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CBC

an hour ago

• CBC

Anorexia is normally treated with therapy. Now a Canadian team is trying the gut

Social Sharing This story is part of CBC Health's Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that by clicking here. Anorexia is a life-threatening eating disorder that can manifest as an intense preoccupation on weight loss. It's classified as a mental illness and normally treated with talk therapy, known as family-based therapy, but that's only effective for about half of the mostly women and girls who have it. Those who don't improve may go to hospital and get locked into a relentless cycle of gaining weight and recovering from malnourishment, followed by weight loss and damage to organs, including changes to the brain from starvation. Now, Canadian researchers are testing a new approach, tapping into the growing understanding of the gut-brain connection. They're going to try treating teens with fecal transplants, to change the bacteria in their gut. "We know that once the symptoms set in and the brain changes, it's really hard to change the course, so if we can intervene early in the adolescent years, we have the best chance," said Dr. Jennifer Couturier, a child psychiatrist and associate professor of psychiatry at McMaster University in Hamilton, Ont. In fecal microbial transplants, a small sample of stool from a healthy person is purified to concentrate the beneficial bacteria minus the waste. The microbiome is then put in a capsule, which the recipient takes for therapeutic purposes. Couturier and her team have Health Canada approval to run a randomized clinical trial in an initial group of 20 females aged 12 to 17 diagnosed with anorexia. They will either take oral capsules along with standard family-based treatment to stabilize nutrition and avoid the harmful effects of starvation or family-based treatment alone. McMaster's own stool bank Fecal transplants have been tested in a small handful of adults with anorexia, including one who restored her weight. In this trial, the McMaster researchers will use the university's own stool bank of donations. Dr. Nikhil Pai, a gastroenterologist at McMaster and a co-investigator on the trial, credited the university's contributions for funding the research and starting the pediatric stool bank. "This is not affiliated with any company," Pai said. "We developed this entirely in-house using carefully screened pediatric donors." Pai said the screening checks for infectious diseases, similar to how blood donations are assessed. Staff at the stool bank then prepare the capsules, which can't be mass produced. WATCH | Exploring the power of poop: There are a few reasons Pai and some other doctors are optimistic participants will benefit. One comes from animal studies. Researchers transplanted gut microbes from humans with anorexia to normal mice models, and found the mice reduced their food intake as if anorexic. Then, when gut microbes from healthy humans were given, the effect reversed. Secondly, young guts are subject to change. Pai said the gut microbiome is malleable in children and teens. "It actually is a very different landscape in adolescence, where if you can make a change, you not only may see some improvement in terms of outcomes for anorexia nervosa in the short term, but … the sustained response," Pai said. Butterflies in the stomach With every meal, trillions of gut bacteria turn breakfast, lunch and dinner into molecules called metabolites that affect the brain. Pai, who also works at Children's Hospital of Philadelphia, said large population-based studies show a few types of bacteria can have an outsized effect on the brain through the gut-brain axis, a connection between the two. "When we feel a bit nervous, sometimes we feel butterflies in our stomach," as a symptom of the nervousness, Pai said. "It's no surprise that we often have these intestinal symptoms that come along with the psychological anxieties." Researchers will follow participants in the clinical trial for eight weeks while they receive the capsules and then for four weeks after that. Pai and Couturier say one aspect they'll record is whether participants are willing to take the fecal transplant — or repulsed by it. Then they'll measure how the patient is doing — by tracking their weight, and mood — and how the microbiome changes based on saliva, urine and stool samples. Gut commands the brain? Scientists are learning more about how gut microbes influence brain function. Various studies have shown people with some psychological problems, including anorexia nervosa, having abnormal intestinal microbes, said Dr. Howard Steiger, former director of McGill's eating disorder program. "We always like to think of the brain as being the command centre for the body," Steiger said. "But you know, a lot of recent findings suggest the gut also controls your brain." In people with anorexia, Steiger said, the thought is that their eating behaviour messes up the way gut microbes influence functions in the brain and body. Given that, transplanting purified fecal samples from healthy individuals could help those with anorexia, said the professor emeritus of psychiatry, who continues to treat people with eating disorders "It's not like total voodoo to think that [fecal transplant] would be a potential adjunct in treatment or maybe even a treatment in itself," Steiger said. Some clinicians now refer to anorexia as a "metabo-psychiatric problem," meaning it is associated with vulnerability both in the brain and the body. "I think that's important because it reduces shame," Steiger said. "People don't develop anorexia because of moral weakness. They carry a real, physical, heritable susceptibility." That means anorexia gets triggered by a combination of nature, or genetics, and nurture, such as life events. Making meal time comfortable Anita Federici, a clinical psychologist north of Toronto, treats adolescents with anorexia using family-based therapy. Federici said initially, the parents or caregivers are empowered to learn how to nourish their child by taking over all meal and snack preparation and supervising intake and weight checks. Then the child might start eating lunch at school unsupervised. In the last phase, the youth regains independence over eating and exercise. About half of younger people with anorexia nervosa who receive family-based treatment for it do really well, Federici said. Change pace of meals? But anorexia rarely "flies solo," Federici said, noting many people also have co-occurring suicidal thoughts or experience self injury, substance use, trauma or PTSD, as well as neurodiversity like autism. All can complicate the picture. Federici said the standard approach of medicalizing treatment for anorexia focuses on gaining weight. Treatment that doesn't take into account the metabolic underpinnings of anorexia can miss the mark, Federici says. "There was research not long ago that demonstrated that there were more serotonin receptors in your gut than there were in your brain," she said, referring to a neurotransmitter with roles including influencing mood. Taking the metabolic basis of anorexia into consideration could mean clinicians may need to change how they feed patients, both in terms of the types of food and the pacing of meals, Federici said. In people with anorexia, the body is dysregulated so they feel soothed when they eat less. While bystanders may think the patient isn't motivated to change, Federici said in reality they're quite motivated. "What I have observed over the years is that these people desperately want to get better. They desperately want a different life, but they need the treatments to be different."

CTV News

4 hours ago

• CTV News

Woman off insulin for Type 1 diabetes after a single dose of experimental manufactured stem cells

Amanda Smith celebrates the day, August 1, nearly two years ago, when she stopped taking insulin to manage her type one diabetes, just a few months after getting a dose of experimental stem cells as part of a study. 'I remember, like, being scared and excited, and it's history now,' she said. The 36-year-old nurse and mother is part of a small, but what some call 'milestone study,' of patients with Type 1 Diabetes using manufactured stem cells, designed to grow in the liver and become the full array of islet cells array of pancreatic islet cells that naturally control blood sugar levels. In a study published in the New England Journal of Medicine, researchers report that of the 12 patients who received a single dose of the stem cells, it eliminated the need for insulin in 10 for at least a year and stopped episodes of low blood sugar, or hypoglycemia, which can lead to dangerous complications, even death. For Amanda, the treatment has been a blessing. Diagnosed with late-onset juvenile diabetes when she was 25, she was plagued with sudden bouts of low blood sugar, or hypoglycemia that would leave her faint, despite close monitoring. The risk was a diabetic coma or worse. 'I get emotional because I'm free from those handcuffs ... I don't have that looming over me every day,' she said from her home in London, Ont. 'I took it as a death sentence,' she said. 'I knew, eventually, like the end is always some sort of complication with diabetes,' she said 'We've ... dealt with a lot of patients that have struggled with diabetes. And to be able to see such a transformational change in their life is just amazing,' said Dr. Trevor Reichman, the lead author and the Surgical Director of the Pancreas and Islet Cell Transplant Program at the University Health Network in Toronto. Dr. Trevor Reichman Dr. Trevor Reichman appears for an interview with CTV News. Reichman says it is the first time that scientists have seen this kind of response with implanted stem cell-derived islets. Vertex, a Boston-based biotech company that sponsored the study, derived the cells from embryonic tissue and then found a way to grow them stem cells in large quantities. Researchers, working at centers in the U.S. and at least three transplant hospitals in Canada, infused them into the patient's liver. Over the next four to six months, Reichman said they transformed into the array of hormone-producing cells found in a normal pancreas, and they were monitoring the patients' blood sugar levels in real time. 'In the liver, they're sensing a patient's blood glucose level, and they're secreting the appropriate hormone,' said Reichman. adding that these biological replacements appear to sense changes in 'seconds or milliseconds. Essentially, it's the same as your native islet cells would function.' 'I think the data is just so very exciting, so very, very powerful,' said Dr. Peter Senior, director of the Alberta Diabetes Institute at the University of Alberta. He was not part of this study. 'The primary objective of the study was just to show that the blood sugars were better and that people were not having severe hypoglycemia. They blew past that. Ten of the 12 people are off insulin,' said Senior. ' It's never been done before in history' said Dr. Michael Thompson, director of Vancouver General Diabetes Centre. 'It's first time they a have achieved a high enough levels of insulin in patients,'using a stem cell product 'It's a big advance' he added. But there's a tradeoff. The patients, however, require immune-suppressing drugs for life, so that the immune system doesn't destroy the cells. There are risks to these immunosuppressive medications, including a higher risk of some cancers, infections, and high blood pressure. Amanda says it is nothing like her constant terror that she might slip into a sudden diabetic coma. 'Taking a couple of pills three times a day is nothing. I take it with breakfast, lunch, and dinner. It's easy. No comparison, none,' she said. 'And I know it's a huge relief for my family, especially my husband, that's for sure.' The study also reports that two patients in the study died, one likely as a result of complications from that immunosuppression, which Dr. Reichman says underscores the need for patients to be closely monitored at experienced transplant centers. A second patient, according to the study, died of severe dementia. Off-the-shelf live cell therapy The idea of using cells implanted in the body to produce insulin, instead of insulin injections, began in Canada 25 years ago. Researchers in Alberta pioneered the Edmonton Protocol. It uses insulin-producing islet cells removed from diseased organ donors that are implanted into those with hard-to-manage Type 1 Diabetes. Some 2,500 patients have been treated around the world, according to the University of Alberta, which reports 80 per cent were able to stop taking insulin injections for a median time of 95 days. Stem cells pipettes (Image credit: Vertex) But the number of procedures is limited because there aren't enough organ donors to meet the demand, and patients also require long-term immune suppression. So, there have been some two dozen companies around the world looking at other ways of getting manufactured islet cells to regulate blood sugar as a replacement for insulin. The Vertex cells, originally called VX-880, have been renamed Zimislecel. The Boston-based pharmaceutical company (says it is ramping up production, as it 'These are fresh, brand-new cells – they're not 60-year-old cells that have already had a life, and we're repurposing them,' said Senior, who works in Edmonton. It pushes the boundary of therapy forward because there is the potential to create a renewable source of insulin-producing cells instead of waiting for cells from deceased donors,' he added. 'I think we've got a treatment for diabetes where we are no longer constrained by organ donors,' said Senior. 'We've got potentially a limitless source of cells that could be used, and that is a massively huge step forward in terms of a cell therapy becoming a reality.' The next step is for someone to produce stem cells that don't require immune suppression, by either genetically engineering the cells or encapsulating them to make them invisible to immune attack. Several pilot studies are underway. It's a welcome advance, according to Senior. While insulin therapy has been a lifesaver for many since its discovery in Toronto by Banting and Best in 1921, it's never been a cure. Stem Cells (Image credit: Vertex) 'I think people with diabetes deserve some of the transformative treatments we've seen in cancer and other diseases but we've been stuck essentially doing the same thing for 100 years,' said Senior. In Canada, there are some 300000 people with Type 1 diabetes. Thirty-two new cases are diagnosed each day. The number of new cases per year increased by 34 per cent between 2000 and 2022, according to Breakthrough TD1(formerly the Juvenile Diabetes Foundation of Canada). Unlike Type 2 diabetes, which is linked to environmental, dietary, and genetic factors, the exact cause of Type 1 diabetes is still unknown, but doctors say the immune system mistakenly attacks insulin-producing islet cells in the pancreas, resulting in a gradual decline in the availability of insulin to regulate blood sugar. Questions remain The study is being continued to include a total of 50 patients, in Vancouver, Edmonton, Toronto and the U.S., with Dr. Reichman's team actively recruiting candidates. There are still many questions. Dr. Reichman admits that no one knows how long these implanted cells will last. Amanda hasn't required any insulin inections for almost two years, the longest documented period so far. He adds there are no signs that the other nine, who also went off insulin, have gone back on the injections since their stem cell infusion. Unclear also is whether this therapy will reduce the longer-term and burdensome complications of diabetes, including heart problems, amputations, kidney failure, and vision loss. However, data from patients treated with the Edmonton protocol, using tissue from deceased donors, show signs of reduced complications, a promising sign for the newer therapy, according to Dr. Thompson. The other concern is that not all patients with severe hypoglycemia may want to make the same choice as Amanda, swapping the diabetes risks for those that come with the anti-rejection medications. 'Taking a couple of pills three times a day is nothing. It's easy. There's no comparison, none,' she said. Another question is that a single treatment therapy for this disease could come with a very high price tag. 'We'll have to wait and see,' said Reichman. Amanda Smith, meanwhile, tries to enjoy her freedom with her family and her work at a long-term care home, without thinking too far ahead. 'What happens if the cells stop working or something? You know, I just try and live right now, and I feel so blessed.' She debates the question - does she have diabetes anymore? 'I don't take any insulin anymore. I don't take medication for diabetes anymore. So, I feel like a regular person again without diabetes.'

CBC

8 hours ago

• CBC

The U.S. is cutting billions from science. Canadian researchers say it's time to step up

Social Sharing Scientists in Canada are scrambling. Over the past few months, the U.S. government has cut billions of dollars in funding from scientific research as part of sweeping cost-cutting measures. "It's really shocking. It's really like this big cloud over science," Kate Moran, CEO of Ocean Networks Canada, told Quirks & Quarks. Ocean Networks Canada participates in a project called the Argo system, an international program that collects information from on and under the ocean using a fleet of robotic instruments that drift with the ocean currents. But that program, which is led by researchers in the U.S., could be at risk. Many Canadian research groups rely heavily on U.S. partners for support and data. But since Donald Trump was elected president of the United States, that support has taken a massive hit. The New York Times reported in March that the administration plans to reduce the National Oceanic and Atmospheric Administration's (NOAA) workforce by up to 20 per cent, which Moran says could have a direct impact on their work. Some of those staffing cuts at the NOAA have already happened. "Because the U.S. is such a big player, I'm not sure we could step up and be like the U.S.," said Moran. And cuts are happening across the board. The administration terminated $1 billion US in cuts to the National Institutes of Health, a move ruled "void and illegal" and blocked by a district judge earlier this month. The government has also been in a battle with Harvard University, putting billions of dollars of potential funding in jeopardy. Layoffs across a number of government agencies have been put on hold by a federal judge in California. In an executive order issued by the White House in May, Trump said that "over the last 5 years, confidence that scientists act in the best interests of the public has fallen significantly." "My Administration is committed to restoring a gold standard for science to ensure that federally funded research is transparent, rigorous, and impactful, and that Federal decisions are informed by the most credible, reliable, and impartial scientific evidence available." Environment and Climate Change Canada told CBC in a statement it "has a long-standing relationship with the U.S. National Oceanic and Atmospheric Administration (NOAA) on operational and research activities related to weather, climate, satellites, and water monitoring," and that the "department has not been formally informed of any changes to its collaboration with NOAA." The trickle-down effect of cuts has left Canadian researchers trying to figure out how to adapt to these uncertain times, while others say it's now Canada's responsibility to step up. Targeting climate science Environmental science and diversity, equity, and inclusion (DEI) efforts seem to be a direct target of the Trump administration's cuts. More than 1,000 scientists and other employees are set to be laid-off from the Environmental Protection Agency's research office. The effects have been felt in Canada. Researchers here filling out forms for U.S. government grants have had to answer questions such as "Can you confirm this is not a climate or 'environmental justice' project or include such elements?" and "Can you confirm that this is no DEI project or DEI elements of the project?" The political climate has Deborah Wench on edge. She relies heavily on information from long-term monitoring projects to fuel her research into the carbon cycle. Wench studies how carbon flows between different climates. To do that, she needs long-term data sets collected from satellites. Wench says the U.S. operates a lot of the satellites used in her research. "I'm not really sure how to express this. It's mostly, for me, a sense of impending doom," said Wench, an associate professor at the University of Toronto. "It's taken decades and the careers of thousands of people to build up these measurement records, and it looks like it will take months to destroy them." Though she didn't want to specify which specific instruments she uses, she says she's concerned it's on the chopping block in the U.S., which would mean a loss of long-term monitoring. Then there's HAWC, a project that will use three Canadian-built instruments to measure the amount of aerosols, water vapour and thin ice clouds in the upper troposphere and lower stratosphere. The information could be used to improve future climate projects, assuming it continues to receive NASA support. Trump's 2026 budget, released in May, proposed a $6 billion US funding cut to the space agency, amounting to 24 per cent of NASA's current budget. WATCH | Canadian scientists trying to keep world's ocean sensors afloat: Canadian scientists trying to keep world's ocean sensors afloat 12 minutes ago Duration 1:32 These robot scientists dive deep into the ocean to measure the vital signs of planet Earth. But proposed funding cuts in the U.S. could mean critical climate data is on the chopping block. "Much of it is just so speculative, right?" said Chris Fletcher, an associate professor at the University of Waterloo. "We're still kind of on the descent.... So it's unclear yet exactly how all of this will shake out, and it's quite unsettling." One of the HAWC instruments was supposed to be attached to a NASA satellite. But Fletcher says that's now in question. "I'm confident from the Canadian side that because of this tremendous investment that Canada has made, that our instruments will fly. The question is about which components of the proposed NASA mission will fly," said Fletcher. CBC reached out to the Canadian Space Agency, but did not recieve a comment before publication. What happens next Canada's Department of Innovation, Science and Industry did not provide an interview or comment to CBC about how Canada plans to respond to funding cuts in the U.S. Frédéric Bouchard says the turmoil in the U.S. means a greater responsibility for Canada to assert its scientific sovereignty. He was part of the federally funded Advisory Panel on the Federal Research Support System, which, in 2023, took a deep dive into how Canada could better support scientific research. "It's our own responsibility to make sure that we have a strong and generous science capacity so we have access to the experts we need, when we need them," said Bouchard, a philosopher of science and dean of the faculty of arts and sciences at the Université de Montréal. "We shouldn't wait for other countries to do all the hard work and hope that we can benefit from it." He says that as American scientists leave the United States, Canada could welcome some of those researchers. He also said it will be important to invest in the future, including support for graduate students both in Canada and abroad in the United States, to make sure they're able to continue work in their field. Even so, Bouchard says, what's happening in the U.S. is going to have an impact — there's no stopping that. "What's happening is destabilizing science across the world," said Bouchard. "We need to make sure we play a larger role and that we build our own muscle mass, if you will, to be able to withstand more of the disruption." Moran says Ocean Networks Canada, and other organizations like it, are ready to do so. She says they are prepared to do simple things, such as download data to protect the long-term data sets. And if there are more cuts in the U.S., she says she's prepared to make the case to the Canadian government and request more funding. "We're talking about what we could do to fill those gaps," said Moran. "Canada has all the skills and knowledge and scientists." Politically-driven chaos is disrupting U.S. scientific institutions and creating challenges for science in Canada. Science is a global endeavour and collaborations with the U.S. are routine. In this special episode of Quirks & Quarks, we explore what Canadian scientists are doing to preserve their work to assert scientific sovereignty in the face of this unprecedented destabilization. Canadian climate scientists brace for cuts to climate science infrastructure and data U.S. President Donald Trump's attacks on climate science are putting our Earth observing systems, in the oceans and in orbit, at risk. Canadian scientists who rely on U.S. led climate data infrastructure worry about losing long-term data that would affect our ability to understand our changing climate. With: Kate Moran, the president and CEO of Ocean Networks Canada and Emeritus Professor of Oceanography at the University of Victoria Debra Wunch, Physicist at the University of TorontoChris Fletcher, Department of Geography and Environmental Management at the University of Waterloo U.S. cuts to Great Lakes science and monitoring threaten our shared freshwater resourceU.S. budget and staffing cuts are jeopardizing the long-standing collaboration with our southern neighbour to maintain the health of the Great Lakes, our shared resource and the largest freshwater system in the world. With: Jérôme Marty, executive director of the International Association for Great Lakes Research and part-time professor at the University of OttawaGreg McClinchey, policy and legislative director with the Great Lakes Fishery CommissionMichael Wilkie, Biologist at Wilfred Laurier UniversityBrittney Borowiec, research associate in the Wilkie Lab at Wilfred Laurier UniversityAaron Fisk, Ecologist and Canada Research Chair at the University of Windsor Unexpected ways U.S. culture war policies are affecting Canadian scientists One of the first things President Trump did after taking office was to sign an executive order eliminating all DEI policies in the federal government. This is having far-reaching consequences for Canadian scientists as they navigate the new reality of our frequent research partner's hostility against so-called 'woke science.'With:Dr. Sofia Ahmed, Clinician scientist, and academic lead for the Women and Children's Health Research Institute at the University of Alberta Angela Kaida, professor of health sciences and Canada Research Chair at Simon Fraser University in VancouverDawn Bowdish, professor of immunology, the executive director of the Firestone Institute for Respiratory Health and Canada Research Chair at McMaster UniversityKevin Zhao, MD/PhD student in immunology in the Bowdish Lab at McMaster UniversityJérôme Marty, executive director of the International Association for Great Lakes Research Canada has a 'responsibility' to step up and assert scientific sovereigntyA 2023 report on how to strengthen our federal research support system could be our roadmap to more robust scientific sovereignty. The Advisory Panel on the Federal Research Support System made recommendations to the federal government for how we could reform our funding landscape. The intent was to allow us to quickly respond to national research priorities and to make Canada a more enticing research partner in world science. With: Frédéric Bouchard, Dean of the Faculty of Arts and Sciences and professor of philosophy of science at the Université de Montreal. Chair of the Advisory Panel on the Federal Research Support System.