Page 48 - An Innovation Spirit ...

A team of cardiac therapies.”
surgeons, vascular
surgeons and
interventional
radiologists meet
regularly to discuss
cases that benefit
from a multi- of-the-art equipment and critical
disciplinary approach
to patient care.
Stem cell reSearch
Researchers at the Peter Munk
Cardiac Centre are attempting
to restore circulation using stem
cells to alleviate the symptoms
of peripheral vascular disease,
a condition that develops when
arteries that supply blood to
internal organs, arms and legs
become blocked.
Dr. Thomas Lindsay, Division
Head of Vascular Surgery at
the PMCC, based at Toronto
General Hospital, is the principal
investigator on the Hemostemix
trial, which involves targeting
diseased tissue with new cells
grown from the patient’s own
blood.
“We are taking the patient’s
own cells, putting them in the
right environment and with
the right stimuli, trying to grow
new cells to inject them back
into the leg to regenerate the
circulation,” explains Dr. Lindsay,
a world-renowned vascular
surgeon with more than 25 years
of experience.
“We know stem cells are
important; they still have not
reached their full potential. In the
vascular field, it’s about getting
growth to happen in someone
who is 70, not 7, and finding out
what the conditions are that
allow for that to happen.”
A breakthrough in this field
would be greatly beneficial for
people suffering from critical limb
ischemia (CLI), a severe form of
peripheral artery disease (PAD)
that can result in limb loss, Dr.
Lindsay says.
Amputation or death occurs in
approximately 50% of patients
with CLI over 5 years, which is
caused by reduced blood flow to
the legs.
46 Peter Munk Cardiac Centre
don’t and why they are different
Dr. Lindsay’s colleague, and the
current University of Toronto
Vascular Chair, Dr. Thomas
Forbes, agrees that the PMCC
provides an ideal environment
for innovation: strong leadership,
support and investment, state-
mass.
Speaking about his role as
chair, he points out the “unique
situation” in vascular surgery
in Toronto, because all of the
hospitals fall under the umbrella
of one university, unlike other
cities where they are divided.
“There is real strength in
numbers and expertise. That’s
what drew me here – the ability
and potential to be a world-leader
in discovery and innovation, and
to educate tomorrow’s leaders.”
Looking to the future, Dr. Forbes
believes the next transformation
in vascular surgery is combining
high-tech hardware with
biologics.
Essentially, this means clinicians Dr. Forbes adds.
will decide on customized
treatments based on what’s found
in a patient’s genes.
“This is precision or personalized
medicine,” explains Dr. Forbes.
“It’s taking the human genome
and deciding on a therapy, based
on what you see. If you take 100
people with aneurysms, they will
not behave the same way. We need
to explore the reasons why some
aneurysms grow and some don’t,
why some rupture and some
the best way to get a CT scan,” Dr.
– and be able to treat patients
accordingly. Research projects at
the PMCC are ongoing; some are
in their infancy, others are more
developed,” he says.
The second part to this is the
hardware, such as stents and
other devices that go into the body
to open up arteries and improve
blood flow.
“Increasingly, we will have
devices that are customized to
the individual patient’s anatomy,”
Dr. Forbes says. One ongoing
project is a collaboration with
engineering to see if aortic stent
grafts (endografts) can be made to
last longer, and how they can best
be tailored to suit individuals.
“Sometimes, it can take a month
or two to get a stent made. In a
serious situation, that’s a problem, Dr. Forbes are clear that first-class
but with the advent of 3-D
printing, that will all change.”
Work is ongoing at the PMCC
to create new types of stents, and
they have been used in animal
models, but not yet in a patient,
It’s this kind of cutting-edge
research that keeps the PMCC on
the global stage.
Another study is imaging-based
and uses advanced MR imaging
to get a visual description of what
a blockage looks like. Based on
this information, doctors will
make a more informed decision
on how to proceed.
“We are also developing new
imaging models. For example,
Forbes says.
“Normally, when you get a CT
scan you are lying down. In their
daily lives, people are standing up
for two-thirds of the day, so we
are looking at whether or not it’s
better to get a CT scan standing
up.”
Yet another area of research is
the push to harness big data.
“We have the epidemiological
data of thousands of patients and
outcomes. The challenge is taking
numbers and applying them to
one person, finding out if there
are any rules you can apply at an
individual level,” he explains.
But aside from the forward
march in terms of science and
innovation, both Dr. Lindsay and
patient care, delivered through
multidisciplinary teams, is the No.
1 way that the PMCC stays ahead
of the curve.
“One of the fundamental things
we have tried to overcome here
is getting specialists to work in
complementary multidisciplinary
teams,” says Dr. Lindsay.
“We work together with
surgeons, interventional
radiologists, anesthetists” and in
complex cases with other highly
trained health-care professionals,
such as cardiac surgeons.
Dr. Forbes concurs. “Our first
obligation is to our patients. We
get referrals from all over Canada
as we specialize in certain areas
that are not available in other
places. Very often, we see patients
who don’t have just one disease.
It’s very important they don’t get
siloed into one area.”
In other words, the PMCC
ensures that patients and their
illnesses come ahead of hospital
administration that likes to
pigeonhole people under one
discipline.
“It sounds simple, but
operationally it’s sometimes
difficult to do across a hospital
with different divisions. That is
a great strength of the PMCC –
the way people can flow easily
through the system because of
this multidisciplinary approach
that is one of the hallmarks
of [the] Peter Munk [Cardiac
Centre],” adds Dr. Forbes.
“Global success starts locally.”