Inflammation in Chronic Disease Videos

The CIHR Inflammation in Chronic Disease Initiative supports innovative research in the field of chronic inflammation. This initiative is co-led by the CIHR Institute of Musculoskeletal Health and Arthritis and CIHR Institute of Infection and Immunity. The Inflammation in Chronic Disease: A priority investment of CIHR video provides an overview of the topic and information about the nine research teams, the Canadian Transplantation Network, and the Canadian Microbiome Project while the Inflammation in Chronic Disease: Patient Perspectives on Research video highlights patients, volunteers and patient educators living with or researching chronic diseases, along with the challenges they face. CIHR wishes to thank the Scientific Directors, patients and researchers who participated in these two videos for sharing their stories with us!

Inflammation in Chronic Disease: A priority investment of CIHR


Inflammation in Chronic Disease: A priority investment of the Canadian Institutes of Health Research (CIHR)

Dr. Hani El-Gabalawy, Scientific Director
CIHR Institute of Musculoskeletal Health and Arthritis
Co-lead of the Inflammation in Chronic Disease Signature Initiative

Hani El-Gabalawy: I’m Hani El-Gabalawy. I’m a rheumatologist, and a professor of medicine and immunology at the University of Manitoba. I’m the Scientific Director of the Institute of Musculoskeletal Health and Arthritis, which is based here at the University of Manitoba.

Dr. Marc Ouellette, Scientific Director
CIHR Institute of Infection and Immunity
Co-lead of the Inflammation in Chronic Disease Signature Initiative

Marc Ouellette: My name is Marc Ouellette. I am the Scientific Director of the CIHR Institute of Infection and Immunity. The Institute of Infection and Immunity co-leads the Inflammation in Chronic Disease Signature Initiative.

What is inflammation?

Hani El-Gabalawy: Inflammation is a critical and key part of how people stay alive. Without inflammation, we wouldn’t be able to get rid of bacteria and viruses, and do a whole bunch of things that are key for the survival of any organism and particularly human beings.

Dr. Jean Marshall
Professor and Head, Department of Microbiology and Immunology
Faculty of Medicine, Dalhousie University

Jean Marshall: We need to understand inflammation so that it can be regulated appropriately, for the appropriate setting. And inappropriate inflammation underpins an enormous range of diseases: allergies, asthma, even Alzheimer’s disease, heart disease, joint disease – they all have aspects of inflammation underpinning the processes that cause those diseases.

Dr. John Brumell
Co-Director, Inflammatory Bowel Disease Centre
The Hospital for Sick Children

John Brumell We’ve been studying the basic interaction of bacteria with human cells for many years. When we realized that many of the genes we were studying were related to inflammatory disorders, we realized we had this huge opportunity to translate some of our basic research into understanding these inflammatory diseases.

Dr. Marie Josée Hébert
Co-Director, Canadian National Transplant Research Program

Marie-Josée Hébert: I would say that inflammation is really central to the clinical path of a patient in need of an organ or stem cell transplant. First, and this is often overlooked, in the period before the transplant, our patients are dealing with cancer or chronic disease, and they are battling against various elements associated with significant inflammatory responses which could impact the success of the transplantation. In addition, inflammation at the time of transplantation, rejection, graft versus host disease, and opportunistic infections that can occur after the transplantation are very much associated with significant inflammatory responses that clearly have an impact on the success of the transplantation.

Inflammation Initiative Projects

Marc Ouellette: The Inflammation in Chronic Disease Signature Initiative is important in several respects. In fact, in many pathologies, there are inflammatory processes. And we are trying to understand the commonalities and the differences in the inflammatory processes for these different diseases, to arrive at a better understanding for better treatment.

Hani El-Gabalawy: We brought together nine highly innovative teams addressing the issue of inflammation in chronic disease and we also brought them together with two established initiatives that being the Canadian Transplantation Network and the Canadian Microbiome Project.

Marie-Josée Hébert The Canadian National Transplant Research Program was created out of an initiative from the Canadian Institutes of Health Research; it also had the enthusiastic support of researchers in the field throughout Canada, for various reasons. First, because transplantation is a field that developed in a multidisciplinary culture – it is rooted in innovation; and also because we needed to acquire new knowledge which we could only acquire by working together across the country.

Dr. Lori West
Co-Director, Canadian National Transplant Research Program

Lori West: The CNTRP is a coalition of more than 100 investigators from all across Canada involved in the science – the clinical as well as the basic science – of transplantation, and the inflammation and immunity related to transplantation very broadly. It’s the first initiative in the world that links solid organ transplant investigators together with bone marrow transplant or haematopoetic cell transplant investigators together with donation and critical care specialists into one integrated community that links these communities in a transformative way who’ve never worked together before.

Dr. Ken Croitoru
Co-Principal Investigator, Genetics, Environmental, Microbial (GEM) Project
Mount Sinai Hospital, Toronto

Ken Croitoru: The GEM Project and the Microbiome initiative component of it, really have happened only because people have come together. It is the only study of its kind, so people are interested, enthusiastic, and committed. CIHR has provided support for an analysis of our cohort to look at how the host genetics influences the intestinal bacteria or the microbiome. What we want to know is: how does the microbiome change before inflammation takes over.

Sir Marc Feldmann
Professor of Immunology, Kennedy Institute of Rheumatology, University of Oxford
Researcher in Anti-TNF Therapy, Winner of the Canada Gairdner International Award (2014)

Sir Marc Feldmann: This particular initiative of the Canadian Institutes of Health Research to try and get networks of multidisciplinary teams is going with the flow of how modern research is being done. Work is now always done in increasingly large, multidisciplinary teams. And so building networks to drive new discoveries in inflammatory research is a very important step.

Hani El-Gabalawy: What each of these teams brings is a different scientific approach to basically the same problem in the same disease. And our hope is that in bringing these different scientific approaches together, the sum will ultimately be greater than the parts.

Marc Ouellette: So today there is a meeting of the different teams funded under the Inflammation in Chronic Disease Signature Initiative, and that meeting is very important here in Winnipeg to be able to ensure networking possibilities between these different teams so they can share the different techniques, the different approaches, the databases to arrive at a better understanding of the inflammatory process.

Sir Marc Feldmann: Inflammation in chronic diseases is a gigantic field now. There’s increasing awareness that all our common diseases have an inflammatory component. So I think the challenge of treating all these diseases effectively is a very major one. But I think it’s a very interesting aspect that many diseases, inflammatory diseases, can be treated by the same treatment.

Current Research Challenges

Hani El-Gabalawy: The challenge that we have is coming up with ways where we can control inflammation that is causing chronic diseases like rheumatoid arthritis, like inflammatory disease, inflammatory bowel disease, like cardiovascular, arterial sclerosis which has an important component in inflammation, while at the same time, retaining the body’s ability to fight infections and use inflammation as it needs to be used. And much of the research that is being funded through the Inflammation Signature Initiative, is to really try to get a better understanding of how this balance can be achieved more effectively.

Dr. Shawn Hayley
Professor, Department of Neuroscience, Carleton University

Shawn Hayley: The theme that kept coming up is that we have to keep talking, we have to keep this dialogue going, and it’s not simply one, two, or even five years, ten years or more – we need long term commitments, and long term interactions where we are interfacing with the different players from all these different team grants now that are sponsored by CIHR.

Sir Marc Feldmann: I think the virtues of comparing different diseases is quite clear and I think progress will probably be quicker than some people believe. However, it’s very clear that chronic diseases do not become chronic because of one problem alone. It’s usually several different pathways that have to be dysregulated and so it’s not possible to study chronic diseases quickly. This scheme that the Canadian Institutes of Health Research wants to fund is not likely to yield its major fruit in five years. This will probably take nearer 10 or 15.

Canada’s Research Strengths

Hani El-Gabalawy: Canadian strengths in inflammation in chronic disease come in a number of different directions. Arguably our biggest strength is that we have a single-payer health care system. It allows us to harness the administrative data sets that we do have. Canada has developed tremendous expertise in using administrative databases for research, for understanding patterns of disease, for understanding prevalence, incidence, and our ability to bring different types of administrative databases together: cancer registries, pharmacy registries, billing information, and this will be compounded by the tremendous strength we have in cohorts. Canadian cohorts in inflammatory diseases in my research area in autoimmune diseases, rheumatoid arthritis, Lupus, scleroderma, and in areas such as inflammatory bowel disease, cancer, the Canadian cohorts have evolved through the tremendous ability of Canadian researchers to collaborate with each other. And I believe that as we move forward, our ability to bring these cohorts together and the information available through these cohorts and interface that with the administrative databases will be unparalleled worldwide.

Marc Ouellette: At this meeting, I still saw a lot of enthusiasm for inter-team collaboration, so usually we see intra-team collaboration, we sometimes see dialogues but in this meeting what I found fascinating, it is this desire for collaboration between the different teams to form a great team in inflammation, sharing common things to be able to advance better. So I think in general it is a very structuring meeting for the future of inflammation in chronic diseases in Canada.

Hani El-Gabalawy: Our understanding of inflammation has resulted directly in incredible treatments that have changed the course of diseases like rheumatoid arthritis, like inflammatory bowel disease. And recognition that the research directed towards concepts like inflammation and immune regulation are research initiatives that are going to benefit a wide number of diseases. This is particularly important for charities, where charities tend to be focused on individual diseases. I’m going to put my money into arthritis, or colitis, or cancer, whereas we’re evolving scientifically in a world where we’re understanding mechanisms that are common to all these diseases. I think it’s becoming increasingly important for the public to really grasp that.

John Brumell: I would say that inflammation in general is the key medical challenge of our time and that as we move forward, we have to put a lot of resources into studying this particular issue in medical science. And this initiative that has been started is, I think, a fantastic step forward in this direction.

Inflammation in Chronic Disease – Patient Perspectives on Research


Inflammation in Chronic Disease – Patient Perspectives on Research

Mike Bellhouse

Mike Bellhouse: I’m Mike Bellhouse. I’ve been living with rheumatoid arthritis since 1991.

Marta Kisiel

Marta Kisiel: My name is Marta Kisiel and I was diagnosed with Crohn’s Disease in 2004. And then more recently in 2013, I was also diagnosed with rheumatoid arthritis, so I’ve got kind of a double edged challenge there.

Lynn Pike

Lynn Pike: My name’s Lynn Pike and I’m an asthma patient.

Marta Kisiel: Managing the Crohn’s, I mean that just means always being cognizant of where the bathroom is. But now, adding another layer to that has been mobility with the rheumatoid arthritis.

Lynn Pike: I was diagnosed at the age of 20 with asthma and at the time I thought it was just mild and over the years, my asthma has flared to the point that I’ve gone into respiratory arrest.

Mike Bellhouse: I’ve been volunteering with The Arthritis Society as a Patient Educator since 1994, particularly in the area of self-management, because I feel that self-management is a very, very important part of living with a chronic disease.

Marta Kisiel: I’ve been involved with Crohn’s Colitis Canada since 2008 as a volunteer and what I’ve been able to do there is a lot of outreach and just talking to members of the community and making them aware of some of the struggles we face as people with Crohn’s and Colitis, but also helping them figure out that this is something that is very common in their community.

Impact of Research on Patients

Mike Bellhouse: I’ve been impacted by research in rheumatoid arthritis in many ways. One is the development of new treatments that have really led to advancements in the ability of people to have better quality of life because the treatments have become so much more effective so that the joint deformities and that sort of thing have been minimized and treatment has come earlier.

Marta Kisiel: I was really excited to see that the research is now, instead of looking at each inflammatory disease in isolation, is starting to look at the relationships between different inflammatory diseases and I mean that’s exciting to me personally because I have two, so Crohn’s and rheumatoid arthritis, and I always thought, I wonder what the relationship there is?

Lynn Pike: I always think it’s a benefit for researchers to network with each other. Sharing information is vital, not only with each other and find out how different diseases relate and how different findings can relate, but as a patient, and understanding our disease and what that means to live with it, and what their research can mean to me personally.

Marta Kisiel: People are also considering other comorbidities, like depression, and like anxiety, and that’s not something I saw in the research before, so again, very narrowly focused on what are the mechanisms of disease. That’s important, but we as patients, we’re not just the disease, so we face other issues, and I’m really excited to hear that people are investigating that. I’m very hopeful.

Sir Marc Feldmann, Professor of Immunology
Kennedy Institute of Rheumatology, University of Oxford
Researcher in Anti-TNF Therapy, Winner of the Canada Gairdner International Award (2014)

Sir Marc Feldmann: In Canada, we need involvement of the patients to help define what they need to have done. And the reason patients are important is that they help the community function and direct resources. The patients are the taxpayers, the patients are the ones that need new medicines and the wishes of the patients are taken into account by the drug regulatory authorities. And the needs of the patients change from year to year.

Dr. Bertus Eksteen, Associate Professor of Medicine, University of Calgary
Health Challenges Project: A Multidisciplinary Approach to Target Chronic Inflammation of the Gut, Liver and Joint

Bertus Eksteen: As we turn into teams that are focused around clinical problems such as this, it’s a really good opportunity for patient organizations to partner with us and for patients to have a real say in driving the direction of research because some of our research has always been done so far away from patient input and didn’t address their priorities. But I think if you create teams and you involve patients and patient support organizations, it really re-focuses what’s important for the community around us and this is a way of addressing that, listening to it, and changing our science to be able to cope with their demands and their needs.

Dr. John Esdaile, Professor of Medicine, University of British Columbia
Health Challenges Project: PRECISION: Preventing complications from inflammatory skin, joint and bowel conditions

John Esdaile: I think one of the interesting things about our research is that we’ve had patient involvement from day one. The very first meeting, we had patients involved from the Arthritis Consumer Experts, from the GI society, from my centre, the Arthritis Research Canada, and from the Skin Patient Alliance. The questions that we are trying to answer are questions patients across Canada said “this is what’s really important to me.”

Challenges patients face the most

Lynn Pike: When I was diagnosed with asthma I don’t remember anybody sitting down and explaining the drugs to me or how they worked, or even really what the disease was. I was just given an inhaler and told to use it when I felt wheezy.

Mike Bellhouse: I would say the biggest challenge that patients do face is just where to find the information. Most patients are going to go to the Internet for the information and there’s such a wide variety of sites out there that purport to give you information about chronic disease, inflammation and arthritis, and it’s really hard to find the good sites.

Lynn Pike: It became out of control to the point that one evening my rescue medication no longer worked, and I went into arrest. As a result from that severe asthma attack, I recognized that I seriously needed to look into asthma treatment and what it meant to live with asthma. And that’s when I became educated in what it meant to live with it and how to live with it.

Mike Bellhouse: Being able to work with researchers to find out where you can find the good information and being able to disseminate that to consumers through consumer organizations or advocacy groups is, I think, a step that needs to be taken so that consumers can get the best information possible.

Lynn Pike: I think the biggest challenge for a patient trying to find the latest information on research and their disease is one, finding a reliable source. We all hit the Internet when we’re diagnosed with something and we try to figure out what it is but actually finding a reliable source with factual information, I think, is number one.

Importance of good communication

Lynn Pike: Another way that it’s a challenge for patients to get the information is to actually have good dialogue with their doctor and their advocacy groups and to be a self-advocate. I think that in today’s day and age that patients need to take some ownership in this and not just take the diagnosis and walk away with it and not do anything. I think it’s up to the patient to have regular conversations because information changes, there’s always new findings.

Marta Kisiel: I think one of the ways researchers can directly better communicate with patients is actually making that part of what they do. So with Crohn’s Colitis Canada, we do invite researchers to come talk to our patient groups and give us insights into what they’re doing. And I do understand that researchers are very busy, but we do appreciate them coming in and speaking to us directly and showing us what they’re doing in their research. With our clinicians again, it’s an issue of taking the time to communicate with the patients, so I think, you know, doctors, sometimes they have the access to that information, but we can feel hurried and rushed in those interviews with our doctors and you know, it comes back to seeing the patient as being bigger than the disease.

Sir Marc Feldmann: One of the big issues is how do we transfer knowledge. And the first round of transferring knowledge is between the scientists. One of the challenges for these multidisciplinary groups based in different centres will be to keep good contact. The second round is to transfer this knowledge from the researchers to the clinical practitioners and that’s not so easy because the clinical practitioners have a varying awareness of scientific progress and very limited time for keeping up-to-date. The third aspect of course is transferring this knowledge to the general public and these days, there are a lot of new tools for doing so, and I think it’s a particularly good aspect of this Canadian scheme that they’ve focused on the outcomes from the very beginning and wish to transfer the knowledge to the public as quickly as possible.

Patient Perceptions of Research Gaps

Mike Bellhouse: Pain is connected with inflammation, and I think controlling the pain, whether it’s looking at the cause of the inflammation or pain pathways that affect how you feel, all of those things have to be investigated and ultimately until we find a cure, pain is the thing that has to be treated most, as I say, whether it’s through attacking the root cause of where the pain is coming from or looking at how the pain gets to the brain and basically affects your whole life.

Lynn Pike: I think the area of need is just so widespread. I know today I learned so much about inflammation and how really it touches each and every person because inflammation is part of so many diseases. So I think probably the greatest need is making sure our researchers have funding and resources in order to do that.

Marta Kisiel: Now I’m seeing that there’s this interest to collaborate and think about the different relationships, so it’s not just being taken in isolation. We’re starting to look at what’s the big picture underlying these inflammatory diseases.

Lynn Pike: I think that we’re so lucky in Canada to have such a wealth of knowledge and some great researchers doing some phenomenal work.

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