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Researchers are testing whether a specialized form of imaging can help in stroke rehab.

A new study aims to assess the use of functional near-infrared spectroscopy (fNIRS), a type of imaging, to provide neurofeedback during stroke rehabilitation with a goal of eventually improving patient outcomes.

fNIRS is used to detect changes in brain oxygen levels using light. More recently it has also been used to develop brain-computer interfaces (BCIs), which allow patients with brain injuries to control devices like robotic arms with their thoughts.

Dr. Sue Peters, a Scientist at Lawson Health Research Institute and Director of the Neurorehabilitation Physiology Lab at St. Joseph Health Care London’s Parkwood Institute, was one of the recipients of the Spring 2022 Lawson Internal Research Fund (IRF) Awards. 

The funds will go towards a new study to assess whether fNIRS can be used to direct neurofeedback in stroke survivors – helping them with rehabilitation.

“Currently, there's no real measure of brain activity that is used in stroke rehabilitation to help make clinical decisions,” says Dr. Peters, who is also a Professor at Western University.

Over 400,000 Canadians live with the effects of a stroke, according to the Heart and Stroke Foundation, and there’s hope that fNIRS could make a big difference by eventually improving movement and independence.

“We're going to use the device in some common tasks that people might do with their arm and determine whether we can use this device reliably and accurately in a stroke-related context,” Dr. Peters explains. 

Participants in the study will imagine moving while remaining still. This activates very similar parts of the brain to when people actually move. If done correctly, patients will see a visual cue generated through measurement using fNIRS.

“We know from MRI studies that when I move my right hand, the left side of my brain is activated,” notes Dr. Peters. “We think we can use this concept in stroke rehab.”

Dr. Peters is recruiting 40 people from the community who are at least six months post stroke and 40 healthy adults of all ages. They will first participate in motor assessment with a physiotherapist and then wear an fNIRS cap while thinking about moving their wrist to measure brain activity.

Previously, there were a lack of methods to image the brain during real-life movement.

“The hope is to eventually conduct a clinical trial where we're testing motor interventions to see whether some things are more effective than others at activating the regions of the brain that were impacted by the stroke.”

Dr. Peters believes the study has the potential to have a big impact on the future of rehabilitation for stroke patients, leading to lasting changes in quality of life.

In a world first, scientists at Lawson Research Institute are leveraging imaging technology to see and track microbes and provide an unprecedented glimpse of the human microbiome.  

Within each of us is a world populated by a bustling metropolis of microorganisms – a tapestry of trillions in a delicate dance to balance health, well-being and vitality.  

Far outnumbering human cells, this dynamic ecosystem of busy bacteria, industrious fungi and elusive viruses is the body’s microbiome. This invisible hive of ceaseless activity is so intrinsic to human health, its explorers say it should perhaps be considered an organ in its own right.

Now, in a world first, Lawson Health Research scientists studying this microcosmic underworld are making the invisible visible – in real time.

The team of Jeremy Burton, PhD, Research Chair of Human Microbiome and Probiotics and Director of the Canadian Centre for Human Microbiome and Probiotic Research at St. Joseph’s Health Care London (St. Joseph’s), is using imaging technology to see and track microbes, providing a perspective never before achieved. 

“Typically, we track microbes by analyzing samples from patients after treatment to improve their gut health with probiotics or microbiota transplantation (FMT),” explains Burton, whose endowed research chair is funded through St. Joseph’s Health Care Foundation. “While we can get detailed information through DNA sequencing techniques, this often takes many months and relies on collecting fecal samples and other samples that may not be easily obtained. It also doesn’t provide all the information we need, like exactly where the microbes have travelled and how long they live.”

'Fantastic insight'

Imaging the microbes allows the Lawson team “to see things in real-time and not worry about clinical samples,” he adds.

Donna Goldhawk, PhD, molecular imaging scientist with Lawson’s Imaging Research Program, explains that imaging is done by attaching a radioactive tracer to cells, such as bacteria, that can be ingested and visualized in the body with positron emission tomography-magnetic resonance imaging (PET/MRI).

Imagine it as a biological version of an AirTag that tracks specific microbes.

“Lawson's environment has been a catalyst for new ideas, collaborations and many Canadian firsts.” - Michael Kovacs, Program Lead, Lawson’s Imaging Research Program, and Lead, Cyclotron & PET Radiochemistry Facility

“It’s through this pipeline that we gain fantastic insight into how the microbiome supports human health,” she says.  

As an example, tracking microbes allows the scientists to see if they are close to or crossing over the gut cell wall.  

“This is critical information because the proximity of microbes to the cell wall will likely determine if the probiotic or FMT therapy is effective or not,” says Burton. “We can now potentially track microbes that we administer to people in real-time and, in the future, be able to tell how sick people are and if they have a dysfunctional microbiota. Eventually, this information will be linked to their other health information for a complete picture.”

Uniquely St. Joseph’s

He notes the work “could only happen here” at St. Joseph’s, with its leading-edge imaging, production of novel tracers (isotopes) within Lawson’s Cyclotron & PET Radiochemistry Facility, and with world-class collaborative expertise – all fueled by the generosity of donors.

Working with Burton and Goldhawk are Lawson scientists, Michael Kovacs, PhD, Frank Prato, PhD, Dr. Michael Silverman, Seema Nair Parvathy, PhD, and Neil Gelman, PhD.

“This exciting work illustrates how innovative technologies can emerge when diverse groups collaborate closely in a multi-disciplinary approach to research within a hospital setting,” says Michael Kovacs, Program Lead, Lawson’s Imaging Research Program, and Lead, Cyclotron & PET Radiochemistry Facility. “Lawson's environment has been a catalyst for new ideas, collaborations and many Canadian firsts.”

The potential impact cannot be over-stated, adds Burton.

“This is the pathway to revolutionizing the way we understand the microbiome in people,” he says. “We’ve spent so long trying to eradicate microbes and studying the ones that cause ill health. Only relatively recently have we begun to study the ones that cause good health. That’s a dramatic shift in approach and, while we’ve come a long way, we’re really only getting started.” 

For the first time since 2019, Lawson Health Research Institute hosted its annual Lawson Impact Awards in-person on November 28 at RBC Place London. Approximately 130 people gathered to celebrate scientists, staff members, learners and partners who have made remarkable contributions to hospital-based research at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London (St. Joseph’s).

“Important and groundbreaking science is conducted daily at Lawson, improving patient care locally and around the globe,” says Dr. David Hill, Scientific Director at Lawson. “The Lawson Impact Awards provides an opportunity for us to recognize the scientists, staff members, learners and partners who drive medical research forward.”

Eight Lawson Impact Award recipients were celebrated at the event, including:

• Leadership Award for Fellows & Students: Dr. John Tran
• Staff Award of Excellence: Alexandria Roa Agudelo
• Community Partner of the Year Award: Keith and Leanne Lavergne
• Community Partner of the Year Award: Jack and Jean Wettlaufer Family
• Community Partner of the Year Award: Ryan Finch
• Dr. Joseph Gilbert Research Contribution of The Year Award: Dr. David Palma for “Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial”
• Innovation Award: Dr. Manuel Montero-Odasso
• Scientist of The Year Award: Dr. Cheryl Forchuk

Two Children’s Health Research Institute (CHRI) award recipients were also recognized. As a program of Lawson, CHRI awards a Scientist and Trainee of the Year annually, sponsored by the Children’s Health Foundation. CHRI’s 2022 award recipients are: Dr. Emma Duerden (CHRI Scientist of the Year) and Kendrick Lee (CHRI Deb Comuzzi Trainee of the Year).

“This year, we recognized a number of leading research professionals from across LHSC and St. Joseph’s who are helping to advance patient care in London and around the world,” adds Dr. Hill. “We were also honoured to recognize three Community Partners of the Year for their generous support of health research.”

Learn more about each recipient on our Impact Awards page and visit the Lawson YouTube channel to watch videos highlighting each of the award recipients. 

Tackling a “dirty dozen” list of health and lifestyle factors can go a long way in lowering the risk of dementia, say London experts.  

Many people could greatly improve their odds against developing dementia by making four, low-cost lifestyle changes – today.

In the first study of its kind, researchers at Lawson Research Institute (Lawson) and Western University have found that about half of dementia cases in Canada can be influenced by 12 lifestyle factors.

Topping the “dirty dozen” list across Canadians’ lifespan, and especially notable from mid-life onwards, are physical inactivity, hearing loss, obesity and hypertension.

The solutions:

• Get off the couch and get moving  
• Tackle hearing loss early
• Lose weight
• Get assessed and treated for high blood pressure

“While lifestyle changes aren’t a magic pill to prevent all dementias, they’re an empowering way to reduce the overall risk,” says Lawson researcher and study lead author, Surim Son, a Western University PhD candidate who with the dementia research program at St. Joseph’s Health Care London (St. Joseph’s).

“We’re talking about significant benefits to Canadian health and health systems,” adds Son.

The findings could also have profound implications in refocusing health policy priorities. The Public Health Agency of Canada is already highlighting the study as part of its resources for national health policy advisors, she notes.

This study is the first to weigh Canadians’ lifestyles and habits against 12 potentially modifiable risk factors for dementia, and the first globally to include sleep disruption on the list.

Son’s paper, published in The Journal of Prevention of Alzheimer’s Disease, builds on a 2017 study in the Lancet that shows 12 modifiable risk factors throughout the course of life could contribute to 40 per cent of dementias around the world.

But Canada’s numbers are considerably higher because more of us indulge in weightier lifestyle risks. For example, four of every five older Canadian adults don’t exercise regularly; one in three is obese or has hypertension; and one in five has hearing loss.

"If half of the dementia cases in Canada are linked to modifiable lifestyle risk factors, this suggests that, today, prevention may be the most effective form of treatment," says Dr. Manuel Montero-Odasso, co-author of the paper and Director of the Brain & Gait Lab at St. Joseph’s Parkwood Institute.

“Dementia doesn’t have to be your destiny, even if that’s part of your genetic story. Our results from the SYNERGIC Trial shows almost everyone can change their risk factors and improve their cognitive resilience,” says Montero-Odasso, who was recently awarded a $2.4-million Canadian Institutes of Health Research grant to train professionals in risk reduction and care for people living with cognitive impairment.

Montero-Odasso’s advice: “Go out for a walk and keep moving. Get a hearing assessment. Keep your blood pressure in check. It’s low-cost and easy to implement. It’s good for your body health, even beyond improving your brain health and reducing your dementia risk.”

The 12 potential modifiable factors (based on a study of 30,000 Canadians over the age of 45), weighted from most significant factor to least:

• Physical inactivity  
• Hearing loss
• Obesity
• Hypertension
• Traumatic brain injury
• Depression
• Less education in early life
• Sleep disturbances  
• Diabetes
• Smoking
• Excessive alcohol
• Social isolation

St. Joseph’s Health Care London is at the forefront of national research exploring biomarkers to better predict dementia and slow its onset.

Dr. Michael Borrie is now seeing grandchildren of patients who came to his clinic when he first started Alzheimer’s research 30 years ago.

His message to this new generation is more hopeful than ever, bolstered by ever-more-reliable ways of early detection and being tantalizingly close to a future of predicting dementia and intervening even before symptoms appear.

“The ultimate goal is to slow cognitive decline – and to stop it if we can – so that people can live independently, and happier, for a lot longer,” says Borrie, Medical Director of the Aging Brain and Memory Clinic at St. Joseph’s Health Care London (St. Joseph’s).

“We’re aiming to alter the trajectory of dementia,” he says.

A geriatrician, clinician and researcher, Borrie is also Platform Lead for the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND), a long-term study within the Canadian Consortium on Neurodegeneration and Aging (CCNA).

Recently, the Canadian Institutes of Health Research announced $20.6 million in funding to continue the work of CCNA, a 30-site, multi-pronged project of which the St. Joseph’s-based team is the lead player. The grant will enable them to advance the frontiers of dementia research to benefit real-world patients here and across the country.

Solving mysteries with biomarkers

Despite the prevalence of Alzheimer’s and other neurodegenerative diseases – and with more than 10,000 new diagnoses in Canada each year – there are still many mysteries to solve: Why do some people have early-onset dementia while others, super-agers, remain alert and active in their 90s? What’s happening genetically, in their environment and personal medical history to advance or protect against the disease?

What is known, however, is the link between damaged nerve cells and specific proteins that misfold and clump together to form amyloid plaques and tau tangles in the brain. Detecting these abnormal proteins early is an important key to diagnosis and prediction.

Locally, the most comprehensive tool has been state-of-the-art brain Positron Emission Tomography (PET) scanning at St. Joseph’s Imaging. Lawson researchers are also involved in reliably detecting amyloid proteins by analyzing participants’ cerebrospinal fluid (CSF) – a surprisingly accurate way of confirming imaging results, says geriatrician Dr. Jaspreet Bhangu, a Lawson scientist and head of the biomarker project.

Through the BioMIND regional research project, Lawson scientists are analyzing PET scans, blood and CSF samples to check for specific protein biomarkers. If shown to be reliable, a series of these tests over time could signal whether the disease is progressing, and could predict whether it will progress or respond to treatment.

All that gets added to an arsenal that includes tests of behaviour, memory and cognitive function.

“It’s a triple assessment, or even a quadruple one, that we can conduct over time. We hope to use these advanced tests to provide vital information, similar to what is done in certain types of cancer,” Bhangu says.

But that’s not all.

Testing potential treatments

St. Joseph’s is also one of the country’s most active sites for clinical trials into whether novel medications might be able to directly pinpoint and destroy the proteins that cause Alzheimer disease.

“This is the intersection of cutting-edge research, top-notch resources and excellent clinical practice to develop personalized treatments,” says Bhangu. “What makes us unique in Canada among dementia researchers is that our science is taking us from bench to bedside – a rapid turnaround from research to direct patient benefit.”

If a person has a strong family history of Alzheimer disease and no symptoms – but does have positive biomarkers confirming presence of disease – they may then choose to take part in a randomized controlled trial to try to alter the trajectory of the disease.

“It’s still in a research context, still in clinical trials – but if Health Canada ultimately approves a treatment, we’ll have the ability and the patient database to be able to translate our findings into clinical practice much more quickly instead of waiting for years,” says Borrie.

All this is good news for a generation eager for answers, Borrie says.

“When we learn more about the mechanisms of the disease, we can find more effective, earlier treatments. And if we can treat people earlier, we hope to move the disease progression curve to the right, to add more years of good cognitive health to someone’s life.”

A “game-changing” new drug offers both hope and time to some people diagnosed with Alzheimer’s disease, says the head of a St. Joseph’s program that played a key role in the medication’s clinical trials. Health Canada has newly approved lecanemab (brand name Leqembi, developed by Eisai Co. and Biogen), which has been shown to slow progression of Alzheimer’s disease in people with mild symptoms.

St. Joseph’s Health Care London, and its innovation arm at Lawson Research Institute, has played a key role as one of multiple sites that have trialed the drug.

“This is game-changing,” says Dr. Michael Borrie, medical director of the Aging Brain and Memory Clinic at St. Joseph’s, whose work in dementia research and clinical practice spans more than three decades.

“We’ve been working for over 20 years to find a compound that is disease-modifying. This is the first approved drug in Canada that addresses the underlying pathology of Alzheimer’s, not just the symptoms.”

Lecanemab works by removing amyloid proteins that accumulate as sticky clumps in the brain and are associated with cognitive decline in people with Alzheimer’s. “It reverses one aspect of the disease by removing the plaque from the brain ,” Borrie explains.

“You can characterize its benefit in terms of time saved. If you were to have this medication for four years, you can ‘save’ one year of cognitive decline. It totally changes the course of their neurodegeneration in a way we haven’t seen before.”

Lecanemab was one of many clinical drug trials assigned to research coordinator Kayla Vander Ploeg when she arrived to work at St. Joseph’s more than a decade ago. “For so long, we had hope that one of these medications would benefit patients long-term. Now we have more than hope. We have results,” Vander Ploeg says.

“Today I’m seeing people who say, ‘my dad or my mom was in this study, and now there’s hope for me.’ ”

There are specific eligibility criteria, including confirmed diagnosis – through cognitive testing and through advanced brain imaging and biomarker tests – plus screening to rule out two gene variations that couldresult in more side effects.

Canada is now one of 51 countries to have approved lecanemab.

Borrie cautioned that Health Canada approval doesn’t necessarily translate to funding coverage. It’s not yet determined who will pay for the medication, or how: when lecanemab was approved in the United States in 2023, the annual cost per patient was more than $26,000.

The length of time from drug development to trials to approval illustrates how painstaking pharmaceutical research can be. But it also highlights how integrating health research into hospital settings can translate more quickly into improved patient care.

Medical physicist Ting-Yim Lee still isn’t sure exactly what interviewers saw in him when they recruited him in 1988 to work in radiology research at St. Joseph’s Health Care London.

But he’s honoured they saw and cultivated that kernel of possibility.

Lee is now recognized as an innovative imaging scientist transforming research and patient care. In June, Lee will receive the Canadian Organization of Medical Physicists’ (COMP) Gold Medal Award for exemplary achievement. It is the organization’s most prestigious award.

“I was hired from Winnipeg to work here,” he says. “I had a thin CV, and very few publications. I was a nobody, I thought. But St. Joseph’s recognizes the potential in people and they saw potential in me. If not for St. Joseph’s nurturing environment, our imaging program would not be what it is today.”

Lee is director of PET/CT Research at Lawson Research Institute (Lawson) and medical physicist at St. Joseph’s Hospital. He is also a professor at Western University’s Schulich School of Medicine & Dentistry and a scientist at Robarts Research Institute.

At St. Joseph’s and Lawson, he has sparked the growth of the Molecular Imaging and Theranostics program. Recently it was chosen to be Canada’s first a GE Centre of Excellence in Molecular Imaging and Theranostics based on the past track record of the Lawson Imaging program of achieving a number of national and global firsts.

Mustard-seed growth

Lee says the Lawson Imaging Program’s development is symbolized by the mustard seed in the St. Joseph’s logo: “The mustard seed is the smallest of seeds and it grows into a strong and beautiful tree. When I started at St. Joseph’s, we’d installed a CT scanner one year earlier, and we were quite behind other hospitals. Then we started developing it bit by bit, piece by piece, leaf by leaf.”

Among his most celebrated achievements is developing CT Perfusion technology, a world-first in 2000 that has revolutionized stroke diagnosis and treatment by providing detailed images of blood flow in and to the brain.

The technology is used in more than 8,000 hospitals worldwide and more than 25,000 licences of the technology have been sold over the last 22 years– the royalties enabling the purchase of new, state-of-the-art CT and PET/CT equipment at St. Joseph’s to the benefit of researchers and patients alike.

Lee’s contribution helped secure a $30-million Canada Foundation for Innovation initiative in 2006, introducing hybrid imaging to Canada—including the nation’s first PET/MRI systems. His

expertise has turned contrast-enhanced CT into a powerful functional imaging tool with applications to oncology, cardiology, and neurology.

Excellence, multiplied

“It is no exaggeration to state that without Dr. Lee, the Lawson Imaging Research Program and the medical physics team would never have achieved the heights of success that it has,” says Frank Prato, PhD, founder of the program in 1982 and its leader until 2024.

Prato says Lee has had “a profound influence” on the careers of hundreds of medical physicists, including training and mentoring 60 graduate and postdoctoral students – many of whom are now training students of their own.

“These multipliers/amplifiers of Dr. Lee’s mentorship have had a profound effect on the excellence of the medical physicists we have in Canada and the excellence of the ones we train for the world,” Prato says.

Lee has published 290 research papers, which have been cited nearly 19,000 times – an indication of their impact in the medical community. He has been awarded the Meritorious Service Cross from the Governor General of Canada and received the Career Achievement Award as a WORLDiscoveries innovator.

The St. Joseph’s difference

More recently, Lee created, in partnership with St. Joseph’s Health Care Foundation and Western, two endowed chairs to research and translate liquid radiation therapy.

His considerable accomplishments are matched by his humility and his eagerness to deflect credit to his colleagues, St. Joseph’s, the St. Joseph’s Health Care Foundation and the broader imaging and research communities.

Excellent technology and research are an outgrowth of the people and culture of St. Joseph’s, Lee emphasizes. “I always feel that when I walk into St. Joseph’s, it immediately has that warm feeling that envelops you. It’s different. It’s a nurturing environment.”

The COMP Gold Medal is the highest award given by the Canadian Organization of Medical Physicists and is given to currently active or retired individuals to recognize medical physicists who have made outstanding contributions:

• A body of work fundamentally altering the knowledge base and practice of medical physics
• Leadership positions in medical physics organizations leading to improvements in the status and public image of medical physicists in Canada
• Significant influence on the professional development of the careers of medical physicists in Canada through educational activities or mentorship

Several London and Lawson-affiliated researchers have won the COMP Gold Medal, including Prato in 2024.

This year’s annual scientific meeting takes place in London on June 4 – 7.

In a world-first clinical trial published in the journal Nature Medicine, a multi-centre study from Lawson Health Research Institute, the Centre hospitalier de l’Université de Montréal (CHUM) and the Jewish General Hospital (JGH) has found fecal microbiota transplants (FMT) from healthy donors are safe and show promise in improving response to immunotherapy in patients with advanced melanoma. 

Immunotherapy drugs stimulate a person’s immune system to attack and destroy cancer. While they can significantly improve survival outcomes in those with melanoma, they are only effective in 40 to 50 per cent of patients. Preliminary research has suggested that the human microbiome – the diverse collection of microbes in our body – may play a role in whether or not a patient responds. 

“In this study, we aimed to improve melanoma patients’ response to immunotherapy by improving the health of their microbiome through fecal transplants,” says Dr. John Lenehan, Medical Oncologist at London Health Sciences Centre’s (LHSC) London Regional Cancer Program (LRCP), Associate Scientist at Lawson and Associate Professor in the Department of Oncology at Western University’s Schulich School of Medicine & Dentistry.
 

A fecal transplant involves collecting stool from a healthy donor, screening and preparing it in a lab, and transplanting it to the patient. The goal is to transplant the donor’s microbiome so that healthy bacteria will prosper in the patient’s gut.

“The connection between the microbiome, the immune system and cancer treatment is a growing field in science,” explains Dr. Saman Maleki, Scientist at Lawson and LHSC’s LRCP, Assistant Professor in Schulich Medicine’s Departments of Oncology, Pathology and Laboratory Medicine, and Medical Biophysics, and senior investigator on the study. “This study aimed to harness microbes to improve outcomes for patients with melanoma.”

The phase I trial included 20 melanoma patients recruited from LHSC, CHUM and Jewish General Hospital. Patients were administered approximately 40 fecal transplant capsules orally during a single session, one week before they started immunotherapy treatment.

The study found that combining fecal transplants with immunotherapy is safe for patients – which is the primary objective of a phase I trial (also called ‘safety trials’). The study also found 65 per cent of patients who retained the donors’ microbiome had a clinical response to the combination treatment. Five patients experienced adverse events sometimes associated with immunotherapy and had their treatment discontinued.

“We have reached a plateau in treating melanoma with immunotherapy, but the microbiome has the potential to be a paradigm shift,” says Dr. Bertrand Routy, Oncologist and Director of CHUM’s Microbiome Center. “This study puts Canada at the forefront of microbiome research by showing we can safely improve patients’ response to immunotherapy through fecal transplants.”

“These exciting results add to a rapidly growing list of publications suggesting that targeting the microbiome may provide a major advance in the use of immunotherapy for our patients with cancer,” adds Dr. Wilson H. Miller Jr. of the JGH and Professor in the Departments of Medicine and Oncology at McGill University.

Previous studies looking at patients receiving immunotherapy who do not respond have found many had an unhealthy microbiome, explains Dr. Lenehan.

“There's a portion of people who don't respond or the treatment just doesn't work,” says Dr. Lenehan. “The hope with the fecal transplant is to make more people respond to treatment.”

These results have also led to a closer examination of the role of the microbiome in regulating how the body responds to disease and how the drugs themselves interact with the microbiome.

“The microbes on and in us - and there's actually a huge amount of those – play a critical role, including modulating some of our immune responses,” explains Dr. Jeremy Burton, Research Chair of Human Microbiome and Probiotics, Scientist at Lawson and St. Joseph’s Health Care London and Associate Professor in the Department of Microbiology and Immunology at Schulich Medicine.

The study is unique due to its administration of fecal transplants (from healthy donors) in capsule form to cancer patients – a technique pioneered in London by Dr. Michael Silverman, Lawson Scientist, Chair of Infectious Diseases at Schulich Medicine and Medical Director of the Infectious Disease Care Program at St. Joseph’s Health Care London.

“Our group has been doing fecal transplants for 20 years, initially finding success treating C. difficile infections. This has enabled us to refine our methods and provide an exceptionally high rate of the donor microbes surviving in the recipient’s gut with just a single dose,” says Dr. Silverman. “Our data suggests at least some of the success we are seeing in melanoma patients is related to the efficacy of the capsules."

The team has already started a larger phase II trial involving centres in Ontario and Quebec. Lawson researchers are also studying the potential of fecal transplants in the treatment of other cancers, including renal cell carcinoma, pancreatic cancer and lung cancer, as well as HIV and rheumatoid arthritis.

This work is not possible without poop donors, and there is a critical need for more. Donors must be between the ages of 18 to 50 and reside in the London, Ont. area. To learn more about eligibility and donating, call the 519 646-6100, ext. 61726 or email Dr. Seema Nair Parvathy, Research Scientist, at SeemaNair.Parvathy@sjhc.london.on.ca.

This research is supported in part through donor funding from London Health Sciences Foundation, Western University, the Lotte and John Hecht Memorial Foundation, the JGH Foundation, Canadian Cancer Society’s Impact Grant program and The Terry Fox Foundation.

Lawson Research Institute scientists and partners will focus on molecular imaging and theranostics to potentially transform the detection and treatment of neurodegeneration and cancer.

The quest to advance detection and treatment of Alzheimer’s disease and to personalize cancer care has received a major boost, with $7.2 million in funding to Lawson Research Institute (Lawson) of St. Joseph’s Health Care London (St. Joseph’s) for first-of-its kind research.

Lawson scientists will partner with a broad team of researchers at London Health Sciences Centre Research Institute (LHSCRI), McMaster University, University Health Network and BC Cancer on the ground-breaking studies focused on molecular imaging and theranostics as a potential game-changer in detecting and treating neurodegeneration and cancer, particularly prostate, brain and breast cancer.

Principal investigator Ting-Yim Lee, PhD, Lawson’s Director of PET/CT Research, and his team of investigators were awarded $2 million through the Ontario Research Fund – Research Excellence for the study titled “Improving Cancer and Alzheimer’s Disease Diagnosis and Treatment Through Cutting-edge Molecular Imaging and Theranostics”. Co-Principal Investigator is radiation oncologist Dr. Glenn Bauman at LHSCRI.  

Additional funding from private-sector partners and Lawson, as well as from donors through St. Joseph’s Health Care Foundation, brings the total research investment to $7.2 million.  

The research has the potential to offer hope for solutions to some of the most prevalent and pernicious diseases affecting Canadians, explains Lee.  

“Both research projects are the first of their kind in Canada aimed at advancing how we diagnose and treat Alzheimer’s disease and cancer,” he says. “This collaborative funding initiative will also drive innovation in the exciting field of molecular imaging and theranostics at St. Joseph’s, at the heart of which is St. Joseph’s new, high-sensitivity GE HealthCare Omni Legend 2 PET/CT – the first in Canada.”

The studies encompass the following:  

• Alzheimer’s disease: The new PET/CT at St. Joseph’s allows researchers to simultaneously study both blood flow and glucose metabolism in the brain. Both these mechanisms are believed to be contributing factors in the onset of Alzheimer’s. By measuring both at the same time, the research team hopes to uncover early signs that the brain is in trouble and at risk of plaque deposits and toxic proteins that have been linked to the development of Alzheimer’s.
• Cancer: The cancer study will focus on developing theranostic techniques to achieve personalized dosimetry – a method used to determine the exact amount of radiation a patient should receive during treatment, based on their individual characteristics. This maximizes effective treatment while minimizing harm to healthy tissues.

Molecular imaging and theranostics is a rapidly emerging field of medicine that combines ultra-precise scans and theranostics (a term that melds the words therapeutics and diagnostics). Together, they offer a one-two punch by integrating imaging and radiotracers that can identify the location and extent of diseased tissues and selectively destroy the abnormal cells while leaving surrounding healthy cells undamaged. In collaboration with GE HealthCare, St. Joseph’s is developing Canada’s first GE HealthCare Centre of Excellence in Molecular Imaging and Theranostics.

“By bridging the gap between research and clinical practice, we hope to ease the burden on patients and their families, offering more effective and compassionate care” 
-Ting-Yim Lee, PhD, Director of PET/CT Research at Lawson Research Institute.

“We are already seeing the impact of novel theranostics  for treatment of men with advanced prostate cancer,” says Bauman. “Promising new theranostic approaches are emerging for many cancers and this investment further positions London to be a leader in this area of research.”

In the initial phase of the studies, 100 patients will be recruited from St. Joseph’s Aging Brain and Memory Clinic at Parkwood Institute for the Alzheimer’s study; while 90 patients will be recruited from London Health Sciences Centre’s Verspeeten Family Cancer Centre for cancer studies. There are plans to recruit patients from the collaborating centres once results from the initial phase are confirmed.

“By bridging the gap between research and clinical practice, we hope to ease the burden on patients and their families, offering more effective and compassionate care,” says Lee. “We are deeply grateful for the opportunity to turn our research into real-world solutions that can make a meaningful impact.”

With dozens of 'firsts' in imaging research, “Lawson is a powerhouse of innovation,” adds Michael Kovacs, PhD, Program Lead, Lawson’s Imaging Research Program, and Lead, Cyclotron & PET Radiochemistry Facility. “We're excited to explore how this work could transform care."

When challenged by surgeons to find better treatments for difficult-to-manage connective tissue diseases, Dr. David O’Gorman gladly accepted.

Dr. O’Gorman is a Molecular Biologist and Lawson Scientist based at St. Joseph’s Hospital, a part of St. Joseph’s Health Care London. His research focuses on understanding normal and abnormal connective tissue repair. He collaborates with researchers and clinicians working in many different disciplines, including those specializing in reconstructive surgery, orthopedics and urology.

Surgical reconstructions can be hampered by a lack of graft tissue, or graft tissue of insufficient quality, making it difficult to achieve optimal outcomes for the patients.

An example is a condition called urethral stricture disease (urethral scarring). This condition occurs in males and typically causes symptoms such as frequent and urgent urination, and slow urinary stream. In extreme cases, it can cause urinary tract infections, permanent bladder dysfunction and renal failure. Recurrence rates after minimally invasive treatments are high, and so many urologists recommend open surgical approaches.

Surgeons can use the patient’s own tissues to reconstruct the urethra after stricture removal. This tissue is normally sourced from the buccal cavity in the mouth but taking large tissue grafts can result in complications. In cases where buccal grafts have been used for previous reconstructions, there may not be enough intact tissue left.

Dr. O’Gorman sees a solution in growing sheets of human buccal tissues in the lab.

“We are currently using buccal graft trimmings as a source of cells, culturing them in a 3D environment and expanding them to create tissues of suitable size, density and elasticity.”

The patient’s own cells are used to generate a tissue graft for urethral reconstruction. While several research groups have developed this approach in the past, few have attempted to translate their models for clinical use.

“Our immediate goal is to provide proof of principle – that we can consistently generate grafts of suitable size and functional characteristics,” explains Dr. O’Gorman, “In the future, we could be providing bioengineered graft tissues for reconstructive surgeries here in London.”

Bioengineered human tissues can also be used as ‘mimetics’ – replications of human tissues – to study diseases, especially those difficult to model using routine laboratory methods.

Instead of a using a growth media or sterile plastic dishes, 3D cell culture is achieved by embedding cells in a matrix of proteins and other molecules normally found in those tissues. In this environment, gene expression and growth is more similar to cells of connective tissues in the body being replicated.

Dupuytren’s disease (or Dupuytren’s Contracture) affects the palmar fascia in the hand, a connective tissue beneath the skin that extends from the base of the palm into the fingers. This disease can be understood as a type of excessive scarring, where normal tissue repair processes have gone awry and dense scar tissue forms, typically causing permanent palm or finger flexion that restricts hand function.

This condition is surprisingly common and may affect more than one million people in Canada. While there are surgical treatment options available, none consistently prevent this disease from recurring in at least a third of patients.

“Due to its high recurrence rate after treatment, Dupuytren’s disease is currently considered incurable. Our challenge is to understand it well enough to develop truly effective treatments,” says Dr. O’Gorman.

Human hands have unique characteristics not found in other species, making animal models impractical. Instead, Dr. O’Gorman’s team extracts cells from the diseased palmar fascia of patients undergoing hand surgeries and bioengineers them into palmar fascia ‘contractures’ in the lab.

“Since the cells from a single palmar fascia sample can be used to grow dozens of little contractures, we can test many different treatments simultaneously to see what works best for each patient.”

This approach may also allow them to determine if Dupuytren’s disease is truly one disease, or a group of similar diseases that cause palm and finger contractures.

“Often, Dupuytren’s disease is clearly heritable, but some individuals have no family history of it and develop apparently sporadic disease,” notes Dr. O’Gorman. “We want to determine if these are truly the same disease at the molecular level.”

Another major cause of abnormal connective tissue repair is infection, and tissue mimetics can play a role here, too. While rare, infections of artificial joint replacements are particularly devastating for patients, as they typically require readmission to hospital to remove the infected joint, weeks of antibiotic-based treatment, and an additional surgery to replace the artificial joint.

In addition to the associated pain and suffering, these procedures are technically challenging and costly to our health care system.

Artificial shoulder joint infections are most frequently caused by the microorganism Cutibacterium acnes (C. acnes). C. acnes infections disrupt normal tissue repair processes after surgery, cause shoulder tissues to die and promote loosening of the artificial joint. These infections are difficult to diagnose, and there is a lack of reproducible
models in which to study them. Dr O’Gorman’s team has set out to create the first human Shoulder-Joint Implant Mimetic (S-JIM) of C. acnes infection.

“While S-JIMs are more complex, they are 3D in vitro cell culture systems designed to mimic human tissues, like those that we use for studying Dupuytren’s disease.”

S-JIMs include layers of artificial human tissue, wrapped around cores of titanium alloy or cobalt chrome, the metals used to create artificial joints. They are co-cultured with C. acnes under low oxygen conditions similar to those that normally occur around artificial shoulder joints.

“We are bioengineering simple 3D cell cultures to more closely mimic the complexity of human tissues, with blood supply, nerves and interactions with other cells.” – Dr. David O’Gorman

Studying the connective tissue layers close to the infection allows researchers to investigate processes that promote infection, such as the formation of a biofilm that harbours and protects the bacteria from the body’s immune system. They are also able to test whether novel treatments can disrupt biofilm formation and increase the effectiveness of antibiotics.

Dr. O’Gorman predicts that in the future, medical researchers will routinely use bioengineered 3D human tissue and organ mimetics to accelerate our understanding of disease.

“The technology is in its infancy, but the potential for using bioengineered human tissues for surgical reconstructions or as disease models is huge. At Lawson, we’re ready to take on health care challenges and build on innovative approaches to improve the quality of life for patients.”

ONLINE EXCLUSIVE: What is 3D cell culture?

Medical researchers have grown human cells in culture media on or in sterile plastic dishes, such as Petri dishes, for more than 50 years. 

Some cells, such as blood cells, can survive and grow in suspension, while others like smooth muscle cells need¬ to adhere to a surface to survive and grow. These are often called “2D cell cultures” because the cells grow horizontally across the bottom of the dish.

Some cells derived from connective tissues, such as fibroblasts, are not only adherent, but also very sensitive to the stiffness of their environment (“biomechanically sensitive” cells). Plastic dishes are at least 10,000 times stiffer than most connective tissues, and when biomechanically sensitive cells detect stiff surfaces, they can change the expression of their genes and behave abnormally. 

The most common proteins in these tissues - and in the entire human body - are collagens, and one routine 3D cell culture approach is to embed fibroblasts in a collagen gel (gelatin). Fibroblasts in this environment can grow in any direction they choose, and their gene expression is more similar to cells in connective tissues. 

These simple 3D cell cultures represent tissue engineering in its most basic form. 

“Our challenge is to bioengineer simple 3D cell cultures in the lab to more closely mimic the complexity of human tissues, which have blood supply, nerves and interactions with other cells and tissues that modify their function and ability to heal after injury,” explains Dr. O’Gorman. 

Dr. David O’Gorman is a Lawson Scientist and Co-director, Cell and Molecular Biology Laboratory at The Roth | McFarlane Hand and Upper Limb Centre in London, Ontario. He is also an Assistant Professor at Western University.