Carol Lang

Dr Carol Lang

NHMRC Peter Doherty Research Fellow

Adelaide Medical School

Faculty of Health and Medical Sciences


Dr Lang holds an Early Career Postdoctoral Research Fellowship from the National Health and Medical Research Council of Australia (NHMRC). Carol has previously undertaken laboratory based research into the composition and function of pulmonary surfactant and has studied the role of the dietary metal zinc, and the proteins that transport zinc, in allergic, viral and smoke-induced airway inflammation and respiratory disease. In 2014, Carol joined The Health Observatory at the Basil Hetzel Institute for Translational Health Research and University of Adelaide to undertake training in epidemiology and to study sleep disordered breathing. Her latest research has focused on the two most common sleep disorders known as obstructive sleep apnea and insomnia. Carol is currently using epidemiological research techniques to study how these sleep disorders relate to cognition and mental health as we age.

The Health Observatory

The mission of The Health Observatory is to conduct innovative population and clinical research studies and produce the evidence for initiatives that promote prevention, lead to early detection and better management of disease, and improve quality of life, well-being and mental health. Observatory research also investigates the interaction of health services with patients to identify opportunities that lead to more effective health care and management, and that will maximise health outcomes. We have research opportunities available to anyone interested in clinical, epidemiological or population research, as well as health services research, health economics or mathematical modelling.

Sleep Disorders and Mental Health

Obstructive sleep apnea (OSA) and insomnia are common sleep disorders that can frequently coexist in patients. OSA is characterised by recurrent episodes of complete (apnea) and partial (hypopnea) closure of the upper airway during sleep whilst insomnia is characterised by subjective problems falling or staying asleep resulting in a loss of vitality, or fatigue during the day.  Both these sleep disorders have a high rate of under-diagnosis in the community and are known to be associated with adverse outcomes i.e. heart disease, diabetes, kidney disease, mental health, accidents and quality of life.

My current work aims to explore the relationships between sleep, cognition and mood disorders across the adult lifespan in men.  Australia, like many countries faces an aging population and as such age-related deterioration in cognition and mental health represent significant economic and quality of life burdens to society. Our work has shown that in men, previously undiagnosed obstructive sleep apnea is associated with depressive symptoms. Moreover, men with both obstructive sleep apnea and insomnia have a greater prevalence, and severity, of depression than men with only one of these sleep disorders.  As a result, we have suggested that clinicians managing either sleep disorders or depression incorporate screening methods to ensure that a patient presenting with one disorder is assessed for the other.  However, it is evident that innovative screening tools are urgently needed in order to (a) better identify and classify sleep disorders (both in sleep clinics and the wider community) and (b) identify those at risk of cognitive dysfunction and/or mood disorders.  This is essential in order that the appropriate treatment strategies can be put in place for individuals.  My work aims to address current gaps in the research of sleep, cognition and mood disorders as we age. One of the limitations of previous studies investigating sleep patterns in ageing and cognition in particular is that most have failed to assess and therefore adjust for pre-existing sleep and mood disorders.  There have been very few community based population studies in this area and even fewer longitudinal population studies to ascertain causality.  

We have completed overnight sleep studies on 837 community-dwelling men in the MAILES Study in 2010-11, and are following their progress. The MAILES Study is a biomedical prospectively followed population cohort study of N = 2569 community-dwelling men from metropolitan Adelaide. Initial recruitment was by random selection via computer assisted telephone interviews (CATI) in 1999-2003. Follow-ups have occurred in 2007-10 (Stage 2, N = 2038), 2010 (Stage 3 CATI, N = 1629), 2010-11 (Sleep Study, N = 837) and 2016 (Stage 5, recently completed). A follow-up in 2017-19 is already planned and funded by the NHMRC. This is the first longitudinal population based study in Australia since the advent of more sensitive sleep study methods and one of very few worldwide to examine health outcomes associated with sleep disorders. 

 Current projects from this data, of which my work is a part, include investigation of:

  1. the independent effects of OSA and insomnia over the follow up period on a composite of clinical health outcomes; quality of life, and health and societal costs, including accidents and work force participation. The aim is to determine a threshold of OSA severity at which overall health becomes compromised and health care and societal costs rise.
  2. new markers of OSA on sleep studies (power spectral analysis, heart rate variability) can be used to improve the precision for identifying those at risk of adverse consequences
  3. the influence of sleep quality and insomnia on health outcomes
  4. health economics analyses, including cost per DALY/QALY and decision analytic simulation studies for treatments

Examples of media articles

http://www.latimes.com/science/sciencenow/la-sci-sn-depression-sleep-apnea-link-20150520-story.html

https://www.adelaide.edu.au/news/news77986.html

https://www.businessinsider.com.au/science-says-men-get-depressed-when-they-cant-sleep-2015-5

http://bitemagazine.com.au/8432-2/

http://www.psychiatrictimes.com/depression/sleep-apnea-increases-risk-depression-men

http://indaily.com.au/news/2015/05/14/depression-and-sleep-disorders-profoundly-linked/

 

Prior Research in Respiratory Medicine

My previous research was laboratory based and included studying healthy and diseased airways [asthma and smoking disorders], airway inflammation, hypoxia and the pulmonary surfactant system using a range of laboratory, biochemical, cell and molecular techniques. Although I am currently focusing on sleep disordered breathing from an epidemiological perspective (described above), please be aware that I do still hold an active interest in airway research and remain open to the possibility of joining collaborative research teams, new research projects and/or supervising students in respiratory medicine. Some of my key research projects have included:

Chronic Inflammation in Disease:  I was a chief investigator on a large collaborative program grant from The Hospital Research Foundation that aimed to investigate common mechanisms of chronic inflammation. I led one of the key projects funded by this grant which looked at inflammasome activation in laboratory models of asthma. Inflammation is the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. Inflammation is normally tightly regulated by the body. Dysregulated or prolonged (chronic) inflammation underpins the chronic diseases that are prominent in our community i.e. Asthma and Chronic Obstructive Pulmonary Disease  (COPD), Chronic Rhinosinusitis, Rheumatological diseases and Stroke. Independent of these chronic diseases prolonged inflammation reduces health and longevity and is associated with aging. The persistence of chronic inflammation is in large part due to over-production or inappropriate production of one or more pro-inflammatory cytokines that drive the mobilisation of inflammatory cells to the sites of tissue injury and inflammation, as well as activation of these inflammatory cells to release proteases, oxyradicals and other agents which cause further damage. Proinflammatory cytokines are produced by immune and inflammatory cells at the site of tissue damage as well as by the damaged epithelium, fibroblasts and neighbouring cells. Pattern recognition receptors (PRRs), which include toll-like receptors (TLRs) and Nod-like receptors (NLRs), are key components of the innate immune system. These PRRs have evolved as intracellular sensors to detect cytosolic microbial components and extracellular “danger” signals such as ATP and toxins. The caspase-1 (NALP3) inflammasome is part of the NLR family, and we proposed that dysregulation or perpetual activation of the inflammasome would play a critical role in driving the process of chronic inflammation. We developed a range of molecular tools targeting the inflammasome pathway (RNAi, antibodies, caspase inhibitors, P2X7 receptor agonist/antagonists) which provided an opportunity to further dissect the mechanisms of disease and identify new therapeutic approaches.

Other Chief Investigators: Prof Peter-John Wormald, Prof Simon Koblar, Dr Susan Lester, Prof Maureen Rischmueller, Dr Lor-Wai Tan, Dr Peter Zalewski

Location: Basil Hetzel Institute for Translational Health Research and The Queen Elizabeth Hospital, Woodville, South Australia.

The role of zinc, and proteins that transport zinc, in the airways and in airway inflammation: My work focused on the links between the dietary metal zinc and asthma and chronic obstructive pulmonary disease. Human asthma is associated with low zinc status and the cells lining healthy airways contain large pools of free zinc. We conducted the first complete study of two newly discovered families of proteins that transport zinc in airway cells (known as zinc transporters) and investigated how the gene and protein expression of these proteins were affected by (1) allergic inflammation, as occurs in asthma; (2) cigarette smoke, which is a major cause of chronic obstructive pulmonary disease, and (3) common respiratory viruses. 

Fellowship Supervisors: Dr Peter Zalewski, Prof Richard Ruffin

Key Collaborators: Dr Chiara Murgia, Dr Rosa Gualano, Prof Gary Anderson.

Location: Basil Hetzel Institute for Translational Health Research and Department of Medicine, The University of Adelaide

Acute Lung Injury and Cell Stretch: Acute Lung Injury is an inflammatory condition that arises from lung insults (eg pneumonia; sepsis) and often requires mechanical ventilation. Alveolar macrophages & alveolar type II epithelial cells release inflammatory mediators in response to bacterial lipopolysaccharide to initiate lung inflammation. High volume ventilation, or cell stretch can worsen lung injury.  Ventilatory treatment strategies can favour low tidal volumes & high end-expiratory volumes to reduce lung stretch & ‘rest’ the lung. “Protective” ventilatory strategies may give rise to hypercapnic acidosis (low pH due to high carbon dioxide. Our work utilised cell culture techniques and defined the specific responses of lung cells to carbon dioxide, stretch and pH. 

Supervisor: Ian Doyle

Location: Department of Human Physiology, Flinders University of South Australia, Bedford Park, South Australia.

Pulmonary Surfactant (PhD research): Pulmonary surfactant is a mixture of lipids and proteins that is crucial for lung function. Due to the biophysical properties of lipids, temperature potentially can have a profound effect on surfactant function. Heterothermic mammals regularly endure changes in body temperature without suffering from surfactant dysfunction. Surfactant is synthesised in alveolar type II epithelial cells & secreted in response to the autonomic nervous system & other regulatory factors. I investigated the thermal dynamics of the surfactant systems in homeothermic & heterothermic mammals, at cellular, compositional, biophysical & functional levels. Although, the value of comparative research is still often undervalued by biomedical scientists my PhD research challenged basic paradigms of surfactant function and impacted the design of therapeutic surfactants in humans (personal communication from colleagues). 

PhD Supervisors: Prof Sandra Orgeig and Prof Christopher Daniels

Key Collaborators: Prof Emiritus William Milsom (University of British Columbia, Canada), Prof Anthony Postle (University of Southampton, UK), Prof Fred Possmayer (Children's Health Research Institute, Canada). 

Location: Department of Environmental Biology, University of Adelaide. 

 

Research Funding Acknowledgements

Research Organisations that have supported my research, and research career include: 

National Health and Medical Research Council of Australia

Australian Lung Foundation/Boehringer Ingelheim; 

Clive and Vera Ramaciotti Foundation;

Boehringer Ingelheim Fonds; 

The Australian Federation of University Women

The University of Adelaide

The Hospital Research Foundation;

The ResMed Foundation

Embla Systems;

Society of Experimental Biology;

American Thoracic Society;

Thoracic Society of Australia and New Zealand.

    Expand
  • Appointments

    Date Position Institution name
    2011 - 2014 Playgroup Coordinator Uniting Church of South Australia
    2006 - 2017 NHMRC Research Fellow (Australian Biomedical Postdoctoral Training Fellowship) University of Adelaide
    2005 - 2006 Australian Lung Foundation/Boehringer Ingelheim Chronic Airflow Limitation Research Fellow University of Adelaide
    2004 - 2005 NHMRC Post-doctoral Research Officer University of Adelaide
    2004 - 2004 NHMRC Research Associate Flinders University of South Australia
    2000 - 2003 Practical Demonstrator University of Adelaide
    1994 - 1998 Research Assistant Child Health Research Institute
  • Awards and Achievements

    Date Type Title Institution Name Amount
    2015 Honour NHMRC Outstanding External Assessor National Health and Medical Research Council of Australia
    2015 Award American Thoracic Society Assembly on Sleep and Respiratory Neurobiology Abstract Scholarship American Thoracic Society Assembly on Sleep and Respiratory Neurobiology $500 US
    2015 - 2015 Research Award University of Adelaide Discipline of Medicine Travel Grant 2015 American Thoracic Society $5000.00
    2015 Scholarship Sleep and Breathing Abstract Bursary
    2010 - 2010 Scholarship Thoracic Society of Australia and New Zealand Janet Elder Travel Award Thoracic Society of Australia and New Zealand
    2006 - 2006 Scholarship Asia Pacific Society of Respirology Career Development Award Asian Pacific Society of Respirology
    2006 Scholarship Qantas Researcher Travel Support Grant
    2005 - 2008 Recognition University of Melbourne Visiting Academic Status
    2004 Invitation 'Thanking Address' at University of Adelaide Science Graduation Ceremony University of Adelaide
    2003 Award Society of Experimental Biology Travel Grant £250
    2001 - 2003 Scholarship University of Adelaide Research Abroad Scholarship $1000
    2001 - 2003 Scholarship Australian Federation of University Women Jean Gilmore Bursary $6000
    2001 - 2003 Scholarship Boehringer Ingelheim Fonds Travel Scholarship 6000DM
    2001 - 2001 Scholarship Society of Experimental Biology Travel Grant £500
    2001 - 2001 Scholarship University of Adelaide DR Stranks Postgraduate Travelling Fellowship $1500
  • Language Competencies

    Language Competency
    English Can read, write, speak, understand spoken and peer review
  • Education

    Date Institution name Country Title
    2000 - 2004 University of Adelaide Australia PhD: Bioscience
    1999 - 1999 University of Adelaide Australia Honours
    1993 - 1998 University of Adelaide Australia Bachelor of Science
  • Certifications

    Date Title Institution name Country
    2009 Advanced Course in Research Statistics Thoracic Society of Australia and New Zealand Australia
    2006 Micromon Recombinant DNA Techniques Course Monash University
    2005 Supervising Postgraduate Research Students Workshop University of Adelaide, Adelaide Australia
    2005 Short course for Respiratory Research Thoracic Society of Australia and New Zealand
    2005 University Teaching for Effective Student Learning Course (part of the Graduate Certificate in Higher Education) University of Adelaide, Adelaide Australia
    2004 Introduction to SPSS II (Statistical Analysis) Course Flinders University of South Australia
  • Research Interests

Research Grants

  • Wormald, PJ*, Koblar, S, Lang C, Lester S, Rischmueller M, Tan LW and Zalewski P.  The Hospital Research Foundation Program Grant. $180,000 pa. (2009-2011). Project Title: Inflammatory mechanisms and therapies in chronic disease - asthma, COPD, stroke, cerebrovascular disease, rheumatology diseases and chronic rhinosinusitis. *Alphabetical order after PJ Wormald.
  • Lang CJ. Clive and Vera Ramaciotti Foundation Establishment Grant. $27,100. (2007-2009). Project Title: Investigating the role of ZIP1 and ZIP14 in airway inflammation and infection. 
  • Lang CJ. The Queen Elizabeth Hospital Research Foundation Research Grant. $30,100. (2007-2009). Project Title: Investigating the role of ZIP1 and ZIP14 in airway inflammation and infection. 
  • Lang CJ, Gualano, R. University of Adelaide, Faculty of Health Science Early Career Research Grant $15,000. (2006-2007). Project Title: The role of zinc in cigarette smoke induced airway inflammation and chronic obstructive pulmonary disease.

Community Grants (voluntary, unrelated to my scientific research)

  • On behalf of Dernancourt Uniting Church. The Uniting Foundation $10,000. (2011-2014). Project Title: DUCKS Playgroup Expansion: to establish a playgroup specifically for grandparents, grandparent carers and their grandchildren.  
  • On behalf of Dernancourt Uniting Church. The Uniting Foundation $50,000 (2016-2018). Project Title: Community Connection and Care for Families.  

 

I have been a research only academic since 2004.  However, I have trained and/or supervised numerous research assistants and students (primarily in hands-on laboratory based research techniques) both in Australia and as a visiting researcher overseas. Only some of those I have supervised or co-supervised are listed below: 

  • 2008-2010 Research Assistant: Rhys Hamon
  • 2007-2010 Part-time Research Assistant: Eugene Roscioli.
  • 2007  Casual Research Assistant: Nicola Leung. 
  • 2005-2006  Part-time Research Assistant: Mary Leong. 
  • 2006 Part-time Research Assistant: Sook-Ching Lee. 

I have had the following training/experience in mentoring and undergraduate teaching at the University of Adelaide:

  • Supervising Mentor for a group of 4 Medical Students: MBBS III Research Project. (2016).
  • Completed Course in University Teaching for Effective Student Learning (part of the Graduate Certificate in Higher Education). Centre for Learning and Development, University of Adelaide. (2006).
  • Workshop on Supervising Postgraduate Research Students, University of Adelaide Graduate Centre. (2005).

Previously I have:

  • participated as a mentee in a Mentoring Scheme for Early Career Women Researchers, Flinders University of South Australia.
  • worked as a Practical Demonstrator for Biology I, Biology of Organisms I and Zoology II. 
  • assisted with National Science Week activities. 
  • been a mentor to secondary students interested in science as a career.
  • conducted presentations and informal Chats to students in the University of Adelaide Science Scholars Program. 
  • helped primary school students complete SASTA Oliphant Science Award projects. 
    Expand
  • Committee Memberships

    Date Role Committee Institution Country
    2012 - 2015 Member School of Medicine Research Committee University of Adelaide Australia
    2009 - 2010 Member Institute Management Committee
    2009 - 2010 Director Basil Hetzel Early Career Researcher Group
    2006 - 2014 Member Discipline of Medicine Research Committee
    2006 - 2010 Member University of Adelaide Faculty of Health Sciences Research Career Development Committee
    2006 - 2008 Member Basil Hetzel Research Institute Management Committee
    2004 - 2007 Chair Basil Hetzel Seminar Series
  • Memberships

    Date Role Membership Country
    2015 - 2016 American Thoracic Society
    2014 - 2015 Member Thoracic Society of Australia and New Zealand
    2005 - 2010 Thoracic Society of Australia and New Zealand
    2005 - 2007 European Respiratory Society
    2005 - 2007 Asia Pacific Respiratory Society
  • Consulting/Advisories

    Date Institution Department Organisation Type Country
    2004 - 2016 Basil Hetzel Institute for Translational Health Research Scientific research
  • Position: NHMRC Peter Doherty Research Fellow
  • Phone: 82227410
  • Email: carol.lang@adelaide.edu.au
  • Fax: 8222 6042
  • Campus: The Queen Elizabeth Hospital
  • Building: QEH - Institute Building
  • Org Unit: Medicine

Connect With Me
External Profiles

Other Links