For the past two summers, Singh, a third-year medical student at the Max Rady College of Medicine, has focused on better understanding the sex-related differences in the development of rheumatoid arthritis.

The B.Sc. (Med.) program provides an opportunity for medical students to spend two summers – following their first and second years of the four-year MD program – immersed in research.

Under the guidance of her supervisors, Dr. Neeloffer Mookherjee, professor of internal medicine, and Dr. Liam O’Neil, assistant professor of internal medicine, Singh’s central hypothesis is that sex-specific immune differences shape preclinical rheumatoid arthritis and follow shared trajectories in both mice and humans.

Singh used a variety of tests to determine the changes in key biomarkers and to identify patterns associated with preclinical rheumatoid arthritis.

UM Today sat down with Singh to learn about her experience as a B.Sc. (Med.) student at UM.

How will the B.Sc. (Med.) research experience help you as a future physician?

I think it’s paramount. I think it gives me a critical lens to look through.  

In some cases, I’m not only looking at the individual patient, but I’m also considering a whole plethora of background information. For example, if a patient comes in and they need a certain medication, then I’m going to think, “What are the pros and cons to this medication? How will their specific situation change with this type of management?” 

Research has given me an appreciation for critical thinking. 

Has the B.Sc. (Med.) experience increased your interest in conducting research after medical school?  

I would say yes, but if you asked me last year, I would have said no. During my first summer, I had a lot of challenges because my experiments weren’t working. It was so frustrating, but this year, now that I got past the hurdles, I would say I can appreciate the process now.  

I would say once you get past the hurdles, it’s definitely worth it. 

What is something about research you didn’t know about until you took part in this program? 

I learned how impactful research is and how you can actually move the needle forward on different things.  

Even when you’re talking to clinicians, they will refer to specific studies. If you ask them a question like, ‘Why are we prescribing a certain medication?’ They will say, ‘Oh, this study has shown it has done this for this group of people, so it’s likely to be the result of that.’  

What has been your favourite aspect of the program?  

Coming into the program, I didn’t realize it would teach me the number of things that it has taught me. For example, I didn’t know I’d be learning how to code. Now, I feel very comfortable using the programming language R.   

What advice would you give a student thinking about pursuing a B.Sc. (Med.) degree? 

I would say if you’re on the fence about doing a B.Sc. (Med.), ask around about different supervisors and don’t just go with someone that would accept you. Be interested in what they’re doing. Go back and look at the different publications they’ve worked on.  

When you’re on the fence about deciding to do it or not, really interview the supervisor and see if it’s someone you’re interested in. Find somebody in the college who can nurture your passion for research because there is somebody. I promise you there is somebody.  

You will really get a lot of value out of the program. 

“Congratulations to the UM researchers who secured CIHR funding for their cutting-edge work in health and well-being,” said Dr. Mario Pinto, UM vice-president, research and international. “This recognition highlights the impact of UM’s innovative health research. These researchers are driving solutions for better health care in Manitoba and globally.” 

Dr. Peter Nickerson, vice-provost (health sciences) and dean of the Rady Faculty of Health Sciences, said the funded projects show the diversity of health research taking place across UM ranging from investigating gut health and HIV/HPV progression to reducing inequities in trail use for urban First Nation and Métis people and examining the interaction of dietary flaxseed with blood pressure medication. 

“The researchers who received project funding are from eight different Max Rady College of Medicine departments, the College of Pharmacy, the Faculty of Education and the Faculty of Agricultural and Food Sciences,” Nickerson said. “CIHR funding is vital to the research that takes place at UM. And it’s essential in advancing science with provincial, national and global implications.”  

One of the 12 grant recipients is Dr. Inna Rabinovich-Nikitin, assistant professor of physiology and pathophysiology at the Max Rady College of Medicine. She and her team received $1,032,750 over five years to study what could one day lead to new treatments to reduce the risk of heart disease in people with disrupted circadian rhythms.  

Circadian rhythms are 24-hour cycles that regulate changes in the body, including heart rate and blood pressure. When the circadian rhythm is disrupted by things like shift work, poor sleep or jet lag, it has a negative impact on the heart and could lead to heart disease, Rabinovich-Nikitin said.  

“It’s known that shift workers have a 40 per cent higher risk of heart attacks, but we can’t do without shift work, so our research is working to develop treatments to help people with disrupted circadian rhythm, such as shift workers,” said Rabinovich-Nikitin, who is also a researcher with the Institute of Cardiovascular Sciences, a joint St. Boniface Hospital Research and UM institute.  

Rabinovich-Nikitin’s preliminary studies suggest that a disrupted circadian rhythm results in abnormal lipid metabolism and accumulation of lipids in the heart, and this might be the underlying cause of heart failure following a heart attack.  

“The goal of the newly funded project is to determine how circadian genes affect lipid metabolism following a heart attack and to understand how modulation of circadian proteins can improve lipid metabolism and cardiac function following a heart attack,” she said.   

“We know how diet and exercise contribute to one’s health, but circadian rhythm is a neglected area of research. It’s very important to have a normal circadian rhythm, and we’re working hard to better understand its impact on our health.”     

UM CIHR project funding recipients 

Dr. Michel Aliani, professor of food and human nutritional sciences, Faculty of Agricultural and Food Sciences; principal investigator, nutritional metabolomics research, division of neurodegenerative disorders, St. Boniface Hospital Albrechtsen Research Centre 

Project: The capacity for dietary flaxseed to inhibit the metabolism of antihypertensive drugs 

Grant: $1,189,575 (five years) 

Using state-of-the-art instrumentation, Aliani’s study aims to prove that flaxseed ingested in the diet can interact with drugs that control blood pressure. Data from the study will explain the action of dietary flaxseed in lowering blood pressure and provide important safety data on the interaction of flaxseed in one’s diet with drugs that lower blood pressure.  

Dr. Marissa Becker, professor of community health sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences; director of technical collaborations at the Institute for Global Public Health 

Project: Prioritizing Place in Sexually Transmitted and Blood-Borne Infection prevention in Kenya: Reframing prevention programs through Program Science 

Grant: $975,375 (five years) 

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 prioritized adolescent girls and young women (15-24 years), 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. Lucy Delgado, assistant professor of educational administration, foundations and psychology, Faculty of Education 

Project: The impact of Métis-specific spaces on the health and wellness of Métis women and Two-Spirit/Indigiqueer people 

Grant: $1,017,452 (four years)  

Through data collected as part of a series of gatherings, interviews and qualitative surveys, Delgado’s project will measure the outcomes for Métis women and Two-Spirit/Indigiqueer peoples engaged in Métis-specific spaces and provide a framework for post-secondary institutions in their creation of Métis-specific spaces. The final stage of this project will be an evaluation of the efficacy of the framework when taken up by new institutions. 

Dr. Jason Kindrachuk, associate professor of medical microbiology and infectious diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences; Canada Research Chair in molecular pathogenesis of emerging viruses; researcher, Children’s Hospital Research Institute of Manitoba 

Project: Characterization of long-term sequelae and immune signatures in Ebola virus disease survivors from 1976-2014 in the Democratic Republic of the Congo 

Grant: $100,000 (one year) 

Kindrachuk’s study will determine whether long-term health impacts following Ebola virus disease are conserved across geographic locations and what epidemiologic or biological factors might be linked to more severe complications and immune durability. The team will focus on disease survivors from multiple historic Ebola virus disease outbreaks within the Democratic Republic of the Congo and will also examine this through questionnaires and analysis of historical samples.  

Dr. Jonathan McGavock, professor of pediatrics and child health, Max Rady College of Medicine, Rady Faculty of Health Sciences; researcher, Children’s Hospital Research Institute of Manitoba 

Project: Honoring Ourselves and the Land – Reducing inequities in trail use for First Nations and Métis people in urban centres in Manitoba 

Grant: $1,266,075 (five years) 

With the help of Elders and Indigenous families, McGavock and his team will deliver and evaluate four main themed urban trail cultural events: 1) Full Moon ceremony walk/ride for girls, women and two-spirited people. 2) Land-based teachings with Elders/Knowledge Keepers. 3) Medicine teachings. The team will work with non-governmental organizations to plant gardens and/or traditional medicines in parks adjacent to the trails. 4) Youth-led teachings about local Indigenous cultures, languages and traditions. 

Dr. Donald Miller, professor of pharmacology and therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences; researcher, Kleysen Institute for Advanced Medicine, Health Sciences Centre 

Project: Improving therapeutic outcomes in medulloblastoma through optimizing brain delivery of agents targeting inhibitors of apoptosis proteins 

Grant: $592,876 (four years) 

Miller’s medulloblastoma research will use a method his laboratory has developed and tested to selectively and reversibly open the blood-brain barrier to increase brain and tumour levels of chemotherapeutics and the XIAP sensitizing drugs to allow both radiation and chemotherapeutic agents to kill the tumour cells in the brain more effectively. Using peptides that target cadherin, the team will temporarily loosen the connections between the brain capillary endothelial cells to allow increased delivery of drugs and sensitizing agents to the brain tumour.  

Dr. Thomas Murooka, associate professor of immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Role of mucosal neutrophils in driving HIV/HPV infection and disease progression 

Grant: $1,139,850 (five years) 

Murooka’s project will focus on specific bacteria linked to inflammatory disease in the lower female genital tract and identify the immune cells that further exacerbate this disease process. The team will use an animal disease model to better understand how this inflammatory process increases HIV and HPV infection, with the overall goal of defining why some individuals are more prone to sexually transmitted infections and to test drug candidates that can lower acquisition risk.  

Dr. Liam O’Neil, assistant professor of internal medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Cigarette smoking induced neutrophilic inflammation as a modifiable risk factor for Rheumatoid Arthritis in First Nations 

Grant: $100,000 (one year)  

O’Neil will investigate the way cigarette smoking interacts with the immune system, leading to rheumatoid arthritis. The team believes neutrophils, a common immune cell, are particularly prone to inflammation, leading to abnormal immune responses in people at high risk for rheumatoid arthritis development.  

Dr. Dake Qi, associate professor, College of Pharmacy, Rady Faculty of Health Sciences 

Project: TAAR1 in adipose tissue is a novel therapeutic target to combat atypical antipsychotics (AAPs)-induced metabolic dysfunction via downregulation of MIF 

Grant: $849,150 (five years) 

Qi’s project will investigate how trace amine-associated receptor (TAAR1) downregulates the release of macrophage migration inhibitory factor in fat cells and its impact on metabolic dysfunction induced by the classic atypical antipsychotics (AAP), olanzapine, by utilizing a combination of molecular and cellular biology techniques and physiological animal models. The team believes that TAAR1 agonists will improve the clinical psychiatric treatment with AAPs. 

Dr. Deanna Santer, assistant professor of immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Role of type III interferons in regulating mucosal immunity in a healthy gut versus ulcerative colitis 

Grant: $967,725 (five years)  

Santer will study fresh gut tissues and blood collected from people with or without ulcerative colitis during routine clinic visits. The team will use a combination of their novel human biopsy culture model, 3D “mini-guts” and immune cells to find out exactly how type III interferons (IFN-L) promote gut health but also how IFN-L could dampen the overreactive immune cells causing symptoms.  

Dr. Jarret Woodmass, assistant professor of surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Reverse total shoulder arthroplasty with and without subscapularis repair: Randomized controlled trial evaluating patient-reported and clinical outcomes 

Grant: $455,175 (five years)  

The aim of Woodmass’ study is to conduct a high-quality, randomized trial comparing outcomes of reverse total shoulder replacement (RTSA) with and without subscapularis repair. This ground-breaking study will provide evidence to support or negate the ongoing use of subscapularis repair in RTSA to optimize patient outcomes and manage scarce health-care resources. 

Unless you have rheumatoid arthritis, an autoimmune condition that causes the body to attack its own tissue, destroying the synovial lining inside of joints.

That eventually leads to erosion of cartilage and bone, a painful and often debilitating condition that can make the simplest tasks – like opening a jar or buttoning a shirt – challenging if not impossible.

So far, science has a clear picture of what it looks like to live with rheumatoid arthritis. But researchers still don’t know what sparks the autoimmune disorder at the heart of it.

“Growing evidence indicates that metabolic dysfunction in lymphocytes may be an important factor,” said Dr. Aaron Marshall, professor and head of immunology at the Max Rady College of Medicine, Rady Faculty of Health Sciences. “But this has not been studied in B cells from rheumatoid arthritis patients.”

With a recent grant of $100,000 ($50,000 per year for two years) from the Arthritis Society Canada, Marshall and his Rady Faculty coinvestigators Dr. Hani El-Gabalawy and Dr. Liam O’Neil now have the initial funds they need to launch a project that could help change the lives of hundreds of thousands of Canadians.

Their project, “Understanding how sugar fuels autoimmune disease,” involves exploring how autoantibody-producing B cells promote the cycle of inflammation that leads to joint damage in rheumatoid arthritis patients.

“This is innovative research that could open a new area of research and identify new approaches to treat and prevent worsening of rheumatoid arthritis,” said Marshall.

The funds are from the Arthritis Society Canada through an Ignite Innovation Grant, a unique program that encourages people to take bold chances by testing out new ideas or theories, especially those that are considered risky, but have the potential for significant rewards if successful.

“We hope to identify specific metabolic inhibitor drugs that can shut down disease-promoting B cells,” said Marshall. “And as many new medicines are being developed to target metabolic enzymes for treatment of cancer, our results may spark collaborations with industry to develop or repurpose such medicines to benefit rheumatoid arthritis patients.”

The Ignite Innovation Grant is awarded at the start of a project, which means that if the research is deemed feasible, preliminary data is not necessary and researchers like Marshall and his team can hit the ground running.

“It was great to be able to move very quickly from a new idea to a funded project to actually test it!” said Marshall. “I hope this will launch a new research direction in my lab and in the arthritis research field.”

Most of the 14 funded professors lead labs in the basic science departments of the medical college, such as immunology, physiology and pathophysiology, or biochemistry and medical genetics.

Their five-year discovery grants and one-year discovery launch supplements from NSERC total $545,000.

“Congratulations on obtaining these prestigious grants in support of cutting-edge science,” said Dr. Brian Postl, dean of the Max Rady College of Medicine and the Rady Faculty of Health Sciences. “We are fortunate to have a wealth of experts at UM whose laboratory discoveries have exciting potential to benefit human health.

“These NSERC grants also make it possible for our professors in medicine to train a large number of undergraduate and graduate students in state-of-the-art research techniques.”

Here are the funded studies:

Dr. Heather Armstrong, assistant professor, internal medicine; Canada Research Chair in integrative bioscience; researcher, Children’s Hospital Research Institute of Manitoba (CHRIM)

Discovery Grant: $28,000; Discovery Launch Supplement: $12,500

Armstrong’s team will focus on dietary fibres from agricultural products. They will examine how certain fibres alter microbial communities in the gut that are needed for the fermentation of fibre, and how this influences immune responses in the gut.

Dr. Robert Beattie, assistant professor, biochemistry and medical genetics

Discovery Grant: $37,000; Discovery Launch Supplement: $12,500

Beattie’s project centres on gene function in the normal embryonic development of brain cells in the cerebral cortex. His team will use new genetic technologies to examine molecular regulators of the proliferation of a specific kind of neural stem cell.

Dr. Britt Drögemöller, assistant professor, biochemistry and medical genetics; Canada Research Chair in pharmacogenomics and precision medicine; researcher, CHRIM

Discovery Grant: $37,000; Discovery Launch Supplement: $12,500

Drögemöller’s team will perform genomic analyses to identify novel genes and genetic pathways associated with variability in human hearing. They will also look at sex-specific auditory differences and how genetic pathways for hearing change as people age.

Dr. Jean-Eric Ghia, professor, immunology; researcher, CHRIM

Discovery Grant: $33,000

Ghia will examine the role of a stress protein in the gut microbiota and in smooth muscle contractions of the colon. In mice bred to lack this protein, his team will test whether a fecal microbiota transfer improves colonic muscle contraction.

Dr. Depeng Jiang, associate professor, community health sciences; researcher, CHRIM

Discovery Grant: $18,000

Jiang, a biostatistician, will develop new statistical models for multilevel data research by using a high-efficiency computer lab for statistical computations and simulations. These new models will provide researchers with new ways to understand their data.

Dr. Meaghan Jones, assistant professor, biochemistry and medical genetics; researcher, CHRIM

Discovery Grant: $31,000; Discovery Launch Supplement: $12,500

Jones will investigate how genes help cells to detoxify after exposure to dioxins, which are environmental pollutants. Her team aims to determine whether cells “remember” exposure to dioxins and mount a stronger response upon re-exposure, and whether this differs between embryos and adult mammals.

Dr. Oleg Krokhin, associate professor, internal medicine

Discovery Grant: $24,000

Krokhin, whose field is proteomics (the large-scale study of proteins), seeks to assist labs in separating peptides, which are produced when proteins are broken down. With the goal of advancing peptide separation science, his team will generate innovative tools and techniques.

Dr. Sam Kung, professor, immunology

Discovery Grant: $32,000

Kung’s project focuses on “natural killer” cells, which are important in maintaining immunity to viruses and tumors. His team will examine how a particular protein regulates natural killer cell biology, in part by studying mice that lack this protein.

Dr. Liam O’Neil, assistant professor, internal medicine; researcher, Manitoba Centre for Proteomics and Systems Biology

Discovery Grant: $28,000; Discovery Launch Supplement: $12,500

O’Neil’s study centres on neutrophils, which are blood cells on the front line of the immune system. His team will investigate how neutrophils modify their release of proteins to improve their ability to neutralize invading pathogens.

Dr. Deanna Santer, assistant professor, immunology; GSK Endowed Research Chair in immunobiology of infectious diseases; researcher, CHRIM

Discovery Grant: $28,000; Discovery Launch Supplement: $12,500

Santer’s focus is type III interferons – proteins released by the immune system to fight viruses. Her team will study their signaling and receptor biology, illuminating processes such as what happens immediately after these interferons bind their receptor in individual immune cells.

Dr. Tabrez Siddiqui, associate professor, physiology and pathophysiology; principal investigator, Kleysen Institute for Advanced Medicine

Discovery Grant: $56,000

Siddiqui’s team will explore the role of synapse-organizing proteins in synapse development in the brain. They will investigate, for example, how these proteins govern brain lamination (cell layering) and plasticity, and how they control synapse numbers.

Dr. Galen Wright, assistant professor, pharmacology and therapeutics; Canada Research Chair in neurogenomics; principal investigator, Kleysen Institute for Advanced Medicine

Discovery Grant: $28,000; Discovery Launch Supplement: $12,500

Wright uses genomics to study DNA repair processes in the human brain. His team will use computational analyses and human stem cell-derived neural models to identify important DNA repair genes and explore the mechanisms underlying how they are regulated.

Dr. Jiuyong Xie, professor, physiology and pathophysiology

Discovery Grant: $32,000

Xie aims to understand how genes have evolved to produce diverse RNA and protein products through an innate process called “alternative pre-mRNA splicing.” His team will use state-of-the-art techniques to uncover molecular details, helping to predict how splicing will evolve in the future.

Dr. Frederick Zeiler, associate professor, surgery; Rudy Falk Clinician-Scientist Professor

Discovery Grant: $33,000; Discovery Launch Supplement: $12,500

Zeiler will develop new techniques for continuous rapid assessment of cerebral autoregulation (control of blood flow to the brain by cerebral blood vessels) in healthy humans. This will allow for analysis of variations in brain regions and differences based on age and sex.

“He would wake up at 5:30 a.m. every morning to go into the lab and start on his research. Then head to the OR at 7:00 a.m. where he had a full patient load,” says Will Falk.

The three-year professorship was inspired by the Centennial Fellowship, a two-year award that allowed Rudy Falk to study in Stockholm with highly respected immunologists.

“What we try to do is give young scientists protected time for research while still establishing themselves as physicians,” says Will Falk.

This year’s recipient, assistant professor of internal medicine and immunology, Liam O’Neil [BSc/09, MD/12] embodies Falk’s zeal for research and clinical practice. While in medical school, O’Neil thought he would practice as a physician full-time. However, while working with different mentors throughout his career, he found himself gravitating more towards research. 

“The more you learn about medicine and disease, the more you realize how little we actually know about diseases such as rheumatoid arthritis. I think that combined with the right mentorship really facilitated my interest in pursuing a research career,” O’Neil says.

This professorship will allow him to study the causes of rheumatoid arthritis and investigate how to possibly prevent the disease once a person has developed the autoantibodies. Working with O’Neil on this study is Dr. Hani El-Gabalawy, professor of internal medicine and immunology and Endowed Rheumatology Research Chair, who also nominated O’Neil for the professorship.

“He has been a huge mentor for me. I certainly would not have applied without his support, he really believed in me,” says O’Neil.

Rheumatoid arthritis affects only about 1 per cent of the population, but around 2 – 3 per cent of people who live in Indigenous communities, where O’Neil and El-Gabalawy have been focusing their research.

O’Neil says the increase in the affliction of rheumatoid arthritis in these communities is likely due to genetics and environmental factors. By observing individuals who are more likely to develop rheumatoid arthritis and observing what may be causing those individuals to develop the disease, they may be able to pinpoint how to prevent the disease.

He and El-Gabalawy are using a combination of nutritional supplements, curcumin, vitamin D and omega 3 to treat people who have rheumatoid arthritis antibodies to see if they can be used as a preventative measure.

O’Neil hopes that this award will bring attention not only to his research on rheumatoid arthritis but also to careers that combine research and clinical practice.

“There’s not many people who take on clinical duties but also engage heavily in doing research. It’s not a common career path so I really saw this professorship award as an opportunity to promote the department and the research we are doing,” says O’Neil. “There is no replacement for physicians engaged in an active research program. I think it’s really important that we continue to promote these types of careers as being viable for individuals who are early in their training programs.”

O’Neil finds working with patients to be one of the most rewarding aspects of his job. He asks them to participate in his research to learn more about what they can do to prevent or treat their disease. 

The project has received a one-year grant from The Winnipeg Foundation Innovation Fund, which supports cutting-edge, collaborative medical research in the Rady Faculty of Health Sciences.

Rheumatoid arthritis (RA) is an autoimmune disease that causes swelling of the joints. Before patients develop RA, they develop autoantibodies and joint symptoms such as pain and stiffness, without swelling.

“Our research team wants to understand if Manitobans who are at high risk to develop RA have differences in their joints that can be detected by thermal imaging,” says the study’s leader, Dr. Liam O’Neil, assistant professor of internal medicine and immunology.  

“A state-of-the-art thermal camera, which UM will acquire for this research, can detect very small increases in temperature – one of the most important features of inflammation. We think that before RA starts, at-risk individuals will show changes to their joints that can be captured by the thermal camera, but not necessarily by physical examination.”

The highly sensitive camera will produce better-quality images than have been attained in most previous studies applying thermal imaging to RA, O’Neil says.  

O’Neil is collaborating on the study with Dr. Pingzhao Hu, associate professor of biochemistry and medical genetics, Dr. Hani El-Gabalawy, professor of internal medicine and immunology, and Dr. Dylan MacKay, assistant professor of community health sciences.

The interdisciplinary team will use deep learning, a form of artificial intelligence, to analyze the thermal images. They will “teach” a computer to interpret the images, recognize inflammation, and develop an automatic method to determine whether the images are from a healthy person or someone at high risk to develop RA.

“This study will use leading-edge technology and has the potential for high impact in the short term, making it an ideal fit for support from The Winnipeg Foundation Innovation Fund,” says Dr. Peter Nickerson, vice-dean research of the Rady Faculty of Health Sciences. “The new thermal camera will also be an asset for other UM researchers with an interest in thermography.”

O’Neil anticipates that the study results will help those who are at risk for rheumatoid arthritis, and their doctors, better understand their often-troubling symptoms.

“By revealing more about how RA develops, the findings will contribute to the search for early treatments to prevent this chronic disease,” he adds. “Thermal imaging may also help researchers understand if preventative treatments are working, and help predict who is most likely to respond to treatment.”

The researchers hope to obtain future funding for a larger, longitudinal study. They propose to follow a cohort of patients, using thermal imaging and other methods to examine the relationship between the patients’ early, pre-clinical signs of rheumatoid arthritis and the clinical onset of the disease.  

The interdisciplinary team is one of only four research groups in Canada to receive funding from CIHR’s Human Immunology Research Teams grant, an initiative to study autoimmune diseases with the goal of improving the knowledge of the human immune system.

“We’re delighted to receive this CIHR funding, but we also recognize the challenges ahead in undertaking such an interdisciplinary project,” said Dr. Hani El-Gabalawy, professor of medicine and immunology and Endowed Rheumatology Research Chair, Max Rady College of Medicine.

The project, titled Prediction and prevention of rheumatoid arthritis in First Nations People, has three aims. The first aim is to improve biomarkers in predicting whether someone will develop rheumatoid arthritis.

El-Gabalawy, the project’s principal investigator, said that rheumatoid arthritis “starts before it starts.” Meaning that before someone develops sore, stiff or swollen joints, and a diagnosis can be made by a doctor, the person has biomarkers in their blood that show their immune system isn’t functioning properly, he said.

The biomarker could be present for up to 10 years before the person develops any symptoms, El-Gabalawy said. However, not everyone who has these biomarkers will develop rheumatoid arthritis. So part of what the research team is trying to do with this first aim is to find better ways of predicting who will develop rheumatoid arthritis.

The project builds on team members’ previous research that showed that rheumatoid arthritis is very common in some First Nations families. El-Gabalawy said that the disease can be particularly damaging and resistant in First Nations people.

Aim two of the project will be a randomized clinical trial in First Nations communities to see whether the combination of turmeric, omega-3 and vitamin D can reduce the risk of rheumatoid arthritis based on biomarkers developed through the first aim. In support of this approach, team members’ previous research showed that this combination of supplements helped prevent inflammatory arthritis in mice.

Co-investigator Dr. Dylan Mackay, an assistant professor in the department of community health sciences and a clinical trialist with the George & Fay Yee Centre for Healthcare Innovation, said that if the results of the trial are favourable, it could mean that treatment costs could be reduced or avoided with the trio of affordable supplements.

“Some of the modern rheumatoid treatments are incredibly expensive,” said Mackay, who is a lead on the clinical trial. “Finding lower cost alternatives that maintain the health of people would be fantastic.”

Researchers will screen about 1,500 people to find under 200 people with biomarkers to be eligible for the study.

The third aim will look at the experience of First Nations people as they progress through the clinical trial from start to finish. Amanda Fowler-Woods, a PhD candidate in the department of community health sciences, Max Rady College of Medicine, said that there have been clinical trials done with Indigenous people before but this would be the first-ever study to gather their experiences.

“We want to know if Indigenous peoples are feeling like research is still not being done in a good way, because if you look at history, that makes perfect sense,” said Fowler-Woods, who is a lead on the third aim. “Our peoples weren’t treated well. Scientific experiments were done on Indigenous peoples, not with them. And the results of that have been traumatic, so this is an opportunity to actually get constant feedback on what we are doing good, and what we are not doing good on.”

Fowler-Woods said that this is also a chance to build a framework for how to combine Indigenous methodologies with quantitative research so scientists are not only doing research with First Nations people but they’re taking care of their spirits, and protecting and honouring who they are.

“It excites me that the communities will feel respected, and they’ll start to see that there’s a possibility that research is actually working to help,” Fowler-Woods said.

El-Gabalawy said that one of the things that thrills him about this project is that it brings seasoned scientists – like Dr. Aaron Marshall, head of the department of immunology, Dr. John Wilkins, professor of internal medicine and director of the Manitoba Centre for Proteomics and Systems Biology, and Dr. Neeloffer Mookherjee, associate professor within the departments of internal medicine and immunology – together with up-and-comers like Fowler-Woods, Mackay, Dr. Liam O’Neil, assistant professor of internal medicine, and Dr. Vidyanand Anaparti, a post-doctoral fellow in the Max Rady College of Medicine.

“I’m excited because this project leverages lots of different expertise at the University of Manitoba,” Mackay said. “I’m glad that CIHR recognized that and funded the project.”