Forget needles, University of Otago – Ōtākou Whakaihu Waka-led research hopes to make getting vaccinated as easy as swallowing a capsule.
Project lead Professor Sarah Hook, of the School of Pharmacy, says vaccines are only beneficial if everyone is willing to be vaccinated and can access vaccination services.
"This is currently not the situation in Aotearoa New Zealand. We urgently need to investigate new approaches to improve vaccine uptake and develop culturally appropriate messaging and initiatives to promote equity in vaccine access," she says.
The project aims to create a simple, self-administered oral vaccine, in a capsule form, which is safe and effective.
The multi-disciplinary team has received $1.2 million Health Research Council of New Zealand grant for the work.
Initially, the focus will be on an influenza vaccine, and a novel vaccine treatment for colon cancer.
Alongside the lab-based research, the group aims to develop resources and initiatives for Māori and Pacific communities to support future vaccination programmes.
"While we believe moving away from injections will be a major benefit to improve vaccine uptake, using a kaupapa Māori framework, we want to find out what other barriers exist that prevent people from being vaccinated. In particular, we would like to reduce inequities that exist around vaccine uptake by Māori and Pacific people."
The collaborative all wāhine team is made up of Professor Hook, Dr Amber Young (Taranaki), also of the School of Pharmacy, Dr Shirley Keown, Turanga Health Research and Development and Clinical Support Manager in Tairāwhiti, and Dr Lisa Connor, Programme Leader of the Infection and Vaccinology Group at the Malaghan Institute in Wellington.
"We are very happy to receive this funding and are keen to start work on this exciting research," Professor Hook says.
The project is one of 11 HRC grants awarded to Otago researchers, worth more than $13.3 million.
One of them aims to advance size-inclusive healthcare by studying the acceptability and utility of cervical screening self-tests for big-bodied people, a population which has historically been overlooked in research and underserved in screening, increasing their risk of undetected cervical cancer.
Associate Professor Lesley Gray, Dr Sally Rose, and Carmen Parata (Ngāti Kahungunu), of the Department of Primary Health Care and General Practice, Wellington, will research the extent to which New Zealand's cervical screening programme works for big-bodied people.
"There are high levels of stigma and bias in health care associated with body size and fatness that mean people delay seeking help, and also impact the quality of care people receive.
"A range of factors determine how accessible services are from the built environment in which we deliver care, to the equipment and language we use in practice. For example, the supplied swab is a standard length – we are interested to know how practical this is for big-bodied people wanting to self-test," Associate Professor Gray says.
Grant recipients
Dr Oliver Lyons, Department of Surgery and Critical Care, Christchurch, and Professor Sue Crengle, of the Department of Preventive and Social Medicine
Tackling gender inequity: The International Women's Aneurysm Trial
$1,439,803
An abdominal aortic aneurysm is when the main blood vessel in the tummy weakens and expands, which is life-threatening if it ruptures. Surgery is often recommended when the risk of rupture is greater than the risk of surgery, but we don't know the best timing for surgery in women. This is because women have mostly been left out of previous research. Women with aneurysms are at a higher risk of rupture, heart attacks, and strokes compared to men. This research asks whether women might benefit from having surgery earlier. The study aims to improve heart and brain health for women with aneurysms by focusing on smoking cessation, healthier diets, and better medications. It will then compare the benefits of early keyhole surgery to the current standard treatment. The research will reduce strokes, heart attacks, and aneurysm ruptures, and will provide better guidelines for doctors treating women with aneurysms.
Dr Anna Pilbrow, Department of Medicine, Christchurch, and Dr George Wiggins, Department of Pathology and Biomedical Science
Copy-number variation: a source of missing heritability for heart failure?
$1,199,926
Heart failure is a leading cause of hospitalisation in adults over 65 years and one in four patients die within one year. Any condition that damages the heart can cause heart failure. However, the rate at which heart failure develops varies considerably and is difficult to predict. Genetics may offer a new approach, identifying those at risk early in the disease course. We aim to investigate how large structural DNA variants (copy-number variants, CNVs), which can cause major disruption via deletion or duplication of genes, influence risk of heart failure. We will utilise large national and international datasets to perform the first genetic association study for CNVs and heart failure and test whether CNVs improve our ability to predict heart failure beyond established risk factors. This will identify CNVs that may improve risk prediction, treatment and management of heart failure and identify new drug targets.
Professor Parry Guilford, Department ofBiochemistry, and Dr Jessica Fairhall, School of Pharmacy
Direct-to-stomach delivery of drugs for the chemoprevention of inherited stomach cancer
$1,199,177
Individuals at risk of the inherited cancer syndrome Hereditary Diffuse Gastric Cancer (HDGC) are recommended to have their stomachs removed to eliminate their high risk of death from stomach cancer. Although this surgical procedure is likely to save their lives, it is associated with lifelong morbidity. To provide an alternative to surgery, we are developing a drug treatment strategy which would eliminate the need for stomach removal. We have previously identified a class of drugs (AKT inhibitors) with strong activity against early-stage stomach cancer, and developed a drug formulation which allows us to deliver these drugs straight to the stomach. Here, we propose to link these earlier advances so that we deliver effective, cancer-preventing drugs directly to the stomach, thus avoiding the side effects that one would typically experience with normal oral or IV drug delivery routes.
Dr Michael Pankhurst and Professor Greg Anderson, Department of Anatomy
Do excessive ovarian hormones cause ovulation failure in polycystic ovary syndrome?
$1,199,974
Polycystic ovary syndrome (PCOS) is the leading cause of infertility in reproductive-age women, but the causes remain unclear. One treatment for PCOS is a surgical procedure that targets the ovary, but this procedure is not frequently performed. This research will investigate how the ovary contributes to the progression of PCOS. We hypothesise that ovary hormone production (inhibin and estrogen) is too high in the ovaries of PCOS patients which causes the reproductive hormone system to shut down before an egg can be ovulated. We will use mouse models of PCOS to examine how ovary hormone production is affected. We will also perform ovary surgery to determine how manipulating the ovary can reverse PCOS symptoms. The project aims to discover new therapeutic targets in the ovary. If pharmaceuticals can be developed to target the ovaries, it would reduce the burden on operating theatres, allowing more patients to receive treatment.
Professor Sarah Hook, School of Pharmacy
Development and delivery of oral prophylactic and therapeutic vaccines
$1,199,997
Vaccination is a key public health care intervention used to prevent infectious disease and more recently, to treat chronic conditions such as cancer. For vaccines to realise health benefits, people must have the confidence and willingness to be vaccinated and the ability to access vaccine delivery services. In Aotearoa New Zealand it is imperative we increase vaccination rates, especially in groups with lower vaccine coverage. Our research aims to minimise access and engagement immunisation barriers and enhance vaccination acceptance. We will develop and evaluate oral vaccines, taken as a capsule, which will be simple and safe to self-administer. Working in partnership with Māori and Pacific researchers and healthcare providers we will develop culturally appropriate vaccination strategies and resources, creating whānau-centred solutions to vaccination barriers. Both approaches will aid reducing the vaccination inequities that exist in Aotearoa and make a real impact on health equity in the prevention and treatment of disease.
Associate Professor Tania Slatter, Department of Medical Laboratory Science, and Professor Gabi Dachs, Department of Pathology and Biomedical Science, Christchurch
Using an imaging drug to reduce brain metastases
$1,196,992
Two-thirds of cancer deaths occur when cancers spread around the body. When cancer spreads to the brain (brain metastases), patients have a dismal prognosis with the metastases challenging to treat. New treatment strategies in Aotearoa New Zealand are urgently needed. We propose that a drug used to treat iron deficiency, anaemia, which can cross into the brain could also treat some brain metastasis by exploiting unique properties of these metastases. We will investigate if brain metastases are vulnerable to the anaemia drug. In the clinic and the laboratory, we will test if brain metastases have an iron accumulation signature that leads to greater drug uptake, and if this is sufficient to target metastases by triggering cancer cell death by iron overload. The anaemia drug is relatively low cost with a good safety record and may provide a new treatment opportunity and improved prognosis for those with otherwise limited treatment options.
Associate Professor Lesley Gray, Department of Primary Health Care and General Practice, Wellington
Acceptability and utility of cervical screening self-tests for big-bodied people
$1,199,831
Cervical cancer is preventable through vaccination, screening, and timely treatment. Aotearoa New Zealand's cervical screening programme now offers a universal self-testing option, which is expected to reduce inequities in participation and cancer outcomes. It is vital that the programme – including facilities, staff, communication and equipment – works for people of all body sizes. Big-bodied people have historically been under-screened, putting them at greater risk of undetected cervical cancer. This research aims to understand how well the new screening pathway, including self-testing, meets the needs of this population. Our pragmatic qualitative approach involves partnering with health and community providers to recruit big-bodied people to share their cervical screening experiences. Findings will guide the development of practical approaches and recommendations for implementing size-inclusive cervical screening with broader relevance across all health services. Investing in the delivery of size-inclusive screening will help improve coverage and achieve downstream reductions in cancer incidence and mortality.
Professor Peter Jones, Department of Physiology
Treatment of Alzheimer's disease via inhibition of ryanodine receptors
$1,197,729
Alzheimer's disease (AD) is a major concern for Aotearoa New Zealand's aging population and has very few treatment options. Seizures are an important morbidity of AD with about 25 per cent of patients experiencing an epileptic event. Seizures in AD are associated with accelerated cognitive decline and an increase in mortality. Hence new treatment options for seizures in AD are urgently needed. This research will examine if modifying calcium signalling pathways within neurons, through targeting calcium channels, can reduce seizures in AD. This will be achieved by monitoring the activity of individual neurons and whole brain electrical activity in a mouse model of AD treated with or without novel calcium channel targeting drugs. We expect that controlling calcium channel activity in AD will reduce seizures and that this may slow the decline in AD. If successful, this will offer a novel treatment strategy for AD, a disease estimated to cost New Zealand more than $300 million annually.
Professor Sally McCormick, Department of Biochemistry
Uncovering the connection between serotonin and Lp(a) metabolism
$1,170,000
Twenty per cent of people have high levels of a form of blood cholesterol called 'Lp(a)' which predisposes them to heart attacks. New drugs have been developed for lowering Lp(a) which are currently in clinical trials but are likely to be expensive if approved. We recently discovered a novel clearance pathway for Lp(a) in liver cells, which is regulated by serotonin-enhancing antidepressants. Our research will investigate the mechanisms behind the regulation of Lp(a) clearance by serotonin in cell and animal models and establish if these antidepressants have the potential to be repurposed for Lp(a)-lowering. The knowledge generated from this study will determine if drugs used to treat depression can also be used to lower Lp(a) levels and therefore heart disease risk. This has potential to reduce medication costs and problems with adherence to multiple drugs for people suffering from these two major, often co-existing, health problems.
Dr Rose Crossin and Professor Joseph Boden, Department of Population Health, Christchurch
Defining and measuring drug harm for youth in Aotearoa New Zealand
$1,199,970
Drug use (nicotine, alcohol, illicit drugs) is a major cause of health loss and inequities in Aotearoa New Zealand. Youth are more vulnerable to drug harm than adults, with Māori youth disproportionately impacted. New Zealand's National Drug Policy aims to "minimise alcohol and other drug-related harm …" yet knowledge about how youth experience drug harm is limited. This hinders our ability to quantify harms, and to design and evaluate effective harm-prevention and early-intervention strategies. We propose a mixed-methods study using participatory theory to investigate how drug harm is experienced and conceptualised by Aotearoa's youth. We will use the findings to develop measures to quantify the nature and extent of drug harm in Aotearoa's youth via a national survey. Our study will inform local and international policy and practice. We aim to reduce drug-related harms, which will add economic value through avoided healthcare costs and benefits to productivity.
Professor Greg Jones, Department of Surgical Sciences
Vascular disease risk prediction using a blood test for smoking exposure
$1,107,917
This study aims to improve how we predict someone's risk of cardiovascular disease by testing a new blood test that more accurately measures a person's lifetime exposure to smoking. Current tools often rely on self-reported smoking history, which can be inaccurate. Our test uses DNA methylation, a type of chemical change in the blood linked to smoking, to provide a more reliable measure. Early results suggest it may predict disease risk better than current methods. We will analyse blood samples from a large group of people to see if this test can improve risk prediction, particularly across all ethnic groups in Aotearoa New Zealand. If successful, this test could lead to more accurate and equitable cardiovascular disease risk assessment, making healthcare more effective and cost-efficient.
