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LONDON, ON – In a newly published study, scientists at Lawson Health Research Institute have adapted PET/MRI technology to accurately image salt within the kidneys of patients with kidney disease.  

“Salt is very difficult to image in an MRI because the signal is much weaker than water,” explains Dr. Christopher McIntyre, Lawson Scientist and Nephrologist at London Health Sciences Centre (LHSC). “We wanted to find a way to look at the fundamental role of the kidney in getting rid of salt and water by using a functional MRI.”

Imaging salt within the kidneys has never been accurately accomplished in patients with kidney disease, but Dr. McIntyre and his team developed new technology and software that was adaptable to a PET/MRI machine at St. Joseph’s Health Care London. The new technology allowed the machine to image salt and water levels within the kidney.

“Salt within the kidneys have only been imaged in pre-clinical models, and low weight, healthy volunteers,” says Dr. McIntyre. “Since the kidney is further away from the MRI coils, and the organ moves when a person breathes, it is definitely very hard to image.”

This was the first study to use MRI to look at salt within the kidneys with a wide range of participant with different body types (10 healthy volunteers), as well as patients with kidney disease (five patients). The research team also imaged patients who had a combination of kidney disease and heart failure, because it is especially important for those patients specifically to be able to release salt and water as part of their treatments.

Currently, clinicians rely on kidney biopsies to measure salt levels, but Dr. McIntyre says that method isn’t as accurate or effective as it could be.

 “The problem is that the biopsies are painful, they have risks, and because it is a small sample of the kidney, we don’t get an accurate perspective of the kidney as a whole,” Dr. McIntyre explains. 

The study, which is published in Radiology has now opened the door to new possibilities when it comes to clinical care for patients with kidney disease.

“Salt is very toxic in patients with kidney failure,” adds Dr. McIntyre. “This will now allow us to diagnose and manage both chronic and acute kidney disease. It is a significant step forward.”

The next steps for the research team will be to compare salt MRI’s to biopsies, while also examining potential new therapy developments. 

“We are hoping we will have a higher degree of certainty moving forward to predict what will happen within the kidneys of these patients, with the possibility of using new targeted and effective treatments in the future,” notes Dr. McIntyre.
 

Neurofeedback, also called ‘brain training,’ consists of exercises where individuals regulate their own brain activity. In a new study from Lawson Health Research Institute and Western University, researchers have found that neurofeedback may be an effective treatment for individuals with post-traumatic stress disorder (PTSD). Published in NeuroImage: Clinical, the clinical trial found that neurofeedback was effective in reducing symptoms of PTSD.   

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“Brain connectivity involves different parts of the brain communicating with each other and helps to regulate states of consciousness, thought, mood and emotion,” explains Dr. Ruth Lanius, scientist at Lawson, professor at Western’s Schulich School of Medicine & Dentistry and psychiatrist at London Health Sciences Centre. “Individuals with PTSD tend to have disrupted patterns of brain connectivity, but our research suggests they can exercise their brains to restore patterns to a healthy balance.” 

Neurofeedback uses a system called a neurofeedback loop in which a person’s brain activity is measured through sensors placed on the scalp and displayed back to them using a computer interface. This allows the individual to complete exercises and visually see the results. 

The trial tested neurofeedback with a total of 72 participants, including 36 participants with PTSD and 36 healthy control participants. Of those with PTSD, 18 were randomized to participate in neurofeedback treatment while the other 18 acted as a comparison group.  

The study found that the severity of PTSD symptoms decreased in participants randomized to receive neurofeedback treatment. After treatment, 61.1 per cent of participants no longer met the definition for PTSD. This remission rate is comparable to gold standard therapies like trauma-focused psychotherapy. 

The research team also used functional magnetic resonance imaging (fMRI) at St. Joseph’s Health Care London to capture brain scans of participants both before and after participation in the trial. They found that individuals with PTSD experienced positive changes in brain connectivity in the salience network and the default mode network following neurofeedback treatment.  

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“The salience network is involved in detecting threat as part of the ‘fight or flight’ response. It is normally hyperactive in individuals with PTSD. Meanwhile, the default mode network is activated during rest and is involved in autobiographical memory. We often see that this network is less active during rest and functionally disrupted among individuals with PTSD,” says Dr. Andrew Nicholson, affiliated scientist at Lawson. “Neurofeedback helped restore the functional connectivity of both networks to healthier levels.” Dr. Nicholson is an assistant professor at McMaster University and was formerly a post-doctoral fellow at Schulich Medicine & Dentistry.  

The study involved weekly sessions of neurofeedback over 20 weeks. Participants were asked to reduce the intensity of the brain’s dominant brain wave – the alpha rhythm. Brain activity was visualized as either a still cartoon or a distorted picture. If the alpha rhythm was successfully reduced, the cartoon started moving or the picture started becoming clearer.  

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“Participants were not instructed on how to reduce the alpha rhythm. Rather, each individual figured out their own way to do so,” notes Dr. Lanius. “For example, individuals reported letting their mind wander, thinking about positive things or concentrating their attention.” 

The team notes the treatment could have a number of clinical implications following further validation. 

“Neurofeedback could offer an accessible and effective treatment option for individuals with PTSD,” says Dr. Lanius. “The treatment is easily scalable for implementation in rural areas and even at home.” 

Read more about neurofeedback and the team's research:

• Leveraging technology to diagnose psychiatric disorders
• Solving the mysteries of PTSD

Dr. Gregor Reid, a world-renowned probiotics researcher at Lawson Health Research Institute, can now add the title of movie consultant to his resume. As part of his Fermented Food for Life (FFFL) project, Dr. Reid created a storyline which was made into a feature film titled The Promised Land by producer Charles Liburd. The film is set in Kenya and features the story of two young soccer players who are bullied by older kids. When their mother begins to produce probiotic yogurt their lives begin to improve.

The movie represents an innovative way to showcase the importance of the FFFL project. As a project of the International Development Research Centre, FFFL aims to empower the local production of probiotic yogurt to reach one million people in Eastern Africa. The project is working to create demand for the production of probiotic yogurt which is proven to help boost energy, increase immunity and prevent diarrhea.

“Through our partnership with Western Heads East and Yoba-For-Life, we are working to set up community kitchens where local women and youth produce probiotic yogurt called Fiti and Yoba,” says Dr. Reid, who is also Director for the Canadian Centre for Human Microbiome and Probiotic Research at Lawson, and Professor at Western’s Schulich School of Medicine & Dentistry. “The Fermented Food for Life project helps to enable this by promoting the importance and demand for the yogurt.”

The film, which cost a total of $45,000 to produce, is set in Kenya and features a realistic portrayal of African life and the challenges people face. The film was directed by Owino Sangiewa and produced by Charles Liburd of No Money No Cry Films. Dr. Reid, an avid soccer fan, drafted the film’s storyboard.

“As you walk the streets of Africa, you see many people wearing different versions of football [soccer] shirts. There is a very good player from Kenya named Wanyama who plays for the Spurs which shows that scouts find players in these countries,” says Dr. Reid. “I got the idea of two kids with a talent for the sport. The story shows the challenges of life in this region. The manner in which the mother starts to make a good living is a true reflection of what is happening in hundreds of communities now making probiotic yogurt.”

“I have been working with African filmmakers for some time and it was a joy to be able to work on The Promised Land to promote Yoba-Fiti in such an innovative way. Combining a health message with training and job creation was an ideal way for a small film company to contribute to the community,” says Charles Liburd, producer with No Money No Cry Films. “Film soaks up human capital, and Africa has an enormous youth unemployment problem. By making this film and inspiring young talent we were able to give employment and create opportunities for a number of people. Another offshoot of the Yoba-Fiti project was that we were able to help the young girl, Sheila, who acted in one of the main roles, get into school by obtaining sponsorship. For me, combining all of these things is filmmaking at its best and truest as an art form.”

The film is available in its entirety on YouTube. Dr. Reid also hosted a London, Ontario premiere at St. Joseph’s Hospital in July 2017. The Africa Institute and Western Heads East will be actively promoting the film as a part of their regular activities. 

 

 

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Dr. Reid (above) hosted a premiere for The Promised Land at St. Joseph's Hospital in July 2017.

In June 2016, a public health emergency was declared in London, Ontario when HIV rates amongst injection drug users more than doubled.

What was abnormal about the emergency in London? The outbreak occurred despite London having Canada’s largest per capita sterile needle and syringe distribution program, a strong opiate substitution therapy program and a multidisciplinary HIV clinic. Many locations with outbreaks in HIV among persons who inject drugs implement these interventions to lower rates of transmission, but they already existed in London.

Researchers at Lawson Health Research Institute and Western University recognized there must have been a novel method of HIV transmission and looked to find a solution.

In two new studies published in the Journal of Acquired Immune Deficiency Syndrome (JAIDS), the research team found for the first time that HIV can be transmitted through sharing of equipment used to prepare drugs before injection and that a simple intervention - heating the equipment with a cigarette lighter for 10 seconds – can destroy the HIV virus, preventing the transmission.

From August 2016 to June 2017, the research team interviewed 119 injection drug users to understand their injection behaviours and risk for HIV. They discovered that those who shared equipment used to prepare drugs for injection were 22 times more likely to contract HIV than those who did not, despite not sharing needles or syringes.

The equipment includes a metal ‘cooker’ used to dissolve drugs in water and a filter used to draw the mixture, known as ‘the wash,’ into the syringe. Injection drug users reported reusing the equipment when consuming controlled-release hydromorphone, one of the most commonly injected opioids.

“Controlled-release hydromorphone is expensive and difficult to dissolve. After the first wash, large amounts of the drug remain in the equipment which is then saved, shared or sold for future use,” explains Dr. Sharon Koivu, Associate Scientist at Lawson and Associate Professor at Schulich Medicine & Dentistry. “While people know not to share needles, some use their own needle multiple times allowing for contamination of the equipment.”

The team took their findings back to the research laboratory. They confirmed that, on average, 45 per cent of the drug remains in the equipment after the first wash. They not only confirmed the HIV virus can be transmitted between needles, cookers and filters, but also discovered that controlled-release hydromorphone has properties that promote survival of the virus.

“The slow release properties in the drug can unfortunately stabilize the HIV virus,” says Eric Arts, PhD, Chair of the Department of Microbiology and Immunology at Schulich Medicine & Dentistry. “For the first time, we were able to demonstrate that sharing equipment could lead to the type of HIV outbreak we observed in the community.”

The team discovered that when the cooker is heated with a cigarette lighter for approximately 10 seconds, or until the wash bubbles, the virus is destroyed. They termed the technique ‘cook your wash.’

The team also confirmed that heating the cooker did not impact drug concentration.

“We had to make sure that cooking your wash would not change the amount of drug being drawn into the syringe,” notes Dr. Michael Silverman, Lawson Associate Scientist and Chair/Chief of Infectious Diseases at the Schulich School of Medicine & Dentistry, Western University, London Health Sciences Centre and St. Joseph’s Health Care London. “If too much drug was released, it could lead to overdoses. If any drug was burnt off or lost, the intervention would not be accepted by persons who inject drugs.”

Partnering with local community organizations like the Middlesex-London Health Unit and Regional HIV/AIDS Connection, ‘Cook Your Wash’ was launched as a public health campaign. 

“The ‘Cook Your Wash’ campaign is one of the most exciting things to happen in our community,” says Dr. Koivu. “We learned from persons who inject drugs, took that information to the lab to develop a solution and then brought that solution back to the community in record time.”

Dr. Silverman adds that local rates of new HIV cases fell dramatically after the introduction of the campaign. “It wasn’t the sole reason for the reduction in HIV rates as other interventions were also introduced, but the timing suggests it was part of the solution.”

The team hopes this research can be used to inform understanding and interventions in other centres facing HIV epidemics amongst persons who inject drugs.

“We hope our findings can be used to reduce the incidence of HIV transmissions even further and that, one day, society will be HIV free,” says Dr. Silverman.

The two studies, “Heating Injection Drug Preparation Equipment Used for Opioid Injection May Reduce HIV Transmission Associated with Sharing Equipment” and “Sharing of Injection Drug Preparation Equipment is Associated with HIV Infection: A Cross Sectional Study,” are published in the Journal of Acquired Immune Deficiency Syndrome (JAIDS). 

A first-of-its-kind study led by Lawson Health Research Institute is receiving $1.2 million in funding from the federal government, delivered through the Veteran Homelessness Program, to better understand homelessness amongst women in Canada who are military Veterans.

“This is an important and yet often invisible problem,” says Dr. Cheryl Forchuk, Lawson Assistant Scientific Director based at St. Joseph’s Health Care London’s Parkwood Institute and the study lead. “This is the first Canadian study to focus exclusively on women Veterans’ experience of homelessness. Gender matters, especially when we’re talking about female Veterans who are homeless. If they’ve experienced sexual trauma or abuse or have children, and the only Veteran housing available is a group setting for men, that will be an issue.”

Dr. Forchuk and her team have begun travelling to cities and towns across Canada to conduct interviews with female Veterans experiencing homelessness or who have previously experienced homelessness. They will gather data such as demographics, history of housing and homelessness, and services accessed. The team will also host focus groups with homeless- and Veteran-serving agency staff. The locations have been selected in partnership with The Royal Canadian Legion and other Veteran-serving groups, focusing on areas with pockets of female Veterans experiencing homelessness. 

“We will also explore the pathways and experiences of homelessness, what barriers are faced, what has been helpful and what future services should focus on,” adds Dr. Forchuk.

“This study is a vital step towards addressing the unique challenges faced by female Veterans experiencing homelessness,” says Peter Fragiskatos, Parliamentary Secretary to the Minister of Housing, Infrastructure and Communities and Member of Parliament for London North Centre on behalf of the Honourable Sean Fraser, Minister of Housing, Infrastructure and Communities. “By investing in research like this, we are making significant progress in understanding and improving the support systems for this population, contributing to the federal government's efforts to end homelessness among Veterans.”

“This significant investment reflects our dedication to addressing the issue of homelessness among female Veterans,” says Arielle Kayabaga, Member of Parliament for London West. “By supporting this pioneering study, we aim to uncover the specific barriers they face and develop targeted solutions that honour their service and ensure they receive the support they deserve.”

The goal of the four-year study is to ensure there is accurate data to inform gender-specific interventions and guidelines for policy, practice and care of female Veterans. Canadian Armed Forces Veterans make up a disproportionate percentage of those experiencing homelessness according to a 2018 report.

“It is clear that the circumstances surrounding this particular subset of our Veteran population are not well enough understood,” says Carolyn Hughes, Director of Veterans Services with The Royal Canadian Legion. “It is our hope that this project will help fill in some of those blanks and at the same time, further enlighten all of us who serve Veterans, so that we may provide even more timely and focused assistance when and where it’s needed most.”

St. Joseph’s Parkwood Institute has an embedded legacy of Veterans’ care, having originally been a Veterans’ hospital and now hosting a Veterans’ inpatient centre, the Operational Stress Injury (OSI) Clinic, as well as the MacDonald Franklin OSI Research and Innovation Centre. The research centre is recognized as Canada’s leader in mental health research dedicated to enhancing the lives and wellbeing of military personnel, Veterans and their families. The directors of the centre are co-investigators on the study.

For more information, please contact:    
Debora (Flaherty) Van Brenk 
Communication Consultant
St. Joseph’s Health Care London
C: 226-577-1429 or 519-318-0657
T: 519-646-6100 ext. 42534
@email