Genetic Health (BLC)
Health, wellbeing, access and equity for children and adults living with genetic diseases.
The primary focus of the Genetics Health group, as part of the Bruce LeFroy Centre (BLC) is conducting cutting-edge research on neurogenetic diseases affecting both children and adults.
Our group has a long-standing clinical and research interest in Friedreich ataxia and other ataxias, such as spinocerebellar ataxia (SCA) and dentatorubral-pallidoluysian atrophy (DRPLA).
The challenge for our researchers is identifying a treatment that can, at the very least, slow the progression of rare diseases in children and adults. While the search for treatment continues, people with rare neurogenetic diseases require access to specialist multi-disciplinary care based on long-term, evidence-based management.
The BLC addresses both critical needs by conducting clinical trials for treatments that aim to slow the progression of neurogenetic disease and by providing the evidence base for translational clinical care. The BLC was a site for the Friedreich ataxia omaveloxolone drug trial, which is now approved as the first pharmaceutical with proven benefits in the US and Europe.
Our Genetic Health group also conducts research into genetic screening. This includes screening for reproductive risks such as cystic fibrosis, Tay Sachs disease and thalassaemia, and screening for conditions that can affect the individual's health, including haemochromatosis. The BLC has led Mackenzie’s Mission, a $20 million Medical Research Future Fund (MRFF) project.
The Bruce LeFroy Centre is made possible by the generosity of the Lefroy family and friends, understands that children and adults with rare neurodegenerative diseases cannot wait for the cycle of pharmacological intervention to turn their way; they need intervention now that will at least slow, but optimistically, reverse the effects of these relentless diseases.
Theme Director
Team Leaders
Our projects
Australian Friedreich Ataxia Stem Cell and Gene Therapy Consortium
The Consortium’s vision is to facilitate and undertake Friedreich ataxia cell and gene therapy clinical trials leading to successful outcomes for patients as soon as possible. The Consortium is a strategic alliance of pre-eminent experts in Friedreich Ataxia, Stem Cells, Gene Therapy, Policy, Advocacy and Regulation. Please support the Australian Friedreich Ataxia Stem Cell and Gene Therapy Consortium.
Read more...Friedreich Ataxia Global Clinical Consortium UNIFIED Natural History Study (UNIFAI)
The Friedreich Ataxia Global Clinical Consortium UNIFIED Natural History Study is a multicentre, prospective, observational natural history study of Friedreich ataxia at approximately 50 international sites. The BLC is the Australian site for this study. The primary aim of the study is to unify the global Friedreich ataxia community (clinician researchers and patients) and contribute to the understanding of disease natural history; track health problems and progression of symptoms that occur throughout the disease course; evaluate change in natural history as new disease specific therapies are approved; create a sustainable data platform to support innovative clinical studies, and facilitate interventional therapy development.
Validating the Ataxia Instrumented Measures in Friedreich ataxia
Friedreich ataxia (FRDA) affects quality of life and daily activities by impairing mobility, balance, speech, lower and upper limb function and vision. This project uses movement analysis technology, specifically the Ataxia Instrumented Measure –Cup (AIM-C) and Ataxia Instrumented Measure – Pendant (AIM-P), to evaluate upper limb movement and balance in children and adults with FRDA enrolled in the Friedreich Ataxia Global Clinical Consortium UNIFIED Natural History Study (UNIFAI). The objective of this study is to validate the Ataxia Instrumented Measures (AIMs) as a measure of the severity of Friedreich ataxia (FRDA) in clinical care and/or clinical trials.
Investigating the use of the Ataxia Instrumented Measure – Spoon (AIM-S) in measuring upper limb function in Dentatorubral-pallidoluysian atrophy (DRPLA)
Dentatorubral-pallidoluysian atrophy (DRPLA) is a neurodegenerative disease caused by an expanded CAG repeat in the ATN1 gene, resulting in a mutant protein (atrophin-1) with a polyglutamine expanded tract. DRPLA is an ultra-rare disease and information regarding its natural history is very limited. To better understand upper body function in an objective manner, the Ataxia Instrumented Measure – Spoon (AIM-S) will be used to quantify upper limb motor control in the study participants. This work will be part of a larger international project that aims to collect longitudinal data in the study participants and investigate a comprehensive set of biomarkers.
Measuring ataxia in children with Friedreich ataxia
Concurrent maturation of the cerebellum (peaking around 12 years) confounds the use of clinical rating scales in children with Friedreich ataxia (FRDA). We utilised the Ataxia Instrumented Measure (AIM), to develop an objective, developmentally-appropriate measure of ataxia in children with FRDA. The AIM system comprises a data logger with inertial sensors and machine learning (ML) based algorithms using carefully extracted features from kinetic and kinematic measurements, providing a score of ataxia severity. We provide a personalised severity score that accommodates typical variability in the development of coordination in children with FRDA and that can be used in clinical trials.
Natural History Study to TRACK Brain and Spinal Cord Changes in Individuals with Friedreich Ataxia (TRACK-FA)
TRACK-FA is the most extensive international, longitudinal, multi-centre neuroimaging study in Friedreich ataxia (FRDA). This study will improve understanding of the natural disease history of FRDA (related to changes in the brain and spinal cord), validate neuroimaging measurements in FRDA, and develop a comprehensive database to facilitate ongoing community research and discovery. The study is a collaboration between six international sites: Monash University/MCRI (Australia), University of Minnesota (USA), Aachen University (Germany), University of Campinas (Brazil), University of Florida (USA), and the Children’s Hospital of Philadelphia (USA). FARA (USA) and several industry partners provide input on study design, endpoints and monitoring.
ClinicalTrails.gov Identifier: NCT04349514
- TRACK-FA
- TRACK-FA: A Natural History Study to TRACK Brain and Spinal Cord Changes in Individuals with Friedreich’s ataxia
The efficacy of rehabilitation for hereditary ataxias – a randomised controlled trial
Rehabilitation is one of the only treatments for people with hereditary cerebellar ataxia (HCA). This project was a multi-site, randomised, single-blind, superiority trial comparing 30-weeks of rehabilitation to standard care in 76 adults and adolescents with HCA. The rehabilitation program included six-weeks of outpatient physiotherapy followed immediately by a 24-week physiotherapy-supported home exercise program. Participants in the standard care group continued their usual care. The primary outcome was the motor domain of the Functional Independence Measure. A range of secondary outcomes measured ataxia severity, balance, and quality of life, with outcomes administered at baseline, seven-, 18- and 30-weeks.
ACTRN12618000908235
The Mackenzie’s Mission Research Study
The Australian Reproductive Genetic Carrier Screening study, Mackenzie’s Mission, offered reproductive genetic carrier screening to Australian couples who were either planning to have children or were in early pregnancy. It gave couples information about their likelihood of having a child with a severe genetic condition including about 750 severe autosomal and X-linked recessive genetic conditions. The purpose of Mackenzie’s Mission is to determine how best to deliver reproductive genetic carrier screening at scale in Australia so that it is available for free to every couple who chooses to have it. The data collection phase of this project is complete and now the data is being prepared for publication. The team is working to provide the necessary information to government to hopefully achieve government-funded testing so all Australians can access such screening should they wish.
Novel SMART AAV vectors for gene therapy for Friedreich’s Ataxia
Friedreich ataxia (FRDA) is an inherited disease caused by mutations in the FXN gene, leading to a significant loss of frataxin protein levels in the body. Reduced frataxin levels leads to cell degeneration, particularly within heart tissue and the nervous system. Gene therapy is currently at the forefront as a potential approach to successfully treat FRDA. The major objective of this MRFF Stem Cell Therapies Mission Grant lead by Dr Mirella Dottori from the University of Wollongong is to use human stem cells as a platform to significantly advance current technologies in gene therapy to treat FRDA.
Repurposing Clinical Grade Medications for Treatment of Friedreich Ataxia Heart Disease
This project, led by Dr Shiang Lim from St Vincent's Institute of Medical Research, aims to develop a new blood test for tracking the onset, progression and severity of heart disease in individuals with Friedreich ataxia. The significance of this test lies in its role in clinical trials, particularly evaluating the benefit of drugs or therapies on heart function. The information gained from this project will enhance our understanding of Friedreich Ataxia, aiding in the identification of effective measures for assessing the effect of drugs or therapies on heart function during clinical trials for Friedreich ataxia.
A randomised placebo-controlled crossover trial of micronised resveratrol as a treatment for Friedreich ataxia
This study, which involved 20 participants, aimed to assess the safety and efficacy of micronised resveratrol as a treatment for FRDA. The primary objective was change in the modified Friedreich Ataxia Rating Scale (mFARS) from baseline to 24 weeks, following treatment with 2g per day of micronised resveratrol, compared to placebo. The results of this study are being analysed and prepared for publication.
Long-Term Open-Label Study to Assess the Safety and Efficacy of Vatiquinone in Patients with Friedreich Ataxia
This study is sponsored by PTC Therapeutics Inc and is a follow-on to a placebo-controlled study evaluating vatiquinone vs placebo in FRDA (MOVE-FA). This long-term study is assessing safety and efficacy of vatiquinone and has enrolled participants from the placebo-controlled study. While the original study did not achieve statistical significance on the primary endpoint (mFARS score), there were important clinical findings including improvement in a measure of fatigue and the mFARS sub-section of upright stability. PTC are in discussion with the US Food and Drug Administration (FDA) to explore potential regulatory pathways to approval based on the results.
A Phase 2a Open-Label, Single Dose Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of MIB-626 (β-Nicotinamide Mononucleotide), a Dietary Supplement, in Adult Patients with Friedreich Ataxia
β-nicotinamide mononucleotide (NMN) is a naturally occurring compound related to Vitamin B3 that is used as a dietary supplement. NMN is thought to have numerous health benefits, including protecting the nervous system, and may therefore be beneficial for people with FRDA. MIB-626 is a type of NMN that has been developed by Metro International Biotech. The aim of the study is to determine the safety and tolerability of MIB-626 compared to placebo, administered for 28 consecutive days, in adults with FRDA. This study is expected to commence in the second half of the year.
A Phase 2 Study of the Safety, Efficacy, and Pharmacodynamics of RTA 408 in the Treatment of Friedreich Ataxia
RTA 408 or omaveloxolone (now marketed as Skyclarys) was developed by Reata Pharmaceuticals (now acquired by Biogen) and is the first approved treatment for Friedreich ataxia. It is currently available in the USA and Europe only. Omaveloxolone targets the activation of transcription factor Nrf2. By increasing Nrf2, oxidative stress is reduced, therefore improving mitochondrial function, which is beneficial in FRDA. The open-label extension component studies longer term safety and efficacy and is still ongoing at MCRI. The process has commenced to seek approval for omaveloxolone in Australia.
Funding
- National Health and Medical Research Council (NHMRC
- Medical Research Future Fund (MRFF)
- Biomedical Translation Bridge Program
- Friedreich Ataxia Research Alliance (USA)
- Friedreich Ataxia Research Association (Australia)
- Ataxia UK
- Cure DRPLA
- L’Association Francaise de l’Ataxie de Friedreich (AFAF)
- Rebecca L Cooper
Collaborations
- Ataxia UK
- Friedreich’s Ataxia Research Alliance (USA)
- University of South Florida (USA)
- IRCCS Medea – Associazione La Nostra Famiglia Institute (Conegliano, Italy)
- Turner Institute for Brain and Mental Health (Melbourne, Australia)
- Department of Physiotherapy, Monash University (Melbourne, Australia)
- Monash Heart, Monash Medical Centre (Melbourne, Australia)
- Department of Engineering, Deakin University (Melbourne, Australia)
- Monash Biomedical Imaging (Melbourne, Australia)
- Royal Brisbane and Women’s Hospital (Brisbane, Australia)
- Children’s Hospital of Philadelphia (USA)
- Machado Joseph Disease (MJD) Foundation (Northern Territory, Australia)
- The University of Sydney
- University of Wollongong
- St Vincent's Institute of Medical Research (Melbourne, Australia)
Featured publications
Corben LA, Collins V, Milne S, Farmer J, Musheno A, Lynch D, Subramony S, Pandolfo M, Schulz JB, Lin K, Delatycki MB. Clinical Management Guidelines for Friedreich ataxia: best practice in rare diseases. Orphanet J Rare Dis. 2022 Nov 12;17(1):415.
Archibald AD, McClaren BJ, Caruana J, Tutty E, King EA, Halliday JL, Best S, Kanga-Parabia A, Bennetts BH, Cliffe CC, et al. The Australian Reproductive Genetic Carrier Screening Project (Mackenzie’s Mission): Design and Implementation. Journal of Personalized Medicine. 2022; 12(11):1781. doi: 10.3390/jpm12111781
Lieschke K, Scott V, Delatycki MB, Lewis S, Munsie M, Tanner C, Corben LA. How Great a Risk Do You Take? A Qualitative Study Exploring Attitudes of Individuals with Friedreich Ataxia Toward Gene Therapy. Hum Gene Ther. 2023 Oct;34(19-20):1041-1048. doi: 10.1089/hum.2023.088. PMID: 37624740.
Milne SC, Corben LA, Roberts M, Szmulewicz D, Burns J, Grobler AC, Williams S, Chua J, Liang C, Lamont PJ, Grootendorst AC, Massey L, Sue C, Dalziel K, LaGrappe D, Willis L, Freijah A, Gerken P, Delatycki MB. The Rehabilitation for Ataxia Study: Protocol for a randomised controlled trial of an outpatient and supported home-based physiotherapy program for people with hereditary cerebellar ataxia. BMJ Open 2020 Dec 17;10(12):e040230.
Corben LA, Nguyen, KD, Pathirana, PN, Horne, MK, Szmulewicz DJ, Roberts M, Delatycki MB. Developing an instrumented measure of upper limb function in Friedreich Ataxia. Cerebellum. 2021 Jun;20(3):430-438.