Cardiovascular

In a small, windowless room at Toronto General Hospital, a bank of seven 3D printers runs day and night, patiently laying down layer after layer of coloured plastic. When the printing is done, the pieces are trimmed and fitted together into perfect models of human hearts, life-sized and correct down to the smallest detail.

The 3D printers are part of the Lynn & Arnold Irwin Advanced Perioperative Imaging Lab at the University Health Network’s Peter Munk Cardiac Centre. Combined with advances in medical imaging and computer modelling, they are allowing doctors to get a better look at heart defects before they go in to repair them, as well as providing better training methods.

The models of the hearts use extremely detailed data from MRIs, CT scans, ultrasounds or other imaging techniques. Normally, doctors are working with two-dimensional images on a printout or a flat screen. As anyone who has ever tried to see their baby on a prenatal ultrasound can appreciate, this isn’t always easy. By turning the data from those images into three-dimensional computer models, and using those models to make solid printed hearts, the lab gives the doctor something that can be held in the hand and examined in detail.

With the printers whirring away in the background, Josh Qua Hiansen, the biomedical industrial designer at the lab, shows how the model will be used by doctors. This particular patient has a malformation of a part of the heart called the superior vena cava, which is allowing blood to mix with blood from pulmonary veins. Doctors want to fit an implant to close the malformed area, and they will use the model to make sure the implant is sized and positioned appropriately to close the area.

The lab was created in collaboration with Matt Ratto, a University of Toronto associate professor in the Faculty of Information and the head of the university’s Critical Making Lab. Co-founders are Dr. Massimiliano Meineri, a �鶹ֱ��app professor of anesthesia, and Dr. Azad Mashari, an anesthesiologist at Toronto General Hospital and a �鶹ֱ��app lecturer who heads the imaging lab. The mandate is to evaluate, refine and translate 3D imaging, modelling and micromanufacturing techniques into clinical and educational practice.

Mashari says that the new techniques provide an inexpensive and flexible way to create all sorts of learning aids. These include medical “phantoms” – printed hearts, spines and other body parts. For instance, heart phantoms are used to train ultrasound technicians. And a phantom spine in flesh-like gel can be used to instruct on how to give spinal injections.

With the capability provided by in-house 3D printing, along with 3D computer models and even virtual reality, Mashari thinks that training and medical visualization will continue to become less expensive and more effective.

Close-up picture of a model of a human heart created with a 3D printer, with numbers 1-5 associated with various parts of the model

1. Left atrium and aorta. 2. Superior vena cava and right atrium. 3. Artifical conduit connecting the right ventricle to the pulmonary arteries (also green). 4. Pulmonic ventricle. 5. Systemic ventricle.

The 3D printed model of the heart above is taken from the scan of a patient with dextrocardia and transposition of the great arteries. The patient has had many surgeries in order to create a normal circulation.

This picture shows the top of the heart, so it is as if you were looking down at it from above the person’s head.

The model shows the spaces inside – as if the walls of the chambers, arteries and veins had been removed, and only the blood they contain was visible. This allows doctors to get a good look at the connections between the chambers of the heart.

To make the heart, images from CT scans were converted into 3D computer models, and then rendered into thousands of “slices.” The printer used these image slices to build up the pieces one layer at a time.

The models are fairly cheap to make, but they do take time. It took a technician about three hours to convert the CT scan for this one into a computer model. Total printer time was 30 to 40 hours.

This story first appeared in the University of Toronto Magazine. Read the most recent issue

'An urgency to contribute': �鶹ֱ��app's Choong Chin (C.C.) Liew considered a visionary for work on cardiovascular genetics

noreen.rasbach — Mon, 16 Sep 2019 20:34:32 +0000

'An urgency to contribute': �鶹ֱ��app's Choong Chin (C.C.) Liew considered a visionary for work on cardiovascular genetics

noreen.rasbach Mon, 09/16/2019 - 16:34

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Choong Chin Liew, known as C.C., "really had a vision of translating basic research in genomics into a practical application for the benefit of humankind,” says Peter Lewis, Professor Emeritus of biochemistry at �鶹ֱ��app (photo courtesy of the Liew family)

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Research & Innovation

Choong Chin Liew was a visionary research scientist whose work on cardiovascular genetics is still paving the way for early detection of a wide variety of diseases from simple blood tests.

Liew, who died in August at the age of 81, was also an enthusiastic mentor to many medical researchers, an entrepreneur and a devoted family man who loved Ontario’s cottage country.

Liew, known to everyone as “C.C.,” arrived in Canada from Malaysia in 1962 to do graduate work at the University of Toronto with Charles Best (pictured left with his wife), the co-discoverer of insulin. He became an assistant professor in 1970, achieved full tenure in 1979, and was a Professor Emeritus in clinical biochemistry and medicine at the time of his death.

Liew’s early work was on diabetes and heart failure, but he is best known for developing what he called the “Sentinel Principle,” the concept that many diseases can be detected and monitored through their gene expression in the blood. Because of the transfer of information between blood cells and tissue cells, he postulated, blood tests can unlock information about diseases elsewhere in the body.

Liew was active in transferring his discoveries to the private sector, earning many patents and founding companies that are still in the process of developing diagnostic tools. A blood test for early assessment of colorectal cancer risk, based on the Sentinel Principle, is currently on the market. Other tests, for several other cancers and even Alzheimer’s disease, are in development.

“C.C. really had a vision of translating basic research in genomics into a practical application for the benefit of humankind,” says Peter Lewis, Professor Emeritus of biochemistry at �鶹ֱ��app, and a colleague and friend of Liew’s for several decades. “His goal was to turn the discovery, from back in the 1990s, into a practical application for the prognostication of disease from a drop of blood.”

A younger C.C. Liew at his microscope (photo courtesy of Liew family)

Liew was “driven,” Lewis says, and “there was not enough time in the day for all the activities he was pursuing.” But he was a delight to work with and very modest about his accomplishments, Lewis adds. “He didn’t seek out recognition publicly, and really flew below the radar.”

Liew’s enthusiasm for research was infectious, and that energy influenced many students who worked with him. ”I got a positive vibe from him,” says Mansoor Husain, who spent time in Liew’s lab as a medical trainee and is now director of the Toronto General Hospital Research Institute. “He obviously loved science. He always had a sparkle in his eye and excitement in his voice when he talked about research.”

As well as being passionate about the work, Liew was also welcoming, and trusted his students, Husain says.

Liew maintained that vigour right until the end of his life, as he continued to work to apply his discoveries. In recent years he collaborated with Alberta-based entrepreneur and scientist Jacqueline Shan, on research into potential applications of his techniques in treating Alzheimer's disease. Shan, co-creator of Cold-FX, recognized that Liew’s work on early detection of illnesses from the analysis of genomic markers in blood was revolutionary, and might lead to the creation of targeted medicines for Alzheimer’s patients.

“He was one of the best scientists I’ve ever seen,” Shan says. “He was very persistent,” even in his later years when he was ill and having chemotherapy treatment. “He worked harder than anybody in the lab. He had an urgency to contribute.”

At the same time, Liew was very caring, she says, and concerned about his colleagues’ families and health. On one long-distance airplane trip, he offered her tips on getting to sleep, so she would be fresh upon arrival, she says.

C.C. Liew and his wife Eng in 2017 on a family trip to Sungai Siput, where he was born (photo courtesy of Liew family)

Choong Chin Liew was born in 1937 in the small village of Sungai Siput in what was then called Malaya. (It became part of Malaysia in 1963). His father was a teacher from China who had moved to Malaya, while his mother was a Chinese-Malayan from Penang. Liew did not have a peaceful childhood, he noted in an autobiography he wrote in 2010, because of the Japanese invasion of Malaya during the Second World War and Japan’s persecution of its Chinese population.

“To escape these upheavals our family moved deep into the jungle,” Liew wrote. “There, we were able to wait out the war in safety.” But after the war there was more turmoil, as the British colonial government tried to crack down on communist insurgents, in what developed into a bloody guerrilla war.

Liew’s family moved to the city of George Town on Penang island, where he went to high school before studying biology at Nanyang University in Singapore. After graduation he taught and worked as a teaching assistant, then decided to pursue graduate work overseas. He wrote to Charles Best, who was then head of the physiology department at �鶹ֱ��app. Best offered him a fellowship.

Liew arrived in Canada by boat in 1962. He noted in his biography that “I was only one of thousands in a history of Chinese immigrants to Canada, over a time span that stretches back to the eighteenth century.” He was lucky, he added, because “by the time I arrived in the 1960s, Toronto was considered quite welcoming.”

Liew was intensely committed to his studies, and often slept in the lab. He also stayed away from the demonstrations and protests that were erupting on campus in the 1960s. “I had already experienced more than a fair share of war and politics in Malaysia,” he wrote. “I had left all of that behind in the forests of rubber.”

But it was a tough time, as he found the Canadian winters difficult, and he struggled to work and live in an English-speaking environment.

Eng and C.C. when they were dating: She moved to Canada two years after he arrived and they marrried soon after (photo courtesy of Liew family)

Two years after his arrival in Canada things improved when his girlfriend Eng came from Malaysia to join him, and they were married at Toronto City Hall a few months later.

After getting his master's degree in physiology and a PhD in pathological chemistry under renowned �鶹ֱ��app professor Allan Gornall, Liew conducted post-doctoral research in Britain and in New York. He had planned to return to Malaysia, but an explosion of anti-Chinese violence there in 1969 changed his mind, and he took a job at �鶹ֱ��app as assistant professor in clinical biochemistry.

Liew’s daughter Gailina says her father was absolutely devoted to the pursuit of science, but he also carved out time for his family. “We would have supper with him every night, but it would be late because he would be working in the lab.” She and her brothers would occasionally spend evenings and weekends in their father’s lab at the Banting Institute on College Street.

“I remember sometimes helping to wash test tubes.”

The family also accompanied Liew on his sabbatical travels, including time in Europe and a three-month tour of Chinese universities. There was always music in the house, Gailina says, because her father loved classical music and opera, and learned to play the piano.

C.C. (second from left in front row) with his family this past June in Lisbon, Portugal (photo courtesy of Gailina Liew)

In the mid 1970s Liew bought a cottage north of Toronto, cementing his connection to Canada. Several of his colleagues at �鶹ֱ��app had cottages, he wrote in his memoir, and “it seemed to me like the thing to do in Canada.” The cottage was a place to relax, read and write, he wrote, and became a treasured weekend getaway.

In the 1990s Liew’s work evolved into the study of cardiac gene sequencing, and in 2000 he established a lab at Harvard Medical School in Boston to continue the research. He made significant discoveries linking gene expression with disease, and found that changes in blood genes reflected broader changes in health.

Recognizing the commercial possibilities of this research – and the need for capital to pursue the work – Liew formed a private company called GeneNews, which is now traded on the Toronto Stock Exchange under the name StageZero Life Sciences. Later he created other business ventures to apply the Sentinel Principle, including companies in Malaysia and China. His long-term aim, he wrote in his memoir, was to “build a personalized health management system that would allow anyone to manage their own health from the information that can be read in a single drop of blood.”

For several years, he worked closely with his daughter Gailina, who held senior executive positions at GeneNews thanks to her background in molecular genetics and her experience as a lawyer. It was a privilege working alongside her father, she says. “He was the scientific visionary and the rest of us just had to help capture all that thinking and turn it into a product.”

Liew’s most important goal throughout his life of research “was to make a positive difference to the patient” by helping prevent diseases or detect them early, Gailina says. But he also touched people all around the world, because he was so outgoing, gregarious, generous and kind-hearted.

Liew died after several years fighting multiple myeloma, but ”he was working up until his last day,” Gailina says.

He leaves his wife Eng, brother Jack Chor, daughter Gailina, sons Allan and Victor, and seven grandchildren. The family has set up an endowment fund in C.C. Liew’s memory to award scholarships and grants to support research aimed at improving human health.

�鶹ֱ��app researcher launches startup to help find new smart drugs

ullahnor — Mon, 24 Apr 2017 17:03:11 +0000

�鶹ֱ��app researcher launches startup to help find new smart drugs

ullahnor Mon, 04/24/2017 - 13:03

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Professor Igor Stagljar's new startup ProteinNetwork Therapeutix will be based in Toronto

Chris Sorensen

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Chris Sorensen

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The lab’s technology maps cell membrane protein interactions for hundreds of diseases like cancer, Parkinson’s, Alzheimer’s, diabetes and cardiovascular disease

Igor Stagljar likens the process of commercializing his ground-breaking research into cell membrane proteins – which has yielded hundreds of new targets for drug-makers seeking cures for cancer and other deadly diseases – to building a highly automated Tesla factory.

But there’s a key difference: ProteinNetwork Therapeutix will be based here in Canada, not south of the border.

Stagljar, a professor of biochemistry and molecular genetics at the University of Toronto, initially considered setting up his new venture in Silicon Valley. But he and business partner Ivan Plavec ultimately decided Toronto was a better option.

“The technology is here and the know-how is here,” says Stagljar, citing �鶹ֱ��app’s large pool of research talent and a growing cluster of venture capital investors on or near the university’s downtown campus. “Maybe some people from my lab will even go to work for the company.”

Read about his latest research findings for Parkinson's

Helping to seal the deal: a $1 million grant from CQDM’s Quantum Leap program. The grant, co-funded by the Brain Canada Foundation, targets research with “very high potential impact” within the biopharmaceutical industry. It’s only the second time the program has funded a Canadian researcher. The other was �鶹ֱ��app’s Andrei Yudin, a professor of chemistry.

Stagljar’s research certainly qualifies as having a potentially big commercial impact.

With the help of his 17-person lab, he developed a new genetic technique that allows researchers to map the interactions between proteins in a cell’s membrane, a process previously made difficult because of the proteins’ fragile, transitory states. The interactions play a key role in determining whether a cell stays healthy or becomes diseased, and are therefore of huge interest to pharmaceutical companies seeking a new generation of precision drugs to cure deadly diseases like cancer.

“There’s about 500 proteins that we know of nested in the cellular membranes that are involved in the onset of various human diseases,” says Stagljar, citing cancer, Parkinson’s, Alzheimer’s, hypertension, diabetes, cardiovascular disease and even migraines. “There are approximately 500 diseases that can be tackled with this technology.”

But studying protein interactions in the lab is not the same as systematically evaluating them on a commercial scale. So Stagljar is in the process of retooling his laboratory at �鶹ֱ��app’s Donnelly Centre for Cellular Biomolecular research, tapping a local Ontario company to design and build robotics that can handle hundreds of screens per day.

Everything should be up and running within the next 12 months. Stagljar’s focus at �鶹ֱ��app will be on “druggable” membrane proteins related to three types of cancer: lung, breast and pancreatic. His company, meanwhile, will use similar technology and equipment to focus on other diseases in partnership with pharmaceutical partners.

“We’re already leading very serious talks with well-known drug companies,” Stagljar says. “Two out of the five biggest pharmaceutical companies are interested in our technology.”

How long until ProteinNetwork expects to see results?

“I think in the next two or three years, we will learn about new drug targets, which, when neutralized by drugs, would lead to cures for these cancers,” says Stagljar. “But before these drugs would appear in clinics is a long process, from nine to 12 years.

“Our focus right now is to build a high-throughput, high-grade technology for biomedical research.”

Learn more about entrepreneurships and startups at �鶹ֱ��app

�鶹ֱ��app's Mansoor Husain to lead Ted Rogers Centre for Heart Research

sgupta — Wed, 23 Mar 2016 13:01:09 +0000

�鶹ֱ��app's Mansoor Husain to lead Ted Rogers Centre for Heart Research sgupta Wed, 03/23/2016 - 09:01

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“Our researchers and physicians will work together with the broader cardiovascular community to transform the management of this disease”

Cardiovascular

Faculty of Medicine

Our Faculty & Staff

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Vivek Goel: “Out of a global search, he emerged from an outstanding field of candidates as uniquely positioned to lead the Centre”

The Ted Rogers Centre for Heart Research, a special Canadian partnership that unites clinical innovation with genetics, stem cells and engineering, has named Professor Mansoor Husain its first executive director.

Husain, an internationally recognized cardiovascular researcher and professor in the department of laboratory medicine and pathobiology, will guide the Centre’s vision and its leading-edge work in heart failure.

“I’m honoured to lead this extraordinary collaboration between The Hospital for Sick Children, University Health Network and the University of Toronto to form a research centre that will improve the lives of Canadians with heart failure,” said Husain.

“Our researchers and physicians will work together with the broader cardiovascular community to transform the management of this disease across the lifespan.”

Historic $130-million gift to establish the Ted Rogers Centre for Heart Research

sgupta — Thu, 20 Nov 2014 10:59:17 +0000

Historic $130-million gift to establish the Ted Rogers Centre for Heart Research sgupta Thu, 11/20/2014 - 05:59

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�鶹ֱ��app professors Craig Simmons and Peter Zandstra and PhD students Jennifer Ma and Curtis Woodford are among the dozens of researchers who will work to advance treatments for heart patients at the Ted Rogers Centre for Heart Research

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Largest private donation in Canadian health-care history will bring together the strengths of SickKids, UHN and �鶹ֱ��app in personalized genomic medicine, tissue engineering, and advanced cardiac care to address heart failure across the lifespan

With the goal to reduce hospitalization for heart failure by 50 per cent over the next decade, the Hospital for Sick Children, the University Health Network and the University of Toronto have announced the creation of the Ted Rogers Centre for Heart Research, funded by an unprecedented donation of $130 million from the Rogers family – the largest monetary gift ever made to a Canadian health-care initiative.

“We’re thrilled to be able to bring the Ted Rogers Centre for Heart Research to life,” said Loretta Rogers, wife of the late Ted Rogers. “We know Ted would have been proud of this bold initiative that will improve heart health for all.”

“The generosity and magnitude of this gift and the transformational effect it will have on heart research truly reflects the pioneering and innovative spirit of Ted Rogers and his family,” said Dr. Michael Apkon, president and chief executive officer of SickKids. “This powerful, collaborative partnership among SickKids, UHN and �鶹ֱ��app will have a global impact. Together we hope to accelerate discovery and cardiac care at an unprecedented pace.”

Heart disease represents a considerable economic strain on the Canadian health-care system. The annual cost for managing moderate and severe heart failure patients in Canada is as much as $2.3 billion.

“Today, one million Canadians are living with heart failure, and that number is projected to increase 25 per cent over the next 20 years,” said Dr. Barry Rubin, chair and program medical director of the Peter Munk Cardiac Centre and a professor of surgery at �鶹ֱ��app. “This unprecedented gift will enable research teams in the Ted Rogers Centre for Heart Research to develop new therapies that will dramatically improve the lives of patients with heart disease.”

The Ted Rogers Centre for Heart Research will bring together more than 30 expert clinicians and researchers from across the partner institutions, as well as up to 80 graduate students, postdoctoral fellows and clinical fellows who represent the future of the field. This critical mass of expertise will improve treatments for heart patients – and develop entirely new therapies. The Ted Rogers Centre for Heart Research will be a magnet to attract additional research talent from around the world, solidifying Toronto’s and Canada’s position as a global leader in cardiac care, said Professor Meric Gertler, president of �鶹ֱ��app.

“The Toronto region is home to one of the world’s largest biomedical science and health education clusters,” said Gertler. “This exceptionally powerful network of researchers and educators is translating exciting ideas, innovations and therapies in stem cell research and regenerative medicine into clinical settings where they will address the most challenging problems across the spectrum of heart disease.

“With its pioneering spirit and innovative approach, the Ted Rogers Centre for Heart Research will be a world-class collaboration and a most fitting tribute to its namesake.”

The Ted Rogers Centre for Heart Research will have facilities in each of the three participating institutions. It will be the first in the world to bring together research, education and innovation in personalized genomic medicine, stem cell research, bioengineering, and cardiovascular treatment and management under one umbrella with a single focus: improving heart health across the entire lifespan, from children to adults.

Each institutional partner will take the lead in a particular area:

SickKids will harness the power of genomic science to decode the genetic foundations of cardiac disease, which will allow for heart disease to be better predicted before it occurs, and will support individualized therapies for children and adults, based on the unique genome of each patient.
UHN, through the application of powerful databases, new biomarkers for cardiac disease, regenerative and individualized medicine approaches and state-of-the-art-real-time home monitoring and telecommunications technologies, will focus on the translation of research discovery into the delivery of care for patients. Foundational to this approach is a customized cardiovascular data module for a new electronic patient record which is linked to a Biobank which will house a vast array of biologic samples that come from both adult and paediatric patients.
�鶹ֱ��app will focus on combining stem cell technology with novel approaches in cellular and tissue engineering for the regeneration of heart muscle, coronary vessels and heart valves. This cutting-edge science, which is crucial to restoring damaged hearts, will be led out of �鶹ֱ��app’s Institute of Biomaterials and Biomedical Engineering, one of the many fields in which the university is recognized as a world leader.

Professor Peter Zandstra, a lead �鶹ֱ��app investigator for the Ted Rogers Centre for Heart Research, says patients with valve disorders, for example, typically need several complex operations during their lifetime to implant larger valves to accommodate the growing heart. They also require drugs to keep their heart from rejecting valve replacements.

“Research at the centre could one day lead to the regeneration of a valve with the patient’s own cells – eliminating a lifetime of chronic illness,” he said.

Cardiac fibrosis is a stiffening of the heart tissue that leads to a variety of cardiac diseases, including heart failure. Zandstra says advances in tissue engineering at �鶹ֱ��app will accelerate the discovery of biomaterials that could be used to treat fibrosis, bringing new hope to patients.

Research at the University will also enlarge our understanding of how genetic, molecular signalling and cellular networks function as the heart develops, opening up the possibility for more effective heart therapies.

The establishment of the new centre will enable �鶹ֱ��app scientists to create technologies and tools for improved heart physiology monitoring, in clinical settings and for patients at home. These efforts will lead to more seamless, integrated care for heart patients.

The Ted Rogers Centre for Heart Research will also establish a competitive innovation fund to drive discovery and development of next-generation therapies for heart failure, and an education fund to attract the best and brightest students and postgraduates to ensure a deep pool of talent in Canada for cardiac care and research.

Over the next decade, the Ted Rogers Centre for Heart Research will help enable more people – adults and children alike, in Canada and around the world – to live long, healthy and happy lives.

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Re-thinking the use of adrenaline after a heart attack

sgupta — Thu, 17 Apr 2014 13:01:52 +0000

Re-thinking the use of adrenaline after a heart attack sgupta Thu, 04/17/2014 - 09:01

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More than 90 per cent of people who experience a cardiac arrest outside of a hospital will die before reaching a hospital or soon after (photo by Matt via Flickr)

Geoff Koehler

Author legacy

Geoff Koehler

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Subheadline

Drug helps restore pulse but doesn't improve long-term survival rate, study finds

Giving patients adrenaline after they suffer a cardiac arrest outside of a hospital does not increase their prospects of surviving long-term, according to new research conducted at St. Michael’s Hospital.

“The vast number of patients who have a cardiac arrest get adrenaline, which has been the drug recommended in treating cardiac arrest for decades,” said Dr. Steve Lin, an emergency physician and trauma team leader at St. Michael’s Hospital and a research fellow at the University of Toronto's Division of Emergency Medicine. “Yet, despite advances in medical treatment, long-term survival rates of patients who suffer a cardiac outside a hospital and receive adrenaline remains low.”

About 40,000 Canadians suffer cardiac arrest outside of a hospital every year and, in Toronto, fewer than 10 per cent survive long enough to be discharged from hospital, Lin said. His findings were published in the journal Resuscitation.

When a person has a cardiac arrest, his or her heart stops beating. Unless the heart is restarted within minutes, the person usually dies. More than 90 per cent of people who experience a cardiac arrest outside of a hospital will die before reaching a hospital or soon after.

Lin and his colleagues looked at clinical trials and data involving out-of-hospital cardiac arrests that were published in medical journals up to July 2013 and found that adrenaline showed no benefit in survival to discharge from hospital or neurological outcomes.

“It is thought that the short-term benefit of adrenaline in improving coronary blood flow may occur at the expense of other organs,” said Dr. Lin. “The drug can cause small blood vessels in other organs to contract, such as in the gut, liver, and kidneys, thus limiting the blood flow to these organs.”

While adrenaline is also given to patients who suffer cardiac arrest in hospitals, Dr. Lin looked only at studies of those outside of a hospital because the cause of cardiac arrest tends to be different between the two settings. Those outside a hospital tend to be related to heart disease and heart attacks. Cardiac arrests in the hospital are usually related to the reasons why a patient would be in the hospital, such as infections or respiratory diseases.

Lin is a research fellow at Rescu – a program based at St. Michael’s that focuses on developing processes and interventions to improve outcomes for patients who suffer life-threatening trauma and cardiac emergencies outside of hospitals. He said that because a standard dose of one milligram of adrenaline showed to be effective in regaining a person’s pulse after a cardiac arrest, physicians also questioned what sort of impact a high dose of adrenaline might have.

“When compared to patients who received a standard dose of adrenaline, those who received a high dose had an even greater chance of regaining their pulse after a cardiac arrest,” he said. “The long-term survival rate, however, did not increase.”

Lin said that those in the medical community need to discuss and study whether adrenaline should still be administered during cardiac arrests. He recommends that paramedics focus on early use of defibrillators and effective CPR instead.

“The use of adrenaline has been the standard of care for so long that it’s been hard to change the culture,” said Lin. “We have reached a point in time where physicians and paramedics have to change the way we think.”

Geoff Koehler is a writer with St. Michael's Hospital, a partner of the University of Toronto.

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Lowering cholesterol by eating chickpeas, lentils, beans and peas

sgupta — Mon, 07 Apr 2014 12:57:35 +0000

Lowering cholesterol by eating chickpeas, lentils, beans and peas sgupta Mon, 04/07/2014 - 08:57

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A serving of beans is 130 grams but Canadians typically eat less than half a serving a day (Bigstock photo)

Leslie Shepherd

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Leslie Shepherd

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Subheadline

One serving per day dramatically cuts "bad" cholesterol

Eating one serving a day of beans, peas, chickpeas or lentils can significantly reduce “bad cholesterol” and therefore the risk of cardiovascular disease, a new study has found.

However, most people in North America would have to more than double their consumption of these foods known as pulses to reach that target, said the researchers at St. Michael’s Hospital.

The study, led by Dr. John Sievenpiper of the hospital’s Clinical Nutrition and Risk Factor Modification Centre, was published today in the Canadian Medical Association Journal. Co-authors include University of Toronto Professor David Jenkins of the Department of Nutritional Sciences in the Faculty of Medicine.

Researchers found that by eating one serving a day of pulses, people could lower their LDL (“bad”) cholesterol by five per cent. This would translate into a five to six per cent reduction in the risk of cardiovascular disease, the second leading cause of death in Canada.

One serving of pulses is 130 grams or ¾ cup, yet Canadians on average eat less than half a serving a day. Pulses have a low glycemic index (meaning that they are foods that break down slowly) and tend to reduce or displace animal protein as well as “bad” fats such as trans fat in a dish or meal.

“Canadians have a lot of room in their diets for increasing their pulse intake to derive the cardiovascular benefits,” Dr. Sievenpiper said. “Only 13 per cent consume pulses on any given day. Pulses already play a role in many traditional cuisines, including Mediterranean and Indian. As an added bonus, they’re inexpensive. Since many pulses are grown in Canada, it’s also an opportunity to buy and eat locally and support Canadian farmers.”

Dr. Sievenpiper’s meta-analysis reviewed 26 randomized controlled trials that included 1,037 people. Men had greater reduction in LDL cholesterol compared with women, perhaps because their diets are poorer and cholesterol levels are higher and benefit more markedly from a healthier diet.

Some study participants reported stomach upset such as bloating, gas, diarrhea or constipation but these symptoms subsided over the course of the study.

Leslie Shepherd is a writer with St. Michael's Hospital.

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Meet the 2012 McLean Award winners

sgupta — Tue, 31 Jul 2012 11:22:26 +0000

Meet the 2012 McLean Award winners sgupta Tue, 07/31/2012 - 07:22

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Milica Radisic and Craig Simmons share a research focus on regenerative medicine for the heart

Erin Vollick

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Erin Vollick

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Broken hearts are the focus of this year’s McLean Award winners: bioengineers Milica Radisic and Craig Simmons.

Part of the Connaught Fund, the prestigious McLean Award honours emerging leaders in basic research in the fields of physics, chemistry, computer science, mathematics, engineering sciences, and statistics. Recipients must have received their PhD within the past 12 years.

Typically, only one MacLean award is handed out per year.

“The quality of McLean applications this year was extremely high—so high that the Connaught Committee decided to make two awards,” said Professor Peter Lewis, �鶹ֱ��app’s Associate Vice-President, Research and Innovation.

Radisic and Simmons both hail from the Institute of Biomaterials and Biomedical Engineering (IBBME)—a biomedical research institute stretching across the Faculties of Applied Science and Engineering, Medicine, and Dentistry. They share a research focus on regenerative medicine for the heart.

It's a fact not lost on the recipients.

"As we were working very hard this January to prepare our proposals, we encouraged each other along the way, knowing that probably only one of us could win," said Radisic, Canada Research Chair in Functional Cardiovascular Tissue Engineering and Associate Professor at the Institute of Biomaterials and Biomedical Engineering (IBBME) and the Department of Chemical Engineering and Applied Chemistry.

"I'm glad to be a part of the research community that is successful in cultivating the spirit of research excellence and collegiality at the same time."

Radisic is being recognized for her work towards enabling the regeneration of cardiac tissue after it has been damaged—for example, after a heart attack. In conjunction with the discovery of a novel new peptide, QHREDGS, that might be capable of enhancing cardiac regeneration, bone regeneration or wound healing, Radisic is developing a prototype network that involves the seeding of vascular tissues with cells that she hopes will create rapid new tissue growth.

"I am greatly honoured that the Connaught Committee recognized my research with the 2012 McLean Award. The funds will enable me to hire students and post-docs to develop new solutions to the vascularization of engineered tissues in vitro and in vivo," said Radisic.

Named one of the Top 35 Innovators under 35 by the MIT Technology Review in 2008, Radisic also received the Young Engineer Medal from the Engineers Canada Society earlier this year.

Simmons, Associate Professor in the Department of Mechanical and Industrial Engineering, IBBME, and the Biomaterials Department in the Faculty of Dentistry, holds a Canada Research Chair in Mechanobiology. He uses a cross-disciplinary approach to tackling the problems of heart valve disease and musculoskeletal degeneration—two problems that appear to have related origins.

By examining the mechanical properties of cells, Simmons and his students seek to determine some of the root causes for these deadly and costly diseases - discoveries that could lead to new or improved treatments.

"I am thrilled and honoured for this recognition of my research group's contributions and the promise of our work," said Simmons. "I'm fortunate to work with an exceptional group of students and researchers, and I'm grateful for the support of the McLean Award, as it will help me to continue to attract outstanding people to our team."

Creating a paradigm shift in understanding how these microscopic building blocks function requires new tools. Simmons and his students have been engineering novel microfluidic devices—small devices that allow for the minute movement and study of liquids—to analyze cell mechanics in new ways, along with new computational models with which to analyze the data.

“Professors Radisic and Simmons are both conducting cutting-edge research on tissue engineering that could lead to breakthroughs and improved health for Canadians,” said Lewis. “On behalf of the University of Toronto, I extend my congratulations to them both on these well-deserved awards.”

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Veins versus arteries

sgupta — Mon, 25 Jun 2012 15:22:15 +0000

Veins versus arteries sgupta Mon, 06/25/2012 - 11:22

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Dr. Stephen Fremes performs open heart surgery (photo by Doug Nicholson)

Marie Sanderson

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Heart surgery patients fare better when surgeons bypass their blockages using arteries grafted from an arm rather than veins grafted from a leg, �鶹ֱ��app research shows.

The Radial Artery Patency Study, published on-line in advance of publication in the July issue of the Journal of the American College of Cardiology, found that a radial artery taken from a patient’s wrist or arm, versus a saphenous vein from the leg or thigh, provides the best outcome five years after coronary artery bypass grafting.

“Previous studies have indicated that the radial artery is not much better than a saphenous vein graft, but this new study challenges that,” says Dr. Stephen Fremes, principal investigator and professor at the University of Toronto, and also Head of the Division of Cardiac Surgery at Sunnybrook Health Sciences Centre.

The randomized study, which involved nine Canadian centres and was funded by the Canadian Institutes of Health Research (CIHR), looked at 269 patients approximately 7.5 years after having a heart bypass.

The radial artery outperformed the saphenous vein, with 12 per cent of patients having a functional graft occlusion (blockage) versus 19.7 per cent of patients who received a saphenous graft. In addition, significantly fewer radial artery grafts became completely occluded at 8.9 per cent, compared with saphenous vein grafts at 18.6 per cent.

Most patients who undergo coronary artery bypass grafting have multiple vessel disease and multiple bypasses. In the RAPS study, the number of bypasses was three and a half. Each patient in the study received both a radial artery graft and a saphenous vein graft at two vessel sites, so the randomization was within the patient, not between patients.

Based on the results, authors recommend a radial artery as a second or third conduit, after a mammary (chest/thoracic) artery.

“The radial artery is a good second option for grafting after the internal mammary artery because of its length, diameter, wall thickness and also because of the lack of harvest-site complications,” adds Fremes. “Radial artery bypass grafts should be used preferentially for the most severely narrowed coronary arteries.”

In comparison to other studies on this topic, which were single site and observational in nature, this study was randomized through several centres.

“The data is real and reproducible,” says Fremes.

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Pregnancy problems that help predict heart trouble

sgupta — Thu, 14 Jun 2012 12:30:36 +0000

Pregnancy problems that help predict heart trouble sgupta Thu, 06/14/2012 - 08:30

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Problems during pregnancy can help identify women at risk for heart muscle disease, say researchers (Bigstock photo)

Kate Taylor

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Women with Maternal Placental Syndromes (MPS) such as pre-eclampsia or gestational hypertension are up to 1.6 times more likely to experience premature heart failure or heart rhythm problems, new research shows.

The study led by Dr. Joel Ray, a professor in the Department of Medicine and the Institute of Health Policy, Management and Evaluation, analyzed data from more than one million pregnant women who gave birth in Ontario between 1992-2009. Ray, a clinician and researcher at St. Michael's Hospital, compared women with and without MPS, and then looked at which ones were later hospitalized for heart failure or dysrhythmias – abnormal heart rhythms – starting at one year after delivery.

“Events in pregnancy can be the ‘canary in a coal mine’ for a woman’s heart health,” Ray said. “For the first time, we found a pronounced tendency for heart failure and dysrhythmias in women who had a prior MPS.”

Risk factors such as high blood pressure, obesity, diabetes and high cholesterol predispose a woman to MPS in pregnancy, and to the heart problems years after pregnancy, he said. These risk factors cause an abnormality in the blood vessel system, affecting both the placenta, and later, the heart muscle.

Ray and colleagues followed the women for an average of eight years. They excluded those with conditions that may also cause heart failure or dysrhythmia such as coronary artery disease or thyroid disease, and adjusted for factors such as obesity, longstanding high blood pressure and socioeconomic status.

The data also showed that the risk for heart failure and dysrhythmias increased with the severity of MPS. Women with more severe cases, such as pre-eclampsia early on in the pregnancy, were up to 2.3 times more likely to have heart failure or rhythm disorders starting from one year after delivery.

The findings build on previous research by Ray that found a connection between women who had MPS and the rates of coronary heart disease and stroke.

“The biggest take home message here is that around a decade earlier, we’re able to see what state the mother’s heart is in,” he said.

“Our research can identify women at a young age who are at risk for heart muscle disease, not just coronary artery disease and stroke, which gives the opportunity to provide healthy interventions,” Ray said. “Doctors can provide dietary and lifestyle medications to significantly lower their risk.”

Even monitoring for high blood pressure – the biggest risk factor for heart failure and dysrhythmias – can make a significant difference, he said.

The study appears online in Heart, a British Medical Journal.

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Cardiovascular

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