“I’m humbled,” said Dr. Vidyanand Anaparti, a research associate in the department of internal medicine at the Max Rady College of Medicine. “I’m honoured my research made the list.”

But this isn’t the first time Anaparti’s work has made the annual list highlighting research breakthroughs in the area of arthritis. Anaparti’s findings have been featured on the list for 2019 and 2020. 

The research that most recently made the list began 12 years ago, when samples of synovial tissue were collected from the knees of 17 patients with early rheumatoid arthritis. Synovial tissue is a connective tissue that surrounds joints. It’s where rheumatoid arthritis begins, Anaparti said.  

After the synovial tissue was collected, the patients’ clinical data was gathered over 12 years and the scientists discovered that the patients could be placed into two groups. One group of patients had significantly high levels of matrix metalloproteinase (MMP) and the other group of patients had low levels. MMP is a group of enzymes that break down proteins found in spaces between cells in tissues. The enzymes were responsible for tissue degradation of synovial tissue and increased inflammation, Anaparti said.  

The research team observed that people with high MMP responded well to treatment, had lower joint inflammation and a reduction in swollen joint count than those who had low MMP levels. The study was published in Frontiers of Medicine last year.

“We can predict by analyzing the genes expressed in the tissue biopsy of an individual who will respond to treatment better and who will resist treatment,” Anaparti said. “We need to collect more samples and conduct more studies to validate our model, but this is definitely a big start and a step closer to a precision medicine based approach to treating rheumatoid arthritis.”

Dr. Siân Bevan, chief science officer, Arthritis Society Canada, said that one in five Manitobans has arthritis and it’s time to transform how we understand and treat this disease.

“By revealing new insights about the molecular features and outcomes of people with rheumatoid arthritis, this research could help tackle the common problem of patients going through trial-and-error cycles before finding the best treatment for them,” Bevan said.

This research will not only benefit patients but the health-care system as well, Anaparti said. The system will save money because patients won’t be on treatments that don’t work for them, he said.

“My sincerest congratulations to Vidyanand on this important accomplishment,” said Dr. Hani El-Gabalawy, professor of internal medicine and immunology at the Max Rady College of Medicine, who is Anaparti’s supervisor along with Dr. Neeloffer Mookherjee, professor of internal medicine and immunology. “The basic and translational research he has undertaken at the Manitoba Centre for Proteomics and Systems Biology provided new insights into how the early molecular and cellular patterns found in the inflamed joints can predict the outcomes of rheumatoid arthritis up to 15 year later.”

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.”