31 Jan 2020

Immune recovery can be precisely measured: Infectious Diseases research wins award

Professor Orla Morrissey
Congratulations to the Department of Infectious Diseases’ Professor Orla Morrissey, who was senior author on a paper that gained a prestigious Publication of the Year Award at the 48th Annual Scientific Meeting of the Australian and New Zealand Society for Immunology in December 2019.

The paper, which appeared in Clinical & Translational Immunology in October 2018, was one of two that received awards for Society publications at the conference. The honours recognise the most outstanding articles based on scientific merit published in the previous year.

The award was given to first author Dr Harini de Silva at the meeting in Adelaide, where the paper’s data were presented. Dr de Silva, then a Senior Research Officer in Professor Morrissey’s group, now works as a Senior Scientist at the Peter MacCallum Cancer Centre.

The pilot study in the paper demonstrates that immune recovery can be precisely measured using CD4+ T-cell (T helper cell) counts, in vitro antigen stimulation, and selected cytokines in allogeneic haemopoietic stem cell transplantation recipients.

Professor Morrissey said she was delighted with this award as it recognises the very precise and systematic research they performed as the first step to solving the perennial clinical problem of who should get antimicrobial prophylaxis and for how long.

“Currently, we only have imprecise clinical risk-prediction models,” she said. “These models misclassify some cases as being low-risk and are not dynamic so we can’t precisely predict when the optimal time for the cessation of antimicrobial prophylaxis is and as a result, we see breakthrough infections. In the HIV world, CD4 counts are used to start and stop antimicrobial prophylaxis and we want to move to such a paradigm for other immunosuppressed patients.

“It is a form of precision medicine that will not only reduce the incidence of infection and its related mortality but also will reduce the unnecessary use of antimicrobial prophylaxis, drug-related toxicity and antimicrobial resistance,” she said.

“This award gives us the confidence that we are on the right track.”

The researchers now aim to confirm their findings in larger and previously unexamined cohorts and to move to clinical trials.

In another paper, published in Clinical Infectious Diseases in December, Professor Morrissey was part of a consortium of 65 global experts, and one of only four Australians, that updated the definitions for invasive fungal diseases (IFD). The revised definitions become the new reference standard for clinical, epidemiological and diagnostic research of patients at risk of these diseases.

“Invasive fungal diseases remain important causes of morbidity and mortality,” Professor Morrissey said. “Definitions of invasive fungal disease are critical for early diagnosis to guide early treatment and consequently improve survival rates. They are also critical for unbiased clinical trials research and for epidemiological surveillance studies,” she said.

Professor Morrissey said that one of the most important changes was the introduction of Aspergillus PCR (polymerase chain reaction) as a diagnostic criterion. Aspergillus PCR (a laboratory technique that makes millions of copies of a particular section of DNA) was not previously included as it was felt it was not sufficiently standardised or validated, she said.

Much research has been performed to standardise and validate Aspergillus PCR including by Professor Morrissey and the other Australian co-authors. These data provided some of the basis for the inclusion of Aspergillus PCR as a diagnostic criterion in the updated 2019 guidelines.

“It is very exciting to see our research contributing to changes in international guidelines; this is what translational research is all about.”  

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