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Charting a new course for MS treatment

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Research from the UBC Faculty of Medicine could stop the disease in its tracks — and even reverse its devastating effects

One day in the spring of 2014, Heidi Scott’s face went numb. Out-of-nowhere, just-returned-from-the-dentist numb, as she vividly remembers.

“I was on a business trip and it took me completely by surprise. My entire face was affected,” Heidi says.

Alarmed, she returned home to see her doctor, who ordered a battery of tests. The results were inconclusive.

Heidi was in her early forties, a runner and in good health. Her doctor said she could expect to make a full recovery, and eventually she did. After a month or two, she regained the feeling in her face.

“Once I was back to normal, the incident felt kind of unreal, like, did that really happen to me?” she says.

A year later, the numbness returned. This time it spread through Heidi’s ear, down the side of her neck, and into her shoulder. There were muscle spasms and spells of intense fatigue. An ear infection was ruled out, as were various nerve issues. Again, the symptoms resolved, and again, Heidi was left to wonder what was going on.

Within a few weeks, she began to struggle with balance and coordination, and slur her speech. Heidi worried that her colleagues at work might think she was drinking. She also worried that people thought the problem was all in her head, because the symptoms came and went. They were unpredictable.

“If we can stop the disease from progressing and help people recover even some of what they’ve lost, the impact on their quality of life would be quite profound.”
Dr. Freda Miller
Professor of Medical Genetics

An MRI finally confirmed that something was indeed wrong. The scan revealed tiny lesions, or ‘sclerae,’ in the white matter of her brain. She was referred to the Vancouver Coastal Health MS Clinic in the UBC Faculty of Medicine’s Djavad Mowafaghian Centre for Brain Health.

After careful consideration of her symptoms and test results, her doctors arrived at a diagnosis: multiple sclerosis (MS). MS is a progressive autoimmune disease that attacks nerve cells in the brain and spine, causing a bewildering array of symptoms.

At the MS Clinic, Heidi was able to access a treatment that helps to control the symptoms and slow the progression of the disease. Unfortunately, like most MS drugs, it’s a powerful immunosuppressant that also leaves her vulnerable to infection. Even a mild illness such as the common cold can be dangerous.

But there’s reason for optimism. New technologies and new research are opening up new possibilities for MS treatment and care.

“Truly, we’re in the midst of a golden age of biomedical innovation,” says Dr. Peter Zandstra, a professor in the UBC School of Biomedical Engineering (SBME) and an expert on stem cells and bioengineering.

“It’s exciting, because the ultimate goal is to give patients their lives back.”

Researchers at the UBC Faculty of Medicine are working across disciplines to do just that. They’re developing novel therapies to control MS symptoms for more patients with fewer side effects, slow the progression of the disease — and even reverse the damage it causes to the nervous system.

And thanks to a new gift — the largest known donation ever for MS research, worldwide — UBC is poised to become a global hub for MS innovation, scaling up its team science approach to bring new and better therapies to patients sooner than ever before.

For the more than 90,000 Canadians living under the shadow of MS — and the 4,000 who receive a diagnosis each year — sooner can’t come soon enough.

Stopping a debilitating disease in its tracks

It’s the unpredictability of the disease that makes MS so difficult to diagnose, treat — and live with.

MS attacks and destroys myelin, the fatty sheath that covers nerve cells in the brain and spine. If you think of nerve cells as, together, forming the cables along which information (in the guise of electrical signals) travels through the nervous system, then myelin is the protective coating that insulates the cables, allowing the information to flow smoothly from place to place without interference. Your brain sends a message to your eyelid, telling it to blink, and it does, simple as that.

As myelin disappears, the nervous system begins to malfunction. Because MS attacks nerve cells seemingly at random, people with the disease can experience a wide range of symptoms. In one person, it might disrupt communication between the brain and the optic nerve, causing vision loss. In another, it might impair bladder function, or cause intense tingling in the hands and feet, even paralysis.

Symptoms come and go, especially in the early stages, and especially in patients with the relapsing-remitting form of the disease, like Heidi Scott. Left untreated, the disease can progress even during periods of apparent remission.

Today’s treatments are life-changing in ways good and bad. For Heidi, they allow her to live almost symptom-free with the assurance that the disease isn’t silently devastating her nervous system. But they also mean giving up the social life most people take for granted.

“I’m fortunate in that I work from home, so it’s easier for me to avoid everyday viruses that can make me very sick. But the side-effects of the treatment have had a tremendous impact. Not everyone understands the implications of being immune-compromised. I’ve fallen out with loved ones because I have to isolate,” she says.

It’s a difficult trade-off, and even then, the current treatments don’t work for everyone. For many patients, MS still means gruelling day-to-day symptoms and long-term disability.

Dr. Megan Levings, a professor in UBC’s Department of Surgery and SBME, has developed a cellular therapy that promises to make immunosuppressant treatments more effective for more people. She leads a team of immunologists and cell engineers who have demonstrated that it’s possible to ‘train’ regulatory T cells (Tregs) — a type of immune cell that controls the body’s response to healthy tissues — to recognize and accept specific types of tissue that a malfunctioning immune system might otherwise attack.

“We want to do for MS what has been done for cancer,” she says. “We know, for example, that some types of T-cell therapies can be dialed up to help the immune system fight against cancer and infection. With MS, we want to dial down the body’s immune response that leads to disease.”

The goal is an immunotherapy that would control the specific and unwanted inflammatory response that, in MS, leads to demyelination — while allowing the immune system to function normally in every other respect. The hope is that MS patients will one day enjoy the benefits of the current treatments with few or none of the side effects.

Thanks to innovative bioprocess engineering techniques developed by Dr. Zandstra and other bioengineers, the therapy, if successful, could be manufactured at scale more readily than most therapeutics, making it quickly and widely accessible to patients as an off-the-shelf treatment.


Dr. Anthony Traboulsee (left) consults with a patient at the VCH MS Clinic at UBC Hospital.

Repairing the brain — and restoring quality of life

For many MS patients, the bigger concern is restoring neurological function they may have already lost.

“It breaks my heart to see patients I’ve known since their diagnosis suffer with serious, progressive disability due to the current lack of treatment options,” says Dr. Anthony Traboulsee, a UBC clinical professor and neurologist at the MS Clinic.

Regenerative medicine may hold the key.

Dr. Freda Miller, a UBC professor and renowned neurobiologist in the Department of Medical Genetics, leads a multidisciplinary team of scientists from UBC and Toronto’s Sick Kids Hospital who are investigating the use of stem cells to repair the damage caused by MS.

Stem cells are the precursors to the specialized cells the body needs to function. Whether a stem cell develops into, for example, a blood cell, an immune cell, or a neuron depends on the signals it receives from its environment, in the form of chemical messages from the network of cells surrounding them.

“The beauty is that the brain contains reserves of neural stem cells. With the right chemical prompts, they can be converted into cells that produce myelin, replacing the ones destroyed by MS,” Dr. Miller explains. “If we can figure out what those prompts are, we can stimulate the brain to repair itself.”

But to decode the messages that prompt a stem cell to become a myelin-producing cell, you have to cut through the noise of all the other communication happening in the cellular environment — a daunting task that requires multidisciplinary expertise and involves huge datasets.

This is where a team science approach makes the difference.

Dr. Miller also works closely with Dr. Zandstra. Neuroscientists from her lab collaborate with his team of physicists and biomedical engineers to model cell networks in three-dimensional space, which they use to formulate and test predictions about cell behaviour. Together the teams are creating a map of cell communication networks that could lead to a breakthrough treatment pathway for MS and other, similar diseases.

“The beauty is that the brain contains reserves of neural stem cells. With the right chemical prompts, they can be converted into cells that produce myelin, replacing the ones destroyed by MS.”
Dr. Freda Miller
Professor of Medical Genetics

Dr. Miller believes her team’s research, if successful, could work in tandem with Dr. Levings’s immunotherapy to give patients a chance at recovery.

“In a perfect world, we figure out a way to regenerate the damaged areas, while our colleagues in immunology train the immune system to leave the new myelin alone,” Dr. Miller says. “It’s a one-two punch.”


90,000+

Canadians live with MS

4,000+

Canadians are diagnosed with MS each year

$33.8M

in new funding for MS research and care


A grand plan to bring new treatments to MS patients sooner than ever

The challenge with any breakthrough discovery, of course, is what comes next. Translating innovative research into an off-the-shelf treatment requires major investment and resources, including pharmacological expertise, clinical trials infrastructure, bio-manufacturing facilities, and much more.

It also requires time, which many patients do not have.

“In terms of disease progression, five or ten years is a very long time for the patients I see. By giving them the opportunity to participate in early-stage clinical trials for promising new therapies, we can give them a greater chance at success,” Dr. Traboulsee says.

With $33.8 million in new funding from an anonymous donor, UBC and its partners are establishing the MS Research Network, a world-class research and patient-care hub that will use the latest advances in cell and gene engineering to develop, manufacture, and test next-generation cell-based therapies.

“If we can stop the disease from progressing and help people recover even some of what they’ve lost, the impact on their quality of life would be quite profound,” Dr. Miller says. “The MS Research Network is an important step toward realizing that dream.”

“Truly, we’re in the midst of a golden age of biomedical innovation. It’s exciting, because the ultimate goal is to give MS patients their lives back.”
Dr. Peter Zandstra
Professor of Biomedical Engineering

Heidi Scott considers herself one of the lucky ones. Nearly a decade on, she is still able to live an active, if carefully managed, lifestyle. She has become a patient-advocate, drawing on her experiences with MS — from pursuing a diagnosis to enrolling in clinical trials — to make it easier for other people to do the same, whatever health issue they might be dealing with.

“As an MS patient, you’re almost uniquely positioned to see the gaps in the system. It’s such a complicated disease and it requires an extremely thoughtful, holistic approach to research, treatment, and care,” she says.

“That’s what is so exciting about this donation and UBC’s work.”


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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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