El-Gabalawy is the 2023 recipient of the Terry G. Falconer Memorial Rh Institute Foundation Emerging Researcher Award in the Health Sciences category, in recognition of her research to improve mental health care for medically vulnerable populations. UM Today caught up with El-Gabalawy to learn more about her and the research she is undertaking.

Tell us a bit about yourself and your research.

I’m a clinician scientist with cross appointments in the departments of clinical health psychology and anesthesiology, perioperative and pain medicine, which is a really unique partnership yielding fruitful interdisciplinary collaborations. I also hold adjunct appointments in psychology, psychiatry and at CancerCare Manitoba. As a registered clinical health psychologist, my specialization is in medical trauma.

As the director of the Health Anxiety and Trauma Lab (HATLab), my research broadly focuses on the interrelationships between mental and physical health, particularly how mental health affects medical procedures like surgery. More recently, I’ve been exploring innovative ways to increase accessibility to mental health treatments for medically vulnerable patients, including the development of virtual reality interventions.

Outside of work, I am a proud mom to two young, wonderful girls who are the centre of my world.

Why is this research important?

The biopsychosocial model of health is well recognized in health care, yet research and clinical practices often still operate in silos, focusing on biological and psychological factors independently. My research illustrates the vital relationship between mental and physical health and supports holistic patient care.

Recently, my focus has shifted towards developing innovative solutions that enable a greater number of medically vulnerable individuals to access evidence-based mental health supports. This approach is critical because we know improvements in mental health care yield significant improvements in physical health and overall functioning.

What does the Rh award mean to you?

Receiving the Rh award is an immense honour, especially considering the large number of incredible early-career researchers at the university. Like many others, my path to academia was not linear, and I faced some bumps along the way.

My dad wrote a quote from Don McLean in my PhD graduation card: “I did a whole lot better than they thought I would.” This award is not only validating but also a reflection of that sentiment. It makes me incredibly grateful for all the opportunities I’ve received to support my development.

What do you hope to achieve in the future?

Lately, I’ve been increasingly thinking about implementation science—how to disseminate our work and ensure that the effective interventions we develop reach a larger number of people within the health-care system. I aim to impact how patients navigate the health-care system and develop person-centred mental health pathways for medically vulnerable patients.

Specifically, I’m interested in integrating mental health supports into the surgery experience more consistently, as improvements in mental health prior to surgery are associated with better patient health outcomes and can also ultimately have benefits for the health-care system as a whole.

What about you might people find surprising?

I am an avid fisherwoman and a Master Angler in three species of fish: pickerel, rainbow trout and catfish. Fishing is a blend of skill, perseverance and luck, which are qualities that also draw me to research.

Any advice for early-career researchers and students?

Follow your passion and interests. In the past, I conducted research in areas that were less exciting to me, despite perhaps more opportunities. However, I found that excitement and interest in your work lead to productivity and fulfilment in your career.

Also, find inspiration in your everyday life. I draw a lot of inspiration from the patients I work with, who have contributed greatly to my research questions.

Lastly, seek supervisors and mentors who will not only cheer you on but also push you to achieve your best. This balance is important.

The one-year grants are part of The Winnipeg Foundation’s $1-million commitment to support innovative medical research projects at the University of Manitoba.

“The goal of this fund is to bring together cross-disciplinary teams to help launch exciting and innovative research,” says Dr. Jude Uzonna, vice-dean, research, Rady Faculty of Health Sciences. “These three projects are excellent examples of the cutting-edge work taking place at the Rady Faculty and the type of research that can be accomplished when we bring together experts from different fields.”

Virtual reality phantom limb pain treatment

A team led by Dr. Renée El-Gabalawy, associate professor of clinical health psychology, and anesthesiology, perioperative and pain medicine at the Max Rady College of Medicine, is using virtual reality (VR) to treat phantom limb pain. The condition, which typically does not respond to standard pain treatments, causes the perception of painful sensations like stabbing, burning or throbbing in a limb that has been amputated.

Dr. Renée El-Gabalawy

The team will be building on its previous research that developed VR technology that incorporated graded motor imagery, a technique used to treat chronic pain by retraining the brain. They will also be conducting a clinical trial to evaluate whether the first-of-its-kind VR treatment works.

One stage of graded motor imagery uses an adapted mirror box therapy, in which a patient’s limb is simulated to make it look like their missing limb is there. This helps the brain accommodate the missing limb thereby reducing pain signals. In the VR setting, the patient sees themself with both their limbs as they perform a sequence of exercises with the use of integrated sensor technology. 

“This funding is instrumental in terms of taking our research to the next step,” El-Gabalawy said. “If it’s found to be effective, I envision a future where this VR treatment will not only be accessible to patients in the hospital, but also in the comfort of their homes.”    

Co-principal investigators include Dr. David Perrin, assistant professor of orthopedic surgery, and Dr. Justin March, assistant professor of internal medicine, Max Rady College of Medicine, and Dr. Elizabeth Hammond, assistant professor of physical therapy, College of Rehabilitation Sciences.

Team studies Huntington’s disease

Dr. Galen Wright, UM Canada Research Chair in neurogenomics, and assistant professor of pharmacology and therapeutics, and biochemistry and medical genetics, at the Max Rady College of Medicine, heads a project to study the genetic modifiers in Huntington’s disease, an inherited condition that causes the breakdown of nerve cells in the brain.

[From left to right] Dr. Galen Wright, Dr. Robert Beattie and Dr. Paul Marcogliese.

“Even though we have known the genetic cause of Huntington’s disease for more than 30 years, no effective treatments exist,” Wright said. “This research is innovative because many of the technologies we are using only became available in recent years.”

The team – comprising experts in human genetics and neuroscience – will take a multifaceted approach throughout this study. The researchers will use innovative techniques to monitor the progression of individual brain cells in animal models. They will also employ an advanced genomic technique, single-cell sequencing, to look at gene expression changes in cell types to understand what’s going on at the disease level.

Wright said Huntington’s disease is among a group of more than 50 diseases caused by genetic mutations known as repeat expansions and most affect the brain. What the team learns from this project could be useful in developing drugs to treat all those diseases, he says.

Co-principal investigators from the Max Rady College of Medicine include Dr. Robert Beattie, assistant professor of biochemistry and medical genetics, and Children’s Hospital Research Institute of Manitoba (CHRIM) researcher, and Dr. Paul Marcogliese, assistant professor of biochemistry and medical genetics, and CHRIM researcher.

Using multi-omics and artificial intelligence to study heart disease

A study led by Dr. René Zahedi, professor of internal medicine, and biochemistry and medical genetics at the Max Rady College of Medicine, is using multi-omics and artificial intelligence to help better understand calcified aortic valve stenosis. The disease occurs when the heart valve to the main artery doesn’t fully open, resulting in a reduction of blood flow to the body.

Dr. René Zahedi

“Calcified aortic valve stenosis is the third leading cause of adult heart disease and we don’t really know what’s causing it,” Zahedi said. “The disease has a very complex molecular mechanism, so we want to look at the disease from different perspectives.”

Team members will use their expertise in proteins and lipids to look at what is going wrong in the heart valve on a molecular level and how it can be treated or stopped. They will also work to identify markers in the blood that could detect early stages of the disease or whether someone will develop it.

Zahedi said the cutting-edge aspect of this research will be their use of artificial intelligence to analyze the data. If all goes well, he said the approach they’re taking in this study could be applied in other areas like cancer and chronic disease research. 

Co-principal investigators include Dr. Amir Ravandi, associate professor of internal medicine, and physiology and pathophysiology, and Dr. Richard LeDuc, associate professor of biochemistry and medical genetics and director of bioinformatics at CHRIM, from the Max Rady College of Medicine.

But imagine being able to experience a realistic “dry run” in advance of your surgery day. By putting on a virtual reality (VR) headset, you could be immersed in a three-dimensional simulation of the hospital environment and get a reassuring preview of the leadup to your operation.

Clinical psychologist Renée El-Gabalawy [B.Sc./08, MA/10, PhD/15] is preparing to study the use of VR to ease the apprehension that many patients with breast cancer feel before surgery.

The assistant professor in the Max Rady College of Medicine says research shows that elevated anxiety and distress before surgery can result in poor surgical outcomes, such as more pain, longer hospital stays and higher rates of complications.

Dr. Renée El-Gabalawy

“It’s really important to figure out how to reduce this anxiety,” El-Gabalawy says. “Using virtual reality to help surgical patients is very innovative. It’s not a mainstream approach. It hasn’t been researched widely at all, and it hasn’t been implemented clinically.”

VR is being used in the United States to treat post-traumatic stress disorder and phobias, the professor says, but not for patients before surgery.

The study is just one of many projects El-Gabalawy is working on that explore the connections between mental and physical health. In the past year, she has published 25 studies.

Two recent papers, published in PLOS ONE and the Canadian Journal of Anesthesia, showed the increasing rates of surgical cancellations and postponements and their detrimental effects on patients’ physical and mental health.

These studies reflect El-Gabalawy’s unique position. She is cross-appointed between the department of clinical health psychology and the department of anesthesiology, perioperative and pain medicine. She says the partnership between the two allows her to hold one of only a few such positions in North America.

El-Gabalawy’s research is focused on the relationship between, and impact of, mental disorders and physical health conditions. She is also interested in studying psychological reactions that are caused by surgery, illness or other medical traumas.

In her upcoming VR study, the 10-minute simulation will give a patient with breast cancer a lifelike preview of everything they will experience after they are wheeled into the operating room. A health-care worker avatar will take the patient through the steps of induction of anesthesia, up to the point where the room goes black.

The study will test three groups. The first will participate in the VR simulation. A control group will watch a 10-minute VR video, and the third group will undergo surgery without viewing the simulation or video.

Participants in the first two groups will answer questions before and after their viewing sessions and have their physiological responses measured. All the participants will have their anxiety monitored on the day of their surgery to see if it differs across the groups. The goal is to discover whether familiarization and desensitization reduce anticipatory surgical anxiety.

El-Gabalawy is conducting the study with breast cancer patients because they experience particularly high rates of pre-surgical anxiety. If the results are positive, she says, VR can be studied for other surgical patients. The VR environment has been built, but the professor is waiting until COVID-19 restrictions are lifted to start the study.

Meanwhile, she is busy with a project focused on how people are coping during the pandemic. In May, she launched a national COVID-19 study. The team surveyed more than 1,000 participants and is following up with them at the six- and 12-month marks.

“We know very little about the long-term mental health implications of the disease,” El-Gabalawy says. “With this research, I really hope that we’ll be able to understand how we can better support people’s mental health and what groups we should be targeting in terms of who needs extra support.”

Preliminary data points to elevated levels of stress and anxiety related to the challenges some people are facing in accessing their regular health care, from massage therapy to seeing a pain physician.

El-Gabalawy, who was born in Fredericton and grew up in Winnipeg, is a proud UM alumna. After graduating with an honours bachelor of science in psychology and a master of arts, she was awarded the prestigious Vanier Canada Graduate Scholarship and earned her PhD in clinical psychology at UM in 2015.

She obtained a research fellowship at Yale University during her PhD studies that was funded by a Canadian Institutes of Health Research Michael Smith Foreign Study Supplement. She then completed a residency in clinical psychology at the Medical University of South Carolina.

El-Gabalawy has been awarded millions of dollars in research funding, as both co-investigator and principal investigator. She has published close to 100 peer-reviewed journal articles and book chapters and has presented research at more than 150 conferences. She is also a co-investigator and the clinical research network director of the Chronic Pain Strategy for Patient-Oriented Research Network at UM.

She happily returned to Winnipeg after her training in the U.S. and was appointed a faculty member at UM, where her father, Dr. Hani El-Gabalawy, is a professor of internal medicine and immunology and her husband, Dr. David Perrin, is an assistant professor of surgery.

“It’s absolutely my dream job,” she says. “I genuinely get up every day and I’m so excited to work. I love the work I do. I am fascinated by the relationship between mental and physical health.”

“Traditional parameters are limiting as Canada strives for new discoveries and innovation,” said Ted Hewitt, chair, Canada Research Coordinating Committee and President of SSHRC. “As society evolves, so must our means of doing research. The New Frontiers in Research Fund is supporting leading-edge research and promoting ideas that would have traditionally been unsupported. Through this program, we are truly paving the way for our emerging researchers to expand their horizons, take risks and deliver outcomes that will benefit Canadians.”

The U of M research projects will investigate ways to reverse frailty, allay anxiety using virtual reality, find new antibiotics, and assess the safety of northern infrastructure in the context of climate change. All projects will receive up to $250,000 in funding over two years.

“I congratulate these four early career researchers and their collaborators on their success in this inaugural national competition,” said Digvir Jayas, vice-president (research and international) and Distinguished Professor at the U of M. “They are each pushing the boundaries of existing knowledge and methods as they seek innovative ways to solve problems that affect every member of society.”

The funded projects are:

Ayesha Saleem

Meaghan Jones

Principle investigators (PI): Meaghan Jones, biochemistry and medical genetics, Max Rady College of Medicine; and Ayesha Saleem, Faculty of Kinesiology and Recreation Management
Project: “Reversing frailty through transmission of epigenetic age by extracellular vesicles.”

The aging population in Canada and around the world requires the development of therapeutic strategies aimed at improving health span (the length of time a person is healthy) to keep pace with the increase in lifespan. In theory, effective anti-aging therapeutics must be capable of altering innate cellular hallmarks of aging such as changes in metabolism and epigenetics. Previous research has shown that transfusing old animals with blood from young animals reverses some aspects of aging, leading to the hypothesis of “youthful” factors in young blood. We propose that these factors are packaged in a type of secretory vehicle called extracellular vesicles (EVs), and that treating old cells with EVs isolated from younger people would reverse physiological markers of aging such as the epigenetic clock and impaired metabolism.

Renee El-Gabalawy

PI: Renee El-Gabalawy, anesthesia, Max Rady College of Medicine
Co-PIs: Rakesh Arora, Pamela Hebbard, surgery, Max Rady College of Medicine; and fellow Max Rady College of Medicine faculty, Natalie Mota, clinical health psychology; William Mutch, anesthesia; Thomas Mutter, anesthesia; and Kristen Reynolds, psychology, Faculty of Arts.
Project: “A targeted preoperative virtual reality intervention with artificial intelligence integration for anxiety in patients undergoing breast cancer surgery.”

Preoperative state anxiety (PSA) occurs in approximately half of breast cancer surgery patients and is associated with several negative mental and physical health postoperative outcomes, which incur costs to both individual patients and the health care system as a whole. Despite this, few targeted and feasible PSA interventions have been developed. The most promising PSA interventions to date involve poorly feasible initiatives where patients are given the opportunity to tour operating rooms (OR) and wards prior to surgery and gain information about the perioperative process in a classroom setting. Immersive virtual reality (VR) is a technologically advanced interface that allows antecedent exposure to simulated stressful environments such as the OR and allows for the integration of interactive artificially intelligent (AI) avatars who can provide information to patients on the perioperative process. We aim to develop and evaluate a novel virtual reality (VR) preoperative intervention with AI avatars to reduce PSA, and mitigate poor postoperative health effects in breast cancer surgery patients

Reducing PSA and preventing poor postoperative outcomes using VR may have significant patient health and financial implications such as reducing levels of acute and chronic postoperative pain and length of stay. This novel research will form the basis of investigating the utility of VR with AI in other surgical cohorts, which may lead to broad implementation of this low cost intervention.

Sabine Kuss

PI: Sabine Kuss, chemistry, Faculty of Science
Title: “Investigation of antibiotic resistance by electrochemistry.”

Antibiotic resistance has developed into a global problem and has led to a dire need for innovative strategies that are able to quantify efflux and influx of agents into bacterial cells for the assessment of potential new and reliable antimicrobial candidates. The overall goal of the work described in this proposal is the development of an electro-bio-analytical tool that can detect and quantify antibiotic drug resistance and assess newly developed investigational antibacterial therapeutics.

The increase of resistance in Gram-negative bacteria in particular is a major cause for concern, as many Gram-negatives cause serious infections, such as pneumonia, and few antibiotics effective against Gram-negatives have been developed. Studying the influx into and efflux from single bacteria and across populations of antibacterial drugs will provide a numerical quantitative measure for drug resistance leading towards the development of a resistance biosensor. Furthermore, by monitoring the bacterial response time to antibiotics this research will help to better understand resistance adaptation and progression, leading towards the development of new agents and strategies to ultimately overcome drug resistance.

Ahmed Ashraf

Pooneh Maghoul

PI: Pooneh Maghoul, civil engineering, Faculty of Engineering
Co-PIs: Faculty of Engineering – Ahmed Ashraf, electrical and computer engineering; Hartmut Hollaender, civil engineer; Ahmed Shalaby, civil engineering
Title: “Threat assessment for northern civil infrastructure affected by climate change using an AI-based geomechanical model”

Civil infrastructure (roads, dams, etcetera) in Northern Canada was originally designed based on our understanding of frozen soil properties as of the last century, to rely on the properties of ice-rich frozen soil for stability. Climate change has forced us to revisit this understanding. Specifically, in recent years, this infrastructure has been suffering from irregular settlements due to the adverse effects of climate warming, degradation of permafrost, and reduced strength of foundation soils due to thawing. With earth’s temperature predicted to increase within the lifetime of this infrastructure, structural integrity risks will be further compounded. There is, therefore, an urgent need to develop innovative solutions and strategies that will enable engineers and decision-makers to use these investments for implementing effective, long-term solutions for mitigating adverse impacts of hazards from the effects of climate warming on Canadian infrastructure.

The main objective of this research project is to develop innovative solutions to predict and enhance the structural integrity of existing critical infrastructure as well as future structures built on permafrost areas under different climate warming scenarios. In addition, it is aimed to create a new publicly available portal that will continuously monitor and predict the displacement of critical northern infrastructure subjected to climate warming hazards. This can be achieved by a multidisciplinary research that combines Geo-mechanical and Hydrogeological Modeling, Artificial Intelligence, Deep Learning, and Computer Vision for Remote Sensing, and Asset Management and Life-Cycle Cost Assessment of Climate Change Adaptation Measures as proposed in this study.