Baker IDI Heart and Diabetes Institute

Baker IDI Heart And Diabetes Institute was formed by the 2009 merger of two separate organisations, the Baker Heart Research Institute (BHRI) and the International Diabetes Institute (IDI).

History

The Baker Heart Research Institute

The Baker Heart Research Institute was established in 1926 in Melbourne with financial support from Mr Thomas Baker, his wife Alice Baker and her sister Ms Eleanor Shaw and was a major collaboration with the Alfred Hospital.^[1] Its first Director was Dr W S Penfold, who served in that role until 1938. The first Director of the IDI was Professor Paul Zimmet and he held that position until the merger in 2008. He is now Director Emeritus, Director International Research, in Baker IDI.

JF Mackeddie, a pathologist originally from Scotland, but who practised in Melbourne in the early 20th Century, became a close friend of Thomas Baker through being neighbours on land south of the city. Mackeddie was “concerned with the science of diseases and the need to apply the advancing knowledge of biological science to human illness…”^[2] After convincing Baker to donate funds, firstly to the Alfred Hospital and then for research, he went on to become one of the founding Trustees of the Baker Medical Research Institute. Mackeddie recruited AB (Basil) Corkill as a biochemist for the new Institute. The salary was paid by Thomas Baker.

"The only consistent basic research in relation to diabetes and carbohydrate metabolism in the 20 years from 1925 was carried out at the Baker Institute in Melbourne" F.I.R. Martin^[3]

The initial project dealt with new techniques for diagnosing diseases of the nervous system, in particular, the changes in cell content and chemistry of cerebro-spinal fluid in various diseases.^[4] Other projects in the early days involved bacteriology, at the time the Institute was started, the advancing edge of scientific medicine, and its application to the management of infectious disease in man. In the 1930s microbiology was a focus, with many of those projects reliant upon blood cultures and the techniques developed were published in a monograph – "Blood Cultures and their Significance" by H Butler in 1937. The Monograph Series lasted until 1974 – with 9 published. They covered anaesthesia, tumours, the cardiovascular system and scleroderma.

Basil Corkill described the methods of diagnosis and treatment of diabetes mellitus at the Alfred Hospital in 1927.^[5] Twenty years later, in 1947, Joe Bornstein a young biochemist was introduced to Basil Corkill, who by then was Director of the Baker Institute. Their work together resulted in the discovery of the 2 forms of diabetes – insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM).^[6] This discovery in 1949 “..literally changed the concepts, research and treatment of diabetes”.^[7]

"In the circumstances of the formation of the Institute it was to be expected that much of the research, at least in the earlier years, would be directed to the application of existing knowledge to the practical problems of clinical medicine" T.E. Lowe^[8]

In their collection of memoirs of Baker Medical Research Institute Alumni, Andrew and Barnett describe the work of the Baker Institute to have “..always been in the interface between scientific medicine and the practice of medicine, a field engendered and enhanced by its association with Alfred Hospital.”^[9] They remark that from its earliest days, the staff were involved in communicating the outputs of research to the clinical community and the community in general. An example being the state-wide tours of Victoria that Basil Corkill and Ewen Downe made to introduce the new insulin treatment of diabetes mellitus.^[10]

In 1940, Paul Fantl became interested in blood clotting. At the time, synthetic Vitamin K was being produced and was often in short supply. Using very simple equipment – test tubes, water bath, stop watches and a centrifuge – he was “in the forefront of a revolutionary concept that led to the recognition of Factors V, VII, and X”, and with Miss Nance, internationally credited with the discovery of Factor V.^[11] He went on to become a member of the International Committee for the Standardisation of the Nomenclature of Blood Clotting Factors in 1956. In 1963 he was honoured when the Fantl-Koller Schema was declared.^[12]

Other areas of research up to 1949 included asthma, eye disease, immunoproteins, scleroderma and surgery. The research on surgery lead to the development of cardiac surgery at the Alfred Hospital.

In the 1950s Tom Lowe decided to make a study of congestive heart failure. He concluded “that the body's fluid system was an 'open system' with an intake and output and divisions of the contents under control of various factors”.^[13] He was also interested in electrocardiography, especially vector cardiography and had machines constructed to show the three-dimensional view.

Between 1949 and 1974, staff at the Baker Medical Research Institute also devoted a significant amount of time and energy to equipment construction to meet the needs of their researchers, this included some early, crude versions of heart-lung machines to aid in cardiac surgery.^[14] Some research on the alimentary canal also was undertaken, however this work ceased in 1968.^[15]

In 1949, cardiovascular research was one of the major growth edges of medicine was cardiology. At the time, it represented two thirds of the total research in the Baker Medical Research Institute. Cardiology research included:

• Further development of cardiovascular surgery
• New techniques of ECG and phonocardiography
• Introduction of cardiac catheterisation to record blood flow and pressure in circulation and introducing diagnostic materials
• Development of plethysmography to measure blood flow in limbs
• Clinical pharmacology of various cardioactive drugs
• Treatment of congestive cardiac failure and of arterial hypertension^[16]

The International Diabetes Institute (1984–2008)

The International Diabetes Institute was started in Melbourne in 1984 by Professor Paul Zimmet AO a number of years after his appointment to the Royal Southern Memorial Hospital.^[17]

“The research of Paul and his team in Pacific and Indian Ocean populations has provided new insights into the genetic contribution of NIDDM as well as the role of obesity, physical activity, nutrition and sociocultural change in the aetiology of this disorder.”^[18]

In 1980 Dr Zimmet was asked by the Council of the Australian Diabetes Society to prepare a submission, along with colleague Dr Ian Martin, titled 'Diabetes in Australia'. The submission was to the Federal Minister of Health. The submission highlighted the impact of diabetes in the community and what government needed to invest to find a cure or treatment and to support people with diabetes.^[19] At the same time, with Drv Matthew Cohen, Zimmet was the first to report their experience with home glucose monitoring and its acceptance in the diabetic population. They found better control, less hypoglycaemia and 95% acceptance.^[20]

One of the most significant contributions of the International Diabetes Institute has been the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). In 2000 it was the first national study to provide estimates of the number of people with diabetes (based on blood tests) and its public health and societal impact. It is now considered an integral component of the National Diabetes Strategy to tackle the mounting problem of diabetes and its complications in Australia.^[21]

In addition to research, the IDI operated diabetes clinics in Melbourne from the site of the Caulfield Hospital. The diabetes clinics are the largest in Victoria, with more than 8000 patients per year and continue to be operated by Baker IDI from the organisation's site in Prahran in Melbourne's inner south east.

Baker IDI Heart and Diabetes Institute (2008–Present)

In 2008 the Baker Heart Research Institute, as it was then known, merged with the International Diabetes Institute (which had operated in Melbourne for over 25 years.^[22])

Baker IDI Heart and Diabetes Institute houses World Health Organisation Collaborating Centres for Research & Training in Cardiovascular Disease^[23] and Diabetes (WHO Collaborating Centre for the Epidemiology of Diabetes Mellitus and Health Promotion for NCD Control).^[24]

Purpose

The aims of research at Baker IDI are to increase understanding of the basic causes of heart disease and diabetes, their risk factors and the links between diabetes, metabolism, lifestyle, and the development of serious health complications, particularly heart, stroke and vascular disease.^[25] The Institute aims to use this knowledge to:

• Help prevent diabetes, heart and vascular disease in the community
• Improve health by reducing diabetes, heart and vascular disease mortality and reducing disability
• Improve medical and surgical treatment of heart disease and diabetes.

The Baker IDI's activities range from research at the laboratory bench to clinical trials in patients, and patient care.The major areas of basic and clinical research are:

• Prevention of diabetes, heart disease and stroke
• Risk factors for diabetes,heart disease and stroke
• Diabetes, coronary disease, heart attack and sudden coronary death
• Heart failure
• Diabetes complications

These problems are approached at various levels:

• Molecular and Cellular
• Experimental models
• Clinical laboratory research
• Within the community through the Diabetes Clinics, Cardiovascular Disease Prevention Unit and Risk Reduction Clinic
• Epidemiological research^[26]

Research outcomes and achievements

• Baker scientists have recently developed a One-Hour mitral valve (the heart's largest valve) repair device. It is implanted in a one-hour day surgery procedure which previously required open-heart surgery. Baker IDI scientist, Dr David Kaye, and his team have invented a device that fixes a leaking valve in the heart. The mitral valve often leaks in patients with heart failure, so-called mitral regurgitation. the valve which really controls the blood flow from the lungs back into the left side of the heart, to be pumped back out through the rest of the body. When the heart enlarges, which is a characteristic feature of heart failure, the left ventricle enlarges and makes this valve function abnormally. Blood goes back into the lungs and that in fact is one of the causes of the symptoms of breathlessness and as you said, waking up in the night short of breath, but it also contributes to heart failure being a progressive disease, one in which the heart continually gets worse. The device is placed in the heart using a catheter-based system. A thin metal wire made of a special medical-grade alloy tightens up this valve, putting a little ring around it from the outside, and this seems to improve the function of the mitral valve and reduce regurgitation.^[27]
• The Institute is the co-ordinating centre for the Australian National Blood Pressure trial.^[28]
• Baker scientists have performed research underpinning international guidelines for the treatment of cardiovascular diseases, including the first studies demonstrating that regular exercise reduces blood pressure and improves insulin sensitivity^[29][30]
• Baker IDI scientists published the first study showing the benefits of walking^[31]
• The Baker IDI has also published widely in nutrition,^[32][33] dietary supplements,^[34][35][36] and metabolism based research^[37]
• Recently, the Baker has shown that some anti-diabetes drugs (ACE inhibitors) also have an anti-ageing effect
• Baker research proved that mental stress and cigarette smoking both provide selective and potentially harmful stimulation of the nerves of the heart.^[38]
• The Baker demonstrated the exercise can lower blood pressure.^[39] The study was a collaboration between the Baker Heart and Diabetes Institute, and the University of Melbourne and University of Queensland.
• Baker IDI scientists have proved for the first time that damage done by unhealthy eating is "remembered" in genetic controls – epigenetics – and turns off good genes needed to prevent diabetes, heart disease and other complications. Lead researcher Assoc Prof Assam El-Osta, from the Baker IDI Heart and Diabetes Institute team, said this meant that eating a chocolate would not only go straight to your hips, but also sit on your DNA.^[40]
• A World-first test to identify people who will suffer heart disease years before they die of a heart attack is being developed by Baker IDI.The test has the potential to screen for heart disease long before any symptoms strike by pinpointing patterns in proteins contained in urine, which were discovered by researchers at Baker IDI Heart and Diabetes Institute. There are no tests to screen for atherosclerotic cardiovascular disease – which is responsible for 80 per cent of heart conditions – and the first sign of illness for many people is a fatal or near-fatal heart attack.The Melbourne team led by Prof Karlheinz Peter developed a urine test with the German biotech company Mosaiques and the University of Freiburg, which has already proved 84 per cent accurate in early trials.^[41]
• Described an assay for glutamic acid decarboxylase to discriminate major types of diabetes mellitus^[42]
• The plasma protein which led to the distinction between type 1 diabetes and type 2 diabetes was discovered by Baker scientists^[43]
• Sir James Officer Brown researched and tested open heart surgery on animals with the support of the Baker Medical Research Institute, and went on to supervise the first successful open heart surgery in Australia in 1957. Other Baker Institute colleagues such as Kenneth N Morris and George Stirling performed the first coronary bypass and the first heart transplant whilst associated with the Institute.^[44]

Structure and organisation

Locations

Research, education to the public, health professionals, biomedical research students and patient care are located within the Alfred Medical Research and Education Precinct in Melbourne Australia, the recently opened research facility in Adelaide, Australia and the Baker IDI Centre for Indigenous Vascular and Diabetes Research in Alice Springs. International projects in heart disease and diabetes are currently conducted in Mauritius, South Africa, Fiji, India and Vietnam.

Funding

The Baker Heart Research Institute is funded from a diverse range of Government and private sources including the corporate sector, trusts and foundations and individual donors.

In 2007 the Baker IDI Concise Financial Report showed receipts from granting bodies of $32.6million. A further $7.4 million came from donations and bequests and $20.27 million from commercial income.^[45]

Subsidiaries

• Nucleus Network Ltd
• Osprem
• V-Kardia Pty Ltd
• Elacor Pty Ltd

See also

• Cardiovascular disease and diabetes in Australia

External links

• The Baker IDI Heart and Diabetes Institute

References