Researchers Under the Scope

In the heart of the Health Sciences Building, Dr. Amanda Hall studies a tray of organoids under a microscope.

"They do need a lot of attention and a lot of feeding," she said, pointing to dot-like points in a gel solution.

The pediatric surgeon and assistant professor of pediatric general surgery will use those dots to identify factors that help infants overcome short gut syndrome.

The rare condition affects roughly 24 in every 100,000 babies born in Canada, presenting a profound challenge for infants born with insufficient intestinal length or compromised absorptive capacity.

"It's a very, very long, difficult road," said Hall. "Often they're stuck in hospital and there's no progress happening, so definitely [families] want another option."

Hall's interest in medicine dates back to the late 1990s in Meadow Lake, Saskatchewan, and a family TV with three channels. In elementary school, she remembered faithfully recording the reality show Life's Little Miracles, where a camera crew followed patients at Toronto's Hospital for Sick Children.

"They'd actually go into the operating room and film the surgeries, which was amazing," she said. "That's what I wanted to do."

After she was accepted to the University of Saskatchewan's College of Medicine, Hall met Dr. Grant Miller and Dr. Gordon Zello during her second year of residency. To become a pediatric surgeon, she had to earn her master's degree, and Miller took the graduate student under his wing, focusing on parenteral nutrition-associated liver disease in infants.

"I just loved research," said Hall. "I loved the struggle, the unending nights of work, then finally that amazing feeling when you see numbers that make sense."

It was the beginning of Hall's deep-dive into the intricacies of the human gut.

Right now, half of infants diagnosed with short gut syndrome get better on their own, with the help of intravenous nutrition. A few undergo complex bowel transplants, but close to 38 per cent succumb to the disease.

"They would have what we call failure to thrive," said Hall. "They don't gain weight, they have uncontrollable diarrhea, they might have vomiting."

In this episode, Hall takes us inside her lab to meet her miniature, spherical organs, cultivated from stem cells, mimicking the intricate structure of the human intestine.

"Definitely you become attached to them. They require a lot of work, a lot of time, and a lot of expense," Hall said.

Hall is exploring the potential benefits of breast milk and probiotics in encouraging growth inside these mini intestines. From there, she hopes to identify specific components that could accelerate the recovery of infants suffering from short gut syndrome.

"We know that breast milk …. helps with our immune function, helps with the actual integrity of the bowel. I'm curious to know does it actually help the bowel grow faster?"

For families grappling with the challenges of short gut syndrome, Hall's work offers a beacon of hope.

"The idea of finding a universal cure is not very realistic," said Hall. "But if we can start identifying different factors to help and improve the process, that'll be very important."

She says a multitude of factors affect short gut syndrome, and some drugs are already in development.

"There's definitely hope on the horizon," she said.

Valerie Verge was in her early twenties when she landed her first job, doing neuroscience research and she loved it. But 43 years ago, her research journey began to take a twist.

"I developed an allergy to rats and mice," she said. "I was using a box of Kleenex a day."

She reluctantly had to admit that this may not be her career path, and spent her evenings earning a 'back-up plan' degree in computer programming at McGill. She refused to give up laboratory work, and went on with her colleagues to code and create an in house computerized image analysis system that was not readily available commercially or affordable.

"That was huge back then," she said. "It came in very, very handy because we were able to integrate images on our microscope with computers and quantitatively analyze them."

As her allergies gradually lessened, Verge stayed in the lab and earned her Ph.D. in the Department of Neurology and Neurosurgery at McGill in 1990, then moved to the Karolinska Institute in Stockholm for post-doctoral studies. By 1992, she followed her heart to the prairies, and found 'wonderful opportunities' for research at University of Saskatchewan's College of Medicine and soon after in a new UofS MS focussed research centre in Saskatoon City Hospital.

Today, she's a professor of anatomy, physiology and pharmacology, and the director of the Cameco MS Neuroscience Research Centre, with expertise converging on a singular goal — finding innovative ways to repair the nervous system.

Her recent peripheral nerve repair collaboration with Dr. Ming Chan from the University of Alberta Department of Medicine and Dr. Gillian Muir, Dean of the UofS Western College of Veterinary Medicine explores acute intermittent hypoxia (AIH) This non-invasive therapy involves breathing controlled alternating cycles of regular air and air with reduced oxygen levels.

"It sounds horrible! But it's not like having a stroke, where you can have zero oxygen," said Verge. "This is more like just taking it down by a percentage to a level that induces a beneficial stress response."

The rationale behind AIH lies in its ability to trigger repair responses. By subjecting the body to a mild, controlled stressor, the therapy aims to activate repair mechanisms that can be beneficial for nervous system repair. Dr. Verge's work involves investigating the impact of AIH on repairing peripheral nerves, outside of the brain and spinal cord and more recently, extending this therapy to investigate repair and neuroprotection in a model of multiple sclerosis.

In a female mouse model of progressive multiple sclerosis, Verge said graduate student Nataliya Tokarska observed an 80 per cent reduction in inflammation levels after just once daily treatment with the AIH protocol for one week

"They're supposed to only get worse. Even two weeks after ending treatment, they're still showing improvement," said Dr. Verge, noting regions with lesions transitioned to a state of 'advanced' myelin repair; axons were being remyelinated and the immune response was dramatically decreased and shifted to a pro-repair state .

"It's an extremely robust repair response like I've never seen in my 43 years of doing research."

Verge said the technique has already helped patients with spinal cord injuries. In humans it does not raise their blood pressure or heart rate or induce memory loss.

Unlike invasive procedures, such as electrical nerve stimulation (ES), the entire body is exposed to AIH. Verge and her team are now building on previous ES findings, showing intermittent low oxygen therapy behaves in a similar favourable manner repairing damaged and severed nerves in animal models.

Grants from the Canadian Institutes of Health Research (CIHR) and MS Canada allow the research team to transition from pre-clinical rat work to human trials in carpal tunnel syndrome, and one day even multiple sclerosis patients. This marks a crucial step toward validating the efficacy of AIH in repairing the nervous system.

"It's a pleasure to see things come full circle," said Verge, who said her role now is to inspire and share insight with the next generation of neuroscientists.

"We're very, very hopeful for the future."

Dr. Evyn Peters has created pivotal changes for patients arriving at Royal University Hospital's mental health short stay unit, and its emergency department.

With 33 publications and interests spanning psychiatry, psychopharmacology and mood disorders, Peters is often one of the first physicians patients see when they're experiencing a mental health crisis.

Peters was finishing his residency at RUH and the University of Saskatchewan's College of Medicine in 2017, when he and his colleagues first proposed ketamine for short-stay patients who had tried multiple antidepressants without success.

After studying best practices in other centres, Peters and his colleagues developed a protocol to treat patients with a ketamine nasal spray. His patients stay conscious, and don't need an intravenous catheter or intensive cardiorespiratory monitoring.

"Not only does it work very quickly but it is twice as effective roughly as your conventional anti-depressants. And what's more impressive is that it's being used for patients typically who've failed to respond to anti-depressants in the past," Peters said.

"It certainly is a cost-effective treatment."

Until 2020, the only other option for hospitalized patients who didn't respond to other drugs was electroconvulsive therapy (ECT).

Hospitals in Saskatchewan sometimes struggle with backlogs, with patients waiting weeks for ECT. A psychiatrist and anesthetist and nurses must oversee the procedures, including treatments which typically stretch over another four weeks.

"That's a long time in hospital," said Peters. "You can get a similar response rate with one or three or four ketamine treatments every second day in about a week in hospital here."

Peters was the lead author on the 2023 article Intranasal racemic ketamine for patients hospitalized with treatment-resistant depression: A retrospective analysis, published earlier this year in the journal Experimental and Clinical Psychopharmacology, together with his University of Saskatchewan psychiatry colleagues Dr. Katelyn Halpape, Dr. Isaac Cheveldae and Dr. Annabelle Wanson.

His patients, on average, were taking 3.5 psychiatric medications when they were admitted. His team made a point of not requiring patients to wean themselves off other anti-depressants during their treatment with ketamine.

"We have a response rate in the hospital here of about 65 per cent, which is what you see in other treatment centres" said Peters. "The vast majority of those patients, about 75-80% get discharged immediately after that treatment."

He said the rest of his patients often face other health and life circumstances complicating their discharge, such as homelessness. On top of that, ketamine is not suitable for anyone who's recently had a heart attack, stroke, blood pressure issues, or who has schizophrenia.

"The goal was just to get it in use, because it was needed," said Peters. "Now we can answer some of these questions about why does it work, and for whom does it work the best?"

By the end of her Grade Eight year in Saskatoon, Wendie Marks was sure about one thing: she knew she wanted to study health and the way early-life development affected the human body.

"I spent a lot of time in the library reading books," Marks said. "I was always kind of the nerdy type."

Marks enrolled at the University of Saskatchewan and thrived, earning her PhD in psychology. Her interests evolved towards behavioural neuroscience, focusing on the mechanisms behind behaviour, stress, and their effects on mental and physical health.

"I wanted to make new knowledge. I wanted to be on the cutting edge of finding new pathways that might be involved in anxiety, or depression," she said.

Under the direction of Dr. Lisa Kalanchuk, Marks looked at stress and depression, during her graduate studies at the University of Saskatchewan. From there, her post-doctoral research veered into epilepsy models at the University of Calgary. Still, Marks' passion for understanding stress and its intergenerational effects never wavered.

When she returned to the University of Saskatchewan last year as an assistant professor in the Department of Pediatrics, Marks steered her research toward investigating stress's effects on health and chronic disease.

This summer, she was appointed as a Tier 2 Canada Research Chair in Developmental Origins of Health and Disease in Indigenous People. Over the next five years, she plans to study the way life experiences, particularly stress and nutrition during pregnancy and early years, can have long-term effects on an individual's health and well-being.

This research isn't just academic for Dr. Marks; it's deeply personal.

Marks is a member of the Asnishinabe of Wauzhushk Onigum First Nation, near Lake of the Woods, Ontario, but she was born and raised in Saskatoon. Her mother and her siblings survived both residential school and the "60s Scoop".

"The whole family was split up. There are aunts and uncles I've never even met," said Marks. "I've seen within my family firsthand the effects that those stressors have played on people, and the effects those things can have on families."

Today, Marks credits her academic and research career to her mother's unwavering support, encouragement and resilience.

"She's one of the strongest people I know," said Marks.

In this episode, Marks explained she'll study stress in two different ways. First, she plans to use a multi-generational rat model to study the consequences of early-life stress by separating mothers from their pups. She'll also model malnutrition by reducing the mother's protein intake.

Her goal is to measure each set of stressors separately, then assess whether they have a deeper effect combined.

"Being hungry or exposed to stress when you're younger, chronically, it's possible that it can rewire your stress circuitry," said Marks, who noted that is the case in numerous animal models.

Her team will investigate how these factors can lead to physiological and cognitive changes, particularly in obesity and brain circuitry.

In the second stage of her research, Marks will observe health conditions in those rats' descendants, and propose potential treatments.

'There's a lot of compelling evidence to suggest that stress and the gut microbiome are linked together and affect our health later on in life," Marks said.

Ultimately, Marks hopes to apply the findings from animal studies to real-world situations within Indigenous communities, and help them come up with preventive strategies.

She hopes to bridge the gap between knowledge and action, ultimately improving the health and well-being of Indigenous communities for generations to come.

"Knowledge itself is powerful," Marks said. "The hope is that with this research we begin to find some of the answers and some of the solutions to decolonize Indigenous communities."

Her work is a testament to resilience, hope, and the profound impact of science in healing intergenerational trauma.

"It's a significant motivator for my research," Marks said. "What can I contribute to try to make our world a better place?"This summer, she was appointed as a Tier 2 Canada Research Chair in Developmental Origins of Health and Disease in Indigenous People. Over the next five years, she plans to study the way life experiences, particularly stress and nutrition during pregnancy and early years, can have long-term effects on an individual's health and well-being.

This research isn't just academic for Dr. Marks; it's deeply personal.

Marks is a member of the Asnishinabe of Wauzhushk Onigum First Nation, near Lake of the Woods, Ontario, but she was born and raised in Saskatoon. Her mother and her siblings survived both residential school and the "60s Scoop".

"The whole family was split up. There are aunts and uncles I've never even met," said Marks. "I've seen within my family firsthand the effects that those stressors have played on people, and the effects those things can have on families."

Today, Marks credits her academic and research career to her mother's unwavering support, encouragement and resilience.

"She's one of the strongest people I know," said Marks.

In this episode, Marks explained she'll study stress in two different ways. First, she plans to use a multi-generational rat model to study the consequences of early-life stress by separating mothers from their pups. She'll also model malnutrition by reducing the mother's protein intake.

Her goal is to measure each set of stressors separately, then assess whether they have a deeper effect combined.

"Being hungry or exposed to stress when you're younger, chronically, it's possible that it can rewire your stress circuitry," said Marks, who noted that is the case in numerous animal models.

Her team will investigate how these factors can lead to physiological and cognitive changes, particularly in obesity and brain circuitry.

In the second stage of her research, Marks will observe health conditions in those rats' descendants, and propose potential treatments.

'There's a lot of compelling evidence to suggest that stress and the gut microbiome are linked together and affect our health later on in life," Marks said.

Ultimately, Marks hopes to apply the findings from animal studies to real-world situations within Indigenous communities, and help them come up with preventive strategies.

She hopes to bridge the gap between knowledge and action, ultimately improving the health and well-being of Indigenous communities for generations to come.

"Knowledge itself is powerful," Marks said. "The hope is that with this research we begin to find some of the answers and some of the solutions to decolonize Indigenous communities."

Her work is a testament to resilience, hope, and the profound impact of science in healing intergenerational trauma.

"It's a significant motivator for my research," Marks said. "What can I contribute to try to make our world a better place?"

When Justin Botterill first arrived at the University of Saskatchewan, he took what he described as a 'shotgun approach' to choosing classes.

Midway through his second year, his psychology professors introduced him to neuropsychology, and to psychiatric and neurological disorders.

He was hooked.

Botterill soon began working with rodent models, later focusing on the hippocampus and pathways involved in forming memories and spatial navigation.

"The hippocampus is widely implicated in a variety of neurological as well as psychiatric disorders," said Botterill. "It's a really important and critical structure."

After completing his PhD in cognition and neuroscience at the University of Saskatchewan, Botterill went on to work as a postdoctoral fellow at the Centre for Dementia Research at the Nathan Kline Institute for Psychiatric Research in New York, then at the University of Toronto Scarborough.

In January, he was hired as an assistant professor at Anatomy, Physiology and Pharmacology at the University of Saskatchewan's College of Medicine.

Today, he's setting up his laboratory and hiring researchers to help examine the dentate gyrus, its granule cells and the diverse roles mossy cells play across the hippocampus.

"Several lines of research over the last five or ten years have really shown that [mossy cells] contribute to a lot of important functions. That's why they're very exciting to study," said Botterill. "It's a really interesting feedback loop."

He said mossy cells are not a single homogenous group of neurons.

"Although historically mossy cells have been treated as a single class of neurons in the hippocampus, several lines of research suggest they differ in their gene expression, morphology, physiological properties, and anatomy," he said.

"No one's really investigated these potential subcategories of mossy cells at a deep level yet."

In this episode, Botterill explains the role mossy cells in the dorsal hippocampus play in spatial and cognitive functions. He said those in the ventral hippocampus show strong links to emotions such as anxiety.

He also is looking at the role these excitatory cells play in Temporal lobe epilepsy, a disease characterized by seizures, along with debilitating cognitive and behavioural effects.

"One in three people with epilepsy don't respond to medication," said Botterill, who said he's hoping to focus on translational research in this area.

Botterill hopes to better identify the cells, circuits and proteins inside the dentate gyrus that generate seizures. Alongside researchers including John Howland and Robert Laprairie, he's hoping to eventually test new therapeutics on these target areas, to see which ones best prevent or reduce seizure activity.

"Can we develop treatments that would improve care for individuals, reduce the severity of their seizures, and allow them to lead healthier lives?"

When Bruce Gordon's relatives descend on Saskatoon this month, his wife will put them to work.

Bruce Gordon was a police officer and a lawyer, who competed as a triathlete and in the Crossfit Games. He was a fierce competitor until he was diagnosed with stage four pancreatic cancer at age 54.

Hear his story in Episode 43.

After Bruce died in 2017, Chris Gordon became one of the chief organizers of the 'Be Like Bruce' fitness festival -- an athletics-driven fundraiser for pancreatic cancer research that's now raised more than $60,000 dollars in his memory.

"A lot of Bruce's family are coming this year to help out. I will have a house full of wonderful guests and I have jobs for them," said Gordon. "I even have a niece that lives in Vancouver who just started triathlon and she's coming to do it."

The festival is also recruiting dozens more volunteers, to keep athletes safe during each event.

The action begins on June 16, 17 and 18 with events at both Crossfit 306, and Riversdale Pool in Saskatoon. There's also a raffle, and merchandise available online.

In this episode, Chris explains why she chose to funnel donations from the fitness festival to the University of Saskatchewan's College of Medicine.

"100% of our donations go to the research," said Gordon. "There's no administration costs, and that to me was a deciding factor."

Earlier this year, Dr. Andrew Freywald and Dr. Franco Vizeacoumar published their 'one-two punch' treatment findings in Clinical Cancer Research. They've collaborated to create a new drug—a bi-specific antibody that targets two key receptors at once.

It's effective in treating triple negative breast cancer and pancreatic cancer in mice, and its creators hope to see it advance to clinical trials over the next five years.

"I just feel like I'm part of that team," said Gordon.

She said if you're not competing at the fitness festival, making a small individual donation still pushes forward pancreatic cancer research at the University of Saskatchewan .

"It may not seem like a lot of of money, it's not millions and billions of dollars, but it makes a huge difference for these researchers," said Gordon. "This is where our money needs to be."

Midway through his undergraduate degree at the University of British Columbia, a laboratory 'help wanted' poster caught Jeff Dong's eye.

He applied, gaining invaluable practical experience that summer in Stephanie Borgland's lab.

"She really supported me in understanding what research is about," said Dong, who went on to complete his PhD through UBC's Department of Microbiology and Immunology, moving to Calgary for post-doctoral work at the Hotchkiss Brain Institute. "That process was really exciting for me."

He accepted a faculty position last year as an assistant professor in the University of Saskatchewan's Department of Biochemistry, Microbiology & Immunology.

Dong is fascinated by macrophages: white blood cells that serve as the immune system's warning system and clean-up crew.

He tracks the way they work in the brain and spinal cord, focusing on how they slip into states of dysfunction with age, and with stress.

"They're the first line of defence," said Dong. "The microglia will go and say, 'okay the cell has died, let me clean this up.' Or if there's the release of something toxic, the cell will say, 'oh, there's something happening here, let me check it out."

With age though, our microglia aren't always as diligent.

"As a cell becomes older, it can forget what it's supposed to do," said Dong.

Dong recently received support from the Natural Sciences and Engineering Research Council of Canada (NSERC) to look more closely at macrophages.

"What are the specific mechanisms or signaling that occur on the macrophages, and how does this lead to their ability to remove or to react against these oxidized lipids?"

He said patients with spinal cord damage, and diseases such as Multiple Sclerosis often endure similar breakdowns.

Dong's work, Oxidized phosphatidylcholines identified as potent drivers of neurodegeneration in Multiple sclerosis, won a Brain Star Award last year from Canada's MS Society and the Canadian Institutes of Health Information. He's also won the MS Society's Catalyst grant for early-career researchers.

"That's a pilot project where we're looking to generate some novel tools and new animal models to study a protein, a molecule we call 'osteopontin'," said Dong. "We think it may be a player in terms of making MS disease worse with age."

In this episode, he talks about macrophage longevity, as well as cellular changes caused by Multiple Sclerosis.

"How long has the cell been responding against the damage, and how old is the cell itself?" said Dong. "They both contribute to the progression."

He's also testing different models, to see whether higher levels of fitness makes cells more resilient against oxidative stress.

"Hopefully we'll have answers in a year or two," he said.

Dong admits he chose the University of Saskatchewan because of its strength in MS research, and because there are so many young biomedical scientists.

"The university is very vibrant in terms of the early career research community," he said. "These are fantastic colleagues who I can grow with and do very exciting research with over the next number of decades."

Before we're even born, our bodies begin to grow and train an army of spies and assassins, creating a crew of immune system fighters in the upper chest's thymus gland. While this production is dominated by T cells, other immune cells such as B cells and plasma cells can be generated within the thymus, albeit at a very low level.

After adolescence, the thymus reduces production at its 'spy and assassin' factory to a trickle. This has consequences because as we age, our immune system makes mistakes, leading to mutations in our DNA; changes in the types of antibodies we produce, and odd feedback loops.

Those glitches contribute to the generation of chronic lymphocytic leukemia or B-cell lymphomas such as non-Hodgkin lymphoma. They can also contribute to the development of autoimmune diseases such as lupus and myasthenia gravis.

"We think this all has to do with a life-or-death signalling loop," said Dr. Peter Pioli, who moved to the University of Saskatchewan last year to become an assistant professor of Biochemistry, Microbiology & Immunology. In February, he published his findings in iScience.

"For autoimmune patients, you get this thymus that gets filled up with all these B-cells and plasma cells, so you no longer have this little trickle; you have a bit of a runaway train," he said.

Using mouse models, Pioli and his team are trying to piece together the triggers convincing aging B-cells to mistakenly ramp up plasma cell production. They want to know how this impacts the development of various diseases.

In this episode, Pioli explains his interest in plasma cells.

"It fascinates and confounds you all in one," said Pioli. "This one cell has to have this perfectly aligned machinery to do this. And it's kind of hard to look away when you find something like that."

A "curious troublemaker" who loved to tinker as a kid, Pioli remembers taking apart tools and objects in his parents' garage, removing pieces and trying to rebuild them. That curiosity carried him through his undergraduate, graduate studies and post-doctoral work in Wisconsin, Utah, and California.

"It's just a lot of fun," said Pioli. "You get the payoff of hopefully finding something that could actually help someone someday: understanding aging, understanding these breakdowns that lead to autoimmune diseases and tissue breakdown."

Pioli admits his scientific career has taken plenty of detours, but he's extremely grateful it unfolded the way it did.

"There's a lot you learn from that, not just in terms of experience," he said. "You also learn about yourself in terms of your potential to persevere. And maybe the potential to be supremely stubborn, to keep at it."

Like a lot of kids, Anurag Sakharkar used to dream about being a doctor, or an astronaut. His parents, both academics, encouraged him to follow his dream.

In high school, he began spending evenings and weekends working at the University of Saskatchewan's biomedical labs, perfecting advanced research methods, western blots and PCR analysis . He began learning about Parkinson's disease with Dr. Changiz Taghibiglou, then started examining novel cancer treatment approaches with Dr. Franco Vizeacoumar.

The Covid-19 pandemic brought Anu's in-person laboratory time to an abrupt halt. Undeterred, he began to spend his nights poring over gene expression data, using computational analysis to identify patterns.

"We integrated all these different methods and looked at the genome coordination as a whole," said Anu. "What important pathways are involved, and how do they connect and interact at the DNA, protein, and RNA levels?"

His curiosity spread from analyzing biomarkers in cancer cells — to learning more about the dramatic changes occurring in an astronaut's body during space flight.

Astronauts lose bone density and muscle mass in space. They endure neurological degeneration, renal and cardiovascular dysfunction, compromised immunity, and upon their return to earth they have a far higher risk of developing cancer. Anu noticed a more large-scale inherent change in these astronauts in his research.

"You see gene correlation and coordination breaking down all over the entire genome," said Anu. "You have a huge systemic trauma that's occurring in these astronauts when they go into space."

Together with Dr. Jian Yang from the College of Pharmacy and Nutrition, Anu started analyzing astronaut gene expression data gathered in NASA's open-source GeneLab. It tracked eight men and two women posted to the International Space Station for a six-month period, including pre-flight, inflight, and postflight measurements.

Anu developed a novel expression analysis method, and has now identified 32 genes with outsized effects on astronauts' health as possible candidates for biomarkers to characterize, monitor, and even treat health issues.

In February, his research was published in Life. With support from the University of Saskatchewan President's NSERC Research Fund, it also formed a partial basis of Anu's honours thesis as he completes his final undergraduate year this spring, majoring in Cellular Physiology and Pharmacology.

He's developed partnerships with universities around the world, along with NASA, the Canadian Space Agency, and private space bioscience companies.

"Space is definitely humanity's future," Anu said. "That future is getting closer and closer."

When Dr. Rachel Asiniwasis returned to the prairies after her dermatology residency in Toronto, she noticed a pattern among many of her pediatric patients.

Hundreds of them were coming to her with itchy, raw patches of skin, the result of atopic dermatitis — eczema.

"One of the biggest frustrations for me is when people say 'oh, it's just a skin problem'," said Asiniwasis. "Itching in many ways is just as impactful as chronic pain,"

Atopic dermatitis is the most common chronic skin inflammatory disease. The vast majority of cases start in children under the age of five. At least one in every ten Indigenous children in Canada has some form of eczema. That figure rises to one in every four children in some Arctic communities.

Asiniwasis said the itch and pain -- amongst other signs and symptoms in moderate to severe cases -- can lead to depression, ADHD, anxiety, and an increased risk of suicide.

Two years ago, she conducted a survey of 50 dermatologists, nurses and family physicians who work in Indigenous communities across Canada. Atopic dermatitis was the most common skin disease reported by their patients, followed by bacterial infections.

Working with medical leaders in five southern Saskatchewan Indigenous communities, Asiniwasis was also granted permission and ethics board approval to perform a confidential chart review for hundreds of pediatric patients with atopic dermatitis. A number of those patients saw their uncontrolled atopic dermatitis devolve into secondary infections, often leading to hospital visits and multiple courses of antibiotics.

"The literature's also showing high rates of bacterial skin infections, which is another part of the scoping review," she said. "We're also seeing problems with chronic impetigo, boils, MRSA, all of these types of bacterial skin infections in those with uncontrolled eczema in rural and indigenous children, across all fronts."

She's seen a number of patients with skin lichenification: something she refers to as 'elephant skin'.

"It comes to a point where often our first line topical therapies don't penetrate and treat it, or it can take months," she said. "We have to escalate therapy in these patients, so that can put them at risk for other side effects. We need to prescribe things like immunosuppressants, like methotrexate, or biologic targeted therapy if it's all over the skin. They can't be put in creams everywhere."

After Asiniwasis asked her young patients and their caregivers to describe barriers to healing their skin, they spoke of long wait times to see dermatologists, often travelling hundreds of kilometres at their own cost to seek care.

They also described the cost of skin care products in northern communities as 'hyper-inflated'. Her patients and their families also face a sharp learning curve, as they adhere to strict bathing regimens, moisturizing, recognizing signs of infection, and learning to use topical ointments effectively.

Asiniwasis said resources in rural and northern communities for follow-up care are often limited.

"We can really tell someone a a lot about someone's health by looking at their skin."