Development of e-learning videos to facilitate uptake and reach of nutrition evidence as part of supportive care for prostate cancer patients across BC

Co-leads:

  • Rachel Murphy
    University of British Columbia
  • Phil Pollock
    Vancouver Prostate Centre / Vancouver Coastal Health Research Institute

Team members:

  • Larry Goldenberg
    Vancouver Prostate Centre
  • Celestia Higano
    Vancouver Coastal Health
  • Mike Marin
    University of British Columbia

Trainee:

  • Kaitlin McLaughlin 
    RD, MPH student

One in eight Canadian men will develop prostate cancer (PC), but most will live for many years after diagnosis. This places a high level of importance on supportive care, particularly regarding lifestyle, as the impact of treatment on health and quality of life are long lasting. Nutrition is a key part of supportive care, helping to inform men about healthy eating and diet recommendations for PC. However, nutrition is rarely a part of standard of care in Canadian cancer centres. In recognition of this gap and other gaps in supportive care, the Prostate Cancer Supportive Care (PCSC) program, a comprehensive survivorship program, provides education (including nutrition education), as standard of care. The Vancouver-based program is being expanded to four additional centres across BC as part of a $6 million commitment from the BC Ministry of Health. A strategic priority of the PCSC program is the development of online materials for a virtual centre to reach men who cannot physically access the program.

The objective of this study is to collaboratively develop innovative online videos that meets the educational needs of men by teaching nutrition concepts and presenting evidence on diet and PC in an interesting and engaging way. E-learning offers more flexibility, wider geographic reach, and on-demand access to provide men greater autonomy over this aspect of their healthcare. Audience-appropriate learning strategies will be used, assisted by the award-wining teaching expertise on the team. The team also has expertise in knowledge translation of nutrition evidence and e-learning methods. Video content will be adapted from evidence-based information including the current in-person education session, medical and scientific literature, and will respond to the findings from a needs assessment being conducted by the project team, which includes feedback from men, their partners, physicians, and stakeholders. Videos will be displayed on the PCSC website and cross-posted with other partner sites. Additional objectives are to refine the videos based on feedback from these groups and to measure the reach and satisfaction.

The outcome of the project is increased nutritional support for men and their families throughout the survivorship continuum. It is anticipated that this project will serve as a model to encourage incorporation of nutrition as a standard of care and will positively affect men’s health across the PC trajectory.

Orthogonal multicolour high-affinity tags for RNA imaging and manipulation

RNA plays a very important role in the regulation of gene expression. Yet, the spatial and temporal dynamics of RNA are still poorly understood, mainly due to the scarcity of effective and simple RNA imaging and purification techniques.

The development of technologies that simultaneously allow imaging, purification and manipulation of multiple RNAs in live cells promises to enable the study of RNA in development, metabolism and disease, which is essential for understanding the control of gene expression in diseases such as autism, cancers and type II diabetes.

Dr. Dolgosheina will develop a multicolour RNA-based imaging method that will allow researchers to simultaneously visualize two RNAs in living cells, while concurrently purifying and/or manipulating RNA interactions with other biomolecules. This new technology will build on, and dramatically increase the capabilities of the bright, high affinity RNA Mango system that she developed during her PhD.

The proposed project is working on an outstanding international problem, and since these tools are urgently needed, the research has attracted significant national and international attention.

This research project will 1) result in international level talks and publications, 2) bring together some of the best international researchers in RNA biophysics and 3) result in intellectual property development, industrial research and training and commercialization via a rapidly growing Canadian biotechnology company, Applied Biological Materials (Richmond, BC).

The effects of balance training with or without cognitive training in older adults with MCI and impaired mobility

Mild cognitive impairment (MCI) is an intermediate stage between normal cognitive function and dementia. The rate of progression of MCI to dementia in older adults has been found to be between 10-12% per year, whereas those without cognitive impairment acquire dementia at a rate of only 1-2% per year. MCI has been linked to poor dual-tasking, impaired balance and functional mobility, and is a significant risk factor for falls. Individuals with MCI need preventive therapies that target both the cognitive and mobility-related outcomes. Dr. Jehu has identified pairing targeted dual-tasking training with balance and mobility training as a promising  preventative therapy.

In recent research, balance and mobility training (BMT), and balance and mobility plus cognitive training (BMT+C) programs have been shown to improve dual-tasking and functional mobility in the healthy older adult population; however no previous interventions have targeted dual-task training in individuals with MCI. Dr. Jehu will extend this work to individuals with MCI in order to improve cognitive and mobility outcomes. The BMT and BMT+C interventions will determine whether individuals with MCI can reverse cognitive and functional declines and improve to healthy older adult norms.

The timed up & go (TUG) is a commonly used clinical functional mobility assessment tool. TUG has been shown to be an independent predictor of cognitive decline following an ischemic stroke, and has accurately differentiated between healthy older adults and older adults with MCI. Dr. Jehu aims to use TUG to improve the diagnostic interpretation of important clinical measures used to evaluate individuals with MCI.

Dr. Jehu’s research may serve to improve the interpretation of clinical diagnostic tools, which could revolutionize the prescription of exercise in older adults with MCI and improve the overall interpretation of commonly used clinical assessment tools.

Servo-controlled device to maintain physiological functioning

300,000 individuals live with spinal cord injury (SCI) in the US alone, of which 180,000 suffer from orthostatic hypotension, sudden falls in blood pressure upon standing. Such dysregulated blood pressure can also be caused by multiple sclerosis, autonomic failure, autonomic neuropathy, or neurological cancers. A high quality, efficient, and cost effective method is needed to help these individuals regulate their blood pressure.

Dr. Krassioukov has developed a device and algorithm for controlling autonomic processes in patients using electrical stimulation, based on the surprising discovery that electrical stimulation of the spinal cord circuitry caudal to SCI can control the activity of disconnected sympathetic circuitry to regulate blood pressure. The device can be individualized, and electrical output may increase or decrease based on the information received from the patient’s physiological monitor.

Dr. Krassioukov’s product may improve patients’ control of autonomic functions such as dysregulated blood pressure due to SCI or other injuries or diseases, improving their quality of life and ability to manage symptoms, at a lower cost and with improved effectiveness than current methods.

Liquid skin substitute accelerates burn and non-healing wounds

Self-expanded mesh grafts are routinely used to treat large burn injuries and skin defects. Although this treatment saves lives, the healed tissue has a fish net-like appearance, a disfigurement that can be devastating for patients. Furthermore, chronic and non-healing wounds seen in the elderly and diabetic patients and those with disabilities such as spinal cord injured patients are the most difficult and costly to treat. 

Dr. Ghahary’s lab has developed a novel, shelf-ready powdered reconstitutable liquid skin substitute called “MeshFill”. MeshFill is liquid at low temperatures and solidified when it is applied to a wound site. As MeshFill is a liquid scaffold, it fills up any cavities, gaps and void areas seen in different chronic wounds and any other injuries. 

MeshFill has already been shown to accelerate the healing process when used on diabetic wounds, and patients with large burn injuries and other skin defects currently treated with a self-expanded mesh graft would also benefit from this technology. The therapeutic use of MeshFill would greatly reduce patient suffering, as well as reducing the economic and social costs of chronic and burn wounds.

Dr. Ghahary will evaluate MeshFill’s safety, effectiveness, feasibility and functionality in animal models. Subject to successful results from these experiments, he will then refine MeshFill’s preclinical safety, manufacturing, sterilization, packaging, and a scaling-up strategy in order to assemble a shelf-ready product. 

Smart Text Analytic Tools (STAT) for analysis of patient-centred communications to strengthen health systems in BC

Healthcare stakeholders, including health authorities, facilities, pharmaceutical companies and insurers are increasingly acknowledging the importance of big data to enhance understanding of health behaviours and health systems. Existing analytic tools available to navigate the volume of diverse data types at a frequency that can match the speed at which data is generated are in early stages of development, and often lack validation due to limited access to health data. The ability of healthcare stakeholders to make sense of this valuable data is restricted by a lack of capacity and user-friendly analytic tools. 

Dr. Lester leads the UBC mobile health (mHealth) research team, which has been developing a set of smart-text-analytic-tools (STAT) to analyze patient and care provider communication data in the form of open natural language text. The WelTel digital health platform was created by Dr. Lester and has been tested in a diversity of geographic (Kenya, Canada, USA, South Africa) and health settings (HIV, TB, Asthma, maternal and child health) since 2005. The result of twelve years of mHealth research is a dataset consisting of hundreds of thousands of text messages sent by patients and providers. Topics of discussion include advice related to medication side effects, information requests, and the need for access to psychosocial and logistical support services. This data has the potential to identify outpatient self-reported priorities over time, informing patient-centered improvements in health system responsiveness and preparedness. 

The UBC mHealth research group will further develop STAT into a minimum viable product  that can analyze a variety of open natural language text data using natural language processing. This tool will allow both public health systems and private enterprise to streamline approaches to analyzing large volumes of text-based data.

Near infrared spectroscopy for the hemodynamic monitoring of acute spinal cord injury

One of the only treatments that could potentially improve paralysis in patients who have suffered an acute traumatic spinal cord injury (SCI) is the elevation of the mean arterial blood pressure (MAP) to provide enough blood supply to the injured spinal cord. It is, however, difficult to know what the MAP target should be for a given patient to optimize their neurologic recovery. 

Currently there is no measurement tool that provides real-time information about the spinal cord blood supply and oxygenation, and allows them to know if their efforts to elevate blood pressure are actually improving (or worsening) the injured spinal cord. Such a tool would provide information to guide clinicians in their treatment decisions and allow them to personalize their care and optimize neurologic outcomes.

Dr. Kwon will explore the potential of near-infrared spectroscopy (NIRS) as a monitoring tool to provide this information, with the explicit goal of developing this technology into a device that can be commercialized to be used in SCI patients. NIRS works by shining near-infrared (NIR) light through tissues and then recording how much light is transmitted versus how much is absorbed by molecules within the tissue. By measuring near infrared light absorption in tissue, NIRS can measure how much oxygen and blood is being delivered, potentially informing us of whether cells within the tissue are being irreversibly injured due to oxygen deprivation.

Dr. Kwon’s research will translate a promising technology (NIRS) into a clinical application for acute SCI patients. His initiative is focused on providing a tool that will assist clinicians in their hemodynamic management of acutely injured patients during a time when their efforts greatly impact patients’ neurologic outcomes.

Genomic Organization At Large (GOALS) predicts aggressive biological behaviour in prostate and breast cancers

Prostate cancer is the most commonly diagnosed form of cancer for men in North America. Prostate cancer deaths have been in decline since the mid-1990s after the discovery of Prostate-Specific Antigen (PSA), which, when used for screening, results in a steep increase in the number of early diagnoses. A large percent of these PSA-detected cases do not express clinically, are slow growing, and do not require treatment, and therefore do not contribute significantly to overall mortality. Conversely, some slow growing cancers are very aggressive and result in death. 

Treatment for prostate cancer can have significant negative impact on quality of life and healthcare costs, and should only be utilized when the cancer itself is likely to be fatal. Treatment recommendations are based on PSA levels , clinical staging, and Gleason scoring. Active surveillance is a preferred approach when the disease is low-risk and small. Significantly, 5-10% of individuals with low-risk disease treated up-front experience poor outcomes. Additionally, >40% of active surveillance patients may progress and require treatment – and half of those will ultimately fail treatment. The effectiveness of active surveillance is limited without a clinical tool to accurately assess risk of progression.

In small pilot studies, Dr. MacAulay’s lab has demonstrated the ability to predict aggressive behaviour in prostate cancers with >80% accuracy using a specific imaging technology that uses the measurement of GOALS in individual cells along with the cell’s position within the patient’s tissue.

Development of a novel organ preservation solution in transplantation

There is a need to improve donor organ preservation strategies to meet donor organ requirements for transplantation. Strategies such as cold flushing and organ preservation solutions are common practices to mitigate organ damage incurred during the transplant procurement, transport and implantation processes, but these solutions can be inadequate for marginal or extended criteria donors (ECD) that are being used in response to increased demand. New organ preservation solutions that are more effective in protecting donor organs, particularly from ECD, are required to fill this gap.

To address this unmet need, Dr. Du’s lab is developing new organ preservation solutions using a novel hyperbranced polyglycerol (HPG). Proof-of-principle  studies using cell cultures and rodent transplant models have shown that this HPG organ preservation solution performs better than conventional solutions in the cold preservation of organs and human cells. A patent application for the technology was granted in May 2015.

Dr. Du’s technology has garnered interest from top companies and key opinion leaders in the transplantation field. To sufficiently validate and de-risk the technology, enabling him to attract industrial interest, Dr. Du will compare the efficacy of HPG organ preservation solution with conventional solutions in donor kidney preservation with a non-human primate model. If the HPG solution performs adequately, it will lead to a clinical trial. 

The success of this technology could lead to a needed increase in the number of organ transplantations for British Columbians who need them.

DNA-PK inhibitors for use in combination with radiation therapy

Half of all cancer patients receive radiation therapy, impacting about seven million people worldwide each year. Enhancing tumour sensitivity to radiotherapy would have a far reaching and significant impact on patients with many kinds of cancer. 

Funded by a $5M grant from the Wellcome Trust, Dr. Minchinton’s lab has developed novel inhibitors of DNA-repair that can dramatically enhance the elimination of cancer cells with radiotherapy. He will improve his previously developed small molecule inhibitors of a DNA repair protein by developing therapeutic regimens to optimize their use for maximum anti-cancer benefit and minimize their effect on normal tissue. The overall aim of the project is to identify optimized inhibitors suitable for clinical candidate evaluation.

After the preclinical work, Dr. Minchinton will seek corporate partners to take the candidate into full clinical evaluation involving Phase I through III clinical trials. DNA damage repair mechanisms as a route to improved therapy could have a significant impact on the effectiveness of radiotherapy for cancer treatment.