Impacts of CIHR-funded research: Bones, Joints, Nerves and Skin
Keeping employed
Dealing with arthritis on the job
Overview
Arthritis is the leading cause of disability in Canada and, as our population ages, the number of people with arthritis is expected to increase. Arthritis is not, however, just a disease of old age. It generally hits hardest when adults are between the ages of 45 and 65 – in the prime of their lives. Dr. Monique Gignac of the University of Toronto tracked almost 500 employed people with arthritis for five-six years. Based on this research, she calculated that the average economic cost of arthritis disability is $11,500 per year per person. Of this, 41% is due to lost productivity, 37% from stopping working or changing jobs and the remaining 22% is due to decreased working hours and/or absenteeism. Workers made a number of adjustments to manage their disability, such as: working longer days to fit in more rest breaks; reorganizing work spaces to reduce or avoid lifting, using a more comfortable chair, using a stool to raise legs or replacing computer mouse.
Impact
Dr. Gignac's research is being developed into presentations and workshops for people with arthritis, both in Canada and across Europe. It has also provided input to a guide being prepared by the Arthritis Society in Canada that will provide people with strategies to help them manage their disease and employment. Her work has led to further research that is creating and testing a workplace intervention for people with rheumatoid arthritis.
First Published
Research profile, September 2007; updated 2009
Pain receptor could be linked to arthritis
Identification of the receptor could lead to new drugs to treat arthritis
Overview
Chronic pain and reduced mobility and function are the most common outcomes of arthritis. Now, Dr. John Wallace of McMaster University, has identified a pain receptor, the PAR2 receptor, that he believes is linked to inflammatory diseases such as arthritis. There is also good evidence from human studies that the receptor plays a role in irritable bowel syndrome.
Impact
Several pharmaceutical companies now have programs to develop ways to block the PAR2 receptor.
First Published
Research profile, September 2007; updated 2009
In the swim of things
Increasing mobility for people with arthritis
Overview
Exercise can improve balance, strength and mobility and prevent falls, but seniors with hip osteoarthritis often find it difficult to participate in such exercise due to pain. Dr. Catherine Arnold of the University of Saskatchewan conducted a two-year clinical trial to study the effect of aquatic exercise alone and aquatic exercise combined with education on reducing the risk of falls in seniors with osteoarthritis in their hips. She found that the participants in the combined education and exercise group had greater gains in their confidence that they could prevent a fall and greater improvement in functional performance compared both to those who had exercise alone and to those who had no intervention.
Impact
The study has led to the establishment of a community aquatic and education program for older adults with mobility restrictions and/or at risk of falling.
First Published
CIHR Health Research Results, 2005-06; updated 2009
Think twice before you cut
What if surgery doesn't help arthritis of the knee?
Overview
About half of all Canadians will deal with arthritis of the knee at some point, whether because of age or injury. Arthroscopic knee surgery, which removes small torn bits of cartilage or smoothes the rough edges of the joint surface, has long been the standard treatment. However, Dr. Bob Litchfield of the University of Western Ontario conducted a trial in which all participants received therapy and education, but only half received surgery. He followed the patients for up to two years and found no difference between those who received surgery and those who didn't.
Impact
The publication of Dr. Litchfield's results sparked a debate in the orthopedic surgeon community. While there are some instances where surgery is justified, Dr. Litchfield hopes his results will encourage orthopedic surgeons to consider non-operative therapies before cutting. Dr. Litchfield plans to explore his finding's application in a further knowledge translation study.
First Published
CIHR-CMAJ Top Canadian Achievements in Health Research Awards, 2009; updated 2009
Category
Clinical practice – treatment
Relieving arthritis pain safely
Ontario research develops new alternative
Overview
With many prescription pain relievers from arthritis taken off the market in recent years, people with arthritis have few options. Many people already take glucosamine, derived from crab shells, to relieve their pain. Dr. Tassos Anastassiades of Queen's University has developed a series of new, synthetic compounds based on glucosamine which have been shown to be effective in reducing inflammation and preventing bone loss in animal models.
Impact
The compounds have been shown to have low toxicity and to have potential both as a pharmaceutical and a nutraceutical. They have been patent protected and Dr. Anastassiades is working with the Canadian Arthritis Network to find a partner for human applications.
First Published
CIHR Health Research Results, 2004-05
Danger – bones at risk!
Anti-depressants can affect bone health
Overview
Daily doses of anti-depressants can help mental functioning. But, in people over 50, they can weaken bones and make them more prone to fractures. Dr. David Goltzman of McGill University tested the bones of more than 5,000 people taking popular forms of anti-depressants called selective serotonin reuptake inhibitors (SSRIs). He found that those taking SSRIs daily were twice as likely to have weaker hip bones and vertebrae, putting them at greater risk of breaking bones.
Impact
The U.S. Food and Drug Administration is considering revising guidelines to incorporate the latest knowledge on the impacts of SSRIs on bone health. In the meantime, there is a wider understanding that treatment for depression using SSRIs among people over 50 should also include strategies for preventing osteoporosis, such as regular bone mineral density tests and lifestyle measures such as getting enough calcium and vitamin D in diets, exercising, stopping smoking and drinking moderately.
First Published
Research profile, November 2007; updated 2009
Fighting bone disease through cellular healing
Convincing cells to grow new bone
Overview
Brittle and broken bones caused by diseases ranging from cancer to osteoporosis or trauma could benefit from new cell-based therapy for bone healing. Dr. Laurie McDuffee of the University of Prince Edward Island is developing a way to take bone cells from adult donor bone and bone-related tissue and stimulate them to become mature, bone-forming cells, also known as osteoblasts. The cells can then be transplanted into diseased bone.
Impact
The technology has been tested both in the lab and in animals, specifically horses. Initial results were promising and the testing is expected to be complete in mid-2010. At that point, if results continue to be positive, the technology will be a step closer to use in humans, where it can help doctors treat orthopaedic patients and improve the quality of life for people with bone disease.
First Published
CIHR Health Research Results, 2003-04; updated 2009
Home is where the recovery is
Hip and knee replacement patients recover better at home
Overview
The number of Canadians waiting for hip and knee replacements remains high. Often these waits are due to a shortage of hospital bed spaces needed for recovery from the surgery. Dr. Nizar Mahomed of the Toronto Western Hospital, University Health Network, led a group called the Total Joint Network that developed a program to reduce wait times, shorten patient recovery time and save money for taxpayers. They studied two groups of patients: one that spent five days in acute care in hospital, followed by home visits from a rehabilitation specialist and another that spent three days in acute care, followed by seven days of inpatient rehabilitation. Surprisingly, they found that the patients who recovered at home had better health outcomes and similar levels of satisfaction with their treatment. The team then turned its attention to hip-fracture patients, reducing wait times for surgery to less than two days and reduced overall rehabilitation stay to 29 days.
Impact
The home-based approach to recovery from hip- and knee-replacement surgery saved more than $10 million in health-care costs in the Greater Toronto Area. Of the hip fracture patients, 20% more patient returned to their pre-injury health status. Their return to health is saving the province about $17 million per year by helping hip fracture patients avoid long-term care facilities. Both models of care have been incorporated into the Ontario Bone and Joint Health Network Initiative to disseminate them across Ontario.
First Published
CIHR-CMAJ Top Canadian Achievements in Health Research Awards, 2009; updated 2009
Regenerating movement
Treating spinal cord injuries
Overview
Neurons play a critical role in helping the nervous system send messages throughout the body but, once damaged, they typically do not regrow, leaving people with spinal cord injuries in wheelchairs. Dr. Timothy O'Connor of the University of British Columbia is leading a team that is searching for chemicals that will help neurons grow. The team is using a technology known as high-throughput screening, which uses a combination of robotics and high-speed computer technology, to test thousands of chemical each day. Once the team has identified chemicals that will promote neuron growth, the next step is testing in animals, in the hopes of developing a treatment for humans with spinal cord injuries.
Impact
Dr. O'Connor's work led to the identification of a compound that enhanced growth of neurites (a growth out of a neuron, either an axon or a dendrite, that promotes connections between neurons). When tested in animal models, it did not promote regeneration of cut nerves, but stimulated sprouting of intact nerves in the spinal cord. This is promising because compensatory sprouting may be a more viable way to stimulate functional recovery in a damaged central nervous system.
First Published
CIHR Health Research Results, 2006-07; updated 2009
Reducing scarring from burns
Protein provides target for treatment
Overview
Serious burns can be treated – but the scars left behind can be debilitating, resulting in limitations to mobility and nerve damage. Dr. Aziz Ghahary, now of the University of British Columbia, but at the University of Alberta when he conducted the research, has discovered a protein that could provide a target for slowing, or even preventing, scarring by interfering in the biological processes that cause scarring. Scarring happens when there is overproduction of extracellular matrix (ECM) proteins and lack of degradation signals. The protein discovered by Dr. Ghahary, called keratinocyte-derived anti-fibrogenic factor (KDAF) enhanced substances that send degradation signals.
Impact
A patent filed on the discovery was licensed to Vancouver-based Augurex Life Sciences Co. in 2007 and the product is en route to commercialization as a method for early diagnosis of arthritis as well as for treatment purposes.
First Published
CIHR Health Research Results, 2004-05; updated 2009
Staying active on wheels
Guidelines improve lives of people in wheelchairs
Overview
Paralympians are some of the most exceptional athletes out there. But all people with spinal cord injuries, not only those who harbour Olympic dreams, can see dramatic improvements in their lives by adding some physical activity. Greater arm strength makes it easier to transfer from wheelchair to car; more leg strength means a person can take off his own trousers at night. Dr. Kathleen Martin Ginis from McMaster University has conducted research to determine how much physical activity is enough. For instance, the general recommendation of 30-60 minutes a day is too much for people in wheelchairs, as it is much more work to wheel a chair than to walk. Based on her research, Dr. Martin Ginis is developing physical activity guidelines and a physical activity guide for Canadians with spinal cord injury.
Impact
Guidelines will provide assistance to people with spinal cord injury as well as those involved in rehabilitation, physical training, etc., aiding in daily functioning, psychological well being and chronic disease prevention.
First Published
Research profile, August 2008; updated 2009
Working out on the run
Fitting fitness into a busy life
Overview
It's tough to find time to exercise at all, much less for the recommended 60 minutes a day. So Dr. Martin Gibala of McMaster University has good news for you – training using very short bursts of high-intensity exercise can be as beneficial as longer periods spent exercising at moderate intensity. Dr. Gibala looked at the impact of interval training: short bursts – say 30 seconds – of exercise at a fast pace, then stopping completely or slowing down for a few minutes, then repeating the cycle several times. He compared two groups of people – one that did 2.5 hours of high-intensity cycling over two weeks and one that did 10.5 hours of moderate cycling over the same period. At the end, both groups showed similar increases in the enzymes produced in thigh muscles. These enzymes are chemical compounds that burn fat and carbohydrates for energy. Now Dr. Gibala is looking at long-term effects of interval training in people in different age groups and at different fitness levels.
Impact
This finding will provide people who can't find time for sustained exercise a different strategy to improve their health and wellbeing with physical activity. Dr. Gibala is currently following up on his research to expand its results.
First Published
Research profile, January 2008; updated 2009
Diagnosing arthritis earlier
Tool assists with osteoarthritis of the knee
Overview
Osteoarthritis is the most common type of arthritis in Canada, affecting three million people, or one in every ten. Early diagnosis can enhance treatment possibilities and slow the progression of disability. Dr. Jolanda Cibere of the Centre for Hip Health and Mobility at the University of British Columbia has developed a tool that helps physicians diagnose osteoarthritis of the knee at an earlier stage. The tool uses MRI, x-ray, biomarkers, clinical assessment and questionnaires to comprehensively assess patients with knee pain. Dr. Cibere and her team are developing a video to educate family physicians, medical students and physiotherapy students, as well as researchers, about the tool's use.
Impact
The tool is being used by the National Institutes of Health in the United States as part of its Osteoarthritis Initiative to ensure data are reliable and standardized. It has also been used by osteoarthritis researchers in their work and Dr. Cibere has had inquiries about it use by researchers in the United States and United Kingdom. The educational video, as well as other knowledge translation tools, will be available in late 2009.
First Published
CIHR Health Research Results, 2003-04; updated 2009
How do you mend a broken bone?
Glue it back together, of course!
Overview
Nearly 1.5 million Canadians suffer from osteoporosis, putting them at risk of breaking bones from simple daily activities. The causes seem simple; the consequences, however, are significant – long hospital stays and difficulty getting around. A Canadian research team led by Dr. Gamal Baroud of the University of Sherbrooke is helping patients with broken vertebrae get out of hospital and back to their active lives more quickly using a kind of super glue in a procedure called vertebrosplasty. During the procedure, a needle is threaded up the spine and a small amount of liquid cement injected into the break. The cement hardens after just 20 minutes. Once done, says Dr. Baroud, up to 90% of patients can walk pain free. Instead of days or weeks in the hospital, they leave within a few hours. Dr. Baroud has been working to reduce the risks of the procedure, which include the liquid cement leaking out of the bone, by using new mineral cements that closely resemble bone.
Impact
Dr. Baroud's research has resulted in a simple device that provides accurate delivery and safety controls at a lower cost than existing devices, as well as additional devices that improve patient safety by reducing cement leaking and intra-vertebral damage. The first generation of products is scheduled for approval in the United States and Canada in 2009, with a second generation scheduled for approval in early 2010.
First Published
Research profile, November 2007; updated 2009
On your mark
New method for predicting rate of osteoarthritis progression
Overview
Osteoarthritis affects one in ten Canadians. Suffering from the disease is like operating in a void – sufferers have no clue when the disease will suddenly take a turn for the worse. A research team led by Dr. Robin Poole of McGill University has found a new and accurate to track the progression of osteoarthritis. The team found that biomarkers in the blood can predict the severity of the disease's progression by measuring collagen degradation.
Impact
Pharmaceutical companies are using the technology for detecting the biomarkers for disease-modifying drug development and are involved in preclinical studies and clinical trials. The assays to test for the biomarkers is produced and marketed by IBEX Technologies in Montreal. Mr. Paul Baehr, President and CEO of IBEX, estimates that the assay kits make up a quarter of company revenues and help keep it profitable "Dr. Poole's contribution has helped us considerably," says Baehr.
First Published
CIHR Health Research Snapshots, 2007; updated 2009
Making a new hip last longer
Fighting bone loss around implant
Overview
Physicians are seeing demand for hip replacements among younger patients growing. But they are often reluctant to carry out the surgery, partly because the implants can fail after 20 years or more, due to severe loss of bone around the new joint. Drs. Helen Burt and Tim Durance of the University of British Columbia have developed a tiny sponge made of biodegradable material and stuffed with stem cells that grow human bone. The sponge can be implanted along with the new hip and prevent the bone loss that can make a second implant necessary. Further research has found that the sponge is effective both in the lab and in animals.
Impact
The development of the sponge is a major breakthrough for hip-replacement patients. The researchers have filed two patents on the process and these are moving to national patent protection in key countries around the world. The University of British Columba has licensed both patents to a Canadian company that is pursuing commercial applications.
First Published
CIHR Health Research Results, 2004-05; updated 2009
Giving cartilage a helping hand
New polymer stimulates cartilage regeneration
Overview
When cartilage in joints is destroyed, whether by injury or arthritis, joint replacement surgery is often the answer. But there may be an alternative. Dr. Michael Buschmann and a team of scientists and engineers at Montreal's École Polytechnique have developed a gelling polymer called BST-CarGel® that can stimulate the regeneration of new cartilage. When applied to a joint, it forms an adhesive scaffolding within the damaged cartilage on which the body's own cells can then build new cartilage.
Impact
BioSyntech, a Quebec company, is commercializing the discovery and is currently conducting a clinical trial of BST-CarGel® in Canada, Spain and South Korea. Interim results from the trial have shown statistically significant improvements in repair tissue quality at 12 months post-treatment due to BST-CarGel® treatment. Final results are expected in 2010.
First Published
CIHR Health Research Results, 2004-05; updated 2009
The search for an end to chronic pain
Basic research yields dividends
Overview
People who suffer from chronic pain can tell you just how debilitating a condition it is. Yet, there are no drugs currently available to treat severe pain. Dr. Terrence Snutch from the University of British Columbia spent many years investigating how N-type calcium channels contribute to chronic pain and other neurological disorders and understanding how they mediate pain transmission. Dr. Snutch was the first scientist in the world to describe the molecular basis for clinically important calcium channels in the cardiovascular, endocrine and nervous systems.
Impact
In March 2006, Vancouver-based Neuromed Pharmaceuticals Ltd. Singed the largest-ever licensing deal with Canadian history with Merck & Co., Inc., worth up to $475 million, to further develop NMED-160, the drug that Dr. Snutch developed from his research. In August 2007, Neuromed and Merck & Co. discontinued development of NMED-160, but continue their collaboration to develop alternate therapies based on N-type calcium channels.
First Published
Researcher profile, July 2006; MP newsletter, spring 2006; updated 2009
Research, rinse and spit
Oral rinse can help detect infection
Overview
One of the standard ways to detect infection is by checking levels of white blood cells called neutrophils. High neutrophil levels provide protection against infection, while low levels denote susceptibility to infection. Neutrophil levels are usually checked with a blood test, but Dr. Michael Glogauer of the University of Toronto has developed an oral rinse that can detect neutrophil levels and monitor a person's susceptibility to infection. The rinse has been tested in children who have received bone marrow transplants. By monitoring neutrophil levels with the rinse, the research team could accurately predict whether the patient was at risk of infection up to one week earlier than the standard blood measurement of neutrophils. The rinse can also be used in patients receiving chemotherapy. The drugs involved in chemotherapy tend to eliminate neutrophils so, if the oral rinse can show a high level of neutrophils, they could potentially be dismissed from hospital earlier due to the lower possibility of infection, translating into cost savings for the health-care system.
Impact
Dr. Glogauer has patented the test in the United States (with a patent pending in Canada) and is working with a Canadian company, CHX Technologies, to take it to market. The next step is a clinical trial in 2010, partly funded by CIHR, to demonstrate the test's ability to predict the onset of periodontal disease. Mr. Ross Perry, owner of CHX Technologies, sees baby boomers as the largest potential market for the PD rinse test. "We're excited about commercializing the test because we know that older patients are really keen about preventive medicine and maintaining their teeth intact for as long as they can."
First Published
Researcher profile, October 2006; updated 2009
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