some will not survive it. “My research is analysing oesophageal tumours to look for genes or proteins that may inform a patient’s individual prognosis and if their tumour will respond to a particular treatment. “This is an important body of work which could lead to individualised treatment approaches and avoid harmful treatments for patients who are unlikely to benefit from them.” Dr Stevenson said he is driven to progress this research given the current poor prognosis for people with this deadly form of cancer. “I think this type of research could be the key to substantial improvement as it will allow us to further sub-classify oesophageal cancer so we can then develop the best treatment approach for each person,” said Dr Stevenson. If you wish to support to this research contact the NORTH Foundation at info@northfoundation.org.au To learn more about Fight for a Cure visit fightforacure.com.au

Dr Colby Stevenson

Generous community support strengthened our research into oesophageal cancer, lifting hopes of improved treatments for the aggressive and deadly cancer. The Fight for a Cure charity donated $100,000 towards Dr Colby Stevenson’s research, on top of a $100,000 donation from the Howlett family, in memory of their son Scott who died from the cancer. The Howlett family welcomed the research saying it would help to raise awareness of this little-known cancer, while improving survival rates through earlier detection and treatment Oesophageal cancer is the 11th most common cause of cancer death in Australia, accounting for over 1400 deaths each year. Sadly, less than 25 per cent of people with this cancer survive more than five years, compared to about 70 per cent for all cancers combined.

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