Research Spotlight: National Medical Lab Week

Meet Dr. Vilte Barakauskas, BCCHRI/WHRI joint-researcher and clinical biochemist working at BC Children’s Hospital, who is part of a team working to establish reference intervals for pregnant women to better interpret lab test results.

Dr. Barakauskas works alongside a large team of people who obtain, process, and analyze specimens – like blood or tissue samples – in the department of Pathology and Laboratory Medicine at the BC Children’s  and Women’s Hospitals campus. As a clinical biochemist she works closely with medical lab technologists, medical lab assistants (MLAs), and clinicians in a role focused on interpreting lab test results, to aid in accurate diagnoses and management of disorders and diseases.

In her day-to-day work, she is also involved with quality oversight in the lab to help ensure that they are producing reliable, accurate, and timely results, as well as providing consultation for healthcare providers and physicians. This might include assisting with test result interpretation by reviewing records, producing interpretive reports, evaluating test performance, or helping to find, select, or order and utilize appropriate tests. She is also involved with decisions around implementing new types of tests or developing tests when a need is identified.

In addition to her role in the lab, Dr. Barakauskas is helping to establish reference intervals for pregnant women around the time of labour through the Pregnancy Reference Intervals for Safe Medicine (PRISM) study. For the average person, lab results are interpreted by comparing against a set of reference intervals. These are a range of data compiled from ‘healthy individuals’ (commonly adults), which can help determine whether or not a patient’s test results are within a normal range, or if there might be a need for further investigation and testing.

However, for patients who belong to a population outside of the ‘average, healthy adult’, it becomes difficult to determine when there is a cause for concern. Dr. Barakauskas offers the example of pediatric medicine, where babies and kids are developing so quickly that it becomes harder to pinpoint what ‘normal’ should look like in test results.

Similarly, pregnancy is a time period during which physiology changes and test results might appear abnormal when compared with non-pregnant adults. Currently, there is little available information about reference intervals for this population, and less data directly applicable to our diverse population of women in British Columbia. Access to representative reference intervals is important because they help reduce the risk of under or over diagnoses and support appropriate patient care.

Creating reference intervals is a daunting task, Dr. Barakauskas explains, as it requires a lot of blood sampling and a lot of data. Further, she emphasizes the added difficulty of collecting specimens from ‘healthy’ populations, who are less likely to require bloodwork as part of their routine care, and thus volunteers for research participation and blood collection are required.

As a result, her team is conducting this research both through a recruitment process, where they seek out ‘healthy’ pregnant women to collect blood from, and through retrospective data analysis, where existing data is sorted using mathematical methods. While the study’s primary goal is to produce reference intervals and improve test interpretation, it will also allow the team to compare these two research methods for future development of reference intervals for other populations.

Dr. Barakauskas and her team have finished recruitment for the initial PRISM study of women around the time of labour, throughout which they had great collaboration across lab staff, nurses, and healthcare providers. They are currently starting sample and data analysis. She would like to acknowledge the mothers who participated, along with all the MLAs, lab technologists, nurses, students, BCCH Biobank and others who invested their time and hard work in the PRISM study and is grateful for the mentorship of co-investigators Dr. Wee-Shian Chan, Head of the Department of Medicine at BC Women’s Hospital, and Dr. Benjamin Jung, Clinical Biochemist, currently at SickKids. Together with Dr. Kate Chipperfield, Hematopathologist in the department of Pathology and Laboratory Medicine, Dr. Chan and an expanded team of clinician and patient collaborators, they will work to begin recruitment for the next iteration of PRISM which will look at blood from healthy mothers postpartum, as well as blood from their infants.

Members of the PRISM research team, and BC Children’s laboratory staff.

To learn more about PRISM click here. To read more about Dr. Barakauskas, click here.

World Immunization Week: Working toward an STI vaccine

World Immunization Week is held April 24-30, 2019, to promote the use of vaccines to protect people of all ages against disease. Vaccination has significantly reduced the burden of infectious disease around the world. British Columbia (BC) has always been a global leader in human papillomavirus (HPV) vaccine research and continues to conduct valuable research in this field.

Early in 2019, the WHO reported one of the 10 biggest threats to global health was vaccine hesitancy. Researchers from WHRI, BCCDC, UBC and various BC Health Authorities are currently conducting research exploring methods to address HPV vaccine hesitancy in particular. The findings of this research are expected to inform all programs in BC, and across Canada to improve HPV vaccine uptake rates. In addition, research is being conducted to explore alternate dosing options for the HPV vaccine, which could have significant effects on health system costs and uptake rates while still maintaining high efficacy.

Exciting research is also being done to investigate the effects of HPV vaccination in the province by examining rates of anogenital warts in males and females, and cervical dysplasia for women undergoing cervix screening. In addition, vaccine researchers, clinicians and public health leaders in BC have developed a consortium that will establish BC as a global centre for leadership in the emerging field of sexually transmitted infection (STI) vaccines.

STIs are a significant cause of morbidity, mortality and health system costs globally, and development of vaccines to protect against various STIs has the potential to address this burden. BC is at the forefront of emerging STI vaccine policy and research.

By Laurie Smith

Dr. Jerilynn Prior awarded the 2019 Aubrey J. Tingle Prize

Congratulations to Dr. Prior, who was recently named this year’s recipient of the Michael Smith Foundation for Health Research Aubrey J. Tingle Prize! 

Dr. Prior was also the recipient of the WHRI Knowledge Translation in Women’s Health Research Award in 2017 for her work at the Centre for Menstrual Cycle and Ovulation Research.

Read the full announcement from MSFHR here.

Congratulations to Kate Wahl and Natasha Orr, recipients of the DA Boyes Memorial Research Award

They received the award for their project “The acceptability of a phallus length reducer, Ohnut, for deep dyspareunia: A pilot.”

About the project:

“Endometriosis affects 10% of women and is the presence of uterine tissue abnormally growing outside the uterus. Endometriosis can result in various types of pain including deep dyspareunia, pelvic pain with deep vaginal penetration that affects more than 50% of women with endometriosis. ​A recently developed buffer worn externally at the base of the penetrating partner may reduce sexual pain by allowing couples to incrementally limit the depth of penetration. This study will look at the acceptability and efficacy of the buffer among couples affected by endometriosis-associated sexual pain.”

Read the full announcement here.

New Innovative Initiative, the Answer Factory, Makes Lab Space and Translational Research Expertise Available to Clinical Investigators Affiliated with BCCHR and WHRI

As part of a joint initiative supported by the UBC Faculty of Medicine and BC Children’s Hospital Research Institute (BCCHR), the Clinical Research Development Laboratory (popularly known as the Answer Factory), has been established to foster the next generation of clinician-scientists and to support innovative patient-centered research.

This new resource, which is part of the services offered through the Clinical Research Support Unit (CRSU) at BCCHR, aims to enable clinical faculty members and early career investigators gain access to a fully functional laboratory as well as technical support to move forward clinical and translational research they would otherwise not be able to conduct due to lack of access to the requisite resources and expertise. Dr. Shirin Kalyan is the translational scientist leading the Answer Factory, and she is available to provide consultation and advice for experimental planning and methodology for developing and implementing clinical and translational research studies. In addition to her role with the Answer Factory, Dr. Kalyan is an adjunct professor with UBC’s Department of Medicine and the Director of Scientific Innovation at a clinical-stage immunotherapy biotech in BC. She has accumulated significant experience in conducting translational and clinical research directed at improving patient outcomes through deepening understanding of disease pathogenesis and developing new treatment strategies.  Dr. Kalyan and the Answer Factory are also available to help support funding applications that aim to understand, diagnose or characterise a clinical problem that requires access to a wet lab or more sophisticated experimental analyses to address. The Answer Factory will be operational by late April 2019. However, it is recommended that any project that is anticipated to need Answer Factory support contact Dr. Kalyan as early as possible in the planning to get in que and to ensure the resources and protocols are in place by the time the project starts.

The ultimate goal of the Answer Factory is to create an environment that allows clinicians to gather new knowledge, promote translational research, and have an immediate impact on patient and public health. To learn more about this unique and new resource at BCCHR and how it may be of potential utility to you, please see: https://www.bcchr.ca/about-us/how-we-support-research/clinical-research-support.

Changing Childbirth in British Columbia Report

Findings from the Changing Childbirth in British Columbia study have been published on the UBC Birthplace Lab website.

This was the first study in the province to look at person centred outcomes for pregnancy and birth.

The report describes results from the online survey and preliminary findings from focus groups, about preferences for care, experiences and outcomes of care for women in BC.

For the full report, executive summary, and content to share on social media, visit the Birthplace Lab website.

Dr. Michael Anglesio: 2018 Recipient of the CIHR Maternal, Reproductive and Youth Health Award

The Early Career Investigator Award will fund a project to investigate the endometriosis micro-environment and cancer driver mutations in Endometriosis.

 How did you get interested in endometriosis research?

My studies have in the past always been focused on cancer, and in the last 10 years or so, specifically on clear cell and endometrioid ovarian cancers. Women with endometriosis are known to be at higher risk for these cancers, and recently my work has shown that endometriosis may, in rare cases, evolve into these cancers. My interest in endometriosis has changed from wanting to know why some become cancerous, while the majority do not.

For your study, you collect saliva and tissue samples from women with endometriosis who undergo surgery. What do you use that for?

Part of the work we do looks at changes in the DNA of endometriosis cells. We want to know if the cells that makes up the endometriosis has acquired specific mutations, and if these mutations are what allow it to grow, cause pain, or turn into cancer. We use the DNA in a patient’s saliva as a reference for that patient. All human DNA is pretty similar, but there are still a lot of differences that make each one of us a little bit different. We want to be sure we look at what makes endometriosis different in each patient, not what makes each patient different from each other. We could also use blood for this, or surrounding normal tissue, but the saliva is convenient to collect and we can be sure there’s no trace of endometriosis DNA!

Congrats on your grant! Can you tell us a little about the project you’ll be working on?

This new project is looking at how endometriosis that has “cancer mutations” might cause different kinds of immune reactions than endometriosis without cancer mutations. We’ll be looking specifically at the kinds of immune cells that are attracted to endometriosis, in different places in the body, and comparing the number, type and response of these immune cells. Immune cells can control a lot of reactions related to inflammation and pain, they can kill off infections and cancers, and they can also tell your body not to fight an infection or cancer. By looking at which mutations affect the immune response we hope to figure out why different women get more vs less pain, and if endometriosis may even be protected or destroyed by the immune system.

A lot of your research happens in the lab – how will the work you’re doing now help people with endometriosis in the future?

There is a lot going on!! Looking at the changes in the DNA of endometriosis is relatively new. In fact, we are the first group to have launched major studies to examine mutations in endometriosis DNA that are not associated with cancer. I hope my experience in cancer research can bring a new perspective to this disease.

My lab’s connection with clinical specialists – like the doctors at the BC Women’s Centre for Pelvic Pain and Endometriosis – may bring real change in the near future. First, we need to find out how cancer-mutations in endometriosis contribute to pain, fertility, or risk of cancer. Having this knowledge could immediately change the way we treat the disease even without new drugs. Depending on the mutations, immune response, and symptoms, a women might be directed to specialist centre for surgery, medical or hormonal therapies, and some women might need long-term monitoring (for example if cancer risk is elevated). As DNA sequencing technologies advance we may also be able to rapidly diagnose endometriosis and provide the proper management to women earlier. Knowing what to look for will make a world of difference!

Congratulations to the recipients of the 21st Annual LifeSciences BC Awards

The awards are presented annually to recognize individuals and organizations representing the life sciences ecosystem in BC. WHRI members Dr. Jerilynn Prior and Dr. Caroline Cameron were among this year’s recipients.

Dr. Prior was awarded the Michael Smith Foundation for Health Research (MSFHR) Aubrey J. Tingle Prize for her career spent advancing research in the areas of women’s menstrual cycles, menopause, perimenopause, and osteoporosis. Read more about Dr. Prior and her work in the full announcement from MSFHR.

Dr. Cameron, a microbiologist and leading expert on syphilis, received the Genome BC Award for Scientific Excellence.

Read the full announcement from LifeSciences BC here.

Dr. Gillian Hanley receives a CIHR Fall 2018 Project Grant

Dr. Hanley received the grant for the project “The effectiveness and cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention”.

  1. In a few sentences, what is your research about?

Evidence strongly points to the fallopian tubes as the tissue of origin for the most common and lethal form of ovarian cancer (representing 70% of all cancers and 90% of all deaths from ovarian cancer). We are determining whether removal of fallopian tubes at the time of hysterectomy or in lieu of tubal ligation (referred to as opportunistic salpingectomy) is an effective ovarian cancer prevention strategy.  Given our effectiveness findings, we will also determine whether opportunistic salpingectomy is a cost effective cancer prevention strategy.

  1. What impact do you hope your research will have?

We expect these results will accelerate what has already been a global change in practice towards opportunistic salpingectomy. If opportunistic salpingectomy is effective in preventing ovarian cancer, we will shift the focus of ovarian cancer to prevention and dramatically reduce the incidence of this deadly disease throughout the world.

  1. Are you using any innovative approaches in your research?

We are taking advantage of both BC’s and Ontario’s rich data resources to assemble a population-based cohort including all women who underwent opportunistic salpingectomy and all women who underwent comparator surgeries (hysterectomy alone and tubal ligation). We will follow them until the end of 2019 to determine rates of ovarian cancer.