Research excellence recognised with $12M funding

Research on a quit-vaping product and Māori views on assisted dying are among health research projects at Waipapa Taumata Rau to win millions in government funding.

Professor Natalie Walker.
Professor Natalie Walker is leading a research project on a quit-vaping product.

The Health Research Council of New Zealand (HRC) has announced a total of $53.7 million in government funding for research into pressing health issues, including a trial to help New Zealanders quit vaping and a project to research Māori views on assisted dying.

HRC chief executive Professor Sunny Collings says the 44 Project Grants across all Aotearoa New Zealand universities provide exciting opportunities to help advance this country’s knowledge and drive meaningful change in the health system.

“We are fortunate to have an extremely talented pool of health researchers in Aotearoa. These project grants are an important way for us to help develop and sustain the country’s health research workforce so they can continue to do the necessary mahi to improve health outcomes for New Zealanders,” says Professor Collings.

Of the total funding, Waipapa Taumata Rau, the University of Auckland received more than $12M.

University of Auckland’s Associate Professor Natalie Walker and her team will use their $1,438,524 grant, over 36 months, to carry out a large community-based clinical trial of two low-cost interventions to help New Zealanders stop vaping. The trial will test whether cytisine – a medicine that partially blocks the effects of nicotine on the brain – is more effective than a tapered reduction in nicotine, when accompanied with text behavioural support from the New Zealand Quitline.

Associate Professor Natalie Walker says it is inevitable that vaping in New Zealand will continue to increase as new tobacco control policies come into effect that will decrease the number of tobacco retailers and only allow reduced nicotine tobacco to be sold.

“These policy changes in the Smokefree Aotearoa 2025 Action Plan will make medical nicotine replacement therapy and vapes (e-cigarettes) the only legal nicotine available for smokers to manage withdrawal symptoms,” says Associate Professor Walker.

“Over time, people who vape may also wish to stop, yet little evidence exists on the best ways to support people to do this. Our trial plans to add to that evidence base, as ideally being both smoke and vape free is optimal for health.

“The priority remains that people should not smoke cigarettes, which kill about 5,000 New Zealanders a year. Our trial will also assess whether interventions for quitting vaping have any unintended consequences on smoking rates.”

University of Auckland 2023 Project Grant recipients

Rangahau Hauora Māori Project Grant: Dr Tess Moeke-Maxwell, Faculty of Medical and Health Sciences
Waerea: Māori whānau experiences of assisted dying in Aotearoa New Zealand
36 months, $1,199,999

The Waerea end-of-life study investigates whānau Māori (n = 40) experiences of accessing and using assisted dying. Employing face-to-face interviewing methods, the group will identify what helps and hinders whānau to access, navigate and use assisted dying services, and explore the impact on whānau when access is declined. They identify how tikanga are used and adapted to support assisted dying and bereavement. Twenty funeral directors, Māori health professionals, rongoā and tohunga practitioners will be interviewed to establish assisted dying cultural competencies. An assisted dying guide will be developed for whānau. Creative arts methods will inform the development of six short videos presenting new assisted dying knowledge to increase understanding of palliative care and assisted dying. Two graphic novels (fictionalised stories) will be produced to inform assisted dying decision-making reflecting A) natural death and B) physician assisted death. An assisted dying Whānau Planning Guide App will incorporate these educational resources. They will publish three articles. 

Professor Winston Byblow, Faculty of Medical and Health Sciences
A compositional neurophysiological biomarker for predicting stroke recovery
36 months, $1,199,999

Stroke is a leading cause of adult disability. Recovering hand and arm function is critical to regaining independence. The group developed the PREP2 tool to evaluate how well a patient’s hand and arm is likely to function three months after stroke. This prediction can be made within the first week post-stroke and improves patient and therapist experiences and rehabilitation efficiency. PREP2 combines clinical and neurophysiological assessments to predict one of four outcome categories for each patient, with 75 percent overall accuracy. The tool is now used in routine clinical care in hospitals in the North Island and is under evaluation at several international sites. The aim of this project is to improve the overall accuracy of the tool. We will achieve this aim by developing and testing a novel compositional neurophysiological biomarker with patients in a real-world clinical setting as a first step toward the development of PREP3.

Professor Alan Davidson, Faculty of Medical and Health Sciences
Development of a targeted drug therapy for acute kidney injury
36 months, $1,199,999

Acute kidney injury, caused by various insults including bacterial and viral (COVID19) infections, nephrotoxic drugs, and reduced blood flow, is associated with significant mortality and risk of developing chronic kidney disease. We have a limited understanding of the processes of injury and repair in acute kidney injury, although DNA damage to kidney cells has emerged as a key factor. New targeted therapies are urgently needed. We address these shortcomings in this proposal with our novel discovery that CDKL5, belonging to a druggable class of enzymes called kinases, is linked to DNA repair during acute kidney injury. We have identified some candidate inhibitors of CDKL5 and propose conducting preclinical testing of these using human kidney organoids (small balls of kidney tissue made from stem cells) and a mouse model of acute kidney injury. This work holds the promise of developing the world's first targeted drug therapy for acute kidney injury, which in the era of COVID19 is urgently needed.

Dr Sarah-Jane Guild, Faculty of Medical and Health Sciences 
Improving lives of hydrocephalus patients - first human trial of a novel device
36 months, $1,199,015

Patients with hydrocephalus have an abnormal build-up of fluid around the brain and need a tube surgically implanted to drain that fluid. Patients and their caregivers live with the constant fear that the tube will block. Warning symptoms include irritability, headaches and vomiting. Unfortunately, there is no way of telling when fluid build-up is causing a rise in brain pressure and potentially impeding blood flow to the brain (life threatening) except for a brain scan in hospital and possibly hospitalisation.

We want to improve the lives of patients with hydrocephalus. We have developed a tool for parents and caregivers to monitor the pressure in the brain remotely via a sensor placed alongside the drainage tube. We will show the device is safe and give reliable brain pressure readings using a large animal model (sheep) before performing a first-in-human safety study to show it is safe for patient use.

Associate Professor Sarah Hetrick, Science
TIPS: Trans-Tasman Internet-delivered Prevention of (youth) Suicide
36 months, $1,437,012

Rates of youth suicide are alarming. A key predictor is suicidal ideation (i.e., thoughts about, or plans of, ending one’s life) with rates up to 20 percent every year. Suicide and suicidal ideation disproportionately affect rangatahi Māori. It is imperative to overcome barriers young people encounter in accessing meaningful support. Given youth are digital natives with high levels of smartphone ownership, mental health applications (apps) are promising. Several promising apps for suicidal ideation have been developed and pilot tested. Before developing further apps, it is imperative to test how well these work across our region. In a trans-Tasman four-armed superiority randomised controlled trial, three apps (Tune In, Village, LifeBuoy) will be compared with a control app. The primary outcome is suicidal ideation, with secondary outcomes self-harm, wellbeing, acceptability, and responsiveness to Māori. This will result in effective apps being available, reduce inequities and drive further development in a rational way.

Dr Kate Lee, Faculty of Medical and Health Sciences
Toward a mechanism for CREBRF R457Q to drive diabetes protection
36 months, $1,199,861

The CREBRF variant (R457Q) specific to Māori and Pacific populations has the largest effect size of any single genetic variant on body mass index (BMI) and yet despite higher BMI it is associated with a 50 percent reduction in diabetes. Our research to date has characterised two mouse models carrying this variant and shown that the mice are protected from large increases in body fat which has metabolic benefit over a lifetime. We have also shown there are several potential mechanisms driving these phenotypes; some of which are important pathways for metabolic health and disease and also have implications for activity of commonly used pharmaceuticals. Our research
proposal seeks to refine our understanding of this variant at a cellular and
molecular level with a focus on fat and muscle cells. This knowledge will
inform future clinical studies that aim to improve healthcare for metabolic
disease in Māori and Pacific people.

Dr Julie Lim, Faculty of Medical and Health Sciences
Disposable, not dispensable: reducing the incidence of cataract post vitrectomy
36 months, $1,139,548

With an ageing population, age-related diseases of the eye are increasingly common resulting in the need for surgery. Vitrectomy is a common procedure in which the vitreous humor is removed to allow access to diseased retina and replaced with saline. Unfortunately, a consequence of vitrectomy, is the development of a cataract which requires further surgery. We propose that the vitreous is important in maintaining low levels of oxygen in the eye and that removal of the vitreous and replacement with saline, increases oxygen levels, resulting in antioxidant imbalance and cataract formation. This study proposes to investigate the molecular mechanisms involved in cataract formation post vitrectomy and to design and test intervention therapies that reduce oxygen levels, restore antioxidant balance, and preserve lens transparency. A major research impact is the potential to transform the management of patients’ post-vitrectomy resulting in improved patient outcomes and reduced healthcare costs.

Professor Julian Paton, Faculty of Medical and Health Sciences
A novel intracranial baroreceptor mechanism for blood pressure control
36 months, $1,199,912

We discovered a novel baroreceptor located inside the brain – ‘intra-cranial’ that senses physiological changes in cerebral blood pressure. Traditionally, ‘peripheral’ baroreceptors in the carotid sinus/aortic arch modulate heart rate and vascular resistance via autonomic nerves. However, when brain blood flow decreases, intra-cranial baroreceptors are activated causing increases in nerve activity to raise arterial pressure, thereby restoring brain blood flow; this has been demonstrated in rats under anaesthesia. We hypothesise that this mechanism also operates in conscious rats, is essential for setting levels of basal arterial pressure and is sensitised in hypertension. Through iteration between a new mathematical model and physiological studies in conscious rats, we will determine: (i) interactions between intra-cranial and peripheral baroreceptors; (ii) if astrocytic signalling is key for intra-cranial baroreceptor function, and (iii) mechanisms of sensory transduction of intra-cranial baroreceptors. Revealing these novel mechanisms will inform future management of hypertension, which affects ~30% of Aotearoa’s population.

Professor John Windsor, Faculty of Medical and Health Sciences
Protecting the lungs of the critical illness patient
36 months, $1,199,915

Key to managing many patients with significant illness is the preservation of sufficient oxygen delivery. When patients are very unwell this process can become compromised and mechanical ventilation is required. Unfortunately, the process of mechanically forcing air into a patient’s lungs can itself cause additional damage to the lung tissue. This is called ventilator-induced lung injury (VILI) and characterised by swollen and inflamed lungs. This makes gas exchange less efficient and adversely affects patient outcomes. Here we propose to test a new class of drug treatment that is intended to prevent the ventilator injury from being initiated and progressing.

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