Collaborative research from bench to bedside
Research into brain tumour management and tumour-associated epilepsy (TAE) is leading to great advances in the field of neuroscience.
Final year University of Melbourne PhD student Dr Simon Liubinas is involved in multidisciplinary and collaborative research between the University’s Departments of Surgery, Medicine and Radiology and the Academic Centre at the Royal Melbourne Hospital.
Mentored by a collaborative supervisory team including Professor Terence O’Brien, Professor Andrew Kaye, Associate Professor Kate Drummond, Dr Andrew Morokoff and Dr Bradford Moffat, Dr Liubinas’s research explores the topic of radiological and molecular features correlating with seizures in patients with ‘supratentorial gliomas’ – or brain tumours.
Dr Liubinas explains that gliomas are the most common malignant brain tumours, with more than 1,500 new cases diagnosed in Australia each year, frequently affecting people aged in their 30s and 40s. Generalised or partial seizures are the main symptom in up to 80 per cent of low-grade gliomas overall, and overall around 50 per cent of glioma patients suffer from one or more TAE seizures.
The seizures are commonly difficult to control with current anti-epileptic drugs and may not be effectively treated by the removal of the tumour. The seizures and side effects from the high-dose, multiple-drug therapies required to control them are a major cause of death and impaired quality of life in these patients, and also often interact poorly with chemotherapy treatment.
The work of Dr Liubinas and his supervisors highlights a field of medicine where both the research and surgical components are equally important.
“There is no known cure and we are never able to remove the tumour completely – so I feel that, in a way, the research is as important in curing the disease as any surgery,” says Dr Liubinas.
The research collaboration between the two disciplines – brain tumour management and epilepsy – is important because there is little research or information about the two separate conditions combined.
Dr Liubinas’s research uses magnetic resonance spectroscopy (MRS) as a non-invasive way of measuring metabolites, which, within a given area of interest and in conjunction with anatomical MRI is useful in the diagnosis and differentiation of brain tumours.
These technological advances are an example of how technology is evolving to advance neuroscience research, Dr Liubinas says.
“We can now do deep brain stimulation to stop tremors, and there are MRI scans similar to GPS systems for brain operations.
“The aim of these new technologies is to work towards and facilitate a personalised medicine,” says Dr Liubinas. “Technological advances are allowing clinicians to tailor treatment to the individual, according to the patient’s genetic profile.”
Dr Liubinas’s research illustrates the success of the Academic Centre Model and importance of cross-departmental collaboration.
Professor O’Brien says that Dr Liubinas’s work is unique.
“Simon has been looking at the biology of brain tumour-associated epilepsy in a way that people have not done before.
“How the two fields of research (brain tumour management and tumour associated epilepsy) interrelate with each other is relatively unexplored. Considering how important it is for patients, it was ripe for the picking for research.”
Working within a collaborative environment has given Dr Liubinas greater access to patients with and without epilepsy. He can examine a rare sample of brain tumour tissue and ‘peri-tumoural’ brain tissue surrounding it, which is where the epilepsy comes from, immediately after surgeons operate. This he says, illustrates the Melbourne Brain Centre’s ‘bench to bedside’ research philosophy.
Dr Liubinas believes the collaborative approach to the research of the Departments of Medicine, Surgery and Radiology at the Royal Melbourne Hospital and the Academic Centre prevents projects from working in isolation.
“Wide ranges of staff attend a weekly brain tumour meeting where clinicians and scientists are involved, so it’s not just lab scientists or clinicians discussing their own projects in isolation. It’s the most sensible method and why the Academic Centre functions well,” says Dr Liubinas.
“The Academic Centre has brought diverse scientific teams together,” says Professor O’Brien, “and the connection of the brain tumour and epilepsy teams has made a great difference in generating ideas.
“The most interesting research is done at the interface of different disciplines because that’s where there are the biggest holes,” he says.