2022 Annual Report of the McGill Department of Medicine

GROUND CONTROL TO

FUTURE DOM

“Tomorrow belongs to those who can hear it coming.”

// David Bowie

Section 1: DOM

CHAIR, ASSOCIATE CHAIR AND DIRECTOR MESSAGES

// Dr. Marc Rodger

W

Ground Control to Future DOM ♫

We hope you enjoy perusing this year’s annual report as much as we enjoyed putting it together. We apologize to David Bowie for copyright infringement, but we SO liked the title for this year’s annual report we’re taking a chance nobody will notice. I know, I know – our readership is so extensive we are taking significant legal risk but what the h*ck! (tongue in cheek)

My love of rock goes way back to pre–grade 7 at Beaconsfield High School on the West Island. I grew up listening to Terry Dimonte on CHOM (97 POINT 7 ChchchchOHm FM (FM, FM, FM)). Classic rock accompanied me while I delivered the Montreal Gazette to more than 70 of my neighbours at 6 am (yes, I’ve always been an early riser). I had some famous people on my route including Réjean Houle, Pete Mahovolich and the Podymows (Including Dr. Tiina our McGill/McGill University Health Centre nephrologist). Enough nostalgia!

2022 was a year of renewal

We spent a good chunk of time, passion and

energy

in 2022 thinking about Future DOM. Our strategic planning exercise was focused on asking you where you want DOM to go/aspire/arrive. You answered in large numbers with more than 180 aspirational ideas. You patiently participated in townhalls and answered surveys to allow us to drill down to 12 key aspirations (or destinations). We next asked you to brainstorm with us on how we will reach these aspirations (tools/processes) and how we will know if we are making progress (metrics).

What will Future DOM look like?

Future DOM will be a place where we train the best in core Internal Medicine because we offer the best core internal medicine training in Canada. Our trainees will feel safe to grow while with us and we will be proud to call them graduates of our training program. Our clinician–teachers will feel valued, and we will celebrate our master clinician–teachers. Having realized our efforts to be the most research–intensive DOM in the country – we will frequently change practice. Our world–class teams will recruit/develop/grow highly productive clinician–scientists who co–create with a renewed core of DOM PhD scientists. We will be advocates/ leaders with an active voice locally and nationally, advocating to ensure our patients get the care we would want for our loved ones. We will be as diverse as those we serve/train/lead because it makes us better colleagues/teachers/providers/ scientists. Finally, and most importantly for me, you will love working in the McGill Department of Medicine because we work to make your life easier, we care about you as a person and we continue the historic traditions of excellence that define McGill.

FROM THE Associate Chair of Medicine

// Dr. Ernesto Schiffrin

T

This message is also a goodbye. After almost 18 years as Physician–in–Chief of the Jewish General Hospital and Associate Chair of the McGill University Department of Medicine, I will be stepping down on June 30, 2023.

I have been privileged to hold these jobs since January 1, 2006. It has been an extraordinary experience for me to lead the Department of Medicine of the JGH and to participate in the leadership of the McGill DOM. I have interacted with a lot of faculty, mainly at the JGH but also at the MUHC and less at St. Mary’s, and have appreciated the collegiality, the knowledge, the generosity and loyalty as well as dedication to caring for patients safely, excellence in teaching and carrying out cutting edge research across sites in the McGill Health system. I have worked beside three McGill Chairs of Medicine, David Eidelman, Jim Martin and now Marc Rodger. It has been a pleasure to collaborate with them in the direction of the Department and trying to bring together the faculty in different sites to create a critical mass of expertise in each specialty within the Department, not always easy despite the best efforts on all sides.

The last three years during the COVID–19 pandemic have been difficult for everyone. However, it has been extraordinary to witness the dedication of all the faculty throughout these difficult times to safe patient care, teaching and research under difficult circumstances.

As we move forward, I am sure that the faculty and the leadership of the McGill DOM will take the Department to greater heights, as summarized in the aspirations of the membership of the Department in the strategic planning exercise being led currently by Marc.

As to me, I am happy that my CIHR funding has been renewed for another 5 years, and I will continue seeing patients at the JGH Cardiovascular Prevention Centre and carrying out translational and clinical research there and at the Lady Davis Institute.

Again, I want to state how privileged I feel to have had the opportunity to exert these leadership positions at McGill and the JGH, and thank all for your excellent work in providing best care, teaching and research.

THE Director of Specialized Medicine, St. Mary’s Hospital Center

// Dr. Bruce Campbell

SSt. Mary’s Hospital Center is an active community–based teaching hospital. While recovering from the disruption of the pandemic, the hospital faced a new human resource crisis. Like sister institutions across the McGill network, the St. Mary’s department will need ongoing collaboration and mentoring from McGill leadership.

To start, in this 2022 report, the St. Mary’s Department of Medicine reserves its highest praise for the work of Dr. Tien Nguyen, who was head of infection control through the worst of the COVID–19 crisis and was a tireless resource to the hospital, the administration, individual department members, trainees and, most of all, to our patients.

While still managing surges of COVID–19 in 2022, the hospital faced increasing nursing and allied health professions shortages. New issues emerged with increased length of stay in the emergency department and longer waitlists for patient rehabilitation and relocation. Challenges included a reduction of critical care beds, displacement of coronary care into the Intensive Care Unit, and a return of high volume to our outpatient clinics and endoscopy service.

Department of Medicine members have replied to these challenges with engagement and determination. Department members continued to provide preclinical and clinical undergraduate and resident teaching and were active in numerous faculty and department–level committees and workgroups. St. Mary’s members are also leaders across the West Island CIUSSS, of which St. Mary’s is the busiest teaching hospital. With a clear need for increased physician leadership in hospital affairs, the department was pleased with the appointment of Dr. Nathalie Ng Cheong as Associate Chief of

Medicine with a focus specifically on outpatient services. The department was also engaged with clinical projects across disciplines, with plans for a new care–of the–elderly multidisciplinary team, a new inpatient sleep service and reform of medicine ward coverage.

Preparatory work continued for the St. Mary’s major infrastructure project: a redesign and building of three new internal medicine clinical teaching units, outpatient and procedural clinical space and an improvement in the multidisciplinary learning environment.

The department also continues to grow its membership, with new hires in General Internal Medicine, Gastroenterology, Geriatrics and Neurology.

Highlighting some individual members:

Dr. Khashayar Esfahani won the Oncology Career Development Award. Drs. Andrea Blotsky and Carolyne Elbaz were the first recipients of the McGill University Department of Medicine Scholarly Quality Award for St. Mary’s. The Quality Hub also resumed operation to help guide future progress.

St. Mary’s Hospital, in 2022, has needed to draw on its sense of community and collegiality in facing challenges across the health care system. Links with the McGill Department of Medicine have been helpful in maintaining capacity though efforts such as the DOM Mentorship Program, Schwartz rounds, McGill–wide Grand Rounds, and consultation during the DOM strategic planning. St. Mary’s members look forward to working with McGill division chiefs to help foster professional growth and promote career advancement. The McGill Department of Medicine continues to assist in maintaining and building on the strength of St. Mary’s clinical and educational missions.

MESSAGE FROM THE Associate Chair,

Advancement

// Dr. Alain Bitton

I

In 2022 we were successful in recruiting the first McGill Department of Medicine (DOM) “Rising Star” with support from the MUHC Foundation. The objective of the Rising Star Program is to promote the  success and productivity of our clinician scientist or medical educator “Rising Stars” by providing salary and operational funding. Supporting our next generation of scientists and academic leaders early in their careers will pave the way for a strong research, education and clinical foundation for our DOM McGill hospitals and University. Our goal for the coming year is to initiate additional “Rising Star” awards across the McGill–wide institutions and the McGill Advancement office.

A focus in the next year will also be to establish a DOM Clinical/Research fellowship. Fellowship programs are instrumental in enhancing the research and visibility of the Department and its divisions. The DOM divisions offer fellowships, but some do not have dedicated funding. Through philanthropic support and the McGill Advancement office the aim will be to create one or two DOM fellowships per year allocated to a division that offers a fellowship but has no funding.

The DOM has also initiated a strategic planning exercise based on aspirations with the aim of establishing goals and priorities for the next several years. The challenge will be achieving and implementing these aspirations fully and in a timely fashion. This can be attained in part through collaboration and philanthropic support obtained from the various foundations across the McGill–affiliated hospitals and the University.

MESSAGE FROM THE Associate Chair, Education

Dr. Annabel Angela Chen–Tournoux

Another clear–cut priority for the Department was to augment support, tangibly, for our education leaders, starting with our training programs. Starting this year, for divisions who opt to supplement the usual PGME stipend to program directors and competency committee chairs, the Department contributes matching funds, thereby amplifying the total impact of division support. We are pleased to see several “early adopter” divisions benefiting from this initiative.

For all of us, 2022 was a year of rebuilding to adapt to the realities of a post–pandemic world. Even as the public health emergency abated, it left lasting effects on our greater society – and on the Department’s educational portfolio. The challenges that arose compelled us to step back, examine how we do things and see with a fresh perspective how we can do better.

With a significant number of vacant positions in the Administrative Excellence Centre (AEC) for much of the year, 2022 was a key juncture to rethink workflows to optimize coordination and streamline processes, with the goal of enhancing the effectiveness, and job satisfaction and fulfillment, of UGME course directors, PGME program directors and administrators. We established clear guiding principles: maintaining an essential level of support for all programs, even when specific positions were unfilled; and involving course/program directors and program administrators to a greater extent in the on–boarding and off–boarding processes for both groups, to optimize continuity for the teaching programs and ensure proper transfer of acquired knowledge and insight during these important transitions. I cannot express enough gratitude to the course and program directors and members of the AEC for their tireless and often unseen efforts to support the programs through one of the toughest years in memory.

With healthier levels of staffing now in place, the time is right to turn our attention to the educational aspirations that Department members have prioritized through the strategic planning process: that our core Internal Medicine program attracts the best candidates and provides the best training in the country; that we ensure a healthy and safe learning and working environment at all levels; and that our clinician–teachers are valued, respected, and master clinician–teachers are celebrated. With increasing numbers of spots for medical student admissions, we will also be actively preparing to augment our capacity to welcome them into the inpatient and outpatient settings. I would like to thank all of the individuals who have contributed so much to our educational mission and, as always, I welcome comments and suggestions from all of our teachers and learners to help us reach our aspirations.

THE Associate Chair, Quality and Safety

// Dr. Emily Gibson McDonald

The Department of Medicine made great strides in 2022 to advance Quality Improvement (QI) and Patient Safety thanks to its people, patients and projects. In 2022 we awarded scholarly quality grants to DOM members totaling $100,000 to advance research in QI and patient safety. Some highlights include 1) Dr. Susan Bartlett, Dr. Sara Ahmed, and Gregory Gooding (graduate student in Experimental Medicine), partnered with Keith Woolrich (Director, Quality, Evaluation, Performance and Metrics; MUHC), Lucy Wardell (Associate Director of Nursing, Medical Mission; MUHC), and Dr. Joyce Pickering (Director, Clinical Teaching Unit; Royal Victoria Hospital) to develop a project that will collect patient–reported outcomes measures (PROMs) for hospitalized medical patients. PROMs can be used to measure the quality of care we provide our patients in terms which are important to patients. 2) At the Jewish General Hospital, Dr. Michael Goldfarb (Division of Cardiology) received funding to establish a Cardio–Psychiatry Unit for cardiovascular primary care prevention for patients living with severe and persistent mental illness. 3) At Saint Mary’s Hospital (SMH), Dr. Andrea Blotsky (Division of General Internal Medicine), Dr. Carolyne Elbaz (Division of Hematology), and Dr. Chloe Gordon (PGY1 Internal Medicine) received funding to implement a pre–transfusion checklist to help the hospital reduce unnecessary red blood cell transfusions. Thematically, the positive results of a two–year implementation study of routine transfusion safety training for post–graduate medical education trainees at the MUHC were also published in JAMA Network Open (Lee TC, Almeida N, Pelletier P, et al., Comparison of Blood Transfusion Rates Before and After Implementation of a Quality

Improvement Initiative for Transfusion Safety and Appropriateness. JAMA Network Open. doi:10.1001/ jamanetworkopen.2022.52253). Did you know that SMH and the MUHC have national designations as Choosing Wisely Hospitals?

Another successful project worth highlighting was the QI intervention that took place on the Dialysis Unit of the Lachine Hospital led by Dr. Tiina Podymow (Division of Nephrology) and Ms. Émilie Bortolussi Courval (Nurse Clinician and PhD student in Experimental Medicine). Patients on dialysis are often prescribed an average of 12 medications. This QI intervention paired deprescribing reports with the medication reconciliation process and improved the safety of medication regimens for almost all patients on the unit. Look for the published results of this study in 2023! Special thanks to Drs. Tomoko Takano, Rita Suri, Emilie Trinh, and Thomas Mavrakanas, along with the nursing team on the Lachine Dialysis Unit, for making this project a success!

Finally, we continue to train our next generation of Quality Improvers. Dr. Saman Ahmad, PGY5 in General Internal Medicine was accepted to Harvard Medical School and will be pursuing a Master of Science in Healthcare Quality and Safety. What an enriching career path Dr. Ahmad has chosen that will surely lead to important innovations and improve patient care! To find out more about opportunities to pursue graduate training in QI and Patient Safety, please reach out to me. In 2023, we had our High Value Healthcare Symposium in person (June 6, 2023) and we were delighted to have awarded our third round of Scholarly Quality Awards.

MESSAGE FROM THE Associate Chair,

Research

// Dr. Susan Kahn

The year 2022 proved to be a success in terms of the DOM’s research mission and productivity – many examples are highlighted in this Annual Report. In my role to help nurture and grow research excellence in our department, there were several notable developments in the past year. Informed by results of the 2021 survey we conducted of our >80 DOM PhD faculty, we proceeded to appoint PhD faculty members to DOM divisions to increase integration and affiliation of PhD researchers within our department. Attesting to the high academic quality of our DOM researchers, we had impressive results in the 2022–2023 FRQ–S competition, with 11 new career awards for a success rate of 50%.

In the fall, we held the 2022 Annual Research Symposium, with keynote speaker Dr. V. Ramachandran, 2021 Lucian Awardee, who gave a fascinating talk on Fundamental Causes of Cardiovascular Disease Risk. Following this, Dr. Philippe Lefrançois, early career researcher, Division of Dermatology, spoke on Basal Cell Carcinoma – A translational approach from a dermatologist’s perspective, Dr. Rita Suri, Division of Nephrology, presented her research on The pandemic response in Quebec hemodialysis

units: A clinical researcher’s perspective, and Dr. Yen–I Chen, Division of Gastroenterology, discussed his work on Emerging Technologies in Interventional Pancreaticobiliary Endoscopy. The Symposium was held virtually once again, and we received excellent feedback on the quality of our speakers and its content. The search committee for the Provostial Tenure Track position awarded to the DOM on racial disparities in chronic disease prevention, management and prognosis concluded its work at the end of 2022; information on our new outstanding hire will be announced soon.

Finally, a few firsts: in 2022 the first MUHC Rising Star Award and MUHC PhD scientist CAS Awards were launched and bestowed, as well as the JGH Clinician–Scientist CAS Awards program, thanks to the support of Dr. Ernesto Schiffrin. In advancing these and other projects, I have been grateful for the support of the DOM Research Advisory Committee, the DOM Executive, Dr. Marc Rodger, and our excellent administrative team. I stepped down from my role as Associate Chair Research at the end of 2022, and I am grateful to have had the opportunity to serve the DOM in helping to advance its research mission.

FROM THE Associate Chair, Wellness

// Dr. Natalie Dayan

OOver the last year, COVID evolved into “just another virus”, yet continues to impact our workload and well–being. Emergency room crowding and a lack of adequate human resources to support our clinical and scholarly work have been accentuated during the pandemic. We are trained to be solution–oriented yet can feel powerless in the face of some of these challenges, partly due to increasing mandates and restrictions imposed on us. It is clear that what has helped the most is our sense of community.

Our first McGill DOM Schwartz Centre rounds was aptly titled “ The Great Resignation: Why I am Still Here.” Panelists Dr. Ernesto Schiffrin – JGH Physician–in–chief, Dr. Mimi Israel –psychiatrist at the Douglas, and Ms. Isabelle Caron – JGH nursing manager, shared their experiences as leaders who felt called to support demoralized staff during challenging times. Subsequent Schwartz Rounds explored the “Intersection of Faculty and Learner Wellbeing: Finding a Common Ground.” Dr. Ning–Zi Sun (core Internal Medicine (IM) program director), Dr. Clara Long (core IM resident) and Mr. Paul Kennedy (Montreal General Hospital Unit Coordinator) each discussed similarities and differences in the wellness challenges facing trainees and faculty, prompting a facilitated discussion about how to support one another in the pursuit of our shared goal to improve patient care. The rounds in May 2023 focused on “Who is in Charge? Moral Distress Caused by Mandates.” These rounds have been attended by > 150 faculty across all DOM sites, and provide a unique opportunity to pause, reflect and share with one another. I encourage you all to attend these rounds to further strengthen our community.

We now have 83 faculty enrolled in the formal DOM mentorship program, a software facilitated, Royal College of Physicians and Surgeons of Canada (RCPSC) accredited program focused on supporting new faculty as they transition to academia. Mentees and mentors have connected across different divisions and hospital sites and have expressed gratitude for the opportunity to develop a new mutually fulfilling relationship and expand their network. We were also pleased to have outstanding mentorship recognized through McGill–wide DOM awards (congratulations to our first recipient Dr. Vicky Tagalakis!) By analyzing our survey data regarding competence in mentorship, and through debrief sessions, we also noted some areas of growth: of 39 completed surveys, 20.5% of mentors felt that more competence in coaching was needed. We also heard that navigating yet another software was cumbersome. We have concrete plans to address these issues by expanding on the mentorship curriculum to include teaching coaching skills, implementing formal orientation for new mentees and by exploring ways of integrating this software within existing McGill platforms. Thank you to all participants in this program for their commitment and for the useful feedback.

In the coming year, we are working on putting the “tools and processes” identified through the Wellness Strategic Plan into action (if you are wondering, the theme is community). In the meantime, please read more about our programs and other wellness resources on the DOM website: www.mcgill.ca/deptmedicine/wellness

MESSAGE FROM THE Associate Director, Administration

// Maria–Isabel Ramirez

I

I began my role as the Associate Director of Administration in the Department of Medicine halfway through 2022, and I am gradually getting accustomed to this vast entity we all know as the Department of Medicine. Despite meeting many of you, there is still a lot for me to discover and learn. The year 2022 marked a significant turning point with the pandemic somewhat subsiding, but it also revealed new dimensions and challenges to life.

As restrictions eased, we witnessed opportunities for development and innovation, and the Department of Medicine was no exception to this. From an administrative standpoint, we have expanded our team by introducing diverse talents and personalities. We have also capitalized on this moment to create opportunities to reassess and hopefully strengthen our administrative structure so to be able to ensure it is responsive and adaptable to the ever–evolving departmental landscape.

Each day, we dedicate ourselves to diligent work, fully recognizing the indispensable contribution of our administrative team in realizing our objectives. Consequently, their well–being is our utmost priority, surpassing all other considerations. While acknowledging the presence of numerous external factors beyond our control as managers and leaders, it remains our responsibility to actively cultivate a work environment where our teams feel nurtured, supported and valued.

Finally, I am enthusiastic about embarking on this challenge as there is a lot to be accomplished. As we strive to reach our objectives, I wholeheartedly embrace constructive feedback and suggestions. I firmly believe in fostering a collaborative and respectful communication environment where our collective efforts can yield even greater results.

“Sometimes you stumble across a few chords that put you in a reflective place.”

// David Bowie

BY TIMOTHY GOULDSON

S A Night at The Opera: Dr. Julia Chabot, Rhapsodic Geriatrician and Covid Conductor

Should you find yourself lost while searching for Dr. Julia Chabot’s office at St. Mary’s Hospital Center in Montreal, stop for a moment and listen for the melodious sounds of a trained operatic voice, then walk toward the source. “I don’t think about it much anymore, but my husband would say that I probably sing all the time, even if I don’t realize it,” says Dr. Chabot, Director of the McGill Geriatrics Residency Program and Assistant Professor in the Department of Medicine, McGill University.

From Diva to Doctor

St. Marys’ resident Diva started to sing at the age of six and went on to take classes in vocal training. When she turned nine, she began to take her gift more seriously which led her to performing at concerts. At 12, she became a singer with the Orchestre Symphonique de Montréal. “I sang a lot pretty much until I started my clerkship in medical school, because then my schedule changed, and it was becoming much more difficult to set aside time to sing,” Chabot says. “It really feels like I had another life before I went into medicine.”

Chabot’s appreciation of music dominated throughout her earlier life, from being a season’s tickets holder for the Montreal Symphony Orchestra, to making major purchase decisions. “When I went to buy my first car, my first priority was a good music system. It was funny. The salesman couldn’t believe it! That’s just one example of how there is always music around in our house, all types of different music.”

It’s perhaps not surprising then, that in Chabot’s plunge into medicine, music would remain highly relevant. After medical school, she started her residency in internal medicine and eventually settled into geriatric medicine. “When I was a resident, I started to think that while we’re obviously trying to heal our patients, there are some limitations to what we can do in terms of medical treatment. That’s when I began to think about bringing music to work with me. I started to wonder if there was a way for me to actually improve the quality of life of my patients, especially working in the hospital setting.”

Music as Medicine

From a patient’s perspective, hospitalization is generally unpleasant. In addition to providing the appropriate care, Chabot began to take into consideration the patient’s adverse predicament and in so doing, started to think of alternative forms of treatment. “We don’t have a magic happy pill that will suddenly cure people in this unfortunate situation. That’s why I started thinking about bringing music into the hospital.”

Her probe into music therapy began at the International Laboratory for Brain, Music and Sound Research (BRAMS), an institute dedicated to the neuroscientific study of music and auditory cognition, located in Montreal, jointly affiliated with McGill University and the University of Montreal. “It occurred to me that there was a possibility for me to study exactly the question that I was wondering about, within a psychology program.”

Dr. Julia Chabot at the age of 11 singing with an orchestra

Then, with a masters in psychology in hand, Chabot proceeded to put her combined training to work. “In the geriatric unit of St. Mary’s Hospital, I created a program where musicians played for the patients every evening. Some of them were from the McGill School of Music. We noticed incredible reactions from the patients. At this point I started to think, you know, while I’m doing medicine and prescribing all sorts of treatments, doing all sorts of tests, really trying to help our patients, I felt that by listening to one song and by creating a connection between the music and the patient, I could actually provide almost better care than I was delivering.”

Chabot proceeded to rigorously evaluate music’s impact on her patients. She concluded the exposure to music resulted in better health conditions. “There was a demonstration of improved positive emotion in our patients. Our research assistants analyzed videos taken of patients while listening to music. In addition to grading responses, we asked our patients how they felt, and both of those measures were correlating.”

Chabot’s combination of medical and psychological training represents a more holistic approach to patient care. “That’s the reason why I went into geriatric medicine. A lot of our patients have cognitive issues, so communication is a big challenge. It’s quite impressive to see how much we can use music to communicate with them. I have a dream that one day we will be able to

prescribe music to patients in the hospital. There are definitely fewer side–effects compared to medication.”

From communicating through music Chabot has gone on to evaluate its effectiveness on insomnia. Her current research involves three groups of patients, one equipped with sleeping headbands that play music, another with headbands that play relaxation sounds, such as ocean waves and falling rain, and a control group. “We took measurements to see how well each group slept. We’ve just finished collecting the data and are currently analyzing it to see what the results show.”

Stepping Up in Crisis

While Chabot was exploring the health benefits of music, another challenge presented itself –Covid 19. In April 2020, in Dorval, 47 long–term patients at a CHSLD Herron passed from the disease. “We were all shocked with what we read in the newspapers about Herron. It was even more shocking because it was happening to patients that I’m trained to care for. I felt I would be able to help. One of the reasons I went into geriatrics is because it involves a vulnerable sector of the population, and we need to protect them. I really wanted to advocate for them.”

Hoping to be able to support efforts to contain the outbreak and to care for the afflicted, Chabot went to CHSLD Herron. What she didn’t expect was her help would be required for an extended period – three to four months. “We basically had to transform long–term residences into mini hospitals. I was coordinating a medical response in the residences, trying to train physicians who understandably were not entirely comfortable treating Covid patients. I remember one day there was a dermatologist, an obstetrician, and me, and we had 100 patients in a CHSLD and I was trying to coach them.”

Chabot eventually made it back to her office at St. Mary’s, where she can be found diligently analyzing research data from her latest geriatric study. If you’re lucky enough, you may even hear a few bars from Renée Fleming’s O mio babbino caro permeating the air.

Dr. Julia Chabot at the age of 14 performing with an orchestra

Section 2: DOM GOVERNANCE COUNCIL AND EXECUTIVE

McGill DOM Governance

DOM Council:

DOM Council acts as the Board of Governors or Parliament of DOM approving major policies and broad strategic directions. DOM Council meets every 2 months.

McGill University Division Directors

Core Training Program Director

2 PhD Representatives

Elected Early Career Representative1

3 Observers2

1 Q 2 yearly election held among DOM early career faculty (<4 years since initial University appointment)

2 Leaders of Hospital Divisions in Hospital DOMs whose primary affiliations are in other McGill Departments (e.g. Medical Genetics, Radiation Oncology)

3 See next page

DOM Executive3

Core Internal Medicine Chief Resident Representative

DOM Executive:

DOM Executive meets every 2–3 weeks and is responsible for delivering on the major strategic directions set by DOM Council.

Associate Chair of Medicine

Associate Chair of Research

Associate Chair of Education

Associate Chair of Quality/Patient Safety

Associate Chair of Wellness

Associate Chair of Advancement

Physicians–in–Chief

Senior DOM staff

Section 3: DOM STRATEGIC PLANNING

Strategic Planning

Another great initiative in 2022 was the launch of the DOM Participatory Strategic Planning.

This endeavour has been truly remarkable, affording us the chance to engage with and listen to the perspectives of every department member and the community. We are thrilled with the outcomes thus far and have full confidence that it

The Strategic Plan Road Map was divided into three phases:

1

2 Tools & Processes: How to Get There

3 Metrics: Defining how far we’ve gotten to the destination

TRAVELED

WHERE SHOULD THE DESTINATION BE? ?

GPS/MAPS

87KM

M C GILL DEPARTMENT OF MEDICINE ANNUAL REPORT 2022 /21

A rundown of our progress so far:

We received over 180 aspirations from surveys/ townhalls which fell under seven Key Aspirational Themes:

• Effective advocates for the best patient care in resource constrained environments

• Planetary health

Key Aspirational Themes

• Most research intensive DOM in Canada

• Patient & community engagement

• I love working here!

• As diverse as those we serve

• Training centre of choice

Themes:

Effective advocates for the best patient care in resource constrained environments

Most research intensive DOM in Canada

I love working here!

At the time of this writing, our goal is to have this finalized by September 14, 2023

www.mcgill.ca/deptmedicine/about–us/strategic–planning

Training

centre of choice

After further survey work, we whittled down to four Key Aspirational

Training centre of choice

Top 3 Aspiration Results

We then surveyed the membership (again!) and identified the top 3 key aspirations per theme:

I love working here

Top 3 Aspiration Results

Effective advocates for the best patient care in resource constrained environments

Top 3 Aspiration Results

Most research intensive DOM in Canada

Top 3 Aspiration Results

Our Core IM programs attract the best candidates and provide the best Core IM training in the country.

A healthy and safe learning and working environment at all levels.

Our clinician teachers are valued, respected and master clinician–teachers are celebrated.

Where leaders, colleagues and institutions care about me as a person and value and respect my contributions.

Place where digital and other innovations lead to top–notch provider experience & administrative excellence.

Where employee growth and development is valued, integrated and paramount to the success of the Department.

Delivering/ developing digital innovations that improve access to quality care (state of the art EMRs, patient–facing apps, virtual care).

Contributing and advocating for solving the current/coming human resource crisis.

3 2 1 3 2 1 3 2 1 3 2 1

Growing number of clinician–scientists who produce the most impactful research in Canada.

PhD scientists and clinicians co–creating in the most translational DOM in Canada.

Rendering state of the art diagnostics and therapeutics accessible to all Quebecers.

More world–class research teams than any other DOM in Canada (i.e. teams of multi–disciplinary scientists working in a specific area).

Dr. Jonathan C. Meakins: An Instrumental Leader in Grounding the DOM

BY ADA PRUNESCU

Assessing the personality and determining the factors that contribute to someone’s success postmortem is challenging, often relying on obituaries for information. However, a lasting impression and legacy of Dr. Jonathan C. Meakins endures. His energy and foresight enabled him to help modernize McGill. “He entered the world of medicine with the orthodox training expected of a physician who had academic ambitions at the time. He soon showed, however, that his outlook on medicine was far from orthodox” (Christie, 1960, p. 1).

Medicine in the early 20th century

In the late 1800s, North American medicine lagged behind Europe. Medical education in the US was dominated by private, profit–oriented schools with lax entry criteria. A scathing report by Abraham Flexner in 1910 led to school closures and criticism. Many Canadian medical schools, including McGill and the University of Toronto, were spared this criticism, instead receiving praise. Flexner drew his inspiration from Johns Hopkins Medical School, where Sir William Osler, a prominent figure at McGill, made significant contributions.

Service and Learning

From 1914 to 1919, Dr. Meakins served in the Canadian Army Medical Corps, where he was assigned to a British physiology team to study the effects and treatment of gas poisoning, an area that was not well understood at the time. Throughout the war, he dedicated himself to this research while also providing care for individuals suffering from gas–poisoning and “soldier’s heart,” now known as post–traumatic stress disorder. Meakins greatly impressed the physiologists involved in war–related studies and seamlessly integrated into esteemed medical and scientific circles in Britain. As a result, he became a highly sought–after candidate for prestigious medical positions following the war.

Meakins ended up accepting an offer to become the Christison Chair of Therapeutics at Edinburgh University, where he served from 1919 to 1924. During this period, he established a laboratory with the purpose of gradually familiarizing Edinburgh clinicians with the principles and methodologies of scientific research and academic medicine. Additionally, he was among the pioneering group of individuals who conducted early trials of insulin. In his acceptance letter to Edinburgh, Dr. Meakins emphasized the significant influence of the University on the field of medicine in North America, particularly at McGill University, his alma mater. He highlighted the fact that certain physicians at the Edinburgh Royal Infirmary had, for some time, been employing a teaching method that involved direct personal interaction between the student and the patient. This innovative educational approach was subsequently implemented at McGill, where it was first observed by Sir William Osler (Fye & Roland, 2010). Class of Medicine, 1924

Ward 26, Royal Infirmary Edinburgh 1913. Dr. J. C. Meakins’ ward where the first human injection of insulin in Europe was given

The early days of McGill’s Department of Medicine

Prior to his death in 1919, Sir William Osler suggested promoting clinical investigation at McGill and included the appointment of a full–time Chair of Medicine for this purpose. Dr. Meakins, whom Osler recognized as an outstanding asset to McGill during his military service, was recommended. Meakins possessed the foresight to understand that the application of experimental research could be integrated into patient care and sought to transform this vision into reality.

In 1924, Meakins arrived in Montreal and assumed multiple significant roles at McGill: Canada’s first full–time Chair of Medicine, Physician–in–Chief of the Royal Victoria Hospital, and Director of the newly established University Clinic. His mission was to integrate research into his hospital department as an integral component of academic medicine. With his noted charisma, energy, vision, wisdom and determination, Meakins swiftly revitalized the Department of Medicine and restored McGill University’s high profile in medical research. Perhaps his greatest legacy to McGill and Canadian clinical science was his creation of the University Clinic where clinicians and basic scientists worked together (Warren, 2010).

Meakins and Christie

During the early 1930s, Dr. Ronald Christie joined the Department as a postdoctoral fellow under the supervision of Dr. Meakins. The department experienced a significant boost thanks to the influential contributions of Meakins and Christie. Pioneers in

the field of respiratory medicine, they conducted vital experiments to advance our understanding of respiratory physiology and the pathophysiology of common respiratory diseases.

Their legacy was carried forward by the recruitment of skilled and innovative faculty members who shared their commitment to academic medicine. The friendly competition that developed among the young investigators generated new ideas that helped advance and broaden the scope of their research. As the outcomes of their investigations became known, a new generation of researchers was drawn to the clinic, ensuring the continuity of research projects year after year. An extended family of researchers was developed, first at the clinic and later in other departments and medical disciplines (Entin, 1987). Reflecting on the growth of respiratory medicine at McGill, it becomes evident that while the individual scientific contributions were significant, the most profound impact of Meakins and Christie resided in the training and mentorship of a diverse group of talented physicians and scientists (Martin & Schwartzman, 2015). The renowned Meakins–Christie Laboratories were established in 1972 to study respiratory diseases and this research unit recently celebrated its 50th anniversary.

Grooving through the corridors of history, back in 1924, the Department of Medicine was composed of a mere 100 members. What a journey it has been when compared to its 1,200 members in 2022.

Putting Character and Career Together

It is undeniable that a balanced and integrated interest in both the sciences and the humanities played a significant role in Meakins’ rise as one of the foremost leaders in medicine in North America.

One aspect of Meakins’ life that provides valuable insight into his social views on medicine and belief in public service is exemplified by his decade–long presidency of the Canadian Mental Health Association. At the time, it was considered less prestigious to focus on mental health, a field often regarded as unscientific. However, Meakins, a specialist in internal medicine and a renowned cardio–respiratory physiologist, dedicated his skills and experience to benefit this field, which speaks volumes about his character.

Meakins himself had begun his career as a pathologist in New York, where he observed firsthand nurses visiting patients in their homes, particularly in the challenging districts of the city. This experience exposed him to the social aspect of medicine. During the first World War, he discovered that emotional factors played a dominant role in a person’s physical well–being. Later, when he moved to Edinburgh, he invited a professor of Psychiatry to join his staff and participate in patient rounds. This collaboration, along with the work of social workers, convinced him that body and mind were indivisible in health and disease (Warren, 2010).

Meakins foresaw the increasing significance of mental health in medical education and practice. His roots in mainstream medicine, coupled with his willingness to venture beyond his own discipline, made him a pivotal figure in advancing these developments. His example inspired others to follow suit.

The ability to perceive medicine as a whole was evident in one of his most significant works, titled “The Practice of Medicine.” His underlying philosophy can be encapsulated by the following passage from his introductory note in the textbook: “Many symptom–complexes cannot be proved to have a factual physiologic, anatomic, biochemical, or psychologic basis. All of these may contribute to the common end, but they must be integrated to apply to the individual as a composite being. To accomplish this objective, the teacher of medicine must be in constant contact with humanity in the raw.”

In 1959, at the age of 77, Dr. Meakins was laid to rest, though his impact at McGill continues to be felt to this day.

A special thanks to Dr. Jonathan Larmonth Meakins who generously provided the archives used to draft this piece and for carrying on his grandfather’s legacy both through sharing this incredible story and for dedicating 36 years to the field of surgery at McGill University. It is difficult to put into words the profound impact the Meakins family has had on medicine at McGill, and for that, we are deeply grateful.

References:

Christie, R.V. (1960). Dr. Jonathan C. Meakins. American Heart Journal, 59(1), 1–2.

Entin, M. (1987). The Dynasties of Research at the Royal Victoria Hospital, Montreal. The Canadian Journal of Surgery, 30(6), 449–450.

Fye, W.B., & Roland, C.G. (2010). Jonathan Campbell Meakins. Clinical Cardiology, 33(4), E57–E59.

Martin, J.G., & Schwartzman, K. (2015). Respiratory medicine and research at McGill University: A historical perspective. Canadian Respiratory Journal, 22(1), e4–e7.

Warren, P. (2010). Dr. Jonathan Campbell Meakins. Laureate Nomination Letter.

Dr. Jonathan C. Meakins standing alongside his family, including grandson, Dr. Jonathan Larmonth Meakins

Section 4: DOM

YEAR END NUMBERS AND SUMMARY

328  Residents

(Reference period: July 1, 2022 to June 30, 2023, Academic Year)

DOM by Numbers

230  Medical Students

(Reference period: July 1, 2022 to June 30, 2023, Academic Year)

42  Fellows

(Reference period: July 1, 2022 to June 30, 2023, Academic Year)

365  McGill–administered research funds

(Reference period: As of July 1, 2022)

25  Retirements/ Departures

(Reference period: Jan 1, 2022 to Dec 31, 2022, Calendar Year)

10  Promotions dossiers

(Reference period: Jan 1, 2022 to Dec 31, 2022, Calendar Year)

65  Postdoctoral Fellows

(Reference period: Jan 1, 2022 to Dec 31, 2022, Calendar Year)

59  New Faculty Hires

(Reference period: Jan 1, 2022 to Dec 31, 2022, Calendar Year)

8 Annual events

(Reference period: Jan 1, 2022 to Dec 31, 2022, Calendar Year)

Faculty Distribution

DOM is one of the largest departments at McGill. It is a vibrant, diverse and top performing unit, with members who pursue scholarly work that contributes to the advancement of knowledge across a vast spectrum of inquiry and who provide excellent clinical care across a vast swath of the Quebec territory. 806

Total # DOM Faculty Members

470  Core Full–time faculty (MDs and PhDs)

336  Part–time faculty (MDs and PhDs)

A key digital innovation in the DOM in 2022 was the implementation of a web–based platform to capture/collect information for the Annual Evaluation exercise.

The platform gives us access to a treasure trove of data to inform and drive our policies, processes, and programming. Here is a snippet of what we learned about DOM through use of the platform.

Full–Time faculty distribution per profile type

49.9%  Clinician–Teacher

3.5% Clinician–Administrator

17.4% Scientist

4.4% Clinician–Educator

8.6% Clinician–Investigator

16.2% Clinician–Scientist

Teaching contributions in the DOM

Clinical contributions in the DOM

Sex Distribution

From a total of 695 part–time AND full–time ranked faculty (Assistant, Associate, Faculty Lecturer and Professor)

31% of MUHC Division Directors // 5 of 16

13% of JGH Division Directors // 2 of 15

DOM has been sponsoring leadership courses for full–time faculty (through the Canadian Medical Association) and we hope this will result in better representation of women in leadership positions in the DOM.

41% of McGill DOM faculty members self–declare as women

Women are: Faculty Lecturers // 49% Assistant Professors // 46% Associate Professors // 37% Full Professors // 26%

In DOM leadership positions, women are:

17% of SMH Division Directors // 2 of 12

67% of DOM Associate Chairs // 4 of 6

Top H–indices for Full–Time Faculty Members Holding Primary Appointments in the DOM

Below we use the H–index metric as one measure of academic success of our members. The index is based on the set of the scientist’s most cited papers and the number of citations that they have received in other publications. “The h–index is an author–level metric that measures both the productivity and citation impact of the publications of a scientist or scholar. The h–index correlates with obvious success indicators such as winning the Nobel Prize, being accepted for research fellowships and holding positions at top universities.”[1]

We obtain our H–index report from SciVal – a research analysis tool now being used at McGill –and the SciVal results are considered to be more ‘conservative’ than those gleaned from Google Scholar, for example, since the latter also includes non–peer–reviewed articles and publications. As a result, the H–index from SciVal will be lower than the Google Scholar H–index.

Ref (1) Bornmann, Lutz; Daniel, Hans–Dieter (July 2007). “What do we know about the h–index?”. Journal of the American Society for Information Science and Technology. 58 (9): 1381–1385. doi : 10.1002/asi.20609.

*Includes faculty with joint appointments to another McGill department, but primary in Medicine.

Top 30 H–indices – 2022

Spotlight on Early Career faculty’s research impact

As the H–index increases with years of active publication, we thought it would be of interest to highlight the top 10 H–indices among our recent Early Career faculty (defined for this analysis as hired (whether full–time or part–time) since 2015 and age < 40):

CIHR Operating Grants (Full–time DOM members)

Year–over–year DOM FRQS Success

There are many reasons for our success including that we recruit the best/brightest and we support them during the crucial early years of their careers. Of course, the benefits of this success are many and include: 1) protecting our FRQS–funded scientists’ time for research, which is a cornerstone of research productivity that reflects well collectively on the DOM and 2) FRQS–funded DOM members go “hors PEM” allowing us to recruit another faculty member (which leads to

a net increase in clinical full–time equivalents). We all win by ensuring/supporting/encouraging DOM FRQS success!

For 2023–2024, the McGill Department of Medicine received 34% of all awards across the University. This raised the DOM’s overall average relative to McGill to 26% from 2018–2019 to 2023–2024.

DOM performance relative to McGill and relative to Quebec

The DOM has a strong tradition of batting at or well above average in FRQS Scientist/Clinician Scientist applications when compared with the rest of McGill and the rest of the province.

FRQS Salary Awards (Spring 2022)

Congratulations to DOM members who were successful in obtaining salary awards for applications submitted in 2021!

What a sweep! 11 Department of Medicine–appointed faculty received awards, for a success rate of 50%. These awards attest to the quality of

the support our department/institutional partners provide and to the excellence of the researchers and their research programs.

CHERCHEUR BOURSIER DE MÉRITE

Dr. Sarit Assouline

Dr. Nitika Pant Pai

CHERCHEUR BOURSIER CLINICIEN SENIOR

Dr. Yves Longtin

Dr. Donald Vinh

CHERCHEUR BOURSIER CLINICIEN JUNIOR 2

Dr. Natalie Dayan

Dr. Emily McDonald

Dr. Ruth Sapir–Pichhadze

CHERCHEUR BOURSIER CLINICIEN JUNIOR 1

Dr. Matthew Cheng

Dr. Phillipe Lefrançois

Dr. Arielle Mendel

Dr. Shaifali Sandal

Dr. Alexander Lawandi

// Infectious Diseases

Dr. Boyang Zheng

// Rheumatology

Dr. Bruno Benzaquen

// Cardiology

Dr. Bryan Ross

// Respiratory Medicine

Dr. Jesse Jacob Popov

// General Internal Medicine

New Full–Time Faculty Appointments 2022

Dr. Judy Luu

// Cardiology

Dr. Marcel Baltzan

// Respiratory Medicine

Dr. Mathew Cherian

// Respiratory Medicine

Dr. Michael Fein

// Allergy and Immunology

Dr. Sonali de Chickera

// Nephrology

Promotions 2022

Full Professor Promotions

Dr. Stella Daskalopoulou

Dr. Giada Sebastiani

Dr. George Thanassoulis

Dr. Tanya Skamene

// Hematology

Dr. Thusanth Thuraisingam

// Dermatology

Dr. Atul Verma

// Cardiology

Dr. Gustavo Duque

// Geriatric Medicine

Dr. Jonathon Campbell

// Clinical Epidemiology

Associate Professor Promotions (Full–Time)

Dr. Stéphane Beaudoin

Dr. Ivan Litvinov

Dr. Nathalie Saad

Dr. Ratna Samanta

Dr. Michael Tsoukas

Dr. Oriana Yu

We are grateful to our Education leaders for their role in the development of the next generation of McGill–trained health care providers, who supervise, guide and mentor approximately 230 medical students, 328 residents and 42 fellows each year.

And we would also like to thank our Education leaders for their role in the development of the next generation of McGill–trained scientists, who teach and supervise approximately 350 graduate students for the current year.

Directors of Postgraduate Residency Training Programs (PGME)

ALLERGY & IMMUNOLOGY

Dr. Michael Fein

CARDIOLOGY

Dr. Negareh Mousavi

// MUHC Co–Director

Dr. Maude Peretz–Larochelle // JGH Co–Director

CORE INTERNAL MEDICINE (R1–R3)

Dr. Ning–Zi Sun

Program Director

Dr. Jonathan How

McGill Assistant Program Director

Dr. Maxime Cormier

Glen Site Director

Dr. Khue Ly

MGH Site Director

Term ended June 2022

Dr. Sana Swaleh // MGH Site Director

as of July 2022

Dr. Elise Levinoff // JGH Site Director

DERMATOLOGY

Dr. Khue Nguyen

// Term ended June 2022

Dr. Osama Roshdy

// Interim July–Nov 2022

ENDOCRINOLOGY & METABOLISM

Dr. Vanessa Tardio

GASTROENTEROLOGY

Dr. Dean Soulellis

// Term ended June 2022

Dr. Chiara Saroli Palumbo // As of July 2022

GERIATRIC MEDICINE

Dr. Julia Chabot

Dr. Dan Liberman

// Assistant Program Director

HEMATOLOGY

Dr. Chantal Cassis

// Term ended June 2022

Dr. Anna Nikonova

// Co–Director as of July 2022

Dr. Laura Anne Habib

// Co–Director as of July 2022

MEDICAL MICROBIOLOGY & INFECTIOUS DISEASES

Dr. Makeda Semret

GENERAL INTERNAL MEDICINE (R4–R5)

Dr. Patrick Willemot

MEDICAL BIOCHEMISTRY

Dr. Brian Gilfix

NEPHROLOGY

Dr. Catherine Weber

RESPIRATORY MEDICINE

Dr. Linda Ofiara

RHEUMATOLOGY

Dr. Fares Kalache

The DOM is responsible for 14 residency training programs and for the delivery of the internal medicine component of the undergraduate medical education curriculum.

Undergraduate Medical Education (UGME)

Internal Medicine component

CHAIR, UGME COMMITTEE

Dr. Nathalie Saad

CLERKSHIP COURSE DIRECTOR

Dr. Ratna Samanta

CLERKSHIP COURSE SITE DIRECTORS

Dr. Tianyan Chen

// Glen

Dr. Jill Pancer

// JGH

Dr. Ratna Samanta

// MGH

Dr. Les Meissner

// SMH

Dr. Moez Tajdin

// Gatineau

TRANSITION TO CLINICAL PRACTICE (TCP) COURSE DIRECTOR

Dr. Andrea Blotsky

TCP COURSE SITE DIRECTORS

Dr. Tianyan Chen

// Glen, Interim 2022

Dr. Andrea Blotsky

// MUHC (MGH/Glen as of January 2023)

Dr. Nan Zhao

// JGH

Dr. Les Meissner

// SMH

Dr. Erica Rubin

// Gatineau

Graduate Studies Program (Experimental Medicine)

Dr. Anne–Marie Lauzon

// Graduate Program Director

Dr. Elizabeth Fixman

// Associate Program Director

DOM Events 2022

McGill DOM Medical Grand Grand Rounds:

Nov 16, 2022 // Howard Frumkin, Planetary Health: from Global to Clinical Jan 18, 2023 // Rory Collins, UK Biobank: a unique combination of scale, depth, duration and accessibility

Mar 22, 2023 // Francoise Baylis, Human genome editing: from the first to the third international summit

April 7, 2022 // 2022 High Value Healthcare Symposium

Dec 1, 2022 // 2022 Research Symposium

Sep 14, 2022 // DOM Annual Awards Soirée

Schwartz Rounds:

Nov 28, 2022 // JGH: The Great Resignation: Why I am still here

M C GILL UNIVERSITY HONOURS AND AWARDS

Dr. Samuel Benaroya was the inaugural co–recipient of the Morty Yalovsky Lifetime Achievement Award for Excellence in Academic Leadership.

Dr. Phil Gold received the McGill University Medal for Exceptional Academic Achievement at Fall 2022 Convocation ceremony.

Dr. Elizabeth Hazel received the McGill Learner & Faculty Awards for Teaching Innovation.

EXTERNAL HONOURS AND AWARDS

Dr. John J.M. Bergeron was named to Order of Canada (Officers).

Dr. Cecilia Costiniuk received the 2022 Excellence in Research Award from the Canadian Association for HIV Research and Canadian Foundation for AIDS Research (CAHR–CANFAR).

Dr. Michelle Elizov received a 2022 Certificate of Merit Award from the Canadian Association of Medical Education for her commitment to medical education.

Dr. William D. Foulkes was awarded the Dr. Chew Wei Memorial Prize in Cancer Research.

Dr. Nadine Kronfli received the New Investigator Award from the Association of Medical Microbiology and Infectious Disease Canada.

Dr. Isabelle Malhamé received the Gairdner Early Career Investigator Award from the Gairdner Foundation and the Canada Gairdner Awards.

Dr. Ariane Marelli received the John J. Day MD Award of Excellence from the Heart & Stroke Foundation of Quebec. She was also elected as Fellow into the Canadian Academy of Health Sciences.

Dr. Morag Park received the 100 Years of Research prize from the Cancer Research Society and Quebec Breast Cancer Foundation.

Dr. Marc Rodger was elected as Fellow into the Canadian Academy of Health Sciences.

Dr. David S. Rosenblatt received the Garrod Association Pioneer Award.

Dr. Jean–Pierre Routy was recognized for his role in bringing the 24th International Aids Conference to Montreal in 2022.

Dr. Rhian Touyz was named Editor–in–Chief of Hypertension, an American Heart Association journal.

Dr. Nathalie Saad: A Novel Approach to Medicine

BY TIMOTHY GOULDSON

D

Dr. Nathalie Saad’s debut novel may be delayed, and understandably so. Her many medical and administrative roles in and around McGill University have her daily agenda booked solid. Parenting will surely add to her workload. The mom–to–be is Assistant Dean, Student Affairs, Undergraduate Medical Education at the Montreal Campus WELL Office, Faculty of Medicine and Health Sciences. She also serves as Director of the Pulmonary Rehabilitation Program at Montreal’s Mount Sinai Hospital and is Vice–President of the Collège des médecins du Québec (CMQ). Fortunately, she was able to set aside some time to discuss her multi–faceted career.

Juggling a Multifaceted Career and Personal Life

To maintain a balanced existence, Dr. Saad retreats on weekends to a cottage by the lake she shares with her significant other in Quebec’s Eastern Townships. Ensconced in tranquility, her downtime is occupied by her first love, literature, the subject in which she obtained her undergraduate degree, the culinary arts, and of course, outdoor recreation. “I’m an Eastern Townships kind of girl,” Saad says, “It’s a different environment. I can go to the lake, winter, or summer, either snowshoeing or paddle boarding.” Not surprisingly, she manages to squeeze in a little work as well.

Back at the office, Saad works on innovative strategies to implement Mount Sinai’s Tele–Pulmonary Rehab Program, a healthcare delivery system she developed. “We started up in 2017 with the program very small because pre–pandemic telemedicine wasn’t really a thing. Nobody actually knew what it meant or thought it was a way to do things. But we grew quite rapidly during the pandemic. In two to three years, we set up a lot of programs. We’re in 13 different sites across the province, but we would like to continue growing and provide accessibility to pulmonary rehab via a guichet d’accès en santé (health access counter) to reach out to the western part of Quebec. Had it not been for the pandemic, I think even the kind of telemedicine program I have now would have taken at least another five to ten years to really solidify, because the laws weren’t in place to make it happen and patients and physicians weren’t ready for it.”

As one might imagine, establishing a new entity requires a specific set of administrative skills, those which do not necessarily come with

medical training. That’s where Saad’s EMBA came into play. “The HEC–McGill EMBA model was a great place for me to look at the problem of accessibility in pulmonary rehab with a completely different twist. It also gave me a lot of tools from a management standpoint, that I wouldn’t have otherwise had. I learned how to better manage people and create teams using different approaches. And that’s what allowed me to start my medical career, looking at things from another perspective and doing things a little differently. You need to take a look at what’s done elsewhere and in fields completely outside of what you do, in order to be creative and see opportunities where otherwise you wouldn’t have.”

Saad’s administrative skills are also essential as assistant dean of student affairs at McGill’s WELL office, which provides students with counseling in wellness, career, and financial issues. “Our mandate is actually pretty broad. Attending medical school can be a difficult time. You start in medicine, but you don’t quite know where you’re going to end up as a resident. So, career counseling is very important because you have four years basically to decide what you’re going to do for the rest of your life. The office also helps students navigate school policies concerning accommodation, absence, parental leave, and provides advice on how to manage starting a family, which can be quite stressful to manage.” The WELL office also provides advice to students struggling with financial obligations.

Navigating Changes and Ensuring High–Quality Care

Her experiences also lead to her getting involved with the Collège des Médecins du Québec. The College is a professional organization responsible for setting educational standards for physicians and regulating the practice of medicine. “For me it’s very important that we look at solutions within the healthcare system and never lose focus of the primary reason why we’re in medicine, and that is to deliver high–quality care. We’re also involved in medical education, which made it a logical continuum in terms of career path.”

At the moment, Saad is examining several aspects of regulation. “There were a lot of changes in the last few years, in terms of how regulatory bodies were organized in the province. There are provincial laws guiding regulatory bodies that specify

good practices for risk management, financial management, et cetera. Also with the College, I’m involved with the other Canadian regulatory bodies and to some extent, the education side.” And with the upcoming changes with the “Projet de loi 15” there will be more work to come.

Optimal Setting for Career Goals

Having a carefully defined set of career goals in mind, Saad says McGill has provided the optimal setting in which to achieve them. “McGill offered a lot of flexibility, and the Jewish General Hospital was very open to new ideas. That was the deal breaker for me. I started off my practice with the idea of doing pulmonary rehab a little bit differently than it had been done in the past in the province, and I needed an environment that was going to be willing to allow me to implement my ideas. The minute I got to McGill they were very receptive of the kind of career path I wanted. The result is I have a medical education and medical administrative kind of career, instead of the more traditional medicine and research path.”

But what about that novel? “I’m going to work on the novel. It’s still in the back of my mind.”

Dr. Nathalie Saad at her cottage in Quebec’s Eastern Townships

“You need to take a look at what’s done elsewhere and in fields completely outside of what you do, in order to be creative and see opportunities where otherwise you wouldn’t have.”

“What I like to do is try to make a difference with the work I do.”

// David Bowie

Section 5: DOM

DIVISION HEADS AND DIVISION AND UNIT REPORTS

Our department highly values and seeks to support the work done by our divisions and of all members throughout the Department. We hope you enjoy reading these reports as much as we did!

The McGill Department of Medicine comprises 16 clinical divisions, encompassing all aspects of internal medicine and its subspecialties. The Division of Experimental Medicine provides graduate students with supervision and training in collaboration with Graduate and Postdoctoral Studies.

Divisions are the life–blood of an academic department of Medicine. Almost all clinical service, research and teaching are done at the Division level.

6 Clinician–Teachers 4 Scientists 1 Clinician–Scientist

5 Notable 2022 Publications (Division or DOM primary member’s name in bold type)

Copaescu AM, Vogrin S, Shand G, Ben–Shoshan M, Trubiano JA. (2022). Validation of the PEN–FAST Score in a Pediatric Population. JAMA Netw Open. 2022 Sep 1;5(9):e2233703.

Fava V.M., Bourgey M., Nawarathna P.M., Orlova M., Cassart Pauline, Cheng M.P., Bourque G., Schurr E, Langlais D. A system biology approach identifies candidate drugs to reduce mortality in severely ill COVID–19 patients, Sci Adv, 8(22):eabm2510, 2022.

Kabir Aunonna, Alizadehfar R, Tsoukas CM Good’s Syndrome: Time to Move on From Reviewing the Past. Front Immunol. 2022 Jan 12;12:815710.doi: 10.3389.

Alvarez F, Istomine R, Hendin H, Hodgins B, Pillet S, Fritz JH, Charland N, Ward BJ,

Clinical Allergy & Immunology

Leadership (from l to r)

Dr. Christos Tsoukas // McGill / MUHC

Dr. Jessie Schwartz // JGH

Dr. Jan Schulz // SMH

Piccirillo CA. A Hemagglutinin 1 Carrying Plant–Based Virus–like Particle Vaccine Generates an Efficacious Cellular Response by Exploiting IL–1 Signaling in Both Adult and Aged Mice. Immunohorizons. 2022 Jun 24;6(6):384–397. doi: 10.4049/immunohorizons.2200036.

Alenazy LA, Hinther K, AlMuhizi F, Fein M, Tsoukas C, Ben–Shoshan M, Copaescu AM, Isabwe GAC. Tolerance of the mRNA COVID–19 vaccines in patients with reported taxane reactions. J Allergy Clin Immunol Pract. 2022 Aug;10(8):2169–2171.e2. doi: 10.1016/j. jaip.2022.05.027. Epub 2022 Jun 9.

Exciting Research in the Pipeline

Project Title: Defining the role of fetal reprogramming in the gut epithelium in health and disease.

Investigators: Drs. Alex Gregorieff (PI) & Danuta Radzioch (CO–PI)

Funding: CIHR – $780,000

Date: 2023–2028

The research proposed in the grant is focused on establishing the mechanism involved in the tissue growth in health and during disease process. The proposed studies will allow better understanding of the role of fetal stem cells during the gut epithelial development, regeneration and tumorigenesis.

There is increased evidence that the fetal reprogramming is involved in colorectal cancer initiation and progression. The studies will reveal prime candidates’ genes and biochemical pathways regulating cancer–associated stem cell populations using organoid models of metastatic colorectal cancers in mice. The proposed studies will allow the researchers to test various treatments discovered to modulate innate cells, especially NK cells to express specific receptors on NK cells that can bind to specific ligands on cancer cells killing cancer cells and preventing the metastatic spread of colorectal cancer. The studies will also generate novel metastatic cancer models expressing recently identified driver mutation associated with metastatic cancer progression that can be exploited therapeutically.

Project Title: Development of 3D artificial thymic organoid (ATO) system that recapitulates thymopoiesis and mature human T cell development from cord– or peripheral blood–derived CD34+ HSC.

Lead: Dr. Ciriaco A. Piccirillo

Dr. Piccirilo’s laboratory has developed a novel and exciting 3D artificial thymic organoid (ATO) system that recapitulates thymopoiesis and mature human T cell development from cord– or peripheral blood–derived CD34+ HSC. They have also achieved FOXP3+ Treg cell development in this system (phenotypic, functional, transcriptional evidence) and are planning to validate function of the ATO T cells in humanized mouse models. In addition, they are adapting the system to use gene–editing strategies to introduce or correct inheritable mutations in the human FOXP3 gene and then test these cells in humanized mouse models. Lastly, they plan to exploit this ATO system to test various small molecular modifiers in potential Treg cell development.

Project Title: Development of MUHC COVID–19 Vaccine Allergy Clinic and conduct of the ARCOV (Allergic reactions to the COVID–19 vaccine) Study.

During the early part of the COVID–19 Pandemic, vaccine hesitancy became a major world health issue, and fear of allergic reactions played a significant role in this hesitancy, due to early

reports of increased rates of anaphylaxis secondary to the mRNA vaccines. Given the uncertainty surrounding the mechanisms of allergic reactions, possible culprit allergens (polyethylene glycol/polysorbate), and utility of skin testing, the MUHC Drug Allergy Team developed the MUHC COVID–19 Vaccine Allergy Clinic and conducted the ARCOV (Allergic reactions to the COVID–19 vaccine) Study to investigate this phenomenon.

In this single–centre prospective study, the team evaluated 611 patients for COVID–19 vaccine–related allergy. The 129 patients enrolled had skin testing. Skin testing with a novel panel of excipients including Polyethylene Glycol and Polysorbate. Of the 40 patients with a history of anaphylaxis secondary to the first dose of the vaccine, 37 had negative skin testing to the excipient panel and 35/37 tolerated the second dose, while 2 had non–severe allergic reactions. Of the three patients with positive skin prick tests to an excipient, 2/3 tolerated another dose without reaction, and one patient had a non–severe immediate reaction.

The results of this study demonstrated that excipients are unlikely the culprit allergen responsible for allergic reactions, and that an allergic reaction to the first dose does not predict tolerance of future doses. These findings are reassuring and support efforts to vaccinate individuals with a previous history of COVID–19 and other vaccine allergies.

Faisal ALMuhizi, Michael Fein, Sofianne Gabrielli, Louise Gilbert, Christos Tsoukas, Moshe Ben–Shoshan, Ana M Copaescu , Ghislaine

Annie Clarisse Isabwe. Allergic reactions to the coronavirus disease 2019 vaccine (ARCOV) study: The McGill University Health Centre experience. Ann Allergy Asthma Immunol. 2022 Aug;129(2):182–188.e1. doi: 10.1016/j. anai.2022.05.014. Epub 2022 May 21.

Impactful Clinical Innovation

Multidisciplinary EoE Clinic

Dr. Natacha Tardio

Eosinophilic Esophagitis (EoE), is a chronic immune–mediated disorder of the esophagus. It presents with difficulty swallowing and food impactions in the adult population, and feeding intolerance, abdominal pain and failure to thrive in children. The diagnosis is made with an endoscopy showing the presence of eosinophils on esophageal tissue. Longstanding eosinophilic inflammation, tissue remodeling and progressive fibrostenoisis of the esophagus result in significant morbidity and poor quality of life in this patient population.

The prevalence and incidence of EoE are significantly increasing along with that of other atopic conditions including asthma and food allergies. Given the complexity in the diagnosis and management of this chronic allergic disorder, it remains under–recognized in both the medical and non–medical communities. The Division of Allergy and Immunology recently developed a multidisciplinary management approach for adults diagnosed with EoE and established a comprehensive clinic consisting of specialists in allergy, immunology, gastroenterology and nutrition. Established at the Montreal General Hospital site, the clinic was inaugurated in the fall of 2022. It provides coordinated care for EoE patients during a single encounter in the context of a comprehensive and collaborative management plan. This endeavour is the first of its kind in Canada for adults living with this condition. Overall, it is expected that this exciting innovative multidisciplinary approach will result in significant benefits; including decreased wait times for EoE patients, immediate communication between specialists facilitating streamlined, coordinated,

and rapid care, decreased hospital resource utilization, and most importantly, an improvement in clinical outcomes.

Biomarker Development to Diagnose Immune Mediated Reproductive Failure

Dr. Geneviève Genest

Infertility affects 1/6 Canadian couples, and 15% of pregnancies end in miscarriage. Unexplained reproductive failure encompasses recurrent pregnancy loss (3 miscarriages) and recurrent implantation failure (failure to conceive after 3 embryo transfers), affects < 3% of couples attempting to procreate but is associated with a significant physical and psychological burden as well as high health care expenditures.

Because the immune system is intimately involved in the establishment and maintenance of pregnancy, the researchers created Canada’s first university–based Reproductive Immunology clinic at the MUHC in 2017. This clinic is now the reference centre in Quebec for patients with unexplained reproductive failure, evaluating more than 400 patients per year for immunomodulatory therapy with a >50% live birth rate. Despite having a dedicated clinic and expertise to treat such a complex and orphan patient population, success rates are limited by the lack of available diagnostic tests or treatment targets. To address these issues, researchers are developing a translational research program to improve our understanding of how the immune system contributes to reproductive failure. Eligible patients are recruited to contribute both baseline endometrial and blood samples as well as pre–and post–treatment blood samples, which are then correlated with clinical metrics and treatment outcomes as part of Canada’s first reproductive immunology biobank and registry. With this project, the team is building a platform for the development of biomarkers that can be used to diagnose immune–mediated reproductive failure and guide individualized treatment while also positioning McGill at the forefront of a Canadian initiative in improving both access to care and outcomes in this patient population.

Leadership (from l to r)

Dr. Atul Verma // MUHC

Dr. Lawrence Rudski // JGH

Dr. Mathieu Walker // SMH

35 Clinician–Teachers

9 Clinician–Scientists

7 Clinician–Investigators

7 Scientists

3 Clinician–Educators

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Andrade JG, Deyell MW, Macle L, Wells GA, Bennett M, Essebag V, Champagne J, Roux JF, Yung D, Skanes A, Khaykin Y, Morillo C, Jolly U, Novak P, Lockwood E, Amit G, Angaran P, Sapp J, Wardell S, Lauck S, Cadrin–Tourigny J, Kochhäuser S, Verma A, for the EARLY–AF Investigators. Progression of Atrial Fibrillation after Cryoablation or Drug Therapy. N Engl J Med. 2023 Jan 12;388(2):105–116. doi: 10.1056/NEJMoa2212540. Epub 2022 Nov 7. PMID: 36342178.

Sharma A, Zheng Y, Ezekowitz JA, Westerhout CM, Udell JA, Goodman SG, Armstrong PW, Buse JB, Green JB, Josse RG, Kaufman KD, McGuire DK,

Ambrosio G, Chuang LM, Lopes RD, Peterson ED, Holman RR. Cluster Analysis of Cardiovascular Phenotypes in Patients with Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine. Diabetes Care. 2022 Jan 1;45(1):204–212. doi: 10.2337/dc20–2806.

Glavinovic T, Thanassoulis G, de Graaf J, Couture P, Hegele RA, Sniderman AD. Physiological Bases for the Superiority of Apolipoprotein B Over Low–Density Lipoprotein Cholesterol and Non–High–Density Lipoprotein Cholesterol as a Marker of Cardiovascular Risk. J Am Heart Assoc. 2022 Oct 18;11(20):e025858. doi: 10.1161/JAHA.122.025858. Epub 2022 Oct 10. PMID: 36216435; PMCID: PMC9673669.

Marelli AJ, Aboulhosn J. Perloff’s Clinical Recognition of Congenital Heart Disease. Philadelphia. Elsevier–Saunders. 7th Edition –eBook ISBN: 9780323547826; Hardcover ISBN: 9780323529648. 2022 Jun 25.

Marelli AJ, Beauchesne L, Colman J, Ducas R, Grewal J, Keir M, Khairy P, Oechslin E, Therrien J, Vonder Muhll IF, Wald RM, Silversides C, Barron DJ, Benson L, Bernier PL, Horlick E, Ibrahim R, Martucci G, Nair K, Poirier NC, Ross HJ, Baumgartner H, Daniels CJ, Gurvitz M, Roos–Hesselink JW, Kovacs AH, McLeod CJ, Mulder BJ, Warnes CA, Webb GD. Canadian Cardiovascular Society 2022 Guidelines for

Cardiovascular Interventions in Adults With Congenital Heart Disease. Can J Cardiol. 2022 Jul;38(7):862–896. doi: 10.1016/j.cjca.2022.03.021. Epub 2022 Apr 20. PMID: 35460862

Exciting Research in the Pipeline – MUHC

Project Title: LEFT HF: LEFT Bundle Pacing vs Standard Right Ventricular Pacing for Heart Failure

Investigators: Drs. Joza, Jacqueline, Essebag, Vidal, Healey, Jeff S, & Verma, Atul

Funding: CIHR – $576,809

Date: 2022–2027

Project Title: Addressing knowledge gaps in the use of lipoprotein(a) screening in cardiovascular prevention

Investigator: Dr. George Thanassoulis

Funding: Heart and Stroke Foundation of Canada –$ 292,407

Date: 2022–2025

Project Title: Brain–Heart Research Integrative Innovation Team Endeavor (BHRIITE)

Investigator: Dr. Matthias Friedrich

Funding: Heart and Stroke Foundation of Canada –$ 2,900,000

Date: 2022–2026

Impactful Clinical Innovation – MUHC

Left bundle branch pacing: a new form of physiological pacing to prevent heart failure

McGill has been at the forefront of performing a new type of procedure called left bundle branch pacing (LBBP). This emerging pacemaker implantation technique consists of placing the right ventricular pacing lead near or within the native left bundle branch to re–create the normal physiologic activation of the ventricles. To better understand its benefits as compared to standard right ventricular pacing, McGill is leading a large Canadian multicenter randomized controlled trial to determine whether LBBP can prevent the onset of heart failure and reduce cardiovascular mortality. This trial has received

funding from both the Heart and Stroke Foundation and Canadian Institutes of Health Research and will change guidelines.

In a clinical setting, researchers have applied this novel technique to patients with pre–existing heart failure where standard coronary sinus pacing does not achieve the desired result, which is the case in more than a third of heart failure patients with electrical dysfunction. By placing both a coronary sinus pacing lead to activate the lateral wall of the left ventricle, and a LBBP lead to activate the interventricular septum and stimulate the native electrical system, they have seen remarkable improvements in functional status. The team aims to further study this more ‘personalized approach to resynchronization therapy’ in order to improve heart failure outcomes.

5 Notable 2022 Publications – JGH

De–frailing intervention for hospitalized cardiovascular patients in the TARGET–EFT randomized clinical trial. Ahmad F, Fountotos R, Goldfarb M, Bharaj N, Munir H, Marsala J, Rudski LG, Afilalo J.Eur Heart J Qual Care Clin Outcomes. 2022 Aug 26:qcac050. doi: 10.1093/ehjqcco/qcac050. Online ahead of print.

PMID: 36026532

Interventions for physician prescribers of opioids for chronic non–cancer pain: protocol for an overview of systematic reviews. Wennberg E, Windle SB, Filion KB, Gore G, Thombs BD, Kudrina I, Paraskevopoulos E, Martel MO, Kimmelman J, Johnson S, Taylor A, Eisenberg MJ. BMJ Open. 2022 Mar 31;12(3):e060964. doi: 10.1136/bmjopen–2022–060964.PMID: 35361655

The Paradox of Pulmonary Vascular Resistance: Restoration of Pulmonary Capillary Recruitment as a Sine Qua Non for True Therapeutic Success in Pulmonary Arterial Hypertension. Langleben D, Orfanos SE, Fox BD, Messas N, Giovinazzo M, Catravas JD.J Clin Med. 2022 Aug 5;11(15):4568. doi: 10.3390/jcm11154568.

PMID: 35956182

Engaging Families in Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. Goldfarb MJ, Bechtel C, Capers Q 4th, de Velasco A, Dodson JA, Jackson JL, Kitko L, Piña IL, Rayner–Hartley E, Wenger NK, Gulati M; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Lifelong Congenital Heart Disease and

Heart Health in the Young; Council on Cardiovascular Radiology and Intervention; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; and Council on Lifestyle and Cardiometabolic Health.J Am Heart Assoc. 2022 May 17;11(10):e025859. doi: 10.1161/JAHA.122.025859. Epub 2022 Apr 21.PMID: 35446109

Severe Mental Illness and Cardiovascular Disease: JACC State–of–the–Art Review. Goldfarb M, De Hert M, Detraux J, Di Palo K, Munir H, Music S, Piña I, Ringen PA. J Am Coll Cardiol. 2022 Aug 30;80(9):918–933. doi: 10.1016/j.jacc.2022.06.017.

PMID: 36007991

Exciting Research in the Pipeline – JGH

Project Title: Impact of Frailty and sarcopenia in Post–Covid Recovery

Investigator: Dr. Jonathan Afilalo

Funding: CIHR – $470,000

Leveraging the Biobanque du COVID–19 du Québec, this cross disciplinary team of geriatricians, emergentologists, internists, intensivists and data scientists are using multicentric health data and radiological images to evaluate frailty and sarcopenia, and accordingly predict the risk of adverse events in N=2,000 older adults post–COVID. One of the exciting applications is using clinical CT image to opportunistically derive measures of low skeletal muscle mass and quality indicative of sarcopenia. The overarching goal is to be able to identify vulnerable patients and proactively refer them to rehabilitation or other geriatric interventions that may mitigate their risks and improve their recovery and quality–of–life.

Project title: FAME (Family Engagment in the ICU Setting)

Investigator: Dr. Michael Goldfarb

The FAME study is a prospective observational cohort with an embedded qualitative study of 198 family members in the ICUs of 4 Canadian hospitals. The objective of the study is to validate the FAMily Engagement (FAME) instrument in the ICU setting. The FAME instrument was developed to quantify the degree and type of engagement behaviors and perspectives of family members of people in the

ICU. The FAME study will explore the role of age, relationship, sex, gender, and race/ethnicity on family engagement, as well as evaluate the relationship between family engagement and family–centered outcomes. The results of this study will inform efforts to measure the impact of family–centered interventions on improving engagement in patient care.

Project title: Aggressive Smoking Cessation Therapy

Post–Acute Coronary Syndrome: The ASAP Trial

Investigator: Dr. Mark J. Eisenberg

The Aggressive Smoking Cessation Therapy

Post–Acute Coronary Syndrome (ASAP) Trial is a 5–year, multi–centre, randomized controlled trial that will assess the efficacy, safety, and tolerability of aggressive smoking cessation therapy initiated in–hospital following ACS. It will recruit 798 adult patients smoking on average at least 10 conventional (tobacco) cigarettes per day who are motivated to quit smoking and have been diagnosed with ACS requiring hospitalization. Patients will be randomized (1:1) to one of two treatment arms: (1) combination therapy of varenicline and nicotine e–cigarettes plus counseling or (2) varenicline plus counseling for 12 weeks, with 52–week follow–up. Smoking cessation post–ACS is essential to reduce morbidity and mortality in this high–risk patient population. ASAP will provide regulators, health care professionals, and smokers with important information about the efficacy of combination varenicline and nicotine e–cigarettes for smoking cessation in patients with ACS

Impactful Clinical Innovation – JGH Pericardial Diseases

The Jewish General Hospital has developed a Pericardial Disease Program, directed by Dr. Vartan Mardigyan, developed organically due the significant increase in complex cases locally and across the province. Now a quaternary program, it has seen tremendous and sustained growth in the volume of patients with refractory pericarditis on Kineret (more than 250 pts treated on Kineret). We see 2–3 new consults per week and approximately 20 to 25 follow–up visits per week facilitated by a full–time specialized pericardial diseases nurse. Patients who are refractory to medical therapy undergo pericardiectomy for constrictive pericarditis with increasing surgeries being performed at our site. The JGH Pericardial Team

led the editorial group of a special edition of the CJC on pericardial diseases, with multiple manuscripts covering these subjects, some written by JGH authors with other important contributors. The JGH participates and helps steer international registries as well with representation on international bodies.

Heart Optimization Pharmacist (HOP) Clinic

The JGH runs an active multifaceted Heart Function Clinic, including a large clinic serving over 700 patients with congestive heart failure, as well as a dedicated cardio–oncology program. The Clinic is directed by Dr. Caroline Michel, with Dr. Richard Sheppard as its Research Director. In 2022, they launched a Heart Optimization Pharmacist Clinic (HOP Clinic) led by Pharmacist Helen Mantzianis, for patients newly diagnosed with congestive heart failure. This program aims to rapidly titrate these patients to maximum tolerated doses of guidelines–recommended therapies, a strategy that was recently demonstrated to be highly effective at reducing adverse outcomes. Patients are seen by the pharmacist early post–discharge and at frequent intervals with an aim to complete the program within 6–8 weeks. The patients are then referred back to their treating cardiologist, who participated as needed during the titration process. The program leverages a Virtual Care platform allowing users to upload vital signs and symptoms, also used in our CHF Clinic, which provides visibility on patient status via a dashboard. We have cared for dozens of patients in the first 6 months of the program and hope to grow it moving forward.

13 Scientists

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Suissa S, Dell’Aniello S, Ernst P. Single–Inhaler Triple versus Dual Bronchodilator Therapy in COPD: Real–World Comparative Effectiveness and Safety. Int J Chron Obstruct Pulmon Dis. 2022 Aug 30;17:1975–1986.

Brunetti VC, Yu OHY, Platt RW, Filion KB The association of long–acting insulin analogue use versus neutral protamine Hagedorn insulin use and the risk of major adverse cardiovascular events among individuals with type 2 diabetes: A population–based cohort study. Diabetes Obes Metab. 2022 Nov;24(11):2169–2181.

Dimakos J, Cui Y, Platt RW, Renoux C, Filion KB, Douros A. Concomitant use of sulfonylureas and warfarin and the risk of severe hypoglycemia: population–based cohort study. Diabetes Care. 2022 Oct; 45(10): e131–e133.

Pradhan R, Lu S, Yin H, Yu OHY, Ernst P, Suissa S, Azoulay L. Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study. BMJ. 2022 Nov; 379:e071380.

Clinical Epidemiology

Abrahami D, McDonald EG, Schnitzer ME, Barkun A, Suissa S, Azoulay L. Proton Pump Inhibitors and Risk of Gastric Cancer: Population–based Cohort Study. Gut. 2022;71(1):16–24.

Exciting Research in the Pipeline

Project Title: Canadian Network for Observational Drug Effect Studies (CNODES)

Investigators: Drs. Robert Platt & Samy Suissa (PI)

Funding: Canadian Agency for Drugs and Technologies in Health (CADTH) – $9,088,000

Date: 2022–2025

CNODES is a pan–Canadian network of over 100 scientists from all Provinces working to ensure the safety and effectiveness of drugs for Canadians, previously funded by CIHR and currently by CADTH. The coordinating centre is located at the Jewish General Hospital’s Lady Davis Institute. CNODES is led by Drs. Robert Platt and Samy Suissa, with collaborating hubs in seven provinces. The studies examine widely used drugs and are carried out in response to queries from government partners, including Health Canada and provincial stakeholders. The results of these studies have important public health implications and have been published in highly ranked peer–reviewed international journals, benefitting not only Canadians, but patients worldwide. The data sources used by CNODES include population databases from seven Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario,

Leadership (from l to r) Dr. Nancy Mayo // MUHC Interim Dr. Samy Suissa // JGH

Sasktachewan, and Quebec) and two international databases (UK CPRD and US MarketScan). CNODES also works in collaboration with the FDA Sentinel Initiative group in rapid–response studies, using a common data model (CDM) for standard analyses, as well as with the European Medicines Agency.

Project Title: Canadian consortium of clinical trial training (CANTRAIN) platform: enhancing career preparedness in RCT research targeting different audiences across the continuum

Investigator: Dr. Kristian Filion (PI)

Funding: CIHR – $11,317,323

Date: 2022–2025

The CANadian Consortium of Clinical Trial TRAINing platform is a pan–Canadian endeavour that is funded by the Canadian Institutes of Health Research whose overarching goals are to enhance national clinical research capability and quality in clinical research education and good clinical practice though accredited training programs and hands–on practice with interactive activities. CANTRAIN integrates 21st century clinical & regulatory affairs experience relative to gender–balanced patients, people with disabilities, their families, policymakers, communicators, communities and real–world operations. The CIHR application included more than 90 applicants from nine different provinces, with the coordinating centre located at the Research Institute of the McGill University Health Centre. CANTRAIN includes four streams: 1) Clinical Research Professionals; 2) Graduate Trainees; 3) Trialists; and 4) Community and Government Partners. The Trialist Stream, which is targeting clinician–scientists, principal investigators, and clinical fellows and residents, is being led by Professor Kristian Filion of the Lady Davis Institute and McGill University. This e–learning platform will be leveraged to develop a Graduate Certificate in Clinical Trials in the School of Population and Global Health at McGill University.

Project Title: Comparative effectiveness and safety of long–acting insulins and neutral protamine Hagedorn (NPH) insulin among patients with type 2 diabetes

Investigator: Dr. Kristian Filion (PI)

Funding: CIHR – $137,700

Date: 2021–2023

As with much of the developed world, Canada is facing a diabetes epidemic. Both long–acting insulins and

Neutral Protamine Hagedorn (NPH) insulin are effective at decreasing HbA1c levels and thus recommended for treatment in patients with type 2 diabetes to attain glycemic control. However, while their glucose–lowing effects have been studied extensively in clinical trials, little high–quality evidence is available regarding their comparative effectiveness and safety in a real–world setting. This CIHR–funded study will compare the rates of major adverse cardiovascular events and of hypoglycemia with long–acting insulins versus NPH insulin among patients with type 2 diabetes, generating the real–world evidence needed to address this knowledge gap. This study will provide regulatory agencies, guideline writing committees, drug plan managers, clinicians, and patients with the information needed to make more informed decisions on the use of different insulins for the treatment of type 2 diabetes. In doing so, it will improve the health of patients with type 2 diabetes in Canada and internationally.

Impactful Clinical Innovation

Emulating a target trial using routinely collected health data and the ‘adaptive treatment strategy’ (ATS).

Dr. Kristian Filion

Arterial hypertension, a leading cause of cardiovascular disease (CVD), is a chronic condition characterized by high blood pressure (BP) and affects 23% of Canadian adults. There is currently an ongoing debate regarding the most appropriate BP target for patients with hypertension, with some recent treatment guidelines now favoring a more aggressive approach to managing hypertension that emphasizes lower target BP levels. The goal of this study is to determine the most effective target BP control plan to prevent major adverse cardiovascular events (MACE) in patients with hypertension at low CVD risk. The researchers are emulating a target trial using routinely collected health data and the so–called ‘adaptive treatment strategy’ (ATS). ATS is a statistical approach that operationalizes the sequential decision–making inherently found in everyday clinical practice. Each ATS includes a list of decision rules on how to modify treatment over time. Using this approach, the team will examine the benefits of different personalized target BP plans, a sequence of treatment change decisions that is predominantly tailored by measured BP. The results of this emulated trial will provide guideline writers, healthcare providers, and patients with much needed insight into optimal target BP plans for hypertensive patients at low CVD risk, improving CVD prevention in this large yet understudied patient population.

Dermatology

7 Clinician–Teachers

4 Clinician–Scientists

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Clinical and psychosocial factors affecting work productivity among patients with hidradenitis suppurativa: A cluster analytical investigation.

Jfri A, Litvinov IV, Netchiporouk E, O’Brien E.J Am Acad Dermatol. 2022 Mar;86(3):675–677. doi: 10.1016/j.jaad.2021.02.066. Epub 2021 Mar 1.

PMID: 33662462 No abstract available.

Geographical distribution of systemic sclerosis in Canada: An ecologic study based on the Canadian Scleroderma Research Group. Muntyanu A, Ouchene L, Zhou S, Hudson M, Rezaeian M, LaChance A, Litvinov IV, Baron M, Netchiporouk E; Canadian Scleroderma Research Group.J Am Acad Dermatol. 2022 Nov;87(5):1095–1097. doi: 10.1016/j.jaad.2021.12.055. Epub 2022 Jan 11.

PMID: 35031410 No abstract available.

Dr. Ivan Litvinov // McGill/MUHC

Dr. Robin Billick // JGH

Population–Based Study Detailing Cutaneous Melanoma Incidence and Mortality Trends in Canada. Conte S, Ghazawi FM, Le M, Nedjar H, Alakel A, Lagacé F, Mukovozov IM, Cyr J, Mourad A, Miller WH Jr, Claveau J, Salopek TG, Netchiporouk E, Gniadecki R, Sasseville D, Rahme E, Litvinov IV.Front Med (Lausanne). 2022 Mar 3;9:830254. doi: 10.3389/fmed.2022.830254.

eCollection 2022.PMID: 35308490

Geographical distribution of systemic sclerosis in Canada: An ecologic study based on the Canadian Scleroderma Research Group. Muntyanu A, Ouchene L, Zhou S, Hudson M, Rezaeian M, LaChance A, Litvinov IV, Baron M, Netchiporouk E; Canadian Scleroderma Research Group.J Am Acad Dermatol. 2022 Nov;87(5):1095–1097. doi: 10.1016/j.jaad.2021.12.055. Epub 2022

Jan 11.PMID: 35031410 No abstract available.

Tools used to assay genomic instability in cancers and cancer meiomitosis. Gantchev J, Ramchatesingh B, Berman–Rosa M, Sikorski D, Raveendra K, Amar L, Xu HH, Villarreal AM, Ordaz DJG, Litvinov IV.J Cell Commun Signal. 2022 Jun;16(2):159–177. doi: 10.1007/s12079–021–00661–z. Epub 2021 Nov 29.

Leadership (from l to r)

Exciting Research in the Pipeline

Project Title: Impact of the Environment on Systemic Sclerosis in Canada

Investigator: Dr. Netchiporouk

Funding: National Scleroderma Foundation (USA) –$200,000 USD

Project Title: Understanding the genomic and cellular landscapes of advanced basal cell carcinoma (BCC)

Investigator: Dr. Lefrançois

Funding: Inaugural Clinician–Scientist Award following Marathon of Hope Cancer Centres Network Competition //

Project Title: Developing Sun Protection and Melanoma Prevention Strategies for Canadian Youth

Investigator: Dr. Litvinov

Funding: CIHR – 100,000$

Impactful Clinical Innovation

Establishment of MUHC specialized centre of excellence for diagnosis and management of atopic dermatitis (www.muhccoead.com)

The centre is directed by Dr. Jack at the MUHC and is accredited by the Global Allergy and Asthma European Network (GA²LEN) Atopic Dermatitis Centers of Reference and Excellence (ADCARE).

22 Clinician–Teachers

12 Scientists

7 Clinician–Scientists

5 Clinician–Investigators

1 Clinician–Educator

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross–sectional analysis of the Canadian Longitudinal Study on Aging. Osteoporos Int. 2022 Dec;33(12):2637–2648.

Burosumab Treatment for Autosomal Recessive Hypophosphatemic Rickets Type 1 (ARHR1). Bai X, Levental M, Karaplis AC. J Clin Endocrinol Metab. 2022 Sep 28;107(10):2777–2783. doi: 10.1210/ clinem/dgac433.

Endocrinology & Metabolism

Leadership (from l to r)

Dr. George Fantus // McGill/MUHC

Dr. Mark Trifiro // JGH

Dr. Les Meissner //SMH

Huffman JE, Butler–Laporte G, Khan A, Pairo–Castineira E, Drivas TG, Peloso GM, Nakanishi T; COVID–19 Host Genetics Initiative, Ganna A, Verma A, Baillie JK, Kiryluk K, Richards JB, Zeberg H. (2022) Multi–ancestry fine mapping implicates OAS1 splicing in risk of severe COVID–19. Nature Genetics [IF: 38.33]. 2022 Feb;54(2):125–127. doi: 10.1038/s41588–021–00996–8. Epub 2022 Jan 13.This paper received lay press coverage from Reuters, CTV and Bell Globe Media, Reuters, CNBC, and MedScape

COVID–19 Host Genetics Initiative (Butler–Laporte G, Nakanishi T,Morrison D, Forgetta V, Ghosh B, Laurent L, Henry D, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Adra D, Richards JB) several hundred authors. (2022) Mapping the human genetic architecture of COVID–19. Nature [IF: 49.962]. Dec;600(7889):472–477. doi: 10.1038/s41586–021–03767–x. Epub 2021 Jul 8.

Butler–Laporte G, Povysil G, Kosmicki JA, Cirulli ET, Drivas T, Furini S, Saad C, Schmidt A, Olszewski P, Korotko U, Quinodoz M, Çelik E, Kundu K, Walter K, Jung J, Stockwell AD, Sloofman LG, Jordan DM, Thompson RC, Del Valle D, Simons N, Cheng E, Sebra R, Schadt EE, Kim–Schulze S, Gnjatic S, Merad M, Buxbaum JD, Beckmann ND, Charney AW, Przychodzen B, Chang T, Pottinger TD, Shang N, Brand F, Fava F, Mari F, Chwialkowska K, Niemira M,

Pula S, Baillie JK, Stuckey A, Salas A, Bello X, Pardo–Seco J, Gómez–Carballa A, Rivero–Calle I, Martinón–Torres F, Ganna A, Karczewski KJ, Veerapen K, Bourgey M, Bourque G, Eveleigh RJ, Forgetta V, Morrison D, Langlais D, Lathrop M, Mooser V, Nakanishi T, Frithiof R, Hultström M, Lipcsey M, Marincevic–Zuniga Y, Nordlund J, Schiabor Barrett KM, Lee W, Bolze A, White S, Riffle S, Tanudjaja F, Sandoval E, Neveux I, Dabe S, Casadei N, Motameny S, Alaamery M, Massadeh S, Aljawini N, Almutairi MS, Arabi YM, Alqahtani SA, Al Harthi FS, Almutairi A, Alqubaishi F, Alotaibi S, Binowayn A, Alsolm EA, El Bardisy H, Fawzy M, Cai F, Soranzo N, Butterworth A; COVID–19 Host Genetics Initiative; DeCOI Host Genetics Group; GEN–COVID

Multicenter Study (Italy); Mount Sinai Clinical Intelligence Center; GEN–COVID consortium (Spain); GenOMICC Consortium; Japan COVID–19 Task Force; Regeneron Genetics Center, Geschwind

DH, Arteaga S, Stephens A, Butte MJ, Boutros PC, Yamaguchi TN, Tao S, Eng S, Sanders T, Tung PJ, Broudy ME, Pan Y, Gonzalez A, Chavan N, Johnson R, Pasaniuc B, Yaspan B, Smieszek S, Rivolta C, Bibert S, Bochud PY, Dabrowski M, Zawadzki P, Sypniewski M, Kaja E, Chariyavilaskul P, Nilaratanakul V, Hirankarn N, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Tokunaga K, Sugiyama M, Kawai Y, Hasegawa T, Naito T, Namkoong H, Edahiro R, Kimura A, Ogawa S, Kanai T, Fukunaga K, Okada Y, Imoto S, Miyano S, Mangul S, Abedalthagafi MS, Zeberg H, Grzymski JJ, Washington NL, Ossowski S, Ludwig KU, Schulte EC, Riess O, Moniuszko M, Kwasniewski M, Mbarek H, Ismail SI, Verma A, Goldstein DB, Kiryluk K, Renieri A, Ferreira MAR, Richards JB.(2022) Exome–wide association study to identify rare variants influencing COVID–19 outcomes: Results from the Host Genetics Initiative. PLoS Genet [IF: 6.02]. 2022 Nov 3;18(11):e1010367. doi: 10.1371/ journal.pgen.1010367. eCollection 2022 Nov. P1–26

Sedki D, Cho A, Cao Y, Nikolajev L, Durgaprasad N, Lubell WD and Laporte SA. Differential cognate G protein coupling regulation at the prostaglandin F2α and angiotensin II type 1 receptors. J. Biol. Chem. 2022 July 21, 298(9):102294.

Islam N, Ayele H, Yu O, Douros A, and Filion K. Sulfonylureas and the Risk of Ventricular Arrhythmias Among People with Type 2 Diabetes: A Systematic Review of Observational Studies. Clin Pharmacol Ther. 2022 Jun;111(6):1248–1257.

Exciting Research in the Pipeline

Project Title: Regulation of Bone Anabolism

Investigator: Dr. David Goltzman

Funding: CIHR – $646,425

Date: 2017–2022

Exploring the interaction of the calcium–sensing receptor and parathyroid hormone in modifying osteoblast activity in bone; implications for therapeutic use of CaSR agonists and antagonists. To investigate whether therapy with Calcium–sensing receptor antagonist can ameliorate osteoporosis and other metabolic bone disease.

Project Titles: Functional and structural understanding of angiotensin II type 1 receptor biased signaling & Dissecting the molecular mechanism for prostaglandin F2 alpha receptor biased signaling.

Investigators: Drs. Stephane Laporte (PI) & Dr. Martin Audet (PI)

Funding: CIHR – $1,189,575 & CIHR – $650,279

These projects involve understanding how drugs convey information through receptors with the goal of developing better tocolytics (prostaglandin F2 alpha receptor) and allosteric biased ligands for the angiotensin II type 1 receptor for improved therapeutics in cardiovascular diseases.

Project Titles: Physiologic– and pathophysiologic–responsive brainstem neurons controlling appetite, Defining the role of Leptin receptors on glutamatergic DMH neurons & Defining the roles for GDF–15 action within the NTS in regulating feeding and body weight.

Investigator: Dr. Paul Sabatini (PI)

Funding: CIHR – $891,225, NSERC – $197,500, & Pfizer Cachexia ASPIRE – $250,000 USD

Dates: 2022–2027, 2022–2027 & 2022–2024

These grants are designed to determine the role and specific neuronal pathways by which satiety factors regulate appetite and weight in the CNS.

Project Title: Sodium Glucose Co–transporter–2

Inhibitor and Dementia Risk

Investigator: Dr. Oriana Yu (PA)

Funding: CIHR – $120,000

Dates: 2022 –2024

To investigate whether therapy with SGLT2i can mitigate the increased risk of dementia in diabetes similar to what has been seen in renal disease and heart failure.

Project Title: USP19 in metabolism – mechanisms and translation & Effectiveness of USP19 inhibitor in rodents.

Investigator: Dr. Simon Wing (PI)

Funding: CIHR – $761,175 & Almac Discovery –$10,503

Dates: 2020–2025 & 2022–2022

To determine in pre–clinical studies whether inhibiting the enzyme USP19 will prevent or treat Parkinson’s disease.

Impactful Clinical Innovation

Determining risk of fracture using bone architecture measures.

Vandenput L, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff–Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson–Hughes B, Diez–Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish–Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P,

O’Neill TW, Obermayer–Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay –Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int. 2022 Oct;33(10):2103–2136. doi: 10.1007/s00198–022–06435–6. Epub 2022 May 31. PMID: 35639106.

Dynamic Spatiotemporal Determinants Modulate GPCR:G protein Coupling Selectivity and Promiscuity.

Sandhu M, Cho A, Ma N, Mukhaleva E, Lee S, GhoshS, Lee JH, Gloriam DE, Laporte SA, Babu MM, Vaidehi N. Dynamic Spatiotemporal Determinants Modulate GPCR:G protein Coupling Selectivity and Promiscuity. Nat. Commun. (2022) Dec 2;13(1):7428.

The Rab GTPase activating protein TBC–2 regulates endosomal localization of DAF–16 FOXO and lifespan.

Meraş, İ.*, Chotard, L.*, Liontis, T., Ratemi, Z.*, Wiles, B., Seo, J.H., Van Raamsdonk, J.M. and Rocheleau, C.E. (2022) The Rab GTPase activating protein TBC–2 regulates endosomal localization of DAF–16 FOXO and lifespan. PLoS Genetics, 18(8): e1010328.

doi.org/10.1371/journal.pgen.1010328

FOXO transcription factors have been shown to modulate lifespan in multiple model organisms and to be associated with longevity in humans. Here the researchers describe a new localization for FOXO to endosomes. They demonstrate the importance of endosomal trafficking for proper localization of FOXO and suggest that the endosome is an important site of FOXO regulation. An intriguing possibility based on our results is that storage of FOXO on endosomes facilitates the mobilization of FOXO as a rapid response to environmental stress.

21 Clinician–Teachers

6 Clinician–Investigators

2 Scientists

1 Clinician–Educator

1 Clinician–Scientist

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Barkun AN, Douketis J, Noseworthy PA, Laine L, Telford JJ, Abraham NS.. Am J Gastroenterol. 2022 Apr 1;117(4):513–519. Management of Patients on Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Peri–Endoscopic Period: A Clinical Practice Guideline Dissemination Tool.

Wetwittayakhlang P, Gonczi L, Lakatos L, Kurti Z, Golovics P, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Long–term Colectomy rates of Ulcerative Colitis over 40–year of Different Therapeutic eras – Results from Western Hungarian Population–based Inception Cohort between 1977–2020.

J Crohns Colitis. 2022 Dec 20:

Gastroenterology & Hepatology

Leadership (from l to r)

Dr. Alain Bitton // McGill/MUHC

Dr. Albert Cohen // JGH

Dr. Gaetano Morelli // SMH

Sebastiani G, Milic J, Gioe C, Al Hinai AS, Cervo A, Lebouche B, Deschenes M, Cascio A, Mazzola G, Guaraldi G Diagnosis of liver fibrosis in aging patients with HIV at risk for non–alcoholic fatty liver disease in Italy and Canada: assessment of a two–tier pathway..Lancet HIV. 2022 Mar;9 Suppl 1:S4 Bessissow T, Kron CM, Marcus V, Lemieux C, Laneuville J, Afif W, Wild G, Lakatos PL, Brassard P, Bitton A. Impact of Endoscopic and Histologic Activity on Disease Relapse in Ulcerative Colitis. Am J Gastroenterol. 2022 Oct 1;117(10):1632–1638.

Chen YI, Chatterjee A, Berger R, Kanber Y, Wyse J, Lam E, Gan I, Auger M, Kenshil S, Telford J, Donnellan F, Quinlan J, Lutzak G, Alshamsi F, Parent J, Waschke K, Alghamdi A, Barkun J, Metrakos P, Chaudhury P, Martel M, Dorreen A Candido K, Miller C, Adam V, Barkun A, Zogopoulos G, Wong C. Endoscopic ultrasound (EUS)–guided fine needle biopsy alone vs. EUS–guided fine needle aspiration with rapid onsite evaluation in pancreatic lesions: a multicenter randomized trial. Endoscopy. 2022 Jan;54(1):4–12.

Exciting Research in the Pipeline

Project Title: Development and validation of a novel endoscopic device for EUS–guided gastroenterostomy

Investigator: Dr. Yen I Chen (PI)

Funding: Axelys – $626,325

Date: 2022–2024

The Axelys grant was awarded for the development of a novel prioprietary assist device for endoscopic bypass. The goal is to bring to market a device that can lead to widespread adoption of endoscopic bypass for malignant gastric outlet obstruction. This would greatly improve the outcome of patients with pancreatic, periampullary, and gastric cancer. The grant will help with the last phase of development and future clinical studies.

Project Title: Comparative Effectiveness and Safety of Biologic Medications (Biosimilar and Innovator Drugs)

Investigator: Dr. Waqqas Afif

Funding: CIHR – $ 1,769,650

Date: 2017–2023

Increased use of biologic medications has led to significant increases in direct health care expenditures. Biosimilar drugs are discounted by up to 40% and could lead to significant health care cost savings, but Canadian uptake of biosimilars has been minimal, given concerns regarding their efficacy and safety. This is an ongoing, CIHR–funded, multi–centre Canadian prospective comparative effectiveness cohort study, in patients with autoimmune disease, comparing the efficacy and safety of biosimilar medications. Demonstrating non–inferiority of biosimilars in IBD in a Canadian cohort will allay fears of using these less costly medications.

Project Title: Impact of Multimodal Prehabilitation Program on High Cardiovascular Risk Patients

Undergoing Noncardiac Surgery – Feasibility

Investigator: Dr. Amine Benmassaoud

Funding: CIHR – $130,050

Date: 2021–2023

The period before surgery is a valuable time to optimize patients at high risk of cardiovascular events by improving functional capacity, nutritional status, emotional stress and management of medical conditions. This research team is conducting a feasibility trial to determine whether a 4–week Multimodal Prehabilitation Program, composed of individualized exercise training, nutrition therapy, and mitigation of anxiety and depression symptoms is feasible and safe in this unique population. They then hope to investigate if this program can reduce postoperative cardiovascular complications in patients at high cardiovascular risk awaiting major elective noncardiac surgery. This ongoing trial is based at the Prehabilitation Clinic of the Montreal General Hospital.

Impactful Clinical Innovation

Liver Transition Care Service

Dr. Tianyan Chen

Through collaborative work with pediatric colleagues at the Montreal Children’s Hospital, this team created a Liver Transition Care service, bringing together adult hepatologists, pediatric gastroenterologists, clinical nurse practitioners, clinical psychologists and nutritionists. This care model is meant to facilitate the transition of whole–person care for adolescents and young adults who suffer from chronic liver conditions. The unique feature of this model is that both the adult and pediatric teams meet with patients and families together during the care transition visits. This is a one–of–a–kind structure in Quebec, facilitated by the joint location of pediatric and adult hospitals at the Glen site. The Liver Transition Care is featured on the MUHC Transition Care platform. The team has established a dedicated referral pathway and service email support for referring MDs, patients, and families, for within MUHC and outside MUHC cases. Since launching in early 2022, the service has 56 patients as of March 2023. The team is in the process of setting up peer–support program for these young adults with complex liver conditions.

41 Clinician–Teachers

10 Clinician–Scientists

4 Clinician–Investigators

3 Clinician–Educators

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Berillo O, Huo K–G, Richer C, Fraulob–Aquino JC, Briet M, Lipman M, Sinnett D, Paradis P, Schiffrin EL. Distinct transcriptomic profile of small arteries of hypertensive patients with chronic kidney disease allows identifying miR–338–3p that targets GPX3 and PTPRS. J Hypertens. 2022;40:1394–1405. DOI:10.1097/HJH.0000000000003160. PMID 35703228.

Schwartz BC, Jayaraman D, Yang SS, Wong EG, Lipes J, Dial S. High–flow nasal oxygen as first–line therapy for COVID–19–associated hypoxemic respiratory failure: a single–centre historical cohort study. Can J Anaesth. 2022 May;69(5):582–590.

General Internal Medicine

Leadership (from l to r)

Dr. Vicky Tagalakis // McGill

Dr. Suzanne Morin // MUHC

Dr. Rubin Becker // JGH

Dr. Gail Goldman // SMH

McDonald EG, Wu PE, Rashidi B, Wilson MG, Bortolussi–Courval É, Atique A, Battu K, Bonnici A, Elsayed S, Wilson AG, Papillon–Ferland L, Pilote L, Porter S, Murphy J, Ross SB, Shiu J, Tamblyn R, Whitty R, Xu J, Fabreau G, Haddad T, Palepu A, Khan N, McAlister FA, Downar J, Huang AR, MacMillan TE, Cavalcanti RB, Lee TC. The MedSafer Study–Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med. 2022 Mar 1;182(3):265–273. doi: 10.1001/ jamainternmed.2021.7429.

Malhamé I, Dong S., Ashraf R., Syeda A., Zipursky J., Horn D., Daskalopoulou SS, D’Souza R. The use of loop diuretics for hypertensive disorders in pregnancy and the early postpartum period: a systematic review and meta–analysis. J Hypertens. 2023 Jan 1;41(1):17–26. doi: 10.1097/ HJH.0000000000003310. Epub 2022 Nov 2. PMID: 36453652.

Popov J, Coelho S, Carrier M, Sperlich C, Solymoss S, Routhier N, Shivakumar S, Aibibula W, Kahn SR, Tagalakis V. Step down to 6 months of prophylactic–dose low molecular weight heparin after initial full–dose anticoagulation for the treatment of cancer–associated thrombosis (STEP–CAT): A pilot study. J Thromb Haemost. 2022 Aug;20(8):1868–1874. doi:10.1111/jth.15760. Epub 2022 Jun 9.

Exciting Research in the Pipeline

Project Title: The “predicting Short–term Adverse cardiovasculaR outcomes in preeclampsiA using BIomarkers” (SARABI) Pilot Study

Investigators: Drs. Isabelle Malhanme (PI), Stella S. Daskalopoulou (co–PI), Vicky Tagalakis & Natalie Dayan

Funding: CIHR – $401,626

Date: 2022–2025

Project Title: Canadian ADAptive Platform Trial of COVID–19 Therapeutics in Community Settings (Can–ADAPT COVID) Studies

Investigator: Dr. Emily McDonald (CO–PI)

Funding: CIHR – $10,000,000

Date: 2022–2023

Project Title: Bone and Muscle Health Following Sleeve Gastrectomy in Men, Premenopausal and Postmenopausal Women

Investigator: Dr. Suzanne N Morin (CO–PI)

Funding: CIHR – $875,925

Date: 2022–2027

Impactful Clinical Innovation

Anticoagulation Stewardship Program – Centre of Excellence in Thrombosis and Anticoagulation (CETAC), Jewish General Hospital

Dr. Maral Koolian is part of a team that heads the newly established Jewish General Hospital (JGH) Anticoagulation Stewardship Program (ASP), a novel and innovative quality improvement program that aims to optimize therapeutic dose anticoagulant prescriptions in hospitalized patients. The multidisciplinary team consists of members of the JGH’s Centre of Excellence in Thrombosis and Anticoagulation and includes a complementary team of pharmacists and specialized nurses.

Initially, within the first six months post–implementation, the ASP team reviewed 447 prescriptions on select inpatient units of which 301 (67%) required a change. Out of those 301 prescriptions, 247 (82%) were adjusted based on a suggestion by the ASP team to the prescribing physician leading to optimization of individual patients’ anticoagulation. Since then, the ASP has expanded to include all JGH inpatient units as well as prophylactic and therapeutic dose anticoagulant prescriptions. Rehabilitation and long–term care centres within the CIUSSS du Centre–Ouest–de–l’Ile–de–Montréal have also been included in the day–to–day review of therapeutic anticoagulation in collaboration with the JGH ASP team. Next steps will be to involve community pharmacists and primary care clinics. The JGH ASP continues to gain traction and exposure both within the JGH as well as outside the institution. Results from the initial implementation period have been disseminated across various channels including peer–reviewed journals as well as on a national podcast. As a result, the ASP team receives regular inquiries to help guide the development of their own stewardship programs, be it different divisions and departments within McGill, community physicians and pharmacists, or different university health networks outside the province.

13 Clinician–Teachers

3

Clinician–Scientists

1 Scientist

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Tessier AJ, Wing S, Rahme E, Morais JA, Chevalier S. Association of Low Muscle Mass With Cognitive Function During a 3–Year Follow–up Among Adults Aged 65 to 86 Years in the Canadian Longitudinal Study on Aging. JAMA Netw Open. 2022;5(7):e2219926. doi:10.1001/ jamanetworkopen.2022.19926

Inceer M, Brouillette MJ, Fellows LK, Morais JA, Harris M, Smaill F, Smith G, Thomas R, Mayo NE. Factors partitioning physical frailty in people aging with HIV: A classification and regression tree approach. HIV Med. 2022 Feb 1. doi: 10.1111/hiv.13236

Hartono FA, Martin–Arrowsmith PW, Peeters WM, Churchward–Venne TA. The Effects of Dietary Protein Supplementation on Acute Changes in Muscle Protein Synthesis and Longer–Term Changes in Muscle Mass, Strength, and Aerobic Capacity in Response to Concurrent Resistance and

Geriatric Medicine

Leadership (from l to r)

Dr. José Morais // McGill/MUHC/JGH

Dr. Shek Hong Fung // SMH

Endurance Exercise in Healthy Adults: A Systematic Review. Sports Med. 2022 Jun;52(6):1295–1328. doi: 10.1007/s40279–021–01620–9.

Leite HT, Manhães AC, Antunes LA, Chan T, Boutros GH, Morais JA. The implementation of a geriatrics co–management of care reduces hospital length of stay. Healthcare (Basel). 2022 Oct 29;10(11):2160. doi: 10.3390/healthcare10112160

Couture S, Lepage MA, Godard–Sebillotte C, Sourial N, Talbot–Hamon C, Kremer R, Grunbaum A. Geriatric Syndromes in Older Adults Hospitalized with COVID–19 in Montreal, Canada. Can Geriatr J. 2022 Sep 2;25(3):269–278. doi: 10.5770/ cgj.25.579.

Exciting Research in the Pipeline

Project Title: Diabetes Mechanisms and Translational Solutions. Novel regulators of autophagy in musculoskeletal system that affect metabolism.

Investigators: Drs. Woo M. (PI), Cheung A (CO–PI), Gouspillou G (CO–PI), Grol M (CO–PI), Kapoor M. (CO–PI), Hussain S (CO–APP), Morais JA (CO–APP), Tsoukas M (CO–APP) & Rockel J (CO–APP)

Funding: CIHR – $2,000,000

Date: 2022–2025

Project Title: Laboratoire vivant sur les transitions (Transilab Laval–ROSA) pour les personnes vivant avec un trouble neurocognitif majeur.

Investigators: Drs. Isabelle Vedel (PI), Yves Couturier (PI), Annie Fortier (PI), Micheline Laverdure (PI), Howard Bergman (CO–I), Marie–Thérèse Lussier (CO–I), Marie–Ève Poitras (CO–I) & Amélie Quesnel–Vallee (CO–I)

Funding: Living labs TNCM – $750,000

Date: 2022–2025

Project Title: A novel multimodal intervention for surgical prehabilitation of patients with lung cancer

Investigators: Drs. Chavalier S. (PI), Carli F (CO–I), Mazurak V (CO–I), Morais JA (CO–I), Scheede–Bergdahl C. (CO–I)

Funding: CIHR – $612,000

Date: 2020–2024

Impactful Clinical Innovation

SAFE Website

Developed by the Geriatric Division of Medicine at the McGill University Health Centre, SAFE is a comprehensive website intended to improve seniors’ overall quality of life and help to prevent falls. It is a user–friendly tool that offers aging adults with mobility issues and their caregivers a viable option for integrating a home exercise program into their daily lives, as well as providing them with information and timely resources regarding their health and well–being. Made up of a series of low–impact exercise videos, this FREE program is divided into four levels with five categories each: warm–up, strength, balance, flexibility and endurance. Based on years of research and primary patient care, SAFE focuses on the physical and psychological benefits of exercise on seniors. Visit safe–seniors.com for more info.

17 Clinician–Teachers

5 Clinician–Investigators

4 Clinician–Scientists

3 Scientists

2 Clinician–Educators

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Henderson Berg MH, Davison K, Popradi G

Real–world effectiveness of brentuximab vedotin in the treatment of CD30–positive cutaneous T–cell lymphoma: a single–centre retrospective review. Br J Dermatol. 2022 Feb;186(2):379–381. doi: 10.1111/bjd.20786. Epub 2021 Nov 15. PMID: 34608632. (IF 11.11)

Mercier FE, Shi J, Sykes DB, Oki T, Jankovic M, Man CH, Kfoury YS, Miller E, He S, Zhu A, Vasic R, Doench J, Orthwein A, Michor F, Scadden DT. In vivo genome–wide CRISPR screening in murine acute myeloid leukemia uncovers microenvironmental dependencies. Blood Adv. 2022

Hematology

Leadership (from l to r)

Dr. Hans Knecht // McGill/JGH

Dr. Chantal Seguin // MUHC

Dr. Adrian Langleben // SMH

Sep 13;6(17):5072–5084. doi: 10.1182/bloodadvances.2022007250. PMID: 35793392; PMCID: PMC9631646. (IF 7.64)

Assouline S, Wiesinger A, Spooner C, Jovanovic J, Schlueter M. Validity of event–free survival as a surrogate endpoint in haematological malignancy: Review of the literature and health technology assessments. Crit Rev Oncol Hematol. 2022 Jul;175:103711. doi: 10.1016/j.critrevonc.2022.103711. Epub 2022 May 16. PMID: 35588937. (IF 6.63)

Valantin MA, Royston L, Hentzien M, Jary A, Makinson A, Veyri M, Ronot–Bregigeon S, Isnard S, Palich R, Routy JP. Therapeutic Perspectives in the Systemic Treatment of Kaposi’s Sarcoma. Cancers (Basel). 2022 Jan 18;14(3):484. doi: 10.3390/cancers14030484. PMID: 35158752; PMCID: PMC8833559. (6.56)

Tanguay M, Séguin C. Recurrent thrombosis rescued by fondaparinux in high–risk patients: A case series. Res Pract Thromb Haemost. 2022 Jul 29;6(5):e12773. doi: 10.1002/rth2.12773. PMID: 35919877; PMCID: PMC9336207. (IF 5.95)

There are many publications with more than 10 co–authors in top–rated journals where a Division member is co–author. These co–authorships occur in the context of clinical studies as leading site–investigators. However, the mirror of the Division’s own research activity is best represented by senior authorships of original research studies or invited reviews.

Exciting Research in the Pipeline

Project Title: Diabetes Mechanisms and Translational Solutions. Novel regulators of autophagy in musculoskeletal system that affect metabolism.

Investigator: Dr. Nathalie Johnson (PI)

Funding: CQDM – $233,520, Roche Pharma –$150,000, Incyte – $50,000, Gilead – $50,000 & the JGH Foundation – $200,000

Date: 2022–2025

This grant offers the possibility to discover relapsing DLBCL very early at the molecular level prior to clinical relapse, to get additional information of the patients’ T–cells, and by that to improve substantially the survival of patients with aggressive DLBCL.

The challenge: Diffuse large B cell lymphoma (DLBCL) is the most common lymphoma and is curable with chemotherapy in about 60% of patients. Relapsed DLBCL (rDLBCL) is frequently lethal because of resistance to further chemotherapy. Chimeric antigen receptor (CAR) T cell therapy is effective in ~40% of these patients. These are “custom” immunotherapies where the patient’s normal T cells are engineered in specialized laboratories to attack a protein on the surface of lymphoma cells. The reasons underlying the success or failure of this laborious and expensive process are incompletely understood but a high disease burden is associated with poor outcomes.

Hypothesis/Aims: Early identification of patients who are not cured with chemotherapy may improve the efficacy of immunotherapies by treating patients in a minimal residual disease (MRD) state. The researchers will monitor the response to chemotherapy using tumour markers in patients’ blood, called circulating tumor DNA (ctDNA) to identify residual or emergent rDLBCL. Additional features of T cells circulating in the blood or found within the lymphoma will complement the use and future improvements of CAR T cell therapy.

Impact: This research will result in a state–of–the–art test, to detect residual rDLBCL before clinical relapse. It will also discover markers that predict success or failure of CAR T cells as well as offering new ideas to improve the quality, yield and efficacy of CAR T cells, translating to improved survival of DLBCL patients. Québec benefits by having,

1) a decreased use of hospital resources, 2) a better return on the investment for expensive CAR T cell therapy, 3) economic growth by stimulating research, development and production by companies involved in ctDNA testing, profiling of immune cells and manufacturing of CAR T cells.

Project Title: Molecular Tools that Block Maturation of the Nuclear Lamin A, Leading to Decrease in Proliferation and Metastasis of Pancreatic Ductal Adenocarcinoma and Colorectal Cancer.

Investigator: Dr. Michael Sebag (CO–PI)

Funding: CIHR – $1,070,800

Date: 2022–2027

Lamins are type V intermediate filament proteins, associated physically with the inner nuclear membrane, tether heterochromatin in the periphery, and exert important scaffolding functions within the nucleus. In human cells two types of lamin have been identified: B–type lamins, encoded by the LMNB1 gene for lamin B1and the LMNB2 gene for lamin B2, and A–type lamins, encoded by the LMNA gene, the alternative splicing of which produces lamin A and lamin C.

Lamin A contributes to the structure of nuclei in all mammalian cells and plays an important role in cell division. Mature lamin A is derived from a farnesylated precursor protein, known as prelamin A, which undergoes two proteolytic cleavage steps catalyzed by the zinc metalloprotease STE24 (ZPMSTE24). Accumulation of prelamin A in the nuclear envelope compromises cell division, increases cell “stiffness” and induces an increased expression of inflammatory gene products. These biochemical changes are characteristic of cellular senescence and lead to significant reduction of tumorigenicity in animal models. Consequently, ZMPSTE24 has been proposed as a potential therapeutic target in oncology. Recently, the researchers demonstrated that siRNA knockdown of ZMPSTE24 in pancreatic ductal adenocarcinoma (PDAC), colorectal cancer (CRC) and prostate cancer cells leads to decrease in cell proliferation. Additionally, they identified hit /lead compounds that block cell migration in several PDAC and CRC cells, a biological requirement for cancer

metastasis. The results are consistent with previous reports demonstrating that genetically engineered Zmpste24–deficient mosaicmice exhibit significant resistance to cancer invasion.

Currently, the researchers are pursuing six key goals in parallel:

1. They are developing efficient synthetic methodologies for the preparation of large combinatorial libraries of ZMPSTE24 inhibitors. They aim to synthesize ~200 compounds/year, with a goal of preparing a total of >1,000 final compounds over a five year period.

2. They are optimizing novel in vitro inhibition assays to more efficiently screen their compounds in order to establish a Structure–Activity Relationship (SAR) model.

3. Currently, there is limited structural information on ZMPSTE24 that can guide drug discovery efforts. The researchers wish to investigate the binding interactions of their inhibitors with ZMPSTE24 at the molecular level by X–ray crystallography.

4. In their preliminary biological screen, they are evaluating the ability of their compounds to block lamin A maturation in PDAC (e.g. HPAF II, KP4 and SW1990) and CRC (HCT–116) cancer cells using Western Blot analysis.

5. They are also evaluating the ability of their compounds to inhibit cell proliferation in an MTS assay using a panel of cancer cell lines, and will expand evaluation tools to include other assays such as Alamar Blue and Flow Cytometry assays.

6. They are also investigating the ability of their compounds to block cell transmigration in order to gain some insight on their potential to inhibit cancer metastasis.

In summary, further identification and characterization of the zinc metalloprotease STE24 (ZPMSTE24) inhibitors offers new ways to block proliferation and metastasis in aggressive adenocarcinoma.

Project Title: Understanding the interactions between blood stem cells and their bone marrow microenvironment for therapeutic potential.

Investigator: Dr. François Mercier (PI)

Funding: Richard & Edith Strauss Foundation –$200,000

Date: 2022–2024

The goal of this research program is to better understand how the interplay between HSCs and their supportive environment within the bone marrow is altered in the context of diseases, and how these alterations of the microenvironment can contribute to problems in blood production. A growing body of evidence suggests that chronic inflammation of the bone marrow environment, which can be triggered by infections or injuries to other organs, impairs the regenerative potential of HSCs and promotes the development of blood cancers. Several mechanisms have been proposed to explain the contribution of inflammation to disorders of the blood system, such as: accelerated proliferation of HSCs leading to DNA damage, metabolic changes leading to oxidative stress, epigenetic changes, and increased fitness of mutated HSCs in inflammatory conditions. Overall, chronic inflammation of the bone marrow may trigger premature aging of the blood system, a concept termed “inflamm–aging”, and a better understanding of the factors at play may inform the development of better preventative strategies.

Thanks to the support generously provided by the Richard & Edith Strauss Foundation, the Mercier research group is actively investigating two regulatory pathways within HSCs and their differentiated progenitors. As outlined in last’s year proposal, single–cell RNA sequencing of AML samples collected in Dr. Mercier’s clinic identified the RNA–binding protein ZFP36L2 as a regulator of stemness in blood cells. Overall, it is hypothesized that ZFP36L2 is post–translationally modified in response to extracellular cues, leading to altered stability of mRNAs that contribute to hematopoietic differentiation. In accordance with this hypothesis, the C–terminal domain of the protein was found to be essential for its activity in blood cancer cell lines. Understanding the regulatory role of ZFP36L2 in HSCs and malignant cells could lead

to the development of treatments that modulate this pathway. In particular, inhibition of the pathway appears to have an anti–leukemic role, and there may be a therapeutic window to explore.

Additionally, this funding supports the investigation of the effect of interleukin–17 signaling (IL–17) on hematopoietic cells, which was initiated thanks to initial funding from the Foundation. Ongoing analysis appears to indicate that altered IL–17 signaling is a feature of aging in the hematopoietic system. IL–17 is a pro–inflammatory cytokine that is elevated in several diseases (i.e. auto–immune, infections, cancer) where low blood cell counts are often observed. Understanding how IL–17 acts on the hematopoietic system could lead to better treatments to prevent alterations of blood production that arise in the context of disease–related inflammation.

Impactful Clinical Innovation

State of the Art Laboratory Hemostasis Testing for the CIUSSS du Centre–Ouest–de–l’Île–de–Montréal

Over the recent years the Hemostasis Unit at the Jewish General Hospital has excelled in teaching, research and clinical innovation.This state–of–the–art Hemostasis/Hematology laboratory is largely the merit of Dr. Mark Blostein.

First, with regards to teaching, Dr. Blostein has taught hemostasis as part of the required rotation during the Royal College of Physicians and Surgeons training program in Hematology training. For the past 20 years, he has taught hemostasis to the current generation of Hematologists trained at McGill. Second, with regards to research, Dr. Blostein has been a local site investigator in landmark clinical trials in hemostasis. Current trials include the testing of antidotes for the new oral anticoagulants and a large clinical trial examining a new type of anticoagulant called factor XIa inhibitors. Third, with regards to clinical innovation, the clinical hemostasis laboratory at the Jewish General Hospital has spearheaded many new changes in hemostasis testing at the CIUSSS du Centre–Ouest–de–l’Île–de–Montréal. These include updating clinical tests for one of the most common bleeding disorders, von Willebrand’s disease, by introducing state of the art testing for this disorder. In addition, Dr. Blostein has led the initiative to standardize antiphopholipid antibody testing across the CIUSSS and the JGH has become the referral centre for testing for Heparin–Induced thrombocytopenia. Finally, the Anticoagulation Clinic continues to be active, both clinically and academically, and is a major clinical service in the CETAC (Centre of Excellence for Thrombosis and Anticoagulation).

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, Palich R, Nori A, Reeves I, Habibi MS, Apea V, Boesecke C, Greenaway C, Vandekerckhove L, Yakubovsky M, Sendagorta E, Blanco JL, Florence E, Moschese D, Maltez FM, Goorhuis A, Pourcher V, Migaud P, Noe S, Pintado C, Maggi F, Hansen AE, Hoffmann C, Lezama JI, Mussini C, Cattelan A, Makofane K, Tan D, Nozza S, Nemeth J, Klein MB, Orkin CM; SHARE–net Clinical Group. Monkeypox Virus Infection in Humans across 16 Countries – April–June 2022. N Engl J Med. 2022 Aug 25;387(8):679–691.

Leadership (from l to r)

Dr. Marcel Behr // McGill/MUHC

Dr. Karl Weiss //JGH

Dr. Joe Dylewski // SMH

McDonald EG, Wu PE, Rashidi B, Wilson MG, Bortolussi–Courval É, Atique A, Battu K, Bonnici A, Elsayed S, Wilson AG, Papillon–Ferland L, Pilote L, Porter S, Murphy J, Ross SB, Shiu J, Tamblyn R, Whitty R, Xu J, Fabreau G, Haddad T, Palepu A, Khan N, McAlister FA, Downar J, Huang AR, MacMillan TE, Cavalcanti RB, Lee TC. The MedSafer Study–Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med. 2022 Mar 1;182(3):265–273.

Kronfli N, Dussault C, Maheu–Giroux M, Halavrezos A, Chalifoux S, Sherman J, Park H, Del Balso L, Cheng MP, Poulin S, Cox J. Seroprevalence and Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Among Incarcerated Adult Men in Quebec, Canada, 2021. Clin Infect Dis. 2022 Aug 24;75(1):e165–e173. doi: 10.1093/cid/ciac031.

Hager KJ, Pérez Marc G, Gobeil P, Diaz RS, Heizer G, Llapur C, Makarkov AI, Vasconcellos E, Pillet S, Riera F, Saxena P, Geller WolffP, Bhutada K, Wallace G, Aazami H, Jones CE, Polack FP, Ferrara L, Atkins J, Boulay I, Dhaliwall J, Charland N, Couture MMJ, Jiang–Wright J, Landry N, Lapointe S, Lorin A, Mahmood A, Moulton LH, Pahmer E, Parent J, Séguin A, Tran L, Breuer T, Ceregido MA, Koutsoukos M, Roman F, Namba J, D’Aoust MA, Trepanier S,

Kimura Y, Ward BJ; CoVLP Study Team. Efficacy and Safety of a Recombinant Plant–Based Adjuvanted Covid–19 Vaccine. N Engl J Med. 2022 Jun 2;386(22):2084–2096.

Monette A, Niu M, Nijhoff Asser M, Gorelick RJ, Mouland AJ. Scaffolding viral protein NC nucleates phase separation of the HIV–1 biomolecular condensate. Cell Rep. 2022 Aug 23; 40(8):111251. doi: 10.1016/j.celrep.2022.111251.

Exciting Research in the Pipeline

Project Title: Expanding the Staphyloccocus aureus network adaptive platform (SNAP^2).

Investigators: Drs. Todd Lee, Matthew Cheng, Alexander Lawandi, Emily McDonald, & others.

Funding: $1,999,785

Impactful Clinical Innovation Long COVID clinic at the JGH

The JGH started a Long COVID clinic at the JGH in September 2022. It is a multi–disciplinary clinic with other medical specialists (respirology, cardiology, rheumatology, neurology) and other health professionals support (occupational health, physiotherapy, social worker). So far more than 300 patients have been evaluated.

Medical Biochemistry

1

Leadership (from l to r)

Dr. David Blank // MUHC

Dr. Elizabeth MacNamara // JGH

1

1

5 Notable 2022 Publications (Division or DOM primary member’s name in bold type)

Couture S, Lepage MA, Godard–Sebillotte C, Sourial N, Talbot–Hamon C, Kremer R, Grunbaum A Geriatric Syndromes in Older Adults Hospitalized with COVID–19 in Montreal, Canada. Can Geriatr

J. 2022 Sep 2;25(3):269–278. doi: 10.5770/ cgj.25.579. PMID: 36117745; PMCID: PMC9427183.

Grunbaum A, Kremer R. Parathyroid hormone–related protein (PTHrP) and malignancy.

Vitam Horm. 2022;120:133–177. doi: 10.1016/ bs.vh.2022.03.002. Epub 2022 Jul 25. PMID: 35953108.

Martine Paquette, Sophie Bernard, Guillaume Paré, Alexis Baass. Dysbetalipoproteinemia: Differentiating Multifactorial Remnant Cholesterol Disease From Genetic ApoE Deficiency. The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 2, February 2022, Pages 538–548, doi.org/10.1210/clinem/dgab648

Martine Paquette Robert A. Hegele, Alain Carrié, Sophie Bernard, Bertrand Cariou, Jacques Genest, Mark Trinder, Sophie Béliard, Alexis Baass. Effect of the LDL receptor mutation type on incident major adverse cardiovascular events in familial hypercholesterolaemia. European Journal of Preventive Cardiology (2022) 29, 2125–2131 doi.org/10.1093/eurjpc/zwac188

Quispialaya KM, Therriault J, Aliaga A, Zimmermann M. Fernandes–Arias J, Lussier F, Massarweh G, Pascoal P, Soucy J–P, Gauthier S, Bertrand J–C, Gilfix B, Vitali P, Rosa–Neto P. Discordance, concordance and added value between cerebrospinal and FDG–PET biomarkers in assessing atypical and early onset AD dementia cases. Neurology 2022 Nov 29;99(22):e2428–e2436. doi: 10.1212/WNL.0000000000201198. PMID: 36266044.

Exciting Research in the Pipeline

Project Title: Co–targeting parathyroid hormone–related protein (PTHrP) and osteoclast activation to counter breast cancer metastasis to bone.

Investigator: Dr. Richard Kremer

Funding: CIHR – $952,425

Date: 2022–2027

Bone metastases occur in ~70% of patients with advanced breast cancer. Most patients die because of metastatic invasion to sites such as the skeleton, brain, liver etc., not from the primary breast tumour. Once breast cancer–derived metastases are established, the condition is generally considered incurable. The skeleton is the main target for breast cancer–derived metastasis, and bone is speculated to be a crucial “reservoir” for cancer expansion to further sites. Current treatments (bisphosphonates and Denosumab) have limited efficacy and aren’t curative: they only target the bone. The parathyroid hormone–related protein (PTHrP) is a signalling molecule associated with many tumour types. PTHrP is also a crucial driver of skeletal metastasis. However, there are no treatments currently targeting PTHrP. We hypothesize that targeting both the bone and PTHrP may be curative. The researchers will further investigate PTHrP’s role using the latest RNA sequencing technology to determine the cellular mechanisms tied to PTHrP’s actions at all stages of metastasis. They will evaluate two new therapeutic approaches (anti–PTHrP monoclonal antibodies combined with bisphosphonates) to counter PTHrP’s driving action in metastatic expansion. The team will use rapid, low intrusiveness diagnostics (liquid biopsies) to validate the therapeutic efficacy of anti–PTHrP monoclonal antibodies on circulating tumour cells from patients with advanced triple–negative breast cancer (a notoriously hard–to–treat condition). The researchers aim to address the urgent need to improve cancer detection technologies and therapies that address cancer spread and bone metastasis. Earlier intervention and new treatment options can lead to better health outcomes in the fight against cancer.

Impactful Clinical Innovation Immunology Testing

Dr. Gang He, medical supervisor of the Immunology section initiated major changes in this section. As we emerged from the COVID–19 pandemic, the immunology section faced a big challenge. Due to the lack of personnel to run the specialty tests, huge backlogs of unreported tests built up, and they had to develop an innovative way to increase capacity. One area heavily impacted was ANA (anti–nuclear body) screening, important for work up for many autoimmune diseases. This was a manual test with a limited number of reportable patterns. The solution brought in is automation. After forming a working committee, the team quickly identified current and future needs, launched the tender and obtained the adequate system. With the new automated system, they will increase testing capacity fourfold and reduce technologists’ time commitment to these tests. In addition, they will provide the results for multiple titers and with better imaging documentation and will be able to provide more patterns for clinicians. The reporting nomenclature will also be upgraded to be consistent with ICAP (International Consensus on Antinuclear Antibody (ANA) Patterns) international standards. Since automation will liberate the technologists during incubation time, they will reorganize the immunology working flow in the future that will further improve efficiency. Ultimately, the quality and quantity of this testing will be greatly enhanced.

The next step, planned for 2023, is to procure a high–capacity, random access, multiplexing instrument to replace the current 13–year–old instrument. This new technology will provide the opportunity to expand the immunology/allergy test menu and improve efficiency through reorganization of work flow.

7 Scientists

3 Clinician–Teachers

2 Clinician–Investigators

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Selinexor in Advanced, Metastatic Dedifferentiated Liposarcoma: A Multinational, Randomized, Double–Blind, Placebo–Controlled Trial. Gounder MM, Razak AA, Somaiah N, Chawla S, Martin–Broto J, Grignani G, Schuetze SM, Vincenzi B, Wagner AJ, Chmielowski B, Jones RL, Riedel RF, Stacchiotti S, Loggers ET, Ganjoo KN, Le Cesne A, Italiano A, Garcia Del Muro X, Burgess M, Piperno–Neumann S, Ryan C, Mulcahy MF, Forscher C, Penel N, Okuno S, Elias A, Hartner L, Philip T, Alcindor T, Kasper B, Reichardt P, Lapeire L, Blay JY, Chevreau C, Valverde Morales CM, Schwartz GK, Chen JL, Deshpande H, Davis EJ, Nicholas G, Gröschel S, Hatcher H, Duffaud F, Herráez AC, Beveridge RD, Badalamenti G, Eriksson M, Meyer C, von Mehren M, Van Tine BA, Götze K, Mazzeo F, Yakobson A, Zick A, Lee A, Gonzalez AE, Napolitano A, Dickson MA, Michel D, Meng C, Li L, Liu J, Ben–Shahar O,

Medical Oncology

Leadership (from l to r)

Dr. Nathaniel Bouganim // MUHC

Dr. Gerry Batist // JGH

Dr. Adrian Langleben // SMH

Van Domelen DR, Walker CJ, Chang H, Landesman Y, Shah JJ, Shacham S, Kauffman MG, Attia S. J Clin Oncol. 2022 Aug 1;40(22):2479–2490. doi: 10.1200/ JCO.21.01829. Epub 2022 Apr 8.

Targeting MDM4 as a Novel Therapeutic Approach in Prostate Cancer Independent of p53 Status. Mejía–Hernández JO, Raghu D, Caramia F, Clemons N, Fujihara K, Riseborough T, Teunisse A, Jochemsen AG, Abrahmsén L, Blandino G, Russo A, Gamell C, Fox SB, Mitchell C, Takano EA, Byrne D, Miranda PJ, Saleh R, Thorne H, Sandhu S, Williams SG, Keam SP, Haupt Y, Haupt S. Cancers. 2022 Aug 16;14(16):3947. doi: 10.3390/cancers 14163947.

Pembrolizumab for previously treated advanced anal squamous cell carcinoma: results from the non–randomised, multicohort, multicentre, phase 2 KEYNOTE–158 study. Marabelle A, Cassier PA, Fakih M, Kao S, Nielsen D, Italiano A, Guren TK, van Dongen MGJ, Spencer K, Bariani GM, Ascierto PA, Santoro A, Shah M, Asselah J, Iqbal S, Takahashi S, Piha–Paul SA, Ott PA, Chatterjee A, Jin F, Norwood K, Delord JP. Lancet Gastroenterol Hepatol. 2022 May;7(5):446–454. doi: 10.1016/ S2468–1253(21)00382–4. Epub 2022 Feb 1.

Impact of the 21–Gene Recurrence Score Assay on Treatment Decisions and Cost in Patients with Node–Positive Breast Cancer: A Multicenter Study in Quebec.Hassan S, Younan R, Patocskai E,

Provencher L, Poirier B, Sideris L, Dubé P, Mihalcioiu C, Chabot–Blanchet M, Guertin MC, Boileau JF, Robidoux A. Oncologist. 2022 Oct 1;27(10):822–831. Oncology clinic–based germline genetic testing for exocrine pancreatic cancer enables timely return of results and unveils low uptake of cascade testing. Wang Y, Golesworthy B, Cuggia A, Domecq C, Chaudhury P, Barkun J, Metrakos P, Asselah J, Bouganim N, Gao ZH, Chong G, Foulkes WD, Zogopoulos G. J Med Genet. 2022 Aug;59(8):793–800. doi: 10.1136/ jmedgenet–2021–108054. Epub 2021 Sep 23.

Exciting Research in the Pipeline

Project Title: Platform for the enrichment of circulating tumor cells (CTCs) for characterization and sensitivity to anti–cancer drugs.

Investigators: Drs. Catalin Mihalcioiu & Richard Kremer

Funding: CQDM – $299,392

This liquid biopsy platform using an innovative circulating tumour cell detection method, will be available at the CIM as a platform available for research.

Project Title: The creation of a McGill University Young Adult program (AYA)

Funding: Generous donations of the Cook and Aziz families

It is well known in the literature that young adults’ cancer needs differ from adult oncology. This program will focus on supporting young cancer patients through their treatment journey and ensure proper transition from the Children’s hospital.

Project Title: CIM–Oncology

Lead: Dr. Ramy Saleh

CIM–Oncology led by Dr. Saleh has streamlined the complex early and late phase clinical trial processes from contracts to recruitment. This has placed McGill Medical Oncology in the international limelight. McGill Oncology has outperformed prestigious US, European and Asian cancer centres in startup and recruitment. Examples are:

• Tropion Breast–03: Lead international site, top enrolling site in the world (Dr. Asselah)

• Pan Tropion –03 & Mk6482: Lead Canadian site and top recruiter (Dr. Saleh)

• Cellular therapies in solid cancers such as CART will be starting in the upcoming year. This will place McGill as a leader in CART for Solid tumors in Quebec.

Impactful Clinical Innovation

Transfer of patients on clinical trials to the CIM infusion centre

Increasing pressures on the chemotherapy treatment room have pushed the nursing and physician oncology leadership to find innovative solutions to treat all cancer patients in a timely fashion. With the support and training from oncology, the ability to transfer patients on clinical trials to the CIM infusion centre has been instrumental. Currently most clinical trial patients are being treated at the CIM infusion centre including novel antibody drug conjugates.

18 Clinician–Teachers

6 Clinician–Scientists

2 Clinician–Investigators

1 Scientist

5 Notable 2022 Publications (Division or DOM primary member’s name in bold type)

Mavrakanas TA. Treatment Options for Venous Thromboembolism in Patients Receiving Dialysis. Clin J Am Soc Nephrol. 2022 May;17(5):623–625.

Navarro–Betancourt JR, Papillon J, Guillemette J, Chung CF, Iwawaki T, Cybulsky AV. The unfolded protein response transducer IRE1α promotes reticulophagy in podocytes. Biochim Biophys

Acta Mol Basis Dis. 2022 Jun 1;1868(6):166391.

Suri RS, Lee JY, Ban MR, Shrum B, Tutunea–Fatan E, Ismail OZ, Leckie SH, McIntyre AD, Xu Q, Lee SH, de Chickera SN, Hegele RA, Gunaratnam L.

Nephrology

Leadership (from l to r)

Dr. Rita Suri // McGill/MUHC

Dr. Mark Lipman // JGH

Dr. Johana Eid // SMH

Defective KIM–1 phagocytosis does not predispose to acute graft dysfunction after kidney transplantation in humans. Kidney Int. 2022 Aug;102(2):435–439.

Sandal S, Schiller I, Dendukuri N, Robert JT, Katergi K, Alam A, Cantarovich M, Fiore JF, Suri RS, Landsberg D, Weber C, Fortin MC. Identifying Modifiable System–Level Barriers to Living Donor Kidney Transplantation. Kidney Int Rep. 2022 Sep 9;7(11):2410–2420.

Hada I, Shimizu A, Takematsu H, Nishibori Y, Kimura T, Fukutomi T, Kudo A, Ito–Nitta N, Kiuchi Z, Patrakka J, Mikami N, Leclerc S, Akimoto Y, Hirayama Y, Mori S, Takano T, Yan K. A Novel Mouse Model of Idiopathic Nephrotic Syndrome Induced by Immunization with the Podocyte Protein Crb2. J Am Soc Nephrol. 2022 Nov;33(11):2008–2025.

Lemieux W, Fleischer D, Yang AY, Niemann M, Oualkacha K, Klement W, Richard L, Polychronakos C, Liwski R, Claas F, Gebel HM, Keown PA, Lewin A, Sapir– Pichhadze R. Dissecting the impact of molecular T–cell HLA mismatches in kidney transplant failure: A retrospective cohort study. Front Immunol. 2022 Nov 24;13:1067075.

Exciting Research in the Pipeline

Project Title: Protein Kinase SLK in the Kidney

Investigator: Dr. Andrey Cybulsky (PI)

Funding: Kidney Foundation of Canada

Date: 2022–2024

Diseases of the renal glomerulus, especially those initiated by immunological processes, account for approximately half of the causes of chronic kidney disease in Canada. Fundamental research into the disordered mechanisms that lead to glomerulonephritis is essential to guide development of novel therapeutics and preventive strategies. In this proposal, the researchers will study abnormalities in cellular pathways in the glomerulus involving a protein kinase called SLK, and how disordered regulation of SLK leads to kidney disease. Previously, they generated mice with a genetic deletion of SLK in podocytes, cells that are critical for sustaining glomerular function. Mice with SLK deletion develop podocyte injury and abnormalities of the structure supporting cellular architecture (“cytoskeleton”). Furthermore, glomerular disease is more aggressive in mice with SLK deletion. The proposed studies will use a tissue–culture system and animal models of glomerulonephritis to characterize mechanisms by which SLK regulates the cytoskeletal structure in podocytes, and how dysregulation contributes to the cause of disease. Elucidation of such basic mechanisms of the causes of disease will lead to testing of therapies in preclinical (animal) models. This approach is likely to be the most productive in the development of treatment strategies for slowing progression of human glomerulonephritis.

Project Title: Safety and Efficacy of SGLT2–inhibitors in Advanced Chronic Kidney Disease

Investigators: Drs. Thomas Mavrakanas (PI), Suri RS (CO–I), Sharma A (CO–I) & Tsoukas M (CO–I)

Funding: Kidney Foundation of Canada

Date: 2022–2024

Sodium–glucose co–transporter–2 (SGLT–2) protects against adverse cardiac events and progression of chronic kidney disease (CKD) to more advanced stages in patients with and without diabetes. However, these trials did not include patients with advanced CKD or receiving dialysis – patients with the highest risks of cardiovascular events. Thus, whether

these agents can be safely used in these high–risk populations to prevent adverse cardiovascular outcomes is uncertain. As SGLT–2 inhibitors are known to be renally cleared, here they will study the pharmacokinetics and pharmacodynamics of two doses of the SGLT–2 inhibitor canagliflozin in patients with glomerular filtration rate of <20 ml/min or receiving hemodialysis. The surrogate endpoints of proteinuria (for patients not receiving dialysis) and left ventricular mass index (all patients) will also be assessed. This study will provide important data on the safety and potential efficacy of SGLT–2 inhibitors in patients with advanced CKD and in those receiving HD in order to inform a large randomized trial to definitively assess the efficacy of SGLT–2 inhibitors on cardiovascular outcomes in these patients.

Project Title: A novel mouse model of minimal change disease driven by podocyte autoantigen and T/B crosstalk

Investigator: Dr. Tomoko Takano (PI)

Funding: Kidney Foundation of Canada

Date: 2022–2024

Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children and also affects adults of all ages. The precise cause of MCD is still unknown, impeding the development of specific treatments. While previous studies have focused on the role of T–cells in the pathogenesis of MCD, recent data suggest that B lymphocytes and antibodies also play important roles. We recently developed a novel mouse model that clinically and histologically resembles human MCD by injecting mice with a recombinant protein representing part of the Crb2 protein that is normally expressed in podocytes. In this proposal, the researchers will delineate the mechanisms by which the Crb2 activates T and B lympocytes to cause podocyte injury. They expect that this study will, for the first time, establish an immune mechanism–based mouse model of MCD that will guide identification of precise cellular and therapeutic targets in human MCD. A parallel translational study which will analyze lymphocytic phenotypes from patients with MCD will be conducted to address clinical relevance of the findings in mice.

Impactful Clinical Innovation

Optimizing use of guideline directed therapy in diabetic patients with cardiorenal syndromes: the McGill University Centre Synchronous Nephro–Cardio–Endo Clinic

Drs. T. Mavrakanas, A. Sharma, & M. Tsoukas

Approximately 3% of the Canadian population has moderate to severe chronic kidney disease, of whom a large proportion also have co–existing diabetes, and structural heart disease. While many treatments now exist to reduce cardiovascular and renal adverse outcomes in these patients (ACE–inhibitors, angiotensin receptor blockers, SGLT2–inhibitors, MRAs, GLP–1 agonists), studies suggest that the use of these evidence–based treatments is suboptimal. Unfortunately, the uptake of guideline directed therapy (GDT) worsens in complex patients with accumulated comorbidities, even though these patients are likely to derive the most benefit. The reasons for this are multifactorial, including prescriber fear of side effects, therapeutic inertia and lack of expert knowledge on how to manage multiple agents in complex patients. The current model of patients seeing multiple specialists consecutively are inefficient, often resulting in long delays before patients start GDT, with loss of time to benefit from them.

In collaboration, the Divisions of Nephrology, Cardiology, and Endocrinology have established a novel model of care that involves patients receiving simultaneous consultations during a single clinic with all three specialties. During this synchronous clinic, the three specialists are able to discuss how to individualize

and optimize treatment – with each other and with the patient – during the same appointment. Patients receive education on disease management, medication indications and side effects, and multidisciplinary care, and leave the clinic with multiple evidence–based prescriptions in hand. Once patients are stabilized on the appropriate therapies, they are discharged back to their family doctors, who are given specific instructions on how to continue and titrate these guideline–directed therapies for each patient.

This clinic is the one of the first of its kind in Canada and in the two years since its inception has already demonstrated concrete benefits: 1) The prevalence of guideline–directed therapies has increased from baseline to follow–up by almost two to five–fold in the 150 patients seen so far (SGLT–2 inhibitor use 44% at baseline to 87% at follow–up; MRA use 25% to 45%, and GLP–1 agonist use 8% to 45%). 2) The clinic is convenient for patients. 3) Many patients from the clinic have enrolled in clinical trials or other research studies. 4) The clinic provides a rich training environment where students and residents have gained experience in how to manage these complex patients with multiple common conditions. Cost–effectiveness analyses are underway.

3 Clinician–Teachers

1 Clinician–Scientist

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Khadadah S, Kimoff RJ, Duquette P, Jobin V, Lapierre Y, Benedetti A, Johara FT, Robinson A, Roger E, Bar–Or A, Leonard G, Kaminska M, Trojan DA. Effect of continuous positive airway pressure treatment of obstructive sleep apnea–hypopnea in multiple sclerosis: A randomized, double blind, placebo–controlled trial (SAMS–PAP study). Multiple Sclerosis Journal 2022;28(1): 82–92.

Kimoff RJ, Kaminska M, Trojan DA. Multiple sclerosis and related disorders. In: Handbook of Clinical Neurology, Respiratory Neurobiology: Physiology and Clinical Disorders, Part II (R.. Chen and P.G. Guyenet, Editors) 2022 Jan. 1 (Vol 189, pp177–200).

Aita R, Petruccelli JA, Gawri R, Gao C. Novel Murine Model of Heterotopic Ossification Induced by Spinal Cord Injury. The Spine Journal 2022 Sep; 22 (9 supplement): S5

Physiatry / Rehab Service

Leadership (from l to r)

Dr. Mohan Radhakrishna // McGill/MUHC

Mazerolle M, Kimoff RJ, Khadadah S, Duquette P, Jobin V, Lapierre Y, Benedetti A, Majetic K, Robinson A, Roger E, Kaminska M, Trojan DA. The long term effects of continuous positive airway pressure treatment of obstructive sleep apnea–hypopnea in multiple sclerosis patients. American Journal of Physical Medicine and Rehabilitation (in press). This abstract was awarded first place for the resident research contest among research submissions at the annual meeting of the Canadian Association of Physical Medicine and Rehabilitation in May, 2022.

Exciting Research in the Pipeline

Project Title: Heterotopic Ossification in Spinal Cord Injury

Funding: Réseau de Recherche en Santé Buccodentaire et Osseuse – $50,000

Date: 2022–2022

Project Title: Inhibition of afferent neuron outgrowth to prevent heterotopic ossification after spinal cord injury

Funding: AO Spine North America Young Investigators Research Grant – $20,000 USD

Date: 2022–2023

Project Title: Elucidating Neurotropic Molecular Mechanisms in Spinal Cord Injury Associated Heterotrophic Ossification

Funding: AO Spine Start–up Research Grant –25,000 CHF

Date: 2022–2023

Project Title: Heterotopic Ossification Induced by Traumatic Spinal Cord Injury: A New Approach to Prophylaxis and Treatment

Funding: North American Spine Society Young Investigator Grants – $43,000 USD

Date: 2022–2023

Bone formation in soft tissues after severe trauma results in increased pain and disability. It does not occur in all trauma patients however and has a predilection for spinal cord injury. Dr. Gao is investigating whether peripheral tissue trauma modulated heterotopic ossification associated with spinal cord injury.

Impactful Clinical Innovation

Physiatric input into patients with multiple sclerosis (MS)

Physiatric input into patients with multiple sclerosis (MS) can help identify and manage disabilities and pain associated with MS. Dr. Theriault sees patients weekly as part of the MNI MS clinic where she sees patients with MS to foster independence in this often–young population.

28 Clinician–Teachers

15 Clinician–Scientists

11 Scientists

4 Clinician–Investigators

3 Clinician–Educators

5 Notable 2022 Publications

(Division or DOM primary member’s name in bold type)

Bhattarai S, Li Q, Ding J, Liang F, Gusev E, Lapohos O, Fonseca GJ, Kaufmann E, Divangahi M, Petrof BJ. TLR4 is a regulator of trained immunity in a murine model of Duchenne muscular dystrophy. Nature Communications. 2022 Feb 15;13(1):879.

Bourbeau J, Doiron D, Biswas S, Smith BM, Benedetti A, Brook JR, Aaron SD, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O’Donnell D, Sin DD, Walker B, Dsilva L, Nadeau G, Coats V, Compton C, Miller BE, Tan WC; CanCOLD Collaborative Research Group and the Canadian

Respiratory Medicine

Leadership (from l to r)

Dr. Kevin Schwartzman // McGill/MUHC

Dr. Jason Agulnik // JGH

Dr. Harold Zackon // SMH

Respiratory Research Network. Ambient Air Pollution and Dysanapsis: Associations with Lung Function and COPD in the CanCOLD Study. American Journal of Respiratory and Critical Care Medicine. 2022 Apr 5. doi: 10.1164/ rccm.202106–1439OC.. PMID: 35380941.

Jalbert AC, Siafa L, Ramanakumar AV, Assayag D. Gender and racial equity in clinical research for idiopathic pulmonary fibrosis: a systematic review and meta–analysis. European Respiratory Journal 2022 Mar 3;59(3):2102969. doi: 10.1183/13993003.02969–2021. PMID: 35058247.

Kaufmann E, Landekic M, Downey J, Chronopoulos J, Teimouri Nezhad S, Tran K, Vinh DC, Barreiro LB, Divangahi M. Lack of evidence for intergenerational inheritance of immune resistance to infections. Nature Immunology. 2022 Feb;23(2):203–207.

Nsengiyumva NP, Campbell JR, Oxlade O, Vesga JF, Lienhardt C, Trajman A, Falzon D, Den Boon S, Arinaminpathy N, Schwartzman K. Scaling up target regimens for tuberculosis preventive treatment in Brazil and South Africa: An analysis of costs and cost–effectiveness. PLOS Medicine 2022; 19(6):e1004032. PMID: 35696431

Exciting Research in the Pipeline

Project Title: Resilient Responses to Protect Lung Health in Nunavik

Investigator: Dr. Faiz Ahmad Khan (PI)

Funding: National Research Council of Canada/ Fonds de Recherche Québec – $600,000 & Inuit Nunangat, United Kingdom (CINUK) Arctic Research Programme – £553,000

Date: 2022–2025

Project Title: Unagi: Computational approach driven repurposed drugs for idiopathic pulmonary fibrosis.

Investigator: Dr. Jun Ding (PI)

Funding: CIHR – $202,572

Date: 2022–2024

Project Title: CD4+T Cells, Alarmins and Human Airway Smooth Muscle Function in Asthma.

Investigator: Dr. Anne–Marie Lauzon (PI)

Funding: CIHR – $383,361

Date: 2022–2024

Impactful Clinical Innovation

New clinical program in bronchiectasis at the outpatient clinics of the Montreal Chest Institute

Dr. Sana Swaleh established a new clinical program in bronchiectasis, in partnership with nurse–clinician Octavian Boitor, at the outpatient clinics of the Montreal Chest Institute.

7 Clinician–Teachers

5 Clinician–Scientists

3 Clinician–Educators

3 Clinician–Investigators

3 Scientists

5 Notable 2022 Publications (Division or DOM primary member’s name in bold type)

Widdifield, J., Kwong, J. C., Chen, S., Eder, L., Benchimol, E. I., Kaplan, G. G., ... & Bernatsky, S. (2022). Vaccine effectiveness against SARS–CoV–2 infection and severe outcomes among individuals with immune–mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population–based analysis. The Lancet Rheumatology, 4(6), e430–e440.

Fitzcharles, M. A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2022). Chronic primary musculoskeletal pain: a new concept of nonstructural regional pain. Pain Reports, 7(5).

Rheumatology

Leadership (from l to r)

Dr. Laeora Berkson // McGill/JGH

Dr. Elizabeth Hazel // MUHC

Dr. Jan Schulz // SMH

Mendel, A., Fritzler, M. J., St–Pierre, Y., Rauch, J., Bernatsky, S., & Vinet, É. (2023). Outcomes associated with antiphospholipid antibodies in COVID–19: a prospective cohort study. Research and Practice in Thrombosis and Haemostasis, 100 Valerio, V., Hudson, M., Wang, M., Bernatsky, S., Hazel, E. M., Ward, B., & Colmegna, I. (2022). Influenza Vaccine Hesitancy and Its Determinants Among Rheumatology Patients. ACR Open Rheumatology, 4(4), 352–362.

Leclair V, D’Aoust J, Gyger G, Landon–Cardinal O, Meyer A, O’Ferrall E, Karamchandani J, Massie R, Ellezam B, Satoh M, Troyanov Y, Fritzler MJ, Hudson M; Canadian Inflammatory Myopathy Study Group. Autoantibody profiles delineate distinct subsets of scleromyositis. Rheumatology (Oxford). 2022 Mar 2;61(3):1148–1157. doi: 10.1093/ rheumatology/keab492. PMID: 34146090.

Exciting Research in the Pipeline

Project Title: Risk stratification and personalized therapy in lupus pregnancies

Investigators: Drs. Vinet, E (PI), Bernatsky S (CO–I), Clarke A (CO–I), Fortin P (CO–I), Hanly J (CO–I), Peschken C (CO–I), & Touma Z (CO–I)

Funding: CIHR – $750,000

Date: 2022–2027

Ranked first out of 26 in the CIHR grant competition

Project Title: Randomized Double–Blind Placebo–Controlled Clinical Trial to Assess the Efficacy of Mycophenolate Mofetil in Subclinical Interstitial Lung Disease Associated with Systemic Sclerosis: a Feasibility Study

Investigators: Drs. Hoa, S (PI), Hudson M (CO–I), Assayag D (CO–I), Golchi S (CO–I), Hambly N (CO–I), Larché M (CO–I), & Senécal JL (CO–I)

Funding: CIHR – $347,000

Date: 2022–2025

// Project Title: Optimizing outcomes of inflammatory arthritis induced by immune checkpoint inhibitors

Lead: Dr. Ladouceur, A

Supervisors: Drs. Hudson, M & Bernatsky, S

Funding: Arthritis Society Post–doctoral fellowship award – $50,000 (plus matched institutional funding)

Date: 2022–2024

Impactful Clinical Innovation

JGH Immune–Related Adverse Event (irAE) Clinic

Dr. Marie Hudson

Rheumatology has played an integral role in the management of cancer patients who develop immune–related adverse events (irAEs) from immune checkpoint inhibitors. In view of the team’s expertise with complex diseases and immunosuppression, they have been fielding referrals not only of rheumatic irAEs (arthritis, sicca, myositis) but non–rheumatic irAEs, in particular refractory irAEs that do not respond to first line steroids as well as patients with pre–existing autoimmune diseases who could be candidates for immune checkpoint inhibitors but for whom the

risk of flare of their underlying disease adds to the complexity of their case. The team has therefore established a ½–day dedicated irAE clinic for three reasons: 1) to establish best practices for the management of irAEs; 2) to provide trainees with an opportunity to focus on this evolving field; and, 3) to optimize recruitment into the MIRAE and CANRio cohorts, respectively local and national research cohorts of patients with irAEs. To their knowledge, this clinic is unique, at least in the province, if not in Canada.

MUHC Young Adult Rheumatic Diseases (YARD) Transition Clinic

Dr. Elizabeth Hazel

Further to her work on the effects of employment and arthritis (Jetha, Arif, et al. “Rheumatic disease disclosure at the early career phase and its impact on the relationship between workplace supports and presenteeism.” Arthritis Care & Research 74.10 (2022): 1751–1760.), Dr. Hazel added the services of a career counsellor to her Young Adult Rheumatic Diseases (YARD) transition clinics. These multidisciplinary clinics take place at the Constance Lethbridge Leighton MacKay Rehabilitation facility, where ancillary services are covered by Medicare. The transitioning young adult is accompanied by the pediatric nurse and their parent(s) and is introduced to the adult rheumatology team. They are then assessed by a physiotherapist, occupational therapist, social worker and career counsellor to uncover areas of need and maximize their chances for successful transition to adulthood. To our knowledge this is the only transition clinic in North America to offer the services of a career counsellor.

Division of Experimental Medicine

Major objectives of the Division of Experimental Medicine (ExMed):

The Division of Experimental Medicine is the graduate program of the Department of Medicine of McGill University. Two hundred and eighty–three professors (clinical and basic science researchers) located in the research institutes of the McGill University teaching hospitals (and Institut de recherche clinique de Montréal, IRCM) supervise graduate students (~350, see details for 2022 below) through their membership in the Division. The Division offers 45 courses ranging from the Biology of Cancer to Quantitative Research Methods.

Governance:

ExMed is led by a Graduate Program Director and an Associate Graduate Program Director. An Executive Committee oversees program development and curriculum review and is comprised of members from each research institute, both PhDs and MDs, and meets every nine months. An admissions committee comprised of five members evaluates applications on a rolling basis.

Programs:

The Division offers six thesis–based degree programs, in addition to the diploma and certificate programs:

• MSc in Experimental Medicine

• MSc in Experimental Medicine, Options in Bioethics, Environment, or Digital Health Innovation

• PhD in Experimental Medicine

• PhD in Experimental Medicine, Option in Environment

• Graduate Diploma in Clinical Research

• Graduate Certificate in Regenerative Medicine

Program Updates from 2022

The Division launched its new format for the oral comprehensive exam (OCE) for students enrolled as of Fall 2022. In the revised OCE, students critically evaluate a research article in their field in addition to presenting their research project. Writing and presentation skills are evaluated, including the ability of students to answer questions both directly and indirectly related to their research project. Passing the OCE is now also required for MSc students wishing to fast–track to PhD.

New Student Stipend Policy

Following several years of consultation with departments, faculty and students, the Faculty of Medicine and Health Sciences initiated a new harmonized stipend policy in September 2022. Students receive a base living allowance in addition to tuition and fees. For the 2022–2023 year, the Division received $950,000 in Graduate Excellence Funds (can only be used by direct deposit in students’ accounts) which were used to help off–set the higher tuition paid by out–of–province and international students. A small portion was also used for Graduate Excellence Awards for Canadians and permanent residents.

Leadership (from l to r)

Dr. Anne–Marie Lauzon // Graduate Program Director

Dr. Elizabeth Fixman // Associate Program Director

Student Funding

In 2022, ExMed students successfully received funding from external and internal sources. Fifty–three students received external studentships totaling $1,239,500; including four CIHR–Doctoral, three NSERC Doctoral, eight CGS–Masters, 13 FRQS Doctoral, and three FRQS Masters awards. Of special mention, PhD student Joan Miguel Romero was awarded a prestigious Vanier scholarship in 2022. Joining two other PhD students who were awarded this honour in 2021 (Alberto Herrero Babiloni and Motahareh Vameghestahbanati), the Division now has three Vanier scholars. Two ExMed students received the Anti–Black Racism Initiative Recruitment awards, a new award offered by McGill. An additional 40 students received internal awards and studentships from the Faculty of Medicine and Health Sciences and its associated research institutes totaling $469,000.

Statistics on Student applications

The ExMed admissions committee reviews all complete applications submitted to the Division and criteria of admission are based on applicants meeting minimum cGPA requirements, letters of recommendation, CVs, English language proficiency and personal statements. Only students who have a supervisor are formally accepted. In 2022, the Division saw a 30% increase in applications submitted to our programs over the previous academic year (310 vs 237). Of the applications received, 46% of applicants were from Quebec, 38% were international, and 15% were non–Quebec Canadians. The Division welcomed 15 new students in Winter 2022 and 111 new students in Fall 2022 (a 22% increase over Fall 2021)

Student Numbers

In addition to a substantial increase in applications submitted to the Division, the overall number of students registered in ExMed programs increased in Fall 2022 from 2021 (376 students in Fall 2022 vs. 356 students in Fall 2021).

Student Numbers (Winter 2022, Fall 2022, Winter 2023)

Back to In–person Activities!

Travel awards

Following two years of funding student presentations at remote conferences, students in the Division of Experimental Medicine were back to presenting at in–person conferences in 2022. Using GREAT Travel award funds from Graduate Studies, the Division provided travel awards to 29 of students to present their research at conferences in Canada, the US and abroad.

Student Orientation

In September 2022, the ExMed Graduate Students’ Society (EMGSS), in collaboration with the ExMed Division held its new student orientation at the Research Institute of the MUHC Research. Students were provided an overview of the programs, program expectations, funding information and university services available to them. Following orientation, the EMGSS organized an in–person social gathering for all students in the Division.

Student Wellness

EMGSS organizes activities to foster inclusiveness and to support graduate students in varied ways. Activities range from the Buddy Program, stress management workshops to social activities, discussions and peer guidance for thesis writing, and career development. In 2022, they hosted a professional LinkedIn profile photo shoot for ExMed students.

In Fall 2022, McGill University hired a Local Wellness Advisor to support the physical and mental health of Graduate Students in the Faculty of Medicine and Health Sciences. The Local Wellness Advisor helps to connect students to resources on and off campus, offer wellness workshops, as well as offer one–on–one appointments.

Special events

In April 2022, the Division hosted an information session with unmatched Med–4 students about MSc and diploma programs.

The 2022 Annual McGill Biomedical Graduate Conference (AMBGC) was held remotely on March 22, 2022, and was attended by more than 200 students and faculty members. The AMBCG included poster sessions, oral presentations and a keynote presentation by Dr. Pamela Silver, Professor of Biochemistry & Systems Biology at Harvard Medical School.

“I don’t know where I’m going from here, but I promise it won’t be boring.”

// David Bowie