Scheduled to open in the Fall/Winter 2013, the Djavad Mowafaghian Centre for Brain Health will unite both patient clinics and research in the areas of neuroscience, neurology, and psychiatry. It will bring together, for the first time under one roof, all the multidisciplinary areas of brain health, including the UBC Hospital Clinic for Alzheimer’s Disease and Related Disorders, the Centre for Huntington’s Disease, the Mood Disorders Centre, the Movement Disorders Clinic, the Multiple Sclerosis Clinic, and research clinical trials.

The Djavad Mowafaghian Centre for Brain Health is a partnership of the Brain Research Centre, UBC Faculty of Medicine, and Vancouver Coastal Health.

Neil Cashman

Dr. Cashman, Professor in the Division of Neurology, has developed an immune-based treatment that targets the toxic form of amyloid-beta, a protein that forms tiny fibers, called plaques, in the brains of Alzheimer’s sufferers.

To date, therapies have been developed that target the plaques. More recent research has shown that a specific form of this protein, which exists prior to their formation into plaques, that actually attacks the brain and causes Alzheimer’s.

Dr. Cashman, a member of the Brain Research Centre of UBC and Vancouver Coastal Health, has discovered a novel way of identifying this short-lived, highly-toxic form of the protein (known as the abeta oligomer) and has produced antibodies that specifically attach to it. This has several advantages in treating Alzheimer’s: it may provide a very effective early diagnostic for the disease, it allows for the development of a therapy to stop the disease’s progression, and ultimately it could lead to the development of a preventative vaccine.

The discoveries made by Dr. Cashman were supported by research funding through CIHR and further advanced through a research collaboration involving UBC, VCHRI, the federally-funded PrioNet Canada Networks of Centres of Excellence and Cangene, one of the nation’s oldest and largest biopharmaceutical companies. Following this collaboration, Cangene licensed the discovery.

“We are pleased to have the opportunity to collaborate with Dr. Cashman who is an expert in misfolded protein diseases and help advance his ground-breaking research in Alzheimer’s Disease” says Dr. Laura Saward, Cangene’s Chief Scientific Officer. “While this work is in its early stages, it is showing promise for the development of a novel immunotherapy to address this devastating disease and fits Cangene’s refocused R&D strategy.”

“This is an all-Canadian solution in terms of its discovery, development and advancement towards the clinic,” says J.P. Heale, Associate Director of UBC’s University-Industry Liaison Office. “The partnerships developed to advance Dr. Cashman’s outstanding research are an excellent example of how Canadian universities, funding agencies and industry partners can work together to tackle a devastating disease of national and global importance.”

Adolescent athletes who experience concussions exhibit changes in their brain for a longer period of time than was previously known, according to new research by Naznin Virji-Babul and Lara Boyd, both members of the Brain Research Centre at UBC and Vancouver Coastal Health.

The results were published in the January edition of the journal Pediatric Neurology.

Lara Boyd (L) and Naznin Virji-Babul (R)

Using a clinical assessment tool and brain imaging, the researchers compared brain white matter structures in 12 adolescents aged 14 to 17 years old who had experienced at least one sports-related concussion in the past two months with 10 otherwise healthy, non-concussed adolescent athletes.

White matter is a type of brain tissue that has a light appearance due to its containing myelin, the fatty coating around axons. Brain cells are composed of a cell body and an axon, a long wire-like tail which conducts electrical messages to other brain cells.

“The imaging results showed that the integrity of white matter in the brain was significantly different between the concussed and non-concussed teenagers,” says Professor Virji-Babul, who is also an Assistant Professor in the UBC Faculty of Medicine and a scientist at the Child & Family Research Institute. “In addition, these changes were strongly associated with the results obtained using a sideline concussion assessment tool.”

The tool, called the Sports Concussion Assessment Tool 2, is often used at the playing field and in clinical settings to determine the level of brain injury based on a combination of scores from a 22 post-concussion symptom scale. Diffusion Tensor Imaging, a type of magnetic resonance imaging, images the movement of water through the brain, which can be affected by brain structure changes from even the mildest of concussions.

The researchers showed that processes and changes in brain microstructure related to an injury persist well beyond the initial event, and this damage may not be noticed or picked up without brain imaging. This leaves open the possibility that concussed adolescent athletes could be returning to sport activity before their brain injury has fully healed.

“Our research has immediate impact on return-to-play decisions made by physicians and medical personnel, coaches, parents, and the athletes themselves,” says Professor Lara Boyd, who also holds a Canada Research Chair in the Neurobiology of Motor Learning. “Age-specific diagnostic guidelines that are applied consistently across the disciplines of neurology, physical medicine, rehabilitation, and sports medicine are needed.”

Nearly one in four people who experienced a concussion between 2009 and 2010 were adolescents, though that number may be higher because the injuries may not have be reported or were treated outside a hospital emergency room. Concussions are especially concerning in children and adolescents because their brains are still developing and may be more susceptible to damage or take longer to fully recover.

The researchers are planning future studies to assess the impact of brain injury on function, in order to understand the risks of returning to play and sustaining additional concussions, as well as developing improved clinical practice guidelines in physicians’ management of sport concussion, including return-to-play decisions.

This study was supported by the Martha Piper Research Fund, the Brain Research Centre, and the University of British Columbia. Analysis of the brain scan images was completed by Michael Borich, a postdoctoral fellow with Professor Boyd.

The Brain Research Centre comprises more than 225 investigators with multidisciplinary expertise in neuroscience research ranging from the test tube, to the bedside, to industrial spin-offs. The Centre is a partnership of the UBC Faculty of Medicine and VCH Research Institute. For more information, visit www.brain.ubc.ca.

The Child & Family Research Institute (CFRI) conducts discovery, translational and clinical research to benefit the health of children and their families. CFRI is supported by BC Children’s Hospital Foundation and works in close partnership with the University of British Columbia, BC Children’s Hospital, and BC Women’s Hospital & Health Centre (agencies of the Provincial Health Services Authority). For more information, visit www.cfri.ca.

Stroke is the leading cause of acquired long-term disability in adults in British Columbia. In 2008/2009 alone there were 4,526 patients in the province who experienced an incident stroke that was severe enough to require hospitalization, and of those patients, 36% died within a year. This makes stroke the third leading cause of death in the province.

“Like many medical conditions, the treatment of stroke and TIA has changed dramatically over years,” says Dr. Harris. “We need to make sure not only do our medical schools include adequate education and training in stroke care and management, but that practicing physicians and healthcare workers are being informed as well.”

As Clinical Leader of the Stroke and TIA Collaborative, an initiative of the BC Patient Safety and Quality Council, he’s providing resources and information, including Canadian best practice guidelines, videos, and educational events, to emergency room healthcare practitioners around the province to help them improve the care of stroke and TIA within their hospital’s emergency department. Already, positive outcomes have been achieved in hospitals around BC, including the building of a TIA clinic at East Kootenay Regional Hospital in Cranbrook to provide timely stroke care on-site, where previously patients would have been transferred to a hospital in Calgary; the reduction in time for stroke patients to receive a CT scan at Victoria General Hospital; and efficiency improvements in care at Mills Memorial Hospital in Terrace.

With funding from the UBC Department of Emergency Medicine, he’s helped position the province as a leader in research and effective knowledge translation of best practices in emergency department management of stroke and TIA. To date, he has been instrumental in developing a stroke registry for BC, evaluating stroke and TIA care in emergency departments around the province, and leading provincial quality improvement initiatives.

In October 2012 he presented research results at the Canadian Stroke Congress leading to recommendations that emergency physicians should receive supplementary training in stroke. In the study, he found that only three of 20 emergency medicine residency programs in Canada had obligatory on-the-job training in general neurology. He also found that less than 2% of lecture time per year was devoted to stroke, in spite of the fact that people with stroke account for 5% of all emergency room patients.

“Since nearly all stroke patients taken to hospital are first seen in emergency departments, and that stroke care management is extremely time-sensitive, it is imperative that emergency department physicians implement up-to-date best care practices,” says Dr. Harris.

Having returned to the School of Population and Public Health at UBC in 2005 to complete a PhD on the evaluation of best practices in the management of patients with TIA and stroke, he is now on the cusp of graduating and remains even more determined to change medical practices. 

With funding from a Canadian Institutes of Health Research (CIHR) knowledge translation grant, along with support from BC Mental Health and Addictions Services and BC Children’s and Women’s Hospitals, earlier this year Dr. Austin helped establish a clinical service to provide genetic counseling relating to serious mental illness free to patients and their families in BC. While the clinic is physically located in Vancouver at the BC Women’s Hospital and Health Centre, Dr. Austin has established telehealth initiatives and periodic outreach clinics to ensure this service reaches all corners of the province.

Genetic counseling is an intervention that helps people to understand and adapt to the genetic contributions of disease. It can help those affected understand and reduce feelings of guilt, shame, and stigma.

“This is the first and only clinic of its kind in the world,” says Dr. Austin, who also holds a Canada Research Chair in Translational Psychiatric Genomics. “Our hope is that this knowledge translation initiative will contribute to changing outcomes for people with serious mental illness and their families.”

CIHR defines knowledge translation as a dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the health care system.

In addition to the clinical services offered, Dr. Austin’s team collaborated with patients and their families to develop an educational booklet about the causes of serious mental illness. That booklet is now being distributed to members of professional organizations of genetic counselors to support them in delivering genetic counseling services for people with serious mental illness elsewhere in the world.

Existing funding ensures that the service will be available for at least another three years, depending on rate of uptake and expansion within the province.

BC Women’s Hospital and Health Centre is an agency of the Provincial Health Services Authority (PHSA).

The Brain Research Centre is a partnership of the UBC Faculty of Medicine and Vancouver Coastal Health Research Institute.

For more information on Dr. Austin’s research and her knowledge translation activities, please visit http://www.bcmhari.ca/faculty/austin-jehannine.php. 

The results of the study, part of the large international clinical trial called the Secondary Prevention of Small Subcortial Strokes (SPS3), were published in the Annals of Neurology in November.

Small strokes, also known as lacunar strokes, are actually surprisingly common, comprising 25% of all ischemic strokes, and occur at a younger age than many other types of stroke. Lacunar strokes are the leading cause of vascular dementia, and are thought to result from diseases of the blood vessels, such as heart disease, hypertension, and diabetes.

Patients who were between 6 weeks and 3 months post-stroke received comprehensive neuropsychological testing including measures of memory, perceptual speed, verbal fluency, motor dexterity, and executive functions. The study included 1663 participants from Canada and the United States who had experienced a lacunar stroke, with initial symptoms of motor, vision, and speech difficulties. Lacunar strokes are different from cortical strokes, which in turn may be associated with far more dramatic symptoms, such as complete disruption of speech, voluntary movements, and awareness.

“Our results showed that about half of all participants met criteria for mild cognitive impairment, even when they had no or minimal physical disability,” said Dr. Jacova. “This challenges the idea that lacunar strokes are generally thought as being fairly benign.”

This study did not assess whether the adverse cognitive effects persisted, worsened, or disappeared over time. However, the researchers will now utilize the SPS3 database to address these important questions in future studies.

“The implications for clinical practice are clear-cut,” says Dr. Benavente, who is also the research director of the Stroke and Cerebrovascular Health Program at Vancouver Coastal Health. “People who have experienced a lacunar stroke should have a cognitive assessment at the earliest opportunity, and this assessment may need to be repeated at follow-up.”

The Secondary Prevention of Small Subcortical Strokes trial was funded by the US National Institute of Health. More information on the SPS3 project is available at http://sps3.med.ubc.ca/.

The Brain Research Centre is proud to help sponsor this conference. For more information and to register, please visit http://braindevelopmentandlearning.com/BDL2013/.

The molecule, known as GSK3-beta, activates a gene that creates a protein, called BACE1. When BACE1 cuts another protein, called APP, the resulting fragment – known as amyloid beta – forms tiny fibers that clump together into plaques in the brain, eventually killing neural cells.

Using an animal model, Dr. Weihong Song, Canada Research Chair in Alzheimer’s Disease and professor of psychiatry, found that disabling GSK3-beta’s effect in mice resulted in less BACE1 and far fewer deposits of amyloid in their brains. Song’s research, published online today in the Journal of Clinical Investigation, also found that such mice performed better than untreated mice on memory tests.

Previous research had shown that GSK3-beta spurred the growth of twisted fibers inside neurons, known as tangles – another hallmark of AD. Song says his discovery of the protein’s dual destructiveness makes it a promising target for drug research.

GSK3-beta, however, is a versatile enzyme that controls many vital physiological functions. The drug used to inhibit GSK3-beta in the mice is too indiscriminate, and could cause several serious side effects, including cancer.

“If we can find a way to stop GSK3-beta’s specific reaction with BACE1, and still leave it intact to perform other crucial tasks, we have a much better chance of treating AD and preventing its progression,” says Song, a member of the Brain Research Centre at UBC and the Vancouver Coastal Health Research Institute (VCHRI), and Director of the Townsend Family Laboratories at UBC. 

BACKGROUND | Alzheimer’s research

An elusive target: Finding AD therapies is particularly challenging because by the time symptoms of memory loss and cognitive decline appear, much of the damage – in the form of plaques and tangles – has already been done and is irreversible. To demonstrate a preventive effect, a new drug would have to be given to a very large group of people, and those people followed over a long period of time to determine if AD rates are lower than a control group.

China connection: Dr. Song conducted some of this research in Chongqing, China, where he is Director of the Canada-China Joint Center for Translational Medical Research in Child Development and Alzheimer’s Disease – a partnership between UBC and the Children’s Hospital of Chongqing Medical University.

The concrete roof and membrane structures have now been completed, and it is anticipated that the metal roof structures will be finished by the end of January. Not only will the building will have permanent power by the end of 2012, but the interior framing will be also be completed by that time, with interior finishing to begin in the early Spring. The installation of the exterior glazing and cladding systems is underway, and is anticipated to be finished by the late Spring. The construction of the bridge connecting the third level of the new building to the second floor of Koerner Pavilion will commence in early 2013.

Please click here for more detailed information on UBC Hospital parking and access during the construction.