Research Location: University of British Columbia

Design and discovery of novel organ specific iron chelating system for the treatment of transfusional iron overload

Iron is essential for different physiological functions and biochemical activities in the body, but is extremely toxic in excess. Because humans don’t have an active mechanism to excrete excess iron, too much iron in the system can lead to iron overload. 

The mainstay treatment for many chronic anemia disorders is frequent red blood cell transfusions. Patients with such transfusion-dependent blood disorders are at a heightened risk of iron overload, which can cause severe damage to vital organs including the liver, heart, pancreas, thyroid and endocrine glands. Systemically accumulated iron is fatal if left untreated, and causes considerable morbidity and mortality. 

Iron chelation therapy is the most widely-used therapeutic approach to improve survival and reduce the risk of iron overload, by chelating and excreting excess iron using small molecular Fe (III) specific chelators. However, the current FDA-approved iron chelators have many limitations, including inefficiency, toxicity, severe side effects, high cost, and patient non-compliance. Consequently, the lifespan of a major portion of transfusion-dependent anemic patients is severely narrowed. To date, no methods are available for the excretion of organ-deposited iron. 

Recent developments in polymer/macromolecular therapeutic approaches shed new light on improving the therapeutic window of small molecular drugs and circumvent the limitations associated with existing therapies. Polymer therapeutics is a widespread multidisciplinary research area with a focus on polymer-conjugates of drugs and proteins, nano drug delivery systems and other macromolecular delivery systems. Several of such systems are approved for market arrival. 

Dr. Abbina’s research will investigate improving the success and efficiency of iron chelation by incorporating biodegradable moieties in a polyglycerol scaffold, and targeting specific organs that are susceptible to iron mediated toxicity. The result of this research will be liver- and heart-specific macromolecular iron chelation systems. 

The preliminary data is promising and we believe this safe and efficient therapeutic approach would benefit numerous patients suffering from iron overload induced diseases including cardiac failure or arrhythmia, cardiomyopathy, liver diseases and other endocrine disorders. This novel chelating system will also open new avenues to address other iron overload pathogeneses, including cancers, diabetes, inflammation and neurodegenerative diseases.

No time for nice? Exploring the nature and influence of workplace incivility and bullying in long-term residential care

Residential care aides (RCAs) provide the majority of hands-on care for individuals in long-term residential care (LTRC). Yet, as they are situated at the bottom of the workplace hierarchy, they receive little respect or recognition for their work. In BC, LTRC workers (mainly RCAs) have the highest rates of on-the-job injury; four times higher than the provincial average and twice as high as acute care workers, due primarily to overexertion and violent or aggressive acts from residents. 
Little is known about RCAs’ experiences of peer workplace incivility and bullying, also known as horizontal violence. This is a significant gap, as staff turnover and absenteeism (factors which negatively impact residents’ quality of care and quality of life) are more correlated to exposure to workplace incivility and bullying than to patient threats and violence. 

Quality person-centred care depends on respectful and collaborative relationships among RCAs; however, workplace incivility and bullying have the potential to significantly disrupt such relationships. For example, faced with workplace incivility and bullying, RCAs may lift or ambulate immobile residents alone rather than asking for help, putting themselves and residents at risk.

Using a critical ethnographic approach, this novel study will examine workplace incivility and bullying among RCAs in LTRC and its effect on care provision. Dr. Cooke’s findings will generate practice and policy recommendations for improving staff relationships that will, in turn, help improve residents’ quality of care and quality of life.

A Community Advisory Committee will provide input throughout the research process. Forums will be held periodically at each study site to share emergent findings, and a publicly-accessible, study-specific website will be created. Findings will also be shared with a variety of knowledge user groups (e.g., health authority residential care quality committees, UBC Centre for Research on Personhood in Dementia’s colloquium series, and the Patient Voices Network) to encourage dialogue and exchange. This will provide an opportunity to stimulate transformation in LTRC beyond the scope of the study sites and influence policy and practice across BC and potentially beyond.

 

Precise prescription of rTMS for treatment resistant depression

Dr. Vila-Rodriguez's research will work towards improving diagnostic accuracy and treatment outcomes in persons suffering treatment-resistant depression (TRD). By incorporating neurophysiological-based biomarkers (NPBs) into clinical practice, treatment response can be more easily predicted, preventing relapse in patients with major depressive disorder. This program of research focuses on the use of repetitive transcranial magnetic stimulation (rTMS), a non-invasive neurostimulation therapy recommended by the Canadian Network for Mood and Anxiety Treatments (CANMAT) as a first-line treatment option for TRD.

This research encompasses the Canadian rTMS Treatment and Biomarker Network in Depression (CARTBIND) trial, an ongoing randomized clinical trial that aims to identify relevant NPBs and uses rTMS to treat TRD. Participants in this trial undergo resting-state electroencephalographic and resting-state functional magnetic resonance imaging before and after rTMS treatment to ascertain which neurophysiological features are good predictors of treatment response. Based on this data Dr. Vila-Rodriguez will develop and test a treatment response classifier and relapse prediction classifier.

The aim of this research is to transform how clinicians prescribe rTMS and how they monitor the treatment course and maintenance by incorporating reliable and robust biomarkers. This approach will optimize treatment efficiency by increasing the response rates for TRD and reducing treatment failure, thereby improving the health of British Columbians who struggle with depression and decreasing costs to the health care system.

Dr. Vila-Rodriguez's knowledge translation model involves the regular use of both the lab website as well as the Twitter account to engage his research audience in research activities to keep them up-to-date on new findings, as well as to facilitate self-learning via educational materials.

Genetic etiology of progressive multiple sclerosis

Multiple sclerosis (MS) is the most common cause of neurological disability in young adults, other than trauma, with over two million people affected worldwide. Approximately 100,000 Canadians have MS, a rate that is nine times higher than the global average. MS symptoms vary widely and may affect vision, hearing, cognition, balance, and movement; negatively affecting many aspects of quality of life. To date, there is no cure or prevention for MS. Although treatments to effectively manage the clinical symptoms of MS are available, they come with several serious and even life-threatening adverse effects; and over time, MS enters a progressive phase which no known therapies can prevent or treat. MS was originally considered an autoimmune disease triggered by exposure to environmental factors, but family studies (twins, adoptees, half siblings) have clearly demonstrated an important genetic component to the disease.

The goal of this research program is to define the genetic components contributing to the onset of MS to provide new tools for scientific investigation and the development of novel and more effective treatments. To this end, Dr. Vilarino-Guell will apply new gene sequencing technologies to over 100 families with several blood relatives presenting with MS, as well as thousands of unrelated individuals diagnosed with MS. Within the last year he has identified disease-causing genetic changes for some of these families, as well as biologically-relevant genetic changes which impact disease progression and the severity of clinical symptoms. These genes and mutations have highlighted specific biological pathways implicated in the onset of progressive MS.

This research will further characterize the genes involved in these cellular processes to better understand the biological mechanisms of progressive disease. The results of Dr. Vilarino-Guell's research will provide the knowledge and tools for the therapeutic advances in the prevention and treatment of MS, tackling its highly debilitating progressive phase which is currently untreatable.

The role of the norepinephrine system in emotionally-biased attention and learning

Individuals vary widely in the aspects of the world they perceive and remember: some filter their environments through rose coloured glasses to perceive sources of pleasure, while others are attuned to signs of threat. Such affective biases in attention influence memory and characterize mood disorders and pathological responses to trauma as well as addictive behaviours. Yet much remains to be learned about neural mechanisms underlying such biases, and the factors that influence their development and potential for change.

Dr. Todd's research will investigate the influence of genetic variation and life experience on emotional biases in learning, attention and memory, and how they can be harnessed to treat affective disorders and addiction. This research will have a direct impact on our understanding of basic neural mechanisms underlying such affective biases, and increase our understanding of how genetic variation and life experience shape these mechanisms to produce behaviours linked to mood disorders and addiction, with important implications for assessing vulnerability and optimizing treatment.

Dr. Todd's five-year research program will work towards an understanding of the role of common genetic variations that influence neurochemical activity in the brain, and the development of behaviour patterns that are linked to mood disorders. Extending her previous work on the influence of genetics and trauma on emotional biases in attention, she will focus on understanding neural mechanisms underlying such biases; investigate whether such biases arise out of individual differences in patterns of emotional learning; and examine the influence of a common genetic variation that influences the availability of norepinephrine in emotional learning. The results of this research will aid understanding of the currently understudied role of norepinephrine in emotional learning patterns linked to mood disorders and addiction.

Responding to the dual epidemics of hepatitis C and addiction in British Columbia

In British Columbia (BC), it is estimated that 78,000 people are living with hepatitis C virus (HCV), most of whom do not even know they have the disease. If left untreated, HCV can cause serious harm, including liver cancer and death. People who inject drugs (PWID) are at elevated risk of HCV infection given their exposure to various individual and environmental circumstances, such as their ongoing addiction and barriers to accessing health care. A growing body of research suggests that harm reduction and addiction treatment programs may present important opportunities to engage PWID in the HCV treatment and care. Efforts are now underway in BC to dramatically expand access to low-threshold addiction treatment that extends beyond traditional methods. Research in this area is particularly timely, as these new policies offer an opportunity to evaluate the impacts of the expansion and optimization of addiction treatment on HCV-related outcomes among PWID.

Dr. Ti's research is an extension of past work that focused on the relationships between infectious diseases, addiction, and the delivery of harm reduction and health services. Utilizing her expertise in this area, Ti will evaluate novel interventions to reduce the health burden caused by HCV and addiction by:

  • Characterizing HCV re-infection rates among PWID and examining harm reduction-based and addiction treatment interventions that may protect against reinfection.
  • Evaluating evolving addiction treatment guidelines and their impact on HCV incidence among PWID.
  • Evaluating the impact of innovative HCV and addiction treatment interventions on treatment uptake and completion.

This research is designed to provide evidence for health system leaders and policy makers to develop policies that are in line with evolving trends in HCV and addiction, and to support health system improvement.

Gene clusters and natural products from the human microbiota

Worldwide, prematurity is the leading cause of death for all infants, with almost one million deaths per year. Babies born before 32 weeks face the worst odds. These babies are only 2% of births, but they account for over 1/3 of all infant deaths. For these infants, a disease called necrotizing enterocolitis (NEC) can be one of the most deadly complications of prematurity after the first week of life. NEC is an acquired condition in which intestinal tissue suddenly becomes inflamed and then begins to die off. NEC has a high mortality rate, and, even if the baby survives NEC, they are subject to considerable life-long health problems, resulting in tremendous costs to the health care system. With rising rates of prematurity, NEC poses a significant health and financial burden on Canada.

Dr. Ryan's research will employ approaches from biochemistry, microbiology, and chemistry to identify the factors produced by beneficial bacteria found in the infant microbiome that protect against NEC. This work will provide essential information for the development of novel therapeutics and preventatives for this costly disease.

Dr. Ryan will also collaborate with the Centre for Drug Research and Development to investigate molecules identified potential new drug leads, and researchers at the Child & Family Research Institute at the BC Children's Hospital to further investigate the role of the microbiome in infant health.

Identifying the molecular mechanisms underlying sex differences in fat storage using Drosophila as a model

In Canada, metabolic diseases (e.g. cardiovascular disease, type 2 diabetes, obesity) are leading causes of death, disability, and hospitalization. Currently, more than 10 million Canadians suffer from metabolic disease, with direct and indirect costs to the economy estimated to be $20 billion each year. Approximately 40% more men than women suffer from metabolic disease. In addition, commonly prescribed drugs used to prevent and treat metabolic disease are more effective in one sex than the other (e.g. fenofibrates). Despite these known differences in metabolic disease between men and women, prevention and treatment guidelines remain largely the same for both.

The main reason doctors do not treat men and women differently is due to lack of vital information about the fundamental metabolic differences between the sexes. The next step forward in preventing and treating metabolic disease is identification of the genes and pathways that control metabolism in each sex. This will provide researchers with a pool of promising new targets that will assist in developing therapies that will be effective in men and women, and eventually help in designing sex-specific treatment guidelines.

Dr. Rideout's research will work towards discovery of these genes and pathways using fruit flies as an innovative model, integrating the unparalleled genetic toolkit available to fly researchers with cutting-edge high-throughput metabolic analysis to answer three fundamental questions: firstly, which genes and pathways are essential for metabolic control in each sex; second, how sex-specific metabolic programs are established and maintained; and lastly, how sex differences in metabolism change in distinct contexts. Dr. Rideout will focus on sex differences in the regulation of fat storage, a key aspect of metabolism. 

Dr. Rideout's research outputs will be the identification of a pool of candidate genes that affect fat storage in each sex. Building on this vital starting point by translating this knowledge into pre-clinical models, and eventually humans, she will collaborate with world-leading experts in diabetes, obesity and cardiovascular disease in the Diabetes Research Group at The University of British Columbia. The innovative approach of this research program will make important strides towards developing personalized therapies for men and women, an important goal in modern medicine.

Improving maternal and perinatal health outcomes in high risk mothers

Among women who give birth in industrialized countries maternal age, obesity, twin or triplet pregnancy, and presence of chronic diseases such as diabetes and hypertension continue to increase. For example, 34% of mothers in Canada today are overweight or obese, and approximately 20% of births are to women over 34 years. These demographic trends highlight the need for increasingly complex obstetric care with careful prenatal monitoring and timely obstetric intervention if necessary. 

Dr. Lisonkova's research will quantify the risk of severe maternal morbidity by developing a score system that will accurately distinguish between high, moderate, and low risk women. This score calculator will help, for example, women in rural areas to decide about transport to higher-level obstetric care, as these women may face geographical barriers to timely transfer. Determinants of these elevated risks will be examined, as well as whether these risks increase with distance to maternity care, seasonally (for example in winter), or occur only among women in selected geographically specific areas.

The results of this research will provide information to women who are contemplating delaying childbirth, who are overweight or obese, or have chronic health problems. This information will also help health care providers in pre-pregnancy and pregnancy counselling, and health care administrators to identify maternal care needs with respect to maternal-fetal medicine specialists and intensive care units. The maternal morbidity risk score calculator can also be used to adjust for baseline risks (maternal comorbidity, etc.) when comparing hospital performance and evaluating new safety measures in maternal care.

This project will be conducted in collaboration with the Society of Obstetricians and Gynaecologists of Canada, Public Health Agency of Canada, and the Department of Family Medicine & Midwifery, University of British Columbia. The collaboration between midwifery, family physicians and obstetricians will be beneficial especially for women in rural areas, for whom accurate risk identification is crucial.

Incentivizing the delivery of sustainable care of chronic diseases in Canada: Case studies in musculoskeletal disease

Concerns about the sustainability of publicly funded health systems and the rising cost of care abound, yet there is little research that explores health care efficiency. Simple cost-saving exercises (i.e. cutting services) may risk harming patients, while more sophisticated, efficiency-saving approaches aim to provide health care at a greater benefit per unit of cost. Encouraging quality and value of health care delivery, whilst reducing waste, is also an indirect way to control health care costs. Undertreatment (failure to use best available care), overtreatment (treatment contrary to best-available evidence or preferences of patients), and poor coordination of care are three key clinical sources of waste. Many large-scale schemes aim to incentivize better health care, but show mixed results.

Dr. Harrison’s research will translate aspects of successful schemes and inform sustainable health care provision in Canada, focusing on musculoskeletal (MSK) diseases as they have been central to successful schemes. MSK diseases affect 11 million Canadians, and contribute hugely to the economic burden of disease in Canada. They have extensive impacts on people’s lives, including their health-related quality of life, ability to work, financial situation and reliance on the health care system. Additionally, high quality care of rheumatic disease requires early access to treatments which are often complex and considerably different from one another. Therefore, it is increasingly recognized that patients need coordinated, multidisciplinary support and care.

Dr. Harrison’s program will encompass policy-focused health economics and outcomes research to inform the design of financial and non-financial incentives to improve the efficiency of health care delivery.

End of Award Update: September 2022

Most exciting outputs

The project allowed me to explore whether a change to introduce a billing code for multidisciplinary care in rheumatology changed the experience of patients visiting rheumatologists in BC. We found that rheumatologists who used multidisciplinary care were able to expand services for patients.

 

Impacts so far

Our work adds to the evidence around incentives for multidisciplinary care in chronic disease. This will help inform future policy decisions.

 

Next steps

I continue to work on the evaluation of incentives and changes in policy for health care. I am currently co-leading a project evaluating the biosimilars initiative in BC.

 

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