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Researchers tackle one of the nation’s biggest health challenges

Researchers from the Kolling Institute will support an important, Australia-wide project to address the inappropriate use of medications in residential aged care.

The initiative, to be co-ordinated by Monash University’s Centre for Medicine Use and Safety, has been awarded $2 million through the Medical Research Future Fund.

It will see pharmacists embedded in residential aged care facilities, so they can implement evidence-based recommendations to improve the use of psychotropic medications in people living with dementia and in aged care.

Australian research suggests more than 60 per cent of residents use psychotropic medications, like antidepressants on a regular basis, and more than 90 per cent of residents experience one or more medication-related problems.

Project lead Professor Simon Bell said rates of psychotropic medication use remain high, despite an overall lack of evidence for benefits and well-established risks.

“New models of evidence-translation are needed to ensure safe and effective medication management,” he said.

“Through this project, pharmacists will work in close partnership with nurses, GPs, residents and their families to provide training in managing changed behaviours and to coordinate education using evidence-based resources.”

Kolling researcher Professor Sarah Hilmer, a leading geriatrician and clinical pharmacologist has welcomed the opportunity to be part of the research team.

“Importantly, this project will help implement best practice for the vulnerable people living in aged care. It’s exciting to work with this multidisciplinary team to improve care in this complex environment,” she said.

The project will involve the New South Wales Therapeutic Advisory Group, which is chaired by Professor Hilmer. The group will lead the development of quality use of medicines indicators for antipsychotics, benzodiazapines and antidepressants.

The four-year program will be conducted in partnership with the University of Queensland, Flinders University, University of Sydney and five aged care providers in Western Australia, Victoria, New South Wales and Queensland.

7 August 2021
Researchers to improve diagnosis for genetic disorders

Kolling researchers will drive a large, national research project to improve diagnostic rates for those with mitochondrial diseases and broaden treatment pathways.

A $3 million grant from the Medical Research Future Fund is being invested in the project, which will involve clinicians, researchers and diagnostic scientists from a host of organisations including the Kolling and the Murdoch Children’s Research Institute.

Kolling Executive Director and project clinical lead Professor Carolyn Sue has welcomed the funding, saying the study will use the latest technology of genome sequencing to help diagnose those with mitochondrial diseases.

“This technology will build on our earlier research which demonstrated that whole genome sequencing was the best way to identify these diseases,” she said.

“In recent years, new DNA technologies have increased our ability to diagnose mitochondrial diseases by more than doubling the detection rate of genetic mutations in affected patients.

“Importantly, we anticipate this new approach with combined omic technologies will raise diagnostic rates to over 70 per cent.

“This landmark improvement will lead to more patients being diagnosed, opening up more effective treatment pathways and crucially, improving long-term health outcomes.”

The technology will offer greater support with family planning and prevent some diseases from being passed on from generation to generation.

“Mitochondrial diseases are very difficult to diagnose, and in some cases it has taken many decades for an accurate diagnosis to be confirmed.

“I’m really pleased to be leading our talented, multi-disciplinary clinical team on this project, which may offer support to a large number of people.

“Mitochondrial diseases can have a devastating impact on individuals and their families. The disease robs people of their energy and can affect any organ in the body.

“That’s why this research is so important and has a great potential to make a significant improvement to many people’s lives, and not just their lives, but their children’s lives as well.”

The project is a collaborative study also involving Kolling researcher Dr Ryan Davis and teams from the Murdoch Children’s Research Institute, Telethon Kids Institute, the University of Melbourne, Monash University, Queensland Children’s Hospital and the Mito Foundation.

12 July 2021
Australian first study to alleviate pain for those with spinal cord injuries

Researchers from the Kolling Institute will partner with international and Australian experts to examine an innovative approach to nerve pain for those with spinal cord injuries.

The ground breaking study has been awarded more than $1.78 million through the Federal Government’s Medical Research Future Fund.

Professors Ashley Craig, James Middleton and Paul Glare from the Kolling will join the study as chief investigators, with Associate Professor Sylvia Gustin from the University of NSW leading the trial.

Professor Craig said the study will investigate the effectiveness of an advanced interactive intervention to reduce nerve pain and improve function.

“We often regard loss of mobility as the most serious impact of a spinal cord injury, but we have found people with this injury consistently indicate nerve pain is their most difficult and debilitating challenge,” he said.

“We know that nerve pain affects up to 75 per cent of people with a spinal cord injury, and they describe the pain as burning, sharp, unbearable, unremitting and terrifying. Such pain is often linked with serious depression.

“Current treatments often involve the use of antidepressants, anti-epileptics and opioids, but these medications provide limited pain relief to around 30 per cent of people and have a host of adverse side-effects related to addiction and kidney failure.

“This means a large number of people with a spinal cord injury continue to experience debilitating pain with no access to effective treatment options.”

The five-year study will assess a new approach using an interactive gaming technology to reduce pain by helping to rectify the negative impact of the spinal cord injury on brain activity.

Spinal cord injuries generally reduce the frequency of brain activity, so this highly-specialised game has been designed to encourage high frequency activity and beneficial changes to the brain.

Professor Craig welcomed the opportunity to be involved in the promising, collaborative trial.

“Around 200 people a year suffer a spinal cord injury in NSW, and while that number may not seem large, these catastrophic injuries have a tremendous impact on individuals and their families,” he said.

“If we’re able to effectively reduce their nerve pain without major side effects, it’ll have an immeasurable impact on their health, their ability to work and function, and specifically their mental health as well.”

The trial will bring together researchers from the Kolling as well as the University of Sydney, University of NSW, University of Technology and the University of Washington.

9 July 2021
Age and sex influence the adverse effects of multiple medications

There are calls for a carefully-considered, tailored approach to the prescription of multiple medicines with new research finding a person’s age and sex influence the impact of multiple medications.

More than half of older Australians take five or more regular medications, with the higher number of medications directly linked to a higher chance of adverse reactions, like falls, confusion and frailty.

Researchers from the Ageing and Pharmacology Laboratory at the Kolling Institute, led by Professor Sarah Hilmer, used an experimental model to measure the impact of multiple medications, including high risk drug classes.

The research confirmed the multiple medications had an adverse impact, reducing independence in daily living, increasing anxiety and reducing physical function including grip strength, motor endurance and gait speed.

Further analysis found the negative impacts were influenced by age and sex.

The decline in independence and increase in anxiety were significantly greater in the old than in the young, while males were more likely to experience reduced grip strength than females.

Professor Hilmer said this was an important body of research and the first study to rigorously assess the effects of age and sex on susceptibility to the adverse impacts of multiple medications.

“The research indicates that a one-size fits all approach to the prescription of multiple medications is not advised, and the differences in age and sex should be considered,” she said.

“To get the best outcomes from medications, we need to practice personalised medicine.

“It’s important to consider not only the person’s diagnosis, but also their age, sex, other medications, other diseases, genetic and environmental factors.

“We would particularly like to see a more cautious approach when multiple medicines are prescribed for older people.”

Co-first author Dr John Mach said further studies are needed to investigate the impact of a broader range of medications.

“While males were more susceptible to the regimen we tested, females may be more susceptible to other drug classes.

“Our study highlights the need for further investigations to ensure medication use across Australia is supported by scientific evidence.”

Dr Harry Wu, who was also a co-first author, hopes the study will be the first of many to promote a more personalised approach to medication use.

“It has been exciting to have the opportunity here at the Kolling to conduct this bedside to bench research, to help understand how to treat and monitor patients who take multiple medicines.”

10 May 2021
Cancer expertise recognised

The Kolling’s Dr Amanda Hudson will lead an exciting pilot study after being awarded an innovation grant by the Mark Hughes Foundation for brain cancer research.

The Bill Walsh Lab scientist is one of a select group to have received funding from the foundation. Her research will now investigate the early detection of disease progression in brain cancer.

Dr Hudson said identifying changes in tumour growth early is the key to maintaining the wellbeing of cancer patients.

“Our project aims to improve the monitoring of patients with brain cancer, so that we can identify if a tumour has begun to grow, even before any symptoms develop,” she said.

“This would allow ineffective treatments to be stopped, and other treatments that may be able to control the tumour to begin as soon as possible.”

Currently brain tumours are monitored with imaging or through surgery, but these techniques have limitations.

This project will use simple blood tests to find factors or protein biomarkers in the blood that change as tumours change.

“Blood samples will be taken at routine clinical check-ups so that patients don’t need to come to the clinic more than necessary.

“This will allow us to follow these factors along each patient’s journey with brain cancer.

We’ll be able to see how the factors change with treatment and over time, and we may be able to predict if the tumour will respond to the treatment.

“We’ve already identified some protein biomarkers in the tumours that change as the tumours starts to grow. We will now test these in the blood to see if those levels also change.

“We will also be looking for all of the proteins in blood, which will help predict the behaviour of the tumour.

“If this project is successful, it will greatly assist the management of patients with brain cancer. “

10 December 2020
Philanthropic funding brings new hope to those with chronic pain
Some of the nation’s leading pain experts are set to embark on research which they believe will change the way chronic pain is managed.

The program of research will be carried out by the team from the Pain Management Research Institute after generous funding from the Ernest Heine Family Foundation.

Located within the Kolling Institute and Royal North Shore Hospital, the Pain Management Research Institute is part of the University of Sydney’s Faculty of Medicine and Health. It is the Ministry of Health’s designated lead site for pain research in NSW.

Institute Director Professor Paul Glare said more than $2,820,000 will go towards three projects over the next three years through the Pathways to Better Pain Management Program.

“Chronic pain affects 20 per cent of the population and one third of people over 65,” he said.

“It is the major cause of disability, costing the Australian economy an estimated $73 billion a year.

“There is a pressing need to develop better management strategies, so we will be launching three research initiatives, which together have the best chance of improving the lives of those living with chronic pain.”

The projects include:
- Research led by Dr Karin Aubrey and Professor Chris Vaughan which aims to uncover new biological mechanisms which produce and maintain chronic pain. This will help to develop safer and more effective medications for chronic pain.
- Research led by Professor Paul Glare and Dr Claire Ashton-James to develop digital behavioural interventions to help patients alter their attitudes and behaviour in response to pain, and lower the use of potentially harmful opioid medications.
- Research led by Associate Professor Paul Wrigley to provide better support to people with chronic pain in the community, reducing their need for Emergency Department care.
Associate Professor Paul Wrigley said his project ED PainPATH represented a unique opportunity to raise awareness of the needs of people with chronic pain and improve access to essential support.

“With the help of a large hospital and community team from across NSW, a care pathway for people with chronic pain is being assessed,” he said.

“It will support people to manage distressing chronic pain through a co-ordinated care program, improving health outcomes and reducing costs.

“Importantly, this initiative could be adopted across the state if it proves successful.”

Dr Karin Aubrey has welcomed the substantial funding for her research, saying there are currently very few effective medications for ongoing pain.

“Chronic pain is challenging to treat and there’s a lot we still don’t understand about what happens in the brain when chronic pain develops,” she said.

“If we can gain a better understanding of how long-term pain changes the brain, we will be in a better position to reduce it.

“Our research will aim to identify new drug targets that influence chronic pain, and this will help us develop new medicines to effectively treat the pain,” Dr Aubrey said.

Professor Glare said we are incredibly grateful to the Ernest Heine Family Foundation for this very generous funding, especially at this time with so much economic uncertainty.

“We anticipate our research will improve the lives of many Australians living with chronic pain, and we are excited to commence this important collection of work.

“We are confident it will deliver results by identifying new drug targets, reducing the use of opioid medications and improving care across the community.”
12 November 2020
Key appointment for Kolling researcher

Congratulations to the Kolling’s Dr Ryan Davis following his appointment as president-elect of the Australian Society for Medical Research. (ASMR)

Dr Davis is part of the Neurogenetics team, driving research into mitochondrial diseases and Parkinson’s disease.

His work bridges basic and clinical research, while he also supports the Neurogenetics Clinic at Royal North Shore Hospital to improve the diagnosis and treatment of neurogenetic conditions.

Dr Davis has welcomed his new role, saying it’s a privilege to be leading the society in its 60th year.

“ASMR is a strong advocate for health and medical research in Australia, with a long history of support for researchers,” he said.

“The current pandemic has highlighted the need for advocacy, given the impact of COVID-19 on the sector, research jobs, and capacity across Australia.

“There is a clear need for greater investment in the basic discovery research pipeline, as well as for the health and medical research sector generally.

“Despite the challenges we’ve faced this year, it’s an opportune time for the sector to come together to highlight the benefits of a strong health and medical research sector, from a better economy to broad health and social benefits.

“I’m optimistic that by strengthening our advocacy through a collective voice, we can deliver greater support and financial backing to the health and medical research sector.”

9 November 2020

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