The health disparity between Indigenous and non-Indigenous Australians is a national tragedy. My research program tackles a devastating autoimmune disease called ‘lupus’. Lupus affects about 1 in 1000 people across the population. However, for reasons unknown, this is two to four times more common (and more severe) in Indigenous Australians. My vision is to unravel the reasons for this and use this knowledge to improve the lives of Indigenous Australians with lupus. To do this, we plan to take blood from patients and measure many thousands of genes and proteins. Using complex data analysis methods, known as bioinformatics, we will analyse all these blood markers at once.
This study will establish a national Indigenous lupus registry and biobank (a library for blood and other biological material) and will allow doctors in the near future to find the right drug for the right patient. It will also ensure that Indigenous Australians suffering from lupus will not miss out on breakthrough treatments, or be needlessly exposed to ineffective medicines. Ultimately, this is an important step to closing the health gap between Indigenous and non-Indigenous Australian lupus sufferers.
During my Fellowship, significant progress has been made to set up a national Indigenous lupus registry and biobank, nested within the Australian Lupus Registry & Biobank (ALRB), including logistics and legal aspects in the Northern Territory. We have been successful in obtaining Ethics and Governance approvals to start the recruitment of patients with lupus in key participating sites where most of Indigenous Australians with lupus are expected to be enrolled. We have also obtained more funding for this project from several organisations. Finally, in a pilot study, we have found that the measurement of hundreds of proteins in the blood can help to group patients with lupus into distinct groups. The program is on track for its long-term objectives.
We don’t know why Indigenous Australians suffer more frequently and more severely from lupus compared to non-Indigenous Australians. This may be due to a combination of risk factors, that have not yet been characterised. This knowledge gap needs to be filled to gauge which “biological pathways” are driving illness in Indigenous Australians with lupus, in order to prescribe them the most effective treatments. Importantly, this knowledge will help to make sure ineffective treatments are not used in Indigenous Australians patients suffering from lupus.
We have shown that the measurement of many proteins in the blood of lupus patients can help to group (or cluster) the patients into distinct sub-groups. The grouping of patients was carried on using complex data analysis methods, known as bioinformatics. Importantly, we found that these groups of patients with lupus were different in term of their symptoms and how severe their illness was. These findings confirm the potential for identifying clinically meaningful groups of patients with lupus based on their blood protein measurement.
In order to set up a national registry and biobank of Indigenous Australian lupus patients, a first step involves getting several legal authorisations. We have been successful in obtaining crucial authorisations from Ethics Committees in Northern Territory to allow the recruitment of lupus patients in the hospitals of Darwin and Alice Springs. This is where most Indigenous Australian lupus patients are expected to be enrolled.
This research program also requires additional of funding to enable the collection of data and blood samples of hundreds of individuals across multiple sites, and the measurement of many thousands of genes and proteins in the blood. We have been successful in obtaining funding from several organisations to support this research program totalling seven awards, including from the National Health and Medical Research Council (NHMRC) and from CSL Limited, an Australian leading biotechnology industry, worth approximately $1 million AUD in total.
Finally, we have developed an important collaboration with Dr James Peters, an expert in lupus bioinformatics working in London. This unique expertise will prove invaluable to this project.
My findings will benefit people suffering from musculoskeletal illness in the near future. The outcomes of our pilot study form the foundation for the analysis of similar blood protein measurement in Indigenous and non-Indigenous Australians with lupus.
My research program is establishing the first ever national registry and biobank of Indigenous Australian lupus. This will build the foundation for numerous translational research outcomes, and will result in better understanding of the illness. This project will determine whether Indigenous and non-Indigenous Australians suffering from lupus can be characterised by the presence of singular markers in their blood, where treatments targeting these pathways are either approved or in the pipeline. Biomarker technology will identify which pathway is dominant and thus potentially support providing Indigenous Australians with lupus early access to treatments that target these pathways. This will also help to ensuring ineffective dugs are not used in these patients, furthermore saving money in the healthcare system. This project could swiftly lead to health policy changes affecting the management and treatment of Indigenous Australians with lupus. Importantly, providing these targeted therapies would improve the health and close the gap between Indigenous and non-Indigenous Australian lupus patients.
With the support supported by the AFA/ARA Heald fellowship, I have been awarded funding including an NHMRC Investigator Grant and industry support from CSL to continue this research program for the next five years. The updated timeline for this research program is as follows below: