Research in the health sector is either basic, that is, research that seeks to understand the cellular or biological mechanisms of diseases or to discover promising molecules for tomorrow’s drugs, or it is clinical, with its activities centered around human subjects. It also includes a third major thrust: population health, a significant strength at the CRCHUM. Among other things, population health research looks at health risks and the organization of health care and services in terms of quality, access, clinical practices and health policy both here and in developing countries.

Clinical research at the CRCHUM can take on three forms: contractual research funded by pharmaceutical companies looking to assess the efficacy of new drugs; research into new treatments funded by granting agencies such as the Canadian Institutes for Health Research (CIHR), the Fonds de la recherche en santé du Québec or other organizations such as the Heart and Stroke Foundation; and lastly, research initiated by physicians and researchers into areas of importance. In the fall of 2010, more than 1,000 research projects were in progress: 314 contractual research, 495 funded by granting agencies and 329 research initiated projects.

With its 362 researchers, graduate students,postgraduate fellows, its large patient cohorts and cutting-edge technological platforms such as imaging, biostatistics, transgenics laboratory, henotyping, biochips, flow cytometry and containment facilities, the CRCHUM is the University of Montreal’s largest affiliated research centre.

AT THE HEART OF CLINICAL RESEARCH: HUMAN BEINGS

“Clinical research evaluates the effects of drugs, procedures and diagnoses on people,” explains François Lespérance, the CRCHUM’s Associate Director, Clinical Research, “our clinical research activities are concentrated in five major themes,each with several sub-themes: cancer, cardiometabolic, infection-immunity-inflammation, musculoskeletal diseases, and neuroscience.”

		The CRCHUM is also very active in clinical trials, that is, the study of the effect of a given drug or a new treatment strategy on a well-defined patient population. For the most part, these studies are “phase III” studies, the step before a drug is commercialized.Products are tested on hundreds, if not thousands of patients and then compared in a randomized manner to standard treatments or to patients receiving a placebo. This step occurs once the tolerance to the product and its toxicity has been tested on a small number of patients (phase I trials) and maximal and minimal doses have been measured (phase II trials). Phase IV trials study the action of drugs once they are on the market and available to large populations.
	Dr François Lespérance

“The depth of our clinical activities attracts major experts,” boasts Lespérance, “we can do things that others can’t.” For example, the CHUM is Quebec’s most important centre for cancer treatment and has the province’s largest neuroscience clinic. It is home to cutting-edge expertise in epilepsy, multiple sclerosis, cerebrovascular accidents, as well as diabetes and hypertension, to name only a few. “Being able to combine this kind of advanced expertise with an immense pool of patients gives us a huge advantage over other centres,” adds Lespérance.

A NEW HIGH-PERFORMANCE RESEARCH CENTRE 

As part of a major hospital modernization program in Quebec, the CRCHUM will soon have a new home. Indeed, construction has begun on a new state-of-the art centre that will make it possible for the CRCHUM to consolidate its clinical research activities at a single site. Clinical research is currently conducted at three different sites. In the new centre, it will be easier for patients initially treated in various departments of the CHUM to come to the research centre for their subsequent follow-up visits rather than visiting various dispersed clinics as is the case at present.

The private sector wants to work with highperformance research centres able not only to recruit patients quickly and efficiently, but also to select patients who meet all criteria of their research protocols. In this way, data quality remains constant and infallible. This is where the number and diversity of patients who visit a hospital the size of the CHUM — more than 500,000 visits annually — is a major advantage for researchers who need large cohorts.

This is precisely what the new CRCHUM will be able to offer,” notes Turgeon: “a controlled environment with standard operating procedures in compliance with good laboratory and clinical practices that are required by major regulatory agencies such as the FDA (Food and Drug Agency) in the United States. Day-to-day clinical activities will not interfere with this cutting-edge research, which means that it will be easier to meet government requirements. Studies that are performed well and without problems avoid costly delays, a feature that is appreciated by our private-sector partners.”

The new CRCHUM will enable a giant step forward, making it possible to increase clinical research activities by 20% in the coming years and to substantially increase the number of phase I, II and III clinical trials. Moreover, the new facilitywill enhance the creativity, talent, expertise and entrepreneurship of the CRCHUM’s researchers, “which will translate into more fruitful partnerships with the pharmaceutical industry,” notes Lespérance.

SYNERGY AND DEPTH

By bringing its top-notch researchers together in a single facility, the new CRCHUM will also become a very stimulating and enviable environment. “Among other things, we have strengths in basic research, clinical research and population health research. By enabling these researchers to work together — another major strength of the new CRCHUM — we will develop a winning synergy relative to other, less-developed centres,” explains Lespérance, “the enormous advantage of the depth of  our research activities constitutes our added value, and we plan to fully develop this edge by creating networks of  researchers.”

This depth of expertise and potential is largely the result of the CRCHUM’s commitment to covering the full continuum of  biomedical research. Basic research and population studies (epidemiological research) at the discovery stage shed light on the environmental, genetic and biological factors contributing to the emergence of diseases and also identify promising treatment avenues. Informed by these discoveries, clinical research develops and tests new treatments and therapies with patients, and the results of this research often provide new insights for refining research at the discovery stage. Lastly, population health experts conduct evaluative research into health systems, health policy and quality of and access to care both in Canada and abroad.

So who are the CRCHUM’s clinical researchers and what kind of research are they conducting?
The following pages provide a few interesting examples.