Keeping it in the family
A father and son team up to help solve a medical puzzle.
One of the universal truths about medical research is that it takes a very long time. Scientists often spend years in the pursuit of knowledge about the tiniest workings of the human body.
Even when scientists discover something that may be useful in treatment, it can take many more years before the results of that research are ready for use in your doctor's clinic or in the hospital. This application of scientific findings to treatment-called translational research -represents the ultimate goal of medical research: to improve health care and make a difference in people's lives. But the demands of science mean that the journey from bench to bedside, from laboratory to clinic, is long.
Yet there are exceptions to this rule. Just ask AHFMR Scientist and biochemist Dr. David Brindley and his son, critical-care physician Dr. Peter Brindley. For them, it all started in the emergency ward of the University of Alberta Hospital with a critically ill patient thought to be experiencing a complete lack of blood supply to the abdomen-a fatal condition unless surgery could be performed immediately.
However, some strange lab findings gave Dr. Peter Brindley pause: inconsistent lactic acid results. High lactate levels indicated a lack of oxygen in the cells, a finding which would have been expected in a patient lacking blood supply to a particular area. But a different lactate test showed normal levels. Other tests later determined that the patient had swallowed ethylene glycol -a toxic ingredient found in antifreeze and various household cleaners, substances often accidentally swallowed by children. Abdominal surgery could have proven fatal. Instead, the patient was treated for ethylene-glycol poisoning and eventually released.
But the strange lactate-test results continued to puzzle Dr. Peter Brindley. "I've been taught that if things don't fit, you are obligated to find out why. That's science." So he got in touch with a research scientist he happened to know quite well-his father.
Intrigued, Dr. David Brindley suggested conducting some experiments to try to explain the odd discrepancy. They took the metabolites of ethylene glycol (the products it breaks down to after it is in the body), added them to blood samples, and ran the samples through the two different analyzers that had provided the contradictory test results that day.
"We found that it was the metabolites themselves that caused the discrepancies in the tests," he explains. The Drs. Brindley dubbed the phenomenon "the lactate gap"-when one particular analyzer shows very high lactate levels, but levels are normal on all other types. This difference can now be attributed to ethylene-glycol poisoning, which otherwise takes several hours to diagnose. "We've basically developed an immediate bedside test for ethylene glycol poisoning," says Dr. Peter Brindley, an important development since time is of the essence in treating this type of poisoning. The longer the patients go without treatment, the higher the likelihood that they will develop kidney failure or other long-term effects, or even die.
The work has proven particularly rewarding for both Drs. Brindley. Within weeks of the initial case, another patient presented at the same emergency department with similar symptoms. Aware of the recent precedent, staff immediately ran both tests and determined that ethylene glycol was the culprit. The second patient was treated and released much more quickly than the first, and recovered faster. Since he and his father published their findings, Dr. Peter Brindley has heard of about a dozen more such cases and has received e-mails from around the world, telling him of similar experiences and the successful use of the new test.
"Having both the science and the clinical findings seemed to amplify this work," he explains. His father adds, "I've published a couple of hundred research papers in my career. As a scientist, I always hope that my work will someday have clinical impact. This already has."
This was a case of "translational research across the dinner table", as the Brindleys put it. In the bigger picture, the excellent clinical and research environment in Alberta is building better links between clinicians and scientists all the time. Physicians have to think in different time frames than scientists, explains Dr. Peter Brindley. Doctors think in terms of how best to help their patients, with much more immediacy than scientists do-with their careful, methodical approach to problems.
"So, as doctors, we provide one piece of the puzzle, and we need to be able to talk to the people who have the scientific training to provide the other piece. Not every city or hospital has these kinds of resources, this kind of environment. AHFMR has helped build that environment here."