Using electronic medical record data and patient reported outcome measures to improve the early identification and management of knee osteoarthritis in Canadian primary care

Osteoarthritis is a painful joint disease and leading cause of disability that affects over 6 million Canadians. The knee is one of the most commonly affected joints. Knee osteoarthritis (KOA) starts with mild joint pain and stiffness that worsens to extreme pain, often requiring surgery if left untreated.  Being able to identify people with KOA in primary care at an early stage of disease would help promote less invasive treatments. Yet, primary care clinicians report many barriers to identifying and treating KOA. The proposed study works with primary care clinicians and their electronic medical records to identify patients with KOA. I will examine the prevalence of KOA across Canada and learn about KOA risk factors like previous joint injury and obesity. As well, the management approach of primary care clinicians for KOA patients will be analyzed. Lastly, a secure online KOA dashboard will be pilot tested in a small group of primary care clinicians. This dashboard will combine the electronic medical record data with patient-selected patient reported outcome measures (PROM) on pain, symptoms, physical activity, and quality of life to inform primary care clinicians and guide their treatment for KOA patients.

Unraveling client selectivity and pattern recognition of J-Protein chaperones involved in preventing intracellular aggregation of polyglutamine peptides

Many neurodegenerative disorders are characterized by the accumulation of proteins forming toxic aggregates inside neurons. Certain proteins contain regions with repeated amino acids that can favor the aggregation process. In the cell, the molecular chaperone system maintains a fully operational protein environment by helping proteins reach and retain their final structure, prerequisite for their functionality. However, two chaperones (DNAJB6b and DNAJB8) were recently identified to also prevent protein aggregation and prolong the lifespan in Parkinson´s and Huntington’s disease mouse models, making them interesting potential therapeutic targets.

Our goal is to identify which proteins inside the cell require DNAJB6b and DNAJB8 for proper folding. We will identify the “client” proteins of the two chaperones by using protein mass spectrometry and biochemical methods. The validation of the newly found interactions, together with the determination of a pattern recognized by the chaperones, will allow the potential design of new therapies for the treatment of amyloid-based neurodegenerative diseases.

Modifying brain activity on an individual basis to improve recovery after stroke

Impaired arm and hand function after stroke (~85% of stroke survivors in Canada) is linked to altered brain activity and overactive brain areas. Practicing a task drives changes in brain areas important for function. Changes in these brain areas lead to recovery. But, overactive brain areas impede recovery. We can temporarily turn down overactive areas with brain stimulation to aid recovery. By targeting general brain areas important for movement, this non-invasive, painless approach shows promise. Yet, its response is varied. We think this is because overactive brain areas differ across individuals after stroke. We will target brain areas for stimulation on an individual basis to improve effectiveness – an approach not yet taken. The proposed work will 1) determine areas for stimulation after stroke by examining brain activity on an individual basis, and 2) pair individualized stimulation with task practice to aid recovery after stroke. We will show that improvements in hand and arm function are maximized when stimulation is tailored to the individual. This work represents a critical step in improving interventions for stroke recovery, leading to improved daily function and better quality of life for Canadians living with stroke.

Severity and Treatment of Menopausal Symptoms in Women Living with HIV

Globally, persons living with HIV are aging, with women constituting over half of this group. Increasingly, women living with HIV (WLWH) are entering menopause, a crucial transition with impacts on overall health and well-being. Regrettably, there is limited research focused on how WLWH experience menopause, leading to a major gap in their quality of care. Preliminary studies suggest that WLWH may experience menopause with heightened symptoms. However, uncovering the true extent of this important relationship awaits detailed clinical analysis. Therefore, we undertake an interconnected set of aims to better understand the progression of menopausal symptoms within two Canadian cohorts of WLWH. For the first time, we evaluate how symptom severity progresses during the menopausal transition in this group. Subsequently, we assess whether hormonal imbalance underlies the increased severity of symptoms experienced in menopausal WLWH. Finally, we evaluate the clinical use of hormone therapy to treat these women which we predict is under prescribed for WLWH. By uncovering unique aspects of menopausal management in HIV, this work will enable development of tailored approaches to improve care for this vulnerable population.

Characterization of Pathogenic Chromatin States in Synovial Sarcoma

Synovial sarcoma (SS) is the most common soft-tissue cancer among young adults. It is an aggressive tumor type in great need of new treatment options. SS tumors are defined by a specific genetic change that causes two separate genes to fuse into one. This new fusion-gene produces the SS18-SSX protein which is thought to remodel the cells epigenome, resulting in the activation and inactivation of a large number of genes. As SS18-SSX cannot be inhibited by any known drugs, we aim to identify the genes and regulatory elements that are directly affected by the protein. We have developed a novel SS mouse model and collected a large series of human tumors in order to study the effects of SS18-SSX in the context most relevant to patient. We will then use state-of-the art approaches to identify and disrupt the most important changes caused by SS18-SSX with the goal of identifying new treatment options for patients with this deadly disease.

Artificial intelligence based discovery of estrogen receptor activation function 2 (AF2) inhibitors as the first-in-class therapies for drug resistant breast cancers

Breast cancer (BCa) is the most common cancer and the second cause of death from cancer among Canadian women. While antiestrogens are effective initially, BCas eventually reach a state where they no longer respond to conventional treatments. In a first effort to develop new drugs for resistant BCas, we developed inhibitors with a novel mechanism of action, able to suppress the proliferation of BCa cell lines that do not respond to standard therapies. While promising, better compounds are required for effective treatment of resistant BCa.

Chemical libraries already contain more than one billion of compounds, starting a new era of computer-aided drug discovery. Unfortunately, screening of such amount of chemicals is not yet possible using standard methods due to the required computational resources. To overcome this limit, we have developed an artificial intelligence method, progressive docking, which allows to virtually screen such libraries for the first time ever. In this way, we will be able to discover new inhibitors by evaluating billions of available compounds, in order to improve the outcome of BCa for women in Canada and worldwide.

Developing novel therapeutic targets to treat arrhythmia-causing ryanodine receptor variants in the heart

Our hearts play a crucial role to distribute blood throughout our bodies. When it beats irregularly, also called an arrhythmia, it can lead to major fatigue, loss of consciousness, or even death in some of the most serious cases. Arrhythmias can either be acquired throughout our lives or have genetic forms. The latter are more rare, but are usually more severe and affect very young people. In this project, we study a genetic form of arrhythmia that is due to mutations in a gene encoding "RyR2".  RyR2 is very large protein that is present in all of our heart muscle cells, and its function is critical for the heartbeat.  In particular, it allows calcium ions to move inside the heart muscle cells to maintain regular heartbeat patterns.  The mutations, found in various families worldwide, affect the RyR2 protein directly, such that the calcium ions move too easily.  We aim to understand how this happens, by solving the 3D structures of the ‘normal’ RyR2, and of RyR2 with a disease mutation.  This comparison will allow us to look at the precise effect of the mutation on the structure of RyR2 and on how it functions. The 3D structures will also help with generating novel drugs that can help treat arrhythmia.

Characterization of Gli proteins as a novel therapeutic target in prostate and breast cancer.

Prostate (PCa) and breast cancer (BCa) are leading causes of cancer deaths. These tumours depend on sex hormones that function through receptor proteins for their growth. For this reason, hormone therapies inhibiting these receptors are the first approach for controlling metastatic disease. However, hormone therapies eventually fail. Therefore, understanding how receptor proteins promote cancer growth will affect our approach for designing effective treatments for PCa and BCa. 

Recently, we showed that sex hormone receptors activate Gli proteins in PCa and BCa cells. Gli proteins are regulators of genes that control cell growth and overactive Gli proteins cause brain and skin cancers. I propose that hormone-activated Gli is responsible for the growth effects of sex hormones in PCa and BCa. My work will characterize the relationship of sex hormones, Gli proteins and cancer cell growth. In addition, I will employ a novel technique to understand binding of Gli proteins with sex-hormone receptors and develop a new strategy to block cancer cell growth. This project will lead to a breakthrough in our understanding of sex hormone receptor action in PCa and BCa and evaluate a new approach to control the growth of these deadly diseases.

Understanding adaptability in egg-laying behavior in Aedes aegypti

Mosquitoes are the deadliest animals on the planet. Aedes aegypti mosquitoes are found in many parts of the world. When they bite people to take blood, they can transmit microorganisms that cause disease. One reason that Ae. aegypti is so deadly is that it is closely associated with people and can breed in a wide range of water-filled containers such as dumpsites, construction sites, and discarded plastic containers.

Ae. aegypti must carefully choose where to lay their eggs. These decisions are achieved by using different senses to detect water where their progeny can thrive. The aim of my proposal is to characterize the genes and brain circuits important for mosqutioes to identify optimal egg-laying sites. I will perform these studies across groups of Ae. aegypti that have distinct egg-laying preferences to understand how these mosquitoes have adapted to the wide variety of environments associated with people.

Ultimately, my work will help us understand why Ae. aegypti (and not other species of mosquitoes) have become so intertwined with us and, thus, are so deadly. These studies will provide foundational data to support critically important mosquito control efforts around the world.

Feeding patterns, nutrient status, and neurocognitive development in toddlers 18-24 months of age: A Randomised Control Trial

Early childhood represents a critical period in which a child’s brain undergoes rapid brain development and is critical to later health and wellbeing. During this time, infants and young children have especially high needs, both for energy and key essential nutrients, when compared to older children and adults. Yet feeding and nutrition guidelines for infants and toddlers during this crucial developmental window remain poorly understood, explained in part by the major changes with regard to infant and toddler feeding practices in the past century.

Therefore, the specific focus of this project is understanding how feeding patterns (including breastfeeding, cow’s milk, and formula) in the first two years of life are associated with toddler cognitive development at 24 months of age. In particular, the research will focus on key nutrients recently identified as crucial for healthy development and function, but which are currently limited in toddler diets and guidelines. The study has clinical and public health implications for toddler nutrition and will help inform and clarify current toddler feeding guidelines in order to improve the health and development of Canadian children.