UHN Surgeon Resolute On Progress of Nanomedicines

The ORT Times - March Issue, 2016


On December 31, 2015, New Year's resolutions from a cache of Canadian icons—artists, politicians, novelists, scientists, and musicians—were collected by National Post reporter Ben Kaplan and posted for all to see. Though I was comforted to read that recording artist Shad planned to “keep taking things one day at a time,” my enthusiasm and curiosity were most piqued by the documented aspirations of one of the University Health Network’s (UHN's) most celebrated surgeons, Dr. Jonathan Irish.

Dr. Irish carries a broad assortment of titles and responsibilities including Chief of Surgical Oncology at UHN, Professor of Head and Neck Surgery at the University of Toronto, and Clinical Lead in Guided Therapeutics at the Techna Institute. He represents the changing face of medicine, being a man classically trained in the surgical arts, but also one who keeps his eyes on the horizon of innovation and development, ever seeking avenues to improve his craft.

In 2013, the opening of his spanking new Guided Therapeutics Operating Room (GTx OR)—a mega-sized operating room (OR) packed with the most advanced image-guidance tools the world has on offer—brought with it plenty of media attention. The Toronto Star dubbed the space “the operating room of the future” and in 2014, Irish was featured in a Toronto Life piece, crowning him the city’s king of surgical oncology. But what I wanted to explore with the good doctor was the National Post article entitled ‘This Year, For Sure’, wherein Dr. Irish was asked to reveal one ‘true’ resolution and one ‘dream’ resolution for 2016.

True resolution: “To go 'first-in-human' in clinical trials with the development of new nanomedicines for image-guided surgery in our GTx OR."

Dream resolution: "Use the telephone more or meet with people rather than email or texting."

Each of these statements made my ears perk up. As a nano-oriented researcher and as someone who sleeps with his phone in another room, I knew I had to learn more about this character.

What I learned first is that Dr. Irish is fantastically accommodating. It was on a dreary Friday evening in February, which for me is prime time for jetting out the door, when the famous surgeon invited me into his GTx OR. And I knew that Irish had operations scheduled that day, but it was only when we began our chat that I learned about the eight-hour laryngectomy he had toiled over and wrapped (stitched) up just before meeting me. 

“Some people spend eight hours on an assembly line. For me, this is much easier…it must mean that I love my job."

An absolute professional.

On the 2nd floor of Toronto General Hospital, you can find the technology-laden OR #20—the GTx OR. This innovative space is the brainchild of a team of imaging experts, surgeons, scientists, and engineers all operating under the Techna Institute’s umbrella. “There were no blueprints for this,” Irish explained as we walked into the GTx OR, a clean and quiet room occupied only by sleeping robots. “This was developed for our team, by our team.”


Some three times larger than a typical OR, the GTx OR was built to accommodate today’s cutting-edge image-guidance technologies, while leaving space for tomorrow’s. After three years of heavy use, Dr. Irish is beginning to see ways for the room to evolve, along with the entire field of surgical oncology. 

Liquidware

“There is a lot of hardware here, and enabling this hardware is software. I think that in the next year or two, we will be moving toward ‘liquidware’.” The liquidware he refers to is the burgeoning suite of nanomedicines approaching human trials. Specifically, Dr. Irish has his eyes on injectable nano-sized agents that could help to visualize disease structures and perhaps even to treat these target areas. These agents might help his team improve patient outcomes by guiding extremely accurate ‘minimal-access’ surgeries and perhaps even by releasing locally-active drugs. Nanovista’s (Drs. David Jaffray, Christine Allen, and Jinzi Zheng) liposome-based visualization agents and Dr. Gang Zheng’s multifunctional porphysomes were mentioned as prime candidates for trials in the not-too-distant future.

"This is extremely high priority,” Dr. Irish emphasized. “We've done so much [preclinical] work, we now need to take nanomedicines to the next level." That next level, according to the doctor, is first-in-human trials through the Princess Margaret (PM) Cancer Centre.

Pushing nanomedicines from the lab bench toward clinical testing aligns well with the PM Cancer Centre’s strategic plan for strengthening its personalized medicine paradigm. Though the translational leap would not be without challenge or expense, Dr. Irish affirms, “first-in-human trials are definitely within our grasp.”

The Personal Touch

The middle-aged doctor knows his tech, but there are areas where he feels that putting it away would come with great benefit. “I think it’s important to communicate. To communicate with your eyes, your face, as you’re walking down a hall or a street or whatever." Though Irish admits that through text and email he has never been accessible to more people, he says there is, indeed, something missing from that kind of interaction: a personal touch.

“There are so many emails that are better dealt with in person.” And when it comes to a creative endeavor, like say, designing the ‘operating room of the future’, there is just no other way.

Dr. Irish beamed when he told me that his ‘dream’ resolution was going very well so far. Only time will tell whether the same will be true for his ‘true’ resolution.