Heading-off sepsis in intensive care

Reads fiction and non-fiction. He recently finished an Ian McEwan novel but is also reading a history of Africa. Goal: to eventually read histories of every region around the globe.

Ariel is from Melbourne but loves travel – so he’s chosen the right career. He spent six months as an exchange student in Montreal where he mastered skiing. He went to Bordeaux for an immersive science workshop last year and revelled in the experience.

Spends a lot of time as a resident tutor at Janet Clarke Hall at the University of Melbourne, helping first, second and third year students.

Plans to build skills especially in computerised and mathematical research He has witnessed brilliant thinking when clinicians cross into brain research so wants to be involved.

Started “PhiloSOFI” a Facebook page for fellow Florey scientists interested in philosophy and neuroscience.

Dr Yugeesh Lankadeva, mentored by senior research leader, Professor Clive May, has developed a technique to provide doctors with an early warning that septic shock (sepsis) is beginning to damage a patient’s kidneys, while there is still time to act.

In intensive care units around the world, bacterial infections causing sepsis are the leading cause of death. In Australia each year, an estimated 10,500 people will suffer acute kidney failure because of sepsis or complications during cardiac surgery, and roughly 3000 of those patients will die.

Yugeesh says that even those who survive are at long-term risk because their kidneys can be so damaged by the trauma. Secondary kidney failure deaths, long-term dialysis and kidney transplants add to the health and economic impact.

Until now, sepsis has been almost impossible to diagnose until it is too late. Doctors could previously only detect severe oxygen loss in the kidneys, leading to irreparable damage, once the acute low blood pressure had become life threatening. By then, patients would be unresponsive to traditional therapy with vasopressors, leading to severe uncontrolled hypotension, reduced organ perfusion, organ failure and death.

For many years, the Florey has been examining how the brain controls body organs, and it was in this context that Yugeesh began exploring sepsis.

Yugeesh has been able to show that while sepsis is developing, extra blood is sent towards the kidney, but less of this blood makes it to the kidney’s inner zone. As that part of the organ becomes deprived of oxygen, cells stop functioning normally, causing the kidneys to fail. Because urine is produced in the kidneys, Yugeesh suspected that oxygen levels in the kidneys would be the same as those in urine. By testing the urine oxygen levels, imminent kidney damage can be detected and treatment begun more quickly.

Importantly, he adds, techniques have been developed so a catheter can be directed to the bladder. “We’ve added methodology to the new technology.”

The technique has worked with patients undergoing heart surgery - another patient group at high risk of developing kidney failure. Simultaneously, a pair of successful observational trials at Austin Health validated Yugeesh's initial results in sheep. Florey colleague and Director of Intensive Care at Austin Health, Professor Rinaldo Bellomo, is collaborating.

The ramifications of the discovery promise to be enormous, both in terms of lives saved, but also in economic savings for the health care system.

“The cost to the health system of dealing with acute kidney failure at the moment is about $400 million,” Yugeesh says.

All of this has occurred at a time when sepsis is an increasing threat. Yugeesh, a National Heart Foundation fellow, says the incidence of sepsis is rising as our population ages and the number of drug resistant infections increases.

Sepsis can affect anyone and can be acquired both within our community (70 per cent of cases) and from hospitals and health care facilities (30 per cent). “It is more common among people with weakened immune systems, such as newborn infants and the elderly.

“It is also a risk for patients with pre-existing health complications, such as cancer, diabetes, AIDS and kidney or liver disease, who don’t have the ability to fight off these infections.”

His work is attracting considerable attention, with politicians from both sides of politics meeting Yugeesh when he visited Canberra recently for an annual “Science meets Parliament” event.

Recently went to MONA and was captivated by the evolutionary origins of art. Why did art happen? What desire motivated early artistic expression? Was it a sexual selection tactic? Do human brains just like patterns and decorations?

Student, Ariel ZeleznikowJohnston, 24, is undertaking a PhD with Dr Emma Burrows and Professor Anthony Hannan. He’s examining whether brain stimulation helps to prevent or delay neural degeneration.

Has been trying to play the piano for a while. He likes the side effects of music on other parts of the brain.

His work with mouse modelling means he sits in a small room performing the same tasks over and over. He sometimes wonders if he’s secretly part of a larger experiment to see if a lack of environmental enrichment affects a PhD student.

“I’d be quite happy if my work ends up helping people or being useful,” Ariel says, “But I just really want to understand how the brain and the mind function.”

Recently had his first paper published, on the environmental enrichment of rodents with touch screens – the Florey’s first such publication.