Two new CIHR catalyst grants are helping to advance healthcare for people living with hepatitis B, and facilitating the launch of a new Canadian partnership to tackle a neglected area of women’s sexual health

The hepatitis B virus (HBV) is the leading global cause of end-stage liver disease, cirrhosis and hepatocellular carcinoma (HCC or primary liver cancer). The management of hepatitis B is often complex and depends upon identifying patients at risk, appropriate diagnostic workup, treatment and follow-up. Chronic hepatitis B affects ~260,000 Canadians. Disease prevalence and the burden of associated liver disease is expected to increase due to the impact of immigration and an aging population.

Dr. Carla Coffin, MD, MSc, and her research team are spearheading an initiative to help prevent HBV infection, and improve linkage to HBV care and access to treatment for patients living with hepatitis B in Canada. The Canadian HBV Network (www.HBVnetwork.ca) is dedicated to raising awareness of HBV in Canada.

“There is an urgent need for systematic research to identify gaps in the HBV care continuum, improve access to therapy, develop better treatments to cure lifelong infection, and reduce the risk of HBV related end-stage liver disease,” says Coffin. She is Professor of Medicine and member of the Snyder Institute for Chronic Diseases at UCalgary’s Cumming School of Medicine.

An effective HBV vaccine has been available for decades, and the World Health Organization (WHO) recommends that the HBV vaccine should be given as soon as possible after birth, for example, giving a birth dose. Infants are at the highest risk of HBV infection progressing to lifelong liver disease such as chronic hepatitis B. Unfortunately, most Canadian provinces do not provide the HBV vaccine until 2 months of age and even as late as grade 5 or 6, or pre-adolescence.  

Canada has a universal healthcare system, but this does not include pharma care such as drug benefits. Despite the availability of potent oral antiviral therapy, persons living with HBV remain at risk for progressive liver disease, such as liver fibrosis, due to limited access to care and treatment.

Coffin and her team are receiving a CIHR Catalyst award that will help them undertake the following:

1. Advocate for Universal Birth Dose HBV Vaccination in Canada
2. Conduct studies to describe diagnostic workup, referral patterns and access to HBV antiviral treatment in Canada
3. Inform strategies that will improve access to hepatitis B care and treatment across Canada
4. Develop a working group to inform a larger team grant to enhance research collaborations, training and contribute towards the global efforts on development of a cure for hepatitis B.   

“Our work will help contribute to the WHO goals of achieving Hepatitis B elimination, an often devastating liver disease,” says Coffin.

A second CIHR catalyst grant is helping Dr. Laura Sycuro, PhD, and her research team investigate whether the vaginal microbiome is an easily modifiable risk factor for chlamydia infection in adolescent girls and young women.

Chlamydia is the most common sexually transmitted infection in Canada and worldwide, contributing to serious reproductive health problems in women, including pelvic inflammatory disease and infertility. Chlamydia disproportionately affects adolescent girls and young women, with 15–24-year-old Canadian females showing two to three times higher infection rates than their male peers. Though important, social/behavioural factors do not fully explain the excess burden of chlamydia experienced by young women.

Consequently, several biological explanations have been put forward, including the fact that the uterine cervix is still developing in a woman’s teens and early 20’s, making its tissues more susceptible to infection. Since this aspect of a woman’s infection risk is difficult to address therapeutically, Dr. Laura Sycuro, PhD, and her study team are investigating whether the vaginal microbiome is a more easily modifiable risk factor for chlamydia infection in adolescent girls and young women. Sycuro is Assistant Professor, Department of Microbiology, Immunology and Infectious Diseases at UCalgary’s Cumming School of Medicine and a member of the Snyder Institute for Chronic Diseases.

Dramatic shifts in vaginal microbiome composition commonly occur through loss of protective Lactobacillus species and overgrowth of anaerobic bacteria; this condition is recognized clinically as bacterial vaginosis (BV). BV is known to increase risk of sexually transmitted infections, including chlamydia, but the mechanisms involved are poorly understood. Moreover, since studies have shown BV is rare prior to sexual debut, it is unclear when the vaginal microbiome starts to affect a woman’s risk of chlamydia.

To answer these questions, Sycuro and her team have completed a longitudinal study of nearly 400 Kenyan adolescent girls (age 17–19 years), 80.5% of whom reported never having sex and the remainder just one lifetime sexual partner at enrollment. Most participants (94.4%) did not have clinical BV at enrollment, and beneficial vaginal Lactobacillus species are prevalent and abundant in this low-risk cohort. While these findings confirm that the study succeeded in enrolling adolescent girls at or before the beginning of sexual activity, the researchers still observed a baseline chlamydia infection rate of 11% (nearly 10X higher than the rate of gonorrhoea, herpes, or HIV), suggesting these adolescent girls were especially vulnerable to this infection around the time of sexual debut.

Sycuro and her team are receiving a CIHR Catalyst award to further understand the issue. The goal of their project is to discover features of the vaginal microbiome and vaginal mucosal environment associated with chlamydia infection in adolescent girls who have recently had their sexual debut. Sycuro and her team hypothesize that particular vaginal bacterial species modify the glycome – sugar molecules that decorate the vaginal tissue and immune cells – to facilitate higher rates of chlamydia infection.

“This CIHR Catalyst Award will facilitate the launch of a new Canadian partnership that aims to tackle a neglected area of women’s sexual health: how vaginal microbiota coordinate glycan modification activities to promote their own survival, form communities, thwart competitors, and modulate the local immune system,” says Sycuro.

“Establishing how these activities intersect with the pathogenesis of sexually transmitted infections like chlamydia promises to produce novel therapies that manipulate the glycome to improve women’s health and protect adolescent girls and young women from chlamydia.”