Medical Breakthroughs of 2009
From the first photo of a memory to heart surgery on a fetus, 2009 was a banner year for medicinein Canada. Go on location and meet the pioneers of some of these incredible medical breakthrough
Dr. Edgar Jaeggi, The Hospital for Sick Children, Toronto
The “SickKids” hospital has come a long way since it opened in 1875 with just six beds. Notable achievements at SickKids include the invention of Pablum, Dr. William Mustard’s development of his eponymous procedure to correct “blue baby” syndrome (a formerly common and fatal heart defect in newborns that results in bluish skin); the discoveries of the muscular dystrophy gene and the genetic
code for cystic fibrosis; and last year, the use of an external artificial lung to keep a teenager alive until donor lungs were available-a medical world first.
None of this mattered, however, to Vicki McKenzie of Gatineau. Last spring, 30 weeks pregnant, McKenzie learned her unborn child had critical aortic stenosis, a severe narrowing of the valve leading to the left side of the heart. Without intervention, the baby could die.
Although sometimes hereditary, the condition didn’t run in McKenzie’s family, nor were her other two children affected. “Most of the time, we don’t know why babies have it,” says Dr. Edgar Jaeggi, head of the Fetal Cardiac Program at SickKids.
McKenzie and her husband, Ian, had a near-impossible decision to make: Their unborn baby needed immediate surgery, but inducing labour and operating early would be, according to Jaeggi, “a high-risk intervention.” And waiting until after a full-term birth could be akin to a death sentence-the baby girl would likely need more major heart surgeries but still have a heart condition, hypoplastic left-heart syndrome, that claims 35 percent of its sufferers before the age of ten.
But there was another possibility: operating while the fetus was still in the womb. The innovative procedure had never before been performed successfully in Canada, but it seemed the best option.
Three days after the aortic stenosis was diagnosed, Jaeggi and his team, with doctors from Mount Sinai Hospital, went to work: A needle was inserted through McKenzie’s abdomen and into the fetus’s grape-size heart. Then, guided by ultrasound, surgeons expanded the narrowed aortic valve with a balloon catheter. The procedure, which took just 20 minutes, ultimately saved the baby’s life.
Although still premature when she was born a month later, baby Océane had benefited from the extra time in the womb (she was a solid six pounds at birth). She’ll probably need a valve replacement one day, says Jaeggi, (“maybe when she’s a young adult.”) But for now, Océane is doing well.
Big Virus Hunters
An imposing building in the heart of Winnipeg is one of just 15 elite sites around the world where scientists are allowed to handle the planet’s deadliest viruses and diseases, including Lassa fever, Crimean-Congo hemorrhagic fever and Creutzfeldt-Jakob disease.
The National Microbiology Laboratory has been around for only ten years, but it has seen remarkable success in that time. In 2005, scientists here created a vaccine for Marburg and Ebola (tropical illnesses with mortality rates of up to 90 percent). And in 2007, they revealed the mechanisms behind the 1918 Spanish flu pandemic (which was caused by H1N1): By infecting monkeys with that virus, which they reconstructed using the genetic sequence American scientists had decoded from some of its original victims, researchers were able to study the mechanics of how it causes the immune system to overreact and fill the lungs with fluid. This discovery has bettered our understanding of what makes some flu viruses so deadly.
Normally toiling in obscurity, the lab’s scientists were thrust into the public eye last spring during the H1N1 flu outbreak. The crisis started in Mexico in early April 2009, when 400 people in Veracruz came down with an unusual flu. Seeking help to identify the culprit, Celia Aranda, director of the Mexican Institute of Diagnostic and Epidemical Reference, couriered 51 specimens, including nasal swabs, from seriously ill people to Dr. Frank Plummer, scientific director of the Winnipeg lab.
A week later, the virus hunters got their quarry, confirming that 17 of the 51 samples held a new strain of H1N1 influenza, a strain known to affect mostly pigs.
The next step was to crack the genetic code of the virus. “Ten people were involved in sequencing the gene,” recounts Plummer. “The place was going 24/7, and some of the people were going 24/7, as well.” By May 6, the lab had decoded Mexican and Canadian samples, proving conclusively that the same virus was making people sick in both countries.
In all, scientists at the Winnipeg lab analyzed 2,100 Mexican samples, and five of the researchers were sent to assist the Mexican scientists in the investigation of the outbreak. Dr. David Butler Jones, director of the Public Health Agency of Canada-which provided another two scientists-describes this work as “one of the lab’s finest hours.”
On top of it all, Plummer’s team made another revealing discovery in the process. As Plummer explains, they found that the spring 2009 strain of the H1N1 flu didn’t have the signature genetic sequences that are thought to have made the 1918 flu outbreak so severe. So, while the virus is still a serious threat, the world can breathe a little easier.
The BC Cancer Agency
In 1935, with B.C.’s death rate from cancer the highest in Canada, a group of prominent citizens founded the BC Cancer Agency to improve the prevention, diagnosis and treatment of the disease. It was here that, in 1949, the world’s first population-based cervical-cancer screening program using the Pap test was launched. Over time, the use of the Pap test, which allows for the detection of
precancerous changes in the cells of the cervix, helped to reduce the incidence of cervical cancer in B.C. women by more than 70 percent. Eventually, the test was used in the rest of Canada and in other developed nations.
Now, the organization’s prostate brachytherapy program-the largest of its kind in Canada-is proving to be a lifesaver for men with prostate cancer. (Brachytherapy involves the insertion of small radioactive seeds in the body to kill cancer cells and inhibit future cancer growth.) Results of a study of the first 1,006 patients in the program show that 95 percent of these men had no increase in their prostatespecific antigen (PSA) levels and very low rates of cancer recurrence or death from prostate cancer.
Clearly, most of the patients had seen excellent results. Such was the case for 74-year-old Norman
Grohmann, former BCTV weatherman, who found out almost ten years ago that he had a cancerous tumour in his prostate. His options included watchful waiting, surgery, external beam radiation or brachytherapy. Grohmann chose the last approach; it seemed to him that it would be the most effective and least invasive.
During a two-hour procedure, needles were used to plant tiny radioactive seeds about the size of salt crystals into Grohmann’s prostate. Afterwards, he felt well enough to go to dinner with his wife. “I’ve had visits to the dentist that are more memorable,” he says.
Grohmann continues to go for his annual PSA test, but his oncologist has pronounced him cancer-free.
There’s good news about cancersurvival rates for Grohmann’s fellow British Columbians, too: In 2005, the province’s mortality rate from all cancers was 152.4 deaths per 100,000 people-the lowest in the country.
According to Dr. Mira Keyes, head of the BC Cancer Agency’s prostate brachytherapy program, “the major goal now is to make the public aware that the program exists. In previous years, we were very modest about it because we were not sure what the results were going to be.”
Picturing the Dawn of Memories
Wayne Sossin, Montreal Neurological Institute
The Montreal Neurological Institute (MNI) was founded more than 75 years ago by Dr. Wilder Penfield, a highly innovative surgeon who made maps of the brain-still in use today-that help us to visualize the connections between specific parts of the brain and the various limbs and organs that they control. Last fall, long-time MNI researcher Brenda Milner (who, at 91, is still hard at work) won a milliondollar Balzan Prize for her work on memory. So it seems fitting that the MNI would be the place where researchers would first visualize a memory as it’s being formed. And that’s exactly what occurred when neuroscientist Wayne Sossin captured the first image of a long-term memory being created.
Scientists can’t photograph memories directly, but using a green fluorescent protein from a jellyfish as a marker, Sossin and a team of collaborators at the University of California, Los Angeles, were able to detect memory formation in a sea slug. Specifically, when a memory was created in the neurons of the sea slug, a protein to “house” that memory was also created. Evidence of this was the visible increase in the levels of the fluorescent green protein at the moment of memory formation.
Scientists have long suspected that the laying down of new memories results in the creation of new proteins, but Sossin’s work provided the first visual evidence of protein-creation, which occurs at the synapses (the connections between nerve cells). “Now we can look at this live,” he says.
By understanding how memories are formed at the cellular level, Sossin hopes to be able to explain what is happening in people who suffer memory loss. “My dream is to be able to reverse that,” he says.
Mending Broken Hearts
Dr. Marc Ruel, University of Ottawa Heart Institute
Founded in 1976, the University of Ottawa Heart Institute is a giant in medical research. In 1986, Canada’s first artificial-heart transplant was performed here and, in 1989, our first neonatal heart transplant (the patient was an 11-day-old baby). In 2006, researchers at the institute discovered the genetic mutation responsible for atrial fibrillation, a type of abnormal heart rhythm.
Add the work of Dr. Marc Ruel to this distinguished list. Ruel, in collaboration with Dr. Joseph McGinn of Staten Island University Hospital, was the first to routinely and successfully perform a specific variant of a minimally invasive coronary-arterybypass technique. In traditional bypass surgery, the breastbone is cut in two and the chest is opened. The patient’s heart is intentionally stopped (a heart-lung machine takes over) while new arteries are grafted on. However, in the technique used by Ruel and McGinn, the surgeon makes an incision between the patient’s ribs that’s not much larger than a paper clip. Using this “keyhole,” the doctor then accesses the still-beating heart, moving it into position as needed so that one or more new arteries can be grafted on. Ruel is now teaching surgeons all over North America how to perform his variant of the keyhole procedure.
On average, it takes about a month of convalescence before patients who’ve had this new type of surgery can return to work-compared with three months of recovery time after the traditional procedure. And there are other benefits, too, as patient Farid Kodsi of Ottawa can attest to: Two years ago, Kodsi, a retired translator, was referred to Ruel for doublebypass surgery. The 67-year-old is still amazed how tiny his post-op scar is. “My friends are just stunned when they see it.
“My brother, who had a bypass 15 years ago, has two scars from the top of his chest almost to his navel.”
Today Kodsi is more active than ever, skiing and swimming without getting tired. “It’s unbelievable,” he
says. “I’m very happy.”