Q&A with Dr Alison Care

Doctor Alison Care is a Heart Foundation Future Leader Fellow at the Robinson Research Institute, University of Adelaide. Her research focuses on preeclampsia, a serious complication of pregnancy that increases a woman’s risk of developing heart disease. There are currently no treatments to stop the progression of preeclampsia, other than premature delivery. Doctor Care’s research aims to better understand the role of an immune cell that could help to prevent preeclampsia and associated heart disease.

What are you currently researching?

In a healthy pregnancy, the mother’s blood vessels adapt and grow to supply oxygen and nutrients to the placenta to support the growing baby. However, with preeclampsia, the mother’s blood vessels do not adapt properly, meaning there is not enough blood supplied to the placenta. In mice, we have identified an immune cell in the mother’s blood that helps the blood vessels to adapt and function properly in pregnancy. These are called regulatory T (Treg) cells, and women with preeclampsia typically have fewer of these cells. Treg cells help to prevent inflammation, and because of this, they are also important for life-long protection against heart disease.

In preclinical studies, my team have demonstrated that treatment to boost deficient Treg cells improves blood supply to the placenta. We are now investigating whether this treatment can then reduce heart disease in postpartum mothers and their offspring. In a complimentary study in pregnant women, we will determine whether there is a connection between low numbers of Treg cells and poor adaption of blood vessels, and the development of preeclampsia. We are measuring the number and function of their Treg cells, and are also using ultrasound imaging to look at how their blood vessels are working. Finally, we are observing women postpartum to understand how having a pregnancy complicated by preeclampsia affects their immune cells and blood vessels.

What difference will your research make to people’s cardiovascular health in Australia?

Preeclampsia is a serious condition, but despite this, there are currently no treatments that can stop its progression, except for premature delivery which has negative impacts on neonatal health. There is a close link between preeclampsia and later development of heart disease, making it imperative to develop effective treatments as a critical strategy for long-term and primary prevention of heart disease.

My research will determine whether Treg cells are a potential target for new medicines to prevent or reduce the severity of preeclampsia and improve long-term heart health. If so, targeting Treg cells may be a promising strategy in pregnancy, and could prevent or reduce the impact of preeclampsia. The ultimate goal of this research is to reduce the number of Australians burdened by preeclampsia-related heart disease.

What motivated you to do your research?

I have always been passionate about women’s health and fascinated by the ways a woman’s body adapts to support pregnancy. For example, a pregnant woman’s blood volume increases by nearly 50%. To accommodate this huge change, the heart must increase its function, and the blood vessels need to adapt too. All of this is to ensure that enough blood is supplied to the placenta to support the growth of the baby. When these normal changes are impaired, it can lead to pregnancy complications, and can increase the risk of heart disease for mothers postpartum.

In 2020, I was pregnant with my daughter and late in my pregnancy I developed gestational hypertension. Experiencing a pregnancy complication, and all of the uncertainty that goes with it, has doubled my drive to unravel the mechanisms that lead to pregnancy complications like preeclampsia. I want to help us to understand how to prevent or reduce the impact that these complications have on mothers and their children. I believe that better outcomes can be achieved for women and their babies, and this is what continues to drive me in my research.

Are there any achievements or discoveries from the past year you can share with us?

My PhD student, Shanna Hosking, was awarded the Laxmi Baxi Foundation Travel award for outstanding research presented at the Society for Reproductive Investigation international conference in March 2023. Ms Hosking shared her work in mice that demonstrates that when Treg cell numbers are low, the adaptation of blood vessels that support the placenta are impaired. However, treatment to boost Treg cell numbers can fix how the mother’s blood vessels adapt, indicating that they are a promising treatment target. We are still exploring the mechanisms through which Treg cells affect blood vessel adaptations in pregnant mice, and we are examining this in women.

Evangeline Lovell is another PhD student in my group, and she received the New Investigator Poster Presentation Award at the same meeting. This was for her work around the impact of deficient Treg cells on postpartum heart disease risk.

What role has Heart Foundation funding had in your career journey?

Funding from the Heart Foundation has been essential in enabling me to continue my independent research program. Through my research I aim to uncover the immune causes of preeclampsia and heart disease. This could inform the development of critical screening tools and treatment targets to improve pregnancy care. Being awarded a Future Leader Fellowship at a key stage in my career enabled me to focus on long-term research pathways from mouse models to our current clinical research.

Do you have a message for Heart Foundation supporters?

Thank you to Heart Foundation donors for supporting this research. Your generosity is contributing to foundational knowledge that will inform strategies to prevent preeclampsia and associated heart disease, and ultimately to reduce the impact of these conditions on mothers and their babies.