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On average it takes five to seven years to diagnose a rare disease. But, for growing numbers of rare diseases, that is all about to change with new artificial intelligence-led technology developed by researchers at London Health Sciences Centre (LHSC) and Lawson Health Research Institute that will be going global.

With funding of $7,551,693 that includes a Genome Canada Genomic Applications Partnership Program (GAPP) grant and support from Illumina Inc., a leading developer of tools for analysis of genetic variation, research led by Dr. Bekim Sadikovic will change what has been years of trial and error in the search for a diagnosis into a simple blood test that could ultimately be available in any lab around the world.

“Despite advances in genome sequencing, it is estimated that nearly 70 per cent of people with a rare genetic disease are not diagnosed,” says Dr. Sadikovic, Research Chair in Clinical Genomics and Epigenomics with the Archie and Irene Verspeeten Clinical Genome Centre at LHSC, and Scientist at Lawson.

“To receive specialized care, you need a specific genetic diagnosis. Without one, you can’t access therapy and, unlike other types of diseases, genetic diseases don't only affect the patient, they affect whole family because they can be inherited,” he says.

Using machine learning, Dr. Sadikovic has developed EpiSign™, the first technology that uses a patient’s epigenome to diagnose genetic disorders. At its most basic level this means that artificial intelligence is used to detect the pattern of chemical signals, called epigenetics, that turn genes within a person’s DNA on or off. The position of this on-off switch for any specific gene could mean someone has blue eyes versus brown eyes, or it could mean they have a rare genetic disease. 

Over the last ten years, Dr. Sadikovic has been researching epigenetics and has created a database that contains the epigenetics of hundreds of genetic diseases, and diseases caused by toxic environmental exposures, the largest database of its kind in the world. 

This decade of research has culminated in an ongoing national trial of this diagnostic technology called EpiSign-CAN. Funded by Genome Canada, the trial involves testing of thousands of patients across 14 Canadian academic hospitals.

“It is these episignatures that allow us to diagnose patients that otherwise cannot be diagnosed with standard genetic techniques,” Dr. Sadikovic explains. “So, we can now interpret this genetic data that we couldn’t understand before, and provide critical answers for patients and families affected by hundreds of rare diseases.”

This $7.44 million grant funding from the Government of Canada through Genome Canada will enable the next phase of the project in which EpiSign™ technology will be implemented in labs at academic institutions in 15 countries around the world. 

“This research is a great example of LHSC’s commitment to supporting the world-leading advances in diagnosis of patients with rare diseases,” says Brad Campbell, Corporate Hospital Administrative Executive at LHSC.

Along with Dr. Sadikovic’s laboratory at LHSC, two industry partners will be involved in this project. Illumina Inc. will be developing custom microchip hardware to facilitate streamlined sample collection, and EpiSign Inc., a Canadian startup biotechnology company which is a partnered venture between LHSC and Dr. Sadikovic, will develop end-user software for automated data analysis in labs around the world.

“The support provided by Genome Canada and Illumina will enable adoption of EpiSign technology and place it at the forefront of patient care globally,” Campbell says.

Dr. Sadikovic’s work has also been supported with funding through LHSC’s Academic Realignment Initiative Awards and generous donor support through London Health Sciences Foundation, including through the Archie and Irene Verspeeten Clinical Genome Centre. 

Media contact:  
Roxanne Beaubien
Senior Media Relations Consultant 
London Health Sciences Centre
Cell: 226-577-1511
@email

LONDON, ON - Researchers at Lawson Health Research Institute are examining whether the use of a daily probiotic can improve outcomes in patients who undergo a total knee replacement surgery.

There are more than 70,000 knee replacement surgeries in Canada each year, and up to 10 per cent of patients experience complications following the procedure.

“One in five patients are dissatisfied after surgery due to pain and discomfort, and some patients need a repeat surgery because there is complication, infection or loosening of the joint,” says Dr. Matthew Teeter, Lawson Scientist at London Health Sciences Centre (LHSC).

Dr. Teeter and the research team are focused on improving patient outcomes. Recognizing that knee replacement patients who are considered healthy tend to have better outcomes, they are interested in how they can better support patients’ overall health as one way to optimize their outcomes.

“The knee replacement patients I see in clinic are very diverse - from young healthy active patients to medically complex to socioeconomically disadvantaged,” says Dr. Brent Lanting, Lawson Scientist and Orthopaedic Surgeon at LHSC. “We know those with poor health do not do as well as those with good health, good diet, and good supports. This study is profound in that it investigates a core aspect of our health – the gut microbiome.”

The research team will recruit 30 participants who are scheduled for a knee replacement surgery. Half of the participants will receive a daily probiotic for six-weeks ahead of the surgery, and the other half will act as a control group.

“Our microbiome is a large part of why we are healthy. A healthy person has a microbiome that produces vitamins and other things which cross over to our system and helps promote healing,” says Dr. Jeremy Burton, Lawson Scientist and Research Chair of Human Microbiome and Probiotics at St. Joseph’s Health Care London. “We are hoping it will improve more deep healing and prevention of the rejection of the joint by improving the microbiota by giving probiotics.”

The team will assess outcomes using CT imaging, looking at the bone and implant and how it is fixing into place. They will also use PET/MRI to look at the cellular activity around the joint and inflammation.

“This should give us a sharp focus of what is going on with the joint and help us determine if there was a positive effect by using probiotics,” explains Dr. Teeter.

If the pilot study proves to be promising, the team will then work towards a larger clinical trial, combining probiotics into pre-surgical care.

“Ultimately, we want better patient outcomes with a simple treatment,” adds Dr. Burton. “If we can help improve outcomes with the use of a daily probiotic, that is a great win.”

The research team received a New Frontiers in Research Fund (NFRF) of $250,000 over three years to conduct this study.

 

LONDON, ON – New research from Western University and Lawson Health Research Institute demonstrates that increased antioxidant levels in the brain may improve outcomes of early intervention in psychosis. In the paper published in Nature Molecular Psychiatry, the research team found that patients with higher levels of an antioxidant called glutathione responded more quickly to medication for psychosis and had improved outcomes. 

“Once patients with psychosis start treatment, some get better in weeks while it can take months for others. We wanted to see if we could understand and influence this disparity,” said Dr. Lena Palaniyappan, Associate Professor at Western’s Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute. “We found that the amount of antioxidants that patients have in their brains predicts the time that it takes for them to respond to treatment.”

Previous research has shown that patients who respond early to antipsychotic medications have better overall outcomes in terms of symptoms and daily functioning. The research team has estimated that a 10 per cent increase in antioxidants could lead to a reduction in length of hospital stay by at least seven days.

“This study demonstrates that if we can find a way to boost the amount of antioxidants in the brain, we might be able to help patients transition out of hospital more quickly, reduce their suffering more quickly and help them return earlier to their work and studies,” said Dr. Palaniyappan who is also the Tanna Schulich Endowed Chair in Neuroscience and Mental Health at Western.

Antioxidant levels in the brain vary naturally from person to person and those variations can be attributed to lifestyle choices like exercise and diet. There are also ways to pharmaceutically boost these levels. A supplement called N-Acetyl Cysteine (NAC) as well as broccoli extracts can increase the brain’s antioxidants if given over a long period of time. 

Dr. Palaniyappan and his team used high-field MRI imaging to examine antioxidant levels in the brains of 37 new patients to the Prevention and Early Intervention for Psychoses Program (PEPP) at London Health Sciences Centre. Antioxidant levels were studied prior to beginning treatment for psychosis and followed up for six months post-treatment.

The MRI scans were acquired at Western’s Centre for Functional and Metabolic Mapping at the Robarts Research Institute with the support of Western's BrainsCAN and the Canadian Institutes of Health Research.

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LONDON, ONTARIO - Living kidney donation rates have remained stagnant over the last decade, and many potential living donors find the evaluation process to be lengthy and difficult to navigate. Researchers from Lawson Health Research Institute and Western University have published results identifying indicators to monitor and improve the performance of transplant centres in how efficiently they evaluate individuals interested in becoming living kidney donors. The findings appear in the current issue of CJASN. 

In 2019, there were 219 living donor kidney transplants in Ontario. There are several advantages to kidney transplantation from a living donor compared to deceased. However, many living donor candidates drop out of the evaluation process for a variety of reasons. 

“From speaking with living donors, we know that some people find the evaluation process frustrating and cumbersome,” says Dr. Amit Garg, Professor at Western’s Schulich School of Medicine & Dentistry and Scientist at Lawson. “To ensure living donation is safe for both the donor and the recipient, a thorough evaluation is needed looking at medical, physical and psychosocial considerations.” Dr. Garg is also Director of the Living Kidney Donor Program at London Health Sciences Centre (LHSC). 

Marian Reich started the journey of living kidney donation 11 years ago, giving the gift of life to her sister-in-law, Susan. “The evaluation process took one full year to complete, and in that time Susan lost the option of a pre-emptive transplant and started dialysis. I wasn’t fully aware that I had to be the driver of the process, and how to do that.” 

Reich believes living donor evaluation should be consistent across the country, with a clearer process outlined for potential living donors and recipients. “Research studies like this one bring forth best practice and evidence-based information that includes the perspective of those with lived experiences.”

The research team, which included Patient Partners such as Reich who co-authored the paper, surveyed 77 participants who were kidney transplant recipients and recipient candidates, living kidney donors and donor candidates, or health care providers and administrators. 

Out-of-pocket cost incurred by donors is one of the most significant barriers to donation. Another challenge is the lack of reliable information about the expectations and requirements of the donation process. For example, the time commitment, nature of the testing and reasons for the tests performed. 

The evaluation process takes on average 10 months to complete, requiring multiple visits to the transplant centre. The intended recipient’s health may deteriorate during this wait to the point they may no longer receive a transplant. “By improving the efficiency of the process, more living donor candidates could complete the evaluation and more transplants performed,” adds Dr. Garg. 

The study found a diverse set of quality indicators to measure the evaluation process, focusing on efficiency and safety to improve patient outcomes. They also identified a single measure tracking the costs of living donor evaluation from a health system perspective to assist with planning and budgeting. 

“This is an important first step towards system monitoring, benchmarking and accountability in living kidney donor evaluation,” explains Dr. Steven Habbous, co-lead investigator and PhD graduate with Lawson and Western’s Schulich School of Medicine & Dentistry. “In other areas of the health care system, there are reported metrics that hospitals and funders use to compare performance between similar hospitals and track changes over time. We need to measure what we value, and value what we measure.”

The team will present the data to the Canadian National Living Kidney Donation Advisory Committee to help develop national guidelines. Potential improvement strategies are to evaluate multiple living donor candidates concurrently for the same recipient or offer some aspects of the evaluation virtually.

The study was funded by the Can-SOLVE CKD Network, a Canada-wide initiative to enhance kidney disease research and care in partnership with patients. The Ontario-based team led by Dr. Garg is one of 18 Can-SOLVE CKD research groups across the country investigating issues such as earlier diagnosis, better treatments, and innovative care – all based on priorities identified by patients.

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Dr. Amit Garg, study co-lead investigator, Professor at Western’s Schulich School of Medicine & Dentistry, and Scientist at Lawson. Dr. Garg is also Director of the Living Kidney Donor Program at LHSC.

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Dr. Steven Habbous, study co-lead investigator and PhD graduate with Lawson and Western’s Schulich School of Medicine & Dentistry

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Marian Reich, study co-author, Patient Partner and living kidney donor

MONMOUTH JUNCTION, NJ USA and LONDON, ON, CANADA – Biotech Support Group and Lawson Health Research Institute announce a collaborative research agreement. The agreement supports further research to monitor protease inhibitor function acquired from blood collected from hospitalized patients with the SARS-CoV-2 (COVID-19) virus. The initial study will be reported as a poster at the upcoming American Society for Mass Spectrometry (ASMS) Conference, Oct. 31 – Nov. 4, 2021, in Philadelphia PA USA. The poster is entitled: “A Preliminary Investigation Using Targeted LC-MS Proteomic Methods Demonstrates Unique Serum Profiles of Hospitalized SARS-CoV-2 Patients. ”     

We describe how serine proteases are enzymes that irreversibly split and sever proteins, and thus play critical roles in many key biological processes including digestion, blood coagulation, and immunity. During stress or inflammation, many proteases are produced and discharged into the general circulation, while others are cell membrane-bound; the largest group being the Type II Transmembrane Serine Proteases (TTSPs). TTSPs play a critical cooperative role in the viral infectivity of coronaviruses, especially so now in the SARS-CoV-2 (COVID-19) pandemic.

With such viral infections, there comes an increased level of serine protease activity, due in part to both, an exuberant innate immune response to counter the infectious insult, and the added TTSP activity that derives from the virus load and propagation. As a result, current clinical practice cannot predict and monitor the protease overload triggered by SARS-CoV-2 (COVID-19) and similar infections, and with that, any possible severity, from thrombosis and other complications.

The purpose of this research agreement is to bring together complementary technologies, methods, and intellectual property towards the goals of:

• utilizing one or more proteomic patterns from Serpin subforms as biomarkers for precision or personalized medicine to clinically manage viral infections; and,

• developing new therapeutic strategies which can modulate serine proteases, for better clinical outcomes of hospitalized Covid-19 patients.

“This is a very exciting collaboration for us as it supports our efforts in sample prep on the product side, along with bolstering our biomarker intellectual property. This is because, for serum/plasma samples, small biological variances remain hard to measure robustly, mainly due to the presence of highly abundant proteins. For validating small differences established from discovery proteomics, it becomes critical to pair target peptides to sample prep methods to best quantify and establish differentiated profiles between disease and normal states. For this purpose, we will report on the beneficial use of AlbuSorb™ PLUS, to deplete Albumin & IgG in our upcoming ASMS poster, ” states Swapan Roy, Ph.D., President and Founder of Biotech Support Group.

“Based on our preliminary Serpin data profiles, we established differences between the three patient cohorts. This suggests the importance of considering Serpin functions as major players in both risk factors for infection, as well as progressiveness to severe disease. Now through this collaboration, we will investigate larger cohorts using the methods to measure functional Serpin features by LC-MS. Our joint goal is to have biomarkers to help personalize clinical decisions, and develop new anti-COVID-19 therapeutic strategies.” states Douglas Fraser, MD, Ph.D., Lawson Clinician Scientist.

“This very timely collaboration will help to further develop critically needed COVID-19 therapeutic approaches that are included as part of an extensive intellectual property portfolio related to Dr. Fraser’s work on COVID-19 diagnostics, outcome prediction and therapeutic approaches that we have filed over the past year,” states Kirk Brown, Lawson Manager, Business Development at WORLDiscoveries. 

Click here to learn more about how BSG’s Sample Prep Products have been used and cited for Discovery, Targeted and Clinical Proteomic applications. 

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LONDON, ON - As part of a randomized controlled trial, a team from Lawson Health Research Institute is the first in the world to treat a patient with COVID-19 using a modified dialysis device. The device gently removes a patient’s blood, modifies white blood cells and returns them to fight hyperinflammation. It is being tested with critically ill patients at London Health Sciences Centre (LHSC). 

Evidence suggests that COVID-19 causes a heightened immune response, termed a ‘cytokine storm,’ in the most severely ill patients. Treatment options to address this hyperinflammatory state are currently limited and there are concerns about global drug shortages. 

“Working in the intensive care unit (ICU), I was aware that more treatment options were needed in the fight against COVID-19,” says Dr. Chris McIntyre, lead researcher, Lawson Scientist and LHSC Nephrologist. “This led to the idea of treating a patient’s blood outside of the body. We could reprogram white blood cells associated with inflammation to alter the immune response.”

The research uses a modified version of a standard dialyzer called an extracorporeal leukocyte modifying device. It gently removes blood in a much slower circuit than standard dialysis. Through a process using specific levels of biochemical components, it targets and transforms white blood cells associated with inflammation before releasing them back into circulation. The hope is that these ‘reprogrammed’ cells will now fight hyperinflammation - rather than promoting it - in affected organs like the lungs.

The clinical trial will include up to 40 critically ill patients with COVID-19 at LHSC’s Victoria Hospital and University Hospital. Research participants will be randomized to receive either standard supportive care or standard supportive care in combination with this novel treatment. The research team will compare patient outcomes to determine if the treatment is effective.

“The ultimate goal is to improve patient survival and lessen their dependency on oxygen and ventilation,” explains Dr. McIntyre. “If effective, it’s possible that this treatment could be combined with other therapies. For example, this could be used to modulate inflammatory consequences while an antiviral drug is used to reduce the viral load.”

Led by Lawson’s Kidney Clinical Research Unit, this new trial was accelerated from initial conception to treatment of the first patient in only 40 days. It represents an important research collaboration with a multidisciplinary team. The trial is leveraging insights gained from another local study led by Dr. Douglas Fraser which is analyzing blood samples from COVID-19 patients at LHSC to better understand the cytokine storm.

“We’re identifying which cytokines or biomarkers are important to the hyperinflammatory response seen in COVID-19 patients,” says Dr. Fraser, Scientist at Lawson and Paediatric Critical Care Physician at LHSC. “With the knowledge we’re gaining, we can study a patient’s blood to determine whether this extracorporeal treatment is making a difference.”

If successful, the treatment also has potential to be used with other conditions like sepsis.

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This modified dialysis device gently removes a patient’s blood, 'reprograms' white blood cells and returns them to fight hyperinflammation.

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Dr. Chris McIntyre, Scientist at Lawson Health Research Institute, is the first in the world to treat a patient with COVID-19 using a modified dialysis device.

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LONDON, ON – Researchers at Lawson Health Research Institute are offering new hope to patients with treatment-resistant depression through participation in a national clinical trial. The study is the first randomized controlled trial to examine the efficacy of a new treatment called magnetic seizure therapy (MST) for patients with treatment-resistant depression as a result of bipolar disorder. 

Treatment-resistant depression is a severe form of depression that does not respond to traditional therapies like medication. It is particularly common in patients with depression from bipolar disorder who are left with limited treatment options. 

For years electroconvulsive therapy (ECT) has been the gold standard for patients with treatment-resistant depression. ECT uses an electric field to induce a seizure that provides a therapeutic benefit. But while ECT is effective, many patients opt out of treatment due to stigma surrounding the therapy and the potential for cognitive side effects like disorientation and amnesia. 

MST has emerged as a promising alternative. MST works in a similar way to ECT but uses a focused magnetic field as opposed to electricity. As a result, MST induces a more focused seizure to reduce the risk of cognitive side effects.

“Magnetic seizure therapy has already been shown as a promising treatment for major depressive disorder or unipolar depression,” explains Dr. Amer Burhan, local site lead, researcher at Lawson and neuropsychiatrist at St. Joseph’s Health Care London. “For the first time, we’re studying how effective the treatment is for depression as a result of bipolar disorder and whether it can reduce the risk of cognitive side effects associated with electroconvulsive therapy.”

The clinical trial is being led by the Centre for Addiction and Mental Health (CAMH) and will also be offered through Lawson and University of British Columbia (UBC) Hospital. Lawson researchers will invite eligible patients with treatment-resistant depression from bipolar disorder to participate in the trial at Parkwood Institute, a part of St. Joseph’s Health Care London.

Eligible patients will be randomized to receive either ECT or MST. Patients will be offered support throughout the study with the goal of improving patient outcomes in both groups. Patient outcomes will be compared to study the efficacy of MST and whether it is associated with reduced cognitive side effects.

MST will be delivered under anesthesia in 12 to 20 sessions. Sessions will last 10 to 15 minutes each with 60 to 90 minutes of recovery time.

“Magnetic seizure therapy holds promise of one day replacing electroconvulsive therapy as the gold standard for treatment-resistant depression,” says Dr. Burhan. If proven as a viable first-line treatment, MST would be very easy to implement in existing ECT clinics. MST would therefore be readily available to patients in need.

“We are on the leading edge of the field of brain stimulation for treatment-resistant depression in collaboration with CAMH and UBC,” says Dr. Burhan. “Our goal is to continue informing the care process through clinically-relevant research that serves patients, medical professionals and the public.”

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LONDON, ON – A study led by researchers at Lawson Health Research Institute (Lawson) provides clinical validation of EpiSign, a molecular genomics test that diagnoses rare, heritable neurodevelopmental conditions.

Invented at Lawson by Dr. Bekim Sadikovic, the diagnostic test uses machine learning to analyze the EpiSign Knowledge Database. This database compiles information on rare genetic diseases using laboratory analyses of the epigenome from patients with suspected genetic abnormalities. The epigenome is a process that can change the expression of a gene without changing the gene sequence.

“Using 211 blood samples, we measured test performance and diagnostic yield in 207 subjects from two different cohorts,” explains Dr. Sadikovic, lead researcher at Lawson and Scientific and Clinical Director of the Verspeeten Clinical Genome Centre at London Health Sciences Centre (LHSC). The targeted cohort were subjects with previous genetic findings that were ambiguous or inconclusive. The screening cohort were those with clinical findings consistent with hereditary neurodevelopment syndromes but with no previous genetic findings.

“Of the 207 subjects tested, 57 were positive for a diagnostic episignature including 48 in the targeted cohort, and 8 in the screening cohort. Only four remained inconclusive after EpiSign analysis,” says Dr. Sadikovic. “This gives us strong evidence for the clinical use of EpiSign, as well as the ability to provide conclusive findings in the majority of subjects tested.”

While currently there are limited treatment options associated with many of these conditions,

providing a diagnosis can help physicians better predict the course of the disease, and allows for better planning and support for the patient. EpiSign is the only test in the world that has been clinically validated for testing these kinds of genetic disorders.

“Patients with rare diseases often wait years and undergo numerous exams and tests before receiving a correct diagnosis, if one is found at all,” says Matthew Tedder, PhD, staff scientist at the Greenwood Genetic Center, one of the EpiSign clinical testing laboratories. “EpiSign provides an additional high-yield diagnostic tool for clinicians to include in their evaluation of patients with undiagnosed diseases, providing better medical management for patients and hope for their families.”

The study, “Clinical epigenomics: genome-wide DNA methylation analysis for the diagnosis of Mendelian disorders", is published in February’s Genetics in Medicine and was completed in collaboration with the Greenwood Genetic Center and the University of Amsterdam.

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LONDON, ON – A new study from ICES, Lawson Health Research Institute and Western University suggests that injection drug users prescribed controlled-release hydromorphone are three times more likely to develop endocarditis, a serious bacterial heart infection, when compared to those prescribed other opioids. The findings, published today in The Lancet Infectious Diseases, build on growing evidence that some controlled-release opioids may lead to higher risk of infectious disease among persons who inject drugs. 

The researchers looked at de-identified Ontario health data for hospital admissions related to injection drug use between 2006 and 2015. Of 60,529 admissions, 733 patients had infective endocarditis. The team found that regions with high hydromorphone prescription rates had more than double the cases of infective endocarditis (254 cases) when compared to regions with low prescription rates (113 cases).

The study also analyzed individual prescription records and found that among persons who inject drugs, those prescribed controlled-release hydromorphone were three times more likely to develop infective endocarditis when compared to those prescribed any other opioid. There was no increased risk for those prescribed the immediate-release form of hydromorphone.

“Added to the existing data, these findings make a compelling argument for the role of controlled-release hydromorphone in the growing risk of infective endocarditis among persons who inject drugs,” says Dr. Matthew Weir, Adjunct Scientist at ICES, Associate Scientist at Lawson and Assistant Professor at Western’s Schulich School of Medicine & Dentistry. 

Opioids are often manufactured as controlled-release or ‘slow-release’ capsules to prevent rapid absorption of the drug. Properties in the capsules help to spread pain relief over a longer period of time.

This is the latest in a series of studies from the research team that suggest some controlled-release opioids may be leading to increased risk of infectious disease among persons who inject drugs. 

In one study, they demonstrated that polymer-coated beads used to provide the slow-release property make controlled-release hydromorphone difficult to dissolve. They found equipment used to dissolve the drug retains up to 45 per cent of the initial dose, leading injection drugs users to save and reuse equipment.

With frequent re-handling of equipment, there are multiple opportunities for bacterial and viral contamination. The team found that HIV and a dangerous bacterium called Staphylococcus aureus are more likely to survive in equipment used to prepare controlled-release hydromorphone since added chemicals that make the drug slow-release promote survival of bacteria and viruses. 

“There’s been a global increase in infectious diseases among persons who inject drugs and our research suggests that controlled-release prescription opioids may be a major culprit,” says Dr. Michael Silverman, Associate Scientist at Lawson and Associate Professor at Schulich Medicine & Dentistry. “We now have evidence that suggests the injection of controlled-release hydromorphone is increasing the spread of HIV, hepatitis C and endocarditis in Canada.” 

The team believes these findings could also explain the increase in infectious complications in the USA and other countries where controlled-release hydromorphone is not on the market.  There are other controlled-release opioids, such as controlled-release morphine, that use a similar slow-release mechanism and may carry similar risks.

“It’s important that people are aware of the infectious risks of injecting opioids and, if necessary, practice harm reduction techniques,” says Dr. Silverman. “We’ve found you can use a cigarette lighter to destroy bacteria and viruses by heating the cooker used to prepare the drug for about 10 seconds or until the mixture bubbles. We’ve termed the technique ‘cook your wash.’” 

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Equipment used by persons who inject drugs

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Cooker with lighter (demonstrating the ‘Cook your wash’ technique)

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Dr. Michael Silverman

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Dr. Matthew Weir

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LONDON, ON – Researchers at Lawson Health Research Institute (Lawson) developed and tested an artificial neural network for diagnosing COVID-19. The AI system was trained to learn and recognize patterns in ultrasound lung scans of patients with confirmed COVID-19 infection at London Health Sciences Centre (LHSC) and compared them to ultrasound scans of patients with other types of lung diseases and infections. 

“The AI tool that we developed can detect patterns that humans cannot. Lung ultrasound scans of patients with COVID-19, as well as other lung diseases, produce a highly abnormal imaging pattern, but it is almost impossible for a physician to tell apart different types of infections by looking at these images. There are details, however, that distinguish COVID-19 at the pixel level that cannot be perceived by the human eye,” explains Dr. Robert Arntfield, Lawson Researcher and Medical Director of the Critical Care Trauma Centre at LHSC.

“The neural network was able to identify the unique characteristics among different scans, and exceed human-level diagnostic specificity. Our study of over 100,000 ultrasound images showed that while trained physicians could – as expected - not distinguish between different causes of lung disease, the AI had nearly perfect accuracy in making the diagnosis.  It’s almost like the AI sees a QR code that we cannot see, unique to the disease.”

LHSC is a global leader in the use of point-of-care ultrasound. It has become an important tool for the diagnosis and care of critically ill patients experiencing acute respiratory failure. The convenience, portability and low cost of using these machines makes them ideally suited for pandemic conditions.

This study is part of a collaborative effort by a small group of local clinicians driven to innovate and create technology that solves complicated problems with AI. “There are a lot of brilliant minds in our city, and I’m very proud that we were able to rapidly pull together a local team to design, develop and test a complex idea,” says Dr. Arntfield. “We are already expanding on these findings with more research.” Lawson has recently approved Dr. Arntfield’s “Project Deep Breathe” which aims to go beyond COVID-19 and explore multiple conditions where lung ultrasound and AI can be paired together.

The study, “Development of a convolutional neural network to differentiate among the etiology of similar appearing pathological B lines on lung ultrasound: a deep learning study”, is published in BMJ Open. 

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London, Ontario - Gulf War technology is making it possible for researchers to detect prostate cancer with a single drop of blood.

Hon Leong, PhD, assistant professor at Western University’s Schulich School of Medicine and Dentistry and scientist at Lawson Health Research Institute, and his team have repurposed a machine once used to detect airborne pathogens in the second Gulf War. The machine is now used for fluid biopsies – a non-invasive way to detect prostate microparticles in the blood in a matter of minutes. Microparticles are essentially garbage released by prostate cells that circulate throughout the bloodstream.

Most men who are more than 40 years old, regardless of their health, have detectable levels of prostate microparticles in their bloodstream. Leong’s research is the first clinical cancer research project to correlate the number of microparticles in the blood to the risk of having prostate cancer – the more microparticles, the higher the risk.

Used in the Gulf War, and more commonly to test water purity, the machine uses flow cytometry to detect microparticles. Flow cytometry measures the specific characteristics of a fluid, such as blood, as it passes through a laser.

Leong’s research provides a more accurate and less invasive testing method for patients suspected of having prostate cancer, and helps to identify patients who are at a higher risk of dying from prostate cancer.

Current methods of detecting prostate cancer, such as the prostate-specific antigen (PSA) test and biopsies, have limitations. PSA tests are based on measuring a specific protein released by the prostate gland, but do not provide a definitive diagnosis. A physical exam and biopsy are needed if PSA levels are elevated. However, even the painful biopsy procedure has a 15 per cent error rate. During biopsies, a painful and invasive procedure, 12 needles are inserted into the rectum, with the hope of extracting material from an area with a tumour.

“Our findings point to a new direction in how we can better identify patients who actually have prostate cancer,” said Leong. “With this test, we can improve the clinical outcomes for patients, reducing costs for unnecessary procedures and reducing errors in diagnosis.”

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LONDON, ON – A team of researchers at Lawson Health Research Institute is investigating whether an artificial neural network could be used to diagnose COVID-19. The AI system is being trained to learn and recognize patterns in ultrasound lung scans of patients with confirmed COVID-19 at London Health Sciences Centre (LHSC) by comparing them to ultrasound scans of patients with other types of lung infections.

“Machines are able to find patterns that humans cannot see or even imagine. Lung ultrasound scans of patients with COVID-19 pneumonia produce a highly abnormal imaging pattern.  This pattern isn’t unique to COVID-19, and can be seen in other causes of pneumonia.  It is plausible, however, that there are details that distinguish COVID-19 at the pixel level that cannot be perceived by the human eye,” explains Dr. Robert Arntfield, Lawson Researcher and Medical Director of the Critical Care Trauma Centre at LHSC. “If we can train a neural network to learn and identify these unique characteristics among different scans, we can apply this AI to enhance the diagnostic power of portable ultrasound.”

Point-of-care ultrasound has become increasingly important for the care of critically ill patients and LHSC is a global leader in the use of this technology at the bedside. Lung ultrasound has proven to be effective in diagnosing different types of lung infections and illnesses, such as pneumonia, with a high degree of accuracy. The convenience, portability and low cost of using these machines has helped them become a standard bedside tool in emergency departments and intensive care units worldwide.

This research project is part of a grassroots effort by a small group of local clinicians to innovate and create technology to solve sophisticated problems with AI. With many of Dr. Arntfield’s team having a background in computer programming, they were able to code the neural network being tested. Minimal funding was required, with the project being driven largely by the urgency of COVID-19 coinciding with the recent creation of this clinical AI working group.

“Our research team has used AI to help improve diagnostics related to other parts of the body. This project is a great example of the unique ability we have here in London to be agile: that is, to identify a gap and move quickly towards finding a solution,” says Dr. Arntfield. “I am thrilled that we were able to move through the approval process quickly, and get our ideas working in such a short amount of time.”

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Dr. Robert Arntfield

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COVID-19 pneumonia ultrasound

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NON COVID-19 pneumonia ultrasound
 

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LONDON, ON - Patients in Ontario with chronic kidney conditions who require dialysis have a significantly increased likelihood of contracting and dying from COVID-19, new research from Western University and Lawson Health Research Institute has shown. Study author Dr. Peter Blake says the research emphasizes the need to prioritize dialysis patients for vaccination. 

Published in CMAJ, the study shows that of the more than 12,000 patients undergoing long-term dialysis in Ontario, 187 patients became infected with SARS-CoV-2 between March and August 2020. Of the patients who were infected, 60 per cent needed to be hospitalized and nearly 30 per cent died. That’s almost four times the mortality rate from COVID-19 than the general population.

The researchers continued to collect data into the second wave of the pandemic, and report that as of the end of January 2021, a further 424 dialysis patients were diagnosed with COVID-19, equivalent to 4.5 per cent of all dialysis patients in the province, and that 130 have now died. 

“Early reports from Wuhan and Milan showed chronic dialysis patients were vulnerable to COVID-19, and that’s why we decided to undertake this study,” said Dr. Blake, Professor at Western’s Schulich School of Medicine & Dentistry and Associate Scientist at Lawson. “We were surprised to see that both the mortality rate and hospitalization rate were so high here in Ontario.”

The researchers also found that patients who regularly underwent dialysis at the hospital, rather than at home, were at far greater risk of COVID-19 infection; and point out that only a quarter of dialysis patients in Ontario currently have at-home dialysis.

“As the pandemic proceeds, focused efforts should be made to protect this vulnerable group of individuals from infection,” said Dr. Blake. “We also encourage patients to take at-home dialysis whenever possible to reduce the risk of exposure to COVID-19.” 

The data for the study was collected by the Ontario Renal Network, which developed a weekly surveillance data collection tool to gather key information about chronic dialysis patients during the pandemic.

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LONDON, ON - Canadian researchers are the first to study how different patterns in the way older adults walk could more accurately diagnose different types of dementia and identify Alzheimer’s disease.  

A new study by a Canadian research team, led by London researchers from Lawson Health Research Institute and Western University, evaluated the walking patterns and brain function of 500 participants currently enrolled in clinical trials. Their findings are published today in Alzheimer's & Dementia: The Journal of the Alzheimer's Association. 

“We have longstanding evidence showing that cognitive problems, such as poor memory and executive dysfunction, can be predictors of dementia. Now, we’re seeing that motor performance, specifically the way you walk, can help diagnose different types of neurodegenerative conditions,” says Dr. Manuel Montero-Odasso, Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry.  

Dr. Montero-Odasso is world renowned for his research on the relationship between mobility and cognitive decline in aging. Leading the Mobility, Exercise and Cognition (MEC) team in London, he is pioneering novel diagnostic approaches and treatments to prevent and combat early dementia.  

This study compared gait impairments across the cognitive spectrum, including people with Subjective Cognitive Impairment, Parkinson’s Disease, Mild Cognitive Impairment, Alzheimer’s disease, Lewy body dementia and Frontotemporal dementia, as well as cognitively healthy controls.  

Four independent gait patterns were identified: rhythm, pace, variability and postural control. Only high gait variability was associated with lower cognitive performance and it identified Alzheimer’s disease with 70 per cent accuracy. Gait variability means the stride-to-stride fluctuations in distance and timing that happen when we walk.  

“This is the first strong evidence showing that gait variability is an important marker for processes happening in areas of the brain that are linked to both cognitive impairment and motor control,” notes Dr. Frederico Perruccini-Faria, Research Assistant at Lawson and Postdoctoral Associate at Western’s Schulich School of Medicine & Dentistry, who is first author on the paper. “We’ve shown that high gait variability as a marker of this cognitive-cortical dysfunction can reliably identify Alzheimer’s disease compared to other neurodegenerative disorders.”  

When cognitive-cortical dysfunction is happening, the person’s ability to perform multiple tasks at the same time is impacted, such as talking while walking or chopping vegetables while chatting with family.  

Having gait variability as a motor marker for cognitive decline and different types of conditions could allow for gait assessment to be used as a clinical test, for example having patients use wearable technology. “We see gait variability being similar to an arrhythmia. Health care providers could measure it with patients in the clinic, similar to how we assess heart rhythm with electrocardiograms,” adds Dr. Montero-Odasso.  

This study was primarily funded by the Canadian Consortium on Neurodegeneration in Aging (CCNA), a collaborative research program tackling the challenge of dementia and other neurodegenerative illnesses. The CCNA was supported by a grant from the Canadian Institutes of Health Research 

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LONDON, ONTARIO - A research study from the Cardiac Arrythmia Network of Canada (CANet) and Lawson Health Research Institute is testing the use of a new online patient care platform designed to help track symptoms for COVID-19 positive patients.  

Patients are now being enrolled in the study from the Urgent COVID-19 Care Clinic at London Health Sciences Centre. This virtual clinic helps identify, triage, monitor and manage potential complications for people recovering from COVID-19 at home. Patients can self-monitor their health with ongoing access to virtual physician support. 

The COVID-19 Virtual Care at Home research study is testing the use of VIRTUES (Virtual Integrated Reliable Transformative User-Driven E-health System), a virtual, patient-centred platform created by CANet to help guide COVID-19 positive patients in managing their illness. They will have remote access to a team of health care providers including those specialized in the fields of cardiology, emergency medicine, internal medicine, infectious disease, neurology and respirology. 

“Using VIRTUES, the care team can monitor a range of symptoms remotely that tells us a lot about how the patient is doing. In addition to tracking their temperature, we are using a home-based pulse oximeter to measure pulse rate and oxygen saturation,” says project co-lead Dr. Marko Mrkobrada, LHSC physician and Lawson Associate Scientist.

As symptoms are logged and tracked, there are alerts for communication between the patient and members of the care team. They can react quickly if additional care is needed such as a visit to the doctor’s office or hospital. 

“The COVID-19 pandemic has highlighted the need for effective virtual health care,” says Dr. Anthony Tang, CANet CEO and Scientific Director. “Technology solutions support this care by giving both patients and health care providers fast and accurate access to critical information about symptom progression.” 

As a made-in-Canada solution, CANet partnered with Clearbridge Mobile, an application development company in Toronto, to adapt an existing virtual care platform. “We responded quickly to provide a way for health care providers to remotely monitor, triage and manage care for patients with COVID-19, and help identify early on those who are at higher risk of complications,” adds Dr. Tang. Before the pandemic, VIRTUES was used for remote monitoring and care for patients with implantable cardiac defibrillators and pacemakers. 

“We want to learn more about making health care technology user-friendly. Patients will have more information about their care and hopefully will experience reduced anxiety,” explains project co-lead Dr. Erin Spicer, LHSC physician and Lawson Associate Scientist. “While the majority of COVID-19 cases don’t require hospitalization, this system allows us to more closely monitor a patient’s progress and make informed decisions if their symptoms worsen.” 

This research project highlights the importance of collaborative effort. Most importantly, with patient partners' active participation in helping design the VIRTUES platform and this research project. Along with CANet’s investment to adapt the VIRTUES platform for this project, the Department of Medicine at Western University’s Schulich School of Medicine & Dentistry has provided active support with many sub-specialists and investments from the Centre of Quality, Innovation and Safety (CQuinS) program.

“I am proud to be associated with this vital initiative. This research project will be comforting for patients contracted with COVID-19, providing reassurance that they are cared for by experts and monitored with technology advancement.” Dr. James Calvin, citywide Chair/Chief of Medicine.

The research team explains that these types of remote care systems may be able to play an important role in stemming the spread of the virus, while providing high-quality, accessible care using fewer resources. It also provides a means of rapid and accurate tracking of case recovery. 

“We want to keep people safe. Following evaluation of VIRTUES here in London, we hope to see it implemented across the province and beyond. Patients have access to enhanced care while being able to hopefully stay in their homes during their recovery, helping to decrease exposure of COVID-19 in the community and for frontline health care workers,” adds Dr. Tang.  

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LONDON, ON - A team from Lawson Health Research Institute will examine the unique personal and professional impacts of the COVID-19 pandemic on frontline hospital workers in Southwestern Ontario. The region’s frontline hospital workers are invited to participate in an online survey to share their experiences during the public health emergency. The goal is to understand impacts unique to our region in order to develop strategies that address the needs of hospital workers. 

“It’s crucial to understand the impact of this pandemic on frontline hospital workers who often face difficult decisions, including risking personal safety to care for patients and the community,” explains Dr. Kimia Honarmand, Lawson Adjunct Scientist and Critical Care Physician at London Health Sciences Centre (LHSC). “Experiences are likely to vary across the province and country based on local circumstances. It’s important we hear the unique perspectives of those in our region.”

The team will recruit health care professionals from hospitals across Southwestern Ontario. Participants will be asked to complete one short survey with questions about their perceptions, causes of stress and coping strategies during the pandemic. The team hopes results can be used to identify strategies that address informational, training and support needs.

In addition to worries about personal safety, the team notes that frontline workers are faced with concerns about rapidly evolving information, patient surges and depletion of resources like ventilators and personal protective equipment (PPE). They suspect social media may play a role in compounding these fears. 

“Compared with past outbreaks like SARS, today’s digital age provides a wealth of on-demand information and the majority is unverified,” says Dr. Honarmand. “While social media can be a place of solidarity and connection, it can also contribute to the spread of misinformation and fear.”

The researchers also suspect that public health measures like physical distancing, while crucial to controlling the spread of disease, may contribute to a loss of social support systems. 

“Taken together, these challenges can lead to stress, anxiety and burnout,” says Carol Young-Ritchie, Executive Vice President, Chief Nursing Officer and Pandemic Incident Management Team Co-Lead at LHSC. “Hearing directly from those on the frontline can help guide hospital administrators and professional organizations in better supporting our people, both during the current pandemic and in future public health emergencies.”

Frontline hospital workers in Southwestern Ontario can learn more and access the survey at https://redcap.lawsonresearch.ca/surveys/?s=E9KKL3CXYE. 

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As the COVID-19 pandemic continues, data is showing that while illness and mortality occur across the lifespan, the death rate increases significantly for those over 65 years of age.

Dr. Manuel Montero-Odasso, Professor at Western University’s Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute is the co-chair of the Canadian Geriatrics Society COVID-19 Working Group. He is available to media for comment on the allocation of health care resources for older adults, and also on recommendations specific to this population to help prevent transmission.

“Particularly for older adults, they need to know that they are the most vulnerable but that there is no need to panic. They should follow evidence-based recommendations if they become sick. Importantly, we also stress the role of caregivers and family members, and we have specific recommendations for them on how to connect with their loved ones,” he said.

Dr. Montero-Odasso has also co-authored a position statement on behalf of the Canadian Geriatrics Society arguing that it is not acceptable to ration critical care admission or life-saving ventilation solely on the basis of age, as has been seen in other epicentres of COVID-19 when health care resource become scarce. They point out that while an established body of evidence supports that mechanical ventilation would likely be futile in some frail older adults with multiple comorbidities, there is a critical ethical difference between decisions made on the basis of futility versus those based on age alone.

“It is a concern not only because of ageism, but because it’s important to understand that age is not the only variable. It is also key to understand previous wishes of patients. You could have a 30-year-old with a chronic neurodegenerative condition who doesn’t want to be intubated and also an 80-year-old who has a high functionality and quality-of-life who does want to use all means possible to survive,” he said. “Age itself should not be the main driver of these decisions; important variables include previous functional capabilities, and levels of frailty. There needs to be a very thoughtful and thorough evaluation.”

Dr. Montero-Odasso says one example of how the COVID-19 Working Group has been involved in policy decisions is related to feedback on the Ontario Health Association Clinical Triage Protocol for Major Surge in COVID Pandemic.

“This important Ontario document does not use age alone in their recommendations and, moreover, it recommends to use proper geriatric tools, such as the Clinical Frailty Scale, in their triage algorithms to guide resources allocation,” he said.

Since COVID-19 was declared a pandemic, the first evidence that emerged was that the older adult population was being hit the hardest. As part of the Canadian Geriatrics Society COVID-19 Working Group, Dr. Montero-Odasso and colleagues have  created resources and recommendations such as global recommendations for older adults, evidence-based position statements on ageism and healthcare resource utilization, and how to support health care workers on the front lines, such as the doctors and nurses in healthcare facilities.

Commentary reflects the perspective and scholarly interest of Western faculty members and is not an articulation of official university policy on issues being addressed.

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LONDON, ON – Children with epilepsy have a higher risk of developing emotional and behavioural disorders, including depression, anxiety and poor self-esteem, yet it has been difficult for researchers to pinpoint why this occurs. In a new study, researchers at Children’s Health Research Institute (CHRI), a program of Lawson Health Research Institute, have found that family environment influences the relationship between clinical characteristics of epilepsy at diagnosis and children's emotional well-being two years later.

Emotional well-being is a broad measure of emotional functioning that includes multiple aspects of mental health, such as depression, anxiety, anger, happiness, or confidence. The researchers studied a group of children aged four to 12 with new-onset epilepsy, investigating factors at the time of diagnosis and their impact on the emotional well-being of the children two years later. The study focused on the role of the family environment, an area that has not been well-studied.

Results showed that clinical factors related directly to the children’s epilepsy, such as the type of epilepsy and frequency of seizures, were not associated with emotional well-being. Instead, several family characteristics, including family stresses, functioning and resources, were strongly associated with emotional well-being.

“This is important for how we think about patient care,” says Dr. Kathy Speechley, principal investigator on the study, Chair of the Children’s Health & Therapeutics Division at CHRI and a professor at Western University’s Schulich School of Medicine & Dentistry. “Treating the physical symptoms of chronic disease alone often does not result in significant improvements in quality of life. We need to examine other avenues for care.”

“From the time of diagnosis forward, it’s important for the health care team to take a broader, family-centred approach beyond controlling a child’s seizures. This means developing a better understanding of what day-to-day life is like for families living with childhood epilepsy, including their stressors, how well they are functioning and the resources they have to aid their adaptation to stressful life events,” says Dr. Shane Goodwin, first author on the study, which was conducted while he was a PhD candidate in the Department of Epidemiology & Biostatistics at Schulich Medicine & Dentistry and a trainee at CHRI. He is currently a postdoctoral fellow at the University of Waterloo.

One example of a family-centered approach to care the researchers point to is referring patients and their families to support programs, such as Clinic to Community in Southwestern Ontario. The Clinic to Community program is funded by the Ontario Brain Institute, and provides information about epilepsy and a network of support services.

The researchers completed the study using data from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES), a multicenter prospective cohort study based in Children’s Hospital at London Health Sciences Centre.

They will now continue to analyze data from the same group of patients as they progress toward adulthood and will develop intervention trials aimed at supporting families’ successful adaptation to life with epilepsy.

The study received funding from the Canadian Institutes of Health Research and the Children’s Health Foundation.

Drs. Kathy Speechley and Shane Goodwin will be available for interviews and photos on Wednesday, January 24 between 1:30 p.m. and 5:00 p.m. 

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LONDON, ON – A new study from Lawson Health Research Institute and Western University suggests that fecal transplants could be used as a treatment for non-alcoholic fatty liver disease (NAFLD). The randomized controlled trial published in The American Journal of Gastroenterology found that fecal transplants in patients with NAFLD result in a reduction in how easily pathogens and other unwanted molecules pass through the human gut and into circulation, known as intestinal permeability. The results could have implications for the treatment of numerous conditions including metabolic syndrome and autoimmune diseases. 

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“Intestinal permeability plays a role in the development of metabolic syndrome which is a major cause of coronary and cerebrovascular disease. It has also been associated with autoimmune diseases like multiple sclerosis (MS), rheumatoid arthritis, systemic lupus and type 1 diabetes,” explains Dr. Michael Silverman, Associate Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry.

Many NAFLD patients have increased intestinal permeability which triggers inflammation, increased fat in the liver, insulin resistance and elevated levels of triglycerides in the blood. The human microbiome – the diverse collection of microbes in our body – is thought to play a role. Previous studies have shown differences between the gut microbiome of NAFLD patients compared to healthy individuals. 

“Our team wondered whether we could change the gut microbiome of NAFLD patients to reduce intestinal permeability,” says Dr. Jeremy Burton, Lawson Scientist and Associate Professor at Schulich Medicine & Dentistry.

The trial included 21 NAFLD patients from London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London. Patients were randomized to receive a fecal transplant using stool from a healthy donor or a placebo (the patient’s own stool). Fecal material was delivered to the small intestine using endoscopy. Patients were followed for six months to assess changes to their gut microbiome, intestinal permeability, percentage of liver fat and insulin resistance. 

While the researchers found no changes in percentage of liver fat or insulin resistance, they observed significant reduction in intestinal permeability in those patients who had elevated intestinal permeability at the study’s start (seven patients in total). They also observed changes to the gut microbiome in all patients who received a fecal transplant from a healthy donor. 

“Our study demonstrates that intestinal permeability can be improved through fecal transplant from a healthy donor,” says Dr. Laura Craven, a recent PhD graduate from Schulich Medicine & Dentistry and first author on the published study. “This suggests that fecal transplant could be used as an early intervention in the treatment of NAFLD to reduce intestinal permeability and prevent inflammation”

“Our findings have implications for other conditions too,” adds Dr. Silverman, who is also Chair/Chief of Infectious Diseases at Western, LHSC and St. Joseph’s. “Changing the gut microbiome could hold promise in preventing and treating metabolic syndrome and autoimmune diseases associated with increased gut permeability.”

The team hopes to next conduct a large multi-centre trial to further investigate FMT as an intervention for NAFLD and as a therapy to reduce intestinal permeability. 

NAFLD is an obesity-related disorder and is the second-leading cause of liver transplant in North America. While reversible if treated early, its progression can lead to liver failure or cancer. Current therapies are not overly effective and the prevalence of NAFLD is increasing. 

Dr. Silverman is a pioneer in the field of fecal transplants, including their use as a treatment for Clostridioides difficile (C. diff). He is involved in multiple studies examining the potential of fecal transplants as treatments or supportive therapies for numerous conditions including multiple sclerosis (MS) and different types of cancer.

“In order to conduct this research, we need stool donors,” notes Dr. Silverman. “By donating your poop, you can help us assess the value of fecal transplants to treat a variety of diseases.”

The team is in need of young, healthy stool donors for fecal transplants. All donors are required to go through a screening process. Those interested in becoming a stool donor can contact Dr. Seema Nair Parvathy, Research Coordinator, Fecal Transplant Program, at 519-646-6100 ext. 61726.

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Stool samples being prepared in the lab.

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Dr. Michael Silverman (left) and Dr. Jeremy Burton (right)

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Dr. Laura Craven

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