Personalizing dialysis

Dr. Amit Garg

Heart attacks and strokes are the leading cause of death among dialysis patients. Lawson scientists Dr. Chris McIntyre, director of the Lilibeth Caberto Kidney Clinical Research Unit at London Health Sciences Centre (LHSC), and Dr. Amit Garg, nephrologist and director of living kidney donation at LHSC, are leading a clinical trial investigating whether personalizing the temperature of dialysis fluid, called dialysate, can protect the heart and brain from injury. Typically, dialysate is set to a temperature of 36.5 ºC to match body temperature. However, body temperature can range from 35.5 to 37.5 °C. Research shows that personalizing the temperature of dialysate to 0.5 ºC below the patient’s body temperature can reduce the frequency of large drops in blood pressure. The study, called My TEMP, will be conducted in all 26 Ontario hemodialysis renal programs, which oversee 84 hemodialysis centres participating in the study and care for more than 7,500 patients.

 

Family environment influences emotional well-being of children with epilepsy

Dr. Shane Goodwin and Dr. Kathy Speechley

Children with epilepsy have a higher risk of developing emotional and behavioural disorders, including depression, anxiety and poor self-esteem, yet it has been difficult to pinpoint why this occurs. Researchers at Children’s Health Research Institute (CHRI), a program of Lawson, studied a group of children aged four to 12 with new-onset epilepsy, investigating factors at the time of diagnosis and their impact on the emotional well-being of the children two years later. They found that clinical factors, such as the type of epilepsy and frequency of seizures, were not associated with emotional well-being. Instead, several family characteristics, including family stresses, functioning and resources, were strongly associated with emotional well-being. The study was led by Dr. Kathy Speechley, chair of the Children’s Health & Therapeutics Division at CHRI, and Dr. Shane Goodwin, who was a PhD candidate in the Department of Epidemiology & Biostatistics at Western University’s Schulich School of Medicine & Dentistry and a trainee at CHRI at the time the study was conducted.

 

Radiation techniques to improve quality of life for lung cancer patients

While palliative radiation therapy is used to ease pain in patients with advanced lung cancer, it often has adverse effects on the esophagus, which leads to symptoms like heartburn and difficulty swallowing. Through the PROACTIVE clinical trial, Lawson scientist Dr. Alexander Louie is testing new palliative radiation techniques to spare these effects on the esophagus and improve quality of life for lung cancer patients. PROACTIVE first launched at the London Regional Cancer Program (LRCP) at London Health Sciences Centre in late 2016. It is now active at multiple centres across Canada. The clinical trial uses more precise radiation techniques to reduce the dosage of radiation to the esophagus or ‘swallowing passage’ with the hope of easing pain, building comfort and allowing for a nutritious diet. PROACTIVE is funded by a Canadian Cancer Society Quality of Life Research Grant. 

 

New test can identify P acnes shoulder infection, a complication of arthroplasty surgery, within 24 hours

Fluorescently labelled human rotator cuff cells infected with P acnes bacteria, which appear red

Propionibacterium acnes (P acnes , or as it has been recently re-named, Cutibacterium acnes) is a type of bacteria typically found deep in the hair follicles and sebaceous pores of the skin. A P acnes infection of the shoulder is a common and serious complication that occurs after arthroplasty (surgery to replace a damaged joint, most commonly with artificial material), which can cause pain in the shoulder joint and often loosens the implant. In most cases, the patient requires additional surgery to remove the infection and replace the implant. It can be difficult to diagnose a P acnes infection as it often presents without symptoms that would be characteristic of an infection, such as pain, skin reddening, or wound drainage. A team of researchers led by Dr. David O’Gorman, Lawson scientist and co-director of Molecular and Cellular Research at the Roth McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London, developed the PCR-RFLP assay, a test which can accurately identify P acnes infection within 24 hours. Current methods take an average of six or more days, and are prone to sample contamination and false-positive results.

 

Preventing family homelessness

From left: Jan Richardson, manager, Homelessness Prevention, City of London; Dr. Cheryl Forchuk, assistant scientific director at Lawson, and professor of Nursing at Western University; Gordon Russell, director of shelters at Mission Services of London; and Peter Rozeluk, executive director at Mission Services of London

Lawson, Western University, the City of London, and Mission Services of London, Ontario, partnered to assess the effectiveness of a shelter diversion pilot-program at Rotholme Women’s and Family Shelter (Mission Services). The Prevention of Homelessness Among Families (PHAF) project showed that a low percentage of families ended up in shelter when accessing the program, and as many as 90 per cent of the families were known to still be housed 18 months later. Rotholme’s shelter diversion program works with families to maintain stable housing prior to eviction. Families at risk of homelessness who contact the shelter before leaving their home are immediately connected with a housing crisis worker. Together, parents and the crisis worker explore alternate housing arrangements, services, and supports. The study was led by Dr. Cheryl Forchuk, Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery at St. Joseph’s Health Care London’s Parkwood Institute.

 

Potential for new glaucoma treatment

From left: Hong Liu, research technician; Venkat Arutla, fourth year undergraduate student working in Dr. Sunil Parapuram’s lab; and Dr. Parapuram, Lawson scientist

Glaucoma is a group of diseases that affect nearly 70 million people worldwide. In some patients with primary open-angle glaucoma, the structure of the trabecular meshwork, a porous tissue in the eye through which the clear fluid that fills the eye drains out, is damaged by fibrosis. Fibrosis is a thickening or scarring of tissue caused by excess matrix molecules, such as collagen, deposited in the trabecular meshwork. This prevents fluid in the eye from draining out normally, which leads to increased pressure in the eye and damage to the optic nerve. A team of Lawson researchers at St. Joseph’s Health Care London led by Dr. Sunil Parapuram found that inactivation of a protein called “phosphatase and tensin homolog” (PTEN) can cause too many matrix molecules to be deposited in the trabecular meshwork, leading to fibrosis. However, when PTEN activity was increased, it reduced the amount of matrix molecules deposited. This means that drugs that can activate PTEN have the potential to be used as a treatment for open-angle glaucoma.

 

Healthy aging and a healthy gut

In one of the largest microbiota studies conducted in humans, researchers at Western University, Lawson and Tianyi Health Science Institute in Zhenjiang, Jiangsu, China, showed a potential link between healthy aging and a healthy gut. With the establishment of the China- Canada Institute, the researchers studied the gut bacteria in a cohort of more than 1,000 Chinese individuals in a variety of age-ranges from three to over 100 years-old who were self-selected to be extremely healthy with no known health issues and no family history of disease. The overall microbiota composition of the healthy elderly group was similar to that of people decades younger, and the gut microbiota differed little between individuals from the ages of 30 to over 100.

 

Brains of patients with schizophrenia have the capacity to reorganize and fight the illness

Schizophrenia has long been considered a degenerative illness with no possibility of a cure. Research led by Dr. Lena Palaniyappan, Lawson scientist and medical director for the Prevention & Early Intervention Program for Psychoses (PEPP) at London Health Sciences Centre, is providing new insights that are challenging this perception. Using imaging data, the team was the first to show that the brains of patients with schizophrenia have the capacity to reorganize and fight the illness. Schizophrenia is an illness generally associated with a widespread reduction in brain tissue volume, but the study found that, given sufficient time, a subtle increase in tissue also occurs in certain brain regions. The project is the result of an international collaboration among scientists in Nottingham, UK; Shanghai and Changsha, China; Lawson; and Robarts Research Institute at Western University.