Dr. Cindy Yeung optimizes medications to improve neonatal care
The Canadian Institutes of Health Research (CIHR) announced funding for the Banting Postdoctoral Fellowships 2023-2024. Waterloo Pharmacy alum and current postdoctoral fellow at The Hospital for Sick Children (SickKids), Dr. Cindy Hoi Ting Yeung (PhD’23, Dr. Andrea Edginton’s Lab) was ranked 13 out of the 182 researchers for her work on Advancing towards model-informed precision dosing: Ontogeny and pharmacogenetics of commonly used drugs in the Neonatal Intensive Care Unit.
Across Canada approximately 1,100 neonates, infants less than four weeks old, per year experience adverse drug reactions to off-label prescribed medications – those not approved by regulatory bodies to treat neonatal populations or neonatal diseases.
For a medication to hit the market, thorough testing on adults is required. As a result, understudied populations, including neonates, are left out of the drug development process.
“The majority of medications, around 90 per cent, used in neonatal treatment are off-label, because many medications have not been studied and approved for this specific population,” Yeung says.
Commonly used medications in neonatal care, indomethacin, used to treat bleeding in the brain and heart abnormalities, and furosemide, used to treat fluid retention, may be underdosed or overdosed because optimal dosing is not yet understood in this population. Complications of non-optimal dosing can lead to heart failure, kidney injuries and bowel injuries in infants.
Yeung’s research will use model-informed precision dosing (MIPD), to develop population pharmacokinetic (popPK) and physiologically based pharmacokinetic (PBPK) models. These models will help researchers better predict what dose is needed for indomethacin and furosemide in neonates. Specifically, it seeks to understand the dose, exposure (drug levels in the body), and response (the effect of the drug) relationship through studying the genetics and maturation of proteins that affect how drugs are cleared by these rapidly growing and changing neonates. In addition, this method will optimize dose requirements and incorporate other factors not previously considered, including the infant’s age, weight, sex, and other factors to avoid drug-induced toxicity – injuries to the infant.
My overall goal is to understand what dose to give infants to achieve a certain exposure that can result in a therapeutic effect. This award highlights my work in populations that are typically left out of the drug development process.
“Other researchers have had similar success from MIPD knowledge in reducing adverse drug reactions in infants. The funding will allow me to collect the data I need to fill in the research gaps to make MIPD a reality for these two commonly used drugs,” Yeung adds.
Yeung thanks the collaborative nature of the team at SickKids, including her supervisor Dr. Tamorah Lewis, Division Head, Clinical Pharmacology and Toxicology, and Senior Associate Scientist, Translational Medicine, pharmacists, assay developers, geneticists, patients and caregivers and the research team helping with data collection and analysis.
The Banting Fellowship program provides $70,000 per year over two years to postdoctoral applicants, both nationally and internationally, who will positively contribute to the country's economic, social and research-based growth. In Canada, only 23 researchers receive the award.
Congratulations Yeung!