Snow Centre for Immune Health
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Terry Snow AM
IMAGE PLACEHOLDER: Terry Snow AM, Ginette Snow, Tom Snow, and Doug Hilton
We take for granted that when we go to our doctor, they will measure the health of some of our body’s systems and intervene as necessary to improve our health.
The cardiovascular system is a great example. At every visit, our doctor will take our pulse (these days we even have smart watches that measure our heart rate continuously), they will take our blood pressure and will listen to our heart using a stethoscope. At a regular annual check-up, the lipids in our blood may be assessed. We do these tests not just when we are ill, but when we are healthy, and if anything is awry, we intervene to prevent illness – for example by taking medicines that prevent lipid build up, reduce blood pressure or reduce clotting.
Despite its centrality to our health, we treat the immune system differently. The only time our doctor considers measuring the health of our immune system is when we are already sick. Although we routinely harness the immune system to prevent infectious diseases and cancers by vaccination and immunotherapy, we almost never prevent diseases of the immune system, at huge costs to patients, to families and to society.
Finding the right balance
The SCIH will change the way society views the immune system. The SCIH will draw on foundational research that allows us to measure key aspects of the immune system in a sophisticated way and use this information to develop tests that allow immune health to be monitored by an individual and their doctor (just like we do with our cardiovascular system) – providing a rational and scalable framework to maintain health and treat immune disease in a personalised way.
From day one, we will apply what we have discovered about the immune system over the past decades to provide benefits to patients and the community. And informed by the experience of patients in the clinic, we will conduct further research that will deepen our knowledge, and this will in turn be used to refine our clinical approach – forming a virtuous cycle. This virtuous cycle will be at the heart of the SCIH.
Shifting health paradigms of a magnitude such as this, requires a new and innovative approach to research and its integration into healthcare settings. This requires a new and visionary approach to funding and supporting research that only private philanthropy can deliver.
The co-design of the SCIH between the teams at the Snow Medical Research Foundation, WEHI, the Royal Melbourne Hospital (RMH) and collaborators across the world, is not just an opportunity to have a major health impact – it is an opportunity to revolutionise the way we conduct research and the way we fund and support research.
The key elements of this new co-designed approach are:
- An inspiring model that will build collaborative programs that are structured and supported for maximum impact and aim to be the best in the world, interact with the best around the world and link with the private sector to have global impacts on health and well-being for individuals, families, and communities.
- A structural process of embedding researchers in the clinical environment and clinicians with researchers to enable clinical problems to drive the research and shorten the journey from scientific discovery to clinical impact.
- Philanthropy and researchers that commit to making a real difference to the community – not leaving advances many years away from impact, as so often occurs.
- Providing an environment that allows researchers to focus on doing science and having impact – not accruing resources.
- A mindset that provides for continuity of core teams while continuously inviting in and supporting new ideas and fresh approaches, wherever and from whomever they arise, provided they are focussed on solving the Snow Centre’s grand challenges.
Pathway to impact
The immune system is crucial for maintaining health
Our immune systems are constantly vigilant, deploying a vast army of cells with specialised roles to detect and, when required, respond to every potential threat we encounter, with enduring memory to protect us from threats again in the future.
Our immune systems, when sub-optimal, are responsible for a huge burden of disease. On one hand, the response may be too weak leading to severe, recurrent or difficult to treat infections. On the other hand, a strong or misdirected response, may lead to autoimmune and inflammatory disease.
One in 20 people have an autoimmune disease, like rheumatoid arthritis, multiple sclerosis, type 1 diabetes or systemic lupus erythematosus (SLE), where the immune system attacks our own tissues and cells.
Allergies and asthma also result from an over-active immune system, causing reactions to common environmental substances which should be harmless. The occurrence of allergic disease in high-income countries has become so common that one fifth of the population has some form of allergic symptoms that can be debilitating.
There is even greater complexity to our immune health than a simple “too strong to too weak” dichotomy represents. For example, some people with an autoimmune disease, like multiple sclerosis, can be abnormally susceptible to infections and cancer, while someone with an immunodeficiency may also experience severe allergic disease and inflammation.
The current management of immune disorders fails to consider the complexity of the immune system
In Australia, and globally, we are facing a ‘tidal wave’ of immune diseases and yet we do almost nothing to prevent them. Instead, we rely on treatments that are grossly inadequate, including broad immunosuppression in the case of autoimmune diseases, ‘band-aids’ such as antihistamines and corticosteroids for allergies, or the avoidance of triggers for allergies (which is impossible for some allergens, such as pollen).
In individuals with weakened immune responses, antibody replacement, lifelong prophylactic antibiotic treatment, or haematopoietic stem-cell transplants are required. Whilst there have been great advances in targeted therapies for some autoimmune diseases, asthma and allergies, these are not sufficiently effective for most patients, and are prescribed in a way that relies on trial and error rather than a personalised, evidence-based approach. The SCIH will transform this ‘one size fits all’ approach.
In Australia, over $1 billion annually is spent on treatments that target immune system disorders1, yet the process for matching patients to the right treatment for their individualised disease is a long way from ideal. Tragically, when treatment is ineffective, or only partially effective, irreversible organ damage can occur, requiring lifelong replacement treatment (e.g., haemodialysis or organ transplantation).
SCIH Programs
The big questions in immunology
Our immune systems are critical for general health, yet we are ineffective at detecting potential weaknesses and targeting therapies with precision. The remarkable variation exhibited by each person presents additional challenges for identifying causes of disease and effective treatments. Despite decades of research, many big questions remain to be solved, with the potential for enormous benefit to the health of humanity.
The ability to ‘wind down’ or turn off immune responses could avoid and suppress autoimmune conditions. The ability to manipulate and reverse the processes that drive allergy would be life changing. The ability to promote or suppress the cells that make antibodies, either protective or damaging respectively, would impact many diseases. The capacity to tune vaccines for improved outcomes would better protect us from infection and subsequent infectious diseases. The ability to identify individuals in danger of developing immune-related problems and monitor and correct the root cause would be transformative.
What is the way forward? A great deal of modern research aims to dissect the immune system and monitor its performance with finer and finer molecular and spatial resolution. While an invaluable arm of the scientific process, these activities add to our appreciation of the scale of the problem, but they don’t add to its resolution.
To solve the problem, we need to change our perspective, we must take a step back and view the whole system, while also taking advantage of our insights into the detail. A whole-of-system approach, adapted from the physical sciences, but reinvented for immunology, will revolutionise immune health.
Patient journey at SCIH
Real Impact
Advances in immune therapy have helped Michael (left) manage an inherited inflammatory disorder. He and his partner Dominique recently welcomed their first daughter Pearl into their family.
Louis lives with life-threatening allergies, which he hopes could be cured one day.