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TranslatingScienceintoBetterHealth

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Princess Alexandra HospitalMedical Research

Translating Science into Better Health

P r i n c e s s A l e x a n d r a H o s p i t a l M e d i c a l R e s e a r c h�

Princess Alexandra Hospital Medical Research Translating Science into Better Health

Researchers at the Princess Alexandra Hospital are dedicated

to turning scientific discoveries into better treatments for human

diseases. No better has this been demonstrated than with the

advent of the first-ever cervical cancer vaccine developed by 2006

Queenslander and Australian of the Year Professor Ian Frazer and

his team (The University of Queensland, Centre for Immunology and

Cancer Research) based at the Princess Alexandra Hospital.

Translating Research: Key to Health .................................................................................................................................................5

From Clinical Problems to New Treatments: The Journeys of Discovery ......................................................................................6 The Story of the Cervical Cancer Vaccine: A Complete Journey from the Laboratory to the Whole Community

Working in our Laboratories: The Early Stages of Discovery ..............................................................................................................8Identifying Problems and Testing Solutions: Researching at the Bedside.........................................................................................8

Antibiotic Effectiveness in Burns – Defences Against Infection ......................................................................................................9

Cancer of the Blood - Overcoming Barriers in CLL .......................................................................................................................9

Cancer of the Blood – Tool to Monitor AML ................................................................................................................................10

Cancer of the Breast – Potential to Revolutionise Care ...............................................................................................................11

Cancer of the Head and Neck – New Ways to Treat Head and Neck Cancers ..............................................................................12

Chronic Liver Disease – Understanding why the Liver Fails .........................................................................................................13

Diabetes – Type 2 – Day to Day with Diabetes ...........................................................................................................................13

Heart - Development of Tools and Diagnostics to Measure Heart Health.......................................................................................14

High Blood Pressure – Curing Blood Preasure ...........................................................................................................................15

Inflammatory Arthritis – Identifying Arthritis Genes .....................................................................................................................15

Liver Disease and Drugs – Know How Your Powerhouse Works ...................................................................................................16

Melanoma – Individualising Treatments .....................................................................................................................................16

Obesity – Understanding how Fat Cells Work – Conquering Obesity ............................................................................................17

Osteoporosis – Strengthening (yourself and) your Back Bone ......................................................................................................17

Rheumatoid Arthritis – Getting your Body to Work Smarter .........................................................................................................18

Spinal Injury – Linking Nerve Cells to Recovery ..........................................................................................................................19

Making Sure our Patients and Communities get the Best Treatments: Improving Health Care Delivery in Hospitals and the Community. .................................................................................................21

Medication Management – Medicines in your Daily Life .............................................................................................................22

Older People – Assessing Older People Anywhere Anytime .........................................................................................................23

Queensland Liver Transplant Service – Liver and the Brisbane Technique ....................................................................................23

Renal Dialysis – At Home at Night .............................................................................................................................................24

Statin Therapy in Patients with Serious Infection – Unexpected Therapy ......................................................................................25

Rehabilitation Program – Home-based Rehabilitation Program for Survivors of Critical Illness or Injury ..........................................25

I’m One of the Lucky Ones – Danielle Tindle. ..................................................................................................................................26

Research at a Glance. ....................................................................................................................................................................28

C O N T E N T S

T r a n s l a t i n g S c i e n c e i n t o B e t t e r H e a l t h�


Professor Ian Frazer

“Medical research is our investment in our children’s future.”

Professor Ian Frazer, 2006 Australian of the Year

2006 Australian of the Year

The Princess Alexandra Hospital is the

pre-eminent research hospita l and is the major

c l in ical tr ia ls centre in Queensland. The Hospita l

has fostered a strong research culture with active

programs in basic science and cl in ical research.

The theme of a l l research at the Hospita l is

translat ional biomedical research, ut i l is ing research-

based understanding of disease processes to

develop new treatments and therapies to improve

the health of the community.

Our researchers – cl inicians and scientists - are

on a journey of working together with patients and at

the laboratory setting to advance treatment and care

for many diseases. They are dedicated to translating

scienti f ic discoveries into better treatments for

major human diseases. One example has been

the development, by Professor Russel l Strong

and his team, of the “Brisbane Technique” of l iver

transplantation. This technique uses par t of an adult

l iver as a donor organ for transplanting into babies

and chi ldren, and is now used worldwide.

A second example of “ translational research” is the

advent of the cervical cancer vaccine developed

by 2006 Queenslander and Austral ian of the Year,

Professor Ian Frazer, and his team at the Princess

Alexandra Hospital. This 15 year journey concluded

with tr ials for the cervical cancer vaccine being 100%

successful resulting in the vaccine becoming

commercial ly avai lable in 2006 to gir ls

and young women worldwide.

Health and disease are complex.

Great solutions of ten require the

collaboration of experts with a

variety of knowledge and skil ls. Our

researchers work collaboratively

with colleagues within and outside the hospital

– across the nation and around the world - to

continuously improve clinical practice to benef it our

patients and community. Questioning, enquir ing,

identifying and researching clinical problems to f ind

clinical solutions are our way of improving care.

The answers may come from research conducted

initial ly at our laboratories or our hospital wards.

Our research involves all professional groups

across the hospital – doctors, nurses, al l ied health

staf f and scientists. Strong collaborative l inks between

these teams, in association with the universities, is a

key ingredient of our success. Our research ranges

from basic laboratory research through to research at

the bedside to whole communities. We are enquir ing

into cancer, brain tumours, l iver disease, hear t

disease, ar thritis, kidney disease, high blood pressure,

obesity, diabetes and osteoporosis. Identifying

inhibitors to the advancement of these diseases and

providing therapeutic solutions are the core priority of

the research teams in delivering improved outcomes in

patient care. Our cl inician researchers are dedicated

to advancing health care and facil i tate best cl inical

practice by initiating, developing, conducting and

supporting research across the continuum of care.

Princess Alexandra Hospital research

has received national and international

recognition; improved the ef f iciency of service

delivery; and enhanced patients’ l ives.

Professor John Prins

Chair, Centres for Health Research

Dr David Theile Snr

Clinical Chief Executive Off icer

T R A N S L AT I N G R E S E A R C H Key to Health

Dr David Theile (Snr) Professor John Prins


Cervical cancer is one of the few human cancers

arising from infection with a virus - the Human

v (HPV). Knowing this, as a result of the work

done by Professor Zur Hausen and colleagues

in the early 1980s, I felt we could treat it l ike

any other viral infection – using the body’s

defences against infection, the immune system,

either to prevent infection or to treat it.

I f irst began to research these possibilities in 1985,

when I was appointed to the position of Director of

Immunology at the Princess Alexandra Hospital.

On appointment I had a couple of research grants;

one on HPV infection and one on autoimmunity.

In the early days, my research team was housed

in the basement of the Princess Alexandra

Hospital renal unit. There was little room to

move, and close collaboration was essential.

A couple of years later, the Lions Kidney and

Medical Research Foundation provided improved

research accommodation where our team was given

half a f loor and over the next f ive years we managed

to build up a substantial research team with funding

from government grants, and from several charities.

In 1990 Dr Jian Zhou and his wife Xiao-Yi joined

my research team. Jian’s knowledge in the field

of HPV virology complemented my interest in HPV

vaccines. Our idea was to insert the DNA coding

for the HPV outer coating into another virus which

could infect skin cells. We hoped that once in a

skin cell, it would produce the HPV virus coating.

Vaccines against papilloma-virus in cattle had

already been developed, using killed virus, so we were

confident we were on the right track, though we knew

we couldn’t use this trick for the human viruses, as

they couldn’t be grown in the lab. Putting the theory

into practice with HPV proved more challenging.

Viewing down a microscope, the virus has an

egg-like quality; a shell of protein encapsulates

the ‘yolk’ of genetic information. One day we saw

to our amazement, in pictures of material purif ied

from cells infected with our hybrid viruses in

the laboratory, that there were proteins forming

into the shape of the HPV virus’s outer shell.

This was the ‘start’ of building a whole virus. No

vaccine had ever been made this way before.

We were always unsure whether the virus shell would

be ef fective as a vaccine – while the animal studes

we had done were encouraging, it was possible that it

F R O M C L I N I C A L P R O B L E M S T O N E W T R E AT M E N T S :

The Journeys of DiscoveryThere are many journeys of discovery underway at the Princess Alexandra Hospital.

The stage of development of each is dif ferent, with the focus varying from laboratory and

clinical experimentation to testing in hospitals or the community. Ultimately each has the

desired endpoint of improving the health of patients or preventing disease in the community.

Here we highlight several areas of our research, through stories which tel l of journeys of

discovery and i l lustrate steps on the research road at the Princess Alexandra Hospital.

The Story of the Cervical Cancer Vaccine:A Complete Journey from the Laboratory to the Whole Community Professor Ian Frazer


would be much harder to protect people against this

very successful virus. Only when the results of the

early clinical tr ials became available in 2001 could we

be sure that this vaccine was doing what it should.

Two vaccines based on our v irus l ike par tic le

technology passed the ini t ia l safety and ef f icacy

evaluations and went into several phases of

c l in ical tr ia l. In 2001, 12,000 women from thir teen

countr ies (6000 on the vaccine ) par tic ipated in

a two year tr ia l of one of these vaccines. It was

necessary to prove that this vaccine not only

prevented infection by HPV virus but also prevented

changes to the cel ls that can result in cancer.

Af ter two years, none of the 6000 women on the

vaccine developed any pre-cancerous changes.

When I star ted work on the HPV vaccine project

in the late 1980s, I thought the hard par t would be

to make the v irus l ike par tic les that have become

the basis of the vaccine to prevent HPV infection.

Whi le that research wasn’t easy, i t was re latively

quick, in comparison with the much longer and

harder business of developing the vaccine and

testing i t. The chal lenge now wi l l be to educate

the general publ ic and the medical profession

about this vaccine, and to ensure that i t is used.

In Austral ia, there are more than 1000 cases

of cerv ical cancer a year, about 300 of which are

fatal. According to the World Health organisation,

more than 270,000 women global ly die of cerv ical

cancer every year. Two vaccines have been

developed with the technology which Dr Zhou

and I descr ibed. One vaccine (Cervar ix ) protects

against two types of HPV that cause 70% of the

cerv ical cancers. The other (Gardasi l ) protects

against these two types, and two types responsible

for genita l war ts. More strains of HPV wi l l be

added to future vaccines, which wi l l eventual ly

protect against more than 90% of cancers.

Gardasi l has now been approved by the Austral ian

Therapeutic Goods Administration as wel l as in

several other countr ies. A school based program to

immunise gir ls is under consideration in Austral ia.


Clinical research involves experiments which directly involve patients and

sometimes healthy members of the community. It can involve studies to

understand how diseases af fect people, ref ining investigations to help in

diagnosis and testing of new treatments including drugs and procedures.

I d e n t i f y i n g P r o b l e m s a n d Te s t i n g S o l u t i o n s : R e s e a r c h i n g a t t h e B e d s i d e

Disease is the result of fundamental cellular processes going wrong. Basic research

into disease is a close collaboration of laboratory based scientists and clinicians, to

exactly def ine the normal process, then why and how this is defective in disease.

Wo r k i n g i n o u r L a b o r a t o r i e s : T h e E a r l y S t a g e s o f D i s c o v e r y


Antibiotic Effectiveness in BurnsDefences Against Infection

We know that understanding the distribution of

antibiotics in the body could help doctors adjust the

dose to ensure antibiotic levels are high enough to

adequately protect burns patients from infections.

Clinical ProblemInfection is one of the main life-threatening

risks faced by patients with extensive burns.

Antibiotics are often given by injection

to prevent infection of burned tissues.

It is not clear just how much reaches

the burned tissue from the blood.

In Our LabIn burned tissue, structure and function are

disrupted. Laboratory experiments have

been conducted into the effects of antibiotic

binding to blood proteins and the effects

of the fluids given in resuscitation to see

whether these influence antibiotic distribution

and penetration of antibiotics into burns.

At the BedsideA technique, microdialysis, has been used

to collect samples of antibiotics in the fluid

from within the layers of the skin. Antibiotic

levels in the skin and in the blood have

been compared in volunteers and in twelve

patients with extensive burns undergoing

surgical removal of burned tissue.

Cancer of the Blood Overcoming Barriers in CLL

Chronic Lymphocytic Leukaemia (CLL) is the commonest

leukaemia in the developed world with highly variable

clinical course. Some patients progress rapidly while

others progress more slowly, with survival ranging

from a few months to more than 10 years.

Clinical ProblemOur ability to predict clinical outcome in an

individual patient with CLL remains limited.

Unlike other cancers, the CLL cells accumulate

in the blood because of their ability to avoid

death rather than excessive growth of the

leukaemic cells. The research is hampered by

lack of suitable models for CLL, lack of CLL

cell lines and inability to keep cells alive once

removed from the body i.e. in cell culture. The

CLL is still incurable mainly because small

number of leukemic stem cells are able to survive

our current treatments. We have developed

strategies to overcome these hurdles.

In Our Laba. Using a relatively new technology called a

DNA chip, we are screening more than 18,000

genes at a time from patients with CLL to see

which ones are on or off. By determining the

level of expressions of large numbers of genes

(on or off), it is possible to predict clinical

outcome. Patient samples have been tested

and. genes have been identified which appear

to discriminate between patients with stable

disease and those who progress more rapidly.

b. By altering the conditions for cell culture we

have been successful in preventing these CLL

cells from dying for up to 7 weeks thus allowing

us to study them closely.

c. We have identified a key protein called PKR

which is important for cell death. This may

be allowing the leukemic cells to live for-ever.

Defective PKR appears to be associated with a

worse outcome.

d. Research is underway to identify, isolate and

characterise the CLL stem cells from patient

samples using new technology.

Change Clinical Practice The above research initiatives are likely to lead

to better diagnosis, individualised treatments

and to new innovative therapy for CLL.


P r i n c e s s A l e x a n d r a H o s p i t a l M e d i c a l R e s e a r c h10

Cancer of the Blood Tool to Monitor AML

Acute Myeloid Leukaemia (AML) is a significant health

burden as the overall outcomes remain poor with at best

only 30 – 40% long-term survivors.

Clinical ProblemFollowing chemotherapy, half of the patients

relapse (deteriorate) despite the fact that no

leukaemia was detected by current tests.

More sensitive techniques are needed to detect

persisting leukaemia in the marrow.

In Our LabBy developing molecular techniques in our

laboratories it is possible to detect and

quantify the persisting leukaemia in about

20% of our patients. Further methods are

under development which can detect residual

leukaemia in up to 80% of cases.

The outcome of this project is to provide a new

tool that clinicians can use to sensitively monitor

the effect of treatment in patients with AML.

This allows a far more accurate assessment of

disease burden and provides information about

the risk of leukaemia returning. This would result

in earlier intervention for resistant or relapsing

disease which is likely to provide superior

outcomes for patients.

Patient - Based StudiesThere are currently two national clinical trials in

two different subsets of AML patients testing the

residual disease assays in conjunction with the

therapeutic strategies being studied. Samples

from patients enrolled on these studies across

Australia are shipped to the Princess Alexandra

Hospital for testing. Results will be correlated

with patient outcome to determine how best to

use the new laboratory tests.

T r a n s l a t i n g S c i e n c e i n t o B e t t e r H e a l t h11

Cancer of the Breast Potential to Revolutionise Care

Breast cancer affects one in 10 women in Australia. The

primary and most effective treatment is surgery. Sometimes

the cancer has spread from the breast by the time of

diagnosis, requiring an operation to remove some lymph

nodes from the armpit area. This is a larger operation with

more side effects, so methods to help the surgeon decide

how extensive the surgery needs to be would be very useful.

Clinical ProblemStudies over many years have shown the

importance of detecting cancer cells in the lymph

glands of the armpit (axilla) when a woman

is treated for breast cancer. The information

gained from removal of these glands (axillary

clearance) is important for: planning treatment;

predicting long term outcome; and reducing the

risk of recurrence in the armpit. With trends to

decreasing tumour size an increasing proportion

of women will undergo axillary clearance, only

to find that that their lymph glands were free

of disease. Unfortunately axillary clearance

also carries with it significant risk of affecting

the arm with numbness, reduced shoulder

mobility and in particular lymphoedema. This

can have an effect on the quality of life of a

woman who has undergone surgical treatment

for breast cancer and delay her recovery.

Patient - Based StudiesThe concept of the sentinel lymph node in breast

cancer is based on the premise that the first

lymph node to receive lymphatic drainage from

a primary cancer in the breast should be the

first site of spread of the cancer. If that gland or

glands can be identified, and analysed it may

indicate the status of remaining axillary lymph

glands by removing only one or a few lymph

glands. Sentinel node biopsy therefore has

the potential to provide accurate assessment

of axillary lymph node status without the risks

of an axillary clearance and perhaps improve

recovery time from breast cancer surgery.

Test the TreatmentThe Royal Australian College of Surgeons Breast

Cancer Section commenced an Australian multi-

centre randomised controlled trial comparing

Sentinel Node biopsy to Axillary Clearance for

invasive breast cancer of 3 centimetres or less.

The trial is called the “SNAC Trial”. Patients who

entered the trial were randomly allocated to

either sentinel node biopsy or axillary clearance.

The two treatments have been compared with

regard to side effects and effect of quality of

life, in particular the effects on the treated arm.

Change Clinical Practice We have been a major contributor to this trial

which was the first randomised controlled

trial of surgical management of breast cancer

devised, initiated and completed within

Australia and New Zealand. The results of

this trial have the potential to revolutionise

breast cancer surgery by proving that a

procedure for surgical treatment of breast

cancer can produce accurate results with

fewer side effects than existing surgery

and allow earlier recovery from surgery.

P r i n c e s s A l e x a n d r a H o s p i t a l M e d i c a l R e s e a r c h1�

Cancer of the Head and Neck New Ways to Treat Head and Neck Cancers

The treatment of cancers involving the head and

neck is gradually improving. However, around 40% of

people who have these cancers will ultimately die of

them. The major reason for the failure of treatment is

the inability to remove or treat small traces of cancer

left behind after surgery or radiation therapy.

Clinical ProblemTheoretically, the best approach for treating

residual disease after surgery should be

chemotherapy. Existing chemotherapeutic

agents are often too toxic to be used in

sufficient doses to eliminate the cancer

cells. New drugs that selectively attack

the remaining cancer cells, without

damaging normal cells in the rest of the

body, will be essential to provide cures.

In Our LabA new class of cancer drugs known as histone

deacetylase inhibitors have been identified and

tested by our researchers. Laboratory tests of a

number of these inhibitors at our Hospital have

shown that they are effective at killing head and

neck cancer cells. These encouraging results

have been published and now form the basis for

a new clinical trial of the inhibitor, valproate, in

head and neck cancer patients at our Hospital.

Clinical StudiesWe have recently initiated an early phase clinical

trial of valproate in patients who have had previous

unsuccessful treatment or for whom traditional

management strategies are not available.

These early trials will allow us to determine the

safety and efficacy of valproate and will identify

whether it is worth going to a larger clinical trial

to test the anticancer properties of valproate.

Change Clinical PracticeThe use of these inhibitors represents a

new class of systemic therapies that may

be available to cancer patients. If successful

the use of these inhibitors will provide a new

therapeutic option for clinicians and patients

in the fight against this deadly disease.

Chronic Liver DiseaseUnderstanding Why the Liver Fails

The Clinical ProblemThe Princess Alexandra Hospital houses the

Queensland Liver Transplant Services. Most

patients undergoing liver transplantation have

cirrhosis or severe scarring of the liver. Common

causes of cirrhosis are viral hepatitis, particularly

hepatitis C; alcohol- and obesity-related liver

disease; and inherited conditions such as

haemochromatosis (where excessive iron is

stored in the liver). Overweight and fatty livers can

increase the rate of liver disease progression for

those patients who have another liver disease and

also decrease the success rate of anti-viral therapy.

We are unsure how these diseases cause liver

scarring, but as these conditions are becoming

more common it is necessary to understand

this process so that effective therapies can be

developed, hopefully to prevent the development

of cirrhosis and need for liver transplantation.

Compared with the treatment of other diseases,

there are relatively few therapies available for

chronic liver disease.

In Our LabWe are investigating whether different genes or

proteins in liver cells can affect the outcome of

liver disease and the response to treatment. We

are also determining which obesity-related factors

contribute to increased rate of disease progression

and the poor success of anti-viral therapy. We

are interested in the ways different cells in the

body communicate with each other, particularly

fat cells and liver cells. We are also examining the

role of other factors such as iron and alcohol on

liver disease and examine the factors that cause

certain liver cells to produce scar proteins.

In Our ClinicWe are reviewing clinical factors that contribute to

the severity of liver damage, to identify new targets

for treatment. Based on our previous research, we

are conducting clinical studies to investigate the

effects of lifestyle modification (diet and exercise)

on the outcome of liver disease and the response

to treatment. This issue is important both before

and after liver transplantation. We are active in

clinical trials of new medications for the treatment

of liver disease. We are also developing specific

non-invasive strategies to monitor and improve the

outcome of a range of treatments.

Diabetes - Type 2Day to Day with Diabetes

The World Health Organisation reports that the number of

people with diabetes world-wide continues to increase. By

2025 it is estimated that due to population growth, ageing,

unhealthy diets, obesity and sedentary lifestyles this number

is expected to increase to over 300 million.

The Clinical ProblemType 2 Diabetes (Mellitus) is a condition in which the

body is not able to respond correctly to the hormone

insulin resulting in increased blood sugar levels. This

leads to many serious health complications.

In Our LabOur researchers are involved in a number of

projects investigating the underlying causes of Type

2 Diabetes Mellitus. These include research on:

a) how high levels of glucocorticoids (which occur

either due to obesity or to certain drug treatment)

induce insulin resistance and Type 2 diabetes;

b) why, in individuals with Type 2 diabetes, the

tissues, organs and cells don’t respond to insulin

in the way that they should; c) the way pregnancy

causes diabetes in some women, because this

might give some clues as to the cause of Type 2

diabetes in the general community. Further-more,

our researchers are using diabetes in pregnancy

as a clinical situation to investigate regulation of

nutrient supply to the foetus and how interactions

between the foetus, placenta and mother

predispose to an increased risk of Type 2 diabetes

and obesity later in life.

At the BedsideOur researchers are involved in a range of clinical

studies in obese individuals and individuals with

Type 2 diabetes. These studies aim to determine

the effects of combinations of long-term lifestyle

changes and pharmacological treatments on

development and/or progression of Type 2

diabetes. This work includes detailed assessment

of heart (cardiovascular) and metabolic changes in

response to different treatments.

Test the Treatment Our clinical researchers are investigating how

improved diabetes control, independent of weight

loss, affects non-alcoholic fatty liver disease.

In the CommunityThese investigations will provide new insights into

the molecular and physiological mechanisms that

contribute to the regulation of insulin sensitivity

and metabolism. Ultimately this knowledge

may translate into new avenues for therapeutic

intervention in diabetes and obesity.

T r a n s l a t i n g S c i e n c e i n t o B e t t e r H e a l t h1�

Heart Development of Tools and Diagnostics to Measure Heart Health

Recording of the position and motion of the heart through

stress echocardiography is often used after a heart attack

to identify whether heart muscle is still viable (i.e. will recover

after bypass surgery) or damaged irreversibly.

Clinical ProblemThe accuracy of stress echocardiography

assessment is dependent on the training and

expertise of the doctor reviewing the study.

A quantitative, automated measurement

would help overcome this limitation. We have

overcome this limitation in collaboration with an

ultrasound equipment company (GE-Vingmed).

In Our LabEngineers developed a means of measuring

strain in the heart, by comparing the velocity of

adjacent pieces of myocardium (the muscular

substance of the heart). This basic physical

parameter measures the deformation of muscle as

it contracts. The optimal approach to acquisition

of this parameter was defined in collaboration

with the clinicians. The technique was validated

in animals whose hearts were implanted

with microcrystals to ensure that the muscle

shortening measured using the strain approach

was indeed the true shortening.

At the BedsideSegments that showed reduced function at

rest had reduced strain rate. Viable segments

showed an improvement in strain rate with

dobutamine stress. We defined normal ranges for

the technique in patients with a low probability of

coronary disease and confirmed these in patients

with normal coronary angiograms.

In patients with a previous heart attack, we found

the strain technique was as predictive of recovery

after heart surgery as an expert interpreter, with the

combination even better. The technique improved

the accuracy of non-expert readers.

In the CommunityStrain rate imaging is used as an adjunct to stress

echocardiography in our laboratory. We have

given training sessions to familiarize other centres

with this technique.

Further developments include modifying the

approach to identify coronary disease in patients

who have not had previous heart attacks, and

using new technologies to improve the robustness

of the technique.



Inflammatory ArthritisIdentifying Arthritis Genes

Ankylosing spondylitis is a common form of

inflammatory arthritis affecting 20,000 Australians, which

causes pain in and progressive stif fness of the spine.

Clinical ProblemAnkylosing spondylitis is a form of inflammation

of the spine and joints in the lower back. Over

time, chronic spinal inflammation (spondylitis)

can lead to a complete cementing together or

fusion of the vertebrae, a process referred to as

ankylosis. There is a strong genetic component.

There are currently no treatments which can

induce remission in the condition or which have

been shown to slow down the progression of

the spinal fusion.

In Our LabWe are performing genetic studies in thousands

of affected individuals and unrelated healthy

people to identify the genes involved. One such

gene which we have shown definitely is involved

in ankylosing spondylitis is IL-1A. This gene

produces a protein which is known to promote

inflammation profoundly.

Patient- Based StudiesWe are investigating the effect of blocking this

protein. If this trial proves successful, then we

will develop treatments to block the function of

this protein to use in ankylosing spondylitis. We

have established a specialist clinic for ankylosing

spondylitis patients at PAH to optimise the

management of their arthritis. We expect if we get

to trial this new treatment approach in humans

that this clinic will act as the main trial centre.

High Blood PressureCuring Blood Pressure

High blood pressure (hypertension) can lead to significant

disease and death – it is the commonest chronic condition

affecting Western communities - due to strokes, heart

disease and kidney disease unless properly treated.

Clinical ProblemTreatment of hypertension usually means lifelong

medications to control blood pressure. These

medications can be expensive and cause side

effects, and in some patients may not be effective

enough to keep the hypertension under control.

For people fortunate enough to be found to have

an underlying reversible cause, specific treatment

of that condition can bring about marked

improvement in blood pressure control and even

cure of hypertension in many cases.

In Our LabOur current research focuses on identifying

abnormal genes that cause primary

aldosteronism so that detection of this

condition will be made easier through

genetic testing allowing many more patients

to be identified and to receive specific and

potentially curative treatment.

Patient- Based StudiesBy testing large numbers of patients, we

discovered that one potentially curable form of

hypertension known as primary aldosteronism,

once thought to be rare, is actually very

common, and accounts for as many as 10% of

people with hypertension.

Change Clinical Practice This finding has led to cure of hypertension in

hundreds of patients with hypertension who

have attended our Unit, and much better blood

pressure control for hundreds more.

Liver Disease and DrugsKnow how your Powerhouse Works

We know that many drugs are el iminated from the

body by metabolism or being changed chemically by

the l iver. Understanding how drugs are distr ibuted

from the blood to the l iver and within the l iver, and

how metabolism is af fected wil l aid in the selection of

appropriate drugs and dosing regimens for groups of

patients with l iver disease.

Clinical ProblemPatients who have liver diseases such as cirrhosis,

who undergo liver transplants or who have had

part of the liver removed to treat cancer can

have an unpredictable response to some drugs

because of the changes in the liver.

In Our LabLaboratory experiments have been conducted

to compare drug metabolism and distribution

between models of healthy livers and diseased

livers. Models have also been developed to

explore the link between arthritis and liver

disease observed in patients. A drug has

been identified in laboratory studies that

can indicate the severity of liver disease and

disruption to liver function when the drug’s

metabolism and distribution are measured.

At the BedsideThe usefulness of the drug marker of liver

disease severity in patients is being tested by the

Therapeutics Research Unit in conjunction with

the Department of Gastroenterology.

Melanoma Individualising Treatments

Clinical ProblemIn the melanoma clinic we have noted a

variation in response to radiation therapy

for patients with melanoma. We would

like to obtain more information on how to

predict response to radiation in patients with

melanoma by a process called micro-array

analysis where multiple minute samples of the

melanoma tissue are tested simultaneously.

Lab ExperimentsSamples from patients with melanoma are

obtained using biopsies and subjected to micro-

array analysis. This is done to streamline the

process for any future project.

Patient- Based StudiesA study is underway investigating the relationship

between biological molecular markers, the

characteristics that are understood to be

indicators of responses to a therapeutic

intervention, and sensitivity to treatment

with radiation. Patients have their tumours

measured, then biopsied. They are all treated

with a standard radiation dose and schedule and

their tissue subjected to micro-array analysis

for molecular markers. Patients with markers

suggesting a predictive ability for radiation

sensitivity are identified.

Test the TreatmentA confirmatory study is performed whereby

patients are identified as having melanoma which

is sensitive or resistant to radiation therapy

markers. Confirmation of the hypothesis can then

be performed.

Change Clinical Practice Patients with certain molecular markers can be

selected to receive radiation therapy in preference

to surgery for localised node positive melanoma.

Those tumours indicating possible radiation

resistance are treated surgically.


Obesity Understanding how Fat Cells Work - Conquering Obesity

We are searching for more ef fective strategies for the

prevention and treatment of obesity - a global problem

among children and adults alike. We are working to gain

a greater understanding of the factors that regulate fat

deposition in humans. We are taking two approaches

to this problem. Firstly, studying human fat cells in

the laboratory and investigating ways in which we can

inf luence their growth rate. Secondly, investigating

whether the ef fects of particular diets, exercise regimes

and drugs have an ef fect to reduce weight.

The Clinical ProblemObesity is a common condition that can lead to

medical problems including Type 2 diabetes, heart

disease, cancer and depression. The combined costs

of obesity arising from direct healthcare spending,

premature death, reduced productivity and lost work

days exceed A$1.5 billion per annum in Australia.

In Our LabAnti-obesity drugs currently available are not very

effective and side effects are common. Our aim of

researching into molecules involved in fat cell growth

and targeting these molecules using drugs is to

develop novel therapies to clinically treat obesity.

In the ClinicWe are investigating how effective particular diets

and particular types of exercise are in reducing

obesity. We are also investigating the potential

benefit of some anti-diabetic drugs as a component

of the management of obesity. In parallel we are

assessing the cardiovascular benefits of these lifestyle

modifications.

In the CommunityWe have developed and initiated the “Change for Life

- Health Program”, an intensive program involving

lifestyle changes such as diet and exercise, which we

are currently conducting clinical studies.

OsteoporosisStrengthening (yourself and) your Backbone

Osteoporosis, a condition where the bone becomes

less dense, af fects 150 mill ion people world-wide

and f i l ls more hospital beds than any other disease.

Osteoporosis which occurs in 50% of women and

30% of men over the age of 60 is usually diagnosed

af ter osteoporotic fracture. The estimated healthcare

cost in Australia is $1.9 bil l ion annually, and with the

continuing expansion of the aging population it is

estimated that women with broken bones wil l f i l l one

in three hospital beds by 2020.

Clinical ProblemBy the time osteoporosis is diagnosed,

significant bone has been lost, and cannot

be recovered with most current osteoporosis

therapies, which are predominantly bone-

protective. Our research aims to identify and

study new genes that may be targeted by novel

osteoporosis therapies to replace lost bone.

In Our LabThe two main areas of research in the unit relate

to the control of bone formation by nerves or by

vitamin D. In each case, the work involves the

study of model systems, using pharmacological

treatments to explore the cellular responses that

lead to increased bone formation.

Patient - Based StudiesFuture studies may include a search for variations

in the DNA sequence of genes shown to regulate

bone formation and to evaluate their relationship

to bone mass in humans. If such variations in DNA

sequence are identified, the possibility that they are

associated with better patient responses to existing

bone-protective treatments and to the sole available

bone-replacement treatment will be tested.

Test the TreatmentIn association with commercial partners, new

drugs will be developed to exploit the genes

shown to be important for bone formation. These

drugs will be tested for the ability to increase

bone mass and decrease low-impact bone

fractures in osteoporotic patients.

Change Clinical Practice Osteoporotic patients will be given the novel

gene-based bone-replacement therapies to

increase bone mass prior to initiation of bone-

protective therapies, which will then prevent or

delay subsequent loss of the newly formed bone.


Rheumatoid ArthritisGetting your Body to Work Smarter

Rheumatoid ar thritis is a painful and sometimes

very disabling disease. The treatment is improving

slowly, but even modern treatments are only

par tial ly ef fective and may have side ef fects.

Clinical ProblemWhile major therapeutic improvements have

occurred over the last 20 years, response to

treatment is often sub-optimal or associated

with toxicity. Drug treatments for rheumatoid

arthritis can suppress the disease, but at

the same time weaken immunity making

patients vulnerable to infections.

In Our LabCertain body cells, called “dendritic cells” are a

natural component of the immune system. They

can be grown outside the body or specifically

targeted inside the body. Our research has

shown that these cells, generated in the presence

of certain chemical inhibitors to produce so-

called “modified dendritic cells” and exposed to

antigen, suppress immune responses in a very

specific way. This research has produced an

ability to suppress arthritic disease in mice.

Test the TreatmentAn early (or “Phase I) clinical trial of “modified

dendritic cells” in rheumatoid arthritis patients is

planned later this year using Rheumatoid Arthritis

“auto”-antigens. This trial aims to establish

whether the technique developed will work in

humans with rheumatoid arthritis, and that the

modified dendritic cells are of low toxicity.

Change Clinical Practice If these therapies prove to be of low toxicity

and to successfully suppress immunity in

patients with rheumatoid arthritis, they will

be the first antigen-specific therapies for

rheumatoid arthritis – suitable for treatment of

approximately 50% of patients with the disease.



Spinal InjuryLinking Nerve Cells to Recovery

The Queensland Spinal Cord Project is conducting a

Phase One clinical tr ial that may assist repair of the

injured spinal cord in humans.

Clinical ProblemEach year, approximately 250 people suffer

a serious traumatic spinal cord injury. While

some of these individuals may have a partial

recovery from their injury, many do not, and

spinal cord injury is currently untreatable.

In Our LabWe are working with a type of cell called an

Olfactory Ensheathing Cell. This is a type of

nerve cell found surrounding the olfactory

nerve in the nose and where this nerve

enters the brain at the olfactory bulb.

The nerves of smell regenerate throughout life.

As these nerves die, Olfactory Ensheathing

Cells assist the growth of the new nerves

from the nose into the olfactory bulb.

Patient - Based StudiesWe are conducting a trial to evaluate a

surgical procedure that may assist repair

of the injured spinal cord in humans by

transplanting these cells from the olfactory

mucosa into the damaged spinal cord.

This trial is based on sound animal studies.

In summary, these animal studies show that

grafted Olfactory Ensheathing Cells induce

recovery after spinal cord transection.

Test the TreatmentThe main aim of this phase one clinical trial

is to establish that the procedure causes no

harm. Any improvement in the neurological

status of the participants would of course be

encouraging, but is not the primary objective.

Change Clinical PracticeWe are hopeful to conduct further studies in

the repair of spinal cord injury. At this time,

we do not know what form this will take, as

our next phase of research is dependent

on the outcomes of this phase one trial.

P r i n c e s s A l e x a n d r a H o s p i t a l M e d i c a l R e s e a r c h�0

Henry Ford

Coming together is a beginning, staying together is progress, and working together is success.

Simply knowing how to prevent or treat a disease is of ten not enough. Educating

people including clinicians as well as patients, assisting patients in getting access

to treatment, and ensuring that they are working satisfactori ly represent major

challenges to the health system. Research around these aspects of the health system

represents the f inal step in bringing a successful discovery to the community.

M a k i n g S u r e O u r P a t i e n t s a n d C o m m u n i t i e s g e t t h e B e s t Tr e a t m e n t s :

I m p r o v i n g H e a l t h C a r e D e l i v e r y i n H o s p i t a l s a n d t h e C o m m u n i t y.

T r a n s l a t i n g S c i e n c e i n t o B e t t e r H e a l t h�1

Medication ManagementMedicines in your Daily Life

Using appropriate medicines safely and ef fectively

can help to maximise health benef its while

minimising r isks. Improving how medicines are

used involves patients, doctors, pharmacists,

nurses and other health professionals.

Clinical ProblemAll medicines can cause side effects or other

problems including hospitalisation and death.

Sometimes not taking a prescribed medicine

causes these problems. Strategies to improve

how medicines are used include services to

review what medicines are taken by people in

aged care facilities and those living at home,

strategies to help people take their medicines and

improving the quality of existing support services.

At the BedsideThree large national studies of new service

models have been conducted to improve

how medicines are used in residential aged

care and domiciliary settings. Two national

studies have explored the effects of dose

administration aids service - devices into

which medicines are repackaged for people to

take at the right time and in the right dose - in

helping people better manage their medicines

and the cost-effectiveness of the service.

Test the TreatmentAn accreditation program for all Australian

community pharmacies (the Quality Care

Pharmacy Program) was evaluated to examine

effects of service quality and a range of other

outcomes. This evaluation included surveys

of community pharmacists and staff, their

customers and general practitioners.

In the CommunityThese studies have been instrumental in the

development of two national government-funded

services. New funding for subsidised dose

administration aids services to be provided by

community pharmacies has been announced.

A study to develop best practice dose

administration aids services has contributed to

pharmacy professional practice standards and

definition of the subsidised service. The finding

that the Quality Care Pharmacy Program led

to changes in the structure and processes in

community pharmacies and improvements in the

services provided to consumers contributed to

further funding and ongoing development of the

program that has been taken up by over 85% of

community pharmacies.

P r i n c e s s A l e x a n d r a H o s p i t a l M e d i c a l R e s e a r c h��

Older PeopleAssessing Older People Anywhere Anytime

The chance of requir ing hospital care increases

with age. Serious i l lness, associated with periods

of inactivity in an unfamil iar environment, exposes

older patients to the r isks of confusion, depression,

loss of mobil ity, fal ls and pressure sores. Hospital

admissions can become unnecessari ly long,

sometimes ending with the person not returning

home, but to institutional care, or even dying.

Clinical ProblemWe know that some of these problems can

be avoided. The emphasis is on prevention

rather than cure. However, prevention requires

special care strategies that can be expensive.

Therefore, our aim is to identify people who are

most at risk of developing these problems and

focusing our prevention strategies on them.

Finding the SolutionWe are studying the journeys that frail older

people take through hospitals, identifying

which groups are most likely to develop these

problems. Gradually a picture is emerging

of those needing the most attention.

At the same time, we are developing “systems”

to routinely assess older people when they

are admitted to hospital. Standard systems of

assessment performed by nurses, supported

by computerised interpretation, enables reliable

identification of the most vulnerable patients,

without the need for detailed review by “geriatric

medicine” specialists.

Applying the SolutionThese assessments identify people who already

have the common diseases of old age – dementia,

delirium, incontinence, weakness – but also those

who are at risk of developing them in hospital.

This internet based system can be implemented

in any hospital in the world, with support from

geriatric specialists in metropolitan hospitals.

This model is taking the high art of geriatric

assessment to all provincial and rural hospitals

where this expertise is otherwise not available.

Queensland Liver Transplant ServiceLiver and the Brisbane Technique

Clinical ProblemIn the late 80s, there was a shortage of small livers

for children requiring transplants and a surgical

solution was needed to address this problem.

Patient - Based StudiesIn 1987 Staff of the Queensland Liver Transplant

Service based at the Princess Alexandra

Hospital and the Royal Children’s Hospital

developed a surgical technique whereby

surgeons took the smaller left side of an adult

liver and transplanted it into infants and young

children. This was a world first and is known as

the Brisbane Technique.

In 1989, for the first time in the world, our

staff at the Queensland Liver Transplant Service

successfully performed a living-related liver

transplant by transplanting part of a mother’s

liver into her son.

Evolution in Clinical Practice In most cases, a liver can be divided so that

it can provide two grafts for transplantation

into two people. This is called the Split Liver

Technique and was first used in Australia in

Brisbane in 1989.

Professor Russel Strong was instrumental in

leading this pioneering work.

In 2003 the Queensland Liver Transplant

Service surgeons joined transplant surgeons

from The Prince Charles Hospital to perform

Australia’s first triple transplant (heart, lung, liver).

T r a n s l a t i n g S c i e n c e i n t o B e t t e r H e a l t h��

Renal DialysisAt Home at Night

The preva lence of chronic k idney d isease is

increas ing in Austra l ia. Current ly, one in three

adul t Austra l ians have at least one indicator of

k idney damage, and moderate to severe d isease

is present in 1.7 mi l l ion Austra l ians. This resul ts

in $ 570 mi l l ion per year be ing spent on end

stage k idney fa i lure and is expected to increase

by $ 27 mi l l ion per year over the coming years.

D ia lys is and transplantat ion are the two forms of

treatment for pat ients wi th severe k idney fa i lure.

The main types of rena l d ia lys is are Haemodia lys is

and Per i toneal D ia lys is. Haemodia lys is can be

done at a hospi ta l, a sate l l i te uni t or in the home.

One form of home haemodia lys is is nocturna l

haemodia lys is. This means that the d ia lys is

is done at home at n ight-t ime. Current ly, in

Austra l ia, the major i t y of haemodia lys is pat ients

are managed wi th convent iona l haemodia lys is.

The Pr incess Alexandra Hospital has over thir ty

years exper ience with home dialysis therapies. The

aim is to improve patient survival and qual i f y of l i fe,

and to investigate the safety of such programs.

Clinical ProblemIn general patient survival with dialysis

therapies is very poor and has not improved

in the last decade. Heart and blood vessel

complications are one of the most serious

complications of kidney failure. We have

designed a study to determine whether

changing from conventional dialysis to

nocturnal dialysis will result in significant

improvements in the heart and blood

vessels, bone mineral metabolism, sleep

quality, nutrition and quality of life.

At the Bedside Our Nocturnal Home Haemodialysis program

commenced in 2004. Patients in our program

have performed their haemodialysis in the home

either alternate nightly or four nights per week.

Most of the dialysis time (6-10 hours) is while

the patient and their partner are sleeping. All

patients in our program have been dialyzing

at home in the daytime for a period of time.

In the CommunityOur patients have reported excellent sleep

while dialyzing and improved quality of life.

To date the program has been very

successful with improved outcomes for

the patients, no significant safety issues

and excellent economic profile.


Statin Therapy in Patients with Serious Infection Unexpected Therapy

We know a lot about how to g ive stat in drugs and

how they work in pat ients wi th h igh cho lestero l

or hear t d isease. Cur rent ly prescr ib ing gu ide l ines

suggest they should be stopped when people get

unwel l . Researchers wi th in our Intens ive Care

Uni t a re look ing at stat in drugs which are used to

lower cho lestero l. They are ver y commonly used

for people wi th hear t d isease or h igh cho lestero l.

The Clinical ProblemEvidence is emerging that statin therapy might

be associated with better survival from serious

infection (sepsis). Sepsis continues to be a

major cause of death in patients admitted

to hospital. This project will determine the

place of statin therapy in patients with sepsis.

The purpose of this project is to better

describe how to use these medications in

patients with serious infection (sepsis).

In Our Lab Experiments have convincingly demonstrated

that statin treatment can improve response

to infection in a variety of ways.

At the BedsideSome studies have suggested that patients

on statins for heart disease are less likely to

develop infections and their infections are

less likely to be severe or result in death.

Other studies have suggested that stopping

statins in patients that present with infections

(as suggested by current guidelines), may

worsen infection outcomes. However, these

studies are observational and are not rigorous

enough to exclude all factors affecting

outcome, such as patient age, severity of the

infection, and the presence of other diseases.

Test the TreatmentWe have commenced a study to assess the

effect of continuing a statin, drug known as

Atorvastatin, on patients who present to the

hospital with infections and who were taking

statin medication prior to becoming unwell.

In the CommunityThe study will help us determine the best way

to use statins when people who take them

become unwell with infection. It will also give us

valuable information about whether to perform

a larger study to determine if atorvastatin can

reduce the risk of death from serious infections.

Rehabilitation ProgramHome-based Rehabilitation Program for Survivors of Critical Illness or Injury

People who survive a critical i l lness or injury that

required admission to an intensive care unit of ten

take a signif icant time to recover, and may not

return to pre-i l lness levels of activity and function.

Clinical ProblemPatients with heart and lung disease

have access to rehabilitation programs,

but there is no systematic rehabilitation

for general intensive care patients.

Patient - Based StudiesAn 8-week home based rehabilitation program

is being tested to determine if it provides any

benefits including activity and health status

to the recovery of survivors of a critical illness

or injury. We have demonstrated that a home

based rehabilitation program is feasible and

that people are prepared to participate. We

are currently testing the program in a group

of 180 people in Brisbane and Sydney.

Change Clinical Practice If this rehabilitation program is found to be

effective in improving the activity and health

status of survivors of critical illness or injury

it may be introduced in many community

settings. The expert skills to implement this type

of program are held by health professionals

working in community health facilities.


I was diagnosed with Hodgkin’s Lymphoma at the age of 22, and spent years

being treated as an inpatient at Princess Alexandra Hospital. It was the fight of

my life and it is difficult for some people to understand why I say that I’m one of

the lucky ones. I realise that not every story has a happy ending such as mine.

So what makes the difference between life and death? I was fortunate

enough to be given treatment which was the result of cutting-edge medical

research. Without access to this new technology, I hate to think what would

have happened. But it is not only medicine which saves lives. The outstanding

medical team which treated me are not only experts in their field; they are

dedicated and caring.

I had the best treatment and the best clinicians. That’s why I’m one of the

lucky ones, and that’s why I have my whole life ahead of me.

I’m one of the lucky ones.


Danielle Tindle

Haematology and Oncology Team

Academic Unit in Geriatric Medicine http://www.health.qld.gov.au/pahospital/research/groups/augm.asp http://www.som.uq.edu.au/research/augm/The unit is developing ways of providing specialised aged care to people in provincial and rural communities, where specialists are in short supply. This involves internet based consultations, video-conferencing with patients and staff, and special systems to provide assessments that can be administered by nurses.

Acquired Brain Injury Outreach Service http://www.health.qld.gov.au/pahospital/research/groups/abios.aspEnhancement of service models for indigenous populations and the transition from paediatric services, and the investigation of long term community care needs.

Alcohol and Drug Assessment Unit http://www.health.qld.gov.au/pahospital/research/groups/ad.aspAssisting and improving the identification, assessment and treatment of alcohol, tobacco and other drug problems encountered both within the Princess Alexandra Hospital and referred by community health practitioners.

Audiology Department http://www.health.qld.gov.au/pahospital/research/groups/audiology.asp Diagnostic aspects of acoustic neuromas and rehabilitative treatment in the areas of hearing, balance, and facial nerve dysfunction.

Australasian Kidney Trials Network http://www.uq.edu.au/aktn/index.htmlEstablished to facilitate clinical trials in kidney disease throughout Australia and New Zealand. Led by a Queensland-based consortium the major focus is to develop better methods for the prevention and treatment of kidney disease, through scientifically rigorous clinical research.

Breast and Endocrine Surgery Unit http://www.health.qld.gov.au/pahospital/research/groups/bed.aspProvide comprehensive world class management of breast and endocrine surgical conditions within a multi-disciplinary setting.

Cancer Collaborative Group http://www.health.qld.gov.au/pahospital/ccg/default.aspA collaborative network of university and hospital basic science and clinical investigators working together to enhance scientific and translational capabilities in the field of cancer research and patient care. The Cancer Collaborative Group encompasses nurses, allied health professionals, solid tissue and haematological oncologists, surgeons from a variety of disciplines, radiation oncologists and biomedical scientists.

Cardiology Department http://www.health.qld.gov.au/pahospital/research/groups/cardiology.asp Research areas cover coronary artery disease, myocardial infarction, acute coronary syndrome, cardiac arrhythmias and devices, acute/chronic systolic/diastolic heart failure, coronary angiography and percutaneous transluminal coronary angioplasty, cardiac echocardiography, cardiac magnetic resonance imaging and cardiac surgery.

Cardiothoracic Surgery Department http://www.health.qld.gov.au/pahospital/research/groups/cardiothoracic.aspStrong research interest in endocarditis, a condition not uncommonly fatal, which presents a major health burden to the community and carries a very high risk of serous complications. A major project is underway to examine the genomic characteristics of pathogenic Staphylococcus aureus isolates from patients with Staph endocarditis.

Cardiovascular Imaging Research Group http://www.health.qld.gov.au/pahospital/research/groups/cirg.asp and http://www.uq.edu.au/solutions/researcher/marwickth.html?uv_category=prjClinical research on non-invasive assessment of cardiovascular functions. Capabilities include cardiac imaging and image processing with expertise in new echocardiographic imaging technologies, myocardial viability, early detection of atherosclerosis, assessment of contractile reserve, and studies of how cardiac imaging techniques can influence patient outcomes and cost-effectiveness of care. The clinical and research capability of the group in cardiac imaging and image processing are unique n the Asia-Pacific region.

Centre for Diabetes and Endocrine Research http://www.health.qld.gov.au/pahospital/research/groups/cder.asp andhttp://www.som.uq.edu.au/research/cder/ Research interests include diabetes (type I and II), obesity, cell signalling, liver metabolism, bone research, pregnancy,functional genomics and endocrine cancers. Carry out research on human adipose tissue and cells.

Centre for Immunology and Cancer Research http://www.health.qld.gov.au/pahospital/research/groups/cicr.asp http://www.cicr.uq.edu.auThe Centre is dedicated to turning scientific discoveries into better treatments for major human disease. The Immunology Programme is focussed on using immunotherapy to treat cancers, arthritis, and diabetes. The Cancer Biology Programme aims to use cellular and molecular approaches to understand the formation and progression of cancers, in order to develop new and better cancer therapeutics and diagnostic tools. Cancers being targeted include head and neck squamous cell carcinomas, melanomas, leukaemia and breast cancer.

RESEARCH AT A GLANCE (http://www.health.qld.gov.au/pahospital/research/default.asp)


Clinical Pharmacology Department http://www.health.qld.gov.au/pahospital/research/groups/cpd.aspCollaborative research projects in transplantation, clinical toxicology, endocrinology, venomics, hypertension, cardiology, pharmacy and neurology. Research endeavours include drug utilisation evaluation and pharmacovigilance; population pharmacokinetic and pharmacodynamic studies; and hypertension.

Clinical Psychology and Neuropsychology http:// www.health.qld.gov.au/pahospital/research/groups/psych.aspDepression in diabetes, working memory and readiness for driving in acquired brain injury, and the development of decision making capacity, self harm, early dementia, and social vulnerability assessment tools.

Colorectal Unit http://www.health.qld.gov.au/pahospital/research/groups/colorectal.aspMain focus is with clinical studies of long term outcome in certain key areas of colonic and rectal disease such as cancer and inflammatory bowel disease.

Diabetes and Endocrinology Department http://www.health.qld.gov.au/pahospital/research/groups/diabetes.aspClinical research involving patients with Type 2 diabetes, obesity, non-alcoholic fatty liver disease and renal disease.

Diagnostic Radiology http://www.health.qld.gov.au/pahospital/research/groups/ddr.aspResearch projects include the utility of whole spine magnetic resonance imaging and spinal infections, comparison of shoulder magnetic resonance imaging with arthroscopy. Involved in various collaborative projects with various units on the campus.

Ear Nose Throat Department http://www.health.qld.gov.au/pahospital/research/groups/ent.aspEngaged in research in preoperative prognostic markers for head and neck and skin cancers.

Emergency Department http://www.health.qld.gov.au/pahospital/research/groups/ed.aspAreas of research interest include trauma registry, medical education and assessment, recording and analysing problem solving models currently in use.

Gastro-Oesophageal Clinical Oncology Group http:// www.health.qld.gov.au/pahospital/research/groups/gastro.aspCollaboration between the upper gastro-intestinal surgery unit and the departments of radiation and medical oncology focussing on clinical trials in oesophageal cancer co-ordinated through multi-disciplinary clinics. A major focus of research is the assessment of the effect of our treatments on the quality of life of patients with oesophageal cancer.

Gastroenterology and Hepatology Department http://www.health.qld.gov.au/pahospital/research/groups/gastroenterology.aspResearch program includes: 1) examination of liver disease in relation to type II diabetes; 2) role of adiponectin in human disease; 3) examination of the effect of different types of exercise on liver injury; 4) outcomes in liver transplant recipients.

Haematology Department – Clinical and Laboratory http://www.health.qld.gov.au/pahospital/research/groups/haematology.aspClinical research program in leukaemias, lymphomas, myeloma, and amyloidosis and related disorders carried out at three levels, basic, translational and clinical, with the focus on improving patient outcomes. Supporting a wide range of laboratory based research through the development of the National Leukaemia and Lymphoma Tissue Bank housed at the Princess Alexandra Hospital.

Hypertension Unit http://www.health.qld.gov.au/pahospital/research/groups/hypertension.asp and http://www.uq.edu.au/solutions/unit/ehru.htmlResearch into the causes and management of hypertension, with particular expertise in endocrine varieties, especially primary aldosteronism, renovascular hypertension, pheochromocytoma, renin-secreting tumours, and the syndrome of hypertension and hyperkalemia with normal glomerular filtration rate.

Infection Management Services http://www.health.qld.gov.au/pahospital/research/groups/ims.aspResearch program focuses on epidemiology of healthcare associated infection; Staphylococcus aureus and healthcare associated yeast and fungal infections and Pharmacokinetics and pharmocodynamics of newer antimicrobial agents.

Intensive Care Unit http://www.health.qld.gov.au/pahospital/research/groups/icu.aspThe emphasis of research is on both clinical and basic science related work.



Internal Medicine and Clinical Epidemiology (incorporating Clinical Services Evaluation Unit) http://www.health.qld.gov.au/pahospital/research/groups/imd.asp and http://www.health.qld.gov.au/pahospital/research/groups/cseu.aspResearch on methods for evaluating healthcare services, improving quality of clinical practice, and promoting evidence-based medicine. Research interests include acute cardiac care, cardiac rehabilitation, evidence-based health policy making, use of clinical indicators derived from administrative data in assessing variation in hospital quality of care. Systematic reviews, patient safety, use of clinical practice guidelines, screening tools for geriatric assessment, implementation of chronic disease management programs and management of medical illness in intellectually disabled adults.

Liver Research Group http://www.health.qld.gov.au/pahospital/research/groups/liver.asp http://www.uq.edu.au/solutions/unit/lmg.htmlResearch examining the mechanisms by which obesity and fatty liver impair the response of the liver to injury and inflammation and develop strategies to monitor and improve the outcome of treatment in overweight patients with liver disease; factors that contribute to the progression of chronic hepatitis C and other liver diseases.

Medical Oncology Department http:// www.health.qld.gov.au/pahospital/research/groups/oncology.aspClinical trials in breast cancer, melanoma, gastroesophageal, colorectal, head and neck, pancreatic and lung cancers in conjunction with Respiratory Medicine. The unit also has a significant history in the conduct of industry-initiated research trials allowing the hospital, and ultimately patients, access to potential cutting edge development in cancer therapy.

Melanoma Clinical Research Group http:// www.health.qld.gov.aut/pahospital/research/groups/melanoma.aspThe Queensland Melanoma Project was originally established to investigate issues such as the incidence of the disease and outcomes from treatment. Recently, the focus has been on the participation in local, national and international trials.

Neurosurgery Department http://www.health.qld.gov.au/pahospital/research/groups/neurosurgery.aspContinuing a phase I trial of olfactory ensheathing cells in spinal cord regeneration. The department has been accepted into the first prospective multicentre international Phase 3 drug trial.

Nursing Practice Development Unit http://paweb.sth.health.qld.gov.au/npdu/default.aspResearch programs are in implementing evidence into practice, clinical teaching, workforce planning, emergency nursing and cancer care.

Nutrition and Dietetic Services http://www.health.qld.gov.au/pahospital/research/groups/nds.aspAcute interventions in oncology, liver and renal disease, weight loss in hepatitis C, malnutrition associated with pressure ulcer and falls, and the development of screening tools for malnutrition, dehydration and patient satisfaction.

Occupational Therapy Department http://www.health.qld.gov.au/pahospital/research/groups/ot.aspChronic disease and aged care assessment and management and hand and upper limb and catastrophic injury rehabilitation. Research in serious injury rehabilitation incorporating aquired brain injury and spinal cord injury research, aged care assessment and hand and upper limb management.

Ophthalmology Department http://www.health.qld.gov.au/pahospital/research/groups/ophthalmology.aspAssistance with audit and preparation of operating procedures of trial of new methods to treat pterygia and research including cell biology of the corneal epithelium; methods of eye banking and eye tissue handling.

Orthotics http:// www.health.qld.gov.au/pahospital/research/groups/orthotics.aspResearching whether or not routine pin-tensioning of patients who wear a halo-thoracic orthosis reduces pin site loosening and associated complications.

Pharmacy Department http://www.health.qld.gov.au/pahospital/research/groups/pharmacy.aspNational leader in the implementation of clinical services, innovative methods of drug distribution and research and implementation of “Quality Use of Medicines” activities.

Physiotherapy Department http://www.health.qld.gov.au/pahospital/research/groups/physiotherapy.aspResearch includes quality-of-life evaluation, geriatric and spinal cord injury rehabilitation, exercise and fatigue in radiation/oncology patients and ankle fracture assessments.

Plastic and Burns Unit http:// www.health.qld.gov.au/pahospital/research/groups/plastics.aspEngaged in frontier research in preoperative prognostic markers for head and neck and skin cancers.

ProstheticsInvestigating a K-Levels classification system and the use of gel liners for limb amputees.


P r i n c e s s A l e x a n d r a H o s p i t a l M e d i c a l R e s e a r c h�0

T r a n s l a t i n g S c i e n c e i n t o B e t t e r H e a l t h�1

Queensland Clinical Trials Centre – Biostatistics http://www.health.qld.gov.au/pahospital/research/groups/biostatistics.asp and http://www.uq.edu.au/qctc/index.html?page=21551Research into methodological and statistical aspects of clinical trials, as well as coordinating and managing controlled trials of major health importance, and providing expert advice to smaller clinical trials conducted by independent investigators.

Queensland Liver Transplant Service http://www.health.qld.gov.au/pahospital/research/groups/qlts.aspInvolved in sponsored trials related to dosing strategies and new agents to reduce long term nephrotoxicity. Collaboration continues with colleagues in Clinical Pharmacology at The Princess Alexandra Hospital and the School of Pharmacy at University of Queensland. The focus of this research involves optimising monitoring of critical dose immunosuppressive agents and liver transplantation.

Queensland Spinal Cord Injury Servicehttp://www.health.qld.gov.au/pahospital/research/groups/qscis.aspResearch projects span from spinal cord regenerative research through management issues to areas of rehabilitation research.

Radiation Oncology Services - Princess Alexandra Hospital and Mater http://www.health.qld.gov.au/pahospital/research/groups/radonc.aspInvolved in trials involving cancers from various sites including oesophagus, rectum, lung, melanoma, head and neck; prostate, lymphomas and breast; coordinating trial centres for a number of trials including lung, bladder and skin cancer.

Renal Medicine (Nephrology Department) http://www.health.qld.gov.au/pahospital/research/groups/nephrology.aspClinical research examining such diverse areas as infection control, anaemia management, chronic kidney disease screening, innovative dialysis therapies, cardiac risk factor intervention, obesity and kidney disease, novel prevention strategies for acute renal failure, preservation of kidney function, and optimization of the safety of anti-rejection drug protocols in transplantation: Basic science research focus in investigating mechanisms underpinning pathological kidney cell growth and fibrogenesis with a view to developing management of acute renal failure, chronic renal scarring and failure, and renal cell carcinoma.

Respiratory and Sleep Medicine http://www.health.qld.gov.au/pahospital/research/groups/sleep.aspMain areas of research are in sleep, mainly sleep disordered breathing, airway disease mainly asthma, chronic obstructive pulmonary disease, lung cancer, respiratory physiology and respiratory infection.

Rheumatology Department http://www.health.qld.gov.au/pahospital/research/groups/rheumatology.aspResearch into the treatment of early rheumatoid arthritis as well as the vascular effects of chronic inflammatory arthritis. Studies regarding effects of various new-wave treatments continue.

Social Work Department http://www.health.qld.gov.au/pahospital/research/groups/social.aspOutcomes and ethical risk auditing and psychosocial assessment of patients who undergo experimental spinal cord surgery.

Speech Pathology http://www.health.qld.gov.au/pahospital/research/groups/speech.aspProjects investigating the timing and effectiveness of dysarthria treatment, swallowing issues following radiation treatment for head and neck cancers, goal-setting in rehabilitation and the impact of spinal cord injury on communication.

Surgical Oncology Laboratory http://www.health.qld.gov.au/pahospital/research/groups/surg_onc.aspResearch into the mechanisms of CD44-mediated metastasis and targets for therapy 2005. The Princess Alexandra Hospital Tumour Tissue Bank is administered within this group and has expanded its activities in support of oncology researchers on campus.

Therapeutics Research Unit http://www.health.qld.gov.au/pahospital/research/groups/tru.asp and http://www.uq.edu.au/solutions/unit/therapeutic.htmlInvestigating pharmacological strategies that may improve quality of life and other patient outcomes. Research is in five main areas, namely, drug design, drug delivery, pharmacokinetics, quality use of medicines and natural products for a range of diseases.

Urology and Renal Transplant http://www.health.qld.gov.au/pahospital/research/groups/urology.aspStrong interest in urological malignancies, including cancers of the kidneys, bladder, testes and prostate gland.

Vascular Surgery http://www.health.qld.gov.au/pahospital/research/groups/vascular.aspParticipant in the International Carotid Stenting versus Surgery trial.



We are gratefu l and ex tend our apprec iat ion to

the many groups and ind iv idua ls who contr ibuted

in a var iet y of ways in the product ion of th is

publ icat ion. Coming together and work ing together

is on ly the beginn ing. We hope you en joy reading

some of the endeavours of our sc ient is ts and our

c l in ic ians at the Pr incess A lexandra Hospi ta l .

Project Manager/Editor: .. . . .Ms Areti Gavrilidis

Editorial Assistants: .. . . . . . . . . . . . . . . . .Dr Brian Gabrielli, Dr Julie Stokes

Design/ Artwork: .. . . . . . . . . . . . . . . . . . . . . . . . .RAD Group

Copies can be obta ined by contact ing the Bus iness

Manager, Centres for Hea l th Research on 07 3240 7665

THANKS

www.pafoundation.org.au

3240 2359

PA Foundation supporting health research at

the Princess Alexandra Hospital

through funds generously

donated by the community.

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