I am the Pregnancy and Birth Theme Leader and Research Leader at the Robinson Research Institute, and lead the Vascular Immunology in Pregnancy research group. My multidisciplinary research team brings together both immunology and vascular biology to understand what causes preeclampsia. I collaborate with researchers globally to integrate the latest research and technology advances, and work closely with Australian clinicians so my research has a pathway to mothers and children.

Preeclampsia is a whole-of-body, whole-of-life condition

Where most research has focused on either the immunology or the vascular biology of preeclampsia, I am one of just a handful of researchers globally combining both fields and looking at how the immune system and vascular system dynamics cause pregnancy complications. As well as delivering a better understanding of the causes, this unified research approach will help us to develop screening tools for diagnosing the disorder, as well as identifying early signs of cardiovascular disease after a complicated pregnancy. 

Screening tools and intervention

A better understanding of the potential causes and triggers of preeclampsia can inform more effective screening tools to identify at-risk women. With my team, we are seeking to develop screening tools that will account for established risk factors, such as obesity and age, while also examining immune system and vascular function to identify all the deficiencies that might trigger preeclampsia. This would allow for intervention at both early and later stages of the pregnancy.

Studies have found that women with preeclampsia have fewer regulatory T cells. These immune cells help regulate or suppress other cells in the immune system and are crucial to the development of the placenta; they are also important to long-term cardiovascular health. We are working to develop targeted immune interventions that can boost regulatory T cell numbers and vascular interventions to improve vascular function, to reduce preeclampsia impacts and improve long-term postpartum cardiovascular health.

Reversing the damage

Through collaboration with the postpartum screening clinic at the Lyell McEwin Hospital established by cardiologist Margaret Arstall, the COFFEE Clinic, I will use non-invasive testing to capture additional measures of vascular function and build a more complete picture of the impact of pregnancy complications.

At the COFFEE Clinic, patients who have previously had severe cases of preeclampsia or other pregnancy disorders are monitored for key health factors and provided personalised health advice. We are looking to capture measures of vascular function using non-invasive measures such as retinal scanning, which provides insight into systemic vascular health, and can reveal changes in microvascular function.

Together, we will be able to broaden our understanding of what is happening postpartum, and how we can reduce the whole-life impact of preeclampsia.

Impact

My focus is to ensure that women from disadvantaged and remote communities in Australia and abroad can benefit from my work. In Adelaide’s CBD, the rate for preeclampsia is around 2-5%. At the Lyell McEwin Hospital, 30 minutes north of Adelaide, the rate is as high as 10%. In regions and countries with reduced access to healthcare facilities that number can increase to 17%.

Preeclampsia affects mothers and infants for life. It can also impact subsequent pregnancies. We need to develop more effective ways of diagnosing and treating this condition, so that we reduce the impact globally.

Vascular Immunology in Pregnancy Research Group - Current Student Projects

Project 1 

Title: Regulatory T cells drive vascular adaptations in early pregnancy to facilitate placental development

Supervisors: Dr. Alison Care, Prof. Sarah Robertson

Description: Preeclampsia is a complication that affects 5-8% of pregnancies worldwide, and poses a significant risk to maternal and infant health. There is currently no treatment for preeclampsia, and therefore up to 12% of infants are born small for gestational age and 20% are born preterm. As such, preeclampsia contributes to long-term health complications in offspring as well as postpartum women. The syndrome is characterised by impaired placental development, which reduces the supply of oxygen and nutrients to the fetus. The anti-inflammatory immune cell, regulatory T cells (Treg), are essential for maternal immune tolerance to the developing fetus and placenta. We have also shown that Treg cells have an integral role in driving the vascular changes that occur during a healthy pregnancy. Accumulating evidence implicates dysregulation of maternal Treg cells in abnormal placental development and the development of preeclampsia. In this project, we will use tissue from a mouse model of preeclampsia to assess placental development. We will investigate how the maternal immune cells assist in the development of the placenta, and their role in facilitating vascular changes required to enable sufficient blood flow to the fetus.

Skills learned during this project: Flow cytometry, immunohistochemistry, tissue collection, ultrasound biomicroscopy, data collection, analysis and interpretation.

Project available for: Honours and HDR

Location: Adelaide Health and Medical Sciences Building, North Terrace

Research project start: Semester 1 and 2

Project 2

Title: Regulatory T cell boosting strategies to improve outcomes in complicated pregnancies

Supervisors: Dr. Alison Care, Prof. Sarah Robertson

Description: Extensive immune adaptations are required in a healthy pregnancy. In preeclampsia, the adaptive immune response and T cell balance are disrupted, favouring a pro-inflammatory environment. Regulatory T cells (Treg) are a specialised T cell subset that suppress inflammation and prevent maternal immunity (i.e. immune rejection) towards the fetus. Tregs are key regulators of vascular function, notably in atherosclerosis and cardiovascular disease, where infusion of Tregs can reverse hypertension. Tregs are also implicated as regulators of vascular function in pregnancy. There are fewer Tregs with reduced anti-inflammatory function in the circulation, decidua and placenta of PE women and in rodent models of PE. In this study, we will determine whether bolstering Treg cell number and function may be a rational therapeutic strategy for the underlying condition of PE. This project will form the groundwork for future development of novel Treg cell-based diagnostic tests for PE.

Skills learned during this project: Flow cytometry, immunohistochemistry, tissue collection, ultrasound biomicroscopy, data collection, analysis and interpretation.

Project available for: Honours and HDR

Location: Adelaide Health and Medical Sciences Building, North Terrace

Research project start: Semester 1 and 2