Cerebral and coronary vascular reactivity in patients at risk for myocardial infarction and stroke using advanced imaging and blood gas control techniques

Cardiovascular disease, including heart attack and stroke, is a major public health concern. The Public Health Agency of Canada indicates that 37 per cent of all deaths in Canada are cardiovascular in origin and approximately 10 per cent of hospitalizations in Canada are related to heart disease or stroke. Cardiovascular risk is currently estimated by assessing risk factors such as smoking status, height, weight, and the amount of cholesterol in the blood. Alternate methods such as viewing the heart and brain with magnetic resonance imaging (MRI) could be more useful, as they would help physicians detect and treat impairments in vascular function much earlier, thus reducing cardiovascular disease risk. Dr. Glen Foster wants to find out how measurements of vascular function are related to stroke or heart disease risk by assessing blood vessel function in patients at risk for both diseases. He is defining the relationship between brain blood vessel function and stroke, and heart vessel function and heart disease, by comparing patients who have recently suffered strokes or heart attacks with subjects who are in low- or high-risk groups for either of these conditions. He will be working with a number of colleagues at UBC who have designed a unique system capable of manipulating and controlling blood oxygen and carbon dioxide content within the MRI scanner to examine changes in vascular function in response. Using the MRI to measure vascular function throughout the vessels of the heart and brain, while accurately controlling the blood oxygen and carbon dioxide, is an important new idea in the clinical setting. This leading-edge concept could revolutionize sub-clinical detection of cardiovascular disease; it could help track how effective treatment is and provide new information in the specific anatomical area of heart disease and stroke.

Towards a patient-specific model of facial skin

Complex surgical procedures on the face, such as jaw reconstruction, frequently result in problematic scars that may be aesthetically upsetting for the patient or can interfere with chewing or swallowing. An accurate facial computer model of a patient’s face could allow surgeons to test different surgical incision pattern designs before surgery to determine which design is likely to result in the best outcome. A computer model of a patient’s face must take into account the complex properties of facial skin, such as the variability of stretch depending on direction. This requires experimental data from tests on a real human face; however, there is little data available at present about the stiffness of facial skin and soft tissues. The goal of Dr. Cormac Flynn’s research is to determine how the complex properties of facial skin affect our chewing and swallowing actions and how facial scars interfere with these functions. He aims to develop a computer model of the face with the most accurate representation of facial skin possible. To do this, he will use a biomedical device to determine the stiffness and thickness of skin and soft tissue below the skin surface of volunteers. His second task will be to use a small robotic device to apply small forces to a volunteer’s face and measure how much the skin surface deforms. The force will be applied to a number of points on the face in succession to provide a rich set of data that will be used to develop the skin model. Dr. Flynn will determine appropriate computer models to represent the skin and underlying soft tissue and apply his data from the first two experiments to set the parameters. Finally, he will merge the face model with an existing computer model of the jaw and tongue developed at UBC. The ability of the resulting model to simulate chewing and swallowing will be compared with existing computer models. This research will provide crucial knowledge about how facial skin and the underlying soft tissues influence chewing and swallowing, and will be used in the development of a computer model that surgeons can use to improve both reconstructive surgery outcomes and quality of life for patients.

Developing Whole Brain and Spinal Cord Markers of Pathology in Neuromyelitis Optica and Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease of the brain and spinal cord (together termed the central nervous system), where inflammation of the myelin coating of nerves leads to cell damage and varying degrees of disability. Neuromyelitis optica (NMO) is another inflammatory demyelinating disease of the central nervous system; however, it differs from MS in a few subtle but important aspects. NMO primarily affects the optic nerves and spinal cord, and evidence suggests that the flow of water in cells is very important in NMO. The similar characteristics of MS and NMO make it difficult to differentiate between the two; however, patient prognosis and optimal treatment for these two diseases are very different. Dr. Shannon Kolind is working to develop a non-invasive quantitative imaging tool for assessing both myelin and total water content throughout the entire central nervous system with the aim of differentiating between MS and NMO in terms of disease processes, diagnosis, prognosis, and treatment outcome. She is using a newly-developed magnetic resonance imaging (MRI) technique that is sensitive and specific to myelin and allows for high-resolution imaging of the brain and spinal cord in clinically feasible times. This technique can also be modified to estimate total water content. Dr. Kolind is using this technique to study the regional differences in myelin and inflammation in areas of focal damage (known as lesions) in MS and NMO, as well as areas of the brain and spinal cord that appear normal but might also have important damage. Ultimately, this research will provide new sensitive and specific imaging markers of excess water (inflammation/edema), myelin health (neuroprotection), myelin loss (neurodegeneration) and myelin repair (remyelination). The importance of this project lies in two potential improvements to the lives of people with MS and NMO. Rapidly and accurately making a diagnosis has a major impact on quality of life by determining the most effective treatment; it also reduces the stress of uncertainty, particularly with regard to prognosis. Furthermore, developing imaging markers and relating them to clinical symptoms will allow easier and more reliable monitoring and prediction of disease progression, which will aid in clinical trials of potential therapies, ultimately leading to the earlier availability of successful treatments.

The role of altered palmitoylation of synaptic proteins in synaptic function/dysfunction in a mouse model of Huntington’s disease

Within each individual cell, different proteins are localized to specific and necessary locations. There are many different ways these proteins are directed to where they need to go. One method for influencing protein localization is palmitoylation, which is the addition of a lipid molecule, specifically palmitate, to the protein. Protein localization is especially important in neurons, where synaptic proteins need to be carefully organized and localized to the pre- and post-synaptic regions of the neuron in order to accurately convey messages from one neuron to another. In Huntington's disease, which is characterized by neuronal death and subsequent severe motor and cognitive disturbances, it appears that synaptic proteins are mis-localized outside of the synapse, which causes synaptic dysfunction prior to cell death and symptom onset. Preventing this early synaptic dysfunction is believed to be a viable means of preventing or significantly delaying cell death and Huntington’s disease symptoms. Previous work has suggested that the level of palmitoylation is decreased in Huntington’s disease and that this may contribute to early synaptic protein dysfunction. Dr. Matthew Parsons is working to determine how the palmitoylation of specific synaptic proteins regulates their localization within the synapse and how this relates to the synaptic dysfunction observed in Huntington’s disease. Specifically, he is using different techniques to compare the properties of synaptic communication, synaptic protein localization and neuronal vulnerability to cell death in mice that have Huntington’s disease and mice with reduced protein palmitoylation. He will also use neuronal cultures from wild-type animals to investigate the effects of experimentally manipulated protein palmitoylation. Should the synaptic dysfunction due to decreased palmitoylation resemble the synaptic dysfunction in Huntington’s disease, he will also attempt to rescue the early Huntington’s disease phenotype by overexpression of a protein known to promote palmitoylation. These studies will help determine whether the regulation of synaptic protein palmitoylation may be a viable target for the treatment of Huntington’s disease.

The role of astrocytes in the brain vascular response to neural activity

Sufficient blood flow to the brain is critical for normal brain function. In response to increased brain activity, a local increase in blood flow to the active area is required to supply extra oxygen and glucose. This increase in blood flow is controlled by signaling molecules, which are released by neurons and astrocytes and can regulate blood vessel diameter. Dr. Clare Howarth will investigate how brain blood flow is controlled in response to increases in brain activity and how this is impaired in disease. In particular, she will be studying the role that astrocytes, a type of brain cell, play in the regulation of brain blood flow. One of the signaling molecules released by astrocytes, prostaglandin E2, can result in blood vessel dilation. Dr. Howarth’s hypothesis is that following a stroke, astrocytes have a decreased ability to produce prostaglandin E2, and this contributes to the long-lasting failure of blood vessels to dilate, leading to increasing neuronal damage. Using multi-photon imaging techniques, she will observe what happens to blood flow in the brain when astrocytes are stimulated with pharmaceutical or light-activated agents under conditions where the production of these signaling molecules is compromised. She will also investigate whether pharmaceutical therapies are able to reverse the effect, allowing blood vessels to dilate and help recover brain function after a stroke. This work will advance our understanding of how brain blood flow is regulated in response to neural activity. This knowledge is essential to understanding normal brain function, functional imaging techniques, and what occurs when the brain energy supply is cut off in disorders such as a stroke.

A Novel Cell Surface Engineering Method for Universal Red Blood Donor Cells via Combination of Enzymatic Cleavage and Polymer Grafting

Blood transfusion has a vital role in modern medicine. Not only is it required in surgery, or for the treatment of acute trauma, but patients with disorders such as thalassemia major and sickle cell anemia require chronic transfusion therapy on an ongoing basis. In chronic transfusion therapy, matching of minor antigens besides the major ABO and RhD antigens is essential; unintentional mismatching of red blood cells remains one of the most common causes of serious and fatal adverse reactions following transfusion. Creation of universal donor red blood cells has the potential to significantly decrease such incidents. Presently, there is no method available for the generation of antigen- red blood cells, in part because of the complexity of proteins on the surface of red blood cells. Previous attempts to create universal donor red blood cells include enzymatic cleavage of terminal immunodominant sugars and the covalent attachment of hydrophilic polyethylene glycol (PEG) polymers to surface proteins on red blood cells to camouflage the antigens. Enzymatic cleavage remains expensive and PEG-grafted red blood cells demonstrated shortened circulation in animal models. Dr. Rafi Chapanian’s research aims to use a novel cell-surface engineering method that combines grafting of highly biocompatible polyglycerol polymers and enhanced enzymatic cleavage of AB antigens to create universal donor red blood cells. He will develop a new powerful class of enzymes that can simultaneously remove group A and B antigens. He will use neutral additive polymers to enhance the efficiency of enzymatic cleavage and will investigate polymer grafting to make the process cost effective. Dr. Chapanian will synthesize linear, branched, and umbrella-like polyglycerol-based polymeric structures and graft them to the primary amines of proteins on the surface of red blood cells. These polyglycerol polymers are highly biocompatible, non-immunogenic and are expected to be superior to PEG polymers. Modified red blood cells will be characterized using standard in vitro testing methods and ultimately will be injected in mice to investigate their circulation. This research holds great promise for the cost-effective generation of antigen- red blood cells and has the potential to significantly improve the blood supply and enhance transfusion safety.

Insight into motor cortex function from in vivo imaging of individual neurons

The cortex is a thin layer on the surface of the brain where most information processing takes place. The cortex is separated into several layers. There are large numbers of neural interconnections that exist between the different cortical layers, as well as many connections with neurons of the spinal cord. In the somatosensory cortex, where the perception of touch is analyzed, there is a spatial representation of the body on its surface. The same type of spatial organization exists in the motor cortex, controlling the body's muscles; however, the spatial organization of the motor cortex is not as well defined, and this characteristic allows for more change and adaptation during learning or in motor recovery after a stroke.

Dr. Matthieu Vanni will explore the participation of independent neurons in the different layers of the motor cortex of the mouse. The mouse is a model that will be used in these studies because it provides opportunities to manipulate the genome, which will be a major asset in stages of this project. Dr. Vanni will be measuring the activation of identified neurons using two-photon microscopy, which achieves a sub-cellular resolution in living tissue. The neuronal activation in the motor cortex will be measured in response to natural movements and/or following excitation/inactivation of individual neurons of the network.

The results of this study will help to better understand the information processing of motor tasks in the brain. This knowledge could have an impact on the understanding of how the brain adapts during learning and after stroke. Furthermore, understanding these cellular aspects will have important implications in the design of therapeutic rehabilitations such as prosthetic or brain stimulation, limiting post-stroke physical disability. This project will use novel applied optical methods: two-photon microscopy and optogenetics. The exceptional resolution and specificity of these new methods will have a strong impact in many other fields as well; for example, they may be applied to study neural compensation mechanisms observed in neurodegenerative diseases such as Alzheimer's or Parkinson's.

Analysis of the influence of retroelements on activation of oncogenes in primary human lymphomas using high-throughput sequencing

Endogenous retroviruses (ERVs) are viral DNA sequences that have repeatedly inserted themselves through the course of primate evolution and in turn become an integral part of the human genome. The human genome contains more than 200 families of ERVs, which together comprise approximately 8 percent of our chromosomal DNA. A growing body of evidence indicates that ERVs have been a major player in molecular evolution and continue to impact the mammalian genome by acting as insertional mutagens, inducing DNA rearrangements and altering gene regulation. Given the potential for harmful effects, it is not surprising that mammals have evolved multiple lines of defense against these endogenous retroviruses, such as modifying the DNA or chromatin structure to prevent the genes from being expressed. In theory, if the ERVs are de-repressed, they could become active and then cause disruptive events leading to cancer. Although the structure, function and impact of human ERVs (HERVs) on the human genome has been studied in detail, their potential contribution to cancer has not been systematically examined. Dr. Mohammed Mahdi Karimi will be applying his experience in bioinformatics methods and high-throughput epigenetic analyses to study HERV families in human cancers. He will examine gene expression patterns and different types of epigenetic modifications, including histone modifications and DNA methylation, in primary lymphocytes isolated from lymphoma patients as well as in cell lines. By identifying the epigenetic changes in the genomes of HERV families, he hopes to determine how abnormal gene expression leads to the development of human lymphomas. Dr. Karimi expects that the results from this initial analysis will reveal genes that are misregulated in cancer as a result of the de-repression of HERVs, and this misregulation will be reflected in changes to the DNA or chromatin modification. The ultimate goal of Dr. Karimi’s research is to identify molecular or epigenetic pathways that are perturbed in different types of human lymphomas, which in turn may potentially be targeted with new therapeutic strategies.

Adherence to Immunomodulators in Multiple Sclerosis: Prevalence and Clinical Impact (The AIMS Study)

Taking prescribed medications as intended, or “”adherence”” is an important strategy for the management of chronic diseases. Half of the individuals with a chronic disease have poor medication adherence, and research has shown that people with poor medication adherence often have more health problems, higher hospitalization rates and a higher risk of death. Not surprisingly, medication non-adherence is extremely expensive, and is estimated to cost the Canadian health care system $8 – 10 billion every year. With an estimated 75,000 Canadians affected, and three new people being diagnosed every day, Canada has one of the highest rates of MS in the world. Multiple sclerosis (MS) is a chronic disease of the brain and spinal cord, leading to disability, severe fatigue and coordination problems. Although there is no known cure, immunomodulatory drugs (IMDs), are now commonly prescribed for MS and can lead to a substantial improvement in the health of people with MS. The benefits of IMD therapy might not be realized in people who have poor adherence; currently very little information is known about adherence to these medications. Dr. Charity Evans is working to determine how many individuals with MS have good adherence to these medications, and if people with poor adherence have higher rates of hospitalizations or worsening of the disease. She will also work to identify any time periods during therapy when an individual is more likely to be non-adherent to their IMD. Dr. Evans will be using administrative health data from three provinces (British Columbia, Saskatchewan and Manitoba), and will be studying those individuals with MS who have received an IMD between 1995 and 2008. The results of this research study will be important to determine the impact that non-adherence may have on patient health outcomes in MS, and will also help identify factors to optimize adherence to MS therapies. These methods will also be applicable to the study of adherence in other chronic diseases requiring similar drug therapies.

Dissecting the role of CD248 in inflammatory diseases

Inflammatory diseases are common, debilitating and affect the well-being of millions of people worldwide. Almost any part of the body can become inflamed, resulting in pain and suffering. For example, Crohn's disease, or colitis, is caused by intestinal inflammation and is manifested by pain, diarrhea and weight loss. Asthma is caused by the inflammation of lung airways and impacts breathing. Atherosclerosis, which involves blood vessel inflammation, leads to heart attacks, strokes, blindness and poor circulation. Because of the wide impact of these diseases, there is an urgent need to control and treat inflammation. The Conway lab was the first to determine that a protein called CD248, plays an important role in controlling inflammatory disorders. When inflammation is present, CD248 is made in high amounts by both stromal and perivascular cells, which reside in all tissues of the body. By generating mice that lack CD248 or a part of the molecule, Dr. Conway's group tested the hypothesis that CD248 might make inflammation worse. Indeed, CD248 ""knockout"" mice develop less severe joint inflammation (arthritis). This finding — that CD248 is involved in inflammation — was very significant, as it points to CD248 as a potential drug target for anti-inflammatory drugs. Dr. Yanet Valdez is now taking this research one step further to determine exactly how CD248 increases inflammation. She is using various biochemical methods to determine which inflammatory diseases are affected by CD248 and what parts of the CD248 protein influence inflammation. The studies will help her figure out how to better turn off the pro-inflammatory effects of CD248 and devise therapies to reduce inflammation severity.