June 16, 2020

Lisa Hui wants answers

Northern Health maternal fetal medicine specialist, Associate Professor Lisa Hui, has recently been awarded an investigator grant in the highly-competitive Medical Research Future Fund (MRFF) clinician researchers initiative, as ‘the next generation of talented Australians having the capacity to make and progress great medical discoveries.’

Lisa completed her clinical training in obstetrics and gynaecology in Sydney and conducted her PhD research at the Mother Infant Research Institute in Boston. She has clinical appointments at both the Mercy Hospital for Women and Northern Hospital and is Associate Professor in the Department of Obstetrics and Gynaecology at the University of Melbourne.

Lisa says the grant recognises that, “It is very challenging to be both a doctor and a researcher at the same time.”

Yet clinician researchers are very valuable because they are at the coalface of health care: “You are seeing patients all the time, you are generating the right research questions, you know where the knowledge gaps are, and your research is much more translatable into improving outcomes,” says Lisa.

Lisa’s investigator grant responds to the MRFF Genomics Health Future Mission by closing ‘the critical knowledge gaps in perinatal genomics’.

Lisa believes genomics is one of the most exciting fields in medicine and has created new powerful tools that tell us how the body works. The study of Genomic Medicine has had several nick names including “personalized” and “ precision” medicine because it allows us to understand the individual’s situation specifically and manage accordingly. Genomic technology now allows researchers to conduct non-invasive prenatal testing that allows  the DNA of the fetus to be examined, without increasing the risk of miscarriage.

“My research program is about how we harness the power of new genomic technologies to improve outcomes for mothers and babies,” says Lisa.

Lisa picked this field of research because, “I feel very strongly that the significant health benefits and ethical implications of genomics in pregnancy care means it deserves a lot more attention than it currently receives.”

Lisa is working on a few fronts to get answers.

One of them is looking at the childhood outcomes for children diagnosed in pregnancy with a genomic change of uncertain significance. She received an NHMRC grant to conduct the PrenatAL Microarray (PALM) cohort study, which has just commenced this year.

“When we do invasive tests, we are sampling cells from the pregnancy to check the baby’s chromosomes. About five per cent of the time we find these genomic changes of ‘uncertain’ or ‘unknown’ significance. We don’t have enough information to know if they have implications for future health or not. This means we can’t give a couple accurate information about the expected health and development of their future child.”

“In this cohort study at the Murdoch Children’s Research Institute, we will be following up with children who had one of these diagnoses before they were born and looking at their development and health outcomes at 2-7 years of age. We aim to follow up several hundred children, which will make it the largest study of its kind in the world,” says Lisa.

She is also part of a research team that will examine the bioethical and regulatory implications of advances in prenatal screening. This Australian Research Council-funded linkage project is led by Prof. Catherine Mills from Monash University and includes industry partners, medical, legal and bioethics researchers.

This is in addition to Lisa’s research work at Northern Health, where she is building up the NCHER Reproductive Health Biobank. She just received philanthropic funding to purchase new equipment for the lab that will greatly expand the range of experiments that can be performed. Work in progress at the biobank include laboratory projects to understand the biology of placental cell-free DNA, and to understand the changes in maternal immune cell memory during pregnancy.

Lisa believes doing research in the Northern community is extremely important.

“The demographics of our population here is very different to Parkville or Heidelberg. There are many pregnancy complications that are influenced by social determinants and that’s why it is important to have research done with our patients to make the results applicable to our population.”

She reports that “Over 25 per cent of our research participants come from culturally and linguistically diverse background, which is in line with our general antenatal population.”

“This is very reassuring, because it tells us that our women are very keen to support research and that we are trusted!”

Lisa would like to see research and women’s health grow at the Northern. “Integrating research with clinical practice, improves the way we care for women. It teaches our clinicians to ask questions, examine evidence, and think about what knowledge we need to generate to improve care.”

“We want to provide opportunities for our trainees and medical students to do research at Northern and be inspired!”

Lisa believes research is a different way to contribute to the wellbeing of our population.

“Generally when people decide to become a doctor it is because they want to help people. Research can make a difference on a completely different scale. You can change practice and potentially reach more people, besides keeping you intellectually stimulated.”

John Ferguson, Chief Medical Officer says,  “We are both proud and excited with  Lisa’s work in perinatal genomics. The sheer diversity of our catchment population means we have a wide variety of genetic variability based on ethnicity and this recognizes that specific genetic conditions are more prevalent in certain nationalities. Lisa is an inspiration to both current and future generations of clinical researchers.”