CABGU – Jewish Independent

Complexities of autism

Israeli neuroscientist Dr. Ilan Dinstein was in Vancouver last month to talk about autism research. (photo by Adele Lewin)

Neuroscientist Dr. Ilan Dinstein was in Vancouver last month to share research and expand knowledge on best practices internationally. An associate professor of psychology and cognitive and brain sciences at Ben-Gurion University of the Negev (BGU), Dinstein is the director of the new National Autism Research Centre (NAC) in Israel.

David Berson, executive director of the Canadian Associates of BGU for British Columbia and Alberta, told the Independent: “CABGU was delighted to be a part of hosting Dr Ilan Dinstein in Metro Vancouver. This visit was spearheaded by Dr. Grace Iarocci, Dr. Elina Birmingham and Dr. Sam Doesburg from SFU [Simon Fraser University] and Dr. Tim Oberlander from B.C. Children’s Hospital.

“Ilan Dinstein is a true reflection of the pioneering spirit that is unique to the Negev region of Israel, where, over the past five years, clinicians from Soroka University Medical Centre and researchers from Ben-Gurion University of the Negev have organically come together to collaborate for the betterment of all of the residents with ASD [autism spectrum disorder] in the region.”

Dinstein spoke with the Independent about the new centre and the purpose of his visit to Canada.

“We started the centre five years ago, to try to understand different causes of autism,” he said. “Autism is not one disorder. There are different sub-types of autism, with different possible roots and risk factors. Some of those factors are biological or genetic; others might be environmental. For example, a premature birth might be a risk factor in the child developing autism. Or the age of the parents – a child of older parents might have a higher risk of autism diagnosis than if the same parents were younger. We at the centre are trying to discover how the combination of genetic and environmental issues affects autism development.”

According to Dinstein, one of the reasons for the creation of the centre was the way science is funded in Israel. “The funding usually comes for one specific question,” he explained, “but autism is a complex, systematic disorder and it needs many facets of study, measurement and research; it needs collaboration and sharing of information. At the centre, we are able to combine different fields of study with the clinical applications, as we work together with the Soroka medical centre.”

The scientists of the NAC study autistic patients from different multidisciplinary angles: neuroscience and cellular biology, language pathology and motor tracking, even facial features.

“The truly unique thing is that we do all our studies inside the hospital,” Dinstein said. “Parents come in with their children, usually when the children are about 3 years old and the parents and the children’s teachers notice the kids’ uncommon behavioural patterns. The diagnosis of autism usually takes four visits. During those visits, we work in collaboration with the doctors, measuring various characteristics of the child’s development to arrive at the right diagnosis.

“We also started a database of all our patients, so we have a centralized well of knowledge about how various biological, cultural and social factors might contribute to autism development.”

Of course, not all of the parents agree to have their child added to the database, but Dinstein said that their recruitment rate is about 80%.

After the diagnosis, the scientists participate in determining a personalized treatment program, based on their research. “Such a program might include teaching the children useful behavioural habits, helping them with language acquisition or providing occupational therapy,” explained Dinstein. “Some autistic kids are very agitated and certain motions, like spinning, might calm them down. Sometimes, autistic children need to learn basic skills: how to dress themselves or brush their teeth.”

Pharmaceuticals can also help children cope with autism, but Dinstein said that only about 10% of patients use medications.

At the NAC, the scientists don’t treat patients, but rather study and make recommendations, develop new technologies and new methods of dealing with the disorder. Working together with clinical professionals, they hope to contribute to a higher rate of success in treatment.

One of the most important aspects of Dinstein’s and his colleagues’ work is an annual follow-up on the patients in the database. Families are required to come back once a year after the initial diagnosis, so the service providers can see their progress, determine what worked and what didn’t, and adjust their recommendations accordingly.

“We are still in the process of enlarging this project,” said Dinstein. “We want to open other locations in Israel, make our database to cover the entire state of Israel.”

The centre’s autism research, in particular its database of patients with autism, inspired interest locally, from scientists and clinicians to families and service providers. The invitation for Dinstein to visit Vancouver came from a range of people.

“Your researchers want to create a similar database to ours, Canada-wide,” said Dinstein about his presentation at the Children’s Hospital. “I met with scientists from UBC [University of British Columbia] and SFU, even some from Victoria. I also met medical professionals, parents, some service providers and stakeholders. I see these meetings as the beginning of a close relationship between autism research in Israel and in Canada. There are similarities there, but there are differences, too. Both countries have different ethnic maps, cultural traditions and genetic variations. We all want to know how such diversity affects autism.”

Olga Livshin is a Vancouver freelance writer. She can be reached at [email protected].

Using AI in health care

Prof. Yuval Shahar, left, and David Berson with Dr. Rachael Ritchie of Vancouver Coastal Health. (photo by Shula Klinger)

The use of artificial intelligence is intended “to harness the power of computers with math and statistics theory to improve the diagnosis and care of patients,” according to Dr. Yuval Shahar, professor of Ben-Gurion University of the Negev’s software and information systems engineering department.

Between May 23 and 30, Canadian Associates of BGU, B.C. and Alberta Region, hosted a visit from Shahar, whose research explores how information technologies can be used to improve numerous aspects of healthcare.

Shahar has spent 30 years working in digital medicine, gained his bachelor and medical degrees from the Hebrew University, and a master’s in computer science from Yale University. He did his doctorate at Stanford University, where he also spent 10 years as a faculty member in the computer science and medicine department. He founded BGU’s Medical Informatics Research Centre in 2000 and, in 2017, was elected as a founding member of the International Academy of Health Sciences Informatics.

During his time in Vancouver, Shahar presented his work to full lecture halls across town, including at Simon Fraser University, University of British Columbia, various government offices, Vancouver General Hospital, Pacific Blue Cross and some start-ups.

The program with which Shahar works requires patients to wear an ECG (echocardiographic) belt around their chest to monitor their heart, as well as a blood pressure cuff. This allows a patient to receive care 24 hours a day. Using Bluetooth, the data collected from these devices are sent to the patient’s cellphone and then to the program’s server in Israel.

MobiGuide was developed with 13 partners in Europe, including Italy, Spain, the Netherlands and Austria. Even with 63 other projects competing for funding – including teams at Oxford and Cambridge universities – the MobiGuide team received seven million euros. “Ben-Gurion already had the necessary technology working,” said Shahar.

The program is led by an Israeli team in the main technology centre at BGU, with the partners from across Europe. Shahar explained how the system works, using the analogy of today’s mapping software. “It’s like a medical version of GPS,” he said. Right now, the program’s focus is on diabetes and hypertension.

One advantage of MobiGuide is the way the server handles massive amounts of clinical research, explained Shahar. For instance, when international guidelines for treating hypertension change, you can update that information in one place and it will be reflected throughout the entire system. That information is then immediately available to all patients and their physicians on the MobiGuide system.

“There are millions of patients on the system now,” said Shahar. “Each cellphone has a customized version of the guidelines in the program so the phone alerts the ‘mothership’ and the server examines the data for anomalies. The mothership knows the full patient history and clinical guidelines.”

The server in Israel also reminds patients to make adjustments, such as to their diet. A phone can contact the mothership to ask for advice, and recommendations are customized for each individual. Personal preferences can be adjusted depending on the patient – for example, when they prefer to be alerted to take their medications. If they are on vacation, they can ask the system not to alert them as frequently.

The system can also be notified to anticipate spikes in blood glucose. For instance, if a patient is attending a wedding and expects to eat rich food, she can tell the system first that it need not be concerned about this. Likewise, if a patient lives alone and has nobody to rely on for support with their health, the system can issue different instructions than for someone with a companion.

Humans are, however, still essential to the smooth running of the system. Shahar relies on “medical-knowledge engineers, graduate students,” who digitize clinical knowledge so that it can be applied on the system. But, he said, “It’s a sign of the future. Chronic patients won’t need to be in clinics all of the time. You want to be there only if there’s no other way.” It is cheaper to offer care in the community, especially in remote areas, even while offering round-the-clock observation.

To date, feedback from patients and the professional community has been consistently good. Compliance with clinical guidelines by physicians has improved, preventing a great deal of human error and possibly fatal mistakes, said Shahar. Likewise, he said, “Compliance was very high, we saw real patient empowerment.”

Patients “said that their quality of life had improved, they felt more secure and safe,” said Shahar. This is important, he explained, because AI in healthcare is not just about technology – human psychology has a huge impact on both patient treatment and outcomes.

As an example of the program’s success, Shahar said, in Barcelona, pregnant women with gestational diabetes were studied. The blood pressure of the research patients was significantly lower than in the control group, who attended in-person clinics. Shahar explained that these data were accompanied by a sense that a “benevolent big brother was monitoring them, and someone was sending alerts and recommendations every few days.”

After a four-year evaluation hosted by a veterans hospital in Palo Alto, Calif., there is evidence that the software developed by Shahar’s team has helped physicians manage oncology data better than before. With only seven to 10 minutes to give to each patient, physicians simply do not have the time to review all the material they need to, while considering its application and significance to individual patients.

In his talk at the Eye Care Centre at VGH, Shahar recalled asking a patient if she minded getting numerous texts from MobiGuide every day. “She laughed, I get 50 texts from my friends, what’s another 20?” he said. But, in reality, she clarified, “How could I mind? This is about the health of my baby.” Shahar added, “They feel that someone knows them deeply.”

According to David Berson, regional executive director of CABGU, Shahar’s visit was a success. He said BGU will examine how Shahar’s research in medical informatics can dovetail with local efforts to revolutionize healthcare, exploring the potential for “patient empowerment, remote monitoring, decision-making support and beyond.”

BGU board member and innovation expert Jonathan Miodowski said there was a need to balance between “blue-sky research and practical solutions” to real-world problems. “Multidisciplinary approach is a hot topic for universities these days – it is critical to bring different perspectives to the research,” he said.

Miodowski described Israel as a world leader in innovation. Last year, Canada raised $4.7 billion in start-up capital, he said, noting that Israeli start-ups, by contrast, raised $10 billion. “For a country that is two-thirds the size of Vancouver Island, that’s pretty significant,” he said. “In a sense, the size of the territory is very convenient. Cross-pollination of ideas is inevitable.”

Miodowski also spoke well of the Vancouver visit. “We planted some seeds on both sides,” he said. “It was very positive. There was real interest in Yuval’s research, real appreciation for what Israel has done in terms of its innovation ecosystem.”

Shula Klinger is an author and journalist living in North Vancouver. Find out more at shulaklinger.com.

Dementia panel covers range

Left to right: Laura Feldman, Dr. Deborah Toiber, Joanne Haramia, Dr. Janet Kushner Kow and Dr. Gloria Gutman. (photo from CABGU)

Alzheimer’s, Dementia and You, an event presented by Canadian Associates of Ben-Gurion University of the Negev on June 5 at the Rothstein Theatre, featured a panel of experts whose presentations and discussion provided insights to both those seeking information and those seeking support.

Keynote speaker Dr. Deborah Toiber of Ben-Gurion University’s department of life sciences, described her approach to neurodegenerative aging as the key factor in understanding diseases like Alzheimer’s. (See jewishindependent.ca/bgu-finds-key-protein.)

Moderated by Simon Fraser University professor emerita Dr. Gloria Gutman, the panel represented a wealth of experience. Dr. Janet Kushner Kow, a geriatrician associated with Providence Health Care and the University of British Columbia, answered questions from the medical perspective. Laura Feldman, with 10 years of grassroots experience at the Alzheimer Society of British Columbia, spoke about the need to seek knowledge and support. Joanne Haramia recounted how families she has cared for through Jewish Family Services have found it easier to cope when they have support from the community. People stayed after the event to mingle and talk to the panelists and ask more questions.

Prior to the event, there was a reception, catered by Nava Creative Kosher Cuisine, for sponsors and partners. Sponsors were InstaFund and Annie Du and Aeron Evans of National Bank Financial, Wealth Management; co-sponsors were the Jewish Community Centre of Greater Vancouver, Jewish Family Services, Louis Brier Home and Hospital, and Jewish Seniors Alliance, with community partners being the Alzheimer Society of B.C., SFU Gerontology Research Centre and the Jewish Independent as media partner.

– Courtesy of Canadian Associates of Ben-Gurion University of the Negev

BGU finds key protein

Ben-Gurion University’s Dr. Deborah Toiber will be part of a panel in Vancouver called Alzheimer’s, Dementia and You: Research, Risk Reduction and Resources. (photo from CABGU)

Alzheimer’s affects about six percent of people over the age 65 worldwide. For years, scientists have been searching for ways to treat it and to discover its roots, but without much success, until recently.

A group of Ben-Gurion University researchers, under the leadership of Dr. Deborah Toiber, is among those who have made breakthroughs. They have discovered that a certain protein, SIRT6, necessary for DNA repair, is largely missing from the brains of people with Alzheimeir’s. The absence of this protein and the gradual decline in its production by the human body as we age might be what triggers the disease.

On June 5, Toiber will be the keynote speaker at Alzheimer’s, Dementia and You: Research, Risk Reduction and Resources. She will be joined in a panel discussion by Laura Feldman from the Alzheimer Society of British Columbia and Joanne Haramia of Jewish Family Services; Simon Fraser University professor emeritus Dr. Gloria Gutman, one of the founders of SFU’s Gerontology Research Centre, will be the moderator. The event, which will be held at the Rothstein Theatre, is being presented by the Canadian Associates of Ben-Gurion University (CABGU) in partnership with the Jewish Independent, the Jewish Community Centre of Greater Vancouver’s Adults 55+ program, the Alzheimer Society of B.C., Louis Brier Home and Hospital, Jewish Family Services, Jewish Seniors Alliance, and L’Chaim Adult Day Care.

According to David Berson, executive director of CABGU, British Columbia and Alberta Region, “the purpose of the panel is to increase the awareness and understanding of Alzheimer’s disease, dementia and neurodegenerative diseases.”

“Deborah was coming to Canada to visit the community in Winnipeg for a similar event,” Berson told the Independent. “We had a wonderful opportunity to bring the young and dynamic researcher to Vancouver and we jumped at it…. Toiber’s research, as I understand it, is part of a race to discover, isolate and understand the characteristics, components and mechanisms of DNA that will allow us to identify and treat neurodegenerative diseases prior to onset.”

In her email interview with the Independent, Toiber talked about her work and her group’s discovery. She said that DNA deteriorate with age. “It is not something genetic or environmental,” she said. “We repair our DNA and continue going on, but the repairs are not perfect. Some DNA remain unrepaired. As we get older, unrepaired DNA accumulate, and their ability to produce proteins diminishes.”

She further explained: “If the DNA is damaged, and a cell feels it is too dangerous to continue with this damaged DNA, the cell may activate a self-destruct mechanism. If too many cells do this, the tissue with the dying cells will deteriorate, such as the brain.” Essentially, the deterioration of the DNA and the reduced production of SIRT6 protein mark “the beginning of the chain that ends in neurodegenerative diseases in seniors. In Alzheimer’s patients, SIRT6 is almost completely gone.”

Toiber said scientists should be focusing on how to maintain the production of SIRT6 and how to improve the repair capacity of the damaged DNA, because that is what causes Alzheimer’s and similar diseases. Unfortunately, it is impossible to introduce the needed protein directly into the brain. “There is a blood barrier that prevents things from passing into the brain,” she said. “But we are trying to find a way to increase the expression of the protein into the brain.”

Toiber has always been fascinated by the molecular biology of the human brain. “I chose this field because I wanted to understand in-depth how the brain works, to investigate what happens when things stop working,” she said. “I think that molecular biology is the answer to all those questions. It’s like being a detective on the molecular level.”

She realizes that a detective’s work is never easy or fast. “Results take years to build, as they are based on previous findings, ours and other scientists’. My current group, where I am the principal researcher, is about three years old. It is a new lab.”

The research is multifaceted and multidirectional. “We do basic science,” she said. “We use animal models and cells to understand what is happening as we age, what is the cause of disease and what can we learn from this to develop treatments or preventive actions. We also collaborate with medical professionals and other scientists to get a fuller picture of various aspects of aging and neurodegeneration, particularly Alzheimer’s disease.”

Toiber’s group doesn’t work on the pharmaceutical angle of how to introduce the protein into patients’ bodies. Instead, she explained, “We are interested in the molecular causes of aging, such as DNA damage accumulation, and how this leads to disease. We work in experimental biology. These experiments are expensive and difficult. It can take a long time to see and understand the results, but it is also rewarding. Molecular processes help us understand how our organisms work and what happens when things go wrong. We have to be optimistic and keep trying.”

Many scientists in related fields of study are interested in Toiber’s work. “I have talked about our research at the international neurochemistry meeting in Paris and at conferences in Crete and Israel,” she said.

To hear her speak in Vancouver, register at eventbrite.ca. There is no cost to attend.

Olga Livshin is a Vancouver freelance writer. She can be reached at [email protected].