Justine Turner

Area of Study / Keywords

intestinal failure short bowel syndrome neonates experimental surgery animal model intestinal development and physiology parenteral nutrition

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About

My field of interest is nutrition. My research training (PhD, postdoc) and clinical training/expertise in gastroenterology have facilitated my participation in nutrition research and education. My research encompasses translational research in neonatal intestinal failure, a devastating health condition that leads to prolonged morbidity and increased mortality in young children. Related to my research expertise I was appointed Chair of the Research Committee for the American Society for Parenteral and Enteral Nutrition (APSEN) in 2014 - 2016, Chair of the Nutrition Committee for the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, 2014 - 2019 and I have been a member of the Canadian Institutes of Health Research Doctoral Awards Committee since 2013.  All my research endeavors are enhanced by clinical experience with children with short gut syndrome and intestinal failure.

1. Neonatal short bowel syndrome: In 2005, I began development of piglet models of intestinal failure and using these models our research has been supported by CIHR, 2008-2022. I was encouraged by my clinical concerns, by the excellent piglet facilities in Edmonton and by concern that existing animal models were not and could not advance the field for the highest risk populations. I wanted to develop an animal model that could improve health outcomes specifically for neonates and infants. The most used models, mature rodents, have limited utility to translate to neonates. I was lucky to be able to collaborate with Paul Wales an internationally recognized expert in intestinal failure and neonatal surgery, who is so dedicated to this field of research that he travels monthly to Edmonton to conduct the surgeries. At this time our jejunocolic model has not been replicated in any other laboratory globally (I believe due specifically to his contribution). We have used this model to address clinical questions that we know to be paramount issues for clinicians in the field. We have been pursuing new therapies for intestinal failure supported both by CIHR and by industry partnerships. Our work has been awarded locally, nationally and internationally. I am particularly proud of the success of my prior PhD and MSc students who were both awarded the Harry M. Vars Award by ASPEN in 2015 and 2016 and 2017. Ours is the only laboratory to have won this international research award three times in a row.
2. Parenteral lipid therapies: My laboratory has been studying novel lipid therapies in intestinal failure associated liver disease (IFALD) the major cause of morbidity and mortality in neonatal intestinal failure patients This research has improved local practice and education. Recent publications have focused on the need to rationally consider risks and benefits of parenteral lipid therapies. My field of enquiry evolved well beyond what we were funded to study (IFALD) to consider complications that have translated to clinical care (e.g. platelet dysfunction and risk of bleeding). My experience on international nutrition committees and journals have highlighted to me that this information needs to be disseminated, due to the misconceptions of many practitioners, including in neonatology, gastroenterology and surgery.  I am widely considered a key knowledge expert in this field by my national and international colleagues.

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Research

We have a number of current projects evaluating new drugs (like different forms of GLP-2) to promote intestinal adaptation to overcome short bowel syndrome.

We are also evaluating novel treatments to address gut microbiome dysbiosis in short bowel syndrome.

The current project we are seeking a new student as a research project is funded by CIHR "Revolutionizing the treatment of neonatal short bowel syndrome by novel therapeutic approaches to intestinal growth" and outlined below:

Babies with short bowel syndrome (SBS) depend on intravenous or parenteral nutrition (PN) to survive. This means years of severe morbidity, a risk of early mortality up to 25%, staggering health care costs, frequent and lengthy hospitalizations, intensive home medical care and an immense burden on the child and family. To stop PN, the intestine must adapt by growing in length and mucosal mass and by functioning better in nutrient absorption. We were supported by CIHR to study glucagon like peptide-2 (GLP-2), a new first-in-class therapy, approved for treatment of adult SBS and now being studied in pediatrics. GLP-2 therapy can make the mucosa adapt, but based on our studies it does not make the intestine grow. Once the treatment is stopped the benefits reverse. Long term could promote tumour growth. We went on to show that combining oral epidermal growth factor (EGF) with GLP-2 did cause intestinal growth. The only real long term solution to the problem of SBS in babies is growing the intestine. Similar to EGF, insulin like growth factor-1 (IGF-1) is present in utero and in mothers milk. It has a key role in prenatal and neonatal intestinal development and recent evidence suggests it is a key mediator of GLP-2 actions. This purpose of this research is to optimize GLP-2 therapy and make the neonatal intestine grow by demonstrating it is necessary to provide both IGF-1 and EGF.  Using our surgical piglet SBS models we will study IGF-1 alone, with GLP-2 or EGF, and all three combined. We will measure growth of the intestine operatively and collect small intestine tissues. We will study histological adaptation and function (using fat balance and Ussing). We will also test durability of effects and explore mechanisms using qtPCR. We are in an excellent position to conduct this research as we are the only laboratory to have a neonatal piglet model of SBS with similar anatomy to babies with severe SBS.  Paul Wales, a neonatal intestinal surgeon conducts all surgeries. Justine Turner, a pediatric gastroenterologist with a PhD in nutrition, manages the laboratory in Edmonton using her clinical and research training. We do Ussing with Donna Vine PhD, an expert in gut physiology and nutrition. Exertise in molecular studies and intestinal neuroendocrinology comes from Patricia Brubaker PhD, Tier 1 Canada Research Chair in gut endocrinology. 

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Teaching

SCHOLARLY PRODUCTS OF CLINICAL PRACTICE

Realm of pediatric feedings disorders

Measuring a Stoma: https://vimeo.com/207137965

Insertion of a Mickey: https://vimeo.com/213285033

Inserting a Corflo Tube: https://vimeo.com/218060914

NG Tube insertion: https://vimeo.com/218287072

ESPGHAN Congress, June 2022, Copenhagen, Denmark . 2022 June;

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Cyrkot S RD, Gidrewicz D MD, Anders S PhD, Marcon M MD, Turner JM PhD MD, Mager DR PhD MSc RD.

Can J Diet Pract Res. 2022 May; 3 10.3148/cjdpr-2022-011

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Pediatric Research Day Department of Pediatrics Virtual. 2022 April;

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CDDW Virtual April 2022. 2022 April;

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ASPEN Nutrition Science & Practice Conference, Seattle, USA. 2022 March;

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JPGN:Reports. 2022 February; 3 (1):e154 not available

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Pauline M., Fouhse J., Hinchliffe T., Wizzard P., Nation P., Huynh H., Wales P., Willing B., Turner J.

JPEN. 2022 January; 10.1002/jpen.2377

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Hinchliffe T., Pauline M.L., Wizzard P.R., Jovel J., Nation P.N., Wales P.W., Madsen K.L., Turner J.M.

Journal of Parenteral and Enteral Nutrition. 2022 January; 10.1002/jpen.2333

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NASPGHAN, Virtual Annual Meeting. 2021 November;

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Sample, Dory, Fouhse, Janelle, King, Seema, Huynh, Hien Q., Dieleman, Levinus A., Willing, Benjamin P., Turner, Justine M.

JPGN: Reports. 2021 November; 2 (4):e127 not available

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Women’s and Children’s Health Research Institute, Annual Meeting Research Day. 2021 November;

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Mueller C., Jonnalagadda S., Torres K.A., Blackmer A., Cetnarowski W., Chen Y., Citty S.W., Dye E., Hubbard V.S., Kumbhat S., Ottery F., Russell M.E., Sacks G.S., Turner J.

JOURNAL OF PARENTERAL AND ENTERAL NUTRITION. 2021 November; 45 (8):1619-1626 10.1002/jpen.2239

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NASPGHAN Annual Meeting, November 2020 [Virtual due to COVID-19]. 2021 November;

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Abdelhadi R.A., Rempel G., Sevilla W., Turner J.M., Quet J., Nelson A., Rahe K., Wilhelm R., Larocque J., Guenter P.

Nutrition in Clinical Practice. 2021 June; 36 (3):654-664 10.1002/ncp.10603

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Quan J., Panaccione N., Jeong J., Underwood F.E., Coward S., Windsor J.W., Ronksley P.E., Gidrewicz D., deBruyn J., Turner J.M., Lebwohl B., Kaplan G.G., King J.A.

Journal of pediatric gastroenterology and nutrition. 2021 May; 72 (5):704-711 10.1097/MPG.0000000000003051

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Lansing M., Slim G., Wizzard P., Rafii M., Pencharz P.B., Nation P.N., Beggs M.R., Alexander R.T., Wales P.W., Turner J.M., Ball R.O.

Pediatric Research. 2021 May; 89 (6):1420-1426 10.1038/s41390-020-01139-1

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Digestive Diseases Week. 2021 May;

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Feeding Matters Conference, April 2021 (Virtual). 2021 April;

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ASPEN Nutrition Science and Practice Conference 2021. 2021 March;

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Hinchliffe T., Pauline M.L., Wizzard P.R., Nation P.N., Brubaker P., Campbell J.R., Kim Y., Dimitriadou V., Wales P.W., Turner J.M.

Journal of Parenteral and Enteral Nutrition. 2021 March; 45 (3):538-545 10.1002/jpen.2053

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CDDW virtual 2021. 2021 March;

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Mager D.R., Cyrkot S., Lirette C., Brill H., Dowhaniuk J., Mileski H., Basualdo-Hammond C., Nasser R., Assor E., Marcon M., Turner J.M.

British Journal of Nutrition. 2021 March; 10.1017/S0007114521000994

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Mager D.R., Cyrkot S., Lirette C., Brill H., Dowhaniuk J., Mileski H., Basualdo-Hammond C., Nasser R., Assor E., Marcon M., Turner J.M.

British Journal of Nutrition. 2021 January; 10.1017/S0007114521002774

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Cyrkot S., Marcon M., Brill H., Mileski H., Dowhaniuk J., Frankish A., Carroll M.W., Persad R., Turner J.M., Mager D.R.

International Journal of Food Sciences and Nutrition. 2021 January; Online ahead of print. 10.1080/09637486.2021.1880553

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Children’s Healthcare Canada Conference, November 2020 (Virtual). 2020 November;

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Seth Sharp, Samuel Jones, Robert A Kimmitt, Michael Weedon, Anne Halpin, Andrew Wood, Seema King, Robin Beaumont, Patricia Campbell, William Hagopian, Justine Turner, Richard A Oram (co senior author)

Alimentary Pharmacology & Therapeutics. 2020 August; published online ahead of print 10.1111/apt.15826