A heart monitoring app developed at UHN has been found to reduce hospitalizations, improve heart health, and increase wellbeing and self-care in patients with heart failure.
Known as Medly, the app collects data on patient symptoms and three heart health metrics: blood pressure, heart rate and patient weight. It then analyses the data using clinically-validated algorithms to provide instant feedback to patients—in the form of app notifications.
The app also alerts the clinical care team of serious changes to the health status of patients. The app sorts and triages these alerts by importance, enabling one nurse to manage up to 350 patients. It’s important to note that the app does not replace clinical visits—instead it provides added support to patients and clinical staff between these visits.
The effectiveness of the app was recently evaluated in a clinical study published in the Journal of Medical Internet Research. The study was led by UHN’s Dr. Patrick Ware, Lead of Implementation Science at eHealth Innovation, and senior author Dr. Emily Seto, Assistant Professor at IHPME at the University of Toronto, and Affiliate Scientist at Techna.
The study enrolled 315 patients at the Peter Munk Cardiac Centre. Over a one-year period, the research team evaluated the app through a variety of ways. These included heart health (using blood tests), the ability of the heart to pump blood, the number of hospitalizations, as well as patient well-being and self-care. Patients were only provided the app for the last six months of the study. This enabled the research team to compare a patient’s health with and without the app.
“We found that use of Medly reduced heart failure-related hospitalizations by half; as well, use of the app was associated with improved heart health, patient well-being and patient self-care,” says Dr. Ware.
The findings suggest that telemedicine-based support could help improve the health of the more than one million Canadians affected by heart failure. The technology could also drastically lower health care costs by reducing unnecessary hospitalization.
Dr. Heather Ross, the co-developer of the app explains, “because the app better informs patients and clinical staff of health status changes, and does so instantly, patients receive the right care at the right time—this is a transformational change.”
This work was supported by the Toronto General & Western Hospital Foundation.
Ware P, Ross HJ, Cafazzo JA, Boodoo C, Munnery M, Seto E. Outcomes of a Heart Failure Telemonitoring Program Implemented as the Standard of Care in an Outpatient Heart Function Clinic: Pretest-Posttest Pragmatic Study. J Med Internet Res. 2020 Feb 8;22(2):e16538. doi: 10.2196/16538.
Dr. Michael Fehlings and his research team at UHN’s Krembil Research Institute have identified a way to improve a cell therapy that might be able to restore function after spinal cord injury.
Paralysis can happen in individuals when certain cells die as the result of the spinal cord injury. Cell therapy works by replacing these lost cells.
Currently, a number of preliminary cell therapy clinical trials have shown promising results using a type of cell known as a neural progenitor cell (NPC). These cells have the potential to become different cells in the brain and spinal cord—including neurons—which are key to recovery.
“Current strategies involve injecting NPCs into the injured spinal cord. A major hurdle is that, rather than becoming neurons, most NPC injected into the spinal cord become other cell types, such as astrocytes, which are involved in the scarring process,” says Dr. Fehlings, Krembil Senior Scientist and senior author of a recent study in Science Translational Medicine.
The researchers, including lead author Dr. M. Khazaei, a scientific associate in the Fehlings lab, conducted a screen for factors capable of improving functional recovery after spinal cord injury. This screen identified a protein known as glial cell–derived neurotrophic factor (GDNF). Using experimental models, the research team discovered that when levels of GDNF were increased in NPCs the cells were more likely to produce neurons. Also, the neurons that resulted from these cells survived better than those from NPCs with lower levels of GDNF.
“While preliminary, these findings provide a promising strategy for optimizing NPCs before they are injected into the damaged spinal cord. By enhancing the ability of NPCs to become neurons, our approach could serve to promote repair and restore function after spinal cord injury.
This work was supported by the Ontario Institute of Regenerative Medicine, Wings for Life, the Krembil Foundation, the Canadian Institutes of Health Research and the Dezwirek Foundation
Khazaei M, Ahuja CS, Nakashima H, Nagoshi N, Li L, Wang J, Chio J, Badner A, Seligman D, Ichise A, Shibata S, Fehlings MG. GDNF rescues the fate of neural progenitor grafts by attenuating Notch signals in the injured spinal cord in rodents. Sci Transl Med. 2020 Jan 8;12(525). pii: eaau3538. doi: 10.1126/scitranslmed.aau3538.
A study from UHN’s Princess Margaret Cancer Centre and The Hospital for Sick Children has revealed exciting new insights that link the development of the digestive system to cancer.
The digestive system, which includes the stomach, the intestines and the colon, begins to form three weeks after conception. The process depends on proteins known as transcription factors. These proteins turn specific genes on and off at carefully controlled times and at different locations in the body during development.
“While recent studies suggest that genes involved in the development of the digestive system are abnormally expressed in some cancers, little is known about the role of related transcription factors in cancer,” says Dr. Hansen He, Senior Scientist at Princess Margaret Cancer Centre.
To address this, the researchers examined gene expression during development of the digestive system. Their analyses uncovered a set of transcription factors—Sox2, Sox9 and Cdx2—that were critical for the development of the stomach and the intestines.
“By comparing the expression of over 20,000 genes during development with those expressed in cancers, we found that cancers that express high levels of Sox2, Sox9 and Cdx2 also expressed genes involved in gastrointestinal organ development. This suggests that organ-specific programs used during development are being reactivated in cancers,” says Dr. Tae-Hee Kim, Scientist at The Hospital for Sick Children.
Using experimental models, the researchers found that Sox2 and Sox9 play similar roles in cancer. While deletion of only one of these genes was not sufficient to prevent cancer initiation, deletion of both did reduce cancer severity.
“Understanding how these molecules guide the development of organs of the digestive system may provide new insights about mechanisms that lead to the initiation and progression of cancers,” says Dr. He.
This work was supported by the SickKids Foundation, the Cancer Research Society, the University of Toronto’s Medicine by Design Initiative, the Natural Sciences and Engineering Research Council, the Canadian Institutes of Health Research, the Ontario Ministry of Research, Innovation and Science, and The Princess Margaret Cancer Foundation.
Francis R, Guo H, Streutker C, Ahmed M, Yung T, Dirks PB, He HH, Kim TH Gastrointestinal transcription factors drive lineage-specific developmental programs in organ specification and cancer. Sci Adv. 2019 Dec 11. doi: 10.1126/sciadv.aax8898.
Dr. Vinod Chandran, an Affiliate Scientist at Krembil Research Institute, is the lead author on a study demonstrating the consistent efficacy of ixekizumab in treating psoriatic arthritis for up to three years.
Psoriatic arthritis is caused by abnormal activity in the immune system that causes joint damage. The disease can occur in up to 30% of people living with psoriasis. There is no cure for psoriatic arthritis. However, there are treatments available to delay the progression of the disease.
Ixekizumab is a biologically derived drug that interacts with the immune system to help fight inflammation. Developed by Eli Lilly and Company, the drug is approved by the US Food and Drug Administration and Health Canada for treating two types of arthritis, including psoriatic arthritis.
To determine whether ixekizumab is safe for long-term use, the research team followed 381 patients receiving the medication for up to three years.
“We found that the safety of the drug remained consistent with previous reports. We also observed improvements in the signs and symptoms of psoriatic arthritis in patients taking the drug,” describes Dr. Chandran. “Long-term studies like this one are important for evaluating the enduring benefits and safety risks of therapies for chronic progressive diseases, such as psoriatic arthritis.”
Within two years of disease onset, 47% of individuals with psoriatic arthritis experience structural joint damage, which is likely to result in irreversible joint deformity and disability. Treatments like ixekizumab can help slow disease progression and improve the quality of life for individuals living with psoriatic arthritis.
This work was supported by Eli Lilly and Company.
Chandran V, van der Heijde D, Fleischmann RM, Lespessailles RM, Helliwell PS, Kameda H, Burgos-Vargas R, Erickson JS, Rathmann SS, Sprabery AT, Birt JA, Shuler CL, Gallo G. Ixekizumab treatment of biologic-naïve patients with active psoriatic arthritis: 3-year results from a phase III clinical trial (SPIRIT-P1). Rheumatology (Oxford). 2020 Feb 7. doi: 10.1093/rheumatology/kez684.
Please be advised that the Drug Discovery in Neuroscience Conference scheduled for April 1, 2020 (and described below) is cancelled until further notice.
We apologize for any inconvenience this may have caused.
On April 1, 2020, Krembil will host its first Drug Discovery in Neuroscience Conference at the Krembil Discovery Tower. All are welcomed and encouraged to attend. Registration is required (here).
This daylong event aims to educate participants about the process of turning research discoveries into druggable targets for small molecule therapeutic development. It will include a panel discussion titled ‘Is Your Target Druggable?’ and presentations about the following topics:
- Neuroscience Drug Discovery in Academia
- Pharmacokinetics in Drug Design
- Intellectual Property and Commercialization
- Artificial Intelligence and Drug Design
Dr. Barbara Tate, a neuroscientist and internationally renowned drug hunter, will provide a keynote address. Dr. Tate has held numerous leadership positions in small and large pharmaceutical companies, including Rodin Therapeutics, Satori Pharmaceuticals and Pfizer. She is currently a Venture Partner at the Dementia Discovery Fund, the world’s largest venture fund focused solely on discovering and developing novel therapies for dementia, including Alzheimer disease.
All attendees are asked to register here. The deadline for registration is 4 pm on Thursday, March 19, 2020.
We look forward to seeing you there!
Date: Wednesday, April 1, 2020
Time: 8:00 am – 5:00 pm
Location: BMO Education and Conference Centre, Krembil Discovery Tower
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
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