The official study completion date for START was June 2024. Since then, the project has finalised data analysis and published research into diagnostic and management approaches in July 2025. Findings regarding acute rheumatic fever (ARF) pathogenesis are also in the final stages, with the paper now available as a preprint.
START identified unexpected differences in diagnostic and clinical practices, highlighting the need for international harmonisation and development of evidence-based treatment guidelines. Our findings have additionally provided new insights into the pathogenesis of ARF, which will likely have impacts beyond those originally identified. This includes improving safety assessment in upcoming Strep A vaccine trials, and identifying new targets for therapeutic intervention.
Currently in development are materials to feed back results from this study to community- including a storybook to be finalised in August 2025.
February 2024: Data acquisition and F2F meeting
Data acquisition across all platforms was completed in February 2024, following delays attributed to the COVID-19 pandemic.
The collected samples were analysed using different platforms, including metabolomics, proteomics, transcriptomics, in vitro assays (spectral flow cytometry) using primary human peripheral blood mononuclear cells (PBMCs), cytokine multiplex arrays, autoantibody profiling, and epigenetic analysis.
START also held a face-to-face meeting, with collaborators travelling nationally and internationally to discuss the project, including the Aboriginal Governance Committee.
START F2F meeting attendees
November 2021: Recruitment finalised
Our dedicated team of clinical and research nurses have enrolled 331 participants with and without ARF in Australia (AUS) and New Zealand (NZ), across 3 sites: Royal Darwin Hospital (AUS), Starship Children’s Hospital (NZ), and Middlemore Hospital (NZ).
Recruitment occurred between October 2018 and November 2021.
Partnering with the Accelerator team at The Kids Research Institute Australia, we are looking to commence analysis mid-2022 using the latest systems biology multi-omics and antibody profiling technology to identify a reliable marker for ARF.
Overview of the multi-omics approach in the START study, detailing participant recruitment, study site locations, sample collection timeline, and analytical platforms used.
August 2021: Capacity building program in Australia
Left to right: Tasha Cole, Mark Mayo, Erin Gargan
The Aboriginal Governance Committee oversees a community-based capacity building program that provides mentoring and career development opportunities for young Indigenous adults living in the Northern Territory.
The START study has supported two young Indigenous researchers to complete a laboratory traineeship at Menzies School of Health Research. Under the guidance of chief investigator Mark Mayo, Tasha Cole and Kyran Kuzio have completed their Certificate III in Laboratory Skills. Previous trainee, Erin Gargan, also provided support and mentorship to Tasha and Kyran during their traineeships.
Left to right: Tasha, Kyran
June 2021: Recruitment in New Zealand
Recruitment in New Zealand ran from May 2019 through to June 2021, with a total of 115 participants enrolled.
Participants were recruited from two Auckland-based study sites. The first site, Starship Children’s Hospital, is New Zealand’s first hospital built exclusively for the health needs of children and young people. Starship provides a wide range of complex medical, surgical, cardiac and mental health services for children throughout New Zealand and the South Pacific.
The second study site, Kidz First Children’s Hospital is purpose built to deliver family centred health care and serve the culturally diverse Counties Manukau community.