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Cracking news from the Westmead Institute for Medical Research QIMR Berghofer, a step closer to safe bone marrow transplants Monash University painting a picture of health with algorithms
FOREWORD I’m delighted to publish our second edition of INSPIRE for 2019 which showcases some of the incredible research underway throughout our membership and to update you on some of the advocacy work Research Australia has championed so far on behalf of the health and medical research sector. great outcomes from this programme. Research Australia continues to highlight frontier opportunities; the Frontiers Research feature from Monash University is a must read on ‘Painting the picture of health with algorithms’.
esearch Australia continues to work with the Australian Government and the Department of Health to ensure the Medical Research Future Fund (MRFF) is investing in cutting edge science at the frontiers of what we currently know about human health. This advocacy has led to the creation of the $570 million Fr o n t i e r H e a l t h a n d M e d i c a l Research Programme. We’r e d e l i g h te d a t t h e r e c e n t announcements by Health Minister, the Hon Greg Hunt MP, that ten promising research projects have been successful in the first Frontiers funding round. This funding has been awarded following a rigorous assessment process which utilised an expert international review panel, Co-Chaired by Research Australia. Our congratulations to Research Australia members in each of those projects. We are looking forward to
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This edition also includes the link between eggs and our eyes! Read more about the research being undertaken at Westmead Millennium I n s t i t u te o n e g g c o n s u m pt i o n preventing macular degeneration. Griffith University, the sponsor of our Discovery Award Category, has provided a fascinating article giving hope to those 12,000 Australians currently living with spinal paralysis. We know only too well how disability is reflected in the economy and they estimate that it is costing the Australian economy around $2 billion annually. In April, Research Australia was joined by the Co-Chairs of Parliamentary Friends of Medicines, John Alexander OAM, MP and Dr Mike Freelander MP to launch our Pre-Election Statement, Healthy Australians, Healthy Economy at Parliament House in Canberra. I invite you to share some of the key subjects addressed and some images capturing this unique forum of politicians, members and key sector influences. Healthy Australians, Healthy Economy of fe r s 6 key re c omme ndations o n th e p o l i cy s et ti n g s n e e d e d to position health and medical research as a significant driver of a healthy population and contributor to a healthy economy. A one-page
summary of the statement is included this issue. And last but by no means least and on behalf of the Board, I welcome Professor Dawn Freshwater as a Research Australia Director. Dawn was appointed Vice-Chancellor of The University of Western Australia in 2017 and prior to that, she served as the University’s Senior Deputy ViceChancellor and Registrar. This year Dawn was also appointed as Chair of the Group of Eight Universities. I look forward to working closely with Professor Freshwater to further Research Australia’s mission. and also hope you are as inspired as I am by The Last Word in this issue written by Dawn on Young Lives Matter. I’m deeply saddened to read that around a third of those who die in the 15-24 age group, have taken their own life. Many of our members are focusing on the youth mental health area and its clear more needs to be done. This was a theme at one of Research Australia’s Parliamentary roundtables, in Victoria, which we use to highlight policy areas and connect your research as an opportunity to guide those much-needed policy and funding decisions. I trust you have an enjoyable read and look forward to your contribution in future INSPIRES. Nadia Levin CEO & Managing Director
Thursday 14 November Metropolis Ballroom Southbank Melbourne
CONTENTS Australian Health & Medical Research
Overview of Research Australia's recent member forums
THE WESTMEAD INSTITUTE FOR MEDICAL RESEARCH
Electronic skin technology changing the landscape of biodiagnostics
MONASH UNIVERSITY 4â&#x20AC;&#x192; INSPIRE 012 | 2019
Bumping up oral health
UNIVERSITY OF WESTERN SYDNEY
Safer bone marrow transplants for blood cancer patients a step closer
MATER MEDICAL RESEARCH INSTITUTE
Publisher Research Australia Ltd
Art direction Matthew Ware p +61 403 844 763 or e email@example.com For Advertising enquiries please contact the Research Australia office on p 02 9295 8546 or e firstname.lastname@example.org
Painting the picture of health with algorithms
INSPIRE ONLINE issuu.com/researchaustralia
Kolling Institute welcomes a new Research Director
THE KOLLING INSTITUTE
Driving a treatment of paralysis & brain injury
THE LAST WORD: Young lives matter
UNIVERSITY OF WESTERN AUSTRALIA
INSPIRE is a publication of Research Australia Ltd ABN 28 095 324 379 CHRISTOPHE KEREBEL CHRISTOPHE My Twitter : @chriskere KEREBEL 384 Victoria Street Darlinghurst NSW 2010 Who can submit articles? Any current member of Research Australia who would like to share a relevant story that affects their organisation including, philanthropic donations and their outcomes, research findings, and any other related health and medical research topic that affects the Australian population. Submission guidelines & deadlines For information regarding how to submit and publishing deadlines visit the Research Australia website. Disclaimer The opinions expressed in INSPIRE do not necessarily represent the views of Research Australia. Whilst every effort has been made to ensure accuracy, no responsibility can be accepted by Research Australia for omissions, typographical or inaccuracies that may have taken place after publication. All rights reserved. The editorial material published in INSPIRE is copyright. No part of the editorial contents may be reproduced or copied in any form without the prior permission from Research Australia. ÂŠ Research Australia 2018.
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A statement from Research Australia, the national peak body for Australian health and medical resea
Research Australia's pre-election statement launch On April 3 Research Australia brought MPs and senators from across the political spectrum to meet with our members to launch our Pre-Election Statement Healthy Australians, Healthy Economy, which identifies 6 key actions the next Australian Government can take to support Australian health and medical research. The evening before we released our response to the Budget and networking was in full force at our breakfast launch chaired by Prof Mary Foley AM. Mr John Alexander OAM MP and Dr Mike Freelander MP, Co-chairs of the Parliamentary Friends of Medicine, welcomed attendees to Parliament House and spoke of the importance of health and medical research. Dr Michelle Blanchard, Acting CEO, SANE Australia and Founding Director of the Anne Deveson Research Sector shared her perspectives on mental health.
Six steps for a healthier Australia Research Australia is calling for six key reforms in the lead up to the next Federal election to ensure all Australians can benefit from our health and medical research sector. Government funding for research must keep pace if Australia is to reap the benefits of a new, knowledge-based economy and a safer, higher quality and more effective health system, but unfortunately there has been a continued decline in NHMRC and ARC funding since 2013. Research Australia’s recommendations come as a recent report released by the Association of Australian Medical Research Institutes found that for every $1 invested in medical research, $3.90 is returned to the broader economy.
Decline in research funding since 2013:
• Real increases of 3% per annum over the course of th next Parliament to redress the decline in The Nationa Health and Medical Research Council’s funding for research that has occurred since 2014/15.
• A similar increase in funding for the Australian Resea Council funding programs to redress the decline that has occurred since 2013/14.
2. A fully-funded, transparent, Medical Research Future Fund • All parties commit to the full capitalisation of the Medical Research Future Fund (MRFF), namely, $20 billion, by 2021.
• Give clarity to the separate, but complementary, role of the NHMRC, ARC and MRFF and their differentiati factors.
3. A standardised national approach to clinical trials
• Greater national coordination to further streamline an standardise registration, recruitment and reporting protocols.
4. Open up digitised health data for research
• Implement the Productivity Commission’s recommendations on greater access to data for research purposes.
5. Promoting Australian Health Innovation
• Provide policy certainty for health innovators by all parties committing to no changes to the R&D Tax Incentive in the term of the next Parliament.
• Reinvest savings from the R&D Tax Incentive to supporting Australian innovation through other programs.
700 13/14 NHMRC
Figure 1: NHMRC and ARC expenditure 2013/14 to 2017/18 (forecast); inflation adjusted using 2014/15 values ($m.)*
* Source: Deptartment of Industry, Innovation and Science.
RESEARCH AUSTRALIA LIMITED ABN 28 095 324 379
384 Victoria Street Darlinghurst NSW 2010
Nicole Millis, CEO Rare Voices, Senator Catryna Bilyn, Dr Mike Freelander MP & John Alexander MP
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1. Long-term, stable funding
6. A consistent approach to rare diseas
• Create a Rare Disease Framework to provide a structure approach to funding research and infrastructure that he ensure effective and equitable access to therapies for th almost 2 million Australians living with a rare disease.
T 02 9295 8546 E email@example.com
My Twitter : @chriskere CHRISTOPHE KEREBEL
Above Dr Mike Freelander MP, Michelle Blanchard, Acting CEO, SANE Australia, Mary Foley, Research Australia, John Alexander MP
ed elps he
Left: Erica Kneipp, Assistant Secretary, Department of Health Middle: Dr Peter Thomas, Director of Policy & Operations, AAMRI Right: Greg Mullins, Head of Policy, Research Australia
Left, Lucy Clynes, Research Australia, Middle, Professor Kerryn Phelps AM MP Right, Associate Professor Greg Kaplan, Research Australia Director, Chief Operating Officer, Ingham Institute 2019 | INSPIRE 012â&#x20AC;&#x192; 7
Awards Article INSPIRE Issue 12 Great research requires great minds and great efforts! One of the best ways to acknowledge, celebrate and reward the incredible milestones of some of the sector’s leaders in health and medical research is through nominating them for one of the annual Research Australia Awards. As the national peak body for health and medical research, these prestigious awards are our celebration of the outstanding achievements of individuals, teams or corporations who drive and support the opportunities that health and medical research and innovation bring to each and every one of our lives.
Research Australia University Roundtable
This year the Award Categories are: 1.
Peter Wills Medal
2. Great Australian Philanthropy Award University of South Australia March 21 3. Health Services Research Awards 37 attendees from across 23 member universities participated our unique University Roundtable kindly 4. Data in Innovation Award hosted by the University of South Australia. This was the 5. Griffith University Discovery Award first time the Roundtable has been held in South Australia. 6. Advocacy Award Research Australia gave an update on Research Funding, 7. Research Award (NEW) Frontiers promises, the R&D Tax Incentive, the Aged Care Royal Commission and other work we have been doing on behalf of our members and the sector. Nominations are open until early July so please submit as nomination page.
As Chair of the NHMRC Research Council, Professor Steve Wesselingh FAHMS spoke about the future of the NHMRC funding programs. Steve specifically addressed the focus on collaboration, clinical trials and cohort studies, and translation. Steve went on to outline the framework being put in place to enable the new grant program to be evaluated against the objectives.
Professor Helen Marshall from the University of Adelaide talked about national and global partnerships as soon as possible. on Simply click here go directly to the lead investigator the ‘B’ Part of Ittostudy, the largest study of its kind globally assessing the herd immunity KEYNOTE SPEAKERS FOR meningococcal vaccine. You are welcome to nominate anybody from any organisationimpact acrossofAustralia howeverBthe primary nominator must be
THIS EVENT INCLUDED: from a member organisation of Research Australia.
Professor Libby Roughead, University of South Professor Ian Olver AM FAHMS who gave an insightful Australia, the leader the Medicine and itDevice Whilst hosts theseCity. awards to showcase the amazingis research andofleaders in the sector, is also look at Research Adelaide’sAustralia impressive Biomed Surveillance CRE and her presentation focused on how one of our core roles is to connect all stakeholders from across the health and medical research pipeline. This includes Professor Karen Reynolds FAA FAHMS from Flinders the Centre has worked over many years to improve the those starting their journey in research, and so we encourage you to nominate students and mid-career researchers, to University talked about the importance of partnering in use of medication, and the translation of research findings support the leading lights of the future. improving the commercialisation of Australian health and into policy and practice. This year research, the Awardsusing winners be announced at a black-tie gala evening at Metropolis Ballroom Southbank Melbourne medical the will Medical Device Partnering on November 14.example of university engagement with A report on the University Roundtable held at Program as an Deakin University in May, will be included in the industry. next Inspire. Please see our website for 1.
The Nominations platform link
Frequently Asked Questions
Previous winners and images
Nadia Levin, CEO Research Australia, Dr Sarah Best winner of the Griffith University Discovery Award, Professor Sheena Reilly, Pro Vice Chancellor (Health) Griffith University and Dr Eric Chow, Highly Commended Award winner. Peter Wills AC (right) presenting Laureate Professor Nicholas Talley AC with the Peter Wills Medal in 2018
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The University Roundtable attendees and speakers
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Above: Presenter Professor Ian Olver AM, former Institute Director, UniSA Cancer Research Institute (left) and Prof Tobjorn Falkmer, Curtin University (right) Left: Engaged attendees at the University Roundtable; Professor Matt Bellgard, QUT (right)
2019 | INSPIRE 012â&#x20AC;&#x192; 9
Health Economics Roundtable The University of Technology kindly hosted our recent Health Economics Roundtable which was very well attended with over 35 member representatives. Research Australia Director and Chair of the Roundtable, Associate Professor Annette Schmiede, introduced Professor Kathryn McGrath, Deputy Vice-Chancellor (Research) UTS who officially welcomed attendees to the Roundtable. Research Australia updated the audience on our work on the development of a Return on Investment Framework for the Medical Research Future Fund. Sharon Musgrave from AbbVie shared a case study with the audience focusing on how Health Technology Assessment (HTA) insights are utilised in shaping evidence packages and access strategies for medicines from a global perspective.
Health Economics Roundtable kindly hosted by the University of Technology Sydney.
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Ralph Lattimore from the Productivity Commission addressed how policy makers use health economics and Geoff Neideck from the Australian Institute of Health and Welfare provided an overview of the data infrastructure currently available, and updated the attendees on the current state of data linkage through AIHW. Professor Tony Scott, President of the Australian Health Economics Society (AHES) led a discussion about a collaborative project between Research Australia and AHES to formalise the way in which policy makers and central agencies consult and engage with health economist in policy creation. The final speaker was Professor Michael Woods from the Centre for Health Economics Research and Evaluation at UTS engaged with the audience on the role of health economics in improving care for older Australians.
Nominating for the Health and Medical Research Awards Great research requires great minds and great efforts! One of the best ways to acknowledge, celebrate and reward the incredible milestones of some of the sector’s leaders in health and medical research is through nominating them for one of the annual Research Australia Awards. As the national peak body for health and medical research, these prestigious awards are our celebration of the outstanding achievements of individuals, teams or corporations who drive and support the opportunities that health and medical research and innovation bring to each and every one of our lives. This year the Award Categories are: 1. 2. 3. 4. 5. 6. 7.
Peter Wills Medal Great Australian Philanthropy Award Health Services Research Award Data Innovation Award Griffith University Discovery Award Advocacy Award Frontiers Research Award (NEW)
Peter Wills AC (right) presenting Laureate Professor Nicholas Talley AC with the Peter Wills Medal in 2018
Nominations are open until early July so please submit as soon as possible. Simply click here to go directly to the nomination page. You are welcome to nominate anybody from any organisation across Australia however the primary nominator must be from a member organisation of Research Australia. Whilst Research Australia hosts these awards to showcase the amazing research and leaders in the sector, it is also one of our core roles is to connect all stakeholders from across the health and medical research pipeline. This includes those starting their journey in research, and so we encourage you to nominate students and mid-career researchers, to support the leading lights of the future. This year the Awards winners will be announced at a black-tie ceremony at Metropolis Ballroom Southbank Melbourne on November 14. Please see our website for 1. The nominations platform link 2. Frequently Asked Questions 3. Previous winners and images
Nadia Levin, CEO Research Australia, Dr Sarah Best winner of the Griffith University Discovery Award, Professor Sheena Reilly, Pro Vice Chancellor (Health) Griffith University and Dr Eric Chow, Highly Commended Award winner.
BUMPING UP ORAL HEALTH
12â&#x20AC;&#x192; INSPIRE 012 | 2019
My Twitter : @chriskere CHRISTOPHE KEREBEL
A cavalier attitude to dental health during pregnancy may be putting babies’ teeth at risk.
he adage goes that a woman loses a tooth for every child. But the outdated idea that poor oral health is the price women must pay for having babies may be putting children’s health at risk. A Western Sydney research team, led by dentist Ajesh George, has introduced an oral health program for pregnant women that has been adopted across two states, significantly improving the health of women and children. George became interested in oral health and pregnancy about ten years ago, following the publication of several studies linking gum disease with adverse pregnancy outcomes. “At that time, Australia didn’t have any guidelines on oral health for pregnant women, there were no promotional resources and no-one really discussed it during antenatal care,” says George, now an Associate Professor at Western Sydney University’s School of Nursing and Midwifery.
EXTRACTING TRUTH FROM MYTH
Pregnancy is associated with poorer oral health for several reasons. “Many women think it’s normal to have bleeding gums during pregnancy, and there are a lot of other misconceptions, for example, that it’s not safe to see a dentist during pregnacny, or fear about potential x-rays that might harm the baby,” says George. Another common misbelief is that the baby leaches calcium from the mother’s teeth to meet its own needs. While it’s true that calcium is mobilised from the mother’s skeleton and absorbed from the foods she eats, studies have revealed that the calcium in her teeth is unscathed. The likelihood of enamel erosion and dental decay are instead increased due to sugar cravings and vomiting caused by morning sickness. Increased oestrogen and progesterone also boost blood flow to the gums, which can cause them to become more irritable and susceptible to damage or infection. Approximately 60 to 80 per cent of women suffer from bleeding gums during pregnancy and almost a third have more advanced gum disease, where the gums begin to recede, and bacteria start eating away at the bone that supports the teeth. The evidence regarding an association between poor oral health and adverse pregnancy outcomes including
2019 | INSPIRE 012 13
preterm birth and low birth weight is less clear. “What we think happens, is that bacteria from the periodontal disease enter the bloodstream, travel down to the placental barrier and trigger an inflammatory reaction, which potentially results in preterm birth and low birth weight,” says George. Studies have found a two- to sevenfold increased risk of such outcomes associated with poor oral health, although there is a paucity of research to demonstrate that it is a direct cause, or that increased dental visits result in improved birth outcomes.
confidence of midwives to promote oral health and can be easily integrated into midwifery practice.
Despite being at greater risk of poor oral health, fewer than half of pregnant women in the US, for example, seek dental care. In Australia, these problems are compounded by a lack of oral health awareness among pregnant women, limited emphasis on oral health during antenatal care, the high cost of private dental treatment, and limited public dental services.
Sarah*, one of the participants in the team’s research commented,
I think it’s important when women get pregnant to know that oral hygiene plays a major role in having a healthy child. I don’t know if a lot of women know that your own oral hygiene plays a big role.” TRAINING MIDWIVES
George and his colleagues decided to upskill midwives in oral health education, because they play a pivotal role in the provision of antenatal care in public health services in Australia. Midwifery services are provided to pregnant women from the very early stages of their pregnancy, so educating midwives enables greater opportunities for oral health intervention. Canvassing midwives revealed widespread ignorance about the importance of oral health, as well as a lack of practical skills for assessing or addressing it. So George and colleagues teamed up with the Australian College of Midwives to develop a comprehensive training programme; evidence-based promotional resources; and a validated screening tool to identify pregnant women who might be at increased risk of poor oral health and need a referral to a dentist. Midwives are also trained to conduct a visual inspection of the mouth, which, although optional, reinforces the idea that oral health is important: “If a midwife says, ‘you’ve told me you have a problem, do you mind showing me where the problem is?’ it suggests to the woman she should address the issue,” George says. An evaluation of 638 pregnant women, recruited from three metropolitan hospitals in Sydney, suggests this midwife-led approach is effective. It showed that the programme can significantly improve the knowledge and *Name has been changed for privacy reasons
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The intervention also improved the uptake of dental services, oral health knowledge, and quality of oral health among pregnant women compared to current practice, with the greatest improvement in uptake (87 per cent) observed when the midwifery intervention was coupled with an affordable and accessible dental referral pathway.
The research indicated that simply telling women to go and visit a dentist wouldn’t be enough; they needed access to affordable services. George and the team worked with public health providers in Victoria to roll out the programme across the state and provide low-income pregnant women with referral pathways. The programme has become state policy and put in place across 55 maternity services. Meanwhile, the screening tool is being used by 75 per cent of hospitals in Victoria. In certain regions, the number of pregnant women being referred to and accessing dental services has risen by more than 50 per cent. George and his colleagues are now investigating the possible longer-term benefits of the programme for women and the oral health of their children, some of whom are now four. Babies acquire most of the microbes living upon and within them from their mothers — including bacteria associated with dental decay.
Usually, if women have poor oral health during pregnancy, this continues after birth, and if they engage in certain feeding practices, such as tasting the baby’s food with their mouth, or sharing the same spoon, then their bacteria will be transferred to the baby’s mouth causing early cavities, which is the most common chronic childhood disease worldwide,” George says. DENTAL GAPS
A study which followed the health of 2,798 Danish twins into old age, found that women with lower socio-economic status lost one tooth per pregnancy, on average, while those from higher socio-economic groups lost a tooth for every two children they had. For men, the correlation was negligible.
Author: Researcher, Associate Professor Ajesh George University of Western Sydney
A common misbelief is that the baby leaches calcium from the mother’s teeth to meet its own needs.”
My Twitter : @chriskere CHRISTOPHE KEREBEL
NEED TO KNOW
• P regnancy is disproportionately associated with poor oral health • A WSU program engaged midwives to educate on dental hygiene • It led to an 87 per cent increase in dentist visits from participants
POOR ORAL HEALTH DURING PREGNANCY HAS BEEN LINKED TO • Increased risk of preterm birth • Low birth weight • Increased risk of stillbirth • Childhood dental decay
Associate Professor Ajesh George, has introduced an oral health program for pregnant women that has been adopted across two states, significantly improving the health of women and children. 2019 | INSPIRE 012 15
NEWS New study indicates regular egg consumption could reduce risk of developing Macular Degeneration.
16â&#x20AC;&#x192; INSPIRE 012 | 2019
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new epidemiological study conducted by researchers at The Westmead Institute for Medical Research indicates that regular consumption of eggs could reduce the risk of developing age-related macular degeneration (AMD).
The study, published online in The Clinical Nutrition Journal, aimed to investigate the relationship between total intake of eggs and the 15-year incidence of AMD. AMD is a chronic condition affecting the central macula that can cause a progressive loss of central vision. Macular degeneration is the leading cause of legal blindness in Australia, responsible for 50% of cases of blindness. Age is a risk factor for macular degeneration, with people aged 50 and over most frequently affected. However, AMD is not a normal or certain part of ageing. Lead investigator, Associate Professor Bamini Gopinath from the Centre for Vision Research at The Westmead Institute for Medical Research says that, to date, no epidemiological studies have investigated the relationship between total egg intake and the risk of developing AMD. “The findings of this study are therefore important as they indicate a significant and independent association between the moderate consumption of eggs and lower risk of developing late AMD*.
Specifically, participants who consumed 2-4 eggs per week versus those who consumed less than 1 egg per week had a 49% reduced risk of developing late AMD after 15 years. “The results were more significant for those participants who developed the ‘wet’* form of late AMD. In those participants whose age of AMD onset was at the 5- or 10-
year follow-up stage of the study, consumption of 2-4 and 5-6 eggs per week was associated with 54% and 65% reduced risk of late AMD, respectively.” Associate Professor Bamini Gopinath adds, “However, there does appears to be a threshold to the benefit of egg consumption in relation to AMD risk as no added benefit was observed in those who consumed an average of one or more eggs per day.” Associate Professor Gopinath says dark-green leafy vegetables are established as being good sources of carotenoids, particularly lutein and zeaxanthin. Therefore, all people with AMD, regardless of disease stage, are encouraged to increase their intake of dark green leafy vegetables as part of their regular diet.
Eggs also represent a cost-effective and rich source of dietary lutein and zeaxanthin. “While eggs contain less lutein and zeaxanthin than dark-green leafy vegetables, lutein and zeaxanthin are better absorbed by the body when sourced from eggs,” says Associate Professor Gopinath. While this initial study strongly indicates the potential of regular egg consumption to help reduce the risk of AMD, Associate Professor Gopinath encourages more studies to verify these findings. The study was based on The Blue Mountains Eye Study, a community-based cohort, and involved 3,654 adults aged 49 years and over. Author: Associate Professor Bamini Gopinath is affiliated with The Westmead Institute for Medical Research, The University of Sydney and The Kolling Institute of Medical Research
* Late AMD is when vision becomes impaired. Late AMD can be classified as dry (atrophic) macular degeneration or wet (neovascular) macular degeneration.
2019 | INSPIRE 012 17
SAFER BONE MARRO TRANSPLANTS FOR BLOOD CANCER PATIENTS A STEP CLO Queensland researchers have conducted Australia’s first clinical trial using genetically engineered immune cells to make bone marrow transplantation for blood cancer safer.
he results of the Phase I clinical trial have been published recently in the journal Clinical Cancer Research.
The research was led by QIMR Berghofer scientist Dr Siok Tey. Dr Tey is also a bone marrow transplant physician at the Royal Brisbane and Women’s Hospital where the trial occurred. About 10,000 Australians are diagnosed with blood cancers such as leukaemia and lymphoma each year. Bone marrow transplantation is the only chance of a cure for patients with high-risk forms of blood cancer, Dr Tey said, with about 700 Australians undergoing a bone marrow transplant each year. “However, there are many others who need a transplant but cannot undergo one because they do not have a suitably matched donor,” she said. “The key to bone marrow transplantation is the immune cells. Immune cells are a double-edged sword - they are necessary for fighting cancer and infection but they can also cause unwanted tissue damage, known as graftversus-host disease. “This is why we generally need to use fully-matched donors. In this clinical trial, for the first time in Australia, we used genetic engineering to make transplantation safer so we could use donors who were only partially matched. “We take the immune cells from the partially matched donors, the n we inser t a ge ne into the se ce lls 18 INSPIRE 012 | 2019
which enables the cells to be killed off if they cause complications, such as graft-versus-host disease.” Dr Tey said the genetic engineering was performed at QIMR Berghofer’s cell manufacturing facility, Q-Gen Cell Therapeutics. Patients received the immune cells after their bone marrow transplant at the RBWH. “What we found really amazing was that these immune cells can massively grow in number in the patients,” she said.
We were able to show, using two independent molecular techniques that a single genetically modified immune cell, when challenged by a cancer, could split into millions and millions of cells within a few days. “This immense capacity for rapid expansion was something that had not been shown before and really demonstrates the ‘power of one’: One cell, if it is the right cell, can grow rapidly and help control cancer or infection.” Anthony Takken was 53 years old when he was diagnosed with high-risk acute myeloid leukaemia in 2014. His only chance for a cure was a bone marrow transplant but he did not have a fully matched donor. He has siblings but none of them was a full match because even brothers and sisters have only a one in four chance of being a full match.
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Dr Siok Tey
Anthony became the first person to enter the clinical trial in January 2015. Dr Tey and her team took immune cells from his brother, who was a partial match, and genetically modified them. Mr Takken then underwent a bone marrow transplant from the same brother, and three weeks later had an infusion of the gene-modified cells. “My cancer has now been in remission for 3.5 years. I have a few health challenges but I have returned to work, I’m travelling the world and the doctors say that the chances of the leukaemia coming back are very low,” Mr Takken said. “At the time I was diagnosed, I was faced with leaving my 16 and 17 old sons to grow up without a father. Thanks to the gene therapy trial, I’ve now made it 3.5 years past my original expiry date!
I’m grateful that Queensland is a significant hub in the world for this kind of research and treatment and I hope it can continue to be well funded because it gives people like me a chance of surviving and living and contributing to society.”
Dr Tey said although it was a small clinical trial, it was critical in demonstrating the ability of even a single cell to control cancer and infection. “Cancer immunotherapy is one of the most exciting developments in cancer treatment this decade. Bone marrow transplantation is actually the earliest form of cancer immunotherapy and continues to be a very effective form of treatment,” she said. “Our trial gives hope to all the people who haven’t been able to find a suitable bone marrow donor in the past. “Every day we are working hard to find the next line of treatment for people with leukemia, people needing a transplant and treating complications from transplant. “It’s exciting that this huge technological development is happening here in Queensland, at QIMR Berghofer and the RBWH. It is also exciting that this study paves the way for the use of other gene-engineering technology that has supercharged the cancer immunotherapy field in the past five to 10 years. “We are now working on our next generation of clinical trials to use gene-modified cells to fight blood cancer and treat complications of bone marrow transplantation.” Author: Dr Siok Tey is the Team Head and Senior Research Fellow at QIMR Berghofer. Dr Siok maintains active clinical practice at the Royal Brisbane & Women's Hospital.
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ELECTRONIC SKIN TEC
CHANGING THE LANDSC OF BIODIAGNOSTICS Gold is a noble and rare metal that has played an important role in the history of human civilisation. It has been widely used in jewellery making, coins, investments, central bank purchases and fabrication of electronics.
I Professor Wenlong Cheng
n the electronics industry, gold has been widely used on printed circuit boards due to its chemical inertness and ability to resist oxidation. In addition, gold has demonstrated excellent biocompatibility and resistance to bacterial colonisation, and is therefore widely used in medical applications such as dental restorations, treating rheumatoid arthritis and some ongoing research in cancer treatment. While we might think of nanotechnology as a new d e v e l o p m e n t, e v i d e n c e of t h e e a r l i e s t h u m a n nanotechnology is found in the 4th century BC, when a Roman artisan created the Lycurgus Cup, a famous artwork using gold nanoparticles, which appears in ruby red in transmitted light and green in reflected light. This is due to localised surface plasmon resonance. Professor Wenlong Cheng’s Nanobionic Group at Monash University is a world-recognised expert in shaping gold at nanoscopic scale with well-defined sizes and shapes for a wide range of applications including drug identification, anticounterfeit, ultrathin lenses and electrocatalysis. Recently, his team has successfully explored innovative ways of using gold for wearable and implantable electronics for artificial intelligence, remote bio-diagnostics and telehealth monitoring. A particular example is using the thinnest gold nanowire electronic inks to develop soft wearable skins for biodiagnostics of various biometric information including artery pulses, body movement, hand gestures, etc. Recently, Prof Wenlong Cheng’s Nanobionics lab has taken a step further to develop powerful gold-coating technologies on virtually all kinds of elastomeric substrates including latex rubber, kitchen preservative film, fish lines, tattoo paper and even human hairs. Unlike traditional gold which is rigid in bulk form, the coated gold films are composed of vertically
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NEED HIGH RESOLUTION IMAGE OF FIGURE SUPPLIED PLEASE
aligned Enoki mushroom-like gold nanowire (Figure 1a, b), where the head side of the gold nanowires appears golden and the tail side appears to be black in color (Figure 1c). Among the “unconventional” properties discovered, they found Enoki mushroom-like gold nanowire film is much more stretchable (Figure 1d) than traditional gold films by evaporation, sputtering or electrodeposition, which is a crucial requirement for the next-generation wearable technology.
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The lab can fabricate gold tattoos with conformal attachment to human skin (Figure 1e). With such conformal adhesion capability, the team could use the gold skins to detect various biometric data including muscle movement, artery pulse waves, glucose level, blood pressure, electrocardiogram (ECG) monitoring, facial expression and body posture monitoring. The detection can be achieved wirelessly by combining with low-energy Bluetooth
Figure 1. (a), (b) Morphology of the Enoki mushroom-like gold nanowire. (c) A photograph of a free-standing gold nanowire film, showing golden reflection from the nanoparticle side but complete dark ness for nanowire side. (d) Photograph of a gold nanowire film with different applied strain. (e) A photograph of a “gold e-skin” tattoo made from standing gold nanowires film conformally attached on human skin. (f) Realtime monitoring of facial expressions.
technologies and a paper battery. One example is to detect autism via tracking facial skin movement (Figure 1f). There is a saying that “current wearables are not wearable”. This is due to the fact that current wearable products are dominated by rigid gadgets; they are bulky and uncomfortable to wear and have and poor data accuracy. Prof Cheng’s vision is to develop disruptive wearable technological solutions from scratch materials innovations (e.g. via soft gold technologies) in order to develop thinner, soft, skin-conformal wearable diagnostic tools that are essentially parts of skins as a “tattoo” or a part of organs in bioimplant. This could lead to a paradigm shift from current hospital-centred diagnostics to future patient-centred diagnostics available anytime and anywhere, transforming the landscape of healthcare. Author: Professor Wenlong Cheng, Nanobionic Group, Monash University
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STILLBIRTH P 22â&#x20AC;&#x192; INSPIRE 012 | 2019
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Prof Vicki Flenady, Director on the verandah of Aubigny Place at the Mater Hill Campus in Brisbane
STILL BIRTH IS TOO COMMON.
As Richard Horton, Editor in Chief of The Lancet stated, “Not all global health issues are truly global, but the neglected epidemic of stillbirths is one such urgent concern”. The burden of stillbirth has far-reaching psychosocial impacts on women, families, caregivers and communities, and wide-ranging economic impacts on health systems and society. For parents and families, stillbirth often results in profound and long-lasting adverse psychosocial effects. Stigma around stillbirth intensifies parents’ distress and often makes them feel more isolated in their grief.
SADLY, NOT ALL PREGNANCIES GO TO PLAN:
• six Australian babies are stillborn each day • for Aboriginal, Torres Strait, and disadvantaged women the risk is doubled • there has been little improvement in rates for over two decades • stillbirth in Australia is 35% higher than top performing countries globally.
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STILLBIRTH IS A SERIOUS PUBLIC HEALTH PROBLEM.
In 2016, the NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) was established to address the tragedy of stillbirth in Australia. This Australia-wide initiative brings together parents, parent advocates, health care professionals, researchers, professional colleges and policy makers to reduce stillbirths and improve the quality care for women and families after stillbirth. Mater Research is home to the national co-ordination site for the Stillbirth CRE. Professor Vicki Flenady is the lead investigator of the Stillbirth CRE, which is a collaboration across seven Australian academic organisations (South Australian Health and Medical Research Institute, Monash University, University of Sydney, Griffith University, La Trobe University, Burnet Institute, and Mater Research Institute -University of Queensland) with strong links to perinatal clinical services and policy, and wide community research. Service to the community is the foundation stone of Professor Vicki Flenady’s research program. “I was a midwife and neonatal nurse before transitioning into research. My original interests in improving outcomes for preterm infants, then to perinatal mortality and finally to the perplexing and tragic loss of lives through unexplained stillbirth. I am passionate about ensuring a multidisciplinary approach that places the women and her family at the centre of research to improve care.”
CHRISTOPHE My Twitter : @chriskere The Stillbirth CRE program focusses on research that KEREBEL THE SAFE BABY BUNDLE CHRISTOPHE KEREBEL translates into improved maternity care and better health Vicki’s team are working collaboratively with a shared outcomes for women and their babies. Importantly, the vision and purpose – addressing the urgent need to same interventions that may reduce stillbirth can also decrease the gap between what is known and what is reduce adverse maternal and newborn outcomes. By done in maternity care in Australia to reduce stillbirth rates. implementing these interventions, the Stillbirth CRE simultaneously aims to reduce a range of adverse A widespread introduction of a ‘bundle of care’ is an effective, efficient and evidence-based approach pregnancy outcomes, with stillbirth as its core focus. to decrease this gap. Bundles for maternity care The four priority areas of the Stillbirth CRE systematically improvement in the UK have reduced stillbirth rates by address The Lancet 2016 series on Ending Preventable 20%. In 2019, the Stillbirth CRE was awarded $1.2 million Stillbirths call to action and the specific priorities pertinent by the NHMRC to develop a similar approach in Australia; to maternity care practice change for Australia. the Safe Baby Bundle.
STILLBIRTH CRE PRIORITY AREAS
• Improving care and outcomes for women with risk factors for stillbirth. • D eveloping new approaches for identif ying women at increased risk of stillbirth • Implementing best practice in care after stillbirth and in subsequent pregnancies. • Improving knowledge of causes and contributors to stillbirth
SENATE INQUIRY INTO STILLBIRTH RESEARCH AND EDUCATION
In early 2018 the Australian Senate assembled a committee to inquire into and report on the future of stillbirth research and education in Australia. Over 269 individuals and organisations (including Research Australia) made submissions, and in December 2018, the Select Senate Committee Inquiry into Stillbirth Research and Education tabled its Report (“the Senate Report”) in the Australian Parliament. The ground-breaking Senate Report gives voice to the parents of stillborn children, to the health and medical professionals, politicians and government employees who wish to work together to reduce the rate of stillbirth and provide best possible support and care for bereaved parents. This Senate Report highlights the way for new action and approaches when it comes to stillbirth research and education, laying the foundation for the work to come. The path forward involves the development of a National Action Plan by the Government. The Stillbirth CRE worked in partnership with Stillbirth Foundation Australia to facilitate extensive public consultation across the Australian stillbirth community. The consultation process was initiated to identify actions to address the recommendations outlined in the Senate Report. Broad engagement across the sector achieved a collaborative report that was provided to the Government to inform the development of the National Action Plan. The sector eagerly awaits the next steps.
Our goal is to reduce stillbirth rates after 28 weeks gestation by 20%. Drawing heavily on lessons learned in the UK and building upon the existing work of the Stillbirth CRE and working in partnership with Perinatal Society of Australia and New Zealand, the Safe Baby Bundle team are integrating and developing clinician education programs based on best practice guidelines and information for women. Working with the health departments in Victoria, New South Wales and Queensland, and in partnership with the Stillbirth Foundation Australia and Still Aware, the Stillbirth CRE aims to implement the bundle of care commencing 2019-2022 and will then evaluate and refine the bundle and its resources as part of the second phase of the Safe Baby Bundle. It is hoped that the Safe Baby Bundle will become a nationally supported program to reduce stillbirth rates in Australia.
Nationally adopted, it is hoped the Safe Baby Bundle will save 200 Australian families from suffering the tragedy of stillbirth annually. The stillbirth community are united and ready to take up the challenge of improving stillbirth outcomes for families. It is time to act.
Authors: Professor David McIntyre is the Director of Obstetric Medicine and Head of Mater Clinical Unit. He is also a member of the Mater Research Governing Board and Professor of Medicine at the Faculty of Medicine, University of Queensland. Professor Vicki Flenady is the Director of the NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE), based at Mater Research – The University of Queensland. She is a nationally and internationally renowned clinical perinatal epidemiologist with specific expertise in stillbirth.
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PAINTING THE PICTURE OF HEALTH WITH ALGORITHMS Recent discoveries in ‘generative deep learning’ to model high dimensional inputs have enabled developed algorithms to generate realistic clinical images. This opens the door for algorithms to not just classify images, but to explain the underlying reasoning and further, provide information into the future of patients’ health.
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onash University's Depar tment of Neuroscience is the first university academic d e p a r t m e n t i n Au s t r a l i a d e d i c a te d to developing and providing personalised solutions for patients with neurological conditions. Established in early 2018, the Department partners closely with the Alfred hospital in Melbourne and is a member of the Alfred Research Alliance. The Alfred Hospital is a tertiary referral centre, with one of the most advanced radiology departments, receiving multiple referrals from across the country for imaging of various neurological and neurosurgical diseases. The Alfred recognises the value of clinical-academic partnership in solving real world problems and hosts multiple clinical studies in collaboration with Monash University researchers. The Alfred embraces informatics and information technology and has operated an electronic medical record and medical imaging archive since 2004, and therefore has a rich clinical database ready to be leveraged by researchers to improve patient outcomes.
APPLYING GENERATIVE DEEP LEARNING
Dr. Jarrel Seah, a researcher at the Alfred Hospital, utilised these advantages to apply the latest advances in generative deep learning, a technique which can display image features learned by a model to justify its predictions, allowing radiologists to better identify faults and biases (opposed to most machine learning methods). This demonstrated that generative deep learning techniques can uncover the expected and unexpected features that algorithms use to diagnose heart failure on chest X-rays. This overcomes a key hurdle of the implementation of deep learning algorithms in clinical practice, enabling swifter and more accurate diagnoses for patients aiding their prognoses in treatment plans.1 The Monash i-BRAIN (i-Bioinformatics Research in Artificial Intelligence Neuroimaging) research group run by Professor Meng Law brings together clinicians, radiologists
My Twitter : @chriskere CHRISTOPHE KEREBEL and researchers to investigate imaging, genomic, clinical
and other biomarkers in the early diagnosis of neurological diseases (e.g. multiple sclerosis, epilepsy, stroke, and Alzheimer’s Disease), by applying artificial intelligence for early and more accurate diagnoses and triage of patients into clinical trials with novel therapeutic agents. Over the next 5 years this group will utilise advances in artificial intelligence technology to develop statistical modelling techniques, which have the potential to predict the future appearance and development of gliomas, thanks to a generous donation of around $250,000 from The Aftershock (a not-for-profit organisation who raise funds and awareness for high mortality rate cancers).
Brain tumours (gliomas) generally affect young individuals in the prime of their lives – generally in their 30s-40s - and the personal and family impacts can be devastating. With generative deep learning techniques, this project will give clinicians the means to analyse vital data and the modelling tools to aid the diagnosis and classification of these gliomas for personal treatment to increase survival rates.
Authors: Professor Meng Law is the Professor in the Departments of Radiology, Electrical and Computer Systems Engineering and Neuroscience at Monash University and Director of Radiology and Nuclear Medicine at the Alfred Hospital. Dr Jarrel Seah is the head of AI research at iBRAIN at Monash University, Department of Neuroscience and a radiology registrar at the Alfred Hospital. Dr Andrew Dixon is a neuroradiologist and co-director of radiology training at the Alfred Hospital. He is Academic Director for Radiopaedia.org, the world's largest online radiology resource, and convener of multiple international radiology meetings each year.
Figure 1. Sample synthetic chest radiographs
Generative visual rationale
1. Seah JCY, Tang JSN, Kitchen A, Gaillard F, Dixon AF. Chest Radiographs in Congestive Heart Failure: Visualizing Neural Network Learning. Radiology [Internet]. Radiological Society of North America; 2018 Nov 6 [cited 2018 Nov 23];180887. Available here.
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Leading Parkinsonâ&#x20AC;&#x2122;s disease and mitochondrial research neurologist, Professor Carolyn Sue, has been appointed Director of Research at the Kolling Institute of Medical Research.
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CHRISTOPHE rof Carolyn Sue AM was the first female adult KEREBEL neurologist to be promoted to Professor in Australia and has been awarded numerous awards. Throughout her medical and research career, Carolyn has provided expert commentary in mitochondrial disease and Parkinson’s disease.
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The Kolling Institute is the oldest medical research institute in NSW, located on the Royal North Shore Hospital campus, and has been at the forefront of research for more than 90 years. It is jointly managed by the University of Sydney and Northern Sydney Local Health District (NSLHD). “Professor Sue is a highly accomplished neurologist and is internationally regarded for her work in both Parkinson’s and mitochondrial disease. She was recently invited to provide expert advice at the Federal Parliament’s Inquiry into Mitochondrial Donation, a new reproductive option to prevent the transmission of mitochondrial DNA disease.
The Kolling Institute is undergoing transformational change and Prof Sue has championed this strategic change, having been the interim Director of Research for more than 12 months.’’ The University of Sydney’s Executive Dean of Medicine and Health, Professor Robyn Ward, welcomed the appointment of Prof Sue. ”Prof Sue is extremely passionate about the Kolling Institute and the importance of translational research in healthcare. She will serve as a wonderful exemplar to the young clinician scientists who are our future’’ Prof Ward said. “She brings much enthusiasm to the role and brings years of academic, research and clinical experience which will help to continue Kolling’s vision in translating research to the patient’s bedside.’’ Professor Sue has worked at the Kolling Institute since 2002. She is the Director of Neurogenetics at Royal North Shore Hospital and Director of the National Centre for Adult Stem Cell Research (Sydney). “It is an honour to be appointed as the Director of Research for the Kolling Institute of Medical Research and I am excited to continue to work with the academic and research teams in the quest to deliver translational research outcomes for patients,’’ Prof Sue said.
Research Australia congratulates Professor Sue on being awarded membership of the Order of Australia (AM) in the 2019 Queens Birthday honors 'for significant service to medicine, particularly to mitochondrial disease'.
I look forward to strengthening the Kolling Institute and supporting the researchers and collaborators in undertaking innovative and life-saving research. I am excited about pursuing the opportunities in research funding and the investment the Federal Government has made in translational research.” Established in 1920 by an Act of Parliament as the Institute of Pathological Research of NSW, the Kolling Institute is an unincorporated joint venture of the Northern Sydney Local Health District and the University of Sydney. Located at St Leonards, it houses state of the art laboratory facilities. invited to speak at international conferences on mitochondria and movement disorders. Author: The Kolling Institute
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Driving a treatment for spinal cord injury A ground-breaking clinical trial set for 2020 is creating new hope for thousands of Australians who suffer the devastating effects of spinal cord injuries.
lmost every day in Australia one life is changed forever by a spinal cord injury. Approximately 15,000 Australians currently live with paralysis caused by spinal cord injury and each year around 300 people are diagnosed with the condition. Each case incurs a cost over a lifetime of between $5 million and $9.5 million, and a combined cost to the Australian economy of around $2 billion annually. A successful treatment would not only transform the lives of sufferers, but create substantial savings for the entire health system. Researchers like Associate Professor James St John from the Menzies Health Institute Queensland (MHIQ) and the Griffith Institute for Drug Discovery (GRIDD) at Griffith University are working towards exactly that outcome. Their globally recognised team is planning to undertake a clinical trial next year to progress this journey and show that their therapy can further regenerate patients’ sensory and motor function.
THE PATH TO ENDING PARALYSIS
Research to find a treatment for paralysis has been undertaken across the world for decades. There have been many dead ends, many partial discoveries and a lot of hope. But now, the pathway to ending paralysis is illuminated. The potential answer? Taking a special type of cell from a patient’s olfactory (sense of smell) system and transplanting it into the spinal cord injury site. 30 INSPIRE 012 | 2019
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Associate Professor James St John and Associate Professor Jenny Ekberg from the Clem Jones Centre for Neurobiology and Stem Cell Research are leading the world in the discovery of a treatment for paralysis and brain injury. Pioneered by the 2017 Australian of the Year—Professor Emeritus Alan Mackay-Sim, this research is working to transform the lives of people who have experienced serious trauma. By combining advanced cell purification techniques with natural product drug discovery and biomedical engineering, the team is designing three-dimensional nerve bridges that will help injured nerves to regenerate. This exciting new therapy now offers hope for a treatment that could see paralysed patients regaining movement and feeling again.
By developing a therapy to treat the injured spinal cord, we can then apply similar approaches to treat acquired brain injuries,” says Associate Professor St John. “Nearly every day in Australia at least one person’s life is devastated by spinal cord injury and many more by brain injury. Our research gives thousands of Australians hope that paralysis doesn’t have to be forever.”
THE 2020 TRIAL
The project is well underway to progress the pre-clinical research into a Phase I/IIa human clinical trial in 2020. The first human efficacy study in 2014 showed the therapy was effective for partially repairing the human spinal cord. Now it’s time to make this therapy more effective, available and affordable. The aim is to conduct a Phase I/IIa clinical trial of a small number of patients with chronic spinal cord injury. First, patients will undertake a sustained functional activitybased therapy to prime their spinal nerves, brain and muscles for the cell transplantation. Then a 3D nerve bridge made of olfactory cells will be implanted into patients with chronic spinal cord injury. The 3D nerve bridge maximises the efficacy of the olfactory cells, reduces the existing scar tissue and promotes the regeneration of the nerve cells.
This methodology ensures that patients receive optimal restoration of motor and sensory function and that outcomes are as consistent as possible. Intensive and sustained functional therapy will be performed for at least 12 months starting immediately after surgery to maximise the regeneration of motor and sensory neural connections. Functional recovery is hoped to be detected in patients within several months after the transplantation. The clinical trial is anticipated to start in south-east Queensland in late 2020. The complete Phase I/IIa clinical trial is expected to cost $20 million over six years. 32 INSPIRE 012 | 2019
WHAT ARE OLFACTORY ENSHEATHING CELLS?
The olfactory system—or sense of smell—is unique in mammals in that its nerve cells are able to constantly regenerate. It’s the only part of our nervous system that regenerates every single day as part of its normal function. And it’s lucky that it does: every time we breathe in, the nerve cells in our nose are exposed to bacteria and toxins and get killed off. If these didn’t regenerate, humans would lose their sense of smell in around a month. Olfactory ensheathing cells (OECs) are crucial to this process of regeneration. They prevent scarring and protect and guide the growing nerve cells. With this knowledge, scientists from around the world have tested the efficacy of OECs for repairing the injured spinal cord, with promising results.
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Associate Professor James St John working in his Laboratory.
HOPE IN SIGHT
“While we believe this approach will be successful, there is still a long way to go. This transformative research has the long-term support from the Perry Cross Spinal Research Foundation, the Motor Accident Insurance Commission and the Clem Jones Foundation—but we need your help too. Griffith University and its partners are on a journey to develop a treatment for paralysis for all. With an evidence-based end game in sight—it’s time to make the impossible, possible,” says Associate Professor St John.
Author: Associate Professor James St John is a world-class researcher at the Menzies Health Institute Queensland (MHIQ) and the Griffith Institute for Drug Discovery (GRIDD) at Griffith University, where he heads the Clem Jones Centre for Neurobiology and Stem Cell Research.
Associate Professors James St John and Jenny Ekberg.
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THE LAST WORD YOUNG LIVES MATTER We should not have to say it, but we do. We have to say it to decision-makers and authorities, and somehow we have to convince young people that it is true.
uman lives matter for their own sakes. We do not acquire significance and importance only when we become economically productive, and lose it when we are not. Disrespect for children, disrespect for the elderly, and disrespect for the unemployed, are linked to the same essential problem: a belief that a person’s worth can be measured in dollars and cents. “What are you worth?” Your worth is immeasurable, and your price is above rubies. But that is not necessarily the way it feels. In Australia, about a third of those who die in the 15-24 age group have taken their own life. They took their lives when the world was before them. Why? For a long time, we were told that there must have been something wrong with them – how could they? Or, is there something wrong with the world? However we answer that question, we are left with a problem. While we are working out the answers, sorting through them and working out how to apply them, somewhere in the world a life is lost to suicide every forty seconds. This terrible loss continues despite all the talk of mental health, all the investment in mental health strategies. Do we need to talk more? Do we need to invest more? Or, do we need to talk and invest differently? We do not know. We only know that we must keep trying. Families and hearts are breaking. So we are trying to understand.
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Young people take risks. They are supposed to take risks. They should experience failure, as well as success – because without failure, success has no meaning. They need to learn resilience – because in any world there will be blows from which to recover. Working to understand the interplay of risk and resilience, the matrix within which risk-taking occurs, and the nature and effects of “the thousand natural shocks that flesh is heir to” is something we can do now. At Young Lives Matter – UWA, University of Western Australia researchers are looking at the ways emergency departments and mental health services interact with patients in a public hospital, and at the development of a suicide risk indicator. One of those contributing expertise is Professor Michael Small, who holds the CSIRO-UWA Chair in Complex Engineering Systems. His bachelor’s degree was in pure mathematics; his doctoral research used nonlinear time series methods to study children’s breathing patterns. Professor Small embedded a post-doctoral researcher in a hospital emergency room to study the interaction of individuals presenting with mental health issues – either suicide ideation or those of self-harm. On the basis of the evidence and experience obtained, a network map of the mental health system was constructed, tracking the flow of people and information. Key individuals and processes were identified, using the same methodology employed to follow footballers
as they play, and patient units became living beings with KEREBEL CHRISTOPHE agency.
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We are also challenging the idea that an individual is simply the sum of a set of parts that can be analysed and categorised as a machine might be.
People are thinking, feeling, adjusting, re-adjusting “beings”. They do more than exist as statistical entities in an unchanging landscape. We are all involved in complex webs of interactions that have different effects and consequences, in environments which are themselves changing. So, we are collecting the usual demographic, environmental and personal history data – but combining them with a time sequence of individual assessments of mood. This is repeated daily or on multiple occasions each week. In this way, we begin to get a picture of the personal mood or perceptions trajectory of specific individuals. The data is studied with a combination of machine learning and techniques from complex systems and dynamical systems theory to understand an individual’s risk of self-harm. The effect is to restore the sense of the vitality and agency of the people whose data is being studied. They are understood as dynamic beings, who create their own lives. Understanding that risk has a trajectory, with variations over time, allows us to consider susceptibility in relation to the presentation of triggers. In other words, a person who does not appear to be likely to self-harm today is less likely to be dismissed as being “okay now”. We are learning to look at people who are more than the sum of their parts, and who live complex, changing lives in complex, changing environments. We are not casting them as characters in a play, where they are typecast as “okay people” and “problem people”. We need the young people we are losing; and we need multi-disciplinary, sensitive and imaginative approaches to saving them. If you or anyone you know needs help you can contact Lifeline 13 11 14
Author: Professor Dawn Freshwater ViceChancellor, University of Western Australia.
ABOUT PROFESSOR DAWN FRESHWATER
Research Australia has welcomed Group of Eight Chair and University of Western Australia Vice-Chancellor, Professor Dawn Freshwater, to its Board of Directors. Research Australia Chairman, Chris Chapman said, “As the national peak body for health and medical research, Research Australia’s Directors are prominent figures from all stages of health and medical research, Professor Freshwater is no exception.” Research Australia’s Managing Director and CEO, Nadia Levin said, “Professor Freshwater’s appointment strengthens our deep connections with the university sector and Research Australia’s historic ties with Western Australian health and medical research. “Her success in leading the development and implementation of a new strategy at the University of Western Australia and her strong background in mental health research make her an ideal fit to join other Directors in guiding Research Australia to realise its full potential as a ‘system architect’ of Australian health and medical research,” Nadia Levin said. Professor Freshwater said that she was honoured to be able to lend her expertise to Research Australia. “As a national peak body, Research Australia holds a pivotal role in bringing together diverse voices from across the health and medical research pipeline. I am very much looking forward to working with the Board of Directors to further embed medical research in the Australian health landscape.”
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