Blog

New research challenges our understanding of tendon suitability for knee reconstructions

With an increasing number of people suffering anterior cruciate ligament (ACL) injuries, researchers at the Kolling Institute say a broader range of tendon grafts could be successfully adopted by surgeons undertaking knee reconstructions.

The research, which is the second-largest human tendon study ever published, is prompting calls for tissue banks to review current age restrictions and the range of tendons approved for grafts.

The study comes as Australia continues to record one of the highest rates of ACL injuries in the world. Interestingly, these injuries are not limited to professional athletes, but are impacting all age groups, particularly children.

Previous research has highlighted a consistent increase in ACL injuries and knee reconstructions in recent years, with the biggest rise impacting children in the five and 14 age range.

Researchers from the Kolling Institute’s Murray Maxwell Biomechanics Lab say their study could help increase the number of tendon allografts used by surgeons, and the options for patients.

Study lead PhD student Dylan Ashton, from the University of Sydney and the Kolling, said if you were to rupture your ACL today and opt for surgical treatment, your orthopaedic surgeon would most likely use your hamstring tendons as a graft to reconstruct your ACL.

“This approach however, can cause additional pain and create functional deficits. It can also be difficult to source enough healthy tendon in younger patients, and those who have re-ruptured their ACL,” he said.

“These issues have increased the popularity of using tendon allografts, which are sourced from deceased human tissue donors.

“Currently there are strict limitations around the type of allografts used, and age limits where tissue banks will only accept donors up to the age of 65 years.

“We expect our research findings will now prompt a review of these restrictions.

“We mechanically assessed the strength of nine tendons from the lower leg, three commonly used as allografts, and six new candidates.

“As part of our research, we investigated the impact of donor age, sex, height and weight on the biomechanical properties of the graft.

“Importantly, we found that donor age was not associated with weaker tendons, even when including donors into their nineties – and the strength of the new tendons was higher than the strength of tendons which are commonly used as allografts.

“We also found that even though these new candidates were slightly smaller, five out of the six new tendon options were able to withstand the same or higher force as a hamstring tendon.”

Laboratory Director, Associate Professor Elizabeth Clarke said our findings are important as it means there could be a much broader range of tendon options available to surgeons and their patients, and this could directly improve outcomes for those who experience this increasingly common ACL injury.

“We hope this new research will give surgeons and tissue banks greater confidence to consider a wider range of tendons, and a higher age range of tissue donors when allografts are indicated for ACL reconstruction,” she said.

The team is pleased to have completed this body of research which represents a significant step towards more evidenced-based options for the treatment of ACL injuries in Australia.

The study’s findings have been published in the prestigious American Journal of Sports Medicine.

20 January 2023
New funding to help drive vital research into heart disease

Congratulations to Kolling Institute researcher and Royal North Shore Hospital cardiologist Dr Steve Vernon who’s been awarded a highly sought-after postdoctoral fellowship by the Heart Foundation.

The fellowship is designed to support talented early career researchers and emerging leaders.

Dr Vernon has welcomed the award.

“I am delighted to receive this postdoctoral funding from the Heart Foundation as it will allow me to expand upon the work I completed during my PhD studies at the Kolling Institute and the University of Sydney.”

Dr Vernon is a clinician researcher working to identify new risk factors and blood markers of early heart disease to help improve risk prediction and prevent heart attacks.

The Heart Foundation fellowship will allow Dr Vernon to continue his work with the BioHEART study, which is using advanced imaging, risk factor and blood marker assessments to identify new signs of heart disease.

This will be particularly important for people who are susceptible to heart disease, without the traditional risk factors.

Dr Vernon will also be working on a study using a new genetic risk score, incorporating thousands of genetic markers, to identify people at risk of heart disease.

This study will focus on designing a new pathway using the genetic risk score for people who are found to have a low or intermediate risk after a traditional heart health check.

Currently, this group is offered counselling to modify their lifestyle, but they’re not offered medications to reduce their risk of heart disease.

It’s estimated up to 20 per cent of this group may be at high risk of developing coronary artery disease in their lifetime based on their genetic risk.

Dr Vernon plans to use the genetic risk score to identify patients at increased risk so that further investigations can be carried out using a CT scan coronary artery calcium score.

This research has the potential to identify a group of people who will benefit from more proactive prevention strategies including targeted medications.

“In my clinical practice as an Interventional Cardiologist, patients diagnosed with life-threatening heart attacks or unexpected cardiovascular disease commonly ask ‘why me?’

“Inspired by my patients, this program of research aims to broaden our knowledge base to answer this question, but more importantly, it has the potential to identify people at risk well before they develop symptomatic heart disease so that we can implement effective preventative therapies.”

20 December 2022
Kolling researcher recognised on the international stage

Congratulations to research fellow Dr Lisa Kouladjian O’Donnell who has received a prestigious award for her contribution to pharmacology.

Lisa was presented with the ASCEPT Early Achievement Award for Women during the annual meeting of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists.

This year’s event was held in Perth in collaboration with the Australasian Pharmaceutical Sciences Association. For the first time in three years, it attracted clinicians and researchers from across the globe.

Lisa’s award is a highly coveted accolade – designed to recognise significant achievement in research in pharmacology or toxicology. It was established to foster gender equality across the field and in future leadership roles.

The University of Sydney’s Emeritus Professor Graham Johnston and Associate Professor Tina Hinton were instrumental is establishing the award, convinced of the need to achieve greater gender equity in pharmacology.

Lisa has welcomed the special award, saying it is a tremendous honour.

“I’m very humbled to receive this award. I’m supported by many women in pharmacology and receiving this award also recognises their achievements.”

As part of the Kolling Institute’s Laboratory of Ageing and Pharmacology, Lisa drives research to improve the quality use of medicines in older adults. She specifically helps develop digital health interventions to identify high risk medicines.

Her main project involves the development and implementation of the Goal-directed Medication review Electronic Decision Support System known as G-MEDSS.

Further information about this system to ensure the safe use of medications is available at https://gmedss.com

16 December 2022
Philanthropic support helping women with gestational diabetes and their babies

Generous funding provided through the Douglas and Lola Douglas scholarship is strengthening evidence around the long term impacts on children born to mothers with obesity and gestational diabetes.

Endocrinologist and Kolling Institute researcher Dr Tessa Weir has been able to continue her valuable research as a result of being awarded the scholarship.

“I am incredibly grateful for the support provided through the Douglas and Lola Douglas scholarship,” she said.

“It has meant I’ve been able to pursue my postgraduate studies and support improvements in the care of women with obesity and gestational diabetes, and their babies.

“My hope is to fill the gaps in evidence and generate guidelines and policy to extend prenatal and perinatal obstetric care, particularly for women managing these health challenges.

“Our research will involve a systematic review to detail how maternal obesity and gestational diabetes directly affects neonatal outcomes. We will also be using new artificial intelligence techniques to develop a personalised risk predictive tool for perinatal outcomes.

“This will also consider the timing of births, with early births linked to many adverse impacts such as developmental delays.”

Dr Weir said this is such an important field of research, with maternal obesity and gestational diabetes contributing to significant, long-term health challenges for unborn children.

“We know from earlier research by fellow Kolling researchers Associate Professor Sarah Glastras and Professor Carol Pollock that these maternal factors can influence foetal programming, and alter an unborn child’s future metabolic risk. This in turn increases the likelihood of ongoing weight issues.

“The prevalence of child and adolescent obesity is increasing, with an alarming 25 per cent of children in Australia over the healthy weight range.

“Childhood obesity is associated with an increased risk of developing cardiovascular disease, chronic kidney disease, diabetes and psychological conditions.

“All of these issues can have a life-long impact, compromising quality and even length of life, so it’s tremendously important we drive research progress in this area and broadly improve the quality of care provided to women and their babies.

“Overall, this scholarship is not only helping me complete my PhD studies, and broaden my experience as a clinician-researcher, it will also hopefully improve the future health of countless children born to women with gestational diabetes and obesity.”

7 December 2022
Transforming treatments for those with diabetes

Kolling researcher and Royal North Shore Hospital endocrinologist Associate Professor Sarah Glastras will have a key role in a national effort to improve long-term outcomes for those with diabetes.

The initiative has brought dozens of experts from across the country together under the banner of the Australian Centre for Accelerating Diabetes Innovations Research.

International collaborators will also be involved, providing crucial research data and supporting advances in the delivery of care.

The centre, which has been made possible with Federal Government funding, will drive improvements in the care of those with diabetes from diagnosis through to its devastating complications.

Importantly, the program will aim to support Indigenous and non-Indigenous Australians, addressing inequities in care and increasing life expectancy for all Australians. Targeted programs will ensure equal access to new products and clinical trials regardless of cultural backgrounds or remote locations.

Associate Professor Glastras is the training lead for the project, and will oversee the program along with a team of training advisors from each state and territory.

“This is a tremendously exciting program bringing the brightest minds in the country together to deliver new models of care for the diagnosis, prevention and treatment of diabetes and its complications,” she said.

“I’m thrilled to have been appointed the ACADI training lead and I look forward to providing much needed support to trainees, especially in the areas of research translation – making sure that the research that we do leads to important benefits and outcomes for our patients.

“The ACADI training program will leverage the expertise from the medical and research community, government and related agencies, commercial partners and people with diabetes.”

The national initiative has identified three priority areas, including a focus on diabetic kidney disease, diabetic foot syndrome and complications from hyperglycaemic hyperosmolar syndrome.

A third of people with diabetes develop diabetic kidney disease, which is the leading cause of end-stage kidney disease, and a major risk factor for cardiovascular disease and premature death.

“Sadly, current interventions only slow the progression of diabetic kidney disease.

“It’s anticipated there will be an increasing demand for kidney replacement therapy with our ageing population and an increasing prevalence of diabetes in younger age groups.

“We are very hopeful that this national initiative will accelerate innovations to improve the lives of people with the disease and at risk of developing the condition.

“Our research will focus on the early identification of people at risk, improvements in diagnosis, prognosis and management. We hope that this collaborative approach will deliver real improvements in the care offered to all communities.”

In further encouraging news, Sydney Health Partners has established a Diabetes and Obesity Clinical Academic Group. Associate Professor Glastras will be part of this new collaborative group which will explore research gaps in obesity, pre-diabetes and diabetes treatment.

11 November 2022
Research expertise on show

The diverse range of exciting research underway across the Northern Health Precinct was profiled during a recent showcase, highlighting the impact of research throughout Northern Sydney Local Health District.

The event directed the spotlight to a range of disciplines driving research including nursing, midwifery, and pharmacy, as well as allied health and public health.

Precinct Academic Director Professor Robyn Gallagher co-ordinated the event, saying it was a wonderful opportunity to showcase a collection of emerging leaders and present details of their valuable projects.

“Our event provided an insight into the successful collaborative efforts involving the University of Sydney and the Northern Sydney Local Health District, and the tangible impact these projects are having on the delivery of care,” she said.

“There are so many dynamic projects underway from a mobile app to support pulmonary rehabilitation to the delivery of remote cardiac rehabilitation, and programs to improve cancer care.

“It was encouraging to hear our researchers are enhancing the delivery of care with nutrition services, speech pathology and sleep programs to name just a few.”

One clinician researcher to present at the event was Associate Professor Tom Buckley – a registered ICU nurse and Precinct Research Education Academic Director.

Tom shared details of his work investigating the physical and psychological impact of bereavement. He has particularly focused on the impact on heart health with research indicating there is an increased cardiovascular risk for both men and women in the weeks and months after they lose a loved one.

“We know that death from a cardiac related event is one of the highest causes of mortality during bereavement,” he said.

His research also assessed the benefits of Aspirin and the heart lowering drug Metoprolol and their ability to reduce cardiovascular risk factors in the weeks after the death of a loved one.

“Our research has shown the use of medication not only lowers the cardiovascular risk factors, but also reduces depression and anxiety symptoms in the early bereavement period.

“Interestingly, we found this trend continued even after people came off the medication, providing a longer-term benefit for this group.”

The showcase profiled the development of Australia’s first mobile health platform which supports those with respiratory disease to complete a virtual rehabilitation program.

The app, originally developed with the CSIRO, is driven by globally recognised experts and offers individualised exercise and education programs.

NSLHD clinical specialist physiotherapist and University of Sydney honorary lecturer Dr Sally Wootton said the team is tremendously proud of the platform.

“It has taken five years to develop our innovative app but we are thrilled to now have a commercial partner and to be supporting a large number of people living with chronic respiratory disease with this virtual rehabilitation program,” she said.

The showcase also focused on research comparing in-person and remotely-delivered cardiac rehabilitation.

PhD candidate Dion Candelaria said services pivoted to remote delivery with the onset of COVID-19, and this provided a chance to measure the benefits of each model of care.

“We found positives with both approaches, with some patients preferring face to face communication with clinicians and other patients, while others welcomed the convenience of the remote service with no travel and quicker access to care.

“We know that the sooner patients access care the better the health outcomes, so there are clearly benefits with remote services.

“We will continue to develop a hybrid model of cardiac rehabilitation care, combining the best components of in-person and remote care.”

The showcase broadened awareness of the diversity of research across the Northern Health Precinct, and encouraged further collaboration.

3 November 2022
Kolling researcher among hypertension thought leaders at international meeting

Kolling Institute researcher and RNSH Senior Hospital Scientist Dr Anastasia Mihailidou says she was delighted to showcase the district’s work in blood pressure management on the world stage.

Dr Mihailidou, who is head of the Kolling’s Cardiovascular and Hormonal Research Lab, presented at the recent International Society of Hypertension Scientific Meeting in Japan.

Globally renowned academics and clinicians were among those who attended the event, which profiled the latest clinical and biomedical research into the treatment of hypertension.

“I was excited to talk about my professional passion about accurate blood pressure measurement,” said Dr Mihailidou, who presented on Hypertension Therapy Using Diagnostic Service for Ambulatory Blood Pressure Monitoring.

“I am proud that my work was considered of interest to the international community involved with this meeting.

“Outlining some of the work being done in this area locally was a great honour not only for myself, but for Royal North Shore Hospital and the Northern Sydney Local Health District.”

This was the ISH’s 29th Scientific Meeting, which this year had the theme, ‘The Wisdom for Conquering Hypertension.’

The five-day event, which took place in the Japanese city of Kyoto, featured several presentations on issues including technological developments and the impact of diet and COVID-19 on cardiovascular health.

Presenting at the event was the latest accolade for Dr Mihailidou, who has previously been appointed by The Lancet to the Commission on Cardiovascular Disease in Women.

Her work has informed clinical practice nationally through the development of the Australian Guidelines for Ambulatory Blood Pressure Monitoring.

Dr Mihailidou, who is also Education Portfolio Executive Member with the High Blood Pressure Research Council, said it had been terrific to present at the meeting.

“I felt it was important to address some of the misinformation that has come from different sources but also confirm what I believe to be the most accurate method in the management and detection of blood pressure,” she said.

“To present was a great honour for myself personally, but I’m ecstatic that a global audience was exposed to the work being done here in the District.”

19 October 2022
Our research expertise recognised with multi-million dollar grants

We would like to congratulate Professors Carol Pollock and Gemma Figtree who have received significant National Health and Medical Research Council Investigator Grants.

Despite a tremendously competitive field, both clinician/researchers have been awarded $2 million to progress their world-leading research and improve long-term patient outcomes.

The announcement highlights the experience and expertise at the Kolling Institute, with Professors Pollock and Figtree joint leaders of our Cardiovascular and Renal Priority Research Area.

Professor Figtree’s research will investigate innovative solutions to reduce heart attacks for those without the typical risk factors.

Professor Figtree, an interventional cardiologist at Royal North Shore Hospital, said approximately one-quarter of first-time heart attack patients do not have any of the typical risk factors of coronary artery disease, and yet they have developed what is regarded as silent coronary artery disease without any symptoms.

Gemma and her team will use this group to extend their understanding of the disease and identify markers relevant to all patients at risk of a heart attack.

Her program will drive the discovery of new biomarkers for the early detection and treatment of coronary artery disease. This will lead to improved knowledge and health outcomes, and importantly, earlier diagnosis and treatment of the disease.

“I am enormously grateful to the NHMRC for this support. It will help my team follow exciting leads towards clinical translation, and help develop a new way of detecting coronary artery disease and preventing heart attacks,” she said.

Professor Carol Pollock’s program of research will work to reduce the personal and societal impact of kidney disease.

Carol is a renal medicine specialist at Royal North Shore Hospital and an internationally respected academic at the Kolling Institute.

Chronic kidney disease currently affects over 13 per cent of the global population and 10 per cent of Australians. End-stage kidney disease is escalating and directly costing the Australian economy around $1.8 billion a year.

Professor Pollock says despite our treatment strategies, a progressive loss of renal function is inevitable.

Our program will involve three main components, including an assessment of new strategies to prevent or slow the development of kidney disease for which we currently have some positive preliminary data. These include ibody therapeutics, and the delivery of mesenchymal stem cells.

We will also expand our program promoting the regenerative capacity of kidney fibroblasts, and finally, we will thoroughly analyse the models involved kidney disease that spontaneously recover from kidney injury compared with the models that progress to irreversible fibrosis.

“I’m really thrilled to have secured this funding to undertake our work and develop our research which we hope will have transformational benefits for patients with kidney disease,” she said.

“While early-stage research requires several years to translate to clinical benefit, we are well placed at the Kolling to speed-up improvements in patient care.

“For a clinician researcher, the Kolling Institute, a partnership between the University of Sydney and the Northern Sydney Local Health District, provides the ideal environment to take basic research to clinical trials.

“Our Renal Research Laboratory has researchers from diverse professional backgrounds and this will facilitate the successful delivery of the research.

“Importantly, we are also well supported by partners in the biotech and pharma industries to accelerate our research into practice.

“The security that five years funding brings is welcomed by my exceptional scientific staff and I would also like to acknowledge the philanthropic support we have received.

“I fully recognise that without seed funding from philanthropists this funding would not have occurred.

“I am grateful for the untied funding that has allowed me and my laboratory to develop preliminary data, which has in turn paved the way for these funds.

“We look forward to progressing our work and sharing some amazing results over the next five years.”

17 October 2022
Outstanding career recognised with national accolade

We would like to congratulate Kolling Institute researcher Professor Sarah Hilmer who has been elected a Fellow of the prestigious Australian Academy of Health and Medical Sciences.

Professor Hilmer is part of a select group of researchers who have been admitted to the academy, which works to advance health and medical research across Australia. She has joined the highly-respected organisation in recognition of her important contribution to healthcare and research.

Sarah has welcomed the election, saying it was not expected.

“I was surprised and honoured to be elected a fellow of the Australian Academy of Health and Medical Sciences,” she said.

“I have great respect for the work of many of the current fellows and I look forward to contributing to the activities of the academy, particularly supporting younger researchers.

“Mentorship for health and medical researchers is a priority for me in my roles at RNSH, the University of Sydney and the Kolling, as well as through the Sydney Health Partners Geriatric Medicine Clinical Academic Group.”

Sarah has worked as the Head of Clinical Pharmacology and as a geriatrician at Royal North Shore Hospital since 2005. Her research and clinical expertise is respected both nationally and internationally.

Sarah leads a research program in ageing and pharmacology at the Kolling Institute and has contributed widely to the management of medication. Her research focuses on understanding and optimising medication use and improving outcomes in older people, particularly those living with multiple conditions.

Sarah has developed the Drug Burden Index, a tool to measure the overall risk of a person’s medicines to their physical and cognitive function. This tool is being used widely across the Northern Sydney and Central Coast local health districts.

Sarah said she has been tremendously fortunate to have worked across clinical practice, research and policy, and to have worked with a wonderful network of mentors, colleagues and mentees.

“I am particularly glad that I have helped train clinicians and researchers with backgrounds in medicine, pharmacy, nursing and basic science in geriatric pharmacology, who can help build this emerging field.”

14 October 2022
Researchers closer to better pain management strategies

Researchers at the Kolling Institute have taken an important step towards the development of safer, non-addictive pain medications by increasing our understanding of spinal cord pain signalling.

This valuable progress has been recognised internationally with publication in the Journal of Physiology, a leading scientific journal.

The findings follow the latest figures indicating more than 20 per cent of the population experience chronic pain, impacting their ability to work, care for families and generally function.

Dr Karin Aubrey said many people currently rely on opioids, like morphine and codeine, to reduce their pain.

“We know however, that these medications have serious side effects and in many cases offer only limited help,” she said.

“Our team, including senior researcher Dr Yo Otsu, is committed to advancing our understanding of how pain signals travel through the body, so that we can use this information to develop safe, new medications.

“This unique study used advanced techniques to unravel the spinal pain control circuit, and determine how opioids affect a key descending pain pathway. Interestingly, this pathway can enhance and reduce spinal signalling.

“Our spinal cords are an incredible information highway, responsible for relaying sensory, motor and pain information to the brain.

“The connections that make up the circuits of the spinal cord are all jumbled together and it’s difficult to unravel them and map how each connection contributes to controlling pain signals in the spinal cord.

“In this study, we’ve identified how a particular point in the spinal pain circuit is controlled by opioids, giving us a clearer picture of how a good pain medication might work.

“We currently have a reasonable understanding of the brain and pain circuits, but there is still so much more to discover.

“Each one of us has about 86 billion cells in our brains called neurons, which is approximately half the number of stars in the Milky Way. Essentially our heads are a small galaxy.

“This gives some context to the complexities of the brain and pain circuits, and the challenges involved in making significant scientific progress and advances in treatments.

“We are encouraged by the progress we’ve made and the deeper understanding we now have around the spinal cord pain signalling and potential targets for new therapies.

“Our findings have broadened our understanding of how the spinal cord pain circuit is organised and affected by opioids.”

This project was made possible with the support of the Ernest Heine Family Foundation and the Pain Foundation.

1 October 2022

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