Graphical imagery of outline of man with circles   Strategic Research Plan

Faculty of Medicine and Health Sciences, Faculty of Dentistry

4. Strategic Priorities

The following sections describe cross-cutting Strategic Priorities inspired by the Major Research Areas detailed above. With the Implementation Strategies detailed in Part B, they aim to highlight key and coordinated approaches to fundamental and applied biomedical and health sciences research at McGill.

In addition, our Faculties will encourage new initiatives to grow McGill’s spirit of innovation in translational science, from ”bench to bedside to the community“. We see these as opportunities to link between bench and clinical research and patient-oriented, community-based work, which will continue to be a particular strength in our Faculties. We aim to fuel and foster novel research and training programs, and an environment that encourages a renewed spirit of entrepreneurship amongst our trainees and researchers.

4.1 Patient-Centered Continuum of Care


The inclusion of diverse patients’ perspectives is increasingly recognized as a gap in biomedical and health sciences research and an important factor for quality improvement of clinical services. These aspects include a vast and complex swath of biological variants, historical heritage and cultural values, whose implications need to be better studied, understood and transferred to the delivery of the best possible healthcare for all. These elements are key factors to understanding and improving health-related behaviors and outcomes.

Patient experience in healthcare consists of the multifaceted interactions between an individual and the organization’s culture and the representations of their respective backgrounds and histories. These interactions influence patient perceptions and responses across the continuum of care. McGill recognizes the significance of these aspects and continues to promote further research to develop and implement evidence-based approaches to probe and consider all aspects of patient experience. Research outcomes are expected to deliver practical information and solutions to the healthcare system and help them identify when and how to re-engineer their practices when necessary. A key research question surrounding the deployment of working solutions will be to respond to the apparent tension between the respect of the patient experience and the imperative of delivering the best possible care to everyone, with the economic resources available.

McGill will continue to develop innovative approaches to understanding the diversity of patient experiences, of their families and communities and will use this knowledge to improve and optimize the quality of care delivered to patients and their support networks. Efforts in this area are encouraged to engage multiple disciplines, including from outside our Faculties, and to leverage the expertise in our Indigenous Health program. Work in this area must also emphasize awareness and avoidance of all forms of sex, gender, age, cultural, religious and racial bias in research and clinical services. These aspects are of particular importance to this strategic area, but we strongly emphasize their relevance and significance to all other strategic priorities and biomedical and health sciences research practices at McGill.

4.2 Biomedical & Health Sciences in the Age of Digital Data


The ubiquitous surge of information technology, coupled with emerging applications of artificial intelligence and other data science approaches, are bound to transform all facets of healthcare. Simultaneously, biomedical and health sciences research approaches are presently undergoing significant mutations that pose new technological and ethical challenges as we step into the age of digital technology and data. These changes are enabled in part by the constantly increasing precision and volume of the many variations of “omics” data available to researchers, generating biological datasets on an unprecedented scale. With each patient now a big-data source, data from single individuals and from research cohorts hold the promise, combined with the appropriate methodology, of enabling unprecedented levels of sensitivity and specificity in the analysis of biochemical, physiological, and environmental interactions that determine health and disease. McGill continues to encourage a systems approach to understanding biology but also acknowledges the imperative of a paradigm shift surrounding the significance and value of data resources and methods to fully realize this vision. Through specific Strategic and Implementation Priorities and in close collaboration with its affiliated hospitals, McGill will enable its researchers and clinician scientists to maximize the value of data to advance their research agenda.

The sources of biomedical research data in humans and disease models have grown tremendously in diversity, precision and efficiency. We are now truly stepping in the era of multi-dimensional and computational approaches for biomedicine. For instance, whole genome sequencing is increasingly faster, more affordable and of higher quality. Their combination with other techniques, ranging from the nanoscale (e.g., single-cell RNA sequencing, microscopies and other bioimaging methods) to the macroscale (e.g., multimodal medical imaging) and biological modulation methods via e.g., drug delivery, optogenetics or brain stimulation, enable the identification of associative or causal effects in relation to other variables extracted from the environment (e.g., in epigenetics), sensory perception, complex behaviour and symptoms. McGill possesses significant strengths in all these areas, in terms of expertise and core platforms. This Strategic Priority is intended to maximize the value of multimodal research data in response to hard research questions, to enable original approaches and methods, which will lead to fundamental, possibly transformative discoveries, and facilitate the development of innovative tools of potential medical and commercial value.

The constitution of high-quality cohorts from the most inclusive and diverse populations of patients and healthy controls multiplies the potential of such approaches, admittedly at considerably greater data collection and management costs. These latter can be mitigated in part via concerted efforts and the mutualization of data collection, data infrastructure and data curation operations within the McGill network and beyond, and the federation of data collections, research software and computing resources. The multi-dimensional nature of biomedical and health sciences research data extends to complex, sometimes unstructured, sets of data linking electronic medical records with a multitude of systems in clinical divisions, healthcare administration, and surveillance. They are particularly valuable to the study of patient trajectories, their interactions with the healthcare system and their treatment outcomes. McGill has a proven track record in this area e.g., in drug safety research and pioneering realizations such as the recent research data warehouse at the MUHC. This expertise and related resources will continue to grow and disseminate, with the encouragement of researchers to participate in and contribute to the design and deployment of related data technologies and infrastructure.

The potential of multi-dimensional data cannot be realized without active research, training and knowledge translation in computational methods, encompassing a wide blend of applied mathematics, computational aspects of biology, chemistry and physics, many sectors of engineering, and computer science, including databases, artificial intelligence and other data-driven approaches, and software engineering.

Our Faculties have historical and established strengths in these areas, augmented by the ongoing Strategic Initiative in Computational Medicine and the Quantitative Life Sciences graduate program. A particular emphasis will continue to be placed on mathematical and statistical modelling at all scales: from biological systems to populations; hypothesis and data-driven multivariate analytics; dynamical systems theory and methods at all scales of observations: from fractions of a second to the lifespan.

Overall, multidisciplinary scientific, clinical and methodological efforts in all areas related to this Strategic Priority, with measurable impact indicators, and training and knowledge translation strategies, will be strongly encouraged and prioritized.

4.3 Key Determinants of Health & Disease: Genes, Behavior & Environment


Diseases result from complex interactions among genetic risk factors, environmental triggers and individual behavior and lifestyle. In rare diseases, a causal genetic component can often be readily identified. In the vast majority of disease conditions though, the involvement of multiple weak genetic effects may be modulated by complex interactions with environmental and behavioral determinants. McGill has established strengths in a multitude of related areas, with a particular emphasis on genomic medicine.

Our Faculties will continue to support research efforts towards gene discovery and treatment in in rare diseases and in common complex disorders, in coordination with the expertise and resources deployed in the Strategic Priority of multi-dimensional and computational approaches for biomedicine. Building on the specific history of the Quebec population, a particular McGill strength will continue to be in the research of genetic determinants causing rare disorders and neglected diseases that affect isolated populations, or that are found in populations with strong founder effects, including ultra-rare disorders of little economic value for the pharmaceutical sector.

Efforts to identify complex polygenic risk scores of more common diseases will be driven by McGill’s CERC in Genomic Medicine. Efforts will be strongly encouraged and prioritized towards the coordination with the Strategic Priority: Biomedical & Health Sciences in the Age of Data to constitute and federate wide and deep patient cohort repositories for research on multiple diseases, with the inclusion of demographic, environmental, geographic and lifestyle data, and behavioral assessments. Here too, these efforts need to be inclusive of the diversity of all population groups in Quebec and Canada, and need to consider the Montreal metropolitan area as a key asset in that respect.

These rich data resources, combined with current technology will enable us to advance our understanding of the mechanisms of epigenetic regulation by behavioral and environmental factors, as a major determinant of health and disease. Multi-dimensional observations at all spatial and temporal scales, coupled with current analytical methods will enable the identification of associations with disease causation, onset, progression, response to treatment and outcomes.

Another related research area concerns studies of the extracellular matrix as a core component of both soft and hard connective tissue integrity and cell signaling. Multidisciplinary studies will be encouraged in this domain, both to better understand fundamental mechanisms and to identify new treatment strategies, for instance in chronic inflammatory conditions.

Another related research area concerns studies of the extracellular matrix in normal cell signaling and in pathological situations. Related multidisciplinary studies will be undertaken of physiological mechanisms disrupted by milieu, and of the mechanisms responsible for immune cell trafficking and sensing of injured, damaged or infected tissues. These represent critical steps in tissue repair and remodeling that are often compromised in patients suffering from chronic inflammatory conditions. Research in these areas will focus on studying the interaction between extracellular cues, their cognate receptors, and their intracellular signaling pathways that together modify cellular metabolism and cell function during normal development and to maintain tissue homeostasis.

The study of complex determinants will extend to research on host-microbe interactions in health, infection, inflammation, development and cancer. These interactions may reveal obvious primary immunodeficiencies, or severe infections, but also be significant in common inflammatory diseases such as inflammatory bowel disease, systemic lupus erythematosus, periodontitis and rheumatoid arthritis. Microbial populations at mucosal surfaces (microbiota) are also suspected to play a role in many unrelated diseases including cancer, diabetes, obesity, and some neurological and psychiatric disorders. Understanding how lifestyle influences microbiota, immune health, obesity, cancer incidence and progression, will necessitate developing outbred models, integrating diet with metabolic change.

On a broader scale, studies (including models) of the socio-economic determinants of health and oral health status, health and oral health trajectories (especially from pre-birth, childhood until the end of adolescence) and health behaviors will also be encouraged. The Department of Family Medicine, the School of Population & Global Health and the Institute for Health and Social Policy as well as the Population Oral Health cluster in our Faculties, and in coordination with other McGill units, are expected to lead these multidisciplinary research efforts. In the greater Montreal area, the St-Mary’s and Douglas research centres are particularly well-poised to lead field work and engage with the community in innovative solutions in that area because of the socio-economically, culturally and linguistically diverse populations served by their partner clinical departments.

4.4 Precision Approaches to Personalized Medicine


We have already highlighted how the advent of large data repositories and biobanks combined with powerful computational approaches and resources enables new multivariate approaches to high-dimensional genotyping and phenotyping for detailed patient stratification. Our Faculties will encourage research in these approaches to enable new prevention strategies and novel clinical options that are specifically adapted to the individual needs of a specific patient. Here too, a particular attention to population diversity is warranted.

The potential of these approaches will be explored for fundamental research and the expansion of clinical trials that integrate discoveries of biomarkers for disease diagnosis, monitoring of its progression and to inform treatment decisions based on individual, quantitative responses as well as discovery and validation of new therapeutic targets. These new biomarkers will play a growing role in the stratification of patients in a new generation of clinical trial designs. Some focus will include studies of rare forms of cancers and cancers for which no therapeutic options or biomarker stratification are currently available. New technologies involving induced pluripotent stem cells, patient-derived xenografts, organoids, as well as integration of pharmacogenomics, metabolomics and highly multiplexed immune monitoring will be leveraged across strategic disease areas.

Complementing the strategic computational approaches detailed above, a range of biological modeling approaches across scales, from molecules to cells grown in vitro and in vivo preparations, behaving systems are required to further the understanding of the cellular and molecular bases of disease. McGill will continue to lead in this domain and will promote approaches based on stem cells both for discovering and testing new therapeutic pathways and drug treatments, and for enabling regenerative medicine approaches via cell replacement in damaged organs and tissues. As already mentioned, McGill has recently established remarkable expertise in induced pluripotent stem cells approaches and related biotechnologies, whose growth and dissemination across strategic disease areas will be encouraged. McGill will also continue to expand its focus on the study of protein structure and function at the atomic level by nuclear magnetic resonance, X-ray scattering and diffraction, cryo-electron microscopy (including tomography) and other biophysical methods that enable elucidation of static and dynamic structures of proteins and tissue structure of medical relevance. Here too, the adoption of advanced bioimaging and new artificial intelligence and data science approaches to solve the complex biological riddles of protein folding, assembly and organization as related to function will be encouraged.

McGill’s unique strengths in electron microscopy research and related infrastructure will continue to play a critical role in the acquisition and implementation of novel correlative electron microscopy infrastructure for the study of new materials and biological specimens (e.g., molecular machines, organelles, extracellular matrices). These technologies will be linked to molecular diagnostics and therapeutic efforts to better understand disease and to design novel treatments. The new McGill-based FRQS Centre for Structural Biology will act as a catalyst in these domains, with a particular focus on structure-directed drug discovery.

Personalized medicine also applies to the health education and psychosocial aspects of disease prevention, of coping with illness and treatment and also of optimal rehabilitation and re-establishment of health and oral health in all dimensions. These efforts will be complemented by studies aimed at enhancing the quality of patient- and family-centered care, involving tailored interventions in management of disease by bringing together providers from different disciplines, as well as involving families, patients and other stakeholders in participatory research.

Because of its dependence on detailed biological information, personalized medicine will require reconfiguration of the multidisciplinary therapeutic team to include a central role for expertise in bioethics, bio-specimen collection and analysis, live cell banking, also for the purpose of constituting high-quality research cohorts, as explained above. Our Faculties will therefore pioneer interdisciplinary training, research and clinical practice to optimize the implementation of personalized health care.

Along similar lines, in partnership with manufacturers and information technology providers, McGill will work to develop analytical and information technology, both for discovery research and for clinical applications. A particular emphasis will be on enabling patient empowerment and partnership by complementing electronic health records with portals, including wearable devices and smartphone apps, to provide informed access to their clinical data, explain their journey through the clinic, encourage their adoption of personalized wellness approaches to nutrition, sleep quality, and exercise to promote recovery and a heathy lifestyle.

McGill will continue its research into the development and commercialization of devices, novel therapeutics and other approaches aimed at improving health, including mechanical engineering as well as stem cell engineering, to replace neural, osseous, pancreatic and cardiovascular tissue, amongst others (e.g., via stents, pumps, grafting materials, implants, biomaterials). Interdisciplinary initiatives in bioengineering aimed at facilitating the development of innovative materials, devices, and tools and supporting their translation into clinical practice to improve health will be encouraged.

Personalized medicine also needs to be considerate of the socio-economic realities of the health care system. Problems of access to high quality health care in Canada, particularly among vulnerable groups, are well recognized. Furthermore, the changing demographics and cultures, education and finances, health problems and health care needs of people living in Canada, along with the fast-changing health care technologies and communication means of today, represent considerable challenges and opportunities to improve health care delivery. McGill’s health professional schools are well positioned to work together and with their multiple primary health care and community partners to develop and test innovative means to deliver health care to, for instance infants, children and youth, the institutionalized elderly, recent immigrants, the working poor and aboriginal groups.

 

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