Monthly Archives

April 2018

Dr. Devereaux, Researcher, Explorer

This discovery will save lives after surgery

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Researchers at Hamilton Health Sciences have discovered that a blood-thinning drug, dabigatran, significantly reduces the risk of death, heart attack, stroke, and other heart or blood-vessel complications in patients following major, non-cardiac surgery.

Every year, approximately eight million people world-wide develop a condition called “myocardial injury after non-cardiac surgery” (MINS), which refers to damage incurred to the tissue of the heart in response to the stress of surgery on the body. The condition affects patients undergoing major procedures such as a hip or knee replacement, bowel resection, or abdominal aortic aneurysm repair, and can lead to severe complications including heart attack, stroke, blood clots, amputations, and even death.

In the first randomized controlled trial to evaluate a treatment for MINS, Dr. P.J. Devereaux, scientific lead for perioperative research at Hamilton Health Sciences’ and McMaster University’s Population Health Research Institute (PHRI) and principal investigator for the MANAGE trial, found that patients who had MINS and received dabigatran twice daily were 28 per cent less likely to suffer a major vascular complication during an average of 16 months of follow-up.

“We now have an option for improving outcomes for a large population of people who have a heart injury after surgery each year,” says Dr. Devereaux.

The study enrolled 1,754 patients in 19 countries, 51 percent of whom were male, with an average age of 70 years. After an average follow-up of 16 months, 11 percent of patients treated with dabigatran experienced a MINS-related event, compared with 15 percent of patients who received a placebo. This translates to a 28 percent reduction in risk for patients receiving dabigatran.
An increased risk of bleeding is an expected complication of treatment with a blood-thinning medication; however, there was no significant difference between the two groups in terms of life-threatening, major, or critical organ bleeding.

The MANAGE study builds on the discovery made by Dr. Devereaux and his colleagues last year which showed that a simple blood test could identify patients with MINS following surgery and alert clinicians to intervene before complications occurred.

“Patients with evidence of even mild damage to the heart after surgery are at high risk of adverse events in the long term,” says Dr. Salim Yusuf, chair of the MANAGE trial and executive director of PHRI. ”It appears that this risk can be mitigated by antithrombotic therapy. Future studies can explore additional ways to reduce these risks.”

“This is an important issue that affects thousands of people around the world,” says Dr. Devereaux. “This discovery marks an important step in the journey to improve outcomes for patients who suffer MINS after surgery.”

holding cannabis buds

Are there long-term effects to cannabis users?

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Before the end of 2018, many Canadians will be able to legally purchase cannabis for recreational use in their communities. But, despite its impending widespread availability, there’s very little known about the long-term physical, psychological and social effects of cannabis, leaving the medical community at odds with the drive to legalize the drug.

Researchers at Hamilton Health Sciences (HHS) and McMaster University have established the Database for Cannabis Consumption and Study, or “DataCann”, to help inform knowledge and use of cannabis in clinical settings.

Once the database is complete, researchers can begin to look for answers around who’s using medical cannabis and why, the benefits and risks, the specific compounds used, the impact on healthcare resources, and further education requirements. Ultimately the hope is that the data collected will impact healthcare guidelines and prescribing practices to ensure optimal outcomes for patients.

Ultimately the hope is that the data collected will impact healthcare guidelines and prescribing practices.

“This database will give us the opportunity to explore a lot of unanswered questions around the medical use of cannabis,” says Dr. Ramesh Zacharias, DataCann co-principal investigator and medical director of the Michael G. DeGroote Pain Clinic at HHS. “We need to know who benefits from cannabis and why to ensure we can provide the most appropriate treatment plans to patients. More importantly, we need to know if there are any long-term risks.”

The team is looking to recruit at least 1,000 participants from across Canada who are using cannabis and have chronic, non-cancer pain. Participants are required to complete an online survey for the first two, eight and twelve months, then every six months thereafter until the database is complete. The project is expected to take five years to complete.

Michael G. DeGroote Pain Clinic patient and regular cannabis user, Kelly was more than willing to participate in the study. She says filling out a survey every few months is the least she can do to help doctors better understand cannabis. All she knows is that the cannabis oil she takes has made a huge difference in managing her pain from Lupus and has allowed her to reduce the amount of medication she takes. The team hopes that information like this will provide some insight into the drug.

“More importantly, we need to know if there are any long-term risks.”

“We have the potential to create the largest medical database on cannabis,” says Dr. Zacharias. “Not only does it give us a strong starting point, but it will provide the foundation upon which to conduct more research in the years to come.”

The DataCann project is a partnership between Hamilton Health Sciences’ Michael G. DeGroote Pain Clinic, McMaster University’s Michael G. DeGroote Institute for Pain Research and Care, and the Michael G. DeGroote Centre for Medical Cannabis Research. Currently, hospital and clinical partners in Toronto, Thunder Bay, Winnipeg and Vancouver are supporting patient recruitment efforts, with a goal to bring in additional partners from across Canada as the project unfolds.

Guillaume Pare, HHS researcher, explorer

Unlocking the code

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By: Dr. Guillaume Paré
Medical biochemist, Hamilton Health Sciences
Senior Scientist, Population Health Research Institute
Associate Professor, Department of Pathology and Molecular Medicine, McMaster University

April marks the 15th anniversary of the completion of the Human Genome Project, a thirteen-year journey led by scientists from around the globe to map all of the genes of the human species and one of the biggest undertakings in scientific history.

When the project began in 1990, the goal was to not only understand genetic factors in human disease, but to set the course for new treatments and prevention methods for ailments like cancer and heart disease. It was a costly project with a price tag of about 3 billion dollars, but the investment was worthwhile: it gave way to a whole new era of discovery in the pursuit of global health.

The last decade and a half has also seen an acceleration in technological advancement. Our genetics lab at HHS is now fully automated – extracting, mapping, sequencing and copying DNA – allowing our team to quickly generate substantial amount of data to support many of the large-scale, global research studies that we lead from right here in Hamilton. These advancements have happened so quickly that, today, our lab could do the same work as the Human Genome Project in less than one week for only a few thousand dollars.

Machine for DNA extraction in the HHS genetics lab

The results of these extraordinary advances are clear. We’re now able to classify more than 1,800 genetic diseases, including genetic forms of common diseases as breast cancer, Alzheimer’s, diabetes and heart disease. Furthermore, scientists have been able to develop tests to better predict a family member’s genetic risk, allowing healthcare providers to help prevent the development of potentially devastating diseases.

We’re now able to classify more than 1,800 genetic diseases.

But, we’re also left with a new set of challenges. Although we’ve unlocked the mystery of our genetic make-up, we’re now dealing with the surge of genetic data we’re able to generate with modern technology. Indeed, the bottleneck in research projects is often data analysis, meaning that the role of “scientist” is evolving in to “data scientist”.

In recent years, we’ve learned that it’s not always a single gene responsible for disease, but that different variations in our genetic makeup can equate to risk. So, what does that mean in terms of data? To start, every person has around 20,500 genes, but within each gene are subtle differences called genetic variants. We’ll record anywhere between 500,000 to 1,000,000 genetic variants per person. Then, multiply that by the thousands of people in a research study. Fifteen years ago, this would have been simply impossible. Not only would it take years to complete by hand, we just didn’t have the computing power to store the data. Currently, we have over 200 terabytes of genetic data stored at HHS. That’s the equivalent of 40 million minutes of high-quality YouTube videos!

Currently, we have over 200 terabytes of genetic data stored at HHS.

Building these data and sophisticated analysis techniques, my team at HHS’ Population Health Research Institute introduced a test earlier this year that can predict an individual’s genetic risk of early heart disease with high accuracy by combining information from a large number of variants. This discovery was made on the shoulders of the Human Genome Project and large-scale international collaborations aiming to decipher the genetic underpinnings of heart disease.

As is the essence of research, the original question that the Human Genome Project sought to answer opened up the floodgates to countless new queries. The endeavour shed a new light on the most precious part of humanity, but we still haven’t fully broken our genetic code. We’ve made immense progress in the last 15 years, but there’s lots more we need to learn.

This is what drives us as researchers and clinicians: to always find new and better ways to prevent disease in people around the world. It’s an ambition we all share; it’s in our DNA.

Dr. Guillaume Pare, medical biochemist, explorer