Spotlight on Associate Professor Benedetta Sallustio

Associate Professor Benedetta Sallustio and her team will be working with $327,214 to develop new medications that prevent heart damage during cancer chemotherapy. We talked to her about this exciting research in the pipeline.

Tell us more about your study

Many of the therapies used to treat cancer take advantage of the ability of cancer cells to rapidly divide. Cancer cells are constantly copying their DNA to pass on to their 'daughter' cells. Cancer therapies target this process by damaging the DNA to cause cancer cell death. This approach relies on the fact that most of the other cells in the body do not undergo constant growth and replication and are, therefore, not affected by the chemotherapy agents. We now understand that many cancer chemotherapies can cause heart damage, even though the heart muscle cells are not rapidly dividing. We believe that in the heart, some cancer chemotherapies activate DNA repair pathways that then divert the heart’s energy stores from maintaining heart function to priming DNA-repair processes.

Many of the cancer therapies that cause heart damage are used to treat cancers (blood, bone and breast) that affect children and young adults. However, no medicines are currently approved for the prevention of heart damage during cancer chemotherapy—particularly in children. Our work will focus on the biochemical pathways in the heart that are involved in DNA damage and repair. We hope to develop new therapies that not only protect the heart during cancer chemotherapy, but that also increase the cancer-killing effect of the chemotherapy. That would be like 'having your cake and eating it too'.

What are the issues facing people with cancer?

Many cancer therapies can damage the heart at the high doses required for an effective cure. Because of this, patients are closely monitored for signs of heart damage during their treatment and, if this is detected, the cancer chemotherapy may be stopped or decreased—potentially decreasing its anti-cancer effect and increasing the possibility of treatment failure or cancer recurrence. For some cancer patients, the first signs of heart damage occur months after the end of chemotherapy treatment. These cancer survivors may then have to deal with the often debilitating consequences of heart disease. To make things worse, many of the cancer chemotherapy medicines that cause heart damage are used to treat cancers that are common in children and adolescents. Early onset of heart disease is a leading cause of illness and death in young cancer survivors.

Tell us about your team

With my co-investigators, Professors Andreas Evdokiou and John Horowitz, I am based at the Basil Hetzel Institute of the Queen Elizabeth Hospital—a purpose-built state-of-the-art research facility that promotes the translation of basic research into the clinic by co-locating research laboratories close to patient facilities, and bringing together biomedical researchers from the University of Adelaide with clinicians and patients. This multidisciplinary environment has allowed us to build a research team with expertise in pharmacology, cancer biology and cardiology, so that we can tackle the issue of cardio toxicity and cancer chemotherapy from different perspectives and knowledge bases. This is a great asset and also provides a very supportive base for the training and development of new and early career researchers.

What are you excited about as part of this study?

I am personally excited that—with all the years of basic laboratory research in therapies for heart disease—we have finally reached the stage where we may have real clinical impact, helping patients to beat cancer! I would never have guessed this new direction 10 years ago, but there is now a growing appreciation that many of the biochemical changes in cancer cells that promote their growth and spread are similar to changes that take place in heart muscle cells of patients with heart disease. It’s really exciting to think that we can apply some of the approaches for cardiovascular disease to the treatment of cancer.

Has any significant work led to this study?

This work has grown from research initially funded by the Heart Foundation, to develop better therapies for the treatment of heart attacks and heart failure. We initially studied the biochemical changes inside the muscle cells of damaged hearts, and tested possible therapies to reverse these changes. However, we are now aware that many of the same biochemical changes also take place inside cancer cells as they start to grow and spread. In 2016, we received seed funding from Cancer Council SA to carry out a small pilot study investigating the effects of heart medicines during cancer treatment. Our very early results suggested that combining some of these medicines with cancer chemotherapy caused an improvement in a blood test of heart function. These results have helped us secure three years of funding so we can now expand our work using ultrasound imaging of the heart (as well as blood tests) and whole-body imaging of cancer growth and spread.

What or who inspires you to pursue your research?

I am very fortunate that I really enjoy my work. My PhD supervisor really encouraged me to pursue a career in medical research. He was a great mentor and role model, but was sadly diagnosed with cancer and passed away at the age of 44, whilst I was still completing my PhD. His integrity, determination and courage have been a constant source of inspiration in my work.

What’s one thing you wish all people knew about cancer and heart damage during cancer chemotherapy?

On a positive note, cure rates for both cancer and heart disease have never been better. Decades of basic and clinical research have led to the identification of important risk factors, early detection and better targeted therapies. There is good reason to be optimistic about the future.

What’s your go-to, health/medicine fun fact that you use at parties/gatherings/networking events?

I like that medical discoveries can come from the most unexpected sources. For example, warfarin—one of the most important medicines for preventing blood clots and strokes—was originally marketed as rat poison, and nitroglycerine—which is used to make dynamite—is also used to treat heart disease.

If you were to achieve a breakthrough finding in this area, how would you and your team celebrate?

Dancing, singing and champagne would probably be involved!