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A Canadian consortium, which includes Lawson Health Research Institute (Lawson), TRIUMF, BC Cancer and Centre for Probe Development and Commercialization, is the first in the world to receive regulatory approval to produce the world’s most commonly used medical isotope, technetium-99m (Tc-99m), using small particle accelerators known as cyclotrons. 

Tc-99m is used in tens of millions of nuclear medicine procedures globally each year. These include cancer scans, cardiac tests, as well as several other diagnostic procedures. As the world moves away from uranium-based nuclear reactors, there has been growing concern in the medical community of a global shortage of these life-saving compounds. This development helps secure a domestic supply of Tc-99m for Canadian patients.

For over a decade, Dr. Michael Kovacs, Director, Lawson Cyclotron & PET Radiochemistry Facility, and Steven Foster, Business Manager, Lawson Imaging, have been working on research that has contributed significantly to this major development. They have demonstrated the successful production of Tc-99m on a standard hospital-based cyclotron at Lawson, confirming that this technology can be used by almost half of the world’s already installed cyclotrons. Clinical trials were conducted across Canada and locally at St. Joseph’s Health Care London.

“In 2011, we received federal funding to see if we could develop a technology to produce Tc-99m in hospital cyclotrons,” explains Dr. Kovacs. “Canada’s Chalk River nuclear reactor was one of the world’s largest suppliers, and it was set to close in 2016. Cyclotron facilities offer a greener, safer, more sustainable approach for producing critical medical isotopes. Our goal was to find an alternative to the traditional means of producing this isotope, and we have been successful.”

Nuclear medicine is a functional imaging technique, meaning that it images biological function. Medical isotopes are converted to radiopharmaceuticals which get injected into the patient during a procedure. According to the specific biological properties of the isotope, they move throughout the body, rendering a 3D map of where the isotope has gone. This gives researchers and medical professionals valuable information of how various physiological processes are performing.

“Canada is a global leader in nuclear imaging technology. With the help of our collaborators across the country, we have home-grown technology to produce commercial quantities of Tc-99m on common cyclotrons,” adds Mr. Foster.  “This technology has been patented and licensed to ARTMS Inc., a spin-off from the consortium, and is now being commercialized and sold throughout the world.”

The process was approved by Health Canada in November, 2020, and is expected to be deployed in British Columbia by 2022. 

Two new interventional studies have been brought to London, focused on improving quality of life for patients with Alzheimer’s disease and their caregivers. Both hope to improve upon standard approaches to treating agitation, a core symptom of Alzheimer’s.

Agitation is a significant source of stress for patients and caregivers. It is complex and difficult to treat. Often, families do not know about this particular symptom of Alzheimer’s and are not properly trained on how to manage care while dealing with agitation. 

“These studies are designed to have a direct impact on patients, families and care providers, to improve quality of life and function in those suffering from agitation due to Alzheimer’s,” says Dr. Amer Burhan, Associate Scientist at Lawson Health Research Institute (Lawson) and Geriatric Neuropsychiatrist, St. Joseph’s Health Care London (St. Joseph’s).

Parkwood Institute, a part of St. Joseph’s, is one of multiple sites participating in these studies across Canada and the United States.

One study aims to identify patients early in their diagnosis, while they are living at home or in the community, and apply a comprehensive psychosocial approach, with or without medication, to help with the management of agitation. “We hope to identify participants and have them participating in our program before they experience a crisis due to agitation,” explains Dr. Burhan.

Psychosocial intervention is a way of helping patients and caregivers understand the reasons for agitation. Agitation can develop due to a wide range of causes. For example, patients may just be bored and need help to find something meaningful to occupy their time, they could be upset about something in their current environment, or may be suffering from physical discomfort or pain.

Interventions can include communicating with patients in a manner that creates calm, scheduling meaningful activities, and maintaining routine and rhythm in life. The research team will connect with families early after diagnosis to give them the tools and support they need.

Initially, participants will be treated using structured psychosocial intervention to help reduce and manage their agitation. After three weeks, they will be reassessed and if significant agitation continues to persist, the patient will be randomly selected to receive either a placebo, or medication known as S-Citalopram to treat agitation while they continue to receive psychosocial care.

Sylvia Wilson is the wife of one of the study participants. By enrolling in this trial, she feels she has gained a much better understanding of her husband’s disease, and is grateful for the support that study participants receive.

“My husband typically does not like going to visit doctors, but Dr. Burhan and his team are great,” says Wilson. “They understand agitation, and other symptoms of the disease very well, and I notice a difference in his mood with the treatment he receives through the study.”

Participants are still able to receive care from their primary physician and care teams, with the study providing an added layer of support.

Another study is focused on Alzheimer’s patients who are admitted to hospital or living in long-term care. The aim is to standardize the approach to care for agitation related to Alzheimer’s. After baseline assessment, participants will be randomized to receive the current treatment as per usual, or an integrated care pathway derived from evidence-informed treatment guidelines. These include washing out medications that have not helped, adding individualized behavioral and environmental support, and if medications are needed, use a specific set of medications and dosages based on best evidence. 

“Better understanding agitation is a growing area of interest in geriatric research. The work being done locally is part of an international effort to create a paradigm shift in treating patients with Alzheimer’s disease and agitation,” explains Dr. Burhan.

Researchers are ready to offer these studies to patients and their families, hoping to make these treatment protocols an integral part of care for patients with agitation due to Alzheimer’s disease. Those interested in learning more about these studies can contact Dr. Burhan at @email or call 519-646-6100 x. 48170.

View the trial brochure

In the media: Study on 'agitation' in Alzheimer's patients seeks participants

In recent years deaths from opioid overdoses have become one of the most common injury-related deaths in North America. The continent also has the highest per capita rate of opioid prescription in the world. 

Recognizing the role that opioid prescribing plays in the national opioid crisis, a team of researchers at Lawson Health Research Institute and Western University have developed a new clinical protocol called STOP Narcotics. A study demonstrating the efficacy of their protocol was presented at the American College of Surgeons Clinical Congress in Boston, Massachusetts on October 24. 

The protocol includes a combination of patient and health care provider education and an emphasis on non-opioid pain control. The study found that they were able to reduce the overall amount of opioids being prescribed after general surgery by 50 per cent while still adequately treating a patient’s post-operative pain.   

“By significantly reducing the amount of opioids prescribed, this decreases the exposure risk and potential for misuse of narcotic medication,” said Dr. Luke Hartford, a resident in general surgery at Western’s Schulich School of Medicine & Dentistry and first author on the study. “This also decreases excess medication available to be diverted to individuals for whom it was not intended.”

The study involved 416 patients at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London who underwent laparoscopic cholecystectomy or open hernia repair. They received medication for post-operative pain through the standardized protocol, specifically acetaminophen (Tylenol) and a non-steroidal anti-inflammatory drug (Naproxen) for the first 72 hours post-surgery. 

The protocol instructs physicians to write a limited prescription of ten pills of opioids (Tramadol), with an expiry date of seven days after surgery, with instructions for the patient to fill this prescription only if adequate pain control was not otherwise achieved. There are also instructions on proper disposal of unused medication for the patient.

Dr. Ken Leslie, scientist at Lawson, associate professor in the Department of Surgery at Schulich Medicine & Dentistry, and Chair/Chief of the Division of General Surgery at London Health Sciences Centre led the implementation of the new protocol.

“We recognized that before STOP Narcotics, every surgeon had a different approach to pain control, and that most surgeons were prescribing more narcotics than are actually needed,” said Dr. Leslie. “When we looked at the data from this new protocol, we saw that the patient’s pain-control was just as good with this pathway, without a huge prescription for narcotics.”

The results showed that in the STOP narcotics group, compared to a control group, there was a 50 per cent reduction in the number of opioids being prescribed. They also demonstrated that only 45 per cent of patients actually filled their opioid prescription, compared to 95 per cent in the control group, and they were also able to increase appropriate disposal of excess opioid medication from 7 per cent in the control group to 23 per cent in the STOP Narcotics group. The levels of reported post-operative pain were the same in both groups.

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The group now hopes to expand the protocol for applications beyond general surgery.

“If we can decrease the opioid exposure risk in our patients, and decrease the amount of excess medication available for diversion, and spread this to other institutions and surgical procedures and specialties, this has the potential to significantly impact the opioid crisis,” said Dr. Patrick Murphy, a resident in general surgery at Schulich Medicine & Dentistry and co-author on the study.

The study, “The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Noninferiority Study to Reduce Opioid Use in Outpatient General Surgical Procedures,” is published in the Journal of the American College of Surgeons.

Dr. Ken Leslie	Dr. Luke Hartford	Dr. Patrick Murphy
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Researchers in London, Ontario have been awarded $1.345 million over five years through the second phase of the Canadian Consortium on Neurodegeneration in Aging (CCNA), announced today as part of Canada’s first national dementia strategy. CCNA is a collaborative research program tackling the challenge of dementia and other neurodegenerative illnesses. 

A Dementia Strategy for Canada: Together We Aspire focuses on preventing dementia, advancing therapies and finding a cure, as well as improving quality of life for people living with dementia and caregivers. 

Clinician researchers from across the country working together 

Dr. Manuel Montero-Odasso, Scientist at Lawson Health Research Institute, is world renowned for his findings on the relationship between cognition and mobility in the elderly, and gait as a predictor of frailty and dementia. He leads the Mobility, Exercise and Cognition (MEC) Team in London, comprised of top researchers in the areas of mobility, exercise and brain health.

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“Evidence from other countries with dementia strategies shows that coordinated, targeted efforts at the national level improves results for all aspects of dementia care and also for research,” says Dr. Montero-Odasso, also a geriatrician and Director of the Gait and Brain Lab at Parkwood Institute, a part of St. Joseph’s Health Care London. 

CCNA was purpose-built to synergize dementia research within the Canadian context. Phase I saw the creation of infrastructure fostering collaboration amongst Canadian researchers, and there are now 20 teams built around important research topics. 

“This kind of effective national collaboration by scientists and clinicians from many disciplines gives the CCNA a cutting edge in research, prevention, treatment and management of all forms of dementia,” explains Dr. Montero-ODasso. “We created a national network of researchers form west to east coast with a high level of expertise to deliver lifestyle interventions to improve cognition and slow down progression to dementia. I feel privileged working with such excellent investigators and leading this important endeavour locally.” 

Preventing dementia through lifestyle changes

The MEC team has several projects in the works, but the majority of the new funding is to complete the SYNERGIC Trial, SYNchronizing Exercises and Remedies on Gait and Cognition. 

This first-in-the-world clinical study is testing a triple intervention aimed at treating Mild Cognitive Impairment (MCI) and delaying the onset of dementia. The SYNERGIC Trial incorporates physical exercises and cognitive training, along with vitamin D supplementation to determine the best treatment for improving mobility and cognition. 

“We are looking at how interventions will work together and targeting cognitive decline at its earliest stage – individuals with MIC,” explains Dr. Montero-Odasso. “Both physical and cognitive exercises have shown promising effects for maintaining cognition, while vitamin D deficiency is associated with cognitive decline.” 

A professor at Western University’s Schulich Medicine & Dentistry, Dr. Montero-Odasso partners with researchers from across the city including Dr. Rob Bartha, imaging scientist at Schulich Medicine & Dentistry and Robarts Research Institute at Western University, and Dr. Kevin Schoemaker who leads the Laboratory for Brain and Heart Health. 

Study participants in the SYNERGIC Trial are asked to complete an individualized and progressive routine of exercises and cognitive training three times a week for six months, with one final assessment at 12 months. The main site for the study is Parkwood Institute with the physical exercises taking place at the Labatt Health Sciences Building on the Western campus.

To date, 138 research patients has been recruited across multiple sites in Canada. 

One participant’s experience 

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One day, Peter Saracino saw an advertisement about a research study. They were looking for participants who were a minimum age of 60 and had minor cognitive impairment. He felt he fit the bill and he was interested in this kind of research. 

“I have family members who suffered from forms of dementia and Parkinson’s Disease. I really understand how hard it hits and I liked that this study was about prevention,” explains Peter. 

Going into it, Peter thought he was in pretty good shape. He has two dogs and walks them regularly. “But by going to the gym and doing the exercises and faster-paced walking, I realized that I wasn’t in as good shape as I thought. My diet was under control but I was still taking blood pressure medication. I didn’t have much energy.” 

After 10 weeks in the study, he feels better than he has for over a decade. “I can garden for longer. I took two notches off my belt. I no longer take my blood pressure medication. I actually feel younger.”

He remembered that last year he slipped and fell four times, which was very unusual for him. Part of his cognitive impairment is that he had trouble with balance, and that has improved for him as well. 

Peter feels that “this is exactly the kind of research that the government should be investing in – an ounce of prevention is worth a pound of cure. This kind of research leads to keeping people independent and healthier as they get older. People are happier. They feel like doing more. There is no downside to improving someone’s health through lifestyle changes, and in fact it is cost effective and helps ease the burden on the health care system.” 

Looking forward 

“Our preliminary analysis from SYNERGIC is giving us a strong indication that a multimodal approach, combining physical exercise, cognitive training and supplementation, has a synergistic effect. It seems the whole is greater than the sum of its parts,” says Dr. Montero-Odasso. 

A major goal for the work of the MEC team in London is to translate their research findings into clinical guidelines that can be used at the front line of care. “Practitioners understand the overall importance of exercise and cognitive vitality, but we are missing more specific guidelines on what kind and how much will work for different patients. Basically, what is an effective lifestyle prescription.”

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Dr. Montero-Odasso adds that “as our population ages, a comprehensive strategy is vital to ensure the growing number of those living with dementia receive the care and support they deserve. Over half a million Canadians are currently living with dementia. By 2031, this number is expected to nearly double.” More than one third of dementia cases might be preventable. 

CCNA Phase II

In CCNA’s Phase II, researchers are working on analyzing the overall health of every patient in a large clinical cohort study, COMPASS-ND. This information will be used to enhance understanding of how changes in the brain affect dementia severity and ways to reduce and prevent this through lifestyle changes. Lawson is the leading recruitment site for COMPASS-ND and the London team will be instrumental in the larger lifestyle interventions moving forward. 

CCNA is funded by the Government of Canada, Canadian Institutes of Health Research (CIHR) and other funding partners. CIHR is providing $31.6 million, and partners—including provincial agencies and non-profit organizations—are providing an additional $14.4 million for a total investment of $46 million over five years. The research on dementia prevention, diagnosis, treatment and care as part of Phase II of the CCNA will support the national strategy.

Related stories

• Researchers testing triple intervention to combat dementia 
• Lawson and Western researchers suggest walking and talking can be an early predictor of dementia 
• How changes in the brain affect walking while talking in older adults