Pursuing the Next Big Breathrough

Sitting in his small, well-organized office, Dr. Ori Rotstein is excited, and it’s easy to see why: he’s about to take charge of one of the most dynamic health-care research organizations in the country.

Raised in Toronto and trained at U of T and the University of Minnesota, Dr. Rotstein is a distinguished surgeon with a research specialty in the effect of traumatic injury on the immune system. “I’m trying to better understand how injury to the body can cause inflammation and injury to the lungs,” he says.

While he claims he wasn’t destined to become a scientist, Dr. Rotstein says he experienced a eureka moment during his training. “My supervisor and I would see patients in the intensive care unit and do little things to make them better: change their fluids, their antibiotics, their ventilator settings.” But then his supervisor said something that changed everything. “He said, ‘The only way we’re really going to help these patients is by understanding why they’re so ill in the first place. We cure patients by understanding disease, and we understand disease by doing research.’ That was the most important moment in my research career.”

Dr. Rotstein has been surgeon-in-chief at St. Michael’s Hospital since 2004, and director of its Keenan Research Centre for Biomedical Science since 2005. But as of May 1 he is now the VP of Research and Innovation, and he’s looking forward to leading St. Michael’s nonstop efforts to achieve the kind of breakthroughs that make a real difference in people’s lives.

“We’re already a strong research institute with well-defined areas of expertise, and my job is to nurture that, find new opportunities and take it to another level,” he explains. “It’s early in the game, but I want to focus on the areas where we can be even more impactful, and raise money to support that. We’re going to find some niches where we can go from being excellent to being outstanding in the world.”

Innovation is a key piece, adds Dr. Rotstein, who was part of the genesis of iBEST (Institute for Biomedical Engineering, Science and Technology), which taps Ryerson University’s engineering and science strengths and St. Michael’s research and clinical expertise to create new health-care solutions. “We have a huge untapped resource in our clinicians, who are always thinking about new ways to do things,” he says. “I hope to help them develop their ideas and maybe even commercialize them.”

While leading an organization that relentlessly pursues the next breakthrough, Dr. Rotstein will also continue his own work. “There are benefits in being immersed in research culture,” he points out. “You gain ideas from other scientists, you use technologies you might not have tried, you interact more with students.”

St. Michael’s will continue to focus on a number of important research areas, he says, using a range of approaches. “One area is translational research—applying what scientists learn from their discovery to the design of interventions and ultimately, to the treatment of disease,” he explains. “We have made excellent progress in understanding tissue and organ scarring, which contributes to kidney failure and heart dysfunction. And our scientists have discovered key molecules that cause diseases. Now drugs have been designed for use in humans to work against those molecules.”

And St. Michael’s scientists are determined to stop at nothing to defeat multiple sclerosis. “We have a high rate of MS in Canada,” says Dr. Rotstein. “We’ve been remarkably successful in taking a hospital program that had a lot of strengths and putting it into a position where it can be world-class. That was mainly because of two families—the Barfords and the Loves—who made a $20-million donation to create our BARLO MS Centre. Through that we’ve also been able to recruit Dr. Montalban, one of the world’s pre-eminent MS neurologists, to oversee our MS program from basic discovery to clinical trials of new drugs.” 

Dr. Rotstein says his teams are also well positioned to capitalize on artificial intelligence. “AI is dominating research around the world—everything from analyzing molecules to exploring public health issues,” he says. “We anticipate that our analytics will be predictive enough for us to improve the delivery of care.  Could outcomes be changed if we had early information about a problem? We’ll be able to help predict what might happen so our health-care teams can best treat their patients.”

Another potential use for AI is the Black Box initiative. “It records everything in the operating room during surgical procedures and uses data analysis to identify errors and improve surgical safety,” says Dr. Rotstein. “The potential to identify where errors might occur and prevent them is very exciting.”

His teams are also addressing some of the issues in the opioid epidemic. “We have scientists working on understanding the misuse of opioids in the community, using large databases to gather information, while others are working on opioids’ effect on the brain and respiration system. We go all the way from discovery to care.

“One of St. Michael’s strengths is trauma and critical care. We have trauma research going on, not only my own but a group that works on improving protocols for transfusion and resuscitation for trauma patients. And we innovate in clinical care. One example is the REBOA [a device that blocks blood flow below the chest to give surgeons more time to operate]. We pioneered that in Canada. It’s another area where we translate cutting-edge research into patient care.”

In the end, Dr. Rotstein stresses, it doesn’t matter whether you’re working with cells and molecules or big data, the issues are the same: identify the problem, ask questions, find the answers through experimentation and translate the findings to the treatment of disease. “It requires creativity, hard work and perseverance,” he says. “Ultimately, it’s the strength of our scientists and research teams that makes us great, and my job is to put them in the best position to succeed.”