For some children with cancer the most painful part of their journey is when they start receiving life-saving treatment. To improve care for these and other sick children, it’s essential to understand why pain can be more intense in some kids than others, and how pain medications can potentially cause harmful reactions.
To answer these questions, Dr. Catrina Loucks is studying genes related to how children experience pain.
Using pharmacogenomics, the study of how genetic variability contributes to individual drug responses, she aims to identify the genetic factors that can help predict a child’s need for, and subsequent response to, specific pain medications.
As part of the multi-disciplinary Canadian Pharmacogenomics Network for Drug Safety, Dr. Loucks is working closely with clinicians, scientists and patients across the country to develop predictive genetic testing to help select the safest and most effective medications for children based on their unique genetic signatures.
This work will enable pain management decisions to be tailored to a specific child’s needs, while also contributing a better understanding of pain response pathways.
Dr. Loucks joined the Evidence to Innovation Research Theme at BC Children’s Hospital Research Institute as a new investigator in July 2021. She’s also an assistant professor in the departments of pediatrics and anesthesiology, pharmacology & therapeutics at the University of British Columbia.
We talked to her about her work and how she’s diving deep into pain management.
What is the main focus of your work?
The main focus of my work is understanding the genetic basis for different responses to medication. This position that I’ve been awarded at BC Children’s is focusing on pain management, so I’m really excited to delve deeper into that area and understand not only how genetic differences influence how we respond to medications, but also how it makes us respond differently to pain; how likely are we to need pain medications, how likely are we to respond to them and how likely are we to get adverse effects from them. That can all be, in part, influenced by genetic factors.
Why is this work important?
It’s important because we’re not necessarily treating everyone appropriately for pain. Some people might be undertreated for pain and other patients might have adverse effects, so they might be harmed in the pain medication journey.
What got you interested in pharmacogenetics in the first place?
I started research in rare disorder genetics at the University of Calgary. I love genetics and understanding the genetic basis for differences. Then I moved to pharmacological genomics where differences in how we respond to drugs influence everyone. Everyone will need drugs in their lives. Everyone has different genetic factors that might make certain drugs more effective for them, and other drugs dangerous for them, so it’s a way to work with clinicians and patients to get the best drugs for everyone. – It’s really exciting.
What keeps you interested in this line of research?
There’s so much to explore, which is really fascinating. Every day we’re finding different genetic factors that influence different pathways. For any topic, but for pain in particular, there’s so much we don’t know. I’m looking at particular patient cohorts, for example, that respond differently to cancer medications. Some might develop a painful toxicity, some might not, and by understanding the genetic basis of who is likely to develop a toxicity, we can actually pinpoint differences in biological pathways that might be affected.
If you know the biological pathway that is perturbed and might make that patient more susceptible to a toxicity, then you can design therapeutics better and design protective strategies better.
There’s just so much we can do to understand and to use that information to improve clinical care.
What are you working on now?
One of the two main projects that I’m focusing on is methotrexate-induced mucositis, which is a painful reaction that happens in childhood cancer treatment. It’s an inflammation and ulceration of the mucosal lining in different areas of the body. It can include areas like the mouth and it can result in a withdrawal of treatment. It’s not only painful and damaging to quality of life, but it can impact cancer care. We’re identifying children with this toxicity and we’re trying to pinpoint genetic factors that will give us hints to why is this happening to this particular patient – do they have increased inflammation because of genetic factors, do they have factors that make them more sensitive to the medication – that kind of thing.
The other project we’re looking at is morphine treatment for children to see if we can identify genetic factors that can predict the appropriate dose, and we’re going to do that by looking at genetic factors.
How did your journey in pharmacogenetics begin?
I’m from Calgary so I did my bachelor program there as well as my master’s, and then moved here to do my PhD at Simon Fraser University (SFU), where I worked with Dr. Michel Leroux. He’s an expert in cilia, which are important for sensation. It’s quite a nice fit moving from sensory processing – how we respond to our environment – and then trying to translate that into how do we respond to pain, a specific kind of sensory response. Even when I was at SFU I collaborated with UBC researchers. BC Children’s provides a wonderful environment to progress the work.
What brought you to BC Children’s?
I did my postdoctoral training here and I love it. I welcome the opportunity to work with clinicians. The really exciting part of my research is the opportunity to identify these genetic factors by working with clinicians to identify patients that might have differences in their response to drugs and then translating that genetic information back to clinical teams and clinicians who are treating patients, to learn how best to modify or inform treatment to help patients in the long run.
