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LONDON, ON – Three studies investigating a range of important COVID-19 questions led by teams from Lawson Health Research Institute and Western University are among an initial 15 projects funded through the Government of Ontario’s COVID-19 Rapid Research Fund.

Studying a human protein in the treatment of critically ill COVID-19 patients

A team from Lawson will be the first in the world to study a human protein called annexin A5 as a potential therapy for COVID-19 patients with sepsis. The randomized controlled trial will enroll up to 60 critically ill patients from London Health Sciences Centre (LHSC). 

“There are no proven therapies to treat COVID-19,” says Dr. Claudio Martin, Associate Scientist at Lawson and Intensive Care Physician at LHSC. “In the most severe cases, it’s complicated by hyperinflammation that can lead to sepsis, acute respiratory distress syndrome (ARDS) and multi-organ failure.”

Sepsis is a life-threatening condition. It occurs when the body’s response to an infection is out of balance, triggering hyperinflammation that can damage multiple organs. Many critically ill COVID-19 patients develop sepsis one to two days before ARDS, suggesting that sepsis is a major contributor to the development of respiratory and multi-organ failure. 

Led by Dr. Martin, this clinical trial aims to fight sepsis in COVID-19 patients with a manufactured form of annexin A5 – a human protein that has strong anti-inflammatory properties. Patients will be randomized to receive either the drug at two different doses or a placebo. 

“The ultimate goal is to determine whether this drug reduces hyperinflammation associated with sepsis in order to prevent respiratory and multi-organ failure,” explains Dr. Martin, who is also a Professor at Western’s Schulich School of Medicine & Dentistry.

The team also believes the drug will prevent cell death and blood clots associated with COVID-19 through annexin A5’s anti-apoptotic (cell death prevention) and anti-coagulant (blood clot prevention) properties.

This is the first time annexin A5 will be tested as a potential sepsis treatment in humans. The research builds on findings of a preclinical study from Dr. Qingping Feng, Lawson Scientist and Ivey Chair in Molecular Toxicology at Schulich Medicine & Dentistry. His team previously found that annexin A5 can inhibit inflammation and improve organ function and survival when treating sepsis in animal models. 

“Annexin A5 is a naturally-occurring protein with great potential as a therapy for sepsis, whether caused by COVID-19 or a different infection,” says Dr. Feng, co-investigator on the project. “If our initial trial is successful, we hope to run a large multi-centre trial to further examine the drug’s potential as a sepsis treatment.”

Developing point-of-care blood test for COVID-19

A team at Western will be using a novel strategy to rapidly develop a blood test for COVID-19 using epitopes – a peptide fragment on the virus that evokes an immune response in humans. 

“The antibody test enabled by multiple epitopes is potentially more sensitive and specific than tests that rely on a single viral protein. Serologic testing plays a pivotal role in charting the landscape of the COVID-19 pandemic and guiding return-to-work decisions,” said Shawn Li, PhD, Professor at Schulich Medicine & Dentistry and Scientist at Lawson. “This funding allows us to put together a team of basic researchers and clinician scientists, including Dr. Ian Chin-Yee and his colleagues at the Department of Pathology and Laboratory Medicine, to work on the various aspects of the project with the common goal of developing a serologic test suitable for point-of-care use as quickly as possible.”

To curb the COVID-19 outbreak caused by the SARS-CoV-2 virus, researchers are looking to solve three critical challenges as quickly as possible – detection, treatment and vaccination. Li says the identification of these epitopes are also the necessary first step to devise strategies for the production of virus-neutralizing antibodies to treat those who are severely ill and also to inform epitope-vaccine development for COVID-19. 

Studying the impact of modified operating conditions for retail food outlets

With the aim of understanding how the pandemic has affected the well-being of businesses and their employees, Jason Gilliland, PhD, Professor in the Faculties of Social Sciences, Health Sciences, and Schulich Medicine & Dentistry at Western, has begun the Food Retail Environment Study for Health & Economic Resiliency (FRESHER) project.

“The project is a rapid response to the widespread closures of, and modified operating conditions for, many retail food outlets,” said Gilliland, who is also a Scientist at Lawson. “The project outputs are expected to help inform policies and programs that will maintain Ontario’s food security, incentivize economic growth during the recovery period, and improve health and economic resiliency among businesses and employees to future pandemics and emergencies.”

Gilliland and his team will examine the economic and social impacts of COVID-19 in southwestern Ontario by identifying what businesses modified their operations, temporarily closed or permanently closed during the outbreak, and how it has affected businesses and their employees.

“The retail food sector is already facing massive job losses which in turn will have negative economic and health impacts on owners and employees,” he said. “As the project is intended to be a rapid response, we needed to quickly mobilize a large team of research assistants to rapidly collect and continuously update the data. This funding is critical as it allowed us to put together an impressive team of student research assistants, most of whom would otherwise have been out of work due to COVID-19.”

More information on the project and links to the surveys can be found at: fresher.theheal.ca. 

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LONDON, ON – Researchers at Lawson Health Research Institute (Lawson) have launched a new study to investigate the use of bovine lipid extract surfactant suspension (BLES^®) for treating severe cases of COVID-19.

Surfactant is made of lipids and proteins. Its primary function is to reduce surface tension in the alveoli in the lungs, helping us to exchange gases and breathe more efficiently. Alveoli can be described as tiny, balloon-like air sacs that exchange oxygen and carbon dioxide to and from the blood stream. When there is less surfactant being produced, or the surfactant is dysfunctional, alveolar walls can stick together, making it difficult to breathe.

Lung analyses from patients with severe COVID-19-induced respiratory failure indicate there is a change in their alveolar type-II cells; the cells which secrete surfactant. This suggests a change to the surfactant being produced, and a decrease in its functional efficacy.

Dr. Jim Lewis, Lawson Scientist and Respirologist at St. Joseph’s Health Care London, and his colleague, Lawson Scientist Dr. Ruud Veldhuizen, are studying whether the use of BLES^®, an exogenous surfactant, given at the time of intubation, will help improve outcomes such as gas exchange, need for mechanical ventilation, systemic inflammatory response, and length of ICU and hospital stay in patients with severe COVID-19.

BLES® is a pulmonary surfactant, manufactured in London, Ontario. It is currently used worldwide to help improve lung function in premature babies. Researchers are confident that it can help adults who develop lung disease and acute respiratory distress syndrome (ARDS).

Dr. Jim Lewis explains, “BLES® has been studied in pediatric and adult populations with ARDS, and we have found that it improves outcomes in patients with direct lung injury when compared to patients receiving standard treatment. We have proven this treatment effective in the past, and COVID-19 seems to be another prototypic case that we think will respond well.”

“Mechanical ventilation, while sometimes necessary, can cause damage to the lungs,” says Dr. Veldhuizen. “In previous studies, we’ve been able to show that if you give the surfactant early, prior to ventilation, you can prevent some of this damage from occurring.”

“The world is focused on finding good treatments for COVID-19. This kind of research is only possible through strong partnerships, and we are thankful for the collaboration that is possible here in London. Many different experts are involved in this study, including scientists and research staff, physicians, nurses, respiratory therapists, pharmacists, and staff at BLES® Biochemicals,” adds Dr. Veldhuizen.

Researchers hope to recruit ten patients to receive the exogenous surfactant, with another ten serving as the control group.

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LONDON, ON – Researchers from Lawson Health Research Institute and Brescia University College found that teenage pregnant women are more likely to live in poverty, have poorer mental health and have higher rates of substance use. 

There are limited Canadian studies on teenage pregnancies, in particular looking at risk factors and birth outcomes compared to women who became pregnant during adulthood. London researchers were able to take advantage of a large sample of pregnant women from Southwestern Ontario by accessing data from patients at London Health Sciences Centre. Of the 25,363 pregnant women making up the total sample of the retrospective cohort study, 4.3 per cent (1080) were 19 years old or younger.

Teenage pregnant women were much more likely than older pregnant women to live in poor, disadvantaged neighbourhoods across Southwestern Ontario. They were also more likely to have a history of depression and had higher rates of depression during pregnancy, with 10 per cent on medication while pregnant. Looking at substance use, 41 per cent of teenage women smoked cigarettes, 13 per cent used cannabis and 7 per cent drank alcohol during pregnancy, which was significantly higher than rates for older pregnant women. 

Once adjusted for other medical, behavioural and economic factors, teenage pregnancy was not associated with a higher risk for preterm birth or low birth weight compared to pregnancy for women ages 20-34 years. However, the infants had a higher risk of low Apgar scores. 

An Apgar score, a test given to newborns soon after birth, indicates how well the baby is doing outside of the womb. Babies with very low Apgar scores are more likely to need assistance with breathing. However, Apgar scores have little correlation with the long-term health of the baby.

“Although teenage pregnancy has been declining in Canada over the past few decades, this does not mean that we have solved this social issue. The majority, 70 per cent, of teenage pregnancies in this country are unintended,” says Dr. Seabrook, Scientist at Children’s Health Research Institute, a program of Lawson, and Associate Professor at Brescia University College. “Unfortunately, declining rates of teenage pregnancy means that the issue has received minimal attention in recent years with respect to social policy.”

Contrary to findings in the United States, where teenage pregnancy is associated with a higher risk for preterm birth and low birth weight, these recent results suggest that geographical context, differences in social inequality and type of health care system are important. It’s possible that Canada’s universal health care system provides a stronger safety net.  

“There are so many factors associated with poor birth outcomes, and the advantage of our sample size and statistical modelling was that we were able to include key medical and behavioural factors which play a larger role than age,” says Dr. Jasna Twynstra, Associate Professor at Brescia University College. 

“Although our study adds to the limited research on teenage pregnancy and birth outcomes, the findings are only from Southwestern Ontario,” adds Dr. Seabrook. “We are currently working on a systematic review and meta-analysis of all studies conducted in Canada on the relationship between teenage pregnancies and adverse birth outcomes to determine whether our findings here are consistent with what’s happening across the country.” 

He hopes the study reopens discussion on this important issue so that work can be done to improve the overall health of teenage pregnant women and their children. “We need to target teenage mental illness, as well as their high substance use during pregnancy, to minimize the impact on their overall health and wellbeing.” 

The study, “Risk Factors and Birth Outcomes Associated with Teenage Pregnancy: A Canadian Sample,” was published in the Journal of Pediatric and Adolescent Gynecology. 

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LONDON, ON – Researchers in London are sharing a new resource that can help municipalities and other organizations better understand social isolation and implement solutions proven to be effective. With input from over 35 community partners and people with lived experience, the research team hopes this tool can be used to support community-based initiatives that counteract poverty and homelessness while promoting mental health and social inclusion.  

“The pandemic has highlighted the issues of isolation and homelessness, and we know there is a connection between mental health and poverty. Unfortunately, right now, many people don’t see solutions in sight,” explains Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson Health Research Institute. “Our new resource offers an expanded understanding of isolation and homelessness based on a very broad view and many different perspectives. We have taken it a step further and given examples of solutions that are working.” She is the lead researcher for CURA (Community-University Research Alliance): Poverty, Mental Health and Social Inclusion.  

Today during a virtual book launch, the team from the CURA discussed details of a new publication from Canadian Scholars: Poverty, Mental Health, and Social Inclusion, edited by Drs. Forchuk and Rick Csiernik. Community partners from Connect for Mental Health (peer support), Impact Junk Solutions from CMHA Elgin-Middlesex, and Goodwill Industries shared more about their successful programs.  

The book brings together research, real stories and information about programs from the London and area community that are working to address these issues. Most of the chapters includes a wide range of co-authors, including psychiatric consumer-survivors, academics, students, front-line service providers and leadership from community partners.  

“In order to find real solutions, the voices of people using the services must be at the centre. Their stories and experiences have been a very important part of producing this book,” says Betty Edwards, Executive Director at Can-Voice, a consumer-survivor group, and Community Director for CURA. “For us to move the needle, we need collaboration across different sectors, for example health, income support, housing and social services. No one sector can solve these issues on their own.” 

The book summarizes the foundational work by the CURA to better understand the inter-relationships between poverty and social inclusion for psychiatric survivors. Social inclusion involves the full participation of marginalized groups in the social and economic benefits of society which can be difficult to achieve for people with the “double jeopardy” of poverty and mental illness. 

“After five years of funding and several published research papers, we wanted to pull the findings together as a whole so that it would be more easily accessed and implemented by a wide range of people and organizations,” adds Dr. Forchuk. “Our hope is that other cities and service providers can pick up this book to see what we’re doing in London, and consider ways that they may reach out to their citizens to address social exclusion. It is also an academic tool to prepare the next generation as they continue to tackle the wicked problem of homelessness.”  

Incorporating an arts-based approach, the book also features photographs taken by photographer Justin Langille who would spend about a month with each of the programs offering solutions and partnered with consumer survivors to capture accurate depictions of what they considered important messages.  

“I reflect back on the past 15 months of the pandemic and know how isolated I have felt at times. Imagine the feelings of isolation or being forgotten that would come with experiencing homelessness? And for some, it’s been most of their adult lives,” shares Dr. Csiernik, Professor at King’s University College at Western University. “We know that many people during the pandemic have lost homes, jobs and food security. Some may have new or worsening mental health disorders. The learnings and solutions like the ones presented in the book are needed now more than ever.”  

A central focus of the CURA team has been understanding homelessness – what lead someone to experience homelessness and how do we as a society respond? By bringing together different perspectives, the CURA team uncovered the issue of hospital discharge to homelessness, leading to research projects at London Health Sciences Centre and St. Joseph’s Health Care London that integrates the City of London’s housing and homeless approach. They have been better able to tailor youth specific homeless interventions after more awareness of the unique challenges of homeless youth. Driven by an information gap identified by the CURA, Dr. Forchuk’s team recently announced a research project testing data algorithms to track and identify who is homeless and where they are located. 

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Photo credit for all images: Justin Langille Photography 
 

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A supported housing unit rendered uninhabitable by an individual suffering from mental illness, which was a challenge for Impact Junk Solutions to de-clutter. (Photo credit: Justin Langille Photography)

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Diane assembles parts on the floor of the Goodwill’s RMHC Social Enterprise program in St.Thomas in April 2014. (Photo credit: Justin Langille Photography)

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Steve helps a co-worker navigate a couch out from a basement in the Blackfriars neighbourhood in London, Ontario in April 2014. Returning to work has been essential for Steve’s successful recovery from mental illness and substance abuse. (Photo credit: Justin Langille Photography) 

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Goodwill RMHC Social Enterprise program employee Donald applies reflective tape to a stack of pylons in March 2014. (Photo credit: Justin Langille Photography) 

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