Pleural Medicine Research

About

The pleura are two thin membranes which cover, respectively, the chest cavity and the lungs themselves, which enable the lungs to expand and contract correctly during breathing. There is little space between them but, in some diseases, such as cancer and respiratory infection, fluid accumulates causing major breathing difficulties. 

Each year more than 60,000 people are affected by pleural disease in Australia and their incidence, mortality and healthcare costs continue to rise.

The Pleural Medicine Group is led by Professor Gary Lee, one of the top clinical academics in pleural research. The group is regarded as one of the most active pleural research groups in the world, combines both clinical and laboratory staff and is closely integrated with the most active tertiary pleural services in Australia.

The group focuses on translational research in common pleural diseases, especially cancer and infection, with a strong publication record on clinical (phase I to multicentre randomised trials) and bench research (molecular biology to animal models). As well as novel diagnostic and management strategies for pleural effusions.

Much of the research work has directly impacted clinical practice and helped reduce patient mortality and morbidity in malignant effusion. For example, setting up of the indwelling catheter services in Western Australia and pleural infection such as the introduction of the new intrapleural therapy.

Recent highlights

• Professor Gary Lee awarded the WA Cancer Researcher of the Year for 2019
• Professor Gary Lee awarded the Practitioner Fellowship, Medical Research Future Fund Next Generation Clinical Researcher Program, NHMRC
• Dr Ed Fysh awarded the NHMRC Early Career Development Fellowship

Current Research projects

• The role of fibroblast growth factor 9 (FGF9)
• Nutritional status in mesothelioma
• Exercise as a therapeutic tool in the management of mesothelioma
• Pleural Effusion and Symptom Evaluation Study (PLEASE)
• Bacterial growth in pleural fluid

Publications

• Chee J, Watson MW, Chopra A, Nguyen B, Cook AM, Creaney J, Lesterhuis WJ, Robinson BW, Lee YCG, Nowak AK, Lake RA, McDonnell AM. Tumour associated lymphocytes in the pleural effusions of patients with mesothelioma express high levels of inhibitory receptors. BMC Res Notes. 2018 Dec 5;11(1):864.
• Lee YCG, Fitzgerald DB. Pleural Biopsy to Capture Causative Microbe: A New Piece of the Pleural Infection Jigsaw. 2018 Oct;154(4):743-745.
• Feller-Kopman DJ, Reddy CB, DeCamp MM, Diekemper RL, Gould MK, Henry T, Iyer NP, Lee YCG, Lewis SZ, Maskell NA, Rahman NM, Sterman DH, Wahidi MM, Balekian AA. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Oct 1;198(7):839-849.
• Rashwan R, Varano Della Vergiliana JF, Lansley SM, Cheah HM, Popowicz N, Paton JC, Waterer GW, Townsend T, Kay I, Brown JS, Lee YCG. Streptococcus pneumoniae potently induces cell death in mesothelial cells. PLoS One. 2018 Jul 30;13(7):e0201530.
• Muruganandan S, Azzopardi M, Fitzgerald DB, Shrestha R, Kwan BCH, Lam DCL, De Chaneet CC, Rashid Ali MRS, Yap E, Tobin CL, Garske LA, Nguyen PT, Stanley C, Popowicz ND, Kosky C, Thomas R, Read CA, Budgeon CA, Feller-Kopman D, Maskell NA, Murray K, Lee YCG. Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial. Lancet Respir Med. 2018 Sep;6(9):671-680.
• Koegelenberg CFN, Shaw JA, Irusen EM, Lee YCG. Contemporary best practice in the management of malignant pleural effusion. Ther Adv Respir Dis. 2018 Jan-Dec;12:1753466618785098.
• Fysh ETH, Thomas R, Tobin C, Kuok YJ, Lee YCG. Air in the Pleural Cavity Enhances Detection of Pleural Abnormalities by CT Scan. 2018 Jun;153(6):e123-e128.
• Sneddon S, Dick I, Lee YCG, Musk AWB, Patch AM, Pearson JV, Waddell N, Allcock RJN, Holt RA, Robinson BWS, Creaney J. Malignant cells from pleural fluids in malignant mesothelioma patients reveal novel mutations. Lung Cancer. 2018 May;119:64-70.
• Thomas R, Murray K, Lee YCG. Treatment Approaches for Malignant Pleural Effusion. 2018 Apr 10;319(14):1507-1508.
• Bhatnagar R, Keenan EK, Morley AJ, Kahan BC, Stanton AE, Haris M, Harrison RN, Mustafa RA, Bishop LJ, Ahmed L, West A, Holme J, Evison M, Munavvar M, Sivasothy P, Herre J, Cooper D, Roberts M, Guhan A, Hooper C, Walters J, Saba TS, Chakrabarti B, Gunatilake S, Psallidas I, Walker SP, Bibby AC, Smith S, Stadon LJ, Zahan-Evans NJ, Lee YCG, Harvey JE, Rahman NM, Miller RF, Maskell NA. Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion. N Engl J Med. 2018 Apr 5;378(14):1313-1322.
• Chan KP, Fitzgerald DB, Lee YCG. Emerging concepts in pleural infection. Curr Opin Pulm Med. 2018 Jul;24(4):367-373.
• Popowicz ND, O’Halloran SJ, Fitzgerald D, Lee YCG, Joyce DA. A rapid, LC-MS/MS assay for quantification of piperacillin and tazobactam in human plasma and pleural fluid; application to a clinical pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci. 2018 Apr 1;1081-1082:58-66
• Muruganandan S, Fitzgerald DB, Lee YCG. Malignant pleural mesothelioma presenting with remitting-relapsing pleural effusions: report of two cases. Respirol Case Rep. 2018 Feb 23;6(3):e00306.
• Komissarov AA, Rahman N, Lee YCG, Florova G, Shetty S, Idell R, Ikebe M, Das K, Tucker TA, Idell S. Fibrin turnover and pleural organization: bench to bedside. Am J Physiol Lung Cell Mol Physiol. 2018 May 1;314(5):L757-L768.
• Fitzgerald DB, Koegelenberg CFN, Yasufuku K, Lee YCG. Surgical and non-surgical management of malignant pleural effusions. Expert Rev Respir Med. 2018 Jan;12(1):15-26.
• Mishra EK, Clive AO, Wills GH, Davies HE, Stanton AE, Al-Aloul M, Hart-Thomas A, Pepperell J, Evison M, Saba T, Harrison RN, Guhan A, Callister ME, Sathyamurthy R, Rehal S, Corcoran JP, Hallifax R, Psallidas I, Russell N, Shaw R, Dobson M, Wrightson JM, West A, Lee YCG, Nunn AJ, Miller RF, Maskell NA, Rahman NM. Randomized Controlled Trial of Urokinase versus Placebo for Nondraining Malignant Pleural Effusion. Am J Respir Crit Care Med. 2018 Feb 15;197(4):502-508.
• Popowicz N, Idell S, Lee YCG. Pathogenesis of pleural infection: A complex warfare. 2018 Jan;23(1):8-9.
• Peddle-McIntyre CJ, Baker MK, Lee YCG, Galvão DA, Cormie P, Graham V, Newton RU. The feasibility of a pragmatic distance-based intervention to increase physical activity in lung cancer survivors. Eur J Cancer Care (Engl). 2018 Jan;27(1).
• Fear VS, Tilsed C, Chee J, Forbes CA, Casey T, Solin JN, Lansley SM, Joost Lesterhuis W, Dick IM, Nowak AK, Robinson BW, Lake RA, Fisher SA. Combination immune checkpoint blockade as an effective therapy for mesothelioma. 2018 Jul 30;7(10):e1494111.