A good start: Cork Infant centre’s dual approach

The appropriately named Infant (Irish Centre for Fetal and Neonatal Translational Research) centre in Cork is finding new treatments for common conditions in pregnant women and newborn babies.

The centre has a unique blend of biomedical research and clinical application that helps it tackle problems that arise during and just after pregnancy, when mother and child are at their most vulnerable.

The driving forces behind the centre are co-directors Prof Geraldine Boylan, professor of neonatal physiology, paediatrics and child health, and Prof Louise Kenny, professor in the department of obstetrics and gynaecology, both at University College Cork.

“It works so well because we come from very different backgrounds but the outcomes we want are the same,” says Boylan.

The two women first met over an incubator holding a pre-term infant. “One night I was called in to look at a baby and I heard it was a traumatic delivery,” says Boylan. “We got chatting and realised there was a lot of overlap between us.”

It was Kenny who had delivered the child. “We started to talk about our common research interests and just hit it off,” she says. Over time their research teams grew together, with the goal of conducting research that could deliver improved treatments in clinical practice. “What we were doing together was unique and could not be reproduced elsewhere,” says Kenny.

Their efforts were transformed when their research group was designated during 2013 as one of seven national research centres, with major State support coming via Science Foundation Ireland.

The centre received funding of €13.6 million, with €7.6 million coming from the foundation and €6 million from 15 industrial partners associated with the centre.

Common ground
Kenny is an obstetrician and is deeply involved in clinical practice, but also holds a PhD – a clinician scientist. Boylan is a neurophysiologist specialising in newborn brain development; she studies brain development in full-term babies and in babies affected by conditions in the mother.

Once they got chatting they realised the common ground. Both were dealing with mothers and babies affected by the top four conditions in pregnancy and delivery: pre-term birth, where the baby is born too early; pre-eclampsia, where a mother develops dangerously high blood pressure; fetal growth restriction, where the infant does not develop fully in the womb; and gestational diabetes, where diabetes in the mother can cause later problems for the baby.

Kenny is most involved before birth, dealing with mothers with these conditions and helping babies through birth. Boylan is most involved after birth, trying to understand brain development, for example by comparing development in pre-term and full-term infants.

“There is surprisingly little research, yet this is an area of huge unmet medical need,” says Kenny. Because doctors do not know what causes conditions such as pre-term birth and pre-eclampsia, they can’t easily identify women at risk of developing them and so can’t diagnose them early.

“The minute the baby is born it is over to me,” says Boylan. “I concentrate on the neonate, it may be at 23 weeks or 40 weeks of gestation – that is when our side of the house becomes involved. My group looks at how the brain is developing.”

Kenny’s work focuses on developing diagnostic tests for these common conditions and the team now has two possible tests, for pre-term and for pre-eclampsia. Success would provide an enormous boost for mothers and babies around the world, but it could also be very valuable commercially to Ireland. That is why commercial companies are willing to invest to keep the infant research centre working.

Valuable results
Boylan's work is also delivering valuable results, trying to develop ways to predict later outcomes after an infant suffers through a difficult birth. She uses EEG equipment to monitor brain activity in full- and pre-term babies, and this is interpreted using mathematical algorithms.

Much other research is under way, including on the development of a monitor that can track brain activity, as well as using umbilical cord blood in the search for biomarkers for birth-related brain injury.

Having both research and a direct clinical outlet for treatments means that the infant centre can have international impact.


PRE-ECLAMPSIA: NEW TEST
Medical conditions in infants just before and just after birth account for 10 per cent of the global disease burden. Yet we know relatively little about the conditions that affect mother and baby despite the large numbers involved, says Prof Louise Kenny, co-director of the Infant centre in Cork.

“One in five women has either pre-term birth, fetal growth restriction or pre-eclampsia. Pre-term birth is a common condition, yet we don’t know what causes it. It affects 6-7 per cent of mothers and we don’t have a clue what causes it, and because of that we can’t screen for it,” she says.

Researchers at the Infant centre based at Cork University Maternity Hospital are working hard to right this situation. Over the past decade the team has been developing “biomarkers” for these common conditions. These are proteins and other biochemcials that, after painstaking analysis, have been shown to be present in mothers at risk of pre-eclampsia.

No one biomarker is enough given the complexity of the condition, says Kenny. “We have a panel of 12-14 biomarkers that can gauge whether a woman has a high or low risk of pre-eclampsia.” They are running tests to assess the accuracy of the approach and have also developed a possible test for risk of pre-term birth.

It took 13 years to put together the test for pre-eclampsia, and they have been working since 2008 on the one for pre-term, she says. Being able to identify mothers who might be at risk would be a huge advance.