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The possibility of stroke is a constant presence in the lives of patients living with atherosclerotic plaque in their carotid arteries.
This plaque may not cause any complications. But there's also a chance it could break apart, travel into the brain and block the blood vessels it needs to function and cause a stroke – and doctors currently have no indication for if, or when, that may happen.
Dr. Kathryn Howe, vascular surgeon-scientist at the Peter Munk Cardiac Centre (PMCC), is determined to answer the million-dollar question: how do we know in which patients this plaque will become vulnerable and cause a stroke?
Her research in this area has earned her the 2020 Wylie Scholar, a prestigious award from the Vascular Cures Foundation in San Francisco, bestowed annually on one vascular surgeon-scientist in North America.
Dr. Howe joined the PMCC in 2018, after completing a PhD in Immunology and her surgical residency at McMaster University, and a fellowship at Stanford University. It was during her time at Stanford that she discovered the specific area she wanted to pursue through her research.
"It was a game-changing moment for me," says Dr. Howe. "It gave me that final piece of the puzzle of what I wanted to ask about atherosclerotic plaque."
Dr. Howe has always had a vested interest in stroke. Between a culmination of brain trauma in her immediate family to having tough conversations with patients, she knows there are gaps in clinical care that need to be addressed.
By studying bundles of genetic information released by endothelial cells that form the inner lining of the carotid arteries, known as extracellular vesicles, Dr. Howe's research is helping identify which patients have a higher risk of suffering a stroke.
"Strokes are one of the most devastating things that can happen to a person and their family," says Dr. Howe. "Having seen it first-hand, it drives me every day to say, 'listen, we have to have a better answer.'''
Now, as the 2020 Wylie Scholar, Dr. Howe is one step closer to getting that answer. The program provides a three-year career development grant to an outstanding young vascular surgeon-scientist who combines active patient care with academic research.
Since its creation in 1996, only three surgeon-scientists outside of the United States have won the award: Dr. Barry Rubin (1998), Dr. John Byrne (2016) and now, Dr. Howe – all of whom are on staff at the PMCC.
Dr. Rubin was transitioning away from his surgical practice when Dr. Howe joined the PMCC two years ago. A natural mentor-mentee relationship formed, and in addition to meeting every few months to discuss research and career development, Dr. Rubin reviews all of his cases with Dr. Howe, and refers all patients to her that require surgery.
"Dr. Howe is an amazingly driven surgeon-scientist," says Dr. Rubin, Chair and Medical Director of the PMCC and vascular surgeon-scientist. "This was a proud moment for me, not only as a former winner of the Wylie Scholar Award, but also as one of Kathryn's mentors."
PMCC's Dr. Rubin won the Wylie Scholar Award 22 years ago
Dr. Howe says she's always been overwhelmed with the mentorship she's found at UHN.
"It's crucial for any early career surgeon-scientist to seek out mentors that have unique skill sets and qualities," says Dr. Howe. "It's been amazing to have Dr. Rubin endorse my training and skills."
Dr. Rubin's research focuses on the way chemicals called prostaglandins affect the healing of the heart after a heart attack. This research won him the Wylie Scholar Award 22 years ago – and led to 19 years of subsequent funding from the Canadian Institutes of Health Research.
"It's so important to believe deeply in what you are researching," says Dr. Rubin.
"For Dr. Howe, there is a personal impact of stroke in her family. That lit a fire in her to do stroke research that you can't just light in anybody – either they have that fire burning or not."
Dr. Howe says there's a unique privilege to being a surgeon-scientist, especially at the UHN. She's able to explore an untouched area of research while running a surgical practice, in a space with colleagues that support her.
For young surgeon-scientists hoping to land where she is, her advice is to remind themselves of the anecdotal stories of people who have persevered.
"The naysayers will always be out there, but if this is what drives you and you really want it then you have to do it," says Dr. Howe.
"It's the only way to be true to yourself."