2020 Annual Report of the McGill Department of Medicine

Residents on COVID ward, Jewish General Hospital

2020 ANNUAL REPORT OF THE

McGill Department of Medicine

Table of Contents I.

Message from the Chair of Medicine . . . . . . . . . . . . 2

XX.

II.

McGill DOM Governance . . . . . . . . . . . . . . . . . . . . . . . 4

XXI. DOM Events (2020). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

III.

Message from the Associate Chair of Medicine . . 5

IV.

Message from the Interim Chief, Department of Specialized Medicine, CIUSSS-ODIM . . . . . . . . . 6

I. 2020 McGill Department of Medicine Research Symposium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

V.

Message from the Associate Chair, Advancement.7

VI.

Message from the Associate Chair, Education . . . 8

VII.

Message from the Associate Chair, Quality & Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

VIII. Message from the Associate Chair, Research . . . . 10 IX.

Message from the Associate Chair, Wellness. . . . . 11

X.

Message from the Associate Director, Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

XI.

Top 30 H–indices for Full Time Faculty Members Holding Primary Appointments in DOM. . . . . . . . . . 14

XII.

DOM by Numbers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

FRQS Salary Awards (Spring 2020) . . . . . . . . . . . . . 29

II. The Louis and Artur Lucian Award . . . . . . . . . . . . . . 31 III. The 5th Annual Department of Medicine Clinical Research Symposium on High Value Care. . . . . . . . . 31 XXII. Lessons Learned During COVID–19. . . . . . . . . . . . . . 33 XXIII. 2020 Kudos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 XXIV. Division Heads and Division Reports. . . . . . . . . . . . . 39 Clinical Allergy & Immunology . . . . . . . . . . . . . . . . . . . . 40 Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Clinical Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Endocrinology & Metabolism . . . . . . . . . . . . . . . . . . . . . 50 Gastroenterology & Hepatology . . . . . . . . . . . . . . . . . . 52 General Internal Medicine . . . . . . . . . . . . . . . . . . . . . . . . 54

XIII. New Full Time Faculty Appointments (2020) . . . . 18

Geriatric Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

XIV. Promotions and Tenure (Granted in 2020). . . . . . . 18

Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

XV.

Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

XVI. Educational Leadership Positions in the Faculty of Medicine and Health Sciences . . . . . . . . 21 XVII. The Ride of a Lifetime . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Medical Biochemistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Nephrology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Physical Medicine / Rehab Service . . . . . . . . . . . . . . . 67 Respiratory Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

XVIII. CIHR Operating Grants. . . . . . . . . . . . . . . . . . . . . . . . . . 26

Rheumatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

XIX. Year over year DOM FRQS success. . . . . . . . . . . . . . 28

Division of Experimental Medicine. . . . . . . . . . . . . . . . 72

Contributors

Design

Department of Medicine

Department of Medicine administrative team

Julie Roussy, Graphic Design, Communications and External Relations

McGill University Health Center

Photographers

Cover photos

Suite D05-2212

Felipe Argaez, Michael Cichon,

Dr. Joyce Pickering and Dr. Marc Roger

Montreal (Quebec) H4A 3J1

Owen Egan, Christine Muschi, and

(top left), Dr. Kevin Schwartzman (bottom

Tel.: 514-843-1578

McGill University Health Centre – Medical Multimedia

right), and Residents at the COVID ward

Fax: 514-843-8182

1001 Decarie Boulevard Mail Drop Number: D05-2214

Jewish General Hospital (top right).

I.

Message from the Chair of Medicine Better together through COVID and beyond!

Dr. Marc Rodger system then sustain this effort through 3 waves over 18 months. We didn’t have a reserve of expert attendings so we came together, improvised and everyone contributed.

We paired experts with non–expert secondary attendings (pseudo–residents) from all Departments and residents from all programs were re–deployed from their usual training. Medical students initially were kept out of our acute care institutions but contributed from the outside. At MUHC, over 50,000 hours of physician time were booked

by MUHC DOM to cover our COVID wards (139/220 MUHC DOM physicians worked on COVID wards). At JGH, physicians from all Divisions contributed over 200 extra weeks of service on COVID wards. At SMH, 24 physicians contributed 55 weeks on COVID wards while 12 physicians provided 36 weeks of service at a makeshift hospital at Lasalle arena and CHSLDs. We were better together…

2020 was a year like no other...

Traditionally these messages focus on what we have achieved in research, teaching and clinical care innovation in the year that passed. Truthfully 2020 was focused on surviving a once in a century pandemic crisis.

It was tough to think about traditional academic health sciences pursuits when our personal/professional lives were turned upside down by COVID. Day to day care of COVID patients and managing non–COVID care with the remaining resources required a monumental effort.

Resilience took a beating as we struggled to look after our patients safely and effectively.

We got through this because we came together, proving we are better together. At peak we needed to staff over 250 COVID ward beds across the McGill

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It was my first full year with McGill DOM. My environmental scan plans (“Rodger on Tour”) to get to know the >470 full time DOM members, understand the care they provide, witness their teaching programs and understand their research was quickly put on hold in late February as COVID approached Canada. Nonetheless, seeing all sites respond to the crisis has been taught me a lot about DOM and its members. My learning curve was accelerated (I wouldn’t wish it on my successor but it was effective). The level of collaboration I lived was heartening, the willingness to step out of comfort zones was inspiring and talent we have in our midst is awesome. I tell friends/family/colleagues that I feel like a kid in a candy store working with such a tremendous group of individuals.

High fives to our administrative team that not only thrived through the pandemic, efficiently working from home, adapting to a new system (“Workday” a.k.a “WorkDay and Night”) but survived onboarding Rodger into a new university and health care system (thank you for your patience).

2020 Annual Report of the McGill Department of Medicine

I hope you enjoy reading our 2020 Annual Report. We have profiled the DOM through the early days of the COVID pandemic in an informative retrospective that explored our response to the unprecedented challenge. We look back on the storied career of Dr. Phil Gold an icon in so many ways, a role model for us all and true humble gentleman. We profile each of our Divisions with a focus on their members and their collective work. We explore DOM factoids, events, promotions, and a myriad of other successes.

DOM also worked hard to develop a fair, balanced and representative governance structure so that all DOM members have at least 2 lines of influence on DOM’s council and DOM’s policy, processes and decisions (through your

PIC, Division Director or early career representative). We appointed 6 Associate Chairs to build leadership bandwidth to deliver programming that will bring our Department to the next level. Next stop is for us to define our collective aspirations through a blank page participatory strategic planning exercise. No doubt we will conclude that the sky is the limit if work together (1+1=3).

We will gladly put COVID in the rear–view mirror but let’s take the silver linings forward…

— Profile photo taken by Owen Egan Image below of Dr. Joyce Pickering and Dr. Marc Rodger taken by McGill University Health Centre – Medical Multimedia

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II.

McGill DOM Governance Associate Chair Education

DOM EXECUTIVE DOM COUNCIL

Associate Chair Research

Associate Chair Wellness

Associate Chair Quality

3 Physicians in Chief (PIC)

Associate Chair Advancement

CORE Training Program Director

DOM Exec

3 PICs

4 |

DOM COUNCIL

15 University Div Heads

DOM COUNCIL

Chief Medical Resident

Elected Early Career Rep

2020 Annual Report of the McGill Department of Medicine

III.

Message from the Associate Chair of Medicine Dr. Ernesto L. Schiffrin feverishly creating a biobank to study COVID–19, another remarkable achievement, or carried out research and published on the disease. I sense a sentiment of pride in our faculty, a feeling of “I was there and I did my part”.

Despite the toll of the pandemic, we have reasons to feel proud of our Department, since there have been shining examples of valour and self– sacrifice across our McGill Health System.

We have seen our colleagues and residents take care of overwhelming numbers of patients infected with SARS–CoV–2, and innovate and adapt in order to offer the best care. Some Department of Medicine members were the champions among the faculty and did many weeks in the COVID wards. I salute their courage, dedication and passion for patient care. Others worked

With the arrival of a new Chair of the Department, important changes to governance took place, creating an opportunity to improve links and collegiality within the Department of Medicine at McGill. At the same time, we had to face a difficult accreditation situation for our Internal Medicine core training program. Again, the faculty rallied and with the right leadership, great strides were made toward overcoming any deficits noted by accreditors. This has also raised awareness about wellness of residents, and faculty, concerns that have been there before, but that COVID–19 has sensitized us to.

After a difficult year, we should look forward with enthusiasm and optimism at the challenges ahead.

However, we are still not sure what the new “normal” will be. The mental health effects of lockdowns, isolation, lack of socialization, and anxiety about COVID–19, on the one hand, and on the other, Post Acute COVID Syndrome, may fill up our outpatient settings. There may be pressure to continue remote work and telemedicine, which may not allow best care practices. We will have to make sure that pressures from outside or inside our institutions do not affect our ability to continue providing the best quality of care, and carrying out outstanding teaching and world class research.

— Profile photo taken by Felipe Argaez

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IV.

Message from the Interim Chief, Department of Specialized Medicine, CIUSSS-ODIM Dr. Bruce Campbell The McGill Department of Medicine has 36 active members at St. Mary’s Hospital, known for its proud tradition in community-based patient care, and its busy clinical teaching services.

St Mary’s Department members were extremely active and engaged in McGill’s response to the pandemic, both inside the hospital and during outreach to respond to the crisis in the long-term care facilities. Dr Tien Nguyen (Infectious Diseases) led hospital infection-control efforts, with dedication and perseverance, from the start of the global crisis.

Dr Julia Chabot (Geriatrics) was recognized for her exceptional contributions to the community response to COVID-19 leading relief teams of physicians into multiple residences and long-term care facilities.

Dr. Nathalie Ng Cheong (Nephrology) took on the role of physician advisor for our outpatient activities, coordinating the reorganisation of our clinics, including adapting a new ministry-constructed modular building built during the first wave.

The Department was heavily engaged in onboarding of students and residents to re-deployment, outbreak management, and the challenging task of making sure their clinical education advanced despite the

6 |

pandemic. The Department ran a series of “night schools” on COVID-19 topics disseminated online across multiple hospital sites, to residents and students and physician groups. Along with all these activities, department members re-deployed to COVID wards, a temporary area care centre and residences in distress, often responding to last minute calls for on-site relief.

As we recover from the pandemic, the Department can now look ahead to new efforts in quality improvement, renovation of clinical space, and planning for a major infrastructure project to update our medical wards, procedural and clinic spaces.

2020 Annual Report of the McGill Department of Medicine

V.

Message from the Associate Chair, Advancement Dr. Alain Bitton The challenges we have endured with the COVID–19 pandemic over the past year have led to reshaping the way we practice medicine, conduct research, and teach students and residents. In response to the pandemic, the McGill Department of Medicine (DOM) adapted rapidly to the new reality, and in the process still successfully maintained its clinical and academic mission.

As Associate Chair of Advancement for the DOM, my mandate is to promote the tripartite goal of excellence in Research, Education and Clinical care. The overarching aim is to help operationalize the strategic goals and priorities of the Department through collaboration and philanthropic support obtained from the various foundations across all the McGill–affiliated hospitals and the University.

For the first year, the advancement priority is to establish the McGill DOM “Rising Star” program. The objective is to cultivate the success and productivity of our “rising stars” by securing 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 Department and our McGill hospitals and the University.

— Profile photo taken by Owen Egan

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VI.

Message from the Associate Chair, Education Dr. Annabel Chen-Tournoux and to explain Competency by Design and Entrustable Professional Activities. They collaborated with other program directors and specialty societies across Canada to create and curate virtual educational content, whose value will endure long past the conclusion of the pandemic.

Training programs also found ways to promote wellness and connection, with online art therapy and yoga classes, secret holiday gift exchanges, fitness challenges, and outdoor social events whenever possible.

The COVID–19 pandemic has been true to its name, leaving essentially no activity of the Department of Medicine untouched – education being no exception.

With in–person meetings suspended, educators demonstrated resilience and creativity, developing innovative strategies to continue teaching, even of technical procedures such as endoscopy, lung ultrasound, and bronchoscopy. Beyond academic half days, journal clubs, OSCE sessions and CaRMS interviews held over Zoom, program directors created videos to provide orientation for rotations

8 |

Important work continued in areas that were priorities even before the pandemic. The core Internal Medicine Program implemented specific processes to improve the learning environment and to encourage frequent observations, timely feedback, and coaching around a growth mindset.

Scholarship in medical education within the Department was boosted with the awarding of three grants for education research projects.

We must acknowledge the more than 130 residents from Department of Medicine training programs who were redeployed to provide 232 resident–weeks of outstanding care for COVID–19 patients in ICUs and inpatient wards.

We also extend sincere thanks to the course directors, program directors, service chiefs, administrators, and the teaching faculty who championed the educational mission of the Department in the face of the unprecedented challenges of 2020.

— Profile photo taken by Felipe Argaez

2020 Annual Report of the McGill Department of Medicine

VII.

Message from the Associate Chair, Quality & Safety How to Spot the Quality Innovator Dr. Emily G. McDonald Over ten years ago, two of our Canadian colleagues published an important commentary in JAMA describing a new career pathway in academic medicine, the Clinician in Quality Improvement (QI) or the Quality Innovator. The commentary addressed the growing interest among medical researchers, educators, and administrators for building a strong culture of patient safety.

The Quality Innovator (not such a rare bird) can range from the faculty member who is implementing local hospital QI initiatives to the clinician researcher or FRQS scientist whose entire research platform centers on healthcare improvement. Engaging staff in quality is important to meet the expectations of hospital accreditation, to address the increasingly complex needs of our patients, and to set a high standard for patient safety education for the next generation of physicians. Although the pandemic was forefront in our minds in 2020, behind the scenes exciting QI initiatives were being developed. This past year we took great strides in establishing a foundation of excellence in quality and innovation in the DoM

through the creation of 5 scholarly quality awards. This funding will support important QI interventions across all DoM sites. At the MUHC, salary awards were introduced to provide protected time to carry out quality work. Looking ahead, we aim to build a strong department of Quality Innovators through the hiring and retention of expert faculty members in this exciting field. I look forward to working with each member of the DoM to grow our quality and safety footprint and to build a diverse group of academic Clinician Quality Improvers.

— Profile photo taken by Owen Egan

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VIII.

Message from the Associate Chair, Research Dr. Susan Kahn

Throughout my own research career at McGill, I’ve benefited from the support and encouragement of our Department and its leaders every step along the way from early–career to mid–career to senior investigator.

It is thus with a sense of honor, appreciation and reciprocation that I now serve as Associate Chair for Research in our great Department.

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My role is to help nurture and grow research excellence in our department. Important goals are to set priorities, develop and expand our Department’s research mission, capacity and outputs, recognizing that our research efforts include a diverse array of investigators (clinician– scientists, wet–lab PhDs, dry–lab PhDs), career stages (early, mid, senior) and research programs, and extend to McGill hospitals, their research institutes, and partner institutions at McGill. I will work towards strengthening connections and improving collaboration and transparency within the DOM and across its 15 Divisions and sites. Our newly convened DOM Research Advisory Committee, consisting of me, Amal Bessissow, Kris Filion, Stephane Laporte, Stephanie Lehoux, Louise Pilote and Kevin Schwartzman, welcomes your input on all matters pertaining to research and will serve as a voice to bring your ideas and concerns to the DOM Executive and the DOM Council.

On the research front, our Department is in excellent shape, as evidenced by the many examples highlighted in this Report. I know that our Department will continue to grow and excel, and I look forward to each and every opportunity to celebrate and take pride in our collective research accomplishments.

— Profile photo taken by Felipe Argaez

2020 Annual Report of the McGill Department of Medicine

IX.

Message from the Associate Chair, Wellness Dr. Natalie Dayan The well–known Declaration of Geneva “I will attend to my own health, well– being, and abilities in order to provide care of the highest standards” is easier said than done in 2021.

The current landscape of academic medicine is characterized by increased patient complexity along with rapidly evolving diagnostics, information technology, and medical education paradigms – all within a strained health care system and a global pandemic. Self–care is all too easy to neglect, and the context is a perfect storm for burnout.

The good news is that faculty well–being is a priority in the McGill DOM. Contemporary approaches to academic well–being include simultaneous “bottom– up” (i.e. stress management and resilience building) and “top–down” (i.e. wellness culture) strategies.

During the past 6 months, I have had the pleasure of working with the DOM Wellness Task Force (thank you Teresa Alper and Drs. Da Costa, Dobkin, Elizov, Ng Cheong, Huertas Garcias, and Hutchinson!) to consider our collective wellness needs, identify priority areas, and build programs based on existing infrastructure. A primary goal is to ensure adequate mentorship of junior and incoming faculty through the

DOM formal mentorship program. Second, communication via the “wellness corner” in the weekly newsletter to enhance general awareness of wellness issues. Finally, tailored personal/professional development initiatives and a proposal for a faculty Well Office are underway.

There is much work to be done at the individual and systems levels. In the meantime, wishing you all a peaceful, healthy, and restful summer, and looking forward to a year of renewed connectivity and well–being.

— Profile photo taken by Owen Egan

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X.

Message from the Associate Director, Administration Teresa Alper

○

○ ○

The year 2020 is one that many of us are unlikely to forget any time soon.

Time contracted on some days and expanded on others. Perspectives changed. Priorities were re–evaluated.

It was vital to appreciate the small things.

“Working remotely actually provided me with more opportunity than ever before to interact (in virtual space) with colleagues from other departments at McGill and allowed us to break down the silos between our units.”

“I feel that although we are all apart, we still remain strong together.”

“What immediately comes to mind is pure amazement that in the space of one day, our team was able to switch gears from work practices that had been in place for decades to land in an entirely new, remote world.

We made it work – really well! Maya Angelou quote: You may not control all the events that happen to you, but you can decide not to be reduced by them.”

The number of “transactions” is significant and, in a given year, departmental administrative staff process and monitor the following (partial list – view numbers to the right).

— Profile photo taken by Owen Egan Image below taken by Steven Rousseau

When contemplating this piece, I knew that the administrative team – who, while working remotely and in isolation for months, continued to deliver services and support the department’s faculty members – needed to be present. Their words follow.

○

12 |

“2020 was a trying year balancing what was a busier year than normal along with the personal struggles with COVID (e.g. kids at home, restrictions, etc.). In spite of this, the DOM administrative team maintained its service to the department, along with the additional work that came with the introduction of the Workday HR system.”

2020 Annual Report of the McGill Department of Medicine

6,227

160

Entrustable Professional Activities (EPAs)

Faculty reappointments (part time/full time)

200+

12,755

Annual evaluation survey – great participation rate during the pandemic

In-training Evaluation Reports (ITERs)

16

300

Retirements/ Terminations

McGill–administered research funds

307

41 Fellows

Residents

75

Postdoctoral fellow appointments

4

Annual events

158 Medical Students

16

Promotions dossiers 63 New faculty hires (part time/full time)

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XI.

Top 30 H–indices for Full Time Faculty Members Holding Primary Appointments in DOM This is the second year we are using the H index metric to highlight the 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’ as 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.

14 |

Top 30 H-indices - 2020 Name

h-index

Bitton, Alain M.

47

Schiffrin, Ernesto L.

99

Dendukuri, Nandini

47

Foulkes, William David

92

Wolfson, Christina M.

47

Muller, William J.

73

Hussain, Sabah N.A.

47

Menzies, Robert I.

72

Petrof, Basil J.

47

Kahn, Susan R.

72

Brophy, James M.

46

Goltzman, David

72

Bartlett, Susan J.

46

Genest, Jacques

70

Daskalopoulou, Stella S.

46

Barkun, Alan N.G.

67

Rahme, Elham

45

Rodger, Marc Alan

65

Karaplis, Andrew C.

44

Eisenberg, Mark Jeffrey

63

Therrien, Judith

44

Sladek, Robert

62

Siegel, Peter Michael

43

Ernst, Pierre P.

61

Benedetti, Andrea L.

42

Pilote, Louise

61

Marelli, Ariane J.

42

Friedrich, Matthias G.

61

Morais, José A.

41

Bourbeau, Jean C.

60

Sheppard, Donald C.

41

Lakatos, Péter László

58

Yale, Jean François

41

Goldberg, Mark S.

58

Dewar, Ken

41

Lin, Rongtuan

58

Radzioch, Danuta

41

Piazza, Nicoló

57

Olivenstein, Ron

41

Yang, Xiangjiao

57

Tonin, Patricia N.

41

Bernatsky, Sasha R.

56

Filion, Kristian B.

40

Sniderman, Allan David

55

Fitzcharles, Mary Ann

40

Martin, James G.

55

Ward, Brian James

40

Behr, Marcel A.

55

Schwartzman, Kevin J.

40

Routy, Jean Pierre G.

54

Bergman, Howard

54

Alaoui-Jamali, Moulay Abdellah

40

Richard, Stéphane

52

Engert, James C.

39

52

Rabbani, Shafaat Ahmed

39

52

Schurr, Erwin

39

Mayo, Nancy E.

51

Weiss, Karl A.

39

Olivier, Martin

51

Giaid, Adel

38

51

Huynh, Thao T.

38

Baron, Murray

50

Johnson, Nathalie A.

38

Tamblyn, Robyn M.

48

Sasseville, Denis A.

38

48

Suri, Rita S.

38

47

Tellier, Raymond

38

Klein, Marina Barbara Richard, Stéphane

David, Samuel

Fantus, Ivan George Hudson, Marie Anne R.

Please note the top 30 H-index list was corrected after the print version went to press.

2020 Annual Report of the McGill Department of Medicine

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 since 2015 and age < 40):

Name

h-index

1

Liberman, Daniel

20

2

Chen, Yen I.

19

3

Launay, Cyrille Patrice

18

4

Cheng, Matthew P.

17

4

Netchiporouk, Elena

17

5

Sharma, Abhinav

16

6

Spaziano, Marco

15

7

Douros, Antonios

14

8

Fonseca, Gregory J.

12

9

Peters, Tricia M.

11

10

Goldfarb, Michael

10

10

Esfahani, Khashayar

10

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XII.

DOM by Numbers

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.

481 Core Full time faculty (MDs and PhDs)

330 Part time faculty

811

(MDs and PhDs)

Total # DOM Faculty Members

95 Adjunct professors (clinical (MD) and research (PhD)) – unranked

161 Associate professors

Affiliates

481

Core Full time faculty (MDs and PhDs

125 Full professors

16 |

12

330

195 Assistant professors

Part time faculty (MDs and PhDs)

77 Part time Assistant and Associate Professors

146 Distributed = Part time faculty lecturers (MDs) at distributed sites (handful are FT)

2020 Annual Report of the McGill Department of Medicine

Sex distribution From a total of 706 part time AND full time ranked (Full, Associate, Assistant, Faculty Lecturer)

Women are

40%

52%

are Faculty Lecturers (no change from 2019)

44%

are Assistant Professors (43% in 2019)

of McGill DOM members are women

34%

are Associate Professors (no change from 2019)

– (38% in 2019)

24%

are Full Professors (25% in 2019)

31%

are Division Directors (no change from 2019)

Women in DOM leadership positions:

7/18 (39%)

2/14 (14%)

4/12 (33%)

4/6 (67%)

MUHC Division Directors

JGH Division Directors

SMH Division Directors

DOM Associate Chairs

Overall 55% DOM leadership positions held by women Canada and most of the world already has a paucity of women in the highest levels of academic leadership.

For example, throughout Canada, there are only 4 deans of medicine and from that small sample, only one is a woman of colour. The pandemic has worsened opportunities for women in leadership in the near future.

According to both business management and improvement science, “You can’t improve what you don’t measure” (Drucker, P). Dr. Gigi Osler, former CMA president, put it this way, “you measure what you treasure.”

Mentorship, sponsorship, allyship, and fostering need to be stressed as positives for building a better society for everyone.1 1

“The Voice of Women in Canada”, https://fmwc.ca/wp–content/uploads/2021/04/

TheVoice_Spring2021–0412%C6%92.pdf – Federation of Medical Women of Canada | 17

XIII.

New Full Time Faculty Appointments (2020) y Dr. Michael Chetrit

y Dr. Dan Liberman

y Dr. Anna Nikonova

y Dr. Lucie Corriveau

y Dr. Karen Matouk

y Dr. Maude Peretz–Larochelle

y Dr. Carolyne Elbaz

y Dr. Thomas Mavrakanas

y Dr. Marc Rodger

y Dr. Chan Gao

y Dr. Arielle Mendel

y Dr. Raymond Tellier

y Dr. Nathan Messas

y Dr. Jessica Thériault

y Dr. Corey Miller

y Dr. Sophie Wojcik

y Dr. Jill Pancer

y Dr. Nan Zhao

Cardiology

Geriatric Medicine

Medical Biochemistry

Gastroenterology and Hepatology

Hematology

Nephrology

Physiatry

Hematology

Medical Biochemistry

y Dr. Cyrille Launay Geriatric Medicine

Cardiology

Hematology

Rheumatology

y Dr. Laura Anne Habib y Dr. Gang He

Hematology

Infectious Diseases

Cardiology

Physiatry

Gastroenterology and Hepatology

Endocrinology and Metabolism

Rheumatology

Respiratory Medicine

XIV.

Promotions and Tenure (Granted in 2020) - Full Time Members Associate Professor Promotions

Full Professor Promotions

y Dr. Jason Agulnik

y Dr. Josée Parent

y Dr. Bertrand Jean-Claude

y Dr. Faiz Ahmad Khan

y Dr. Ruth Sapir-Pichhadze

y Dr. José Morais

y Dr. Nathalie Bottega

y Dr. Makeda Semret

y Dr. Igal Sebag

y Dr. Cecilia Costiniuk

y Dr. Benjamin Smith

y Dr. Mélanie Mondou

y Dr. Catherine Weber

y Dr. Sharon Nessim

y Dr. Gerasimos Zaharatos

Tenure

y Dr. Nandini Dendukuri

Please note the list of 2020 Promotions was corrected after the print version went to press.

18 |

2020 Annual Report of the McGill Department of Medicine

| 19

XV.

Education The DOM is responsible for 16 residency training programs and for the delivery of the internal medicine component of the undergraduate medical education curriculum.

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 160 medical students, 300 residents and 40 fellows each year.

And we are grateful to our Education leaders for their role in the development of the next generation of McGill–trained scientists, who teach and supervise approximately 300 graduate students each year.

Directors of Postgraduate Residency Training Programs (PGME) Allergy & Immunology

Critical Care

Medical Biochemistry

y Dr. Natacha Tardio

y Dr. Dev Jayaraman

y Dr. Brian Gilfix

Cardiology – Co–Directors

Dermatology

Medical Genetics

y Dr. Annabel Chen–Tournoux, JGH

y Dr. Khue Nguyen

y Dr. Laura Russell

y Dr. Maude Peretz–Larochelle

Endocrinology & Metabolism

Nephrology

y Dr. Natasha Garfield (term ended

y Dr. Catherine Weber

y Dr. Vanessa Tardio (effective

Respiratory Medicine

(term ended December 2020)

(effective January 2021)

y Dr. Negareh Mousavi, MUHC Core Internal Medicine (R1–R3)

y Dr. Ahsan Alam, McGill Program

Director (term ended June 2020)

y Dr. Ning–Zi Sun (effective July 2020) y Dr. Ning–Zi Sun, McGill Assistant Program Director (term ended June 2020)

y Dr. Jonathan How (effective July 2020)

y Dr. Jennifer Landry, Glen Site

Director (term ended June 2020)

y Dr. Maxime Cormier (effective July 2020)

y Dr. Khue Ly, MGH Site Director y Dr. Elise Levinoff, JGH Site Director

20 |

January 2020)

January 2020)

Gastroenterology

y Dr. Linda Ofiara Rheumatology

y Dr. Dean Soulellis

y Dr. Elizabeth Hazel (term ended June 2021)

Geriatric Medicine

y Dr. Fares Kalache (as of July 2021)

y Dr. Julia Chabot Hematology

y Dr. Chantal Cassis Medical Microbiology & Infectious Diseases

y Dr. Makeda Semret General Internal Medicine (R4–R5)

y Dr. Patrick Willemot

2020 Annual Report of the McGill Department of Medicine

Undergraduate Medical Education (UGME) – Internal Medicine component

Graduate Studies Program (Experimental Medicine)

y Dr. Nathalie Saad

y Dr. Anne–Marie Lauzon,

Chair, UGME Committee Clerkship Course Director Transition to Clinical Practice (TCP) Course Director

TCP Course Site Directors

y Dr. Tianyan Chen

(Glen – while Dr. Shaifali Sandal on parental leave in 2020)

Graduate Program Director

y Dr. Elizabeth Fixman,

Associate Program Director

y Dr. Shaifali Sandal (Glen – current)

Clerkship Course Site Directors

y Dr. Jason Agulnik (JGH)

y Dr. Tianyan Chen (Glen)

y Dr. David Shannon (MGH)

y Dr. Nathalie Saad (JGH)

y Dr. Les Meissner (SMH)

y Dr. Ratna Samanta (MGH)

y Dr. Moez Tajdin (Gatineau)

y Dr. Les Meissner (SMH) y Dr. Erica Rubin (Gatineau)

XVI.

Educational Leadership Positions in the Faculty of Medicine and Health Sciences Dr. Donald Boudreau has been appointed as Interim Director of the new Institute of Health Sciences Education.

Dr. Sabrina Fallavollita has been appointed to the position of Assistant Dean, Undergraduate Medical Education (UGME).

Dr. Beth-Ann Cummings has been appointed Assistant Dean, Health Professions Education.

Dr. Regina Husa was appointed to the position of Competency-based medical education (CBME) Lead, Postgraduate Medical Education (PGME) in 2020 and has been appointed to the role of Associate Dean, Postgraduate Medical Education (PGME) and Professional Affairs as of January 1, 2021.

Dr. Michelle Elizov has been appointed in the role of Associate Dean, Faculty Development.

Dr. Mélanie Mondou has been appointed Associate Dean, Undergraduate Medical Education (UGME).

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XVII.

The Ride of a Lifetime Profile of Phil Gold

by Ashley Rabinovitch

As Dr. Phil Gold prepares to retire from McGill University after six decades of service, his friends and colleagues paint a vivid portrait of an icon whose influence will be felt for generations to come.

In the fall of 1953, Dr. Phil Gold set foot on campus for the very first time. As he surveyed the stately porticos, the fresh–cut lawns, and the sea of unfamiliar faces, he turned to his best friend, Mortimer Levy, and said, “Mort, I’m going to leave this place better than I found it.”

And he did.

Over the next six decades, Dr. Gold’s accomplishments in cancer and immunology research, clinical practice, hospital administration, and teaching would become the stuff of legend. Now, at the age of 84, he has accumulated more letters than the alphabet behind his name and more awards and accolades than he can list from memory.

It would have been easy for someone who made a once–in–a–lifetime research breakthrough at 29 years old to rest on his laurels. Dr. Gold could have become arrogant or detached, content to inhabit an upper echelon of intellectual superstars without much interest in the everyday concerns of his patients, colleagues, or students. But that’s not what happened.

22 |

Finding the needle in a haystack As an undergraduate student in Honours Physiology at McGill, Dr. Gold never harboured any aspirations to attend medical school. “Frankly, I saw medicine as a distraction,” he admits. “I was much more interested in pursuing a career in research at the time.” When he complained to his mentor, Sir Arnold Burgen, that he had run out of physiology classes to take at McGill, Burgen convinced him to change course and apply to medical school.

Dr. Gold enjoyed medical school more than he anticipated and graduated with a handful of prizes to show for his efforts. After graduation, he began what would become a lifelong love affair with the Montreal General Hospital, an integral part of the McGill University Health Centre (MUHC). As the Montreal General celebrates 200 years, it’s hard to overstate the impact of Dr. Gold on the past 50.

Back in 1961, though, he was a first–year resident in internal medicine who was deeply grieved at the ravages of cancer.

“I saw so many patients who were suffering, and all we could do for them was fill them with radiation, drugs, and hope,” Dr. Gold remembers. “I thought there had to be a better way.”

2020 Annual Report of the McGill Department of Medicine

In 1963, Dr. Gold embarked on a PhD in physiology in the laboratory of Dr. Samuel Freedman, a clinical immunologist who would later serve as Dean of the Faculty of Medicine from 1977 to 1981. His career trajectory shifted dramatically when he came across a paper on immunologic tolerance.

The author had demonstrated that if researchers exposed an animal to a foreign molecule in utero or immediately after birth, they could fool the animal’s immune system into thinking that the molecule is native to their body.

After reading the paper, Dr. Gold hatched a plan to induce tolerance to normal human bowel tissues in a newborn rabbit. Sir Arnold Burgen tried to dissuade him, insisting that “the field of cancer research is littered with the bodies of people with good ideas.”

Dr. Richard Cruess, who preceded Dr. Fuks as Dean of the Faculty of Medicine from 1981 to 1995, was an attending orthopaedic surgeon at the Royal Victoria Hospital at the time of the discovery of CEA. “At that time, there was this feeling that wonderfully exciting things were happening in cancer immunology,” remembers Dr. Cruess. “Along with Sam Freedman, Phil really did create a whole new world of possibility in cancer research. That’s what makes him such an icon.”

Dr. Gold’s unusual experiment succeeded beyond anyone’s wildest dreams. He successfully induced tolerance to normal human bowel tissues in newborn rabbits, injected them with human colon cancer cells as adults, and searched for any differences in how the rabbits’ immune systems reacted to cancer cells compared to normal cells. He found what he was looking for: carcinoembryonic antigen (CEA), a protein that indicates the presence of cancer.

Once the word began to spread, Dr. Gold’s career took flight. The paper he co–authored was the most highly cited in the medical literature at one point in time, and the FDA soon recognized CEA as the first human tumour marker for cancer. To this day, clinicians use a CEA blood test to diagnose and manage certain types of cancer, particularly cancers of the large intestine and rectum.

Dr. Gold frequently remarks that three things determine the course of one’s life: “the genome, the epigenome, and the ‘fortunome,’—in other words, your genes, your environment and luck.” He designed an experiment in a way that removed the haystack to find the needle, and it worked.

“I was lucky, and I knew I was lucky,” he reflects. “I know me better than anyone knows me, and I’m not a genius.”

His contemporaries beg to differ. According to Dr. Abraham Fuks, another renowned McGill immunologist who previously served as Dean of the Faculty of Medicine from 1995 to 2006, Dr. Gold achieved a rare feat. “Aside from the fact that he was so young when it happened, his findings were monumental when you consider their lasting impact,” Dr. Fuks reflects. “Not many lab tests innovated in 1965 are still used clinically today. That’s remarkable. This is what happens when highly ambitious, talented people find ways to execute a creative idea.”

The grandfather of cancer research Dr. Gold and his colleagues leveraged the discovery of CEA to launch a new chapter in cancer research and clinical care at McGill. Dr. Fuks, who was a resident at the Montreal General at the time, still remembers the impression that Dr. Gold and his colleagues made on the people around them.

“Phil Gold, Sam Freedman, Joe Shuster, and David Hawkins worked so well as a group and demonstrated so much joy in their work that they influenced my own decision to choose immunology as a clinical and research career,” he affirms.

Dr. Gold and his research group relocated to the McIntyre Medical Sciences Building in 1968. He accepted a role as the first director of the newly inaugurated McGill Cancer Centre in 1978 while serving as a professor of medicine, physiology, and oncology at the Faculty of Medicine. The Centre evolved into the first university–based Department of Oncology in North America, which now includes the world–class Rosalind and Morris Goodman Cancer Research Centre.

| 23

“People like Dr. Gold saw the future,” says Dr. David Eidelman, the current Dean of the Faculty of Medicine and Health Sciences.

“Unlike most people of his time, he approached cancer as a subject of mechanistic inquiry instead of this mysterious, hopelessly untreatable disease.”

University between 1985 and 1990. Dr. Christos Tsoukas, who has served as Director of the Division of Clinical Allergy and Immunology at the McGill University Health Centre (MUHC) since 2007, was a resident when Dr. Gold made his return. In those years, the Montreal General was “very much a reflection of the past,” Dr. Tsoukas recalls. “Dr. Gold’s predecessor ran the hospital like an army general. He was so intimidating that your knees would start to buckle whenever you ran into him.”

The discovery of CEA has given rise to more than a few scientific careers over the years. Dr. Nicole Beauchemin, a principal investigator at the Goodman Cancer Research Centre, calls herself the “scientific granddaughter” of Dr. Gold, with her mentor, Dr. Abe Fuks, in the generation above her. “Phil is like the root of a very large, majestic oak tree,” she illustrates. “With the discovery of CEA, he opened up a new field of research and inspired dozens of research teams to build upon his work. Every year, the tree grows more branches.”

When Dr. Gold took the helm, the atmosphere shifted perceptibly. “Dr. Gold would go out of his way to relate to residents with enthusiasm and collegiality, and that’s an attitude that continues today through all of the directors and division leaders who were once residents,” says Dr. Tsoukas.

In 1986, Dr. Beauchemin contributed her experience in molecular biology and cloning to a Cancer Centre project designed to successfully clone the CEA gene. She and other researchers, both inside and outside of the McGill ecosystem, went on to discover nearly 30 more genes that all relate in some way to the original CEA protein. By using these proteins as markers to track, treat, and understand cancer cells, they can develop targeted therapies based on gene expression profiles.

Dr. Tsoukas highlights a truth that surprises many people who meet Dr. Gold for the first time: While he is often the most revered person in the room, he’s also the kindest.

“He’s always shaking your hand or giving you a hug,” says Dean Eidelman. “He has remarkably few enemies for someone at his level.”

According to Dr. Tsoukas, Dr. Gold is someone who would be called an “influencer” in today’s parlance, a cheerleader who rallies his team to greatness by setting an example.

“He has always encouraged, not dictated, while maintaining a healthy sense of humour,” says Dr. Tsoukas.

To Dr. Beauchemin, Dr. Gold is like a founding father whose footprints are visible everywhere she looks. “To this day, he still participates in meetings of the global CEA research community,” she shares. “That passion for discovery and possibility has never waned.”

If Dr. Beauchemin is a scientific granddaughter of Dr. Gold, Dr. Genevieve Genest is a great–granddaughter. Initially inspired to enter the field of immunology after an electrifying presentation by Dr. Gold in her undergraduate microbiology class, Dr. Genest is on track to become a clinician–researcher at the Montreal General. “He’s served as a mentor and a role model from the beginning,” she affirms. ‘’He’s the type of person who can see what makes a person tick, ignites and nurtures that passion, and unwaveringly supports his mentees until they reach their goals.”

Honey over vinegar In 1980, Dr. Gold returned to the Montreal General as Physician–in–Chief and simultaneously served as the Chairman of the Department of Medicine at McGill 24 |

‘’He’s the type of person who can see what makes a person tick, ignites and nurtures that passion, and unwaveringly supports his mentees until they reach their goals.”

DR. GENEVIEVE GENEST

2020 Annual Report of the McGill Department of Medicine

Dr. Tsoukas remembers the time when a visiting medical student from Greece was overwhelmed with excitement about meeting Dr. Gold, whose reputation had preceded him from across the globe. The student, who struggled to fully express himself in English, tried to tell Dr. Gold, “I want to be like you,” but what came out instead was, “I would like to be in your shoes.” With a twinkle in his eye, Dr. Gold took off his shoes and offered them to the bewildered student.

Dr. Gold has always maintained that people accomplish more with honey than with vinegar. “I genuinely enjoy being nice to people,” he affirms. “And when you’re nice to people, you find that they’re frequently nice to you.” But while kindness has always served him as a strategic asset, there is nothing calculating about his desire to make colleagues and patients feel seen and valued.

On one particularly memorable day, the condition of a terminal cancer patient at the Montreal General was declining quickly. The patient grew up on a farm in India, where people prefer to die as close to the land as possible.

Dr. Gold fulfilled his patient’s dying wish by wheeling him out to the hospital lawn, where he lay with his family members and caregivers for several hours as he took his final breaths.

As the sun rose, he died with dignity on the land. Dr. Gold sat with his patient for four hours on the lawn that day.

Untrammeled optimism When Dr. Gold accepted the role as Physician–in–Chief at the Montreal General, he encountered a dire financial situation. “I went to the cupboard, and the cupboard was bare,” he says. “We had no money to do what we needed to do.” At the next departmental meeting, he announced the “three percent solution,” a plan for closing the gaps by taxing everyone who made a patient income at three percent of that income.

No one climbs to the top of the ladder without the ability to make unpopular decisions and endure high levels of stress. Dr. Gold has seemingly mastered the art of paddling furiously beneath the surface while maintaining a calm, jovial exterior. Before taking over as Chair of the Department of Medicine at McGill, he re–read an entire textbook on internal medicine from cover to cover. For a full decade, he chain–smoked his way through long hours of reading and survived on four hours of sleep a night.

“There were often difficult days and sleepless nights,” he acknowledges, “but I tried to remain positive.” He would eventually quit smoking cold turkey out of a desire to spend more years with his beloved wife, Evelyn, whom he calls his “life,” and their three children.

“There is a lot of steel and ambition in him,” Dr. Cruess has observed. “But it’s all layered on top of this wonderful personality. Even the disagreements were fun.”

What strikes people most when they work with Dr. Gold in any capacity is his “untrammeled optimism,” says Dr. Fuks.

“He has this can–do attitude combined with energy, and that makes him come across as larger than life. When you walk into a room, you know he’s there.” According to Dean Eidelman, Dr. Gold could be so unrelentingly optimistic that he could come across as unrealistic at times. Even in the bleakest funding environments, he could be relied upon to focus on what could be done, not what couldn’t be done.

“He taught me that I have a significant ability to change my worldview if I choose to do so,” says Dean Eidelman.

Ultimately, Dr. Gold’s sunny outlook played an instrumental role in persuading donors to give generously and staff to economize willingly. By the time he stepped down in 1995 to become the Executive Director of the Clinical Research Centre at the MUHC, the cupboard was full again.

Passing the baton Despite his decades of accomplishment as a clinician– researcher, Dr. Gold places the greatest value on his teaching efforts. “Research is ultimately a shot in the dark,” he reflects.

“If you’re lucky, as I was, you win. But teaching the next generation is how you reproduce yourself.”

Dr. Fuks, who has written extensively on the power of metaphor in medical discourse and teaching, points to Dr. Gold’s famous use of metaphors in his immunology lectures. Former students like Dr. Genest can still recall in detail the way Dr. Gold likes to equate the immune system with two football teams, assigning each player on the team a role. “Phil knows how to tell a story rather than putting facts onto a board,” says Dr. Fuks.

Dr. Cruess and his wife, Dr. Sylvia Cruess, who once created a small group program to study professional identity formation, could always rely on Dr. Gold to light up a room with his quick wit and enthusiastic demeanor. “Phil in a small group with medical students is sheer magic,” Drs. Cruess have witnessed. “It’s hard to get him out of the room.”

Dr. Gold still teaches guest lectures when invited, but he is satisfied with the legacy he is leaving behind as he eases into retirement exactly 60 years after he became a first–year resident at the Montreal General. “That legacy is my students, my children, and my grandchildren, who have all gone on to do great things,” he affirms. “Now it’s their turn to carry the mantle. I’ve had the ride of a lifetime, and I’m grateful for it.”

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XVIII.

CIHR Operating Grants DOM punching above our weight at the LDI-JGH

ALL LDI–JGH

$22,716,758 25 M

ALL LDI–JGH ALL LDI–JGH

$22,080,631

$22,867,297

ALL LDI–JGH

$21,330,322 ALL LDI–JGH

$17,713,029 20 M

15 M

56.4% 44.7%

43.6%

56.1%

$ 9,970,793

$ 9,939,823

2016-2017

$ 9,868,430

5M

$ 9,405,467

10 M

2017-2018

2018-2019

2019-2020

$ 12,032,755

41.4%

DOM LDI–JGH

2020-2021

Reference period: LDI–JGH July 1–June 30

26 |

2020 Annual Report of the McGill Department of Medicine

DOM punching above our weight at the RI-MUHC

ALL RI–MUHC

$49,921,950

ALL RI–MUHC

$46,607,341

ALL RI–MUHC

ALL RI–MUHC

$44,171,070

50 M

ALL RI–MUHC

$45,447,035

$42,047,788

40 M

30 M

48.4% 41.3%

43.2%

45.1%

46%

$ 20,903,853

2017-2018

2018-2019

2019-2020

$ 24,173,329

$ 18,978,267

2016-2017

$ 19,085,426

10 M

$19,240,582

20 M

DOM RI–MUHC

2020-2021

Reference period: RI–MUHC April 1–March 31

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XIX.

Year over year DOM FRQS success 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.

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 success are many and include 1) protecting our FRQS funded scientists’ time for research, which is a cornerstone of research productivity that reflects 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!

90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Success Rate % 2017-18

Success Rate % 2018-19

Success Rate % 2019-20

DEPARTMENT MEDICINE

Success Rate % 2020-21

TOTAL - MCGILL

Success Rate % 2021-22

TOTAL - QUEBEC

Source: Research Office, Faculty of Medicine and Health Sciences

28 |

2020 Annual Report of the McGill Department of Medicine

XX.

FRQS Salary Awards (Spring 2020) Congratulations to DOM members who were successful in obtaining salary awards for applications submitted in 2019!

Chercheur Boursier Senior

Overall 83% (10/12) of our applicants were successful compared to a provincial average of 52% in the competition. 100% (3/3) of our Chercheurs Boursiers applicants were successful (compared to provincial average of 54%). 77% of our Chercheurs Boursiers Cliniciens were successful (compared to provincial average of 53%).

Chercheur Boursier Clinicien Chevronné

y Dr. Carolyn Baglole y Dr. Kristian Filion

y Dr. Matthias Friedrich

Chercheur Boursier Junior 1

Chercheur Boursier Clinicien Senior

y Dr. Antonios Douros

y Dr. Ariane Marelli y Dr. George Thanassoulis

Chercheur Boursier Clinicien Junior 2

y Dr. Evelyne Vinet y Dr. Sushmita Pamidi y Dr. Cedric Yansouni Chercheur Boursier Clinicien Junior 1

y Dr. Negareh Mousavi y Dr. Yen-I Chen | 29

XXI.

DOM Events (2020) The Department organizes three major events each year (see below) plus two information sessions – one for newly recruited faculty and the other for those who will be submitting an application to FRQS. Despite the COVID–19 pandemic, DOM faculty and staff organized two well–attended high quality events, albeit with virtual adjustments - it was Zoom all the way!

I. 2020 McGill Department of Medicine Research Symposium The virtual Symposium was held on November 10th, 11th and 12th, 2020 and was attended by more than 100 registrants. The audience was, as always, exposed to the excellent research being performed by members of the Department as well as the outstanding talks, from the keynote speakers.

Dr. Marc Rodger was the first keynote speaker.

He provided a stimulating account of his career as a researcher and the obstacles that he needed to overcome to reach his research goals. His inspiring talk emphasized the need for resolute determination, and how it led to the execution of clinical trials that answered important questions related to thrombosis.

The second Keynote speaker was Dr. Rita Redberg, professor of medicine at the University of California, San Francisco who presented her work on how less health care can have favourable effects on health. She covered areas of interest such as “deprescribing” of medications documenting the tendency to focus in practice guidelines on the intensification of treatments, with insufficient attention to low value services.

Dr. Oriana Yu described her observational study of a sodium glucose co–transporter inhibitor and the risk of below knee amputation in diabetic patients, providing reassuring evidence of the safety of this class of drug.

Dr. David Langleben provided a review of the pulmonary circulation and how pressures within the system are regulated during exercise through recruitment and distention of vessels. His elegant work resolved areas of controversy surrounding the issues related to pulmonary blood flow during exercise.

30 |

Dr. Anne–Marie Lauzon addressed the role of smooth muscle in the excessive airway narrowing of asthma. Her biophysical approaches revealed abnormal properties of airway smooth muscle in small airways and the influence of inflammatory mediators on these properties.

Dr. Giada Sebastiani reviewed the problem of no–alcoholic fatty liver disease, its causation, diagnosis and its interaction with other illness such as type II diabetes and HIV infection.

She detailed the role of novel non–invasive diagnostic tools.

Dr. Yves Longtin presented on the epidemiology of Clostridium difficile infections. He stressed the impact of this organism despite significant improvements in incidence rates. He provided a detailed analysis of the determinants of C. diff infections, including those occurring in Quebec.

Dr. Danuta Radzioch described the abnormalities of fatty acid metabolism in patients with defective or absent CFTR that leads to cystic fibrosis. She detailed the changes during exacerbations of CF and described the potential role of fenretinide in correcting the abnormal lipid metabolism.

Dr. Matthias Friedrich detailed the varied applications of magnetic resonance imaging in the assessment of cardiac disease. He described how MRI may be used to evaluate tissue damage, myocardial function, the vasculature and myocardial oxygenation.

Dr. Brent Richards described the basis for polygenic risk scores and illustrated their utility for the assessment of fracture risk in patients, reducing the need for the testing of bone density.

We extend thanks to the presenters and to Ms. Caroline Alcaraz, for the work done in organizing the event.

2020 Annual Report of the McGill Department of Medicine

III. The 5th Annual Department of Medicine Clinical Research Symposium on High Value Care This year’s high value healthcare symposium hosted by the Clinical Practice Assessment Unit took place online due to the pandemic. This was made possible because of the incredible support provided by Caroline Alcaraz and the DoM.

Dr. Joseph Hill

II. The Louis and Artur Lucian Award The 2019 winner of the prestigious Artur and Louis Lucian Award in Cardiovascular Science was Dr. Joseph A. Hill, M.D., Ph.D., Professor of Internal Medicine and Molecular Biology, and Chief of the Division of Cardiology and Director of the Harry S. Moss Heart Center at the University of Texas Southwestern Medical Center. Dr. Hill is a cardiologist– scientist whose research focuses on molecular mechanisms of remodeling in the disease–stressed myocardium. Dr. Hill’s research group is working to decipher mechanisms of structural, functional, metabolic, and electrical remodeling in heart disease with a significant focus on possible therapeutic intervention.

As part of the Lucian award, Dr. Hill visited Montreal (virtually) from October 5th to 9th, 2020. During his visit, Dr. Hill gave a Grand Rounds presentation shared between the McGill University Health Centre (MUHC) and the Jewish General Hospital (JGH) and a Lucian Lecture to a university–wide audience. Additionally, Dr. Hill animated several workshops that included researchers at the JGH, MUHC, Department of Pharmacology and the Montreal Heart Institute. Dr. Hill’s topics ranged from cardiac remodeling to ethical issues in publishing and maintained the high standards of scientific and clinical presentations that we have associated with the Lucian Award.

The theme of the conference was Quality in the Time of COVID; although we usually host this event in November, this year it took place in January. We were lucky to have keynote speakers join us virtually from across North America. Attendance was at an all–time high with close to 130 participants tuning in to the keynote speech. I was excited to co–host with Dr. Arielle Mendel, a new academic QI recruit to the Division of Rheumatology.

Dr. Vinay Prasad presented a dynamic talk that led some of us to scrutinize medical research results more carefully. He provided several interesting examples of blockbuster drugs whereby the trial methodology might have biased the main study findings. Dr. Lauren MacKenzie from the University of Manitoba gave an insightful overview of how to conduct outpatient COVID–19 research during the pandemic.

Many trainees presented their amazing high value medical research posters online and Dr. Amr Alwakeel took home the first–place prize in the always popular trainee abstract slam. He presented on the impact of a pleural care program on the palliation of malignant pleural effusions.

Locally, we featured work from Dr. Susan Bartlett on the importance of including patient reported outcomes in COVID–19 research and Dr. Laura Pilozzi–Edmonds described a root cause analysis of the COVID–19 response at Saint Mary’s Hospital. Finally, from Dr. Daniel Blum we learned that permissive underdialysis regimens during the pandemic could be both safe and effective. Thanks to all those who attended who helped organize this year’s symposium.

We look forward to seeing you all at next year’s event (virtual vs in person TBD)!

We look forward to an exciting visit from Dr. David Kass, the 2020 Lucian awardee to happen in the Fall 2021.

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32 |

2020 Annual Report of the McGill Department of Medicine

XXII.

Lessons Learned During COVID–19 Profile of a Pandemic Written by Caroline Phaneuf Edited by Diane Lewis The world had no idea what was to come when SARS–CoV–2 hit China in mid–December 2019. The confinement of Wuhan seemed extreme to many and few thought McGill and its teaching hospitals would be so affected a mere three months later. In record time, it was a rush to re–organize teaching, care and research, aiming to beat the worst pandemic in over a century.

“It’s amazing how wrong we can all be,” admitted Dr. Joyce Pickering, Executive Associate Physician–in– Chief at the McGill University Health Centre (MUHC) and Associate Chair, Education, McGill Department of Medicine.

“Up until late February, the idea of a lockdown in Montreal was inconceivable.” By March 13th, it was a new world not only in Montreal and in Quebec, but in our hospitals and our university.

Around March 10th, Dr. Marc Rodger, who had started his positions as Chair of the Department of Medicine & Physician–in–Chief at the MUHC on January 1st, saw alarming Tweets from colleagues in Milan. A few days later, he was awoken at 3 am due to the time difference with confirmation that the worst was true. “I immediately forwarded their response to the assistant deputy minister of health, who answered 20 minutes later saying ‘I can’t sleep either!’ That’s when it got really serious.”

Left: Dr. Joyce Pickering and Dr. Marc Rodger. Above: Dr. Joyce Pickering.

The JGH was one of the first four designated COVID–19 centres in Quebec. “We had planned to increase the ICU capacity to 100, because we expected many patients requiring specialized care,” explained Dr. Ernesto L.

Images by McGill University Health Centre - Medical Multimedia | 33

Schiffrin, Physician–in–Chief, Sir Mortimer B. Davis–Jewish General Hospital. “This ended up not to be the case, although we went from 24 ICU beds to 80. The reality is we’ve had patients that are not candidates for the ICU, despite having a regular influx of patients daily.”

This situation echoes what occurred at the MUHC’s Glen and MGH sites, which had also initially planned for more ICU beds and respirators. “In the beginning, we had a much higher staffing ratio of physicians to patients because we were concerned that we were going to have what we were seeing on TV in Italy and New York, where there were going to be young patients who were deteriorating before our eyes and we were needing to go to the ICU,” stated Dr. Kevin Schwartzman, Director of Respiratory Medicine at the MUHC, who led the creation of the COVID wards at the Glen with his team. “But in truth, as we know from statistics and media coverage in Quebec, that’s really not what happened. In fact, most of the people who have required hospitalization have been elderly. The number of patients who have required, and who have been suitable for intensive care, has been a relatively small minority,” Dr. Schwartzman added.

“It’s been an explosion of knowledge and it’s been both exciting to monitor and track it, and daunting” DR. MARCEL BEHR, Chief of Infectious Diseases at the MUHC

Members of the MUHC’s senior administration, via the Emergency Measures Coordinating Committee or Comité de coordination de mesures d’urgence, created a physical plan of both the Glen and the MGH, pinpointing which units could be used and in what sequence they would open.

The COVID ward at the Glen began with a small unit of eight patients, whereas the MGH began with 12 patients.

This progressively increased with the addition of more and more units over the course of the first three months of the pandemic.

The government left most logistical decisions up to individual institutions, giving only high–level guidance as to how to deal with COVID patients.

Another challenge in such a pandemic has been constantly providing excellent medical care and being ahead of the logistics game despite near daily new information. “It’s been an explosion of knowledge and it’s been both exciting to monitor and track it, and daunting,” stated Dr. Marcel Behr, Chief of Infectious Diseases at the MUHC, who worked in a COVID ward.

It is important to take note of what can be learned to help guide the response to future health crisis. “When there’s something new, one temptation is to say that old rule books and governance structures should be thrown away,” said Dr. Behr. “In fact, when there’s a new threat, this helps to reveal the strengths we already have, the teams we already have, the people, procedures and equipment we already have. The idea is to build upon existing strengths,” he stated.

McGill and the Faculty of Medicine had taken the very difficult decision to pull medical students back from hospitals to protect their safety, among other reasons. It was also immediately unclear whether residents could work in COVID wards, so staffing had to initially rely solely on staff doctors.

Above: Dr. Kevin Schwartzman. Image by McGill University Health Centre

Dr. Marc Rodger asked Respiratory Medicine to set up the COVID wards at the Glen. At the MGH, General Internal Medicine took the leadership role.

- Medical Multimedia

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2020 Annual Report of the McGill Department of Medicine

“Relatively early on, Dr. Rodger and I agreed to model our organization on a traditional Department of Medicine teaching ward, where we have a doctor overall in charge and that attending physician is usually on–duty for a week continuously, sometimes two,” explained Dr. Schwartzman, who was in charge of creating the medical manpower plan. These attendings would be from Respiratory and General Internal Medicine, as well as Infectious Diseases and Geriatrics. Working under him or her, would be “pseudo–residents” – staff physicians usually less familiar with COVID–type patients who had volunteered to help.

They would be scheduled on eight hour shifts, offering 24/7 coverage. A COVID unit would therefore be staffed by teams of five to six nurses, an attending physician, residents (in some cases), nurse practitioners, and “pseudo– residents”.

Over the course of the first three months of COVID wards, the “pseudo–residents” came from a wide array of disciplines. “For example, we had a number of dermatologists, whose daily practice is very far removed from what they’ve had to do in the COVID wards,” stated Dr. Schwartzman. Some specialists, who spend much of their time in the lab, volunteered for shifts, as did physicians from disciplines that are mostly outpatient.

A number of doctors from outside the Department, such as family physicians, also helped out. “We’ve also had some surgeons,” Dr. Schwartzman added. The “pseudo– residents” started by doing a few day shifts to re–familiarize themselves.

Above: Dr. Kevin Waschke. Image by Michael Cichon

Another key member of the staffing organization team was Dr. Kevin Waschke, from Gastroenterology and Hepatology.

protection gear and nurses and others to help, it became much less stressful .”

Dr. Waschke started his career as a soldier in 1992, at 21 years old, with the Canadian Grenadier Guards, later became an officer, a position he continued through his undergraduate studies and residency. This leadership training, coupled with his experience serving during the ’98 ice storm, offered good preparation for the COVID pandemic.

One of the biggest lessons learned for Drs. Rodger, Waschke and Schwartzman has been the importance of communication. Dr. Rodger explained, “Dr. Waschke provided me valuable battlefront advice. It’s been likened to a war in many different ways, and it’s true. In our first interaction, Kevin explained battlefield psychology. If it’s about command and control: 20% will fight, 80% will hide.

If you create culture of being “in it together”, making people realize it’s a worthy battle, then 80% come to fight. I always had that in mind in our communications and that’s what has happened for us,” he added.

Early on, Dr. Waschke helped lead the creation of a detailed inventory of available physician staffing resources.

Although the Department would have had the ability to decide which members were to work in COVID wards (i.e. “voluntell”), it was not necessary. “People pretty much volunteered,” stated Dr. Schwartzman. “As the units became more part of day–to–day practice and demystified, as people realized there was actually a high level of safety, and as people understood there was enough personal

Dr. Marcel Behr saw his division members contribute significantly to the COVID wards. He himself worked in a COVID ward at the Glen for seven days, with Dr. Don Sheppard, Director, McGill Interdisciplinary Initiative in Infection and Immunity as his “pseudo–resident”. “The most positive (part of the) experience was how controlled

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the environment was, how collegial the teams were, how everything had a place. The nurses and physiotherapists and occupational therapists and social workers were all really on the same side, looking to the same goals. You felt there was order,” he recalled.

The stress and anxiety related to working on the COVID wards came from a variety of sources and affected people in various ways. While some physicians have not been terribly affected, others have had a more difficult time, feeling quite depressed, anxious and very stressed, according to Dr. Schiffrin. “Several members of our team have had to lean over their dying patients with an iPad, trying to help the patient communicate with their family for likely the last time. The patients die alone, which has been very shocking to see and endure. It’s made the situation very stressful and emotional,” he added.

“I’ve seen some usually very calm, cool and collected docs that have a lot of difficulty dealing with what they’re experiencing on the COVID wards,” added Dr. Rodger.

Several physicians reported how depressing and stressful it has been to care for patients who are isolated from their families and loved ones. “I found it really tough to see that,” said Dr. Joyce Pickering.

Despite all this, the majority of the individuals who worked in the COVID wards expressed enthusiasm about returning and doing more than one week. “They have felt something

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heroic about it, despite the fact many are afraid to take the infection back to their families,” commented Dr. Schiffrin.

“I have to say we’ve seen the best in people here: they are dedicated, working passionately and heroically and exposing themselves without hesitating about what has to be done.”

“I think one of the things this pandemic will push us to do, as a society as a whole, is reflect on how little reserve we have in our healthcare system and our long–term care system,” suggested Dr. Rodger. “We will surely all collectively recognize that a lot of suffering could have been alleviated if we had had more reserve in the system.”

One of the most positive outcomes of these COVID wards at the MUHC has been a major step forward in breaking down silos.

“We’ve really witnessed a willingness to come together in teams between nurses, physicians and others that may have never worked together before,” commented Dr. Schwartzman. “The feedback has been universally positive.

“This has been a huge challenge,” concluded Dr. Rodger. “many human tragedies, death in isolation and great fear, but there have also been key, important, nimble and rapid collaborative transformations we need to keep after this adventure is over.”

2020 Annual Report of the McGill Department of Medicine

XXIII.

2020 Kudos McGill University Honours and Awards Dr. Emily Gibson McDonald and Dr. Todd Lee earned recognition for their MedSafer app, which tied for the 2020 Marika Zenka Roy Innovation Prize at the McGill Clinical Innovation Competition.

Dr. Barry Posner became the eleventh winner of the McGill University Medal for Exceptional Academic Achievement, one of the University’s highest honours.

Dr. Brent Richards has been named a William Dawson Scholar.

Dr. Ernesto Schiffrin has been bestowed McGill’s highest honour - the Distinguished James McGill Professor award.

Dr. Dean Soulellis received the UGME TCP Teacher award of excellence for Internal Medicine.

Dr. Ning-Zi Sun was awarded the inaugural Emerging Leader Award from McGill Postgraduate Medical Education.

Dr. Robyn Tamblyn has been bestowed McGill’s highest honour - the Distinguished James McGill Professor award.

* This list does not include numerous recognitions bestowed at the departmental and divisional levels.

External Honours and Awards Dr. Marcel Behr received the John Embil Award for Mentor of the Year from the Association of Medical Microbiology and Infectious Diseases.

Dr. Maziar Divangahi has been inducted as a member to the College of New Scholars, Artists and Scientists by the Royal Society of Canada.

Dr. Andrea Benedetti was appointed Deputy Director of the Canadian Statistical Sciences Institute.

Dr. Mathew Hannouche received the Medical Students Champion Award from the Canadian Federation of Medical Students.

Dr. Matthew Cheng has been selected as the recipient of the 2020 AMMI Canada Young Investigator Award by the Association of Medical Microbiology and Infectious Disease (AMM) Canada.

Dr. Inés Colmegna made Canadian Arthritis Society’s 2020 Top 10 Research Advances list.

Dr. David Dawson was awarded the 2020 Canadian Society of Internal Medicine Osler Award.

Dr. Natalie Dayan received the New Investigator Award 2020 from the Canadian Society of Internal Medicine.

Dr. William Foulkes is the recipient of the Prix Wilder-Penfield 2020 for biomedicine by the Quebec government.

Dr. Marina Klein was elected into the Canadian Academy of Health Sciences as new Fellow.

Dr. Isabelle Malhamé is the recipient of the 2020 Canadian Foundation for Women’s Health General Research Grant for her project “Improving the management of obstetric hypertensive emergency.”

Dr. Thomas Mavrakanas received the Canadian Society of Nephrology New Investigator Lectureship 2020 Award.

Dr. Emily Gibson McDonald was appointed to the Canadian Task Force on Preventive Health Care.

Dr. Martin Olivier received the 2020 Bernhard Cinader Award, the highest honour given by the Canadian Society for Immunology.

Dr. Jean-Pierre Routy made Nature’s Top 10 scientific discoveries of 2020.

Dr. Maida Sewitch was awarded the designation of Canadian Association of Gastroenterology Fellow.

Dr. Abhinav Sharma’s mobile app, MyHeart Counts Canada, was selected as a Healthy Futures Accelerator by the LEAP | Pecaut Centre for Social Impact.

Dr. Don Sheppard was named to the Board of Directors of GlycoNet. Dr. Peter Siegel is the recipient of the Scientific Distinction Award from the Quebec Breast Cancer Foundation.

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2020 Annual Report of the McGill Department of Medicine

XXIV.

Division Heads and Division Reports Divisions are the life–blood of an academic Department of Medicine.

Almost all clinical service, research and teaching are done at the Division level.

Our Department highly values and seeks to support the work done by our Divisions.

We hope you enjoy reading our Divisional spotlights as much as we did!

The McGill Department of Medicine comprises 13 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.

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Clinical Allergy & Immunology Leadership Dr. Christos Tsoukas (McGill / MUHC) Dr. Peter Small (JGH) Dr. Jan Schulz (SMH)

Report

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CLINICIAN SCIENTISTS & INVESTIGATORS PHDS CLINICIAN TEACHERS & EDUCATORS

Dr. Christos Tsoukas Profile photo taken by Owen Egan

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Kant S, N Zhang, A Barbé, JP Routy, C Tremblay, R Thomas, J Szabo, P Côté, B Trottier, R LeBlanc, D Rouleau, M Harris, RP Dupuy and NF Bernard. Polyfunctional Fc dependent activity of antibodies to native trimeric Envelope in HIV Elite Controllers.

Front Immunol. 2020 Sep 30;11:583820. doi: 10.3389/ fimmu.2020.583820. eCollection 2020. PMID: 33101312 E. E. Kroon, C. J. Kinnear, M. Orlova, S. Fischinger, S. Shin, S. Boolay, G. Walzl, A. Jacobs, R. J. Wilkinson, G. Alter, E. Schurr, E. G. Hoal and M. Möller. An observational study identifying highly tuberculosis–exposed, HIV–1–positive but persistently TB, tuberculin and IGRA negative persons with M. tuberculosis specific antibodies in Cape Town, South Africa. EBioMedicine, 61: 103053, 2020 Copaescu A, Mouhtouris E, Vogrin S, James F, Chua KYL, Holmes NE, Douglas A, Slavin MA, Cleland H, Zubrinich C, Aung AK, Goh MSY, Phillips EJ, Trubiano JA. The Role of In Vivo and Ex Vivo Diagnostic Tools in Severe Delayed Immune– Mediated Adverse Antibiotic Drug Reactions. Australasian Registry of Severe Cutaneous Adverse Reactions (AUS– SCAR).J Allergy Clin Immunol Pract. 2021 May;9(5):2010– 2015.e4. doi: 10.1016/j.jaip.2020.12.052. Epub 2021 Jan 13.PMID: 33453452 Alvarez F, Al–Aubodah TA, Yang YH, Piccirillo CA. Mechanisms of TREG cell adaptation to inflammation. J Leukoc Biol. 2020 Aug;108(2):559–571. doi: 10.1002/ JLB.1MR0120–196R. Epub 2020 Mar 23. PMID: 32202345

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Youssef, M., De Sanctis, JB., Shah, J. Dumut, DC., Hajduch, M., Petrof, B.J., Radzioch D. Age–dependent progression in lung pathophysiology can be prevented by restoring fatty acid and ceramide imbalance in cystic fibrosis.

Lungs (Springer Nature). 2020. Jun;198(3):459–469. doi: 10.1007/s00408–020–00353–2. Epub 2020 Apr 18. PMID: 32306138.)

Exciting Research in the Pipeline Supported by the European Regional Development Fund (2019–2024) – € 27 004 524 (Equivalent to $ 39,786,580 CAD) Molecular, Cellular and Clinical Approach to Healthy Aging Dr. Danuta Radzioch is one of four PIs. The project is conducted at four Research Centers The concept of immune system–mediated clearance of senescent cells is well established. The genotoxic effects of several cytokine species produced by senescent cells can spread damage in tissues manifested as secondary (and tertiary) senescence and thus contribute to ageing and to the pathogenesis of aging–associated diseases. Therefore, the elimination of senescent cells in humans may provide a rejuvenation effect, as has already been documented in mice. A series of studies to elucidate multidimensional interactions of cancer, stromal and immune cells during ageing and senescence will be conducted. The role of cancer in premature aging will involve the study of specific cancer–related signaling pathways and senescence models as well as patient studies to test the role of cancer and anti– cancer therapies in promoting and accelerating aging.

2020 Annual Report of the McGill Department of Medicine

National Institutes of Health USA (NIAID–NIH) (2016–2022) – $11 million CAD Mechanisms of Immune Protection from TB among HIV–infected Individuals (R01–AI–14–072) PI: Dr. Erwin Schurr People living with HIV are at increased risk of developing tuberculosis (TB) in endemic regions. In 2018, there were an estimated 1.45 million deaths caused by TB which included 250,000 HIV–positive people. The proposal aims at identifying genetic factors that protect HIV–infected persons who are exposed to the tubercle bacillus from becoming infected and developing TB disease. The findings will have major implications for the definition of innovative TB infection prevention strategies in the HIV–infected population and lead to reduced TB incidence in this highly TB vulnerable population.

CIHR Foundation grant (2015–2022) – $ 2,500,000 CAD Host genetic dissection of mycobacterial infection phenotypes PI: Dr. Erwin Schurr Tuberculosis (TB) and leprosy are the two main human mycobacterial diseases. The objective of the research is to define the functional validation of the main genetic vulnerabilities that govern the host pathogen interplay in TB and leprosy. The study aims at combining genetic susceptibility with systems biology to identify specific immune mechanisms that are protective for infection and/ or disease and thus leverage both innovative host tailored therapies and vaccine development. The results may lead to either gene expression or SNP based diagnostics for infection and risk of progression from infection to disease, two key problems for eradication of leprosy and control of TB. Hence, the expected results will exploit a better understanding of disease pathogenesis for improved disease control.

Impactful Clinical Innovation Multidisciplinary Eosinophilic Esophagitis (EoE) Clinic An exciting and innovative current clinical project recently initiated by our Division involves the establishment of a Multidisciplinary Eosinophilic Esophagitis (EoE) Clinic.

In the past decade, there has been a significant increase in atopic and food allergic disorders including EoE. Once considered a rare entity, eosinophilic gastrointestinal conditions have become more widespread. The complexity in the diagnosis and management of these conditions merits a collaborative approach. Therefore, the objective of this clinic is to provide multidisciplinary care for adults diagnosed with eosinophilic esophagitis, with experts in Allergy and Immunology, Gastroenterology, and Nutrition. This initiative is a first in the province and would encourage scholarly work within the field of EoE along with developing a teaching program for students and residents. Treatment of allergic comorbidities, nutritional consultation for diet therapy and endoscopic assessment of disease activity are all essential components of therapy and require a collaborative effort. The specific aim of this clinic is to address an unmet need and to provide benefit to an increasing number of patients who suffer from this condition with minimal currently available resources.

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Cardiology Leadership Dr. Nadia Giannetti (MUHC) Dr. Richard Haichin (MUHC Interim as of January 2021) Dr. Lawrence Rudski (JGH) Dr. Mathieu Walker (SMH)

Report – MUHC

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CLINICIAN SCIENTISTS & INVESTIGATORS PHDS CLINICIAN TEACHERS & EDUCATORS

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Abhinav Sharma, Neha Jadeja Pagidipati, Robert M. Califf, Darren K. McGuire, Jennifer B. Green, David L. DeMets, Jyothis Thomas George, Hertzel Chaim Gerstein, Todd Hobbs, Rury R. Holman, Francesca C. Lawson, Lawrence A. Leiter, Marc A. Pfeffer, Jane E.B. Reusch, Jeffrey S. Riesmeyer, Matthew T. Roe, Yves D. Rosenberg, Robert J. Temple, Stephen D. Wiviott, John J.V. McMurray, Christopher B. Granger. Impact of Regulatory Guidance on Evaluating Cardiovascular Risk of New Glucose–Lowering Therapies to Treat Type 2 Diabetes Mellitus: Lessons Learned and Future Directions. Circulation 141(10):843–862, 2020.

Hao Yu Chen, Benjamin J. Cairns, Aeron M. Small, Hannah A. Burr, Athithan Ambikkumar, Andreas Martinsson, Sébastien Thériault, Hans Markus Munter, Brian T. Steffen, Richard Zhang, Rebecca T.Levinson, Christian M. Shaffer, Jian Rong, Emily Sonestedt, Line Dufresne, Johan Ljungberg, Ulf Näslund, Bengt Erik Johansson, Dilrini K. Ranatunga, Rachel Anne Whitmer, M. Budoff, Albert Nguyen, Ramachandran S. Vasan, Martin G. Larson, William S. Harris, Scott M. Damrauer, Ken D. Stark, S. Matthijs Boekholdt, Nicholas J. Wareham, Philippe Pibarot, Benoît J. Arsenault, Patrick Mathieu, Vilmundur Gudnason, Christopher J. O’Donnell, Jerome I. Rotter, Michael Tsai, Wendy S. Post, Robert Clarke, Stefan Söderberg, Yohan Bossé, Quinn S. Wells, Julie Gustav Smith, Daniel J. Rader, Mark Lathrop, James C. Engert, George Thanassoulis. Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids with Aortic Stenosis. JAMA Cardiology 5(6):694–702, 2020.

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Mahyar Etminan, Mohit Sodhi, Saeed Ganjizadeh–Zavareh, Bruce C. Carleton, Abbas Kezouh, James M.Brophy. Oral Fluoroquinolones and Risk of Mitral and Aortic Regurgitation.

Journal of the American College of Cardiology 74(11):1444– 1450, 2019.

Andrade JG, Wells GA, Deyell MW, 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, Macle L, Verma A; EARLY– AF Investigators. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. New England Journal of Medicine. 2020 Nov 16.

Li Y, Nair P, Lu XH, Wen Z, Wang Y, Dehaghi AAK, Miao Y, Liu W, Ordog T, Biernacka JM, Ryu E, Olson JE, Frye MA, Liu A, Guo L, Marelli A, Ahuja Y, Davila–Velderrain J, Kellis M. Inferring multimodal latent topics from electronic health records. Nature Communications. 2020 May 21;11(1):2536.

Exciting Research in the Pipeline Courtois Signature Project (2018–2023) – $10 million PI: Dr. Matthias Friedrich Co–led by Dr. Nadia Giannetti and Dr. Friedrich, The Courtois Cardiovascular Signature Program is a unique study aiming to personalize cardiovascular health, based on the unique combination of your genetic, microbiotic, environmental, and other factors. (cvsignature.ca).

CIHR (2016–2021) – $3 million Child–Bright PI: Dr. Ariane Marelli Part of a $25M SPOR initiatives, directed out of the Montreal Children’s Hospital, this initiative improves outcomes for children with brain–based disabilities. Led by Dr. Marelli, a transition of care digital health intervention was designed in Montreal and is being deployed in a clinical trial across Canada. (www.child–bright.ca).

Impactful Clinical Innovation The Satoko Shibata Family Heart Centre: Bringing Genomics and Precision Medicine to Cardiovascular Care The Satoko Shibata Family Heart Center seeks to be a center of excellence in providing clinical care to patients with inherited cardiovascular disease and will allow McGill University to continue to be at the forefront of cardiovascular genetic research. The Family Heart Center, inaugurated in April 2021 will combine sophisticated state– of–the–art technologies to help understand the root cause of inherited diseases. The integration of the rapidly evolving 2020 Annual Report of the McGill Department of Medicine

fields of genomics, imaging technologies, and cardiac procedures provides a detailed assessment of the entire genome, as well as, a complete structural characterization of heart, allowing us to markedly improve our diagnostic capabilities for inherited heart disease.

This cardiovascular genetics centre, will provide a multi– disciplinary approach for the diagnosis, prevention, and treatment of cardiovascular patients and their families.

Led by Drs. Jacqueline Joza and George Thanassoulis, patients are referred from academic and community institutions alike for evaluation. Patients will have the opportunity to work with a multidisciplinary team of health professionals comprised of dedicated nurses, cardiologists, genetic counselors, and geneticists specialized in the management of inherited cardiovascular disease. As a quaternary care center, research is the major focus of the Family Heart Center. The research will expand on several areas of concentration in cardiovascular disease including the ongoing MUHC CV signature program.

Report – JGH

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CLINICIAN SCIENTISTS & INVESTIGATORS PHDS CLINICIAN TEACHERS & EDUCATORS

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Eisenberg MJ, Hébert–Losier A, Windle SB, Greenspoon T, Brandys T, Fülöp T, Nguyen T, Elkouri S, Montigny M, Wilderman I, Bertrand OF, Bostwick JA, Abrahamson J, Lacasse Y, Pakhale S, Cabaussel J, Filion KB; E3 Investigators.

Effect of e–Cigarettes Plus Counseling vs Counseling Alone on Smoking Cessation: A Randomized Clinical Trial. JAMA. 2020 Nov 10;324(18):1844–1854. doi: 10.1001/jama.2020.18889.

Bendayan M, Messas N, Perrault LP, Asgar AW, Lauck S, Kim DH, Arora RC, Langlois Y, Piazza N, Martucci G, Lefèvre T, Noiseux N, Lamy A, Peterson MD, Labinaz M, Popma JJ, Webb JG, Afilalo J. Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY–AVR Study. JACC Cardiovasc Interv. 2020 May 11;13(9):1058–1068 Semsar–kazerooni K, Dima D, Valiquette J, Berube–Dufour J, Goldfarb M. Early Mobilization in People with Acute Cardiovascular Disease. Can J Cardiol. 2020.

S0828–282X(20)30311–1. doi: 10.1016/j.cjca.2020.03.038

One aspect of the center will focus on patients with inherited arrhythmias (for eg. long QT syndrome, brugada syndrome, catecholaminergic polymorphic VT and arrhythmogenic cardiomyopathy) from diagnosis to management, as well as for the prevention of sudden cardiac death in family members. Patients with a primary heart failure presentation (such as dilated and hypertrophic cardiomyopathies) will similarly undergo relevant genetic evaluation. The arrhythmia service is actively involved in leading and collaborating in numerous Canadian and International studies that will be offered to these patients.

The other major aspect of the center will focus on the inherited causes of myocardial infarction, and lipid disorders.

The use of novel risk markers (including but not limited to detailed genomic profiles, advanced lipoprotein testing (i.e. Lp(a) and apoB measurement), non–invasive imaging techniques (using computed tomography) and cutting edge novel magnetic resonance imaging will be used to provide a personalized and refined risk assessment for our families.

Hirani N, Brunner NW, Kapasi A, Chandy G, Rudski L, Paterson I, Langleben D (Co–Chair), Mehta S, Mielniczuk L; CCS/CTS Pulmonary Hypertension Committee. Canadian Cardiovascular Society/Canadian Thoracic Society Position Statement on Pulmonary Hypertension. Can J Cardiol. 2020 Jul;36(7):977–992. doi: 10.1016/j.cjca.2019.11.041.

Lawrence Rudski, James L. Januzzi, Vera H. Rigolin, Erin A. Bohula, Ron Blankstein, Amit R. Patel, Chiara Bucciarelli– Ducci, Esther Vorovich, Monica Mukherjee, Sunil V. Rao, Rob Beanlands, Todd C. Villines, Marcelo F. Di Carli. Multimodality Imaging in Evaluation of Cardiovascular Complications in Patients With COVID–19: JACC Scientific Expert Panel. J Am Coll Cardiol. 2020 Sep 15; 76(11): 1345–1357.

Exciting Research in the Pipeline CIHR Project Grant Vaping Safety: A Knowledge Synthesis PI: Dr. Mark Eisenberg; Co–Investigators: Dr. Andrea Benedetti, Dr. Carolyn Ells, Dr. Kristian Filion, Dr. Roland Grad (Family Medicine), Dr. Brett Thombs (Psychiatry) CIHR Operating Grant (2020) – $ 937,950 COVID–19 May 2020 Rapid Research Funding Opportunity, 2020 – A Collaborative Data Analysis Platform to Improve Clinical Care in Patients with COVID–19 Co–PI: Dr. Jonathan Afilalo CIHR Project Grant (2020–2024) – $ 428,400 Geriatric Intervention for Frail Heart Failure patients: The GIF–HF Trial PI: Dr. Jonathan Afilalo | 43

Impactful Clinical Innovation

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Balloon Pulmonary Angioplasty (BPA) Program The Jewish General Hospital’s Center for Pulmonary Vascular Diseases is an internationally recognized center of excellence, established approximately 35 years ago

by Dr. David Langleben. Its multidisciplinary approach incorporates the Divisions of Pulmonary Medicine, Rheumatology and the JGH’s Thrombosis Center as well as the Division of Cardiac Surgery. It provides translational care including new discoveries in mechanisms of pulmonary vascular recruitment, first in man therapy and state–of–art surgery and interventions. The Balloon Pulmonary Angioplasty Program, led by Dr. Ali Abualsaud is one example of our culture of innovation.

Research

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Established to provide treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH) to pulmonary endarterectomy that are not candidates for pulmonary endarterectomy. It is one of a few programs around the world, 1 of 2 in Canada and is the only cardiology lead program nationally.

Clinical Volumes:

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As of December 31, 2020, approximately 65 BPA sessions were performed in nearly 50 patients. A lot of effort has been put into ramping up our BPA volumes from 1–2 a month in the first year to 1–3 per week at the current time.

Traditionally, each patient requires an average of 3–4 BPA sessions. However, as we have gained more experience and with resource pressures related to COVID–19, we have developed a more aggressive approach. As a result, we are seeing significant improvements frequently with fewer treatments on a more accelerated time frame.

Outcomes

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Historically, BPA was known to be an effective procedure but the risk of major or fatal complications led to a loss in interest. In 2017, The Japanese registry reported the outcomes of multiple centers in Japan lead by Dr. Hiromi Matsubara from Okayama, Japan.

Efficacy of the 60 BPA session at the JGH was variable and dependent on multiple factors including, location of disease, the presence of total occlusions, and patient cooperation. Overall, clinical improvement markedly exceeded our expectations with most patients having symptomatic improvement.

We are in the process of writing up our initial experience which should be the first published Canadian experience of the use of BPA in patients with CTEPH.

5–year growth plan

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Objectives:

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In summary, we have demonstrated efficacy and safety of BPA and had a major impact on the management of patient with CTEPH.

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As more international registries on BPA are published, it is very likely that randomized trials for BPA versus pulmonary endarterectomy will ensue particularly for CTEPH patients with distal disease and we expect to participate in these trials. It is certainly possible that BPA becomes a first line therapy for many patients which will increase the volumes.

As we publish our results and gain more expertise in this therapy, our referral base is widening. We are committing additional resources to this unique program, to meet the demand.

St. Mary’s Hospital: Impactful Clinical Innovation Creation of Nurse Practitioner Managed Heart Failure Clinic We have recently hired 2.5 Cardiology Nurse Practitioners.

Our project would be to create a specialized heart failure clinic run by the NPs with a dedicated physical space and administrator. Heart failure continues to impose a heavy burden on society especially as the patient population ages. Heart failure is one of the most common reasons for admission to hospital. Patients with this condition have a high readmission rate and frequently visit the emergency dept. Any measure put in place to better treat these patients using guideline–driven medical and device therapy has been shown to reduce hospitalization rates. Our heart failure clinic has been run out of the medical day center for many years now and limited to Friday mornings. Now that we have nurse practitioners, we would like to have them assess and follow these sick patients in partnership with the SMH cardiologists. For this to happen, a new clinical space would need to be built and an administrative agent hired.

2020 Annual Report of the McGill Department of Medicine

Clinical Epidemiology Leadership Dr. Robyn Tamblyn (MUHC) Dr. Samy Suissa (JGH)

Report – MUHC

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PHDS

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Robinson ME, Simard M, Larocque I, Shah J, Nakhla MM, Rahme E. Risk of Psychiatric Disorders and Suicide Attempts in Emerging Adults with Diabetes. Diabetes Care. 2020 Feb;43(2):484–486.

Tratt, E. Sarmiento, I., Gamelin, R. Nayoumealuk J, Andersson N, Brassard P. Fuzzy cognitive mapping with Inuit women: what needs to change to improve cervical cancer screening in Nunavik, northern Quebec? BMC Health Serv Res 20, 529 (2020) June https://doi.org/10.1186/s12913– 020–05399–9 Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, Skipper CP, Nascene AA, Nicol MR, Abassi M, Engen NW, Cheng MP, LaBar D, Lother SA, MacKenzie LJ, Drobot G, Marten N, Zarychanski R, Kelly LE, Schwartz IS, McDonald EG, Rajasingham R, Lee TC, Hullsiek KH. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for COVID–19. N Engl J Med. 2020 Jun 3:NEJMoa2016638. doi: 10.1056/NEJMoa2016638 Drolet M, Bénard E, Pérez N, Brisson M et al (Brassard P).

HPV Vaccination Impact Study Group. Population–level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta–analysis. The Lancet. 2019 Jun 26. pii: S0140–6736(19)30298–3. doi: 10.1016/S0140– 6736(19)30298–3.

Exciting Research in the Pipeline Canadian Foundation of Innovation (2017–2023) – $ 4,938,349 Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation (BRILLIANT) PI: Dr. Sara Ahmed The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation (BRILLIANT–Rehab) program aims to provide evidenced–based research to improve rehabilitation for individuals with Acquired Brain Injury. Bringing together researchers from both McGill and the University of Montreal, the vision of the BRILLIANT Rehab program is to optimize mobility of persons with acquired brain injury (ABI) across the lifespan. The program will develop and deploy a comprehensive clinical and community based mobility monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions optimized for specific patient sub–groups. These innovations will be used by front–line clinicians to deliver cost–effective care. It’s known as the right intervention to the right person at the right time and accounts for long–term functional potential and meaningful participation in the community.

Impactful Clinical Innovation Digital Health Innovation The Division is leading the development of a potential Institute of Digital Health Innovation in collaboration with the Department of Surgery. To kick off the strategy the Division planned a 3–day symposium (June 2–4) to showcase teams at McGill and in the academic health network that are involved in digital health innovations with the aim of identifying common challenges, opportunities, and resource requirements. A post–symposium consensus building meeting was convened in late June to summarize common challenges and opportunities and develop a white paper for outlining the strategy for moving forward. This initiative builds on the newly developed CLIP platform in surgery that provides a living laboratory in the clinical environment to evaluating innovations for improving clinical care and patient outcomes, and the new concentration in digital health innovation for training the next generation of highly qualified personnel in this area.

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Clinical Epidemiology cont.

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5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Giorgianni F, Ernst P, Dell’Aniello S, Suissa S, Renoux C. β 2–Agonists and the Incidence of Parkinson Disease. Am J Epidemiol 2020 ;189(8):801–810. doi: 10.1093/aje/kwaa012.

Douros A, Lix LM, Fralick M, Dell’Aniello S, Shah BR, Ronksley PE, Tremblay E, Hu N, Alessi–Severini S, Fisher A, Bugden SC, Ernst P, Filion KB for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators.

Sodium–glucose co–transporter 2 inhibitors and the risk of diabetic ketoacidosis: A multicenter international cohort study. Ann Intern Med 2020;173:417–425.

Douros A, Renoux C, Yin H, Filion KB, Suissa S, Azoulay L. Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation. Am J Med. 2019;132(2):191–199.

Loo S, Azoulay L, Nie R, Dell’Aniello S, Hoi Yun Yu O, Renoux C. Cardiovascular and cerebrovascular safety of testosterone replacement therapy among aging men with low testosterone levels: a cohort study. Am J Med 2019. Sep;132(9):1069– 1077.e4. doi: 10.1016/j.amjmed.2019.03.022.

L Jiang, K Oualkacha, V Didelez, A Ciampi, P Rosa–Neto, AL Benedet, S Mathotaarachchi, JB Richards, CMT Greenwood, and for the Alzheimer’s Disease Neuroimaging Initiative (2019). Constrained instruments and their application to Mendelian randomization with pleiotropy. Genetic Epidemiology 2019;43(4): 373–401. doi:10.1002/gepi/.22184.

Exciting Research in the Pipeline Canadian Institutes of Health Research, Canadian Network for Observational Drug Effect Studies (CNODES) (2016–2021) – $ 17,500.00 PI: Dr. Samy Suissa The Canadian Network for Observational Drug Effects Studies (CNODES) is a network of over 120 Canadian

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researchers, analysts and trainees, funded by CIHR and DSEN, headquartered at the JGH–LDI Division of Clinical Epidemiology and headed by Dr. Suissa. At the Provincial level, CNODES has established close collaborations with INESSS, with whom they are currently working for example on a series of multi–database pharmacoepidemiology studies on the safety and effectiveness of the newer antidiabetic drugs. At the Canadian level, CNODES collaborates directly with Health Canada on studies of drug safety (cardiovascular, pregnancy, diabetes, infections, etc…) and with CADTH on studies of drug safety and effectiveness in the real–world setting. Two yearly CNODES meetings conducted in Canada bring together over 100 participants to share and learn about new methodologies to study drug safety. CNODES has also conducted studies within a collaboration between Health Canada and the European Medicines Agency on the safety of the newer oral anticoagulants, and is now establishing links to collaborate with the FDA’s Sentinel Initiative. At the wider international level, collaborations have been established with researchers and database holders from France, Italy, Taiwan and Israel to conduct joint international studies on drug safety for infrequently used drugs. These initiatives have been the object of workshops on worldwide collaborations organized

by CNODES members in several international conferences and have attracted a large number of trainees and post– docs to the LDI.

Canada – Germany collaborative industrial R&D program (National Research Council of Canada & German Federal Ministry for Economic Affairs and Energy) – (2020–2022) – $ 2,334,622 AIR_PTE – AI based risk prediction and treatment effect estimation based on health claims data PI: Dr. Antonios Douros AIR_PTE aims to develop artificial intelligence (AI) based methods to improve and automate treatment effect estimation, ultimately supporting multiple evaluations and therapy decisions at the clinical point of care. The methods will be developed and compared within the context of treatment of venous thromboembolism using administrative healthcare data from Quebec and Germany, and then generalized in further settings. This 2–year project is funded with €700,000 by the Canada – Germany collaborative industrial R&D program (National Research Council of Canada and German Federal Ministry for Economic Affairs and Energy). The McGill Department of Medicine (with Dr. Antonios Douros as representative) participates as an associated non–funded partner.

2020 Annual Report of the McGill Department of Medicine

CIHR Project Grant (2018–2022) – $ 5,340,000 Estimating the effect size of rare genomic variants on cognitive and behavioural traits underlying neurodevelopmental disorders Co–PI: Dr. Celia Greenwood (Oncology) Children are referred to the developmental pediatric clinic for a broad range of neurodevelopmental disorders (NDs) including intellectual disabilities (ID), severe learning disabilities, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), speech and language disorders, motor and coordination disorders. The genetic contribution to these NDs ranges from 50 to 80%.

Whole genome chromosomal microarrays (CMA) are now well established as a first–tier clinical diagnostic test for NDs. CMAs allow genome–wide identification of copy number variants (CNVs), which are either deletions or duplication of genomic fragments larger than 1kb. In the clinical setting, the American College of Medical Genetics classifies CNVs in three categories5 : i) “pathogenic” (contributes to disease), ii) “Variants of unknown significance” (VUS) and iii) “Benign”, which don’t contribute to disease. CNVs are classified as “pathogenic” because they disrupt a gene or a genomic region associated with altered neurodevelopment. The routine implementation of CMAs in medical diagnostics currently identifies “pathogenic” CNVs in 10 to 15 % of children with NDs. With the implementation of whole exome sequencing as a routine diagnostic procedure in the developmental clinic, the number of rare variants (in the form of Single nucleotide variants – SNVs) identified in patients will increase dramatically. For most rare variants reported back to patients, there are few or no data characterizing their effect on cognition and behavior. Because effect sizes of rare variants on continuous traits are undocumented, it is difficult for clinicians to estimate the precise contribution of a rare CNV or SNV to neurodevelopmental symptoms in given a patient. This knowledge gap is due to 2 issues: 1) Most “pathogenic” CNVs and SNVs are “non–recurrent”.

Because they are observed only once or a few times in patients, it is impossible to reach the statistical power required for individual association studies. 2) Most studies have focussed on associating mutations with complex categorical diagnoses such as autism or ID. However, it is thought that these diagnoses result from the alteration of several cognitive and behavioral traits, and the impact

of rare mutations on these dimensions remain unknown.

Instead of studying CNVs individually, this grant proposed to develop and implement analytic methods for characterizing, scoring and estimating the nature and function of the CNVs and their impact on NDS. The concept builds on data suggesting that mutations disrupting genes with shared characteristics (eg. constraint scores, co–expression modules during stages of brain development, function relevant to NDS such as synaptic function, etc.) may converge on cognitive mechanisms.

Impactful Clinical Innovation Sodium–glucose cotransporter–2 (SGLT2) inhibitors are a newer class of antidiabetic drugs that have shown favorable effects in cardiovascular outcome trials and are currently recommended as second– to third–line treatments in the management of type 2 diabetes. In 2018, the Canadian Network for Observational Drug Effect Studies (CNODES), led by the Division, initiated a large multicenter project to assess the effectiveness, and safety of SGLT2 inhibitors among patients with type 2 diabetes in real–world clinical practice. Electronic healthcare databases from 7 Canadian provinces and one from the UK. Studies were also conducted on the safety of sulfonylureas. This wide project involved several members of the Division who each led parts of this large undertaking.

Specifically, we assessed the risk of major adverse events with SGLT2 inhibitors in the real–world context of clinical practice, including cardiovascular events, death, below– knee amputation, urosepsis and diabetic ketoacidosis.

The safety of sulfonylureas revolved around cardiovascular events and hypoglycemia. Members of the Division led these efforts with the results published or submitted for publication in major journals: British Medical Journal, Diabetes Care, Diabetes Obesity and Metabolism, and Annals of Internal Medicine and the American Journal of Medicine. These studies will provide useful insight regarding the use and effects of SGLT2 inhibitors and sulfonylureas in real–world clinical practice. They will help inform patients and regulators, as well as aid clinical decision making in balancing risks and benefits when prescribing pharmacotherapy for type 2 diabetes.

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Dermatology Leadership Dr. Linda Moreau (McGill / MUHC) Dr. Robin Billick (JGH)

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5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Ghazawi FM, Cyr J, Darwich R, Le M, Rahme E, Moreau L, Netchiporouk E, Zubarev A, Roshdy O, Glassman SJ, Sasseville D, Litvinov IV. Cutaneous malignant melanoma incidence and mortality trends in Canada: A comprehensive population–based study. J Am Acad Dermatol. 2019 Feb; 80(2): 448–459. doi: 10.1016/j.jaad.2018.07.041. Epub 2018 Aug 6.

Ratnarajah K, Le M, Muntyanu A, Mathieu S, Nigen S, Litvinov IV, Jack CS, Netchiporouk E. Inhibition of IL–13: A New Pathway for Atopic Dermatitis. J Cutan Med Surg.

2020 Dec 22:1203475420982553.doi:10.1177/120347 5420982553. Epub ahead of print. PMID: 33350863.

Gabrielli S, Le M, Netchiporouk E, Miedzybrodzki B, Baum S, Greenberger S, Staubach–Renz P, Ben–Shoshan M. Chronic urticaria in children can be controlled effectively with updosing second–generation antihistamines. J Am Acad Dermatol. 2020 Jun;82(6):1535–1537. doi: 10.1016/j. jaad.2020.02.041. Epub 2020 Feb 21. PMID:32088268.

Le M, Ghazawi FM, Netchiporouk E, Litvinov IV. The Novel Role of Antibiotic Treatment in the Management of Cutaneous T–Cell Lymphoma (CTCL) Patients. J Cutan Med Surg. 2020 Jul/Aug;24(4):410–411. doi:10.1177/1203475420926981.

Epub 2020 May 12. PMID: 32394726.

Exciting Research in the Pipeline CIHR Project Grant and CIHR Priority Announcement (5 years) – $ 573,000 & Early Career Investigator in Cancer – $ 25,000 Prize Ectopic reactivation of normally silenced germ cell programs contributes to genomic instability, carcinogenesis and cancer progression in Cutaneous T–Cell Lymphomas (CTCL) PI: Dr. Ivan V. Litvinov; Co–Applicant: Dr. Jean–Jacques Lebrun This project will study the role of cancer meiomitosis, a new process describing the clashing of mitosis and meiosis machineries during the cell cycle, in driving genomic instability and cancer progression in Cutaneous T–Cell Lymphoma. The study is poised to answer a number of important questions leading to improved understanding of the key drivers of genomic instability in CTCL and elucidation of the biologic significance of cancer meiomitosis with major implications for Dermatology and Oncology and potential impact on patient care.

Canadian Dermatology Foundation (2020–2023) – $205, 000 Canadian Atopic Dermatitis Cohort for Translational Immunology and Imaging Co–Investigator: Dr. Carolyn Jack Dr. Jack’s RI–MUHC lab is leading the fundamental research components of this study, and receiving 205,000 CAD (34% of total award) over the next three years, for human cutaneous and circulating Tcell immunophenotyping correlates of skin disease.

MITACS grant with Quebec Industry Innovaderm Research Inc. (2020–2021) – $ 45,000 Severity of disease and skin T cells in adult atopic dermatitis Dr. Carolyn Jack This industry–partnership grant supports learners in Dr. Jack’s lab. Current work combines world–class expertise for effectuating human clinical studies with my state–of– the–art RI–MUHC immunophenotyping platform, expertise and qualified team that is now into its third year.

Jfri A, Netchiporouk E, Raymond K, Litvinov IV, O’Brien E. Association of Clinical Severity Scores with Psychosocial Impact in Patients with Hidradenitis Suppurativa. J Am Acad Dermatol.

2020 Aug 8:S0190–9622(20)32410–5. doi:10.1016/j. jaad.2020.08.022. Epub ahead of print. PMID: 32781189.

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2020 Annual Report of the McGill Department of Medicine

Impactful Clinical Innovation Founding of first tertiary care adult atopic dermatitis clinic in Canada, Digital Health Transformation, and establishment of Eczema Quebec.

Dr. Carolyn Jack’s work establishing the McGill University Hospital Network Center for Excellence in Adult AD is recognized internationally and by the Canadian Dermatology Association with a National Public Education Award. A patient–engagement platform involves integrated knowledge translation and participatory research, as it

pertains to clinical and/or translational studies as well as to the development of innovative digital clinical tools. This co–developed a mobile health application ‘EczemaQ’, for which there is an ROI and expanding industry partnerships.

The digital application downloads to patients’ smart phones and delivers evidence–based knowledge for participatory research and clinical disease management in accordance with international guidelines. The myEczema option allows for consented and secure patient data collection, disease severity tracking, and objective image capture of disease flare or remission.

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Endocrinology & Metabolism Leadership Dr. George Fantus (McGill / MUHC) Dr. Mark Trifiro (JGH) Dr. Les Meissner (SMH)

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Dr. George Fantus

CLINICIAN TEACHERS & EDUCATORS

Profile photo taken by Owen Egan

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Niaz Mahmood, Ani Arakelian, Haseeb Ahmed Khan, Imrana Tanvir, Andrew P. Mazar and Shafaat A. Rabbani. Anti– urokinase receptor (uPAR) antibody (huATN–658) blocks breast cancer growth and skeletal metastasis; effects which are potentiated in combination with Zometa. Bone Research.

2020,8:18. doi: 10.1038/s41413–020–0094–3.

V Forgetta, J Keller–Baruch, M Forest, A Durand, S Bhatnagar, JP Kemp, M Nethander, D Evans, JA Morris, DP Kiel, F Rivadeneira, H Johansson, NC Harvey, D Mellström, M Karlsson, C Cooper, DM Evans, R Clarke, JA Kanis, E Orwoll, EV McCloskey, C Ohlsson, J Pineau, WD Leslie, CMT Greenwood, JB Richards.(2020) Development of a Polygenic Risk Score to Improve Screening for Fracture Risk: A Genetic Risk Prediction Study. PLoS Med [IF:9.4]. 2020 Jul 2;17(7):e1003152. doi: 10.1371/journal.pmed.1003152. eCollection 2020 Jul. Haidar, A., M.A. Tsoukas, S. Bernier–Twardy, J.–F. Yale, J. Rutkowski, A. Bossy, E. Pytka, A. El Fathi, N. Strauss, and L. Legault. A novel dual–hormone insulin–and–pramlintide artificial pancreas for type 1 diabetes: a randomized controlled crossover trial. Diabetes care, 2020. 43(3): p. 597–606.

Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, Kolkhof P, Nowack C, Schloemer P, Joseph A, Filippatos G; FIDELIO–DKD Investigators. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type

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2 Diabetes. N Engl J Med. 383(23):2219–2229, 2020. doi: 10.1056/NEJMoa2025845. Epub 2020 Oct 23.PMID: 33264825 J–F Yale Endocrinology MUHC site.

Feig DS, Donovan LE, Zinman B, Sanchez JJ, Asztalos E, Ryan EA, Fantus IG, Hutton E, Armson AB, Lipscombe LL, Simmons D, Barrett JFR, Karanicolas PJ, Tobin S, McIntyre HD, Tian SY, Tomlinson G, Murphy KE; MiTy Collaborative Group. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo–controlled trial. Lancet Diabetes Endocrinol. 2020 Oct;8(10):834–844. doi: 10.1016/S2213–8587(20)30310–7.

PMID: 32946820 Clinical Trial.

Exciting Research in the Pipeline Canadian Foundation for Innovation – $ 691,891 Infrastructure for the Biobanque Québec COVID–19: A scientific platform for Canadian COVID19 Open Science Research PI: Dr. Brent Richards; Co–Applicants: Dr. Christina Greenaway, Dr. Vincent Mooser (Human Genetics), Dr. Claudia Kleinman (Human Genetics), Dr. Celia Greenwood (Oncology) This infrastructure has been purchased already to enable biobanking of samples and data from individuals affected

by COVID–19. To date, we have recruited ~1,400 individuals into Canada’s largest hospital–based COVID–19 biobank at the Jewish General Hospital.

2020 Annual Report of the McGill Department of Medicine

Public Health Agency of Canada – $7 million Biobanque Québec COVID19: A biobank of samples and data from patients with COVID19 infection Co–PIs: Dr. Brent Richards ($4.2 million), Dr. Vincent Mooser (Human Genetics)

CIHR (2020–2024) – $ 612,000 A novel multimodal intervention for surgical prehabilitation of patients with lung cancer PI: Dr. Stéphanie Chevalier (School of Human Nutrition); Co–Investigators: Dr. José A. Morais, Dr. Jonathan Spicer (Surgery)

Fonds de recherches Québec Santé and Genome Québec – $3 million Biobanque Québec COVID19 : A biobank to of samples and data from patients with COVID19 infection Co–PIs: Dr. Brent Richards ($1.8 million), Dr. Vincent Mooser (Human Genetics)

This RCT will investigate whether a multimodal prehabilitation intervention combining a mixed–nutrient supplement with structured exercise training, or the supplement alone against a placebo leads to improvement in functional capacity and postoperative outcomes in surgical patients with lung cancer. This approach aimed at improving muscle health and physical function prior to surgery may facilitate post–surgical recovery, reduce complications and hospital stay.

JGH Foundation – $ 135,000 A biobank of data and samples from patients with COVID19 infection PI: Dr. Brent Richards This pan–Quebec consortium aims to build a network of COVID–19 biobanks, with a centralization of data and samples. This is the largest COVID–19 biobank and has already provided data and samples to approximately 50 research programs across the world. This biobank was funded by multiple sources including the Public Health Agency of Canada, FRQS and the Jewish General Hospital Foundation.

McGill Interdisciplinary Initiative in Infection & Immunity – $ 300,000 Proteomics study of individuals with COVID19 infection Co–PIs: Dr. Brent Richards ($ 255,000), Dr. Brent Mooser (Human Genetics) This programs aims to use proteomics to identify circulating proteins that can act as drug targets for COVID–19 and biomarkers. To date work from this grant has been published in Nature Medicine and two companies are actively developing medications to treat individuals with severe COVID–19.

Impactful Clinical Innovation A new post–endocrine residency specialty year of training in Reproductive Endocrinology and the Endocrinology of Pregnancy has been established by Dr. Rachel Bond, Dr. David Morris and Dr. Vanessa Tardio. This could be considered as a Formation Complémentaire. This additional training will allow foreign Quebec and foreign MDs already trained in general Endocrinology and Metabolism to attain subspecialty expertise in the clinical management of disorders and diseases of reproductive endocrinology and complications of pregnancy. There is, apart from clinical exposure through Endocrinology, Obstetrics and Gynecology, Infertility and Urology, a teaching as well as research component. It is expected that this expansion of our Endocrinology Division program will enhance its international profile and provide specific expertise to service the population of Quebec.

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Gastroenterology & Hepatology Leadership Dr. Alain Bitton (McGill / MUHC) Dr. Albert Cohen (JGH) Dr. Gaetano Morelli (SMH)

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CLINICIAN SCIENTISTS & INVESTIGATORS PHDS CLINICIAN TEACHERS & EDUCATORS

Dr. Alain Bitton Profile photo taken by Owen Egan

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Guaraldi G, Maurice J, Marzolini C, Monteith K, Milic J, Tsochatzis E, Bhagani S, Morse C, Price J, Ingiliz P, Lemoine M, Sebastiani G, on behalf of the SHIVER Network.

New drugs for NASH and HIV infection: great expectations for a great need. Hepatology (impact factor: 14.679) 2020 May:71(5):1831–1844. doi: 10.1002/hep.31177.

Cervo A, Milic J, Mazzola G, Schepis F, Petta S, Krahn T, Lebouche B, Deschenes M, Cascio A, Guaraldi G, Sebastiani G. Prevalence, predictors and severity of lean non–alcoholic fatty liver disease in HIV–infected patients.

Clin Infect Dis (impact factor: 9.055) 2020 Apr 13:ciaa430. doi:10.1093/cid/ciaa430.

Benmassaoud A, Roccarina D, Arico F, Leandro G, Yu B, Cheng F, Yu D, Patch D, Tsochatzis E. Sarcopenia Does Not Worsen Survival in Patients With Cirrhosis Undergoing Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites. Am J Gastroenterol. 2020 Nov;115(11):1911–1914. doi: 10.14309/ajg.0000000000000959. PMID: 33156111.

Verdon C, Reinglas J, Coulombe J, Gonczi L, Bessissow T, Afif W, Vutcovici M, Wild G, Seidman EG, Bitton A, Brassard P, Lakatos PL. No Change in Surgical and Hospitalization Trends Despite Higher Exposure to Anti– Tumor Necrosis Factor in Inflammatory Bowel Diseases in the Quebec Provincial Database From 1996 to 2015. Inflamm Bowe Dis. 2020 Jul 17:

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Chen Yen–I, Chatterjee Avijit, Berger Robert, Kanber Yonca, Wyse Jonathan M, Lam Eric, Gan Seng Ian, Auger Manon, Kenshil Sana, Telford Jennifer, Donnellan Fergal, Quinlan James, Lutzak Gregory Donald, Alshamsi Fatma, Parent Josee, Waschke Kevin, Alghamdi Adel, Barkun Jeffrey, Metrakos Peter, Chaudhury Prosanto, Martel Myriam, Dorreen Alastair, Candido Kristen, Miller Corey S, Adam Viviane, Barkun Alan N, Zogopoulos George, Wong Clarence K. (2021).

EUS–guided fine needle biopsy alone vs. EUS–guided fine needle aspiration with rapid on–site evaluation of cytopathology in pancreatic lesions: a multicenter randomized trial. Endoscopy, ahead of print, ahead of print. doi:10.1055/a–1375–9775

Exciting Research in the Pipeline CIHR project scheme (2020–2025) – $ 685,400 The role of fatty liver in the epidemic of advanced chronic liver disease among people living with HIV. PI: Dr. Giada Sebastiani This grant will expand a pre–existing the LIVEHIV Cohort to other Canadian centers (Toronto, Vancouver and Ottawa) with the primary objective of understanding the contribution of NAFLD to incident liver cirrhosis in people living with HIV. In the next 5 years, the CIHR–funded LIVEHIV cohort will involve more than 20 investigators across Canada and worldwide with a publication plan of 20 peer–review articles, contribution to international guidelines and to the NA–ACCORD.

2020 Annual Report of the McGill Department of Medicine

Boston Scientific Corporation (2020–2022) – Total Research Award $ 150,000.00 EUS–Biliary drainage vs. ERCP in malignant distal biliary obstruction: A multicentre randomized controlled trial (ELEMENT trial) PI: Dr. Yen–I Chen Potential practice changing study in improving biliary drainage in patients with pancreatic cancer in which 10 Canadian sites are actively recruiting.

Canadian Partnership Against Cancer (2021–2023) – $ 606,640 Validation and optimization of the use of a province–wide colonoscopy referral sheet PI: Dr. Alan Barkun This award targets both the accumulated delays due to the COVID–19 pandemic and the validation and further refining of a province–wide used colonoscopy referral sheet assigning different priorities and wait–times according to a list of clinical, laboratory and imaging indications.

Impactful Clinical Innovation Advanced interventional service and interventional suite This is a unique collaboration between interventional radiology and therapeutic endoscopy at the MUHC to advance the field of imaged guided procedures. Our group has performed several Canada first procedures and some world first interventions including image–guided gastrointestinal bypass, biliary bypass, percutaneous cholangioscopy, and EUS–guided portal pressure measurements. This has had a significant impact on reducing surgical procedures needed in the management of patients with pancreatic–hepatobiliary disorders. We are leaders in these interventions raising national and international recognition of the MUHC in image guided interventions. We are currently raising funds for a state– of–the–art interventional suite that has garnered support from the MUHC and the MUHC Foundation.

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General Internal Medicine Leadership Dr. Vicky Tagalakis (McGill) Dr. Suzanne Morin (MUHC) Dr. Rubin Becker (JGH) Dr. Gail Goldman (SMH)

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Dr. Vicky Tagalakis Profile photo taken by Felipe Argaez

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Schiffrin EL. How Structure, Mechanics and Function of the Vasculature Contribute to Blood Pressure Elevation in Hypertension. Can J Cardiol. 2020;36(5):648–658. doi: 10.1016/j.cjca.2020.02.003. PMID: 32389338.

Henke PK, Kahn SR, Pannucci CJ, Secemksy EA, Evans NS, Khorana AA, Creager MA, Pradhan AD on behalf of the American Heart Association Advocacy Coordinating Committee. Call to Action to Prevent Venous Thromboembolism in Hospitalized Patients: A Policy Statement From the American Heart Association. Circulation 2020 Jun 16; 141(24):e914–e931.

Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, Skipper CP, Nascene AA, Nicol MR, Abassi M, Engen NW, Cheng MP, LaBar D, Lother SA, MacKenzie LJ, Drobot G, Marten N, Zarychanski R, Kelly LE, Schwartz IS, McDonald EG, Rajasingham R, Lee TC, Hullsiek KH. A randomized clinical trial of hydroxychloroquine as post– exposure prophylaxis for COVID–19. NEJM. 2020, May. Rabi DM, McBrien KA, Sapir–Pichhadze R, Nakhla M, Ahmed SB, Dumanski SM, Butalia S, Leung AA, Harris KC, Cloutier L, Zarnke KB, Ruzicka M, Hiremath S, Feldman RD, Tobe SW, Campbell TS, Bacon SL, Nerenberg KA, Dresser GK, Fournier A, Burgess E, Lindsay P, Rabkin SW, Prebtani APH, Grover S, Honos G, Alfonsi JE, Arcand J, Audibert F, Benoit G, Bittman J, Bolli P, Côté AM, Dionne J, Don–Wauchope A, Edwards C, Firoz T, Gabor JY, Gilbert RE, Grégoire JC, Gryn SE, Gupta M, Hannah–Shmouni F, Hegele RA, Herman RJ, Hill MD, Howlett JG, Hundemer GL, Jones C, Kaczorowski

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J, Khan NA, Kuyper LM, Lamarre–Cliche M, Lavoie KL, Leiter LA, Lewanczuk R, Logan AG, Magee LA, Mangat BK, McFarlane PA, McLean D, Michaud A, Milot A, Moe GW, Penner SB, Pipe A, Poppe AY, Rey E, Roerecke M, Schiffrin EL, Selby P, Sharma M, Shoamanesh A, Sivapalan P, Townsend RR, Tran K, Trudeau L, Tsuyuki RT, Vallée M, Woo V, Bell AD, Daskalopoulou SS. Hypertension Canada’s 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020 May;36(5):596–624. doi: 10.1016/j.cjca.2020.02.086. PMID: 32389335.

Raparelli V, Elharram M, Moura CS, Abrahamowicz M, Bernatsky S, Behlouli H, Pilote L. Sex differences in effectiveness of newer glucose–lowering drugs added to metformin in type–2 diabetes. JAHA. 2020 Jan; 9(1):e012940. doi: https://doi. org/10.1161/JAHA.119.012940 . PMID: 31902326.

Exciting Research in the Pipeline UK Medical Research Council and CIHR – UK Canada Diabetes Research Team Grants 2019 (2020–2025) – $ 950,000 Remission of diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction (RESET) PI: Dr. Kaberi Dasgupta This study tests a novel and innovative approach to diabetes management: the remission of diabetes. If demonstrated to be effective, it will create a case for creation and implementation of provincial funded programs. The partnership with the UK is important because the UK National Health Service is already

2020 Annual Report of the McGill Department of Medicine

implementing a publicly funded pilot to offer meal replacement products through its services. Canadian health ministries may be favourably influenced by uptake by the NHS. CIHR (2020) – $6 million Network of Clinical Trial Networks Funding Opportunity: COVID–19 Co–PI: Dr. Emily McDonald This grant will provide the infrastructure for conducting trials during the pandemic. It links together multiple different Canadian research networks and establishes multi–disciplinary collaborations. The impact of this grant will reach far beyond COVID, as it will help to develop solutions that address the disjointed approach to research taking place across the country. The goal is to establish a foundation for rapidly conducting vital trials for emerging infectious threats. This will allow us to quickly adapt and recruit patients to trials in three settings: outpatient, hospital wards and critical care. It will leverage knowledge and processes that already exist across multiple networks and will unite researchers for the common goal of providing rapid answers to important questions that impact the lives of the Canadians during the pandemic and post–pandemic.

CIHR (2020–2025) – $ 1,844,570 Early Prediction of preeclampsia Using arteriaL Stiffness in high–risk prEgnancies; a multinational study (PULSE) PI: Dr. Stella Daskalopoulou PULSE is a 5–year multinational prospective observational clinical study examining arterial stiffness and hemodynamics in combination with blood biomarkers, ultrasound imaging, and psychosocial profiles as a multimodal approach to the prediction of preeclampsia during early pregnancy in women at high risk of developing hypertensive disorders of pregnancy. The study aims to recruit 2,400 high–risk pregnant women from obstetrics clinics at 8 sites in Canada, the United States, and the United Kingdom and will collect detailed information on the above domains during both the first and second trimesters of pregnancy as well as on pregnancy outcomes after birth. With an embedded validation study and a cost–benefit analysis, PULSE will provide the most comprehensive examination of preeclampsia predictors to date, with the potential to reshape clinical management of high–risk pregnancies.

Impactful Clinical Innovation GIM PACE Clinic (PACE = Perioperative Assessment, Care and Education) Drs. Beth Cummings, Maral Koolian and Teresa Cafaro have developed the fast–track Jewish General Hospital GIM PACE Clinic (PACE = Perioperative Assessment, Care and

Education) where patients are assessed and optimized prior to surgery. The ‘Drop the Preop’ Choosing Wisely approach to perioperative testing has been adopted. The GIM Division provides support and guidance to the Family Medicine physicians and other subspecialties in preoperative assessments to ensure that their participation is value– added for the patients. GIM also works with the pharmacy department to update local perioperative medication guidelines and leads perioperative quality improvement projects.

Use of Technology to Improve the Effects of Social Isolation of Hospitalized Patients During the COVID–19 Pandemic: TIES–COVID Acceptance and Patient Satisfaction Dr. Ines Colmegna (Rheumatology) and Dr. Amal Bessissow To evaluate the uptake and patient satisfaction with the use of video telephony (i.e., technologies for the reception and transmission of audio–video signals by users at different locations, for communication between people in real time) using an electronic tablet. Patients admitted on COVID ward and CTUs were provided with a tablet and technology support. Most participants (83%) reported that the tablet helped them to communicate with their relatives and 74% were somewhat or totally satisfied with the amount of communication they had established with their loved ones.

Although recruitment is recently completed, we hope to continue to use this system in patients admitted to the CTUs. This will increase our ability to ensure effective communications with patients’ families in the presence of the patients, specifically when there are issues with protective isolation or when family members cannot visit patients in person. We will need to approach Telus to evaluate these next steps.

St. Mary’s Hospital: Institution of a Clinical Nurse Practitioner Discharge Coordinator This project entails the creation of a clinical nurse practitioner (NP) discharge coordinator on the medical CTU. The individual will assist with discharge planning and help with follow up of complex Internal Medicine patients.

The individual will be able to follow medication changes made in hospital, labs, or any other discharge issue deemed appropriate. This project will aim to reduce the number of patients who bounce back post discharge. These patients represent a large number of admissions and ER visits. Length of stay might also decrease if clinicians feel confident that their patients will have appropriate follow up in the community. The NP will work collaboratively with the medical team. If successful, this project may lead the way in further integrating NPs in Internal Medicine practice.

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Geriatric Medicine Leadership Dr. José Morais (McGill / MUHC) Dr. Ruby Friedman (JGH) Dr. Shek Hong Fung (SMH)

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Dr. José Morais Profile photo taken by Owen Egan

5 Notable 2020 Publications

Exciting Research in the Pipeline

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

Canadian Space Agency (2020–2021) – $1.5 million Microgravity Research Activity: Understanding the health impact of inactivity for the benefit of older adults and astronauts Initiative

Tam TB, Morais JA, Santosa S. Obesity and Aging: Two–Sides of the Same Coin. Obesity Reviews 2020 Apr;21(4):e12991. doi: 10.1111/obr.1299. IF: 7.31 Coussa A, Bassil M, Gougeon R, Marliss EB, Morais JA. Glucose and protein metabolic responses to an energy– but not protein– restricted diet in type 2 Diabetes. Diabetes Obes Metab. 2020 Aug;22(8):1278–1285. doi: 10.1111/dom.14026.

IF: 5.9 Beauchet O, Sekhon H, Cooper–Brawn L, Launay C, Gaudreau P, Morais JA. Motoric cognitive risk syndrome and incident dementia in older adults from the Québec NuAge cohort. Age Ageing. 2020 Nov 17:afaa235. doi: 10.1093/ageing/afaa235. IF: 4.9 Goldfarb MJ, Semsar–Kazerooni K, Morais JA, Dima D. Early Mobilization in Older Adults in the Cardiac Intensive Care Unit. Age Ageing. 2020 Nov 28:afaa253. doi: 10.1093/ ageing/afaa253. IF: 4.9 Minnella EM, Ferreira V, Awasthi R, Charlebois P, Stein B, Liberman AS, Scheede–Bergdahl C, Morais JA, Carli F. Effect of two different pre–operative exercise training regimens before colorectal surgery on functional capacity: A randomised controlled trial. Eur J Anaesthesiol. 2020 Nov;37(11):969–978. doi: 10.1097/EJA.0000000000001215.

IF: 4.5

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PI: Dr. José Morais; Co–Investigators: Dr. Stéphanie Chevalier (School of Human Nutrition), Dr. Tyler Churchward–Venne (Kinesiology), Dr. Sabah Hussain, Dr. Simon Wing This project aims to identify how bedrest gives rise to health–related changes as a model of accelerating aging, while measuring the positive effect of exercise as a countermeasure. This study will help to improve bedrest and inflight countermeasures and recovery programs, as well as new protocols for pre– and post–bedrest/ spaceflight health monitoring. We will study mechanisms associated with muscle and bone loss, insulin resistance and physical performance.

CIHR (2020–2024) – $ 612,000 A novel multimodal intervention for surgical prehabilitation of patients with lung cancer.

PI: Dr. Stéphanie Chavalier (School of Human Nutrition); Co–Investigator: Dr. José Morais This study will test an intervention with potential to reduced complications and loss of autonomy associated with surgical interventions in lung cancer patients.

2020 Annual Report of the McGill Department of Medicine

CIHR (2020–2023) – $ 420,751 Ketone bodies as therapeutic agents to reduce the harmful effects of bed rest on muscle mass and metabolic health in older adults PI: Dr. Tyler Churchward–Venne (Kinesiology); Co–Applicants: Dr. Stéphanie Chevalier (School of Human Nutrition), Dr. Gilles Gouspillou, Dr. José Morais This study will evaluate an intervention using ketone bodies to reduce muscle loss associated with bedrest, which has clinical relevance.

Impactful Clinical Innovation Creation of a Geriatric–Oncology Clinic Aging of the population and progress in technology and treatments of cancer have enable frail older patients to access treatments previously not offered but with a greater burden of side effects due to their frailty. In a joint project with Oncology we have opened a geriatric–oncology clinic in the Cedars Cancer Centre. Geriatricians are well positioned to contribute to prognosticate and to assist frail older patients to get the best benefit from their oncology treatments.

CIUSSS l’Ouest de l’Île physicians over the last year, organizing the transition of milieux de vie to acute care units, preventing as much as a possible transfers to an already strained hospital system. Welcomed physician volunteers, who were not always familiar with acute medical care, were oriented and trained with a rapidly evolving knowledge base early on in the crisis and protocols of care were developed. Over the year, as the knowledge base about the approach to outbreaks in LTC and RPA settings increased, Dr. Chabot was instrumental in the creation of a COVID guide for physicians and la Communauté de pratique des médecins en CHSLD, currently consisting of over 400 members across the province.

St. Mary’s Hospital: Music Program for seniors With COVID–19 visit restrictions from family members, the isolation of hospitalized older adults was more evident than ever before. A pre–existing live music program for hospitalized seniors, which demonstrated a tendency to lowering falls risk, was put on hold. An innovative program spearheaded by Dr. Julia Chabot and volunteer medical students, using computer tablets provided by the St. Mary’s Hospital Centre Foundation, provides live music performances to lessen isolation and improve hospital life.

St. Mary’s Hospital: COVID–19 Response to Long Term Care and Résidences Privées The COVID–19 pandemic severely affected vulnerable older adults early on in the pandemic. Dr. Julia Chabot, from the Division at St. Mary’s Hospital, led the medical response of

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Hematology Leadership Dr. Hans Knecht (McGill / JGH) Dr. Molly Warner (MUHC) Dr. Adrian Lengleben (SMH)

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PHDS CLINICIAN TEACHERS & EDUCATORS

Dr. Hans Knecht Profile photo taken by Felipe Argaez

5 Notable 2020 Publications

Exciting Research in the Pipeline

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

CIHR (2018–2023) – $ 1,208,700 Optimizing immunotherapy in high–risk lymphoma PI: Dr. Nathalie Johnson

Bienz M, Haliotis T, Pehr K, Benlimame N, Mai S, Knecht H. 3D Telomeric Fingerprint of Mycosis Fungoides/ Sézary Syndrome: A Pilot Study. Journal of Investigative Dermatology, 2020 (E–pub Nov 16, 2020) (IF 7.14) Avram AT, Blostein MD, Hirsch AM, Warkentin TE. Venous limb gangrene and pulseless electrical activity (PEA) cardiac arrest during management of deep–vein thrombosis and progressive limb ischemic necrosis following vascular surgery. Am J Hematol. 2020, 95:712–717. (IF 6.97) Peng X, Ouyang J, Isnard S, Lin J, Fombuena B, Zhu B, Routy JP. Sharing CD4+ T Cell Loss: When COVID–19 and HIV Collide on Immune System. Front Immunol. 2020 Dec 15;11:596631. doi: 10.3389/fimmu.2020.596631. (IF 6.43) Sapon–Cousineau V, Sapon–Cousineau S, Assouline S. PI3K Inhibitors and Their Role as Novel Agents for Targeted Therapy in Lymphoma. Curr Treat Options Oncol. 2020, 21:51. (Invited Review) (IF 3.90) Waller DD, Monczak Y, Michel RP, Shustik C, Sebag M. Spontaneous remission and clonal evolution in lenalidomide associated secondary AML. Leuk Lymphoma. 2020, 61:1724–1727. (IF 2.97)

Therapeutic resistance is the main cause of death in patients with lymphoma, the most common being diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL) and Hodgkin lymphoma (HL). Clonal evolution occurs under the selection pressure of chemotherapy and can be assessed by monitoring mutations in the plasma circulating tumor DNA (ctDNA). Remarkably, chemo–resistant lymphomas can respond to T cell mediated immunotherapy. Inhibitors against PD1, a critical immune checkpoint (IC), have dramatically improved the outcome of some patients with relapsed HL. Beyond PD1, little is known regarding the immune–mediated mechanisms that dampen T cell functions in lymphoma. We show that tumor–infiltrating T cells (TILs) isolated from all 3 lymphomas express multiple ICs, in addition to PD1. We also show that cytokines drive the expression of ICs on T cells, likely through the JAK–STAT pathway, and that inhibiting this pathway decreases the expression of multiple ICs. We hypothesize mutations in the plasma ctDNA after 2 cycles of chemotherapy will identify high–risk patients that might benefit from immunotherapy and that the optimal immunotherapy regimen should combine a PD1 inhibitor with another IC inhibitor or a JAK inhibitor.

Using primary lymphoma and blood samples from our lymphoma bank we will aim to 1) Develop a ctDNA panel to monitor tumor response in DLBCL, FL and HL; 2) Characterize IC and STAT targets in DLBCL, FL and HL; and 3) Identify the best combination immunotherapy regimen to treat DLBCL.

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2020 Annual Report of the McGill Department of Medicine

CIHR (2019–2024) – $ 780,300 Immunosuppressive pathways and HIV reservoirs in tissues PI: Dr. Jean–Pierre Routy Despite the success of antiretroviral therapy (ART) in transforming HIV into a chronic infection, people living with HIV (PLWH) remain at risk for various non–AIDS inflammatory comorbidities including cancers. Such non– AIDS comorbidities are associated with persistent immune activation, aging, co–infections like cytomegalovirus (CMV) as well as gut dysbiosis, epithelial gut damage and subsequent microbial translocation. PLWH present with gut dysbiosis associated with an increased activation of both circulating CD4+ and CD8+ T–cells.

Therefore, novel gut microbiota–modulating therapies in addition to ART could aid in reducing inflammation and immune activation, gut damage and microbial translocation. Amongst the various gut–modulation strategies under investigation, the Amazonian fruit Camu Camu (CC) presents itself as a prebiotic candidate based on its anti–inflammatory and antioxidant properties in an animal model, as well as fecal stool transplant.

Immunology and virologic markers will be measure prospectively in blood and colon samples in participants in these two studies supported by the CIHR grant. Primary patients’ results of the Camu Camu study will be presented at the mondial AIDS Congress in Berlin in July this year. Stéphane Isnard, PhD, was attributed a Young Investigator award for his Abstract. Relevance of study finding will include HIV and cancer patients where microbial translocation is a co–factor for disease progression and immunotherapy response.

Richard & Edith Strauss Foundation (2020–2021) – $ 100,000 Understanding the interactions between blood stem cells and their bone marrow microenvironment for therapeutic potential PI: Dr. François Mercier Dr. Mercier’s laboratory uses CRISPR genetic editing technology in pre–clinical models of acute myeloid leukemia (AML) or hematopoietic stem cell transplantation to uncover new genetic master regulators of hematopoiesis.

His research has been and is supported from grants from the Cancer Research Society ($120,000), Leukemia and Lymphoma Society ($75,000), Cole Leukemia Foundation ($150,000), Terry Fox Research Institutes ($90,000) and Richard & Edith Strauss Foundation.

The most recent project entitled “Understanding the interactions between blood stem cells and their bone marrow microenvironment for therapeutic potential”, awarded by the Richard & Edith Strauss Foundation is mainly performed by a talented graduate student coached

by Dr. Mercier, PI of the grant. The main objective of this grant is to identify novel genetic regulators of hematopoietic stem cell fate in vivo through development of CRISPR/Cas9 perturbation methodology in mouse hematopoietic stem cells and development of in vivo multiplexed fluorescent lineage tracking. The work goes straight ahead and promising results appear to be in the pipeline.

Impactful Clinical Innovation This is the complete reorganization of the Hematology Fellow program over the past years with excellent current and future results. Dr. Chantal Cassis’s relentless efforts to direct our fellows into research projects with Hematology staff physicians paid off in 2020 as never before.

Hematology and Thrombosis fellows ranked as first authors in six manuscripts, underscoring the importance of a strong research spirit within the McGill Hematology Curriculum.

Proof of principle was the outstanding presentation entitled “A retrospective end of life study of patients with hematologic malignancies and the importance of end of life discussion in serious illness”, held by Dr. Victoria Korsos, second year Hematology Fellow, together with Dr. Cassis at the virtual JGH Medical Grand Rounds of June 15, 2020.

Currently, the slide scanning project for morphology teaching is under way and a Residents’ room, equipped with large high–resolution screens to teach blood and bone marrow cytology, is now arranged in the JGH at the E–1 level.

Our two teaching Leitz microscopes (over 30 years of service) in the morphology room of the JGH are in a desolate condition and need to be replaced rapidly. These old instruments will be replaced by one ZEISS AxioScope.5 Co–Observation system 4 heads and one AxioScope.5 Co–Observation system. Both instruments were purchased issued with a 10 years’ warranty service contract. The costs of CAD 130K were covered by the JGH Foundation through donations for equipment for the JGH Hematology Division.

The instruments are currently assembled in Germany and will be installed early in July 2021. This allows us to teach blood and bone marrow morphology under optimal conditions.

Two formal lectures per year during the Hematology academic half–day, expert physician rounds, laboratory teaching to Hematology Fellows, preparation and organization of the annual McGill Hematology in–training exam, which is composed of 3 parts (written, oral scenario and morphology), as well as teaching the TCP class “An approach to anemia” at all 3 sites (JGH, MGH and Glen) for medical students guarantees now and in future early immersion in Hematology as a cornerstone in MD formation.

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Infectious Diseases Leadership Dr. Marcel Behr (Interim) (McGill / MUHC) Dr. Karl Weiss (JGH) Dr. Joe Dylewski (SMH)

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5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Cheng MP, Lawandi A, Butler–Laporte G, De l’Etoile– Morel S, Paquette K, Lee TC. Adjunctive Daptomycin in the Treatment of Methicillin–Susceptible Staphylococcus aureus Bacteremia: A Randomized Controlled Trial. Clin Infect Dis. 2020 Jul 15:ciaa1000. doi: 10.1093/cid/ciaa1000.

Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, Skipper CP, Nascene AA, Nicol MR, Abassi M, Engen NW, Cheng MP, LaBar D, Lother SA, MacKenzie LJ, Drobot G, Marten N, Zarychanski R, Kelly LE, Schwartz IS, McDonald EG, Rajasingham R, Lee TC, Hullsiek KH. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for COVID–19. N Engl J Med. 2020 Aug 6;383(6):517–525. doi: 10.1056/NEJMoa2016638.

Matthew P Cheng 1, Cedric P Yansouni 2, Nicole E Basta 3, Michaël Desjardins 4, Sanjat Kanjilal 5, Katryn Paquette 6, Chelsea Caya 7, Makeda Semret 2, Caroline Quach 8, Michael Libman 2, Laura Mazzola 9, Jilian A Sacks 9, Sabine Dittrich 10, Jesse Papenburg 11. Serodiagnostics for Severe Acute Respiratory Syndrome–Related Coronavirus 2 : A Narrative Review. Ann Intern Med. 2020 Sep 15;173(6):450–460. doi: 10.7326/M20–2854. Epub 2020 Jun 4. PMID: 32496919; PMCID: PMC7281623.

Bastard P, Rosen LB, Zhang Q, Michailidis E, Hoffmann HH, Zhang Y, Dorgham K, Philippot Q, Rosain J, Béziat V, Manry J, Shaw E, Haljasmägi L, Peterson P, Lorenzo L, Bizien L, Trouillet–Assant S, Dobbs K, de Jesus AA, Belot A, Kallaste A, Catherinot E, Tandjaoui–Lambiotte Y, Le Pen J,

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Dr. Marcel Behr Profile photo taken by Owen Egan

Kerner G, Bigio B, Seeleuthner Y, Yang R, Bolze A, Spaan AN, Delmonte OM, Abers MS, Aiuti A, Casari G, Lampasona V, Piemonti L, Ciceri F, Bilguvar K, Lifton RP, Vasse M, Smadja DM, Migaud M, Hadjadj J, Terrier B, Duffy D, Quintana–Murci L, van de Beek D, Roussel L, Vinh DC, Tangye SG, Haerynck F, Dalmau D, Martinez–Picado J, Brodin P, Nussenzweig MC, Boisson–Dupuis S, Rodríguez–Gallego C, Vogt G, Mogensen TH, Oler AJ, Gu J, Burbelo PD, Cohen JI, Biondi A, Bettini LR, D’Angio M, Bonfanti P, Rossignol P, Mayaux J, Rieux–Laucat F, Husebye ES, Fusco F, Ursini MV, Imberti L, Sottini A, Paghera S, Quiros–Roldan E, Rossi C, Castagnoli R, Montagna D, Licari A, Marseglia GL, Duval X, Ghosn J; HGID Lab; NIAID–USUHS Immune Response to COVID Group; COVID Clinicians; COVID–STORM Clinicians; Imagine COVID Group; French COVID Cohort Study Group; Milieu Intérieur Consortium; CoV–Contact Cohort; Amsterdam UMC COVID–19 Biobank; COVID Human Genetic Effort, Tsang JS, Goldbach–Mansky R, Kisand K, Lionakis MS, Puel A, Zhang SY, Holland SM, Gorochov G, Jouanguy E, Rice CM, Cobat A, Notarangelo LD, Abel L, Su HC, Casanova JL. Autoantibodies against type I IFNs in patients with life–threatening COVID–19.

Science. 2020 Oct 23;370(6515):eabd4585 Meziane O, Salahuddin S, Pham TNQ, Farnos O, Pagliuzza A, Olivenstein R, Thomson E, Alexandrova Y, Orlova M, Schurr E, Ancuta P, Haddad É, Chomont N, Cohen EA, Jenabian MA, Costiniuk CT. HIV Infection and Persistence in Pulmonary Mucosal Double Negative T Cells In Vivo. J Virol.

2020 Nov 23;94(24):e01788–20. doi: 10.1128/JVI.01788– 20. Print 2020 Nov 23.PMID: 32967958 Free PMC article.

2020 Annual Report of the McGill Department of Medicine

Exciting Research in the Pipeline

Impactful Clinical Innovation

CIHR – $1.1 million for randomized controlled trial platform Staph aureus network protocol PI: Dr. Matthew Cheng

MUHC Antimicrobial Stewardship Program: website/ guideline development and longitudinal audit– feedback activities to reduce or shorten antimicrobial use, including patients with COVID–19.

The SNAP Canada trial will help determine best treatment practices and improve outcomes in patients with Staphylococcus aureus bacteremia, which is a major public health problem and is among the most common and serious bacterial infections in the world due to its proclivity for causing metastatic infection, severe sepsis, and death. The investigators propose a pragmatic, adaptive platform randomized controlled trial embedded within routine care that will transform infectious diseases trial and establish robust infrastructure that will endure for future studies.

CIHR COVID–19 Rapid Research Funding Opportunity– Therapeutics – $ 360,377/year Development of small interfering RNAs (siRNAs) for the treatment of Severe Acute Respiratory Syndrome– Coronavirus–2 (SARS–CoV–2) PI: Dr. Anne Gatignol We are developing siRNAs against SARS–CoV–2 RNA to be used intranasally in the early stage of the infection.

Once we have shown the efficacy and absence of toxicity, they could be used as a nasal spray for every newly diagnosed positive individual to decrease the viral burden and the severity of the disease.

Our objective is to improve the quality of antimicrobial prescriptions at the MUHC in ways that will ensure patient safety and better outcomes. To that end we are developing thoughtful guidelines (accessible online), prospectively auditing antimicrobial prescriptions with immediate feedback to prescribers, and systematically monitoring antimicrobial use.

We have identified that about 30% of antimicrobial prescriptions at the MUHC are “inappropriate” (unnecessary antimicrobial, or non–optimal agent/ dose/route). Performing weekly audits with feedback to prescribers has an immediate impact, with 75% of the recommendations being accepted by treating teams. Conducting these monitoring activities with specific interventions throughout the institution will have implications on patient safety and clinical outcomes through gradual improvements in the quality of antimicrobial prescriptions. We are also establishing collaborations with research teams to assess innovative stewardship interventions, in keeping with the MUHC mission of excellence in clinical care, research and teaching.

Canada Foundation for Innovation – $2.2 million Containment level 3 lab capacity to support research on preventives and therapeutics for COVID–19 PI: Dr. Marcel Behr The CL3 lab CFI award provides an enabling platform for McGill–affiliated investigators and industrial partnerships. The goal is to be able to understand the cause of the pandemic virus by doing research in a safe facility, including in vitro models that allow drug discovery and in vivo models of treatment and vaccination.

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Medical Biochemistry Leadership Dr. David Blank (MUHC) Dr. Elizabeth MacNamara (JGH)

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5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Gloria Assaker, Anne Camirand, Bassam Abdulkarim, Atilla Omeroglu, Jean Deschenes, Richard Kremer, Siham Sabri.

PTHrP, a biomarker for CNS metastasis and node–negative adjuvant chemotherapy–selection in triple–negative breast cancer). Journal of the National Cancer Institute Cancer Spectrum. Volume 4, Issue 1, 2020, pkz063.

Gawa Bidla, David S. Rosenblatt, Brian M. Gilfix.

Identification of Variants in Alpha–1–Antitrypsin by High Resolution Melting. J Appl Lab Med. 2020 Dec 17;jfaa191. doi: 10.1093/jalm/jfaa191.

Paquette M, Bernard S, Blank D, Paré G, Baass, A. A simplified diagnosis algorithm for dysbetalipoproteinemia.

J Clin Lipidol. 2020 Jul–Aug;14(4):431–437. doi: 10.1016/j. jacl.2020.06.004. Epub 2020 Jun 10. PMID: 32631794.

Marc–Antoine Lepage, Nicholas Rozza, Richard Kremer, Ami Grunbaum. Safety and Efficacy Concerns of Lopinavir/ Ritonavir in COVID–19 Affected Patients: A Retrospective Series. medRxiv 2020.07.23.20153932; doi: https://doi.org/ 10.1101/2020.07.23.20153932.

Exciting Research in the Pipeline CIHR (2019–2024) – $ 914,175 Effect of 1,25–dihydroxyvitamin D3 on control of cell growth and differentiation PI: Dr. Richard Kremer A lack of vitamin D has been linked to the development and progression of several types of cancer including breast 62 |

cancer. Most breast cancer patients who have a recurrence will develop cancer spread to the skeleton, which causes considerable suffering and morbidity including pain and fractures. Bone metastases are currently treated with anti–resorptive agents such as the potent bisphosphonate zoledronate (zometa) or Denosumab (Xgeva) that help reduce bone destruction by cancer cells. Unfortunately, these agents are not a cure and the number of patients experiencing skeletal complications is reduced by only 40%. Furthermore, these agents do not show any benefit on survival, which exemplifies the need for novel therapies and/or agents that will improve the efficacy of current therapies. In this proposal we will build on our recent finding that vitamin D deficiency activates the bone marrow environment, and help cancer cells seed and grow in this favorable “soil”. We aim to develop improved vitamin D therapies with minimal side effects by enhancing the local activity of vitamin D in the bone microenvironment. For this purpose, we have developed unique pre–clinical models to test this hypothesis.

This innovative therapeutic approach when combined with approved anti–resorptive therapies such as bisphosphonates and Denosumab aims to significantly improve the devastating skeletal complications seen in the great majority of patients with advanced breast cancer.

CIHR (2015–2021) – $ 739,955 Co–targeting parathyroid–hormone related protein (PTHrP) signalling and osteoclast activation to counter breast cancer metastasis to bone PI: Dr. Richard Kremer Skeletal metastases appear as complications in up to 70% of breast cancer patients. Once bone tumors are established, they are usually incurable. In advanced cases, the skeleton often bears the major tumor burden, causing considerable suffering and morbidity due to hypercalcemia, pathological fractures, cord compression and intractable pain. The current therapies against skeletal invasion use anti–resorptive agents such as bisphosphonates, but these compounds are not curative and new targets must be identified in the fight against bone metastases. Breast tumors and other types of cancer are composed of two main populations of cancer cells.

The bulk of a tumor is composed of cells with limited proliferation capacity that are sensitive to conventional anti–cancer therapies. There is also a small population of long–lived cancer stem cells (CSCs) that are resistant to chemo– and radiotherapy. A notoriously difficult–to–treat cancer is the CSC–driven triple–negative breast cancer (TNBC). TNBCs have very poor prognosis because they

2020 Annual Report of the McGill Department of Medicine

currently lack effective therapies. Traditional cancer therapies can effectively de–bulk tumors but fail to produce long–term remissions and prevent metastases, possibly due to their inability to eliminate CSCs. Our laboratory has identified a novel target known as the parathyroid hormone–related protein (PTHrP), previously implicated in the development of bone metastases, but which has never before been associated with CSCs or TNBC. We have produced an anti–PTHrP antibody that blocks PTHrP action and is highly efficient against breast cancer growth and metastases. Our preliminary studies suggest that PTHrP is very likely a driving force behind CSC proliferation and dissemination to distant organs.

Our goal is to attack this resistant breast cancer cell population within bone with our novel blocking monoclonal antibodies against PTHrP, in combination with approved bone targeting bisphosphonates, to eradicate skeletal metastases.

Impactful Clinical Innovation Alzheimer Disease Testing Working with Dr. Pedro Rosa (Douglas Hospital), we plan to validate two commercial assays to quantitate total Tau and phosphoTau in CSF from subjects in the Canadian Consortium on Neurodegeneration in Aging. This would provide support for patients undergoing anti–Tau therapies.

Accumulation of amyloid plaques, and neurofibrillary tangles composed of hyperphosphorylated tau protein, are pathological hallmarks of Alzheimer’s disease. Potential availability of anti–Tau therapies has generated a need for quick, reliable, low–cost, and widely available diagnostic methods to support accurate identification of patients with tau pathology. CSF biomarkers offer potential advantages compared with imaging techniques for the assessment of neurodegenerative disease pathology, including the ability to measure multiple analytes reflecting distinct pathological hallmarks in the same sample. Roche Diagnostics has validated two CSF assays to quantitate total Tau and phosphoTau in CSF. We are currently working with Dr. Rosa and Roche Diagnostics to validate the Roche tests locally and we are involved with Canadian Consortium on Neurodegeneration in Aging. Dr. Rosa has a large bank of CSF from a well–studied patient cohort. We are looking to be the first to introduce such testing in Canada to provide support for this group of patients undergoing anti–Tau therapies. The current AD diagnostic pathway relies on clinical symptoms and the ability to rule out other dementia causes; this is a suboptimal approach, since the hallmarks of AD often begin years before the appearance of clinical symptoms. The availability of low cost, widely available assays such as those by Roche would be helpful in establishing an accurate early diagnosis especially when the ethology of a cognitive impairment is uncertain and in wider segment of the patient population than is currently possible.

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Nephrology Leadership Dr. Rita Suri (McGill / MUHC) Dr. Mark Lipman (JGH) Dr. Johana Eid (SMH)

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5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Derish I, Lee JKH, Wong–King–Cheong M, Babayeva S, Caplan J, Leung V, Shahinian C, Gravel M, Deans MR, Gros P, Torban E. Differential role of planar cell polarity gene Vangl2 in embryonic and adult mammalian kidneys. PLoS One. 2020 Mar 23;15(3) Sapir–Pichhadze R, Zhang X, Ferradji A, Madbouly A, Tinckam KJ, Gebel HM, Blum D, Marrari M, Kim SJ, Fingerson S, Bashyal P, Cardinal H, Foster BJ. Epitopes as characterized by antibody–verified eplet mismatches determine risk of kidney transplant loss. Kidney Int. 2020;97(4):778–85.

Matsuda J, Maier M, Aoudjit L, Baldwin C, Takano T. ARHGEF7 (β–PIX) Is Required for the Maintenance of Podocyte Architecture and Glomerular Function. J Am Soc Nephrol. 2020 May;31(5): 996–1008.

Mavrakanas TA, Garlo K, Charytan DM. Apixaban versus No Anticoagulation in Patients Undergoing Long–Term Dialysis with Incident Atrial Fibrillation. Clin J Am Soc Nephrol.

2020;15(8):1146–1154.

Navarro–Betancourt JR, Papillon J, Guillemette J, Iwawaki T, Chung CF, Cybulsky AV. Role of IRE1α in podocyte proteostasis and mitochondrial health. Cell Death Discov.

2020 Nov19;6(1):128.

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Dr. Rita Suri Profile photo taken by Christinne Muschi

Exciting Research in the Pipeline US Department of Defense (2020–2022) – $ 339,820 Novel Aminoglycoside Therapy of Nonsense Mutations in Polycystic Kidney Disease Co–PIs: Dr. Paul Goodyer (Pediatrics), Dr. Elena Torban, Dr. Ahsan Alam ADPKD, affects 1:750 people and is inherited as a dominant trait associated with mutations of PKD1 or PKD2 genes.

Progressive cyst enlargement and renal dysfunction occur during adult life, usually leading to end–stage kidney disease (ESKD). About 25–30% of PKD is caused by Nonsense Mutations in the PKD1 or PKD2 genes that halt normal synthesis of the corresponding polycystin protein. The premise underlying our research proposal is that these PKD Nonsense Mutations may be treatable with a new nontoxic aminoglycoside (ELX–02) that relaxes translational fidelity of the ribosome and permits read through of premature STOP codons. This drug (ELX–02) has been shown to restore functional protein expression in other rare diseases such as cystinosis and cystic fibrosis. Whether this strategy can be applied to PKD has never been tested.

In this proposal, we will establish proof–of–principle for ELX–02 therapy of PKD. 1) We will establish a series of nonsense mutant proximal tubular cell lines from human patients. Using parallel strategies, we will: a) isolate urinary proximal tubular cells from PKD patients at our medical center who harbor a PKD gene nonsense mutation and inactivate the trans allele with CRISPR/Cas9 editing technology; b) isolate biallelic mutant cells from surface

2020 Annual Report of the McGill Department of Medicine

cysts of PKD kidneys at the time of nephrectomy (X1–2/ yr) prior to transplantation. 2) We will show that ELX–02 induces polycystin expression (qRT–PCR and Western immunoblotting) in patient cells with a PKD1 nonsense mutation in compound heterozygosity with another mutation. 3) We will show that ELX–02 restores normal tubular cell phenotype in vitro (cell migration, adhesion, canonical WNT signaling, YAP activation and cyst formation in 3D cultures).

We propose a novel therapeutic approach to PKD, using a new non–toxic aminoglycoside derivative that should restore expression of the missing PKD protein.

By capturing PKD mutant cells from patient urine, we will be able to ascertain whether ELX–02 can restore the normal tubular cell phenotype in vitro. Our studies will open the path to clinical trials that could halt cyst enlargement, allow military personnel to perform their duties and potentially avert progressive renal failure.

CIHR (2020–2021) – $ 476,333 Impact of COVID–19 on Patients Receiving Hemodialysis: The Quebec Renal Network (QRN) COVID–19 Study PI: Dr. Rita Suri There are 24,000 Canadians living with kidney failure who must receive regular hemodialysis treatments to stay alive.

This involves coming to the dialysis unit 3 days every week, for 4–5 hours at a time. While this is burdensome at the best of times, the COVID–19 pandemic has made life even more difficult for hemodialysis patients. As they cannot self– isolate, they are at higher risk of infection than others. If they do get infected, this may not be easily identified because they may not have typical symptoms or may deny them for fear of being denied dialysis. Yet, due to their underlying medical illnesses, dialysis patients are at risk of becoming quite ill from COVID–19. The precise risks to their health are uncertain. Finally, widespread application of infection control measures in dialysis units and physical distancing, while needed to control spread of COVID–19, may have unforeseen impacts on all hemodialysis patients. These range from encountering problems with transportation, interfering with their critical need to get to the dialysis unit, to their interactions with the health care team, access to non–dialysis health care, and inability to have their loved ones at their bedside during dialysis. Being the province hardest hit with COVID–19, we have established a province– wide team of kidney doctors and other experts in Quebec to study: (1) the infection control measures implemented in each dialysis unit; (2) how to better identify dialysis patients who have COVID–19; (3) their risk of dying from COVID–19 and the longer–term risk of COVID–19 on their physical

and mental health; (4) whether they develop antibodies to this infection; and (5) how all dialysis patients have generally been affected by this pandemic with respect to dialysis and non–dialysis medical care. The results of this comprehensive study will guide our understanding of the impact of COVID–19 on dialysis patients in order to help improve their care both in Canada and globally.

CIHR (2019–2024) – $ 830,026 Defining the immune dysfunction in childhood nephrotic syndrome: Toward therapeutic reversal without glucocorticoids PI: Dr. Tomoko Takano; Co–PI: Dr. Ciriaco Piccirillo (Microbiology & Immunology) Nephrotic syndrome is the most common kidney disease among children. Affected children have massive leakage of protein into the urine and as a consequence, develop body swelling (edema). Most children respond to treatment with steroids, however many of them require repeated courses for frequent relapses of the disease. Long–term use of steroids causes many side effects including obesity, growth retardation, hypertension, cataracts, poor bone health, and cosmetic effects. Minimizing the use of steroids has been identified as the number one priority of the patients and families. A non–steroid drug, rituximab, is now known to be effective in the treatment of nephrotic syndrome, but it is entirely unclear how it works. In this study, we will investigate the mechanisms by which rituximab alleviates the symptoms associated with nephrotic syndrome, allowing patients to stay in remission. Blood collected from affected patients when their disease is active, and after successfully treated with steroid or rituximab, will be analyzed using the state–of– the–art technique called immunophenotyping. One of the investigators in the research team, Dr. Piccirillo, is the leading researcher of this technology in Canada. The analyses will inform us which cells in the blood are active before treatment, and become inactive after treatment.

We will also find out if steroids and rituximab have different effects on blood cells. With this approach, we are likely to uncover how this common pediatric disease occurs – it has been a mystery for over five decades. Furthermore, understanding how rituximab works in nephrotic syndrome will enable us to identify patients who are most likely to respond to rituximab thus avoiding steroids. Finally, if the culprit cells are known, we can develop new drugs specifically targeting these cells. The hope is that we will not need to use steroids at all in the future.

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Impactful Clinical Innovation Improving the Diagnostic Accuracy of Rejection in Kidney Transplants Developed by Dr. Sapir–Pichhadze and collaborators Antibody mediated rejection (ABMR) is a major cause of kidney allograft loss. While many treatments can mitigate ABMR, diagnosis can be problematic as it depends on the accurate application of the Banff Classification of Kidney Allograft Pathology. In a recent survey, we found that pathologists and clinicians assigned a diagnosis different than intended by Banff when presented with the same cases approximately 30% of the time. These discrepancies have implications for patient management, as in our survey, treatment approach varied according to the assigned diagnosis.

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We have developed a computer program called Banff–IT, to improve the consistency of diagnosis of ABMR in clinical practice. Banff–IT evaluates allograft pathology findings and histocompatibility tests based on the Banff Classification system, and assigns diagnoses using standard phrases in English or French. The algorithm has been validated locally and collaborators at CHUM plan to use it as a diagnostic aid. In the short–term, we plan to evaluate whether use of this tool results in different management decisions compared to standard practice, and we eventually hope to determine whether its use can improve long–term kidney allograft outcomes in Canada and globally.

2020 Annual Report of the McGill Department of Medicine

Physical Medicine / Rehab Service Leadership Dr. Mohan Radhakrishna (McGill / MUHC)

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CLINICIAN SCIENTISTS & INVESTIGATORS CLINICIAN TEACHERS & EDUCATORS

Dr. Mohan Radhakrishna 5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Auclair–Pilote J, Lalande D, Tinawi S, Feyz M, de Guise E. Satisfaction of basic psychological needs following a mild traumatic brain injury and relationships with post–concussive symptoms, anxiety and depression. Disabil Rehabil. 2019 Jun 22:1–9. doi: 10.1080/09638288.2019.1630858.

Exciting Research in the Pipeline Multiple Sclerosis of Canada (2012–2021) – $ 95,000 per year for 3 years; extended for an additional 6 years A randomized, controlled, clinical trial of continuous positive airway treatment of obstructive sleep apnea–hypopnea in multiple sclerosis Co–PIs: Dr. Daria Trojan (Neurology), Dr. John Kimoff Co–Investigators: Dr. Amit Bar–Or (Microbiology), Dr. Marta Kaminska, Dr. Yves Lapierre (Neurology), Dr. Andrea Benedetti Fatigue is the most common and typically most disabling symptom for multiple sclerosis (MS) patients. Sleep disorders are common in MS and are related to fatigue. In a previous study, we found that obstructive sleep apnea–

Profile photo taken by Owen Egan

hypopnea (OSAH) is most common sleep disorder in MS, occurring in 58% of 62 MS patients, and is strongly related to fatigue. In a non–randomized, controlled trial, we reported that treatment of OSAH can improved fatigue in MS. Continuous positive airway pressure (CPAP) is the best treatment for OSAH in the general population. The aim of this study is to complete the first randomized, controlled clinical trial to evaluate the clinical effectiveness of a six–month course of CPAP treatment on fatigue and other clinical outcomes in MS patients with OSAH. This study may lead to a treatment for fatigue for MS patients.

Impactful Clinical Innovation Mild traumatic brain injury can lead to prolonged disability.

In concert with members of the Division of Neurosurgery some physiatrists are involved in early assessment of mild traumatic brain injury. In this novel program, there is both physician and psychologist input early after the injury. This is unique with the goal to see whether this reduces the symptoms and long–term disability often associated with mild traumatic brain injury.

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Respiratory Medicine Leadership Dr. Kevin Schwartzman (McGill / MUHC) Dr. Andrew Hirsch (JGH) Dr. Harold Zackon (SMH)

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CLINICIAN SCIENTISTS & INVESTIGATORS PHDS CLINICIAN TEACHERS & EDUCATORS

Dr. Kevin Schwartzman Profile photo taken by Owen Egan

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Giorgianni F, Ernst P, Dell’Aniello S, Suissa S, Renoux C. Beta 2 agonists and the incidence of Parkinson’s disease. Am J Epidemiol. 2020 Aug 1;189(8):801–810. PMID:32016345

Smith BM, Kirby M, Hoffman EA, Kronmal RA, Aaron SD, Allen NB, Bertoni A, Coxson HO, Cooper C, Couper DJ, Criner G, Dransfield MT, Han MK, Hansel NN, Jacobs DR Jr, Kaufman JD, Lin CL, Manichaikul A, Martinez FJ, Michos ED, Oelsner EC, Paine R 3rd, Watson KE, Benedetti A, Tan WC, Bourbeau J, Woodruff PG, Barr RG; MESA Lung, CanCOLD, and SPIROMICS Investigators. Association of Dysanapsis With Chronic Obstructive Pulmonary Disease Among Older Adults. JAMA. 2020 Jun 9;323(22):2268– 2280. doi: 10.1001/jama.2020.6918. PMID: 32515814 Mayara Lisboa Bastos, MD, MSc; Jonathon R. Campbell, PhD; Olivia Oxlade, PhD; Menonli Adjobimey, MD, MPH; Anete Trajman, MD, PhD; Rovina Ruslami, MD, PhD; Hee Jin Kim, MD; Joseph Obeng Baah, MD, MPH, DThM; Brett G. Toelle, PhD; Richard Long, MD; Vernon Hoeppner, MD; Kevin Elwood, MD; Hamdan Al–Jahdali, MD; Lika Apriani, MD, PhD; Andrea Benedetti, PhD; Kevin Schwartzman, MD, MPH; and Dick Menzies, MD, MSc. Health System Costs of Treating Latent Tuberculosis Infection With Four Months of Rifampin Versus Nine Months of Isoniazid in Different Settings. Ann Intern Med. 2020;173:169–178. doi:10.7326/M19–3741 Newbold R, Benedetti A, Kimoff RJ, Meltzer S, Garfield N, Dasgupta K, Gagnon R, Lavigne L, Olha A, Rey E, Pamidi S. Maternal Sleep–Disordered Breathing in Pregnancy 68 |

and Increased Nocturnal Glucose Levels in Women with Gestational Diabetes. Chest. 2020 Jul 17:S0012– 3692(20)31911–5.

Mayara Lisboa Bastos,1,2 Gamuchirai Tavaziva,1 Syed Kunal Abidi,1 Jonathon R Campbell,1,6 Louis–Patrick Haraoui,3 James C Johnston,4 Zhiyi Lan,1 Stephanie Law,5 Emily MacLean,6 Anete Trajman,1,2 Dick Menzies,1,6 Andrea Benedetti,1,6 Faiz Ahmad Khan,1,6. Diagnostic accuracy of serological tests for COVID–19: systematic review and meta– analysis. BMJ 2020;370:m2516 Khan N, Downey J, Sanz J, Kaufmann E, Blankenhaus B, Pacis A, Pernet E, Ahmed E, Cardoso S, Nijnik A, Mazer B, Sassetti C, Behr MA, Soares MP, Barreiro LB, Divangahi M. M. tuberculosis Reprograms Hematopoietic Stem Cells to Limit Myelopoiesis and Impair Trained Immunity. Cell. 2020 Oct 29;183(3):752–770.e22. doi: 10.1016/j.cell.2020.09.062.

Exciting Research in the Pipeline CIHR (2020–2023) – $ 707,626 Community Health Workers in Tuberculosis Prevention and Care Services in Nunavik PI: Dr. Faiz Ahmad Khan Nunavik is the region of Inuit Nunangat in Quebec, and a key element of its tuberculosis (TB) Elimination Plan is the deployment of Community Health Workers (CHWs) into the teams providing frontline TB prevention and care services in Nunavik villages. The goal of this project is to develop and pilot a training program for the formation of CHWs on TB 2020 Annual Report of the McGill Department of Medicine

prevention and care activities in Nunavik, that is informed

by Nunavimmiut (Inuit of Nunavik) values and knowledge, including culturally–relevant and effective approaches to teaching. This will be achieved by working with Nunavimmiut to co–create a vision of what CHWs working on TB will do in Nunavik, and to co–develop the educational programme.

Impactful Clinical Innovation

CIHR (2020–2025) – $ 726,750 Understanding the basis of diaphragmatic weakness in critical illness PI: Dr. Basil Petrof

Liquid biopsy for non–small cell lung cancer: comparing plasma cell–free DNA/RNA to tissue next generation sequencing to assess turnaround time, patient distress and cost–effectiveness. This opened in 2020 at JGH and MUHC, led by Dr. Jason Agulnik and supported by the Rossy Cancer Foundation.

Patients admitted to the intensive care unit often develop severe muscle atrophy and weakness, which can also involve the diaphragm. This causes difficulties in weaning patients from mechanical ventilation and also leads to prolonged diaphragmatic weakness once patients leave the ICU. The purpose of this project is to develop a better understanding of the biological mechanisms underlying this diaphragmatic weakness, so that more effective treatments and preventive measures can be developed.

CIHR (2020–2022) – $ 187,425 Sublingual Fentanyl for acute relief of breathlessness in patients with advanced COPD : A randomized double–blind, placebo–controlled, crossover design trial PI: Dr. Jean Bourbeau Breakthrough COPD dyspnea represents an important element in the spectrum of managing breathlessness in COPD patients. A novel approach that includes the use of small doses of sublingual liquid fentanyl might be effective while remaining safe to treat breakthrough COPD dyspnea.

This approach has been shown to be effective for pain control but has never been tested to treat breakthrough COPD dyspnea. This is a multicenter randomized trial to evaluate the effect of sublingual fentanyl on dyspnea in severe to very–severe COPD patients with persistent dyspnea despite optimal therapy. This study is a crucial step toward appropriate treatment selection for breakthrough COPD dyspnea and will also pave the way to future research for control of acute refractory breathlessness in other severe respiratory diseases.

March 2020 saw the development of the first non–ICU COVID ward at MUHC, on Glen C4 which is a space previously used for clinical research. Multiple MUHC Respiratory Division physicians with nurse–manager Cordelia McNeal from MCI Respiratory Day Hospital are involved.

The Balloon Pulmonary Angioplasty for Chronic thrombo– embolic pulmonary hypertension at the JGH is a shared project with the Division of Cardiology where patients with inoperable CTEPH are offered BPA to improve hemodynamics, symptoms and quality of life. It is a new procedure, and we are the only center in Quebec performing it, and one of only 2 centers in Canada. These patients have a relatively rare condition where we have expertise at the JGH in all aspects including pulmonary hypertension management, thrombosis expertise, technical abilities and surgical support. We are uniquely placed to follow these patients from the entire province through the pulmonary hypertension/CTEPH clinic. We give patients with limited treatment options state of the art care and comprehensive multi–disciplinary follow–up.

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Rheumatology Leadership Dr. Christian Pineau (McGill / MUHC) Dr. Murray Baron (JGH) Dr. Laeora Berkson (JGH Interim as of January 2021) Dr. Jan Schulz (SMH)

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CLINICIAN SCIENTISTS & INVESTIGATORS PHDS CLINICIAN TEACHERS & EDUCATORS

Dr. Christian Pineau Profile photo taken by Owen Egan

5 Notable 2020 Publications (Division or DOM primary member’s name in bold type) Colmegna I, Useche ML, Rodriguez K, McCormack D, Alfonso G, Patel A, Ramanakumar AV, Rahme E, Bernatsky S, Hudson M, Ward BJ. Immunogenicity and safety of high–dose versus standard–dose inactivated influenza vaccine in rheumatoid arthritis patients: a randomised, double–blind, active– comparator trial. Lancet Rheumatol 2020;2(1):e14–e23.

Maltez N, Puyade M, Wang M, Lansiaux P, Marjanovic Z, Charles C, Steele R, Baron M, Colmegna I, Hudson M, Farge D. Canadian Scleroderma Research Group; MATHEC– SFGMTC network. Autologous hematopoietic stem cell transplant in systemic sclerosis is associated with marked improvement in health–related quality of life. Arthritis Rheumatol 2020 Sep 10. doi: 10.1002/art.41519.

Arielle Mendel, Daniel Ennis, Ellen Go, Volodko Bakowsky, Corisande Baldwin, Susanne M. Benseler, David A. Cabral, Simon Carette, Marie Clements–Baker, Alison H. Clifford, Jan Willem Cohen Tervaert, Gerard Cox, Natasha Dehghan, Christine Dipchand, Navjot Dhindsa, Leilani Famorca, Aurore Fifi–Mah, Stephanie Garner, Louis–Philippe Girard, Clode Lessard, Patrick Liang, Damien Noone, Jean–Paul Makhzoum, Nataliya Milman, Christian A. Pineau, Heather N. Reich, Maxime Rhéaume, David B. Robinson, Dax G. Rumsey, Tanveer E. Towheed, Judith Trudeau, Marinka Twilt, Elaine Yacyshyn, Rae Yeung, Lillian Barra, Nader Khalidi and Christian Pagnoux. CanVasc Consencus Recommendations for the Management of Anti–Neutrophil Cytoplasmic

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Antibody–Associated Vasculitis: 2020 Update. The Journal of Rheumatology September 2020, jrheum.200721; DOI: https://doi.org/10.3899/jrheum.200721 Almeida–Brasil CC, Pineau CA, Vinet E, Hanly JG, Peschken CA, Clarke AE, Fortin PR, Abrahamowicz M, Bernatsky S. Arthritis Care Res (Hoboken). Predictors of unsuccessful hydroxychloroquine tapering and discontinuation: Can we personalize decision–making in systemic lupus treatment?

2020 Dec 26. doi: 10.1002/acr.24548. Epub ahead of print.

PMID: 33369255.

Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, Marder W, Guyatt G, Branch DW, Buyon J, Christopher–Stine L, Crow–Hercher R, Cush J, Druzin M, Kavanaugh A, Laskin CA, Plante L, Salmon J, Simard J, Somers EC, Steen V, Tedeschi SK, Vinet E, White CW, Yazdany J, Barbhaiya M, Bettendorf B, Eudy A, Jayatilleke A, Shah AA, Sullivan N, Tarter LL, Birru Talabi M, Turgunbaev M, Turner A, D’Anci KE. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Apr;72(4):529–556.

2020 Annual Report of the McGill Department of Medicine

Exciting Research in the Pipeline MI4 Flagship Programs (2020–2025) – $ 950,000 Interstitial Lung Disease in Systemic Autoimmune Rheumatic Diseases: from Prediction to Cure PIs: Dr. Silvia Vidal (Human Genetics), Dr. Christian Pineau, Dr. Deborah Assayag, Dr. Ines Colmegna This large–scale collaborative project will investigate the causes of onset and progression of interstitial lung disease in patients with autoimmune diseases. The aim is to understand better this devastating complication in order to develop effective targeted therapies and even prevent its onset.

MI4 Flagship Programs (2020–2025) – $ 950,000 Stand Up to Rheumatoid Arthritis PIs: Dr. Marie Hudson, Dr. Ines Colmegna, Dr. Sasha Bernatsky This innovative project will look at elucidating the mechanisms responsible for the onset and progression of rheumatoid arthritis, one of the most common and devastating inflammatory joint disease. This important work will lead to the future identification of novel therapeutic targets.

The Arthritis Society Stars Career Development Award (2020–2023) – $ 375,000 TNF Inhibitors and Infections in Pregnant Women and their Offspring PI: Dr. Evelyne Vinet

safety of these medications in pregnancy and thus lead to a safer use of these medication and to safer and more successful pregnancies and pregnancy outcomes in these young women.

Investigator–initiated grant funded by BMS (Bristol Meyers Squibb) Foundation (2020–2023) – $ 250,000 Development of a Canadian Research Group of Rheumatology in Immuno–Oncology (CanRIO) for Prediction and Optimal Management of Inflammatory Arthritis associated with Cancer Immunotherapies.

PI: Dr. Marie Hudson A recent innovation in the treatment of many severe malignancies, Cancer Immunotherapies have unfortunately shown to cause adverse events in some patients in the form of new or worsening autoimmune diseases. This grant will enable the establishment of a Canadian research network that will better characterize the frequency and severity of these adverse events and lead to a safer use of these lifesaving medications.

Impactful Clinical Innovation Stand Up to Rheumatoid Arthritis is an interdivisional (JGH, MGH and MUHC) project to advance evidence–based decision making around the use of biologics for rheumatoid arthritis by embedding pragmatic trials into clinical practice.

TNF inhibitors are part of the essential therapeutic regimen of a large number of young women with inflammatory arthritis, inflammatory bowel diseases and inflammatory skin diseases. This important project will help clarify the

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Division of Experimental Medicine Leadership Dr. Anne–Marie Lauzon, Graduate Program Director Dr. Elizabeth Fixman, Associate Program Director

Experimental Medicine is a Division of the Department of Medicine that provides a graduate student training program for faculty members of the department, and enables professors located in the Research Institutes of the McGill teaching hospitals (and Institut de recherches cliniques de Montréal, IRCM) to supervise graduate students.

There are 261 clinical and basic science researchers who, through their membership in the Division, supervise graduate trainees, of which there are ~300 (see details for 2020 below).

The Division offers 45 courses and six thesis–based degree programs, in addition to the diploma and certificate programs:

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•

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MSc in Experimental Medicine, Environmental Option MSc in Experimental Medicine, Digital Health Innovation Option (New for Fall 2021!)

PhD in Experimental Medicine PhD in Experimental Medicine, Environmental Option

EXMD 604 and 605 – Recent Advances in Cellular and Molecular Biology I & II, previously offered as EXMD 604D1–D2, was split into two separate courses for 2020–2021, resulting in increased enrollment.

EXMD 636 – Fundamentals of research; Shaping and Situating Research was cross–listed with HSE 703

MSc Option in Digital Health Innovation (approved Fall 2020, launching Fall 2021) focuses on the basics of clinical epidemiology, medical artificial intelligence, clinical innovation, and applied data science, including the use and generation of digitized health and social data using specialized software.

Graduate Program Revisions and Development

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Graduate Diploma in Clinical Research Graduate Certificate in Regenerative Medicine

EXMD 630 – Developing digital health innovations for health impact, elective course in the new M.Sc. option in Digital Health Innovation

New and Revised Programs

MSc in Experimental Medicine, Bioethics option

New and revised courses:

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Profile photo taken by Owen Egan

MSc in Experimental Medicine

Program Updates from 2020

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Dr. Anne–Marie Lauzon

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Oral Comprehensive Exam (OCE) – committee established to review and standardize the current OCE, revisions to be finalized in 2021.

In 2020, the content of the Academic Advisor Tips & Tricks and New Members meetings was revised to provide training on student supervision for new members in the Division.

Student Stipends All students must receive an annual minimum stipend from either their supervisor or external fellowships. The Faculty of Medicine is developing a harmonized stipend (HS), with an implementation goal of Sept 2022 and the Division of ExMed supports and promotes the HS.

EXMD 601 – Real World Applications of Data Science and Informatics, required course for the new M.Sc. option in Digital Health Innovation

2020 Annual Report of the McGill Department of Medicine

Student Funding

Application statistics

In 2020, Experimental Medicine students were successful in receiving funding from both external and internal sources. Forty–two (42) students received external studentships and awards in the total amount of $903,700.

An additional 31 students received internal awards and studentships in the total amount of $364,633. In addition, the Division of Experimental Medicine disbursed $650,000 of its Graduate Excellence Funds to its MSc and PhD students as recruitment awards and international student tuition supplements.

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 a personal statement.

For the period 2015–2020, 41% of applicants were from Quebec, 39% from abroad and 20% non–Quebec Canadian residents. Despite the challenges of COVID–19, our overall student numbers increased in 2020. In addition, the Division welcomed 97 new students in Fall 2020, an increase of 15% from Fall 2019 (n=82).

Student Numbers (Winter 2020, Fall 2020, Winter 2021) Term

Diploma

MSc

PhD

Not registered in Minerva, counted as students (e.g.

Leave of Absence (LOA), Time Limitation(TL))

TOTAL

2020/01

20

115

132

3 (LOA), 2 (TL), 2 (DNR)

274

2020/09

10

149

140

4 (LOA), 1 (TL), 1 (DNR)

305

2021/01

12

151

147

5 (LOA), 4 (TL), 4(DNR)

323

Graduation Statistics (Years to Complete)

Student Wellness

For the calendar year 2020 (Feb 2020, May and Oct. 2020 grads), the average time to complete programs was: MSc: 2.21 years, n=42; PhD: 6.4 years, n=20; Diploma: 1.21 years, n=17. As the quality of our students increases (based on higher admission standards), it is expected that these times will further decrease.

The Experimental Medicine Graduate Students Society (EMGSS) organizes activities to foster inclusiveness and support graduate students in varied ways. Activities range from stress management to social activities, discussions and peer guidance for thesis writing, to workshops on career development, etc. Students are also given information about the McGill Student Wellness Hub at Orientation Sessions and the link is posted on the front page of our webpage. These activities were held virtually throughout 2020. Two student affairs coordinators and one student affairs administrator also provide support to ExMed students.

Governance Experimental Medicine is led by a Graduate Program Director and an Associate Graduate Program Director. An Executive Committee is in charge of curriculum overview and is comprised of members from each Research Institute, both PhDs and MDs, and meets every nine months.

Special events

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Student Orientation The EMGSS, in collaboration with the Division, hosts a new student orientation in September and January of each year, where students are provided an overview of the Division, program expectations, funding information, and university services available to them.

Buddy Program In the Fall of 2020, because several international students were not able to get to Montreal due to the pandemic, the EMGSS launched a buddy program where senior ExMed students helped incoming students and answered their questions about the program, McGill, life in Montreal, etc.

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The 2020 Annual McGill Biomedical Graduate Conference (AMBGC) was held remotely on October 21, 2020, and was attended by 190 students and faculty members. The AMBCG included poster sessions, oral presentations, and a keynote presentation (Dr. Elaine Fuchs of the Howard Hughes Medical Institute).

In 2020, the Division participated in two Graduate Student Recruitment events organized by the Faculty of Medicine, one held in person and virtually on February 4, 2020, and the other held virtually on November 16, 2020.

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“The level of collaboration I lived was heartening, the willingness to step out of comfort zones was inspiring and talent we have in our midst is awesome.

I tell friends/family/colleagues that I feel like a kid in a candy store working with such a tremendous group of individuals.”

CHAIR, DR. MARC ALAN RODGER