U of T-Ted Rogers Centre Partnership to 'Make Leaps' in Tech for Heart Failure Care

U of T-Ted Rogers Centre Partnership to 'Make Leaps' in Tech for Heart Failure Care

A new partnership between the University of Toronto and the Ted Rogers Centre for Heart Research seeks to reimagine how high-quality, digital approaches to heart failure can be equitably delivered to all Canadians.  

TRANSFORM HF will build, support and fund a community of multidisciplinary engineers, basic and data scientists, clinicians and health experts to develop solutions that will help monitor and proactively treat people with heart failure in their own homes and empower them toward greater self-care.  

New therapies are dramatically improving quality of life and survival in heart failure, and technology is capable of changing how the disease is managed, says Heather Ross, a professor in the Temerty Faculty of Medicine and scientific lead at the Ted Rogers Centre. 

“Unfortunately, these therapies and approaches are underutilized and inaccessible to a lot of Canadians. Our goal is to unite the right people in devising new medical and artificial intelligence technologies that will achieve equitable access to high-level care across our country’s vast geography.”  

Heart failure affects at least one million Canadians, statistics show. Nine out of 10 die within 10 years, having experienced a reduced quality of life, frequent lengthy hospital stays, and chronic disruptions to jobs, relationships and family life.  

Ross is co-leading TRANSFORM-HF with Craig Simmons, a professor in the department of mechanical and industrial engineering in the Faculty of Applied Science & Engineering and the Institute for Biomedical Engineering.

“We will bring together the vast amount of technology developed at the University of Toronto and deploy it in new ways,” says Simmons, who is also a Ted Rogers Centre scientific lead and director of the Translational Biology and Engineering Program. “Our engineers and scientists will help our clinical partners deliver expert care to remote locations and perform continuous monitoring to keep people with heart failure safe.”  

He says some of these innovations, including biosensors and remote monitoring tools, already exist, while others will be co-designed by experts in different fields, and by patients themselves.  

“Technology is often developed in a bubble, so for our engineers and scientists to collaborate with patients on design will change everything,” says Simmons. “The ability to interact with end users early will help us create solutions that work more quickly and more smoothly.” 

“In medicine we must do things with patients, not to patients,” adds Ross. “They are the ones who will use these technologies. They can tell us if our ideas make sense, or how they can be tweaked.”  

A key goal of the program is to build user-centered technology that can be adapted by any patient, in any environment, with any specific need.  

The TRANSFORM HF team will devise a new era of biosensors that can be packaged and used by Canadians in any community. These include wearable sensors built into fabric – socks, patches, vests – that monitor clinically relevant vitals like heart rate, blood pressure, breathing patterns and fluid accumulation. They may include a mobile app that makes use of a special camera to assess blood flow below the skin, and tech that syncs with consumer products like the Apple Watch or Fitbit.  

Simmons says the team will also conceive new ways of bringing diagnostics that are done in the lab to people’s homes.

“Patients often have to travel for them and wait days for results,” he says. “What if we could give them a small device that, for instance, takes a pinprick of blood, runs a test and produces results in 15 minutes? These microtechnologies already exist, but they haven’t been engineered to specifically focus on markers important for heart failure.” 

Such innovations can yield oceans of data, which may hold new signals that reveal the state of someone’s heart failure or the risk of it worsening. The machine learning component of TRANSFORM HF is about creating algorithms that can predict someone’s risk of hospitalization, and enabling clinicians to intervene early to help keep that person in a stable condition. 

TRANSFORM HF plans on training graduate students, scientists and clinicians across disciplines, beyond the lab and in communities and homes where their innovations are to be used.  

“An immersive training experience allows our students to see first-hand what the constraints are, what power is available, what internet connectivity is like, and who the people are that they are designing technology for,” says Simmons. “New innovations will be set up to make a true difference in people’s lives.”  

This training also includes commercialization, as students and fellows will explore entrepreneurship and vital aspects of translating technology such as regulatory rules. 

All of this will rely on brand new partnerships with patients and communities at all stages of development.   

“This is a special opportunity to co-create and test new inventions in a collaborative sandbox, and I expect it to build into a long-term funding model to create a pipeline of innovations in the heart failure space,” Simmons says.  

“For decades, we’ve watched heart failure care evolve incrementally,” says Ross. “But with all stakeholders working together, we will generate ideas that allow for transformative changes in how we manage this complex disease.

“Instead of taking steps we can make leaps.” 

A new partnership between the University of Toronto and the Ted Rogers Centre for Heart Research seeks to reimagine how high-quality, digital approaches to heart failure can be equitably delivered to all Canadians.  

TRANSFORM HF will build, support and fund a community of multidisciplinary engineers, basic and data scientists, clinicians and health experts to develop solutions that will help monitor and proactively treat people with heart failure in their own homes and empower them toward greater self-care.  

New therapies are dramatically improving quality of life and survival in heart failure, and technology is capable of changing how the disease is managed, says Heather Ross, a professor in the Temerty Faculty of Medicine and scientific lead at the Ted Rogers Centre. 

“Unfortunately, these therapies and approaches are underutilized and inaccessible to a lot of Canadians. Our goal is to unite the right people in devising new medical and artificial intelligence technologies that will achieve equitable access to high-level care across our country’s vast geography.”  

Heart failure affects at least one million Canadians, statistics show. Nine out of 10 die within 10 years, having experienced a reduced quality of life, frequent lengthy hospital stays, and chronic disruptions to jobs, relationships and family life.  

Ross is co-leading TRANSFORM-HF with Craig Simmons, a professor in the department of mechanical and industrial engineering in the Faculty of Applied Science & Engineering and the Institute for Biomedical Engineering.

“We will bring together the vast amount of technology developed at the University of Toronto and deploy it in new ways,” says Simmons, who is also a Ted Rogers Centre scientific lead and director of the Translational Biology and Engineering Program. “Our engineers and scientists will help our clinical partners deliver expert care to remote locations and perform continuous monitoring to keep people with heart failure safe.”  

He says some of these innovations, including biosensors and remote monitoring tools, already exist, while others will be co-designed by experts in different fields, and by patients themselves.  

“Technology is often developed in a bubble, so for our engineers and scientists to collaborate with patients on design will change everything,” says Simmons. “The ability to interact with end users early will help us create solutions that work more quickly and more smoothly.” 

“In medicine we must do things with patients, not to patients,” adds Ross. “They are the ones who will use these technologies. They can tell us if our ideas make sense, or how they can be tweaked.”  

A key goal of the program is to build user-centered technology that can be adapted by any patient, in any environment, with any specific need.  

The TRANSFORM HF team will devise a new era of biosensors that can be packaged and used by Canadians in any community. These include wearable sensors built into fabric – socks, patches, vests – that monitor clinically relevant vitals like heart rate, blood pressure, breathing patterns and fluid accumulation. They may include a mobile app that makes use of a special camera to assess blood flow below the skin, and tech that syncs with consumer products like the Apple Watch or Fitbit.  

Simmons says the team will also conceive new ways of bringing diagnostics that are done in the lab to people’s homes.

“Patients often have to travel for them and wait days for results,” he says. “What if we could give them a small device that, for instance, takes a pinprick of blood, runs a test and produces results in 15 minutes? These microtechnologies already exist, but they haven’t been engineered to specifically focus on markers important for heart failure.” 

Such innovations can yield oceans of data, which may hold new signals that reveal the state of someone’s heart failure or the risk of it worsening. The machine learning component of TRANSFORM HF is about creating algorithms that can predict someone’s risk of hospitalization, and enabling clinicians to intervene early to help keep that person in a stable condition. 

TRANSFORM HF plans on training graduate students, scientists and clinicians across disciplines, beyond the lab and in communities and homes where their innovations are to be used.  

“An immersive training experience allows our students to see first-hand what the constraints are, what power is available, what internet connectivity is like, and who the people are that they are designing technology for,” says Simmons. “New innovations will be set up to make a true difference in people’s lives.”  

This training also includes commercialization, as students and fellows will explore entrepreneurship and vital aspects of translating technology such as regulatory rules. 

All of this will rely on brand new partnerships with patients and communities at all stages of development.   

“This is a special opportunity to co-create and test new inventions in a collaborative sandbox, and I expect it to build into a long-term funding model to create a pipeline of innovations in the heart failure space,” Simmons says.  

“For decades, we’ve watched heart failure care evolve incrementally,” says Ross. “But with all stakeholders working together, we will generate ideas that allow for transformative changes in how we manage this complex disease.

“Instead of taking steps we can make leaps.” 

U of T-Ted Rogers Centre Partnership to 'Make Leaps' in Tech for Heart Failure Care
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Researchers Grow Mini-Organs to Study Brain Development and Disease

Researchers Grow Mini-Organs to Study Brain Development and Disease

“Organoids.”

It’s a word that has a science-fiction sound to it, but, in fact, organoids are at the core of what scientist Jeff Wrana calls “revolutionizing biology.”

That’s because organoids offer the promise of new treatments for a host of diseases and conditions, from inflammatory bowel disease to autism spectrum disorder.

“An organoid is a little organ that we can create using human and mouse embryonic stem cells,” says Wrana, a professor in the department of molecular genetics in the University of Toronto’s Temerty Faculty of Medicine and a senior investigator at Mount Sinai Hospital’s Lunenfeld-Tanenbaum Research Institute. “They provide an opportunity to make tiny models of the intestines, liver and kidneys. Our team’s focus now is making cerebral organoids, which are models of parts of the brain.”

The organoids are not “mini-brains,” however, because they are only tiny pieces of tissue that don’t have anywhere near the complexity of even a mouse brain. These are not brains that can think or have consciousness. But these models are offering powerful ways to study disease.

Doing this sophisticated work requires a top-flight team with a wide range of expertise: Like Wrana, Laurence Pelletier is also a senior investigator at the Lunenfeld-Tanenbaum Research Institute and a U of T professor of molecular genetics; Liliana Attisano is a professor in U of T’s department of biochemistry and Canada Research Chair in Signalling Networks in Cancer; Ben Blencowe is a U of T molecular genetics professor and the Banbury Chair in Medical Research; and Sidhartha Goyal is a professor in U of T’s department of physics in the Faculty of Arts & Science. Attisano and Blencowe are also scientists at U of T’s Donnelly Centre for Cellular and Biomolecular Research.

The team is one of 11 sharing nearly $21 million in funding from Medicine by Design over three years. Funded by a $114-million grant from the Canada First Research Excellence Fund, Medicine by Design is a strategic research initiative that is working at the convergence of engineering, medicine and science to catalyze transformative discoveries in regenerative medicine and accelerate them toward clinical impact.

Wrana and his colleagues have already done important work using organoids to study how cancer starts and how the intestines can regenerate after injury.

Now focusing on the brain, the team will use organoids to examine how the tissue in the brain develops. A key part of this process is a complex phenomenon called splicing that starts with the genes. It’s an essential part of development. It is responsible for ensuring that segments of genes, referred to as exons, are precisely joined to make RNA transcripts that can direct the production of proteins, the key building blocks of all cells. Importantly, the process of alternative splicing, whereby exons are joined in different combinations to generate multiple protein products from a single gene, is critical for the development of complex organs such as the brain.

Blencowe and his collaborators showed previously that there is a link between autism and abnormal alternative splicing of very short exons, called microexons, which are found primarily in the brain. These microexons are either spliced in or left out of the final gene transcript before it directs protein synthesis. Microexons can have a dramatic effect on a protein’s ability to bind its partners, which is required during brain development. This was an important finding, but researchers didn’t understand the role of individual microexons until recently.

In January 2020, Blencowe and his team published a paper in the journal Molecular Cell that characterized the function of a single microexon that is frequently skipped in transcripts in the brains of people with autism.

The researchers showed that mice engineered to lack the microexon displayed behaviours related to those seen in autism, such as avoidance of social interactions. The mice also performed poorly in a learning and memory test.

Now Blencowe, working with Wrana’s Medicine by Design-funded research team, will be able to investigate this process further using the human brain model provided through the organoids the team is creating.

“We will be able to model how neural tissues develop with the organoid,” says Wrana. “And, remember, since we are using human stem cells, we will be creating human models of disease and conditions like autism. Using mice is certainly helpful, but a mouse model can’t recapitulate all the aspects of a human disease. We think that using human models will bring us unique insight because there are human-specific aspects to many of these signaling networks.”

Blencowe says this investigation could ultimately lead to important new therapeutic approaches for people with autism. One possibility is increasing the activity of a regulator of microexon splicing using small molecules. An organoid model under development by Wrana’s group will provide a valuable initial test of the efficacy of this approach.

But to do a more complete range of brain research, Wrana’s team ran up against a big problem: they couldn’t get the organoids to grow blood vessels.

“If we’re going to do our work to the full extent, we need these models to include other types of cells typically found in the brain. And blood vessels are essential.”

Fortunately, they discovered a way to get something very much like blood vessels into the models by using microfluidic devices.

“It’s like a little pump where we can implant organoids in these devices. The device pumps nutrient solutions around the organoid. The solution isn’t true blood, but it mimics blood. And that will stimulate the formulation of blood vessels in the device. Those blood vessels will actually support organoid growth.”

Wrana says the development of this device is a major step forward because it will enable the team to examine conditions like stroke. The project will also develop tools to help the development of safer and more efficient drugs and improved strategies to treat stroke.

“You can take the microfluidic device and put in little beads. The beads will get taken up into the blood vessels. As they move towards the organoid brain model, the blood vessels get smaller and smaller. And at some point, these beads will actually clog the blood vessel. So we think this can be a model for stroke. We can induce a stroke-like event and look for the earliest changes that occur in a human system when a stroke happens and that will help in the development of drugs to prevent and treat stroke.”

The vascularized brain model will also enable the researchers to examine the inner workings of the blood-brain barrier that protects the brain from pathogens and toxins.

“This is a big question in drug development,” says Wrana. “You want some drugs to penetrate this barrier to treat diseases that affect the brain, such as multiple sclerosis. But there are other drugs that you don’t want to get into the neural tissue because they could damage the brain. So, this organoid model could potentially allow us to measure if drugs can penetrate the human blood-brain barrier, because the human blood-brain barrier isn’t exactly the same as those in animals like mice.”

Wrana says this kind of adventurous research wouldn’t be possible without the support of Medicine by Design.

“Our work would never be funded through traditional grant funding mechanisms, which tend to be more conservative. Medicine by Design allows you to think about possibilities and then actually try to do the pie-in-the-sky experiment. For example, developing our microfluidic device is not something you could propose to do in a standard grant platform, which would have required preliminary data. We probably wouldn’t get the funding until we had actually produced the device. But Medicine by Design has supported us in these more speculative ideas. That’s really been transformative for our research program. “

With files from Jovana Drinjakovic

“Organoids.”

It’s a word that has a science-fiction sound to it, but, in fact, organoids are at the core of what scientist Jeff Wrana calls “revolutionizing biology.”

That’s because organoids offer the promise of new treatments for a host of diseases and conditions, from inflammatory bowel disease to autism spectrum disorder.

“An organoid is a little organ that we can create using human and mouse embryonic stem cells,” says Wrana, a professor in the department of molecular genetics in the University of Toronto’s Temerty Faculty of Medicine and a senior investigator at Mount Sinai Hospital’s Lunenfeld-Tanenbaum Research Institute. “They provide an opportunity to make tiny models of the intestines, liver and kidneys. Our team’s focus now is making cerebral organoids, which are models of parts of the brain.”

The organoids are not “mini-brains,” however, because they are only tiny pieces of tissue that don’t have anywhere near the complexity of even a mouse brain. These are not brains that can think or have consciousness. But these models are offering powerful ways to study disease.

Doing this sophisticated work requires a top-flight team with a wide range of expertise: Like Wrana, Laurence Pelletier is also a senior investigator at the Lunenfeld-Tanenbaum Research Institute and a U of T professor of molecular genetics; Liliana Attisano is a professor in U of T’s department of biochemistry and Canada Research Chair in Signalling Networks in Cancer; Ben Blencowe is a U of T molecular genetics professor and the Banbury Chair in Medical Research; and Sidhartha Goyal is a professor in U of T’s department of physics in the Faculty of Arts & Science. Attisano and Blencowe are also scientists at U of T’s Donnelly Centre for Cellular and Biomolecular Research.

The team is one of 11 sharing nearly $21 million in funding from Medicine by Design over three years. Funded by a $114-million grant from the Canada First Research Excellence Fund, Medicine by Design is a strategic research initiative that is working at the convergence of engineering, medicine and science to catalyze transformative discoveries in regenerative medicine and accelerate them toward clinical impact.

Wrana and his colleagues have already done important work using organoids to study how cancer starts and how the intestines can regenerate after injury.

Now focusing on the brain, the team will use organoids to examine how the tissue in the brain develops. A key part of this process is a complex phenomenon called splicing that starts with the genes. It’s an essential part of development. It is responsible for ensuring that segments of genes, referred to as exons, are precisely joined to make RNA transcripts that can direct the production of proteins, the key building blocks of all cells. Importantly, the process of alternative splicing, whereby exons are joined in different combinations to generate multiple protein products from a single gene, is critical for the development of complex organs such as the brain.

Blencowe and his collaborators showed previously that there is a link between autism and abnormal alternative splicing of very short exons, called microexons, which are found primarily in the brain. These microexons are either spliced in or left out of the final gene transcript before it directs protein synthesis. Microexons can have a dramatic effect on a protein’s ability to bind its partners, which is required during brain development. This was an important finding, but researchers didn’t understand the role of individual microexons until recently.

In January 2020, Blencowe and his team published a paper in the journal Molecular Cell that characterized the function of a single microexon that is frequently skipped in transcripts in the brains of people with autism.

The researchers showed that mice engineered to lack the microexon displayed behaviours related to those seen in autism, such as avoidance of social interactions. The mice also performed poorly in a learning and memory test.

Now Blencowe, working with Wrana’s Medicine by Design-funded research team, will be able to investigate this process further using the human brain model provided through the organoids the team is creating.

“We will be able to model how neural tissues develop with the organoid,” says Wrana. “And, remember, since we are using human stem cells, we will be creating human models of disease and conditions like autism. Using mice is certainly helpful, but a mouse model can’t recapitulate all the aspects of a human disease. We think that using human models will bring us unique insight because there are human-specific aspects to many of these signaling networks.”

Blencowe says this investigation could ultimately lead to important new therapeutic approaches for people with autism. One possibility is increasing the activity of a regulator of microexon splicing using small molecules. An organoid model under development by Wrana’s group will provide a valuable initial test of the efficacy of this approach.

But to do a more complete range of brain research, Wrana’s team ran up against a big problem: they couldn’t get the organoids to grow blood vessels.

“If we’re going to do our work to the full extent, we need these models to include other types of cells typically found in the brain. And blood vessels are essential.”

Fortunately, they discovered a way to get something very much like blood vessels into the models by using microfluidic devices.

“It’s like a little pump where we can implant organoids in these devices. The device pumps nutrient solutions around the organoid. The solution isn’t true blood, but it mimics blood. And that will stimulate the formulation of blood vessels in the device. Those blood vessels will actually support organoid growth.”

Wrana says the development of this device is a major step forward because it will enable the team to examine conditions like stroke. The project will also develop tools to help the development of safer and more efficient drugs and improved strategies to treat stroke.

“You can take the microfluidic device and put in little beads. The beads will get taken up into the blood vessels. As they move towards the organoid brain model, the blood vessels get smaller and smaller. And at some point, these beads will actually clog the blood vessel. So we think this can be a model for stroke. We can induce a stroke-like event and look for the earliest changes that occur in a human system when a stroke happens and that will help in the development of drugs to prevent and treat stroke.”

The vascularized brain model will also enable the researchers to examine the inner workings of the blood-brain barrier that protects the brain from pathogens and toxins.

“This is a big question in drug development,” says Wrana. “You want some drugs to penetrate this barrier to treat diseases that affect the brain, such as multiple sclerosis. But there are other drugs that you don’t want to get into the neural tissue because they could damage the brain. So, this organoid model could potentially allow us to measure if drugs can penetrate the human blood-brain barrier, because the human blood-brain barrier isn’t exactly the same as those in animals like mice.”

Wrana says this kind of adventurous research wouldn’t be possible without the support of Medicine by Design.

“Our work would never be funded through traditional grant funding mechanisms, which tend to be more conservative. Medicine by Design allows you to think about possibilities and then actually try to do the pie-in-the-sky experiment. For example, developing our microfluidic device is not something you could propose to do in a standard grant platform, which would have required preliminary data. We probably wouldn’t get the funding until we had actually produced the device. But Medicine by Design has supported us in these more speculative ideas. That’s really been transformative for our research program. “

With files from Jovana Drinjakovic

Researchers Grow Mini-Organs to Study Brain Development and Disease
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Breast cancer care technology developed by U of T alumni enters North American health care market

Breast cancer care technology developed by U of T alumni enters North American health care market

Tiny new technology with a U of T connection is set to make a big difference in breast cancer care.

MOLLI Surgical, a company co-founded by Temerty Medicine alumnus and now professor Ananth Ravi and U of T alumna Fazila Seker (B.Sc. 1994), recently entered the U.S. healthcare market with a new magnet-based technology for locating tumours within the breast. The technique results in less pain for patients, more accuracy for surgeons, and a streamlined care approach that could reduce surgery backlogs caused by the COVID-19 pandemic.

Seker, MOLLI president and chief executive officer, launched the company in 2018 with Ravi, a medical physicist who was then working at Sunnybrook Health Sciences Centre, one of the University of Toronto’s affiliated hospitals. Three years later, the technology has been cleared by the U.S. Food and Drug Administration and licensed by Health Canada for sale in North America

“What we set out to do is to really simplify healthcare so that more patients can get the care that they need quickly,” Seker says.

Ravi, who has since left Sunnybrook to take on the role of chief science and clinical officer with MOLLI, says the inspiration for the invention came about during a casual conversation at a barbecue with a surgeon who wanted a less invasive, more accurate way to locate lesions within the breast.

“Improvements in screening and imaging technology allow care teams to spot smaller and smaller tumours, even before they’re palpable,” says Ravi. “But the way surgeons take out these tumours remains the same. They can’t rely on touch alone to identify where it is.”

Breast cancer care teams currently rely on “hook wires” to mark the location of tumours for surgical excision. The procedure, described by patients as “traumatic and painful,” is done on the day of surgery and involves inserting a wire into the breast to mark the tumour location. Patients then wait at the hospital for their surgery appointment, often for hours, with a protruding wire that is painful and can be dislodged by catching on clothing, leading to inaccurate surgical outcomes.

LESS PAIN, BETTER ACCURACY

MOLLI technology implants a tiny sesame seed-sized magnet in the breast to mark the location of the tumour. Care teams then use the MOLLI wand and special tablet technology to locate the tumour for removal.

The less invasive procedure pinpoints lesions with greater accuracy, allowing surgeons to remove tumours in their entirety with better cosmetic outcomes for the patient.

Unlike the hook wire, the MOLLI magnet can be implanted up to 30 days before surgery.

“MOLLI is fully implanted, so there’s no needless waiting at the hospital, which is required with the wire,” says Seker.

Cutting down on time spent in hospital is especially important during COVID-19, when patients fear of exposure may cause them to delay treatment.

STREAMLINING BREAST CANCER CARE

The technology also helps to streamline the process for care teams. Ravi likens the care team, comprised of radiology, pathology, and surgery, to a three-legged stool. If something goes wrong with one leg, like an unexpected delay, the whole structure is set off balance.

Because the MOLLI magnet can be inserted up to 30 days prior to surgery, each part of the care team can do their work individually without having to coordinate schedules or patient transfer within the hospital.

“It improves capacity and takes a load off communication between the different disciplines, allowing them to focus their care and attention on the patient experience, instead of managing administrative tasks,” says Ravi.

Seker and Ravi note that the MOLLI system could help clear pandemic-related surgery backlogs faster than using traditional procedures. Studies have shown that similar “decoupling” can increase operational capacity by up to 34 per cent.

“During COVID-19, anything you can do to improve operational efficiency and reduce stress placed on staff teams is something we should look forward to,” he says.

“A TAILORED SOLUTION”

MOLLI launched after a meeting between Ravi and Seker to discuss the promising new technology. Seker, who was then director of venture development, medical devices with MaRS Innovation, thought the idea had great potential.

“It wasn’t technology in search of a problem,” she says. “It was a tailored solution to a well-defined clinical problem.”

“Toronto is a hotbed of medical device innovation and working within the constraints of the Canadian healthcare system drives cost-effective designs in the industry,” she continues. “That’s a real need with the rising cost of healthcare.”

Canadian philanthropist and entrepreneur James Temerty also saw potential in the technology and came aboard as an early investor when the company launched in 2018.

CONNECTED TO U of T

Seker, who is an alumna of U of T’s chemical physics program, says her time at U of T helped to prepare her for this career path.

“Chemical physics helped me develop the critical thinking skills and the ability to navigate tough problems and questions,” she says. “It was a terrific foundation for what I’ve been able to do since then.”

Ravi, also an alumnus (BASc 2004, PhD 2009), began his education as an undergrad with U of T’s engineering science program. A co-op placement with Sunnybrook pulled him towards biomedical engineering, leading him to a PhD in medical biophysics and residency in medical physics.

“The profession is one where you can innovate and develop new things that have a profound and immediate impact on patient care,” he says. “MOLLI is an extension of that.”

“The U of T ecosystem is wonderful for innovation and translation of cutting-edge technology into clinical practice and commercialization,” he continues. “It connects people with disparate disciplines to collaboratively work together with engineers and technical teams to build a device that addresses a very particular need.”

While MOLLI was designed initially for breast cancer care, Seker is excited about the potential for broader use of the device. “MOLLI is a finding technology,” she says. “It’s not restricted to breast or oncology uses, but any general surgery application.”

Tiny new technology with a U of T connection is set to make a big difference in breast cancer care.

MOLLI Surgical, a company co-founded by Temerty Medicine alumnus and now professor Ananth Ravi and U of T alumna Fazila Seker (B.Sc. 1994), recently entered the U.S. healthcare market with a new magnet-based technology for locating tumours within the breast. The technique results in less pain for patients, more accuracy for surgeons, and a streamlined care approach that could reduce surgery backlogs caused by the COVID-19 pandemic.

Seker, MOLLI president and chief executive officer, launched the company in 2018 with Ravi, a medical physicist who was then working at Sunnybrook Health Sciences Centre, one of the University of Toronto’s affiliated hospitals. Three years later, the technology has been cleared by the U.S. Food and Drug Administration and licensed by Health Canada for sale in North America

“What we set out to do is to really simplify healthcare so that more patients can get the care that they need quickly,” Seker says.

Ravi, who has since left Sunnybrook to take on the role of chief science and clinical officer with MOLLI, says the inspiration for the invention came about during a casual conversation at a barbecue with a surgeon who wanted a less invasive, more accurate way to locate lesions within the breast.

“Improvements in screening and imaging technology allow care teams to spot smaller and smaller tumours, even before they’re palpable,” says Ravi. “But the way surgeons take out these tumours remains the same. They can’t rely on touch alone to identify where it is.”

Breast cancer care teams currently rely on “hook wires” to mark the location of tumours for surgical excision. The procedure, described by patients as “traumatic and painful,” is done on the day of surgery and involves inserting a wire into the breast to mark the tumour location. Patients then wait at the hospital for their surgery appointment, often for hours, with a protruding wire that is painful and can be dislodged by catching on clothing, leading to inaccurate surgical outcomes.

LESS PAIN, BETTER ACCURACY

MOLLI technology implants a tiny sesame seed-sized magnet in the breast to mark the location of the tumour. Care teams then use the MOLLI wand and special tablet technology to locate the tumour for removal.

The less invasive procedure pinpoints lesions with greater accuracy, allowing surgeons to remove tumours in their entirety with better cosmetic outcomes for the patient.

Unlike the hook wire, the MOLLI magnet can be implanted up to 30 days before surgery.

“MOLLI is fully implanted, so there’s no needless waiting at the hospital, which is required with the wire,” says Seker.

Cutting down on time spent in hospital is especially important during COVID-19, when patients fear of exposure may cause them to delay treatment.

STREAMLINING BREAST CANCER CARE

The technology also helps to streamline the process for care teams. Ravi likens the care team, comprised of radiology, pathology, and surgery, to a three-legged stool. If something goes wrong with one leg, like an unexpected delay, the whole structure is set off balance.

Because the MOLLI magnet can be inserted up to 30 days prior to surgery, each part of the care team can do their work individually without having to coordinate schedules or patient transfer within the hospital.

“It improves capacity and takes a load off communication between the different disciplines, allowing them to focus their care and attention on the patient experience, instead of managing administrative tasks,” says Ravi.

Seker and Ravi note that the MOLLI system could help clear pandemic-related surgery backlogs faster than using traditional procedures. Studies have shown that similar “decoupling” can increase operational capacity by up to 34 per cent.

“During COVID-19, anything you can do to improve operational efficiency and reduce stress placed on staff teams is something we should look forward to,” he says.

“A TAILORED SOLUTION”

MOLLI launched after a meeting between Ravi and Seker to discuss the promising new technology. Seker, who was then director of venture development, medical devices with MaRS Innovation, thought the idea had great potential.

“It wasn’t technology in search of a problem,” she says. “It was a tailored solution to a well-defined clinical problem.”

“Toronto is a hotbed of medical device innovation and working within the constraints of the Canadian healthcare system drives cost-effective designs in the industry,” she continues. “That’s a real need with the rising cost of healthcare.”

Canadian philanthropist and entrepreneur James Temerty also saw potential in the technology and came aboard as an early investor when the company launched in 2018.

CONNECTED TO U of T

Seker, who is an alumna of U of T’s chemical physics program, says her time at U of T helped to prepare her for this career path.

“Chemical physics helped me develop the critical thinking skills and the ability to navigate tough problems and questions,” she says. “It was a terrific foundation for what I’ve been able to do since then.”

Ravi, also an alumnus (BASc 2004, PhD 2009), began his education as an undergrad with U of T’s engineering science program. A co-op placement with Sunnybrook pulled him towards biomedical engineering, leading him to a PhD in medical biophysics and residency in medical physics.

“The profession is one where you can innovate and develop new things that have a profound and immediate impact on patient care,” he says. “MOLLI is an extension of that.”

“The U of T ecosystem is wonderful for innovation and translation of cutting-edge technology into clinical practice and commercialization,” he continues. “It connects people with disparate disciplines to collaboratively work together with engineers and technical teams to build a device that addresses a very particular need.”

While MOLLI was designed initially for breast cancer care, Seker is excited about the potential for broader use of the device. “MOLLI is a finding technology,” she says. “It’s not restricted to breast or oncology uses, but any general surgery application.”

Breast cancer care technology developed by U of T alumni enters North American health care market
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Grand Questions: Medicine by Design Invests $3 Million in the Future of Regenerative Medicine

Grand Questions: Medicine by Design Invests $3 Million in the Future of Regenerative Medicine

Treating heart failure without transplant surgery. Delivering powerful cell therapies to patients where they live – no matter how remote. Recording how cells talk to one another in the body to personalize future therapies.

These are just some of the transformative advances the University of Toronto’s Medicine by Design initiative hopes to enable through its Grand Questions Program, which is investing $3 million to prepare for the future of regenerative medicine.

The four multi-disciplinary teams from U of T and its partner hospitals that will undertake the research were recently announced during a launch event.

“The Grand Questions we posed are not safe or easy to address,” says Michael Sefton, executive director of Medicine by Design and a University Professor in the department of chemical engineering and applied chemistry in the Faculty of Applied Science & Engineering and the Institute of Biomedical Engineering. “Our ambition for the Grand Questions Program is to set the agenda for regenerative medicine for years to come and improve health outcomes for people living with degenerative diseases. To achieve that, we need to go beyond the obvious and provoke new ways to think about these problems.”

The Grand Questions Program is the culmination of more than a year of work that began with community consultations, a widely attended workshop in spring 2020 and engagement with Medicine by Design’s scientific advisory board to define the questions to be explored.

“The Grand Questions Program began with ‘pooling the imagination’ of the community, exploiting the wealth of disciplines of our researchers and having a conversation about how we would collectively prepare for the future,” says Sefton.

Through community consensus, six questions emerged that were deemed to be of paramount importance to regenerative medicine. An initial call for proposals resulted in eight teams being shortlisted to submit detailed proposals.

“We admire the bravery of all those who applied,” Sefton says. “All four of the funded projects are risky and we do not expect their projects to lead in a straight line to a successful outcome. But that is exactly what is required to move regenerative medicine forward.”

Can we create technologies that track cells?

Alison McGuigan, who leads one of the projects, says the program pushed her and her team to think of concepts they might not have thought about otherwise.

“Going through the Grand Questions process was disorienting – in a good way,” says McGuigan, who is a professor in the department of chemical engineering and applied chemistry in the Faculty of Applied Science & Engineering and the Institute of Biomedical Engineering. “It was such an interesting way to think of a problem: The Grand Questions Program sets goals and then asks us to think about how we could use our skill sets, in combination with those of others in the community, to address that problem.”

McGuigan adds, “Normally, research funding is for a further extension of what I’m already doing. Grand Questions allowed me to look at what I was doing and ask myself how I could apply it in a new, ambitious way.”

McGuigan’s project focuses on recording cell history. Her team is finding ways to record cells’ communications with other cells, also known as signalling. To make cell therapies work, researchers need to understand not only how cells function on their own, but also how interactions with neighbouring cells and the environment affect what they do.

The technology McGuigan and her team are proposing resembles a “contact tracing app” for cells that can measure very specific inputs and outputs from cells. Through its work, the team envisions being able to precisely program how a cell interacts with the environment where a cell therapy is taking place, dramatically increasing the effectiveness of therapy. In time, this research could also lead to therapies being personalized to individuals.

“Our project brings synthetic biology, molecular engineering, machine learning and other disciplines together,” McGuigan says. “Grand Questions gives us a chance to form collaborations that will outlast the two year-funding period and keep solidifying and growing.”

How can we make regenerative medicine accessible to everyone?

Keith Pardee and his team want to make regenerative medicine affordable and accessible to everyone.

“Regenerative medicine currently requires specialized skills and expensive labs and equipment,” says Pardee, who is an assistant professor in the Leslie Dan Faculty of Pharmacy. “To make cell therapies available in every community – not just urban and well-resourced ones – is an important ethical challenge we need to address.”

Pardee’s project will focus on laying the groundwork to one day make the cell manufacturing that normally takes place in complex manufacturing facilities available in a sealed cartridge – effectively creating portable cell manufacturing systems. This means the process of making cell therapies could be done outside of major centres and would no longer require specialized skills, allowing on-demand manufacturing for cell therapies.

The project leverages multiple technologies and approaches, including nanotechnology, synthetic biology, microfluidics and cell analytics – some of which are already running in the labs of U of T investigators – and combines them into a novel approach.

“In an ideal scenario, patients would come in for an outpatient procedure for cell collection and then either receive their custom cell therapy the same day or within a week,” Pardee says. “This is a tall order, but enabling the vision of bedside cell therapy is what is needed to solve the challenge of accessibility and affordability of these potentially life-saving cancer therapies. The Grand Questions program is an exciting opportunity to do just that: take on big needs and set a course toward solving the problem.”

Can we make tissues that perform better than nature?

Michael Garton, another of the project leads, says the Grand Questions proposal gave him an opportunity to expand his collaborations given that the program includes international experts who act as key advisers to the funded teams.

“Through Grand Questions, I connected a team of people that includes some of the pioneers of regenerative medicine and synthetic biology,” says Garton, who is an assistant professor in the Institute of Biomedical Engineering. “As a newer investigator, this ambitious project and the potential of the Medicine by Design funding gave me a vehicle to reach out to these individuals and assemble this amazing team.”

Garton’s project merges synthetic biology with stem cell biology and aims to overcome the challenges of tissue transplants by genetically “upgrading” tissue before it is used. An important part of his team’s proposal is to establish a hub called Centre for the Design of Novel Human Tissues, which will facilitate the merging of the disciplines.

Currently, when tissues are transplanted, up to 90 per cent of cells will die because of lack of blood flow, or ischemia. Garton’s project explores the idea of introducing new gene circuits into tissue that will be sophisticated enough to control the ischemic response. Gene circuits are engineered systems that mimic natural function in cells to perform customized, programmable actions.

“In the next 20 years, we aim to have a stem cell therapy that could repair damaged tissue after a heart attack within a week or two,” Garton says. “It could also lead to gene therapies that give brains or hearts the ability to survive ischemic stroke and heart attack.”

Can understanding the physics of organ development lead to regeneration?

Sevan Hopyan, an orthopaedic surgeon and senior scientist at the Hospital for Sick Children and associate professor in the departments of surgery and molecular genetics in U of T’s Temerty Faculty of Medicine, says the Grand Questions Program gives him and his team an opportunity to do work that might not be funded by conventional means.

“The Grand Questions program allows us to pursue ideas that, while still rigorous, are outside of traditional approaches,” Hopyan says. “Medicine by Design allows us to be part of a community where these approaches are not only acceptable but encouraged.”

Hopyan leads a Grand Questions project that focuses on tissue and organ regeneration, but, in his team’s case, the aim is to study the physics of regeneration. Currently, regenerative medicine researchers can make many cell types, but are still figuring out how to bring those cells together to form functional, three-dimensional organs.

The team is studying animal embryos to understand how organs are formed by the embryo. The novelty of the approach, Hopyan says, is applying the principles of physics to their observations. Most of the current work that studies organ formation observes development but does not deconstruct the underlying physical forces driving the development in the body.

“Approaches to regenerating functional tissues or organs often rely on the self-organizing properties of cells in a dish or on a scaffold. Those methods advance by trial and error and commonly reach an impasse,” says Hopyan. “By seeking to define the possibly small number of physical rules by which tissue building blocks are generated in the embryo, we’re hoping to facilitate more rapid advances in tissue regeneration.”

Hopyan’s project combines physics, mechanical engineering and cell biology, among other disciplines, to make observations about development. Then it uses those observations to empower computational simulations of development and performs experiments to confirm the models.

Hopyan sees the long-term impact of this project enabling the generation of organs in the lab to replace ones that are deficient or damaged. And he says that the project takes an expansive view.

“Any disease or congenital condition that causes tissue to not be formed and functioning correctly would benefit from being able to create solid organs in the lab. This project could impact dozens of diseases, and it’s the inter-disciplinary nature of this project that raises the ceiling of what we can accomplish.”

Learn more about the full Grand Questions teams

Treating heart failure without transplant surgery. Delivering powerful cell therapies to patients where they live – no matter how remote. Recording how cells talk to one another in the body to personalize future therapies.

These are just some of the transformative advances the University of Toronto’s Medicine by Design initiative hopes to enable through its Grand Questions Program, which is investing $3 million to prepare for the future of regenerative medicine.

The four multi-disciplinary teams from U of T and its partner hospitals that will undertake the research were recently announced during a launch event.

“The Grand Questions we posed are not safe or easy to address,” says Michael Sefton, executive director of Medicine by Design and a University Professor in the department of chemical engineering and applied chemistry in the Faculty of Applied Science & Engineering and the Institute of Biomedical Engineering. “Our ambition for the Grand Questions Program is to set the agenda for regenerative medicine for years to come and improve health outcomes for people living with degenerative diseases. To achieve that, we need to go beyond the obvious and provoke new ways to think about these problems.”

The Grand Questions Program is the culmination of more than a year of work that began with community consultations, a widely attended workshop in spring 2020 and engagement with Medicine by Design’s scientific advisory board to define the questions to be explored.

“The Grand Questions Program began with ‘pooling the imagination’ of the community, exploiting the wealth of disciplines of our researchers and having a conversation about how we would collectively prepare for the future,” says Sefton.

Through community consensus, six questions emerged that were deemed to be of paramount importance to regenerative medicine. An initial call for proposals resulted in eight teams being shortlisted to submit detailed proposals.

“We admire the bravery of all those who applied,” Sefton says. “All four of the funded projects are risky and we do not expect their projects to lead in a straight line to a successful outcome. But that is exactly what is required to move regenerative medicine forward.”

Can we create technologies that track cells?

Alison McGuigan, who leads one of the projects, says the program pushed her and her team to think of concepts they might not have thought about otherwise.

“Going through the Grand Questions process was disorienting – in a good way,” says McGuigan, who is a professor in the department of chemical engineering and applied chemistry in the Faculty of Applied Science & Engineering and the Institute of Biomedical Engineering. “It was such an interesting way to think of a problem: The Grand Questions Program sets goals and then asks us to think about how we could use our skill sets, in combination with those of others in the community, to address that problem.”

McGuigan adds, “Normally, research funding is for a further extension of what I’m already doing. Grand Questions allowed me to look at what I was doing and ask myself how I could apply it in a new, ambitious way.”

McGuigan’s project focuses on recording cell history. Her team is finding ways to record cells’ communications with other cells, also known as signalling. To make cell therapies work, researchers need to understand not only how cells function on their own, but also how interactions with neighbouring cells and the environment affect what they do.

The technology McGuigan and her team are proposing resembles a “contact tracing app” for cells that can measure very specific inputs and outputs from cells. Through its work, the team envisions being able to precisely program how a cell interacts with the environment where a cell therapy is taking place, dramatically increasing the effectiveness of therapy. In time, this research could also lead to therapies being personalized to individuals.

“Our project brings synthetic biology, molecular engineering, machine learning and other disciplines together,” McGuigan says. “Grand Questions gives us a chance to form collaborations that will outlast the two year-funding period and keep solidifying and growing.”

How can we make regenerative medicine accessible to everyone?

Keith Pardee and his team want to make regenerative medicine affordable and accessible to everyone.

“Regenerative medicine currently requires specialized skills and expensive labs and equipment,” says Pardee, who is an assistant professor in the Leslie Dan Faculty of Pharmacy. “To make cell therapies available in every community – not just urban and well-resourced ones – is an important ethical challenge we need to address.”

Pardee’s project will focus on laying the groundwork to one day make the cell manufacturing that normally takes place in complex manufacturing facilities available in a sealed cartridge – effectively creating portable cell manufacturing systems. This means the process of making cell therapies could be done outside of major centres and would no longer require specialized skills, allowing on-demand manufacturing for cell therapies.

The project leverages multiple technologies and approaches, including nanotechnology, synthetic biology, microfluidics and cell analytics – some of which are already running in the labs of U of T investigators – and combines them into a novel approach.

“In an ideal scenario, patients would come in for an outpatient procedure for cell collection and then either receive their custom cell therapy the same day or within a week,” Pardee says. “This is a tall order, but enabling the vision of bedside cell therapy is what is needed to solve the challenge of accessibility and affordability of these potentially life-saving cancer therapies. The Grand Questions program is an exciting opportunity to do just that: take on big needs and set a course toward solving the problem.”

Can we make tissues that perform better than nature?

Michael Garton, another of the project leads, says the Grand Questions proposal gave him an opportunity to expand his collaborations given that the program includes international experts who act as key advisers to the funded teams.

“Through Grand Questions, I connected a team of people that includes some of the pioneers of regenerative medicine and synthetic biology,” says Garton, who is an assistant professor in the Institute of Biomedical Engineering. “As a newer investigator, this ambitious project and the potential of the Medicine by Design funding gave me a vehicle to reach out to these individuals and assemble this amazing team.”

Garton’s project merges synthetic biology with stem cell biology and aims to overcome the challenges of tissue transplants by genetically “upgrading” tissue before it is used. An important part of his team’s proposal is to establish a hub called Centre for the Design of Novel Human Tissues, which will facilitate the merging of the disciplines.

Currently, when tissues are transplanted, up to 90 per cent of cells will die because of lack of blood flow, or ischemia. Garton’s project explores the idea of introducing new gene circuits into tissue that will be sophisticated enough to control the ischemic response. Gene circuits are engineered systems that mimic natural function in cells to perform customized, programmable actions.

“In the next 20 years, we aim to have a stem cell therapy that could repair damaged tissue after a heart attack within a week or two,” Garton says. “It could also lead to gene therapies that give brains or hearts the ability to survive ischemic stroke and heart attack.”

Can understanding the physics of organ development lead to regeneration?

Sevan Hopyan, an orthopaedic surgeon and senior scientist at the Hospital for Sick Children and associate professor in the departments of surgery and molecular genetics in U of T’s Temerty Faculty of Medicine, says the Grand Questions Program gives him and his team an opportunity to do work that might not be funded by conventional means.

“The Grand Questions program allows us to pursue ideas that, while still rigorous, are outside of traditional approaches,” Hopyan says. “Medicine by Design allows us to be part of a community where these approaches are not only acceptable but encouraged.”

Hopyan leads a Grand Questions project that focuses on tissue and organ regeneration, but, in his team’s case, the aim is to study the physics of regeneration. Currently, regenerative medicine researchers can make many cell types, but are still figuring out how to bring those cells together to form functional, three-dimensional organs.

The team is studying animal embryos to understand how organs are formed by the embryo. The novelty of the approach, Hopyan says, is applying the principles of physics to their observations. Most of the current work that studies organ formation observes development but does not deconstruct the underlying physical forces driving the development in the body.

“Approaches to regenerating functional tissues or organs often rely on the self-organizing properties of cells in a dish or on a scaffold. Those methods advance by trial and error and commonly reach an impasse,” says Hopyan. “By seeking to define the possibly small number of physical rules by which tissue building blocks are generated in the embryo, we’re hoping to facilitate more rapid advances in tissue regeneration.”

Hopyan’s project combines physics, mechanical engineering and cell biology, among other disciplines, to make observations about development. Then it uses those observations to empower computational simulations of development and performs experiments to confirm the models.

Hopyan sees the long-term impact of this project enabling the generation of organs in the lab to replace ones that are deficient or damaged. And he says that the project takes an expansive view.

“Any disease or congenital condition that causes tissue to not be formed and functioning correctly would benefit from being able to create solid organs in the lab. This project could impact dozens of diseases, and it’s the inter-disciplinary nature of this project that raises the ceiling of what we can accomplish.”

Learn more about the full Grand Questions teams

Grand Questions: Medicine by Design Invests $3 Million in the Future of Regenerative Medicine
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Tanz Centre Findings May Help Detect Young-Onset Alzheimer’s

Tanz Centre Findings May Help Detect Young-Onset Alzheimer’s

While Alzheimer’s disease most often appears in late life, as many as one in 10 people who develop it begin to experience the disease before age 65. This young-onset version is often undetected and misdiagnosed, with debilitating results.

In a recent study, University of Toronto researchers have found key differences in symptoms between people who develop Alzheimer’s earlier versus later. The researchers showed that two mental illness symptoms — depression and anxiety — are much more common in people with young-onset Alzheimer’s than in those with late-onset Alzheimer’s.

The findings underscore the need to consider Alzheimer’s in midlife when these symptoms occur with cognitive or thinking problems, and may improve diagnosis and the quality of life for affected individuals.

“If you get cognitive impairment at age 55, people are not thinking about Alzheimer’s disease,” says Carmela Tartaglia, an associate professor in the Tanz Centre for Research in Neurodegenerative Diseases and the senior author of the study published in January in the journal GeroScience. “The fact that people get Alzheimer’s disease before age 65 is less well known, so many people have considerable delay in diagnosis, often up to five years.”

This delay can have dire consequences. “Many patients have gone through several doctors, psychiatrists or other specialists, and medications,” says Tartaglia, who also cares for patients in the Memory Clinic at University Health Network. “They've been told that they’re having a midlife crisis, are depressed or anxious, or are going through menopause. They may experience significant anxiety about losing their memory. Some people have even lost their jobs.”

The delay in diagnosis is not surprising, given that mental illness symptoms are common in people with Alzheimer’s — more than 80 per cent of people develop at least one mental illness symptom, such as depression, anxiety or apathy, as the disease progresses.

In the study, the researchers — including U of T master’s student Melisa Gumus, the study’s first author — determined the prevalence and severity of mental illness symptoms over a four-year period in 126 people diagnosed with young-onset Alzheimer’s and 505 people with late-onset Alzheimer’s. When examining questionnaires about mental illness symptoms completed by caregivers, the researchers included people who were taking medications to treat mental illness symptoms as having mental illness symptoms, even if the person no longer exhibited symptoms. This novel approach provides the clearest picture of prevalence.

The study showed that depression and anxiety are much more common in young onset, both at the start of and throughout the four years. For example, at the start of the study, 64 per cent of people with young-onset Alzheimer’s had depression and 33 per cent had anxiety, while 41 per cent with late-onset Alzheimer’s had depression and 17 per cent had anxiety. There was no significant difference between the two groups in the prevalence of other mental illness symptoms or in the severity of any symptoms.

While the study did not explore why depression and anxiety are more common in young onset, in addition to possible differences in disease processes, there are psychosocial differences such as heavy responsibilities for raising children, earning income or caring for elderly parents that may play a role.

“Our hope is that the findings help patients get diagnosed earlier,” says Tartaglia. “If, for example, a patient is 55 years old and has a new onset of depression or anxiety that is not situational, consider this as the beginning of neurodegenerative disease.” While there is no cure to stop the progression of Alzheimer’s, an accurate diagnosis allows people to take steps early. People at the early stages of the disease may be eligible to participate in clinical trials to slow the progression of Alzheimer’s or reduce specific symptoms. As well, people may be able to modify their work, apply for disability benefits or make other changes to improve their quality of life.

In another initiative to understand the links between depression and dementia, the Tanz Centre for Research in Neurodegenerative Diseases, the Temerty Faculty of Medicine and the Toronto Dementia Research Alliance are supporting brain medicine research fellowships. Find out more and apply.
 

While Alzheimer’s disease most often appears in late life, as many as one in 10 people who develop it begin to experience the disease before age 65. This young-onset version is often undetected and misdiagnosed, with debilitating results.

In a recent study, University of Toronto researchers have found key differences in symptoms between people who develop Alzheimer’s earlier versus later. The researchers showed that two mental illness symptoms — depression and anxiety — are much more common in people with young-onset Alzheimer’s than in those with late-onset Alzheimer’s.

The findings underscore the need to consider Alzheimer’s in midlife when these symptoms occur with cognitive or thinking problems, and may improve diagnosis and the quality of life for affected individuals.

“If you get cognitive impairment at age 55, people are not thinking about Alzheimer’s disease,” says Carmela Tartaglia, an associate professor in the Tanz Centre for Research in Neurodegenerative Diseases and the senior author of the study published in January in the journal GeroScience. “The fact that people get Alzheimer’s disease before age 65 is less well known, so many people have considerable delay in diagnosis, often up to five years.”

This delay can have dire consequences. “Many patients have gone through several doctors, psychiatrists or other specialists, and medications,” says Tartaglia, who also cares for patients in the Memory Clinic at University Health Network. “They've been told that they’re having a midlife crisis, are depressed or anxious, or are going through menopause. They may experience significant anxiety about losing their memory. Some people have even lost their jobs.”

The delay in diagnosis is not surprising, given that mental illness symptoms are common in people with Alzheimer’s — more than 80 per cent of people develop at least one mental illness symptom, such as depression, anxiety or apathy, as the disease progresses.

In the study, the researchers — including U of T master’s student Melisa Gumus, the study’s first author — determined the prevalence and severity of mental illness symptoms over a four-year period in 126 people diagnosed with young-onset Alzheimer’s and 505 people with late-onset Alzheimer’s. When examining questionnaires about mental illness symptoms completed by caregivers, the researchers included people who were taking medications to treat mental illness symptoms as having mental illness symptoms, even if the person no longer exhibited symptoms. This novel approach provides the clearest picture of prevalence.

The study showed that depression and anxiety are much more common in young onset, both at the start of and throughout the four years. For example, at the start of the study, 64 per cent of people with young-onset Alzheimer’s had depression and 33 per cent had anxiety, while 41 per cent with late-onset Alzheimer’s had depression and 17 per cent had anxiety. There was no significant difference between the two groups in the prevalence of other mental illness symptoms or in the severity of any symptoms.

While the study did not explore why depression and anxiety are more common in young onset, in addition to possible differences in disease processes, there are psychosocial differences such as heavy responsibilities for raising children, earning income or caring for elderly parents that may play a role.

“Our hope is that the findings help patients get diagnosed earlier,” says Tartaglia. “If, for example, a patient is 55 years old and has a new onset of depression or anxiety that is not situational, consider this as the beginning of neurodegenerative disease.” While there is no cure to stop the progression of Alzheimer’s, an accurate diagnosis allows people to take steps early. People at the early stages of the disease may be eligible to participate in clinical trials to slow the progression of Alzheimer’s or reduce specific symptoms. As well, people may be able to modify their work, apply for disability benefits or make other changes to improve their quality of life.

In another initiative to understand the links between depression and dementia, the Tanz Centre for Research in Neurodegenerative Diseases, the Temerty Faculty of Medicine and the Toronto Dementia Research Alliance are supporting brain medicine research fellowships. Find out more and apply.
 

Tanz Centre Findings May Help Detect Young-Onset Alzheimer’s
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Alumni Establish New Early-Career Professorship in Anesthesiology and Pain Medicine

Alumni Establish New Early-Career Professorship in Anesthesiology and Pain Medicine

While Shields Research Day is always a highlight on the Department of Anesthesiology and Pain Medicine’s annual calendar, this year’s event was especially memorable thanks to an announcement from Department Chair, Dr. Beverley Orser.

At the close of her remarks to faculty, staff and learners, Orser shared that Dr. Hal Marryatt and his partner John Alchin have generously established a new early-career professorship in the Department. Marryatt and Alchin are both U of T alumni and previously supported the creation of the Department’s Dr. Alan K. Laws Award.

“I’m so pleased that John and Hal are once again investing in our Department and the incredible talent of our clinician-scientists,” said Orser. “This new professorship will be awarded to a faculty member within the first five years of their career for a five-year term to ensure they have the time and resources that are necessary to begin and succeed in a career in academic medicine. This professorship supports a very critical transition in the life of an investigator between being a trainee and evolving into an independent scientist.”

Thanks to Shields Day’s virtual format, Marryatt and Alchin were then able to join the event’s web broadcast from their home in Philadelphia to say a few words.

“We are so grateful to have this opportunity to make a meaningful gesture towards an institution to which we owe a great deal,” said Marryatt, with Alchin at his side. “We believe in supporting people on their way up. We are thrilled to be able to support someone who will hopefully build a career on a foundation we’ve been able to supply.”

Watch the full video of Orser’s announcement here.

While Shields Research Day is always a highlight on the Department of Anesthesiology and Pain Medicine’s annual calendar, this year’s event was especially memorable thanks to an announcement from Department Chair, Dr. Beverley Orser.

At the close of her remarks to faculty, staff and learners, Orser shared that Dr. Hal Marryatt and his partner John Alchin have generously established a new early-career professorship in the Department. Marryatt and Alchin are both U of T alumni and previously supported the creation of the Department’s Dr. Alan K. Laws Award.

“I’m so pleased that John and Hal are once again investing in our Department and the incredible talent of our clinician-scientists,” said Orser. “This new professorship will be awarded to a faculty member within the first five years of their career for a five-year term to ensure they have the time and resources that are necessary to begin and succeed in a career in academic medicine. This professorship supports a very critical transition in the life of an investigator between being a trainee and evolving into an independent scientist.”

Thanks to Shields Day’s virtual format, Marryatt and Alchin were then able to join the event’s web broadcast from their home in Philadelphia to say a few words.

“We are so grateful to have this opportunity to make a meaningful gesture towards an institution to which we owe a great deal,” said Marryatt, with Alchin at his side. “We believe in supporting people on their way up. We are thrilled to be able to support someone who will hopefully build a career on a foundation we’ve been able to supply.”

Watch the full video of Orser’s announcement here.

Alumni Establish New Early-Career Professorship in Anesthesiology and Pain Medicine
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Online Resources Fill Learning Gap for Children with Celiac Disease and Diabetes

Online Resources Fill Learning Gap for Children with Celiac Disease and Diabetes

Two new online modules developed by University of Toronto researchers are providing interactive e-learning on the gluten-free diet for children with both celiac disease and type 1 diabetes, and their caregivers.

The modules offer an overview of the gluten-free diet in the context of type 1 diabetes, with specifics on how to maintain the diet, helping bridge a knowledge gap for Canadian families and young patients dealing with type 1 diabetes.

“There is a lack of dietetic resources in many institutions that care for patients with diabetes,” said Catharine Walsh, an assistant professor of paediatrics at U of T’s Temerty Faculty of Medicine who led development of the modules.

“There is often not much time for clinicians to go into detail about the gluten-free diet with patients newly diagnosed with celiac disease, and diabetes care is frequently provided in community-based clinics that tend to have clinicians specially trained in diabetes but not necessarily with expertise in celiac disease and the gluten-free diet,” said Walsh, who is also a clinician-scientist at The Hospital for Sick Children (SickKids).

The goal is to standardize care across institutions, said Walsh, and to let patients focus on personalized questions during their time with specialists rather than on gluten-free diet basics that can be covered in detail online.

The learning modules were partially funded by the Joannah & Brian Lawson Centre for Child Nutrition at U of T, and are available through a new ‘celiac hub’ on the AboutKidsHealth website and the AboutKidsHealth for Teens website.

Celiac disease and Type 1 Diabetes eLearning module example

Celiac disease is an autoimmune disorder in which an inflammatory reaction to gluten — found in wheat, barley, rye and many processed foods — causes damage to the intestine and malabsorption of nutrients.

The only current treatment for celiac disease is lifelong adherence to a strict gluten-free diet, which can be a challenge for children with type 1 diabetes because they already face problems dealing with daily dietary issues.

Children with type 1 diabetes are about six times more likely to develop celiac disease than those without diabetes.

Walsh and her colleagues developed and refined the online modules through two rounds of usability testing with more than 30 children aged 10 to 19 and caregivers.

“Some users wanted more visual examples of foods, some others asked for a table of contents,” said Veronik Connan, a registered dietitian and research assistant at SickKids who led the user testing. “We also moved to a model that lets users move freely to access the content they want quickly, for example, lists of ingredients that are allowed on the diet.”

The changes were generally minor and the user feedback was largely positive, Connan said. Several parents commented that they liked the ability to share links to the modules with school teachers, camp leaders and other caregivers.

THE CELIAC TEAM - PROFESSOR PEGGY MARCON, VIKKI SCAINI (RN), INEZ MARTINCEVIC (RD), VERONIK CONNAN (RD), PROFESSOR CATHARINE WALSH

The researchers are sharing the modules with clinicians and patients at SickKids, and through the Canadian Celiac Association, Diabetes Canada and other organizations. They also hope to translate the work into French and Spanish for a global reach.

Connan emphasized that although management of celiac disease requires strict adherence to a gluten-free diet, patients have many food options which are naturally gluten-free (for example, milk, eggs and vegetables) and do not necessarily have a gluten-free label.

“Reading food labels is very important, but knowing which foods and ingredients are naturally gluten-free is also important and can be liberating,” says Connan. “I think all of that is reflected in these useful and user-friendly educational modules.”

The online modules were created with support from U of T’s Joannah & Brian Lawson Centre for Child Nutrition and the Canadian Foundation for Dietetic Research.

Two new online modules developed by University of Toronto researchers are providing interactive e-learning on the gluten-free diet for children with both celiac disease and type 1 diabetes, and their caregivers.

The modules offer an overview of the gluten-free diet in the context of type 1 diabetes, with specifics on how to maintain the diet, helping bridge a knowledge gap for Canadian families and young patients dealing with type 1 diabetes.

“There is a lack of dietetic resources in many institutions that care for patients with diabetes,” said Catharine Walsh, an assistant professor of paediatrics at U of T’s Temerty Faculty of Medicine who led development of the modules.

“There is often not much time for clinicians to go into detail about the gluten-free diet with patients newly diagnosed with celiac disease, and diabetes care is frequently provided in community-based clinics that tend to have clinicians specially trained in diabetes but not necessarily with expertise in celiac disease and the gluten-free diet,” said Walsh, who is also a clinician-scientist at The Hospital for Sick Children (SickKids).

The goal is to standardize care across institutions, said Walsh, and to let patients focus on personalized questions during their time with specialists rather than on gluten-free diet basics that can be covered in detail online.

The learning modules were partially funded by the Joannah & Brian Lawson Centre for Child Nutrition at U of T, and are available through a new ‘celiac hub’ on the AboutKidsHealth website and the AboutKidsHealth for Teens website.

Celiac disease and Type 1 Diabetes eLearning module example

Celiac disease is an autoimmune disorder in which an inflammatory reaction to gluten — found in wheat, barley, rye and many processed foods — causes damage to the intestine and malabsorption of nutrients.

The only current treatment for celiac disease is lifelong adherence to a strict gluten-free diet, which can be a challenge for children with type 1 diabetes because they already face problems dealing with daily dietary issues.

Children with type 1 diabetes are about six times more likely to develop celiac disease than those without diabetes.

Walsh and her colleagues developed and refined the online modules through two rounds of usability testing with more than 30 children aged 10 to 19 and caregivers.

“Some users wanted more visual examples of foods, some others asked for a table of contents,” said Veronik Connan, a registered dietitian and research assistant at SickKids who led the user testing. “We also moved to a model that lets users move freely to access the content they want quickly, for example, lists of ingredients that are allowed on the diet.”

The changes were generally minor and the user feedback was largely positive, Connan said. Several parents commented that they liked the ability to share links to the modules with school teachers, camp leaders and other caregivers.

THE CELIAC TEAM - PROFESSOR PEGGY MARCON, VIKKI SCAINI (RN), INEZ MARTINCEVIC (RD), VERONIK CONNAN (RD), PROFESSOR CATHARINE WALSH

The researchers are sharing the modules with clinicians and patients at SickKids, and through the Canadian Celiac Association, Diabetes Canada and other organizations. They also hope to translate the work into French and Spanish for a global reach.

Connan emphasized that although management of celiac disease requires strict adherence to a gluten-free diet, patients have many food options which are naturally gluten-free (for example, milk, eggs and vegetables) and do not necessarily have a gluten-free label.

“Reading food labels is very important, but knowing which foods and ingredients are naturally gluten-free is also important and can be liberating,” says Connan. “I think all of that is reflected in these useful and user-friendly educational modules.”

The online modules were created with support from U of T’s Joannah & Brian Lawson Centre for Child Nutrition and the Canadian Foundation for Dietetic Research.

Online Resources Fill Learning Gap for Children with Celiac Disease and Diabetes
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Cancer’s Susceptibility to COVID-19

Cancer’s Susceptibility to COVID-19

As the pandemic continues, several studies from around the world have reported an increased risk of COVID-19 among individuals affected with cancer. And cancer patients comprise a higher proportion of COVID-19 cases than expected.

To understand why, a study led by Fei-Fei Liu, a professor of radiation oncology, medical biophysics and otolaryngology at Temerty Medicine looked at whether genes known to facilitate viral entry into the body were expressed differentially in healthy versus cancer tissues in adults and children.

“Specific factors found on the surface and inside of our cells help the SARS-CoV-2 virus gain entry during a COVID-19 infection,” explains Liu, who is also a radiation oncologist at the Princess Margaret Cancer Centre and senior scientist at Ontario Cancer Institute. “Given the increased COVID-19 infectivity rates among cancer patients, we suspected that these factors were elevated during cancer.”

Using available large-scale genomic datasets, the team evaluated the expression of three critical factors for entry—ACE2, TMPRSS2 and CTSL—in various healthy and cancerous human tissues.

They found that expression of these SARS-CoV-2 viral entry genes was increased in respiratory, gastrointestinal and genitourinary tract tissues in individuals with cancer versus health individuals. Furthermore, expression of these genes were lower in cancer tissues from children compared to those from adults.

The team further investigated why cancer patients experience more severe COVID-19 symptoms than the general population. They assessed whether radiotherapy—a common cancer treatment that uses radiation to destroy cancer cells—hindered the body’s natural defense mechanisms that are needed to fight the virus.

The team’s findings revealed that radiotherapy did weaken immune defenses and did so by changing the expression of genes involved in immunity. These changes were restored to normal a few weeks post-treatment. Similar effects were observed with chemotherapy as well.

“Further work is needed to understand whether it would be beneficial for clinicians to adjust the timing of radiotherapy or chemotherapy for cancer patients during an active COVID-19 infection in order to minimize their impact on immune system function,” says Liu.

This work was supported by the Canadian Institutes of Health Research, the Government of Ontario, the Ministry of Science and Technology of Taiwan, the Ontario Institute for Cancer Research and The Princess Margaret Cancer Foundation. FF Liu holds the Peter and Shelagh Godsoe Chair in Radiation Medicine. TJ Pugh holds a Tier 2 Canada Research Chair in Translational Genomics.

Source: University Health Netowork

As the pandemic continues, several studies from around the world have reported an increased risk of COVID-19 among individuals affected with cancer. And cancer patients comprise a higher proportion of COVID-19 cases than expected.

To understand why, a study led by Fei-Fei Liu, a professor of radiation oncology, medical biophysics and otolaryngology at Temerty Medicine looked at whether genes known to facilitate viral entry into the body were expressed differentially in healthy versus cancer tissues in adults and children.

“Specific factors found on the surface and inside of our cells help the SARS-CoV-2 virus gain entry during a COVID-19 infection,” explains Liu, who is also a radiation oncologist at the Princess Margaret Cancer Centre and senior scientist at Ontario Cancer Institute. “Given the increased COVID-19 infectivity rates among cancer patients, we suspected that these factors were elevated during cancer.”

Using available large-scale genomic datasets, the team evaluated the expression of three critical factors for entry—ACE2, TMPRSS2 and CTSL—in various healthy and cancerous human tissues.

They found that expression of these SARS-CoV-2 viral entry genes was increased in respiratory, gastrointestinal and genitourinary tract tissues in individuals with cancer versus health individuals. Furthermore, expression of these genes were lower in cancer tissues from children compared to those from adults.

The team further investigated why cancer patients experience more severe COVID-19 symptoms than the general population. They assessed whether radiotherapy—a common cancer treatment that uses radiation to destroy cancer cells—hindered the body’s natural defense mechanisms that are needed to fight the virus.

The team’s findings revealed that radiotherapy did weaken immune defenses and did so by changing the expression of genes involved in immunity. These changes were restored to normal a few weeks post-treatment. Similar effects were observed with chemotherapy as well.

“Further work is needed to understand whether it would be beneficial for clinicians to adjust the timing of radiotherapy or chemotherapy for cancer patients during an active COVID-19 infection in order to minimize their impact on immune system function,” says Liu.

This work was supported by the Canadian Institutes of Health Research, the Government of Ontario, the Ministry of Science and Technology of Taiwan, the Ontario Institute for Cancer Research and The Princess Margaret Cancer Foundation. FF Liu holds the Peter and Shelagh Godsoe Chair in Radiation Medicine. TJ Pugh holds a Tier 2 Canada Research Chair in Translational Genomics.

Source: University Health Netowork

Cancer’s Susceptibility to COVID-19
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Maternal Mental Health Amid the Pandemic

Maternal Mental Health Amid the Pandemic

An estimated 15 to 20 per cent of expectant and new mothers experience mental health issues like anxiety or postpartum depression. Adding a global pandemic to the mix only heightens worries for women, says Ariel Dalfen, a perinatal mental health expert and assistant professor of psychiatry at Temerty Medicine.

Over the past 12 years, Dalfen headed The Perinatal Mental Health Program and Telemedicine Program at Mount Sinai Hospital. The largest program of its kind in Canada, the hospital provides assessment and treatment to women through pregnancy, pregnancy planning and up to a year postpartum.

Ariel Dalfen

Dalfen recently stepped down from her senior role but continues her psychiatric practice with the program and her advocacy for mental health and access to perinatal mental health care.

Recently, Dalfen spoke with writer Blake Eligh about supports for expectant and new mothers and offered tips to manage the stress and isolation of a pandemic pregnancy.

The COVID-19 pandemic has been stressful for everyone. What are expectant and new parents dealing with right now?

This situation hits people in so many ways. In the spring, intensive care units experienced a wave of pregnant patients with severe COVID-19 symptoms. People are extremely anxious and nervous about the new variants. They’re not going out because they’re worried about getting COVID-19. We also see people coping with severe illness or the loss of loved ones.

Many pulled their other children from school or daycare, which adds to everyday challenges, like trying to work from home. A recent study in The Lancet highlighted jobs losses and income among the biggest stressors for parents right now.

How do these stressors impact perinatal mental health?

The pandemic has added extra stress, with huge implications for women. They may be cut off from in-person visits with family or community support workers come to their homes, or be unable to attend support groups for new mothers. New moms rely on these supports and may experience increased physical, logistical and emotional burdens as a result.

We also see more sadness or anxiety. This could lead to a worsening of existing mental health issues or a recurrence of previous mental health problems. For some, we see an increase in problematic ways of coping, such as increased substance abuse or disordered eating.

When do common worries cross over into something that might require mental health supports? Are there signs to watch for?

People may notice they can't turn off their mind or they aren’t sleeping. When health and well-being are significantly impacted, it’s important to reach out for help, because it could be more than just normal anxiety.

What’s the first step in seeking support?

Just speaking about it is an important first step. People often find when they start to speak out, they find that others are in the same boat and struggling, too.

Family doctors are often a good point of contact to get an initial assessment and can help provide a connection to a therapist or a referral to see a psychiatrist. Other care team members, like an obstetrician or midwife, can also help women connect with social workers, mental health care providers and therapists.

What supports are available when it’s safer to be apart?

Our population has traditionally had a lot of barriers to in-person care. Specialized perinatal mental health services are concentrated in downtown Toronto, so factors like traffic, parking fees, getting time off work or having to find childcare can make it hard for people to get to in-person appointments, even if they live in the Greater Toronto Area. Access can also be complicated by medical or mobility considerations related to pregnancy.

Through Mount Sinai’s Perinatal Mental Health Telemedicine Program, we offer specialized care to women across the province so they can get help when and where they need it. Since the world shut down in March 2020, we’ve been able to continue to offer timely individual care to people in the comfort of their own environments through telemedicine and to expand the program to include group care, as well.

There are many other good online resources, like the Pandemic Pregnancy Guide on Instagram, Mind Beacon, AbilitiCBT and COVID-19 mental health information from the Centre for Addiction and Mental Health.

What can women do to manage their own stress right now?

First, it’s normal to feel stress because the world feels like a stressful place. Pretending it doesn’t exist won’t make it go away, so it’s important to acknowledge and validate that anxiety.

Turn off the news or social media so you’re not continuously bombarded by COVID-19 news. I know, that's easier said than done, but it is so helpful.

Find time to be with people. Whether virtually or safely in person, talking to friends and having time to just laugh and relax can help turn our minds to something else.

I also encourage people to talk their partners, if they have one, or to family members and friends. It can feel better to know you're not alone, even if there aren't concrete things people can do to help.

What is your advice for women worried about variants, vaccines or going out in public?

First, everyone needs to follow local advice and guidance from public health experts. Then, within those rules, people can determine what they need to do to keep themselves and their families safe. For example, some parents choose to keep their children in daycare services, while others feel it isn’t right for them.

Clinics like the UHN clinic on the St. George campus offer vaccinations to pregnant women. The early data is reassuring and health care providers who care for pregnant individuals encourage patients to get vaccinated as soon as possible. This is a reassuring step to reduce COVID illness and transmission.

How can family and friends lend support?

Stigma sometimes makes people nervous to talk about mental health issues, but most of us wouldn’t think twice about telling someone they should get help for a physical injury. It’s important to raise concerns about mental health changes you may notice in others in a clear, caring and supportive way.

Open the door to conversation. Starting with a fact-based observation or question like, “I notice you don’t seem like yourself lately,” or “How are you sleeping these days?” can help demonstrate that you care and want to be helpful and supportive.

An estimated 15 to 20 per cent of expectant and new mothers experience mental health issues like anxiety or postpartum depression. Adding a global pandemic to the mix only heightens worries for women, says Ariel Dalfen, a perinatal mental health expert and assistant professor of psychiatry at Temerty Medicine.

Over the past 12 years, Dalfen headed The Perinatal Mental Health Program and Telemedicine Program at Mount Sinai Hospital. The largest program of its kind in Canada, the hospital provides assessment and treatment to women through pregnancy, pregnancy planning and up to a year postpartum.

Ariel Dalfen

Dalfen recently stepped down from her senior role but continues her psychiatric practice with the program and her advocacy for mental health and access to perinatal mental health care.

Recently, Dalfen spoke with writer Blake Eligh about supports for expectant and new mothers and offered tips to manage the stress and isolation of a pandemic pregnancy.

The COVID-19 pandemic has been stressful for everyone. What are expectant and new parents dealing with right now?

This situation hits people in so many ways. In the spring, intensive care units experienced a wave of pregnant patients with severe COVID-19 symptoms. People are extremely anxious and nervous about the new variants. They’re not going out because they’re worried about getting COVID-19. We also see people coping with severe illness or the loss of loved ones.

Many pulled their other children from school or daycare, which adds to everyday challenges, like trying to work from home. A recent study in The Lancet highlighted jobs losses and income among the biggest stressors for parents right now.

How do these stressors impact perinatal mental health?

The pandemic has added extra stress, with huge implications for women. They may be cut off from in-person visits with family or community support workers come to their homes, or be unable to attend support groups for new mothers. New moms rely on these supports and may experience increased physical, logistical and emotional burdens as a result.

We also see more sadness or anxiety. This could lead to a worsening of existing mental health issues or a recurrence of previous mental health problems. For some, we see an increase in problematic ways of coping, such as increased substance abuse or disordered eating.

When do common worries cross over into something that might require mental health supports? Are there signs to watch for?

People may notice they can't turn off their mind or they aren’t sleeping. When health and well-being are significantly impacted, it’s important to reach out for help, because it could be more than just normal anxiety.

What’s the first step in seeking support?

Just speaking about it is an important first step. People often find when they start to speak out, they find that others are in the same boat and struggling, too.

Family doctors are often a good point of contact to get an initial assessment and can help provide a connection to a therapist or a referral to see a psychiatrist. Other care team members, like an obstetrician or midwife, can also help women connect with social workers, mental health care providers and therapists.

What supports are available when it’s safer to be apart?

Our population has traditionally had a lot of barriers to in-person care. Specialized perinatal mental health services are concentrated in downtown Toronto, so factors like traffic, parking fees, getting time off work or having to find childcare can make it hard for people to get to in-person appointments, even if they live in the Greater Toronto Area. Access can also be complicated by medical or mobility considerations related to pregnancy.

Through Mount Sinai’s Perinatal Mental Health Telemedicine Program, we offer specialized care to women across the province so they can get help when and where they need it. Since the world shut down in March 2020, we’ve been able to continue to offer timely individual care to people in the comfort of their own environments through telemedicine and to expand the program to include group care, as well.

There are many other good online resources, like the Pandemic Pregnancy Guide on Instagram, Mind Beacon, AbilitiCBT and COVID-19 mental health information from the Centre for Addiction and Mental Health.

What can women do to manage their own stress right now?

First, it’s normal to feel stress because the world feels like a stressful place. Pretending it doesn’t exist won’t make it go away, so it’s important to acknowledge and validate that anxiety.

Turn off the news or social media so you’re not continuously bombarded by COVID-19 news. I know, that's easier said than done, but it is so helpful.

Find time to be with people. Whether virtually or safely in person, talking to friends and having time to just laugh and relax can help turn our minds to something else.

I also encourage people to talk their partners, if they have one, or to family members and friends. It can feel better to know you're not alone, even if there aren't concrete things people can do to help.

What is your advice for women worried about variants, vaccines or going out in public?

First, everyone needs to follow local advice and guidance from public health experts. Then, within those rules, people can determine what they need to do to keep themselves and their families safe. For example, some parents choose to keep their children in daycare services, while others feel it isn’t right for them.

Clinics like the UHN clinic on the St. George campus offer vaccinations to pregnant women. The early data is reassuring and health care providers who care for pregnant individuals encourage patients to get vaccinated as soon as possible. This is a reassuring step to reduce COVID illness and transmission.

How can family and friends lend support?

Stigma sometimes makes people nervous to talk about mental health issues, but most of us wouldn’t think twice about telling someone they should get help for a physical injury. It’s important to raise concerns about mental health changes you may notice in others in a clear, caring and supportive way.

Open the door to conversation. Starting with a fact-based observation or question like, “I notice you don’t seem like yourself lately,” or “How are you sleeping these days?” can help demonstrate that you care and want to be helpful and supportive.

Maternal Mental Health Amid the Pandemic
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Cannabis Change: Aging Into a New Demographic

Cannabis Change: Aging Into a New Demographic

It’s been more than two years since cannabis was legalized in Canada. In that time, Dr. Jonathan Bertram says people grew more comfortable talking to him about marijuana. Increasingly, the people asking are older patients.  

Bertram is a lecturer in the Department of Family and Community Medicine and was the co-chair of the Canadian Coalition for Seniors Mental Health Cannabis Working Group. 

It published guidelines on cannabis use disorder among older adults, which Bertram spoke about at the Cannabinoids in Clinical Practice conference, held by the Canadian Consortium for the Investigation of Cannabis.

The two-day virtual event featured Canadian and internationally renowned experts speaking about emerging research, the evolving regulatory system and the health effects of cannabis.  

Though the most recent legal changes involve recreational use of marijuana, the guidelines differentiate between medical and non-medical use. A distinction influenced in part by the intersection of normalized alcohol and cannabis use, says Bertram, who is also an addiction medicine physician at the Centre for Addiction and Mental Health (CAMH). 

“People don’t always knowingly buy a six-pack of beer for their insomnia or anxiety, but our normalized drinking culture may factor into their decision making,” says Bertram whose community practice includes pain medicine. “Some of the people who come to see me for pain assessments also ask about cannabis for these kinds of symptoms. It’s clear there’s a therapeutic bent to their interest in cannabis.”

According to the most recent National Cannabis Survey by Statistics Canada, nearly half of all Canadians report using cannabis at some point in their lives. Though seniors are less likely to use cannabis than younger people, earlier research by the agency found that cannabis use is increasing among adults aged 65 and older more quickly than in other age groups.

The acute effects of cannabis use can present a particular concern for older adults. In this group, changes in blood pressure, heart rate or balance can be enough to require medical supervision. Other side effects, like drowsiness, might not be considered adverse on their own, explains Bertram, but can still leave people vulnerable to other risks, like falls.

Bertram doesn’t advocate for or against the use of cannabis, nor does he prescribe it. But he notices a tension around talking about the harms and benefits of cannabis — which he says can get in the way of physicians educating themselves and their patients.

“In older adult settings, there’s a real age-related stigma when it comes to talking about drugs,” he says. “I think it’s important for clinicians to think about language when we screen people for drug use and invite them to speak with us about their substance use.”

Though not indicated in screening for problematic use of cannabis, Bertram points to the Senior Alcohol Misuse Indicator (SAMI) as a model for non-judgmental communication around marijuana.

Rather than focusing first on substance use, SAMI guides clinicians to explore the symptoms that might prompt people to use alcohol, an important parallel that could be drawn when screening for problematic cannabis use. 

For example, instead of asking if someone uses pot, whether they use excessively or have a problem, Bertram suggests beginning with questions about how a person might be sleeping, how their appetite is or if they have difficulty unwinding after socializing or being at work.

The answers can help patients ease into conversation about whether they use substances to help with these symptoms and to what extent.

Bertram says there’s evidence the SAMI approach shows greater sensitivity and specificity when screening older adults for alcohol use — and could likely yield similar results for cannabis.

“Cannabis can be beneficial and it can be harmful,” says Bertram. “And it’s important we counsel our patients in the spirit of appreciating both so they can make educated decisions.”

It’s been more than two years since cannabis was legalized in Canada. In that time, Dr. Jonathan Bertram says people grew more comfortable talking to him about marijuana. Increasingly, the people asking are older patients.  

Bertram is a lecturer in the Department of Family and Community Medicine and was the co-chair of the Canadian Coalition for Seniors Mental Health Cannabis Working Group. 

It published guidelines on cannabis use disorder among older adults, which Bertram spoke about at the Cannabinoids in Clinical Practice conference, held by the Canadian Consortium for the Investigation of Cannabis.

The two-day virtual event featured Canadian and internationally renowned experts speaking about emerging research, the evolving regulatory system and the health effects of cannabis.  

Though the most recent legal changes involve recreational use of marijuana, the guidelines differentiate between medical and non-medical use. A distinction influenced in part by the intersection of normalized alcohol and cannabis use, says Bertram, who is also an addiction medicine physician at the Centre for Addiction and Mental Health (CAMH). 

“People don’t always knowingly buy a six-pack of beer for their insomnia or anxiety, but our normalized drinking culture may factor into their decision making,” says Bertram whose community practice includes pain medicine. “Some of the people who come to see me for pain assessments also ask about cannabis for these kinds of symptoms. It’s clear there’s a therapeutic bent to their interest in cannabis.”

According to the most recent National Cannabis Survey by Statistics Canada, nearly half of all Canadians report using cannabis at some point in their lives. Though seniors are less likely to use cannabis than younger people, earlier research by the agency found that cannabis use is increasing among adults aged 65 and older more quickly than in other age groups.

The acute effects of cannabis use can present a particular concern for older adults. In this group, changes in blood pressure, heart rate or balance can be enough to require medical supervision. Other side effects, like drowsiness, might not be considered adverse on their own, explains Bertram, but can still leave people vulnerable to other risks, like falls.

Bertram doesn’t advocate for or against the use of cannabis, nor does he prescribe it. But he notices a tension around talking about the harms and benefits of cannabis — which he says can get in the way of physicians educating themselves and their patients.

“In older adult settings, there’s a real age-related stigma when it comes to talking about drugs,” he says. “I think it’s important for clinicians to think about language when we screen people for drug use and invite them to speak with us about their substance use.”

Though not indicated in screening for problematic use of cannabis, Bertram points to the Senior Alcohol Misuse Indicator (SAMI) as a model for non-judgmental communication around marijuana.

Rather than focusing first on substance use, SAMI guides clinicians to explore the symptoms that might prompt people to use alcohol, an important parallel that could be drawn when screening for problematic cannabis use. 

For example, instead of asking if someone uses pot, whether they use excessively or have a problem, Bertram suggests beginning with questions about how a person might be sleeping, how their appetite is or if they have difficulty unwinding after socializing or being at work.

The answers can help patients ease into conversation about whether they use substances to help with these symptoms and to what extent.

Bertram says there’s evidence the SAMI approach shows greater sensitivity and specificity when screening older adults for alcohol use — and could likely yield similar results for cannabis.

“Cannabis can be beneficial and it can be harmful,” says Bertram. “And it’s important we counsel our patients in the spirit of appreciating both so they can make educated decisions.”

Cannabis Change: Aging Into a New Demographic
Admin Help - SEO
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Optimize this page for search engines by customizing the Meta Title and Meta Description fields.

Use the Google Search Result Preview Tool to test different content ideas.

Admin Help - Social Share
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Select a Meta Image to tell a social media platform what image to use when sharing.

If blank, different social platforms like LinkedIn will randomly select an image on the page to appear on shared posts.

Posts with images generally perform better on social media so it is worth selecting an engaging image.

Author
Erin Howe
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