Feature: Understanding the insidious nature of sepsis
By Emily Leighton, MA'13
In mid-October, former U.S. President Bill Clinton was hospitalized for several days.
The culprit? Sepsis.
One of the leading causes of preventable death worldwide, sepsis is the body’s extreme immune response to infection. It occurs when an infection triggers a chain reaction, leading the body to damage its own tissues and organs.
In President Clinton’s case, he was admitted to hospital with a urological infection that had spread to his bloodstream.
Anyone can get an infection, and almost any infection can lead to sepsis. But with such an ambiguous presentation, sepsis is difficult to identify. And time matters. Without prompt medical attention, it can lead to tissue damage, multi-organ failure and even death.
Robarts clinician-scientist Dr. Aleksandra Leligdowicz is conducting a large-scale research platform to study the life-threatening condition and improve early diagnosis and treatment.
Working with colleagues in the Intensive Care Unit (ICU) at London Health Sciences Centre’s University and Victoria Hospitals, she is establishing a prospective cohort study to follow newly admitted patients with suspected or proven infection.
As part of the study, biological samples, such as blood and bronchoalveolar lavage fluid, and patient data will be collected at the time of admission, as well as the subsequent two days of the patient’s hospital stay.
The samples will be catalogued and stored at Robarts in a special facility known as a biobank that will be housed in Leligdowicz’s lab.
In analyzing this data, Leligdowicz hopes to collaborate with research centres across Canada, the US and the UK to answer big research questions: What is sepsis? How can we better define it? And how can we better predict clinical outcomes?
“We don’t have the magical token that tells us that an individual has sepsis,” she explained. “We want to better understand what sepsis is at the molecular level.”
By collecting a blood sample early and pinpointing the molecular pathways that are contributing to deterioration, the hope is that physicians will be able to definitively identify individuals who are at risk of sepsis and respond to appropriate treatment.
“In emergency medicine, we refer to ‘the golden hour’, the window of time when we have the best chance of preventing more serious complications or death. And in the context of sepsis, it’s more like the golden six hours,” said Leligdowicz. “The sooner we are able to identify the correct diagnosis, the sooner we can begin the correct treatment and stop the overwhelming inflammatory response.”
A former Rhodes scholar, Leligdowicz completed a doctoral degree in human immunology at Oxford University. As part of her graduate research, she lived in The Gambia for three years to study HIV-2 infection in the West African population.
She returned to Canada to complete medical school at McGill University and pursued an internal medicine residency at the University of British Columbia. A fellowship in critical care medicine at the University of Toronto followed.
“I was captivated by the acuity and complexity of the cases in critical care,” she said. “Not just in the clinical work, but in the interaction with patients and the diverse interprofessional teams involved.”
Feeling the pull to return to scientific research, Leligdowicz moved on to postdoctoral fellowships at U of T and the University of California, San Francisco. Working at the forefront of translational medicine, she learned how to effectively optimize clinical trials, collect and study patient samples and collaborate with diverse groups of researchers.
Arriving at Robarts and the Schulich School of Medicine & Dentistry earlier this year, she says the collaborative research environment offers unique opportunities. “I’m incredibly fortunate to be here, to participate in world-class research and to be given the space, mentorship and start-up funding to do so,” she said.
Recruiting research-intensive faculty and supporting bench-to-bedside translational research are goals in the School’s new Strategic Plan.
At Robarts, Leligdowicz is setting up a joint lab with her husband and research partner, Dr. Mark Chandy, a cardiologist and clinician-scientist with expertise in applying stem cell biology to understanding mechanisms of cardiovascular disease. The biobank offers opportunities for his research program as well.
For Leligdowicz, the corridor linking Robarts with University Hospital represents the Institute’s potential to produce impactful translational research.
“The ability to come up with meaningful questions, to collect data and analyze it – to me that is one of the most exciting aspects of being a clinician-scientist,” said Leligdowicz. “Medicine isn’t just about the here and now, it’s striving to provide better care in the future.”