“I congratulate these successful Rady Faculty researchers and their partner networks whose work is contributing to the highest attainable standard of health as a fundamental right here in Manitoba and around the world,” said Dr. Mario Pinto, UM’s vice-president (research and international). 

“It is wonderful to see Manitoba leading the nation with the highest average and median grant values, a testament to the outstanding quality of research conducted at the University of Manitoba.”  

Dr. Peter Nickerson, vice-provost (health sciences) and dean of the Rady Faculty of Health Sciences, said that the funded projects in the Spring 2024 competition show the diversity of health research taking place across the faculty.  

“The researchers are examining a wide range of topics – from new drug combinations to treat blood cancer to determining how the communication between astrocytes and neurons occurs. This CIHR funding is crucial for advancing science and will inevitably have an impact on the health of patients both locally and globally,” Nickerson said.  

One of the 11 Rady Faculty grant recipients is Dr. Jude Uzonna, professor of immunology at the Max Rady College of Medicine and vice-dean (research) at the Rady Faculty of Health Sciences. He and his team received $1,005,976 over five years to study what could one day lead to new treatments for leishmaniasis.  

Leishmaniasis is an understudied parasitic disease spread by sand flies that can cause skin sores and even fatal damage to internal organs. The disease affects more than 12 million people worldwide, Uzonna said, and it’s starting to spread to non-endemic countries like Canada.  

“It’s coming,” he said. “It’s really coming because of global warming, increased immigration from endemic countries to Canada and soldiers coming back from peacekeeping duties. The numbers are growing, but if we can develop a vaccine for it, then it becomes a magic bullet used to prevent it.”  

The team has found that leishmaniasis triggers the production of a molecule called pentraxin 3 (PTX3) in infected people. PTX3 weakens a specific part of the immune system that normally helps fight the parasite, so Uzonna suggests that targeting PTX3 might be a good way to develop new treatments for the disease.  

This study aims to better understand the role of PTX3 in the disease. It will also look at whether the level of PTX3 can predict if someone will benefit from treatment or not, which is important because the current drugs used can be toxic.  

“If we can show that PTX3 is causing a problem, then we can develop a molecule that can target and block PTX3 production. We can combine the molecule with a drug to make treatment more efficient and better. That will have a significant impact,” Uzonna said.  

Rady Faculty of Health Sciences CIHR project funding recipients 

Dr. Marissa Becker, professor of community health sciences, Max Rady College of Medicine 

Grant: $100,000 (one year)  

Using a program science approach, Becker and the team will develop a deeper understanding of how physical, organizational, social and relational dimensions of place shape ecologies of risk and safety for adolescent girls and young women, female sex workers and their male sexual partners in Nairobi County, Kenya. This work will generate contextualized knowledge for prioritizing place-based strategies to optimize sexually transmitted and blood-borne infection prevention program coverage and address unmet needs. 

Dr. Sanjiv Dhingra, professor of physiology and pathophysiology, Max Rady College of Medicine; researcher, Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre 

Grant: $1,067,176 (five years)  

Dhingra will lead a study focused on understanding the reasons for rejecting transplanted donor-derived mesenchymal stem cells in the heart. This research will help to develop strategies to prevent rejection and improve the survival of implanted stem cells in the heart. 

Dr. Jody Haigh, professor of pharmacology and therapeutics, Max Rady College of Medicine; researcher, Research Institute in Oncology and hematology, CancerCare Manitoba 

Grant: $1,071,000 (five years) 

Haigh aims to identify new drug combinations to treat aggressive forms of blood cancer and to determine ways to avoid drug resistance to these treatments that can sometimes occur during cancer therapy. This project will be important in identifying and confirming new drug approaches that can be used in personalized medical care for childhood and adult blood cancer patients in Canada. 

Dr. Julie Lajoie, assistant professor of medical microbiology and infectious diseases, and Francis A. Plummer Professorship in Global Infectious Diseases, Max Rady College of Medicine 

Grant: $1,132,200 (five years)  

Lajoie and the team will follow female sex workers from Nairobi, Kenya, who are using an injectable contraception called depot medroxyprogesterone acetate (DMPA) for six months and determine the immune activation and inflammatory profile in the blood and at the female genital tract. They will also examine whether using DMPA impacts the capacity to respond to previously exposed viruses and affects the cells’ capacity to respond to the stress hormone cortisol. 

Dr. Aaron Marshall, department head and professor of immunology, Max Rady College of Medicine; researcher, Research Institute in Oncology and Hematology, CancerCare Manitoba 

Grant: $1,151,326 (five years) 

Marshall’s project deals primarily with B lymphocytes, the immune system cells responsible for producing antibodies. The research aims to define the cellular reprogramming signals that either switch on or switch off B lymphocytes and how these networks are altered in chronic autoimmune disease. 

Dr. James Nagy, professor of physiology and pathophysiology, Max Rady College of Medicine 

Grant: $898,876 (five years)  

Using experimental mouse models, Nagy and the team will determine how spinal neurons, called V0c neurons, contribute to force level control in the limbs. He expects the results will challenge current textbook knowledge on force generation during movement and reveal new concepts on how command signals to motoneurons are converted to desired levels of muscle activity. 

Dr. Zulma Rueda, associate professor of medical microbiology and infectious diseases, Max Rady College of Medicine; Canada Research Chair in Sexually Transmitted Infection – Resistance and Control 

Grant: $688,501 (four years)  

Rueda will lead a study that will generate a comprehensive and systematic understanding of the knowledge, attitudes and practices about HIV and other sexually transmitted and blood-borne infections (STBBI) among people living with HIV and people who face disproportionate risk of acquiring HIV/STBBI (people experiencing houselessness, people who inject drugs) and health and service providers in Manitoba. 

Dr. Tabrez Siddiqui, associate professor of physiology and pathophysiology, Max Rady College of Medicine; researcher, Kleysen Institute for Advanced Medicine, Health Sciences Centre; researcher, Children’s Hospital Research Institute of Manitoba 

Grant: $1,143,676 (five years)  

Neurexins are essential proteins that help nerve cells in the brain communicate with each other, and changes in the genes for these proteins can increase the risk of developing autism. Siddiqui’s research highlights the possibility of fixing certain brain communication issues by targeting specific proteins, offering hope for new treatments. 

Dr. Jillian Stobart, assistant professor, College of Pharmacy 

Grant: $944,776 (five years)  

Stobart’s project aims to determine how the communication between astrocytes and neurons occurs. This will be the first evidence that astrocytes can change brain circuits responsible for the sense of touch and is important because astrocyte-neuron communication changes in disease. Problems with astrocytes and their communication with neurons could be the missing link in these disorders. 

Dr. Geoffrey Tranmer, associate professor, College of Pharmacy  

Grant: $730,576 (five years)  

Tranmer and the team plan to create new and improved versions of the ALS drug edaravone and test the drug-like properties of these molecules in test tubes and ALS animal models. This will allow the team to determine and optimize the drug properties of the new ALS drug and will enable them to develop an optimized drug candidate ready for advanced clinical trials. 

Dr. Keith Fowke and Dr. Mario Pinto with patient cohort at Nairobi research clinic.

Today, UM research in Kenya includes two major inter-related Rady Faculty of Health Sciences programs led by Keith Fowke, Department Head of Medical Microbiology and Infectious Diseases and James Blanchard, Executive Director of the Institute for Global Public Health. Responding to a need for public health advocacy from UM research partners in Kenya, Global Public Health programs expanded to Kenya in 2008 as an extension of successful projects originally started in India.

“Our programs in Kenya are a unique example of how laboratory-based researchers interested in molecules and cells are collaborating with researchers studying issues of stigmatization and together they make meaningful impacts for marginalized people,” said Keith Fowke.

As researchers began working with marginalized patient cohorts, increased need for community-based supports emerged, informing new programs developed by UM researchers Dr. Souradet Shaw Canada Research Chair (CRC) in Program Sciences & Global Public Health, Dr. Marissa Becker, Dr. Lisa Lazarus, Dr. Lisa Avery, Dr. Joshua Kimani, Dr. Larry Gelmon, Dr. Lyle McKinnon, Dr. Julie Lajoie, Dr. Leigh McClarty, Dr. Jason Kindrachuk CRC in Molecular Pathogenesis of Emerging and Re-Emerging Viruses and Dr. Rob Lorway, CRC in Global Intervention Politics and Social Transformation,. 

“When I first came to Kenya in 2009 there was a group of young men who were starting to attend clinics established for female sex workers, many of whom identified as gay and bisexual, which is criminalized in Kenya,” said Rob Lorway. “Some were young students, and some were older or married, but what was important is that they had a high HIV prevalence. They came to us because we provided safe spaces from Kenya’s public healthcare system that can be, at times, quite judgmental.”

A legacy of evidence-based support & patient directed research

Four decades ago in the early 1980s, after eradicating an outbreak of the sexually transmitted infection Chancroid in Manitoba, Dr. Allan Ronald was recruited to lead a similar program with the Department of Medical Microbiology at the University of Nairobi, Kenya. Dr. Francis Plummer, then an infectious disease fellow on Ronald’s team studying with a group of sex-workers, would gain global renown for the discovery of a link between the spread of sexually transmitted diseases and the emerging HIV/AIDS epidemic.

Among the patient cohort exposed to HIV/AIDS, Plummer and his team identified a group of women with a natural immunity to HIV-1, the virus that leads to AIDS. Over the following 17 years UM researchers, including Fowke, studied the immune system of these women leading to new approaches to HIV prevention. The women participating in the study had contributed to saving and improving the lives of tens of millions of people living with HIV around the world but continued to live a criminalized lifestyle at the fringes of society.

Dr Elizabeth Ngugi, a local public health nurse working with Plummer in managing the patient cohort in the 1980s and ‘90s, recognized the adversity these women and others like them endured each day. Through advocacy, a new patient-directed research model was developed to foreground the needs and voices of patients as fully recognized research partners, rather than research subjects.

Keith Fowke, who was a graduate student at UM labs in Kenya at that time, recalls of Dr. Ngugi, “she was a very direct and clear-thinking woman. Beginning in 1984, Dr. Ngugi developed a peer educator model to train sex workers and support them as informed and educated leaders within the community. Dr. Ngugi’s influence has been global and has resulted in a deep 40-year relationship with this community which has now evolved into the Sex Worker Outreach Program (SWOP) which has been adopted as a best-practice model by the World Health Organization, UN AIDS and countless others.”

Dr. Julie Lajoie (second from left), Dr. Mario Pinto, Joyce Adhiambo (pictured in SWOP t-shirt) and Dr. Keith Fowke pictured here.

Now in 2024, UM infectious disease research in Nairobi encompasses 10 SWOP clinics providing HIV prevention and care services to more than 30,000 female sex workers, about 9000 men who have sex with men and close to 1500 transgender individuals. Supported by Joshua Kimani and Larry Gelman who follows in the legacy left by Dr. Ngugi, some patient partners are now respected community organizers like Joyce Odhiambo with SWOP Ambassadors, who presented to EU Parliament in Brussels in 2018.

Current clinical programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) deliver HIV care and prevention services. However, due to the criminal status of sex work and homosexuality in Kenya, the mere presence of HIV medications or even condoms could provoke harassment or police response.

Members of the patient cohort meet at a Nairobi health clinic.

“In Kenya 4% of the general population is infected with HIV, and in sex workers it’s about 28%,” said Fowke. “Despite these high risks, many women in our cohort choose not to take anti-HIV drugs to prevent infection because of the stigma resulting from their association with being used to treat HIV infection. We are working on providing new approaches to HIV prevention that would be acceptable to these women, including the anti-inflammatory drug, aspirin, which may prevent the immune cell HIV infects from entering the vaginal mucosal environment thereby preventing infection.”

Community empowerment through global public health research

Members of the male patient cohort meet with Dr. Keith Fowke and Dr. Mario Pinto.

“We’re talking about marginalized and stigmatized people, whose lives and livelihoods are criminalized,” said Lorway. “Within the first year of our program 12% of men who have sex with men who originally tested negative for HIV were testing positive. So, despite clinicians doing everything they could at the time – providing risk reduction counseling, supplying condoms and lubricant – HIV infection was growing among these men in our cohort.”

Tourism in Kenya has influenced hotspots where gay and bisexual men can congregate and celebrate themselves. By mapping these hotspots, the Global Public Health team have provided local clinicians and community organizations the ability to establish program catchments and generate their own accurate community health data to inform program coverage targets that guide the funding priorities of donors and the Government of Kenya. Furthermore, by providing training to community leaders so that they can cultivate their own research agenda, now community leaders are coming to Lorway and the team for support with their own investigations.

These expanding partnerships have paved the way for organizations like SWOP Ambassadors, who provides legal aid training and support to sex workers and engages with police to ensure that the right to access healthcare services is respected. The internationally-funded community based organization, HOYMAS (Health Options for Young Men on HIV, AIDS, and Sexually transmitted infections) has now established a clinic in Nairobi which guarantees non-discriminatory care and runs anti-stigma campaigns focused on sexual health and human rights advocacy.

“The shifting scope of Global Public Health research in Kenya is a strong sign of transformational success,” said Mario Pinto, Vice-President (Research and International). “The work of these dedicated researchers and clinicians to advance health as a human right has empowered these underserved communities, not just in self-advocacy, but as entrepreneurs and leaders in their field on the international stage. We know that when people of sexual minorities live free of harassment and stigmatization, they are more likely to access life-saving medical care and be their authentic selves.”

CFI-Funded laboratory provides much-needed sex worker outreach programs

Dr. Keith Fowke and Dr. Mario Pinto pictured with Dr. Julius Oyugi, Director of the University of Nairobi Institute for Tropical and Infectious Diseases

In Kenya, UM has partnered with the University of Nairobi to build a Canada Foundation for Innovation funded lab on their campus and has now developed 10 different SWOP clinics across the city as part of ongoing sex worker outreach programs. “When we first started this program, there wasn’t much medical research infrastructure in Kenya, now I’m supervising Kenyan PhD students doing cutting edge research projects without having to leave their country and we are able to hire all staff locally through with grants available to African institutions,” said Keith Fowke.

Decades of results in overcoming epidemics and securing international funding from partners including Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS has helped to foster good relationships with government. health officials have signaled a willingness to collaborate on efforts to prevent an emerging epidemic of anal cancer among men who have sex with other men resulting from the sexually transmitted infection HPV.

“We have begun addressing an epidemic of cervical cancer resulting from HPV among female sex workers, but a different approach is needed to provide care for men who have sex with men,” said Lorway. “Hate speech almost constantly enters the political theatre during times of economic disruption like the COVID-19 pandemic, so it’s often about quiet negotiations with health official — which can be frustrating because of the urgent need for care. Working with our local partners we’ve established new provisions for anal health care for men who have sex with men. Although working in such a prohibitive political climate can be challenging, these partnerships provide the room we need to discretely develop programs without provoking a negative public reaction.”

Research impacts at home in Manitoba

Joyce Adhiambo (left) and Victoria Were (right)

“There is a presumption that access to care and sex worker support programs are less advanced in the global south. However, in Canada, by criminalizing the clients, we push sex works even further underground,” said Lorway. “Criminalizing sex work makes it extremely difficult to deliver health services. In this case we have something to learn from our work in Kenya about how to provide services to those who are hardest to reach.”

Leading the way in sex work advocacy in Manitoba is the Sex Workers of Winnipeg Action Coalition (SWWAC)  who are partnering with UM infectious disease expert Julie Lajoie, to facilitate an ongoing information exchange between the sex worker communities in Nairobi and Winnipeg. Two community leaders came to Winnipeg in 2022 to discuss their role as grant co-applicants and to share strategies on getting organized in the face of criminalization and public stigma.

“In Canada, we have a parallel issue of Missing and Murdered Indigenous Women, and tragically, there are commonalities in the experiences of marginalized people on both sides of the ocean,” said Keith Fowke. “In Manitoba we’re at least a decade behind African programs in HIV prevention approaches. There are more new cases of HIV in Manitoba this year than in epidemic of the 1980s and ‘90s, and it’s mainly among women in indigenous communities.  We need to adapt global best-practices to prevent infections in Manitoba.”

The Winnipeg-based community resource center Sunshine House is leading the way in Manitoba by offering HIV and sexually transmitted disease testing services and have held a Science + Supper, often featuring presentations from UM Faculty members.

“Programs like those offered at Sunshine House, SWWAC and SWOP Ambassadors are foundational,” said Lorway. “Something we as researchers can always work toward is the de-monopolization of science, to put the power to make change into the hands of those who most urgently need it.”