Regenerative medicine and stem cell therapies with Rebecca Lim

Michele Ong

Hello. My name is Michele Ong, and I'm a computer scientist. Welcome to the first episode of STEAM Powered, where I have conversations with women in STEAM learn a little bit about what they do and who they are, hopefully, ELI5 style. My first guest is Rebecca Lim. Rebecca is a stem cell biologist by training and holds appointments at both the Monash Health Translation precinct as well as the Ritchie Centre at the Hudson Institute of Medical Research where she runs her own research group.

She's also an inventor on two patents in her area. Join us as we talk about weightlifting, her love of dogs, and her work in regenerative medicine and stem cell therapies. Also, just a content warning, we touch briefly on animal-based research. Nothing graphic, but just so you know. Alright. Here we go. Thank you for taking the time. It's going to be fun. Thanks for being my experiment. But yes.

So, yeah, how long ago did we meet now? It was uni, right?

Rebecca Lim

2004 because that would be the year I started Iai. Right? Exactly. Yeah. Yeah. Yeah. Yeah. Yeah. because remember there was the Iai and Jodo championships in 2005 --

Michele Ong

Yes. --

Rebecca Lim

A year before that.

Michele Ong

Ahh. That's right. Yeah. That's nuts. Are you still doing any of that?

Rebecca Lim

I haven't been since the start of weightlifting.

Actually, I lie. So there was probably about 3 months where it was in overlap. I was still training and I was still doing weightlifting. And the whole reason for starting off weightlifting was because I was just getting quite bored.

Because the katas don't really change. The- the challenges haven't changed. And I needed something new. And I also found that it was a bit of a chore to have to teach at work and be in charge of people at work, and then come into my hobby and have to teach it.

Michele Ong

Having to be restores there. Yeah. That's tough.

Rebecca’s journey to weightlifting

Rebecca Lim

And I missed learning something from scratch and I'm being taught. You know, it's- it's so nice and it's so burden-free to go and just go, I have no idea what I'm doing. Something's wrong, let's fix this. So yeah.

So that- that was why I went in search for a completely different hobby. Yeah. Very strange hobby.

Michele Ong

Well, it's not that strange. A lot of people are doing that kind of thing now.

Rebecca Lim

I think a lot of people are doing crossfit, which I had watched, and I thought that looks like too much cardio for me. Honestly, I watched crossfit and just went, that's- that's not me. And I was- I'd always been at the gym. So I always- so this was coming on maybe 4 or 5 years that I had been working with a personal trainer and I was looking after myself just from a diet perspective and exercise and trying to maintain good health. So I was going to the gym purely for good health.

And the whole Olympic weightlifting thing came when my u- my regular personal trainer was away on holidays, and I got assigned a different personal trainer. And she just said, come along with me, this is not the boys-only zone. And she introduced me to the squat rack, she got me doing deadlifts, and I thought, oh this is- this is kinda interesting, kinda fun. And she- Because our sessions were always in the morning, there was hardly anyone around, so there was no intimidation of I've gotta go to this. It's really busy and full of very beefy men, and do my very sad, very tiny weights. And, you know, all that judgment. So there was none of that because it was early. It was just us, and it helped that it was a female trainer who was just all about encouraging me to to do this.

And then she said, oh have you heard of Olympic weightlifting? And I thought, is that something to do with the Olympics? That was honestly my response and so she then showed me a couple of videos on YouTube and said, yes, it's done at the Olympics, but this is what I mean. And what struck me was that weightlifting in my head, what I thought weightlifting was was actually powerlifting where they do very, very, very heavy weights and the people are just really beefy and all muscle. I hadn't realised, I hadn't known anything about Olympic weightlifting. And what really struck me was the videos that she showed me and she was probably quite strategic about this. The videos that she showed me were women, and they were in the 45 to 64 kilo weight class.

So these were small, petite, obviously very strong women. And the speed that they had and the flexibility that they had, and that just kind of caught my eye and thought. Oh okay, so this sport is not just about being strong, you have to have all these things.

And so she said, well, if you like this, I can't teach you that, but I think you need to go look for an Olympic lifting gym and have a go see what you think. So I emailed maybe 3 or 4 different gyms.

Olympic lifting as an inclusive community

Rebecca Lim

The first one that got back to me is the gym that I ended up staying with. Yeah. And it's quite interesting because you go into the that gym that I go to and about 70 percent are women.

Michele Ong

Oh wow. That's an interesting distribution.

Rebecca Lim

I know. I know. So the head coach is male. His assistant just female. But the clientele is, yes, 70 percent women. They're for the most part, they are not women in their twenties or thirties even.

About half of them are, you know, late thirties and older. We've got a family where husband and wife come and then their mum looks after the child and then then grandma comes. As in training, and they they do, like, a little bit of a shift. So it's really nice because it's a very inclusive environment. People are all shapes and sizes, and different stages of their journey.

And Right. I think it's a very different sport because a little bit like Iaido, that we both know, it's a very individual sport. It's your turn or you do your thing and you have your best attempt. The difference is unlike Iaido where it's silent and everyone's just kind of watching, Olympic lifting when it's your turn, the whole room is rooting for you.

It doesn't matter if you know the person. You just look at them and just think, wow, it took so much courage and so much training to get to where you are. And everyone's just cheering for you. So it's it's a very very different sport. And I felt that really appealed to me.

Yes. There's really no other aspect of my life where that happens.

Michele Ong

Just quietly there doing science in the background.

Rebecca Lim

Well, there's a little bit of that, but then there's also the you cheer for your own team sort of thing?

Michele Ong

Yes.

Rebecca Lim

And that doesn't really happen with Olympic lifting. I think because everyone's trying to- you can see-

Michele Ong

Everyone's trying to achieve and yeah.

Rebecca Lim

Yeah. And they're trying to beat their own record, their own previous record. It's not even-

Michele Ong

It's not competitive. It it's very community oriented.

Rebecca Lim

I think there's there's the element of being community oriented, but there's also this focus on your personal best. Yeah. Your personal best is your personal best. So it doesn't matter if you're lifting 5 kilos lighter than the last person because they know that your- each person's chasing after their own goals.

Michele Ong

Your own goals. Yeah.

Rebecca Lim

Yeah. So I think that that kind of creates an atmosphere where everyone's just really encouraging.

Michele Ong

Yeah. That's fantastic. Such a great vibe.

Rebecca Lim

It is.

Michele Ong

So that's- You've been doing that how long now?

Rebecca Lim

So it's May now, I'd say 15 months.

Michele Ong

Oh, not that- not that long.

Rebecca Lim

No. Not all that long. It feels like it's been ages because I think I- I kind of obsess over things. I- I didn't go, like, once a week for a while and then increase my load.

I just kinda went like, okay. Sign me up. I'm here.

Michele Ong

That's awesome.

Rebecca Lim

So yeah. Yeah. It it it's very addictive.

Michele Ong

It's always gonna be addictive when you're feeling challenged, when you're feeling like you're achieving constantly.

Rebecca Lim

Yeah. And we've all got our own things to work on. So you kind of, you know, you you're given a program and you know what you're there to do.

Michele Ong

Yeah.

Rebecca Lim

So I found that on top of just trying to get good at weightlifting, I found that I've also started to pay more attention to, you know, how active I am during the course of a day, drinking enough water, eating enough protein. Yeah.

I'm sort of looking after my body a little bit better than I used to instead of taking it for granted. Turning 40 this year also helps to kind of remind you.

Michele Ong

Yeah.

Rebecca Lim

Niggles cannot just be ignored. Yeah.

Michele Ong

Yeah. It's all starting to add up now.

Rebecca Lim

Yes, very much so.

How weightlifting has improved Rebecca’s work/life balance and made her a better teacher

Michele Ong

Because you're committing so much to, you know, all the weightlifting stuff, do you find that it's difficult to balance that with what you're doing at work? Or does it just kind of compliment beside each other quite well?

Rebecca Lim

I think the the the most-- the biggest difference that weightlifting's made to my work, and this is what people have said to me as well, is that I am a lot more careful with my time.

Michele Ong

Yes.

Rebecca Lim

So it takes me about 45 minutes to get from work to where I train at peak hour. So I am out the door at 5PM.

Michele Ong

Yeah.

Rebecca Lim

And I used to stay at work 'til 7-8PM. This this idea of work-life balance never really kind of dropped because I would work 'til I got tired, and then I'd go home. Until, you know, I felt like I was done for the day and then I'd go home, which wasn't the best for work-life balance.

Michele Ong

Yeah.

Rebecca Lim

And I think now with weightlifting, I'm I'm a lot more conscious of that and, you know, making sure I get enough sleep. I never really used to care about either. It was just, you know, if I've slept-- if I haven't slept enough, I haven't slept enough, and I'll just drag myself into work, feeling very sorry for myself. These days, I'm so much more disciplined about it. So I think it's affected work, but in a positive way.

Michele Ong

Mhmm.

Rebecca Lim

The other thing that I've found as well is that I've become a lot more understanding. I I think I've become a better teacher because of my coach. Watching how he trains beginners, like myself, and also being reminded that we all had to start somewhere has made me a lot kinder when I when I teach people. I I tend to put frustration aside and kind of-- and also I recognise their own personal frustration.

It's not that someone doesn't wanna do a particular job well. They they want to do it well. They're just as frustrated that they can't as much as I am. And it's been so helpful going into a sport and starting from scratch and being reminded, like, we all started here. No one's having fun right now.

We're just gonna have to be brave and just get through this.

Michele Ong

Yeah.

Rebecca Lim

So it's really helpful for work as well.

Michele Ong

That's amazing. Have they told you they've noticed that as well?

Rebecca Lim

I don't think they have, but I have kind of seen that they are a lot more relaxed.

And now now they're okay to come in with "I screwed up, help."

Michele Ong

Yeah.

Rebecca Lim

So I'm I think it's been I think it's been good for everyone.

Michele Ong

Everyone's benefiting.

Rebecca Lim

Yeah.

Michele Ong

Yeah.

Rebecca’s journey to stem cell research

Michele Ong

So how did you get, like, what interested you to get into stem cell research from uni? Like, is that did you study that specifically as a specialisation? Or you just kind of fell into it.

Rebecca Lim

Did kind of fall into it. So I fell into stem cells and I fell into clinical translation. And now I've just fallen into stem cell clinical trials. So stem cells was not something that was offered at uni when I was going through uni. It was--

Michele Ong

It's so new.

Rebecca Lim

It it was so new. It was something that only researchers did. So there weren't even undergraduate units that talked about it.

Michele Ong

Yeah.

Rebecca Lim

Just by sheer luck, I selected a PhD project that had a component of stem cell research in there.

I didn't recognise it at the time. So my PhD research was how a drug that is meant to influence the progression of viral hepatitis, so hepatitis B and hepatitis C --

Michele Ong

Mhmm.

Rebecca Lim

-- how patients staying on an antiviral drug would then also have lower instances of cancer, liver cancer. So chronic hepatitis there's a much higher chance of patients going from chronic hepatitis to liver cancer.

Michele Ong

Yeah.

Rebecca Lim

That's-- that's one of the more-- the the natural progression of the disease of your

Michele Ong

Yes.

Rebecca Lim

What was observed was that if those patients stay on the antiviral treatment for a long period of time, they also get less cancer, even though it's an antiviral drug. It's not an anti cancer drug.

Michele Ong

Yeah.

Rebecca Lim

My PhD project was to try and understand how that worked. And what I found was that this antiviral medication also has an effect on stem cells within the liver. And it is through that effect that you get less cancer.

Michele Ong

Yeah.

Rebecca Lim

So it was never set out to be a stem cell project.

Michele Ong

Yep.

Rebecca Lim

And at that time, we never really referred to them as stem cells either.

Michele Ong

Yeah.

Rebecca Lim

We call them another name and it wasn't until maybe 2 or 3 years after my PhD that it became recognised that these are actually stem cells within the liver and we should treat them as such. And that was around about the time that I moved to Melbourne from Perth and --

Michele Ong

Yeah.

Rebecca Lim

-- was, you know, part part of a stem cell group and was more exposed to this notion of stem cells. So I kind of fell into it, really, yeah. It was never by choice.

Michele Ong

Wow. Well, I guess that's what a lot of science is about, right? Just kind of figuring stuff out that's new that people didn't know before.

Rebecca Lim

Yeah. And I think, I think sometimes career progression's also just keeping an open mind.

Michele Ong

Yeah.

Rebecca Lim

Just being curious and saying, well, doesn't sound like a bad idea, maybe this could be interesting.

Michele Ong

Mhmm.

Rebecca Lim

And then just going with it.

Michele Ong

Yeah. Of course.

Stem cell classification criteria

Michele Ong

You said you were calling the stem cell something different. Like what-- how do you distinguish between stem cells and things that aren't stem cells? Like, what, what criteria do you use to determine that?

Rebecca Lim

So there are two major criteria. One is that a stem cell can self-renew. So a stem cell must be able to make another stem cell. And the other criteria is that the stem cell must be able to turn into something else. So so it's referred to as a differentiation. So stem cell must be able to differentiate. So that's a very broad classification, and stem cell scientists would, you know, further refine that definition.

So blood stem cells. So bone marrow stem cells. So bone marrow transplants are actually a transplantation of stem cells from the bone marrow.

Michele Ong

Right.

Rebecca Lim

And the issue and the controversy around stem cells back in probably the early 2000s --

Michele Ong

Mhmm.

Rebecca Lim

-- were that the limitation of the definition was around embryonic stem cells, so that you do have to destroy an embryo in order to get stem cells. 2020, the world's a very different place for many reasons. But the definition of stem cells are also very different. So we now know that every tissue has stem cells. So you can get --

Michele Ong

Yeah.

Rebecca Lim

-- cells from hair follicles, from dental pulp, from fat, and every organ has their own stem cells that are involved in ensuring that the organ continues functioning.

Michele Ong

Yeah. So our general body regenerating itself over time as we get older and --

Rebecca Lim

Sure.

Michele Ong

-- that's that's all part of that.

Rebecca Lim

Yeah. Skin, for instance, you cut yourself. The reason why it doesn't turn into an ulcer is because if you're well, there are stem cells within the skin of the the deeper layers of the skin that will create more of themselves. Some create more stem cells, and then they'll differentiate and eventually repair that void.

Applications of liver stem cells

Michele Ong

So can you use, like, the liver stem cells somewhere else? Or is it unique to different areas?

Rebecca Lim

So there are a couple of things that people are investigating for liver stem cells. One of them is when you've got-- So for instance, when there's paracetamol overdose --

Michele Ong

Mhmm.

Rebecca Lim

-- that causes a type of acute liver injury that overwhelms the liver's ability to repair itself.

Michele Ong

Yeah.

Rebecca Lim

And one of the things that people are asking is can you deliver a drug that would then activate the liver stem cells to their maximum capacity to then repair the liver.

Another group of scientists are looking at, they're looking at collecting livers stem cells and looking to see if that can be a method of maybe-- as a substitute for whole liver transplantation. So rather than transplanting whole liver, they'll, they'll have a scaffold and they'll put these liver stem cells and grow like a mini liver and then transplant that instead of looking for, for an organ donor.

Michele Ong

Very cool.

3D printing of organs

Michele Ong

So is that related to the 3D printing organ type stuff or is that slightly different?

Rebecca Lim

There are people who are looking to do 3D printing.

The 3D printing is quite complex as you can imagine.

Michele Ong

Yeah.

Rebecca Lim

Because what you're trying to print is a scaffold and an organ that has multiple cell types. So you're not just trying to print liver stem cells.

You're trying to print bile ducts --

Michele Ong

Yep. All the other aspects and--

Rebecca Lim

Yeah, exactly. So what others have suggested is rather than doing 3D printing, which could be quite complex and might take a while to develop, is to have a scaffold preprinted and then you see the liver stem cells in there, but they're, but they are thin enough to allow for blood to just flow over and for the or-- the mini organ to then do what it needs to do without requiring its own circulatory system.

Michele Ong

It's a different approach, but you're still kind of building a new organ from a different way of sourcing it.

Rebecca Lim

Yeah. So the liver would-- the, the, the mini liver, if it works, would still do the same things as the rest of the liver. So the idea not being that you explant the diseased tissue, but rather that you then transplant additional mini liver into the recipient so that --

Michele Ong

Yeah.

Rebecca Lim

-- there is some, there's some, I guess, capacity to deal with--

Michele Ong

It seeds that-- yeah.

Rebecca Lim

Yeah. So it would still do things like produce bile acids. It would still produce albumin and detoxify tox-- things like paracetamol, but without having to remove the liver that's already there because there might still be some functional tissue that's still left in that liver. Yeah.

Michele Ong

Is that why you're-- Okay.

How investigations into stem cells lead to regenerative medicine

Michele Ong

Because stem cells, as you explained, is all about the regeneration aspect. That's how you got into regenerative medicine for the field and area that you'll researching now?

Rebecca Lim

So another one of those where I never really chose to do it, it just kind of happened. So the lab that I signed up to-- the lab that moved from Perth to work with --

Michele Ong

Mhmm.

Rebecca Lim

--had disbanded. I moved from Perth to Melbourne in December 2006--

Michele Ong

Mhmm.

Rebecca Lim

--And by September 2007 the lab had disbanded.

Michele Ong

Wow.

Rebecca Lim

And I was basically, job hunting. I don't know if you wanna edit this out. So I found myself, you know, I, I was going for job interviews and I-- around Melbourne, I got a job offer with a cancer lab. And I thought, aw that sounds kind of interesting. My PhD had something to do with cancer. Maybe I'll go ahead and do that. But I also, at the same time, got offered the job that I have now, and that was work with an obstetrician.

I think what struck me was that I really liked him. He was-- it was just a personal connection, that led me to go with one job rather than the other.

Michele Ong

Yeah.

Rebecca Lim

Because I, I felt like the mentorship was going to be the most important thing, not the day to day work.

Michele Ong

Yes. Well, have to like who you're working with.

Rebecca Lim

Yeah. And not to say that I didn't think that I would get mentored well. I just didn't have that instant spark of connection.

And I think that paid off because working with this obstetrician, I was actually working on a disease called preeclampsia. So I was recruited to work on a work called preeclampsia. And that work went well. And for a little while, both the placental stem cell work that I still work on now and the preclampsia research program were both progressing well.

Michele Ong

Mhmm.

Rebecca Lim

And at some point, I just you know, you think I gotta clone myself to keep working at this pace, right. And I had to decide, you know, which one I loved more. And it was the stem cell work that I enjoyed a lot more of, and that was right about the time the term 'regenerative medicine' was coined. And I thought, well, this is, this is a good opportunity to get in at the ground level and grow this research program. And so far that work has continued to gain a lot of traction.

So with that piece of work, we essentially just turn biological waste into something that can be used. So as a regenerative medicine, it's very cheap. So the stem cells that we work on are from the amniotic membrane.

Michele Ong

Yep.

Rebecca Lim

So that's the membrane that surrounds the baby during pregnancy. And the amniotic membrane along with the rest of the placenta is usually discarded after the baby's been born.

And instead of that, you know, instead of it being chucked out, we ask parents if they would consent to us keeping the placenta for research use, and we take the placenta back to our lab and we isolate the cells from the amniotic membrane. And we've been doing that work for over 10 years now and we're now in five clinical trials around Australia, soon to be moving towards other countries as well. So It's progressing well.

Michele Ong

Yeah.

Rebecca Lim

And I think, like with most experimental therapies, it will take a while before, you know, this is offered to everyone, for example, because there's a lot of research that still needs to be done.

Michele Ong

Yeah. But when, you know, I was pregnant, we got shown all these things about CellCare and all those other stem cell bank places.

Rebecca Lim

Yeah.

Michele Ong

You know, it's like, well, they show you the the brochure, they go, you know, this is a kid who'd benefited from this, but you don't really-- you still don't really understand from the marketing what that involves or, you know, what kind of scope all of that stuff has.

And for a lot of people because they don't understand how all of this works, it's kind of, oh I'm donating stuff to science. And that's this hazy cloud of you know, I, I don't know. So being able to hear from you just how it kind of hangs together all the different ways that it can be applied, that's really cool. You know, it's amazing just hearing about the growth in that area. Yeah.

Rebecca Lim

Yeah.

The beginnings of investigating how to more accurately determine who has good stem cells

Rebecca Lim

Speaking of growth in the area, one of the projects that I'm working on at the moment, I'm, I'm writing a grant on and a little bit obsessed over it at the moment, is that's how it always starts. Like, it starts as a little obsession.

That's how all good science starts, right?

Michele Ong

Yes.

Rebecca Lim

Is actually, to find out which women have good stem cells.

Michele Ong

Yeah.

Rebecca Lim

Like stem cells from the placenta because that's actually not known.

And it's not obvious to everyone. So for instance, Australia has-- Around the world, Australia has the highest rate of gestational diabetes. So there's diabetes that only occurs during pregnancy. Is that any good or bad? The assumption is that, oh you're, you're now diabetic, so that's probably gonna affect your placenta.

So those women are generally not asked to donate their tissues to --

Michele Ong

Because it might be, yeah, compromised in some way.

Rebecca Lim

Well, we've never done that research before.

Michele Ong

So.

Rebecca Lim

So, we have to.

Michele Ong

Yeah. Exactly.

Rebecca Lim

And does it affect all the stem cells or just one type? We don't know.

Michele Ong

That's cool. So that's the thing that you're working on right now to get--

Rebecca Lim

Yes.

Michele Ong

Yeah.

Rebecca Lim

It's my current obsession. So antidepressants in Australia are about double what is used around the world. So antidepressants during pregnancy... does that have an effect? Does it cross the placenta? Does it mean that the cord blood is not as good?

We don't know. So cold blood banks, their criteria is about volume of cord blood and how many cells are in the cord blood.

Michele Ong

Mhmm.

Rebecca Lim

But how good the stem cells are, never been studied before. And so there's this huge knowledge gap that we have to address and I think that's the role of the scientists in in this area. You know, we ask the questions. We answer them. And then with that, you can create then-- you know, policies around it, and position statements that blood banks can then use.

Grading stem cells for quality control

Michele Ong

So the the cells that you have, from what you're able to access you grade those as well in terms of how good they are or how potent?

Rebecca Lim

Yeah. So we've been working with the International Society for Cell Therapies, Cell and Gene Therapies, and there's actually a recommendation that there need to be potency assays before you release them.

So for-- it's it's basically a set of quality control measures. So rather than just saying this bag of cells contains 5 doses, we're saying that this bag of cells will do, at very minimum, will address inflammation, will address wound healing, etcetera, etcetera. So what that means is that of say 50 placentas, maybe only 3 of them will get released for a particular indication and maybe the rest we've released for something else.

Michele Ong

Okay.

Rebecca Lim

Or maybe of the 50, maybe 5 of them will actually fail that level of batch testing where they've got those number of cells, they're 95 percent viable, so they look healthy, but they don't actually do what we need it to do. And having those really tight criteria means that we have a better sense of what clinical efficacy is gonna do.

So by the time you take it to a clinical trial, it should work and--

Michele Ong

Reliably and repeatably, yeah.

Rebecca Lim

Yeah. Exactly.

The question of what makes stem cells more or less potent

Michele Ong

Okay. So from the ones that you haven't found to be as potent, have you been able to identify the criteria for why that is or...?

Rebecca Lim

Not yet, and I suspect that's because we haven't actually asked the right questions. So --

Michele Ong

Right.

Rebecca Lim

-- in science, you start off with a hypothesis, and then you power, you do the statistics, and you have enough patients in each group to actually ask that question. And I think because we haven't specifically asked that question, we've never had the statistical power to answer it.

Michele Ong

Yeah. So you haven't been able to pin it down?

Rebecca Lim

Exactly. We'll have, you know, 2 or 3 in each group. So it's not really enough for us to actually answer that question. So we're hoping that by asking it very explicitly now, we'll actually be able to answer it and have a very clear understanding of who should be a cord blood donor for instance. Does a BMI over 30 mean that placental stem cells are not so good, maybe the cord blood's okay, but maybe placental stem cells are not so good. So, yeah, we wanna be able to answer that.

And I think having that clarity allows the field to progress a lot quicker.

Michele Ong

Yes.

What grant writing involves

Michele Ong

So what's involved in getting, you know, this grant proposal up?

Rebecca Lim

A lot of--.

Michele Ong

Yeah.

Rebecca Lim

So the the fun thing about grant proposals is at the proposal stage anything is possible because you're just asking a question But the the less fun about it is where essentially salaries are on the line. This is how we fund research. So if we don't get the funding, we don't get to pay the people to do the work. People lose their jobs. So there's a endless amount of pressure while you're writing a proposal as well.

But the the guts of it is essentially getting a very clear question across. So your grant-- Someone reading your grant should understand what question you're asking. They shouldn't, if it's well written, they shouldn't have to be a specialist in the field. So I should be able to explain concepts such as why it's important to answer this question, how many people are affected by it, how it could change policy. So that's just the gist of what goes into a grant. You know, having aims that are very clear and having a time frame that's achievable. So if for instance, the incidence of gestational diabetes was only 0.5 percent. And in our hospital, we're in a very large hospital, but if we're in a very small hospital, and we only get maybe 50 women coming all year, then the chances of us being able to fulfill those numbers is pretty slim. So having a project that's very feasible, making sure that you can actually achieve those aims in the time frame that you prescribed, that's gonna all be in that grant. Yeah.

Collaboration for obtaining research data

Michele Ong

Obviously, you need numbers to make things statistically significant. Would you work with other hospitals to get extra data in the event that what you're looking for has too small a sample size?

Rebecca Lim

Yeah. So if we were in that situation, then the answer is definitely yes. And that's when you would have co-investigators that are from those other hospitals to make sure that you can, you know, collectively as a team actually answer those questions. We won't have to do that in this particular case because we're actually the biggest public service provider in Victoria, and we're also a very large maternity tertiary hospital.

So we get all the complicated cases. So kind of, the argument that I'm making in the ground is kinda like, it's logical that we do it where we are because we get, you know, with respect to our cesarean list, we get more unhealthy than healthy because the healthy women are, you know, delivering-- they're doing home births or they're just doing a vaginal delivery. So what ends up on the elective cesarean list tends would be the complex cases Anyway.

A day in the lab

Michele Ong

Yeah. You said you've only been in the lab, like, twice since all of the quarantine stuff. So ordinarily, what would a day at the lab be like for you?

Rebecca Lim

I'll give you the the full 'what could happen'.

Michele Ong

Yep.

Rebecca Lim

When I go into the lab, it could be a phone call from the midwife to say that there is a placenta ready for collection and I'll go into the operating theatres, get changed into scrubs, pick up the placenta in operating theater, that's generally when the obstetrician is stitching mum up after the baby's been delivered, and we'll pick that up, bring it up to the lab and start the stem cell isolation.

Michele Ong

Yep. So you did pick up just to ensure control of the sample.

Rebecca Lim

There is a bit of that. So there is this term called chain of identity and chain of custody. And so having a trained person be part of that chain just eliminates error out of it. We also have to pull out the amnion from the rest of the placenta in a sterile manner. So this allows us to then use those cells for clinical applications or in in the clinical trials.

So that requires a special amount of training and then knowing how to sterilise the amniotic membrane. All of that actually happens in the operating theatre.

Michele Ong

Okay.

Rebecca Lim

So what we bring up is actually just the amniotic membrane. That's already been sterilised. So the operating theatre already has a sterile field and that's where all that happens.

The animal house (Content warning: animal-based research, no graphic detail)

Rebecca Lim

The other thing that could happen when I go into the lab is going down to the animal house. So animal-based research, it unfortunately still remains a huge part of clinical translation. So we would not be allowed by regulators to introduce a therapy into humans if we've never shown safety and efficacy in animal models. So that is unfortunately part of it.

When you go into the animal house, you're going to do a bunch of work under, you know, animal ethics approval, of course. And there's a lot of measures that we put in place to make sure that the animals are are looked after in the most humane way possible. When you collect that data and you present that to a human ethics committee, and they're convinced and you get the okay to now help patients who are incredibly ill, it's, yeah, it's really rewarding.

The diseases of focus in Rebecca’s research

Rebecca Lim

The diseases that we're going after as well are intractable diseases. I should have mentioned that upfront. We don't go after disease indications where they can be treated using contemporary measures. So for instance, one of the things that we're looking at is acute ischemic stroke. So if after the 3 to 6 hour period and a clotbuster cannot be administered, there's virtually nothing you can do for those stroke patients.

Michele Ong

Yeah.

Rebecca Lim

And those are the types of stroke patients we're going after where nothing else can be done. And there is an opportunity for us to make a difference. And another disease that we're going after is Crohn's related perianal fistulas. And this is a debilitating disease in people who are young, you know, people in their twenties, thirties, forties, who should have good functioning bodies and because of Crohn's disease, they they can't. So we'll work with a bunch of colorectal surgeons to see if cell therapy could be the way to go for those patients.

Michele Ong

You're, you're covering quite a few areas with the research at the moment.

Rebecca Lim

Yeah. So the-- it might seem strange initially that we're going across from, you know, very premature babies with bronchopulmonary dysplasia at one end, to Crohn's disease sort of like in the twenties to forties, and then to stroke at the other end of the spectrum. But underlying all of those conditions is inflammation that is not addressed with anti-inflammatories. So you can't give an anti-inflammatory and have the disease actually calm down. All of those diseases are extremely complex. There is a need to create blood flow across all of those diseases, and there is an opportunity to reactivate the stem cells that are already in the tissues that are affected.

Michele Ong

Mhmm.

Rebecca Lim

Bearing in mind that every tissue has their own stem cells. So we're proposing that the cells that we transplant will turn into new tissue. What we're saying is that they'll go into those tissues and actually reactivate all of those processes and--

Michele Ong

Trigger it all again.

Rebecca Lim

Yeah. Exactly. So that's, that's kind of how it's kind of gotten to the breadth that it has.

Michele Ong

Yeah. Okay. I can definitely see how that spread the scope of it.

Rebecca Lim

And the really cool thing that I think as well is that none of these clinical trials came because we were knocking on the doors of clinicians.

Michele Ong

Yeah.

Rebecca Lim

They've always been, here's our science, and then, you know, we'll publish it. We'll do the usual academic thing. We'll publish it and we'll present at conferences. And then the, the clinicians come to us saying, we've got this thing that we're dealing with day to day, and there's no treatment for these patients. Can we work with you to see if this works? So that's been really rewarding as well.

Michele Ong

It's great that they're able like, other people are seeing the scope of the work and try to expand on it.

Rebecca Lim

Yeah. Yeah. It takes a lot of courage from-- you know, on their part, because they're the investigator as well. Alright. Yes. Absolutely. And I think we're quite fortunate in Australia that there's, there's a good-- in my opinion, there's a really good balance with between medical innovation, so people just sticking their necks out to say it's worth a go because nothing else we've tried worked so far, and having really good human ethics requirements and having really good regulatory approval processes in place to ensure that anything that does get approved to go into humans has actually gone through the rigmarole of all of those steps.

Michele Ong

It's just part of the process.

Rebecca Lim

Yeah. Yeah.

Michele Ong

We're kind of approaching my limit of time with you. So we might move on to those other weird questions that I showed you.

Bonus Question 1: What hobby or interest do you have that is most unrelated to your field of work?

Michele Ong

So, we probably touched on some of this already, but what hobby your interest do you have that is most unrelated to your work?

Rebecca Lim

Well, we've talked about weightlifting already. That's quite unrelated. But probably another thing that's quite unrelated is dog training.

Michele Ong

Dog training. Okay.

Rebecca Lim

Yeah. I don't have a lot of time to spend on it, but I really enjoy it. Yeah. It's one of those hobbies where really the outcome that you get in your dog is entirely dependent on how you train your dog?

Michele Ong

Yes.

Rebecca Lim

And it can be very frustrating because you need to work out what it is that you're doing wrong that's giving you the effect that you don't want.

Michele Ong

So frustrating because the dog's not going to tell you.

Rebecca Lim

No. Sometimes they do, very rarely.

Michele Ong

And that's why you've been doing fostering over the years as well?

Rebecca Lim

Yeah. We've-- I think we'll probably fostered more this year. In the past, it's been hard to foster because I travel a lot for work, but I think we'll probably be fostering a lot more this year while Australia is not allowing us to go anywhere. Not that I'm complaining, I think-- I think we're in a pretty safe place here.

Michele Ong

We are. Definitely.

Bonus Question 2: Which childhood book holds the strongest memories for you?

Michele Ong

And which childhood book holds the strongest memories for you.

Rebecca Lim

On the same thread, Shadow the Sheepdog by Enid Blyton. So when you asked me that question, I was like, which of my books do I remember being the most dog-eared over and over again.

Michele Ong

Yeah.

Rebecca Lim

So as your typical Asian child growing up in Singapore--

Michele Ong

And raised on Enid Blyton.

Rebecca Lim

--and not allowed to have a dog.

Michele Ong

Definitely not.

Rebecca Lim

So I think that was probably why I'm so obsessed with dogs and pretty much the first chance I got, I got a dog.

Michele Ong

It's like, right. I've been deprived of this, gonna make it happen now.

Rebecca Lim

Yep. Yeah. I wanted a dog that would follow me everywhere like Shadow the Sheepdog did.

Michele Ong

Yeah.

Rebecca Lim

Unfortunately, I got a Great Dane, who-- but was in most parts just lazy.

Michele Ong

Yeah.

Rebecca Lim

I could have done better with selecting my breeds, but eh.

Michele Ong

All good. Still got a good companion out of it even though it wasn't quite what you were reading.

Rebecca Lim

Yeah. Yeah.

Bonus Question 3: What advice you would give someone who wants to do what you do? Or what advice should they ignore?

Michele Ong

And lastly, probably the harder one. What advice would you give someone who wants to do what you do? And, you know, or what should they not listen to?

Rebecca Lim

As I've mentioned repeatedly, I completely fell into this.

Michele Ong

Yeah.

Rebecca Lim

So I think my advice would be don't plan where you think you're gonna go because it can be difficult and probably would lead to a lot of disappointment.

Michele Ong

Yeah.

Rebecca Lim

Because you you tend to, if you set your goals up and it doesn't quite work out the way you think, there's probably a lot of self-critique which is not healthy anyway. I would say keep your options open. If it sounds like fun and if it will pay you enough to make ends meet, just give that a go.

If you're passionate about something and the stars line up, you will end up in a place that you're pretty happy with anyway.

That sounds like a compromise. It's not really. I don't mean it as a compromise. Also, I think as-- if you're thinking of going into science and if you're thinking, oh I wanna be an academic, I wanna work for university, I wanna be a professor, I wanna be a scientist, whatever.

If that's the way you're thinking, chances are you're a geek, and it you're a primary school geek, fret not, there's plenty of you out there. It won't be so obvious initially, but as you get older, you will find your community, and it does get easier. But also never think that because you're booksmart that life is gonna be easy, because so much of the skills that you have to acquire as you build a career, you know, outside of studying, as you start building a career, you can't read about it. You can read about it. You're not gonna learn a lot from books. A lot of it's just putting yourself out there and just being brave and trying it out for yourself.

I would also warn people not to stick with something if your gut feeling is I'm not great at this, I'm not really enjoying this. Then quit early. Quit early and try something else. Because sticking around with it, it's overrated.

Michele Ong

Yeah. And --

Rebecca Lim

Yeah.

Michele Ong

-- you you you can burn yourself out because if you're trying to push down a path that's just not working. It's just--

Rebecca Lim

Yeah.

Michele Ong

You're not gonna, you're not gonna love it, it's not going to, you know, help you grow.

Rebecca Lim

Yeah. And I think with any line of work or in any career path, you you have to have the wisdom and the maturity to ask yourself: Is it me, is it the type of work, or is it the work environment? Because it could be any of those or a combination of other things. So if you think actually, like well-- actually, do ask yourself the question, do I like what I do, I just don't like it in this setting, or is it me? I'm just not cut out for it and it's just ego that's making me stick to this. Yeah. That's probably all the advice I would give.

Michele Ong

It's all good advice.

Rebecca Lim

So subjective too.

Michele Ong

It is. But it's, it's that reflection. So that's always important.

Rebecca Lim

Yeah. And if you're constantly in a rush, to get to your next task, you just don't have that time for self reflection, so it's really important to make time for that.

Michele Ong

Yeah. definitely.

Rebecca Lim

Mhmm.

Michele Ong

Cool. That's been very cool.

If you'd like to learn a bit more about Bec's work, I've included some links below, and you can reach out to Bec on Twitter @biotechbec. That's BIOTECHBEC.

So, Bec, thanks again.

Rebecca Lim

That was fun.

Michele Ong

It was. Talk to you later. Enjoy the rest of your day. Thank you.

Rebecca Lim

You too. Bye.

Michele Ong

This has definitely been fun. I do plan on making more of these. So if you enjoyed this conversation, please subscribe to my channel, leave a comment below, and share this with your geeky and geek-curious friends. Thank you for watching, and I'll see you in the next video.