Dr Malcolm Starkey is the leader of the Urinary Tract Immunology & Microbiology Research Group in the Department of Immunology at the School of Translational Medicine at Monash University. He is also the Founding Director of the Bladder and Kidney Health Discovery Program. This discovery program provides a multidisciplinary platform to address the unmet need for new treatments and diagnostics for many debilitating urinary tract conditions. Dr Starkey is a member of the Urinary Tract Infection Global Alliance and Monash Women's Health Alliance. He is also the lead scientific adviser to Chronic UTI Australia and a key opinion leader to Travere Therapeutics. 

Dr Starkey's team studies urinary tract infections and rare genetic causes of kidney stone formation. His team is interested in how microbial challenges predispose to chronic diseases with a specific emphasis on mucosal and type 2 immunity. 

Dr Starkey completed his PhD in Immunology and Microbiology at The University of Newcastle, Australia. He then undertook post-doctoral training at the National Heart and Lung Institute, Imperial College, London, before returning to Australia as a National Health Medical Research Council (2014-17) and Australian Research Council (2018-20) fellow investigating type 2 immunity in respiratory diseases. 

URINARY TRACT INFECTION (UTI)

Vision: To bring UTI care into the twenty-first century.

We are pursuing three critical pillars of research and action:

1. Improving diagnosis

2. Creating innovative treatments

3. Driving community understanding

By improving diagnosis, we can give doctors the tools they need to know what’s going on for a patient and to set them on the right treatment path from the outset. 

By designing more innovative treatments, we can ensure those treatment pathways solve the problem for everyone – including addressing Chronic UTIs – without exacerbating antibiotic resistance. 

By partnering with community advocacy groups, raising public awareness, and sharing what we have learned with clinicians on the frontline, we’ll unlock widespread change in how our society understands and cares for the enormous number of people with UTIs. 

RARE GENETIC KIDNEY DISEASE - CYSTINURIA

Vision: To bring rare genetic kidney diseases out from the shadows and provide new hope to patients, starting with cystinuria.

Cystinuria is a genetic cause of severe and recurrent kidney stones, affecting 1 in 7000 people. The disease often presents in childhood and has no cure or effective treatment. This is compounded by a lack of accurate tests that do not involve repetitive exposure to radiation (e.g., X-rays, CT scans) for monitoring stone growth and recurrent stone episodes. 

To address these challenges, we have developed a novel Slc7a9^G105R mouse model of cystinuria that mirrors the exact point mutation in humans with cystinuria. This model is superior to existing experimental models in 3 critical ways;

1. Affects males and females equally, allowing for preclinical studies in both sexes

2. 90-100% of Slc7a9^G105R mice form substantial cystine stones

3. Substantial stones form by nine weeks of age, allowing for rapid preclinical testing of novel treatments (e.g., small molecules, gene therapy)

We are partnering with leading industry partners, academic institutions and hospitals to develop new treatments, novel biomarker diagnostics and clinical trials for cystinuria. 

Immunotherapies for urinary tract infection

Urinary tract infections are a common cause of bacterial infection, especially in females. These infections are often chronic or recurrent and can cause long-term damage to the urinary tract, especially in children. In some cases, the bacteria can ascend to the kidney and cause kidney scarring, a pivotal precursor to the development of chronic kidney disease, which predisposes to systemic health complications, including cardiovascular disease and diabetes.

Impact of stroke on bladder immunity

Stroke is a leading cause of mortality and morbidity. Bacterial infections are one of the most common complications following stroke. Bacterial urinary tract infections (UTIs) occur in one-quarter of stroke patients and are a risk factor for post-stroke mortality. However, the mechanisms underpinning increased susceptibility to, or severity of UTI following stroke have not been studied. This project aims to assess the effect of stroke on the epithelial barrier in the urinary tract and antibacterial immune responses.

Novel treatments for the rare kidney stone disease cystinuria

Kidney stones are a common urinary tract problem that disproportionally affects men. Stones can cause obstructions in the urinary system and are a significant risk factor for the development of chronic kidney disease. Current treatments for stones focus on removing the stones, often with multiple invasive procedures. There is a lack of understanding of why stones reoccur and why individuals with stones are at increased risk of developing chronic disease. Therefore, there is a clear need for novel approaches to prevent stone recurrence and its harmful consequences.

Targeting type 2 immunity in chronic urinary tract infection

The bladder is a unique and often forgotten mucosal site. When the bladder is exposed to bacterial pathogens it sheds superficial epithelial cells to eliminate the invading bacteria. The bladder epithelium has to rapidly repair itself to maintain epithelial integrity to prevent exposure to toxins in the urine. If this repair response is insufficient, it may leave the host susceptible to infection. If the repair response is exaggerated, it may lead to remodelling and fibrosis of the tissue.

- Director, Bladder and Kidney Health Discovery Program 

- Member of the Department of Immunology executive committee and School of Translational Medicine research implementation committee, providing advice on the function and research vision of the department and school

- Department coordinator for the Winter/Summer Vacation Scholarship Program