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SEPTEMBER 2010 Volume 14, Number 5
Biofuel Development
Rapid Diagnostic Testing
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Benchtop Flow Cytometry
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Dual Platform Technology
R&D News.......................... 1 Appointments..................... 6 Pharma Notes..................... 7 New Products................... 15 Calendar........................... 17 Career Spotlight............... 18
University of Toronto team contributing to 2016 mission to mars
NASA and the European Space Agency are jointly developing the ExoMars Trace Gas Orbiter mission for launch in 2016. This is an artist’s concept of the planned spacecraft, which will carry five science instruments plus a European entry, descent and landing demonstrator vehicle. The orbiter will also serve as a communications relay for Mars surface missions. Photo - ESA Left: MATMOS (shown here at right in a schematic representation) will be housed on the upper of deck of the NASA-ESA ExoMars Trace Gas Orbiter, slated for launch in 2016. Photo - JPL
An international team of scientists including several atmospheric and planetary researchers from the University of Toronto will develop an instrument to search for signs of life on Mars during the 2016 ExoMars Trace Gas Orbiter NASA-European Space Agency mission.
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The instrument, known as MATMOS (Mars Atmospheric Trace Molecule Occultation Spectrometer), will probe the atmosphere of Mars in search of biological sources of methane and signs of life. “We are very excited to be part of this international team contributing
to ExoMars,” said team member Barbara Sherwood Lollar of U of T’s Department of Geology. “MATMOS will build on the exciting reports of methane in the Mars atmosphere by investigating a suite of trace gases in the planet’s atmosphere that will help develop models of the planet’s geologic activity and address questions regarding any potential biogenic activity.” MATMOS will help scientists attempt to solve the mystery of methane on Mars by confirming seasonal distribution patterns, and providing new interpretations of the origin of the gas on Mars. Methane was discovered on Mars in 2003 in greater abundance than expected. It is a possible biomarker for signs of life, since the gas is
readily produced by biological activity. Selected by NASA and the European Space Agency for launch onboard the ExoMars Trace Gas Orbiter slated for launch in 2016, MATMOS is being developed in partnership between the Canadian Space Agency (CSA), the California Institute of Technology (Caltech) and NASA’s Jet Propulsion Laboratory (JPL). Sherwood Lollar, fellow U of T scientists Jonathan Abbatt of the Department of Chemistry and Kimberly Strong and Kaley Walker of the Department of Physics, along with Dalhousie University’s James Drummond, York University’s Jack McConnell and the University of Winnipeg’s Ed Cloutis, are contributing to the CSA’s effort.
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New advances will further brain research of diseases such as Alzheimer’s and Parkinson’s The University of Calgary, Faculty of Medicine scientists have been involved in the development of new technologyLabFocus.fisherbrand.Dec09.pdf that monitors brain
cell activity at a resolution never achieved before. The University of Calgary, Faculty of Medicine, proved it is possible to cultivate a network of 12/11/09 9:09:53 AM
brain cells that reconnect on a silicon chip, or the brain on a microchip. Developed with the National Research Council of Canada
(NRC), the new silicon chips are also simpler to use, which will help future understandig Continued on page 3
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September 2010
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Naweed Syed, PhD of how brain cells work under normal conditions and permit drug discoveries for a variety of neurodegenerative diseases such as Alzheimer’s and Parkinson’s. The new technology from the lab of Naweed Syed, PhD, professor and head of the Deparment of Cell Biology and Anatomy, in collaboration with the NRC, is published online this month in the journal, Biomedical Microdevices. “This technical breakthrough means we can track subtle changes in brain activity at the level of ion channels and
synaptic potentials, which are also the most suitable target sites for drug development in neurodegenerative diseases and neuropsychological disorders,” said Syed, who is also a member of the Hotchkiss Brain Institute and advisor to the vice president Research on Biomedical Engineering Initiative of the University of Calgary. The new neurochips are also automated. It used to take years of training to learn how to record ion channel activity from brain cells, and it was only possible to monitor one or two cells simultaneously. Now, larger networks of cells can be placed on a chip and observed in minute
detail, allowing the analysis of several brain cells networking and performing automatic, large-scale drug screening for various brain dysfunctions. This new technology has the potential to help scientists in a variety of fields and on a variety of research projects. Gerald Zamponi, PhD, professor and head of the Department of Physiology and Pharmacology, and member of the Hotchkiss Brain Institute at the University of Calgary, says, “This technology can likely be scaled up such that it will become a novel tool for medium throughput drug screening, in addition to its usefulness for basic biomedical research.”
Ontario Pharmacists’ Association supports government strategy to curb misuse of prescription narcotics The Ontario Pharmacists’ Association (OPA) announces that it supports the Ontario government’s Narcotics Strategy, intended to ensure prescription narcotics are prescribed and used appropriately. “Prescription narcotic diversion and abuse is a serious safety issue for all of us - from the pharmacists and other healthcare professionals who are trying to ensure patients have access to the medicines they need, to the communities that are harmed by diversion and abuse,” said Dennis Darby, chief executive officer of the Ontario Pharmacists’ Association. “We support the Ontario government in launching this important initiative, and will continue to play a key role in educating pharmacists and the public to ensure we’re doing our part.”
As the professional association representing Ontario’s 12,000 pharmacists, who are on the front lines of patient care, the OPA is aware of the risks and issues associated with prescription narcotic diversion and abuse. The association is developing a strategy to help address this issue, in a comprehensive and methodical manner. This strategy complements those of the provincial and federal governments, and of other health care provider groups. As part of its strategy, the Ontario Pharmacists’ Association is participating in a multi-stakeholder approach to assist pharmacists and physicians in the implementation of the new clinical practice guidelines for prescribing opioids for non-chronic cancer pain.
BC firm develops products to control algae and bacteria in water, crops and food
E n v i r E a u Te c h n o l o g i e s ’ has developed and is now marketing environmentally responsible and metallic
mineral-based biocides, fungicides and algaecides that use minute quantities of mineral ions, including copper,
zinc or silver, or combination of these minerals, to protect water, wastewater, food and disease control in crops. The company’s self-mixing compounds can control algae and bacteria in potable water reservoirs, odour and bacteria in waste treatment facilities, and disease in plants and foods. One of EnvirEau Technologies’ products also helps protect greenhouse and field crops and extends their shelf-life. EnvirEau was born after Frank Varseveld, president and chief executive officer, arranged the purchase of the intellectual property of another company and went to work on research and development in 2005. “We wanted to come up with a means of reducing the synthetic chemical pesticides in use today for controlling micro-organisms in water, soil and food,” said Varseveld, an engineer. “This is a global need, and we felt it was important to improve
the sustainability of our planet.” Varseveld turned to the National Research Council of Canada Industrial Research Assistance Program (NRCIRAP) for help with the R&D phase of the company’s development. Thanks to the NRC-IRAP contribution EnvirEau received, the firm was able to conduct laboratory and field testing to improve the ionization of the minerals in its products. “IRAP’s contribution was really important to optimize the performance of the product, and to make it more valuable to the end user,” Varseveld says. “The NRC-IRAP industrial technology advisor that the company worked with also helped EnvirEau organize its projects.” The company’s products can replace synthetic chemical pesticides, fungicides, biocides and disinfectants, including chlorine. They don’t harm the people handling them, and have minimal side
effects for the environment, said Varseveld. “Our goal is to be a global leader in this field,” Varseveld said. In addition to the largescale municipal uses that EnvirEau’s products are designed for, the company is also working on a simple application to add one of its products to water, designed for household use in developing nations. By controlling E. coli, cholera, and other water-based pathogens, the company hopes to save lives in under-developed countries and even in rural Canada, where poor water quality is an issue. “If you put a drop of Polydex concentrate into three litres of water and leave it to sit overnight, it will be safe to drink the following day,” Varseveld said. “It won’t be safe from all organisms, but the most common ones, including E. coli.” EnvirEau is currently testing that application in Africa.
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September 2010 Laboratory Focus www.bioscienceworld.ca
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Noveko International Inc. announces new generation of ultrasound scanners for sale Noveko International Inc. announces that its subsidiary S.A.S. E.C.M. (ECM) has achieved major breakthroughs with its new generation of ultrasound scanners, by signing an exclusive distribution agreement for the ImagyneTM ultrasound scanner (for human medicine) in the People’s Republic of China, as well as obtaining contracts for the marketing of the new ExagoTM ultrasound scanner (for veterinary medicine) in Canada and the U.S., all for an approximate value of $12 million over a three-year period. As the result of a process begun over 18 months ago, ECM recently obtained authorization from the State Food and Drug Administration of the People’s Republic of China (SFDA) to sell its ImagyneTM ultrasound scanner in China, and consequently concluded an exclusive distribution agreement with Ningbo Xingaoyi Magnetism Co. Ltd (NXM), a leading Chinese high-tech firm specializing in the manufacturing
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of magnetic resonance equipment. ECM has also achieved major breakthroughs in the marketing of its ExagoTM scanners in the equine market in Canada and the U.S., having recently concluded with key players in North American veterinary medicine, contracts for a value of more than $4 million over a three-year period. “We are already positioning ourselves as a serious player in the equine ultrasonography market, which is a new market for us. The conclusion of this agreement reflects the growing interest in our technology since its launch. We are confident of pursuing this success in the coming quarters,” said Patrice Émery, president of ECM. The Exago TM, a new generation portable scanner introduced on the market during the past quarter, is initially intended for veterinarians, mainly in the equine market. After obtaining the required approvals, it will also be intended for use in human medicine, notably for emergency, anaesthesia and army requirements.
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Functional Technologies reports positive results of novel Malaria treatment trials Functional Technologies Corp. in cooperation with University of Toronto scientists, announce promising initial results of a revolutionary yeast-based approach for the treatment of malaria. In pre-clinical proof-of-concept tests involving four separate animal trials (mouse models), including one looking at uptake and three for potency, a positive effect against malaria was demonstrated using Functional Technologies’ specifically enhanced yeast. Importantly, no toxicity was reported, even at 100 times the effective dosage. In this novel approach to malaria treatment, the yeast is used both to produce and deliver a protein that neutralizes malarial parasites. After the protein-laden yeast is ingested, the active proteins bind to the parasites in the bloodstream, rendering them benign. In sharp contrast to conventional and widely used chemical treatments that often pose significant side effects for the patient, Functional Technologies’ yeast application has not shown such side effects at the doses used in the preliminary mice studies. In the aforementioned mouse trials, the anti-malarial protein was detectable in the bloodstream after oral administration; the company believes this indicates the potential for an
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orally-applied product. Oral dosing is generally considered the most costeffective, safe and convenient method available for treatment programs in impoverished countries. Dr. Ian Crandall, a leading malaria researcher and professor of pharmaceutical sciences at the University of Toronto, working with Dr. Subrata Chowdhury, the company’s primary scientist on the project, directed the testing of the malaria-infected mice. Dr. Crandall commented: “As far as I am aware, this is a totally fresh approach to malaria treatment that is showing early and promising efficacy and safety. It presents a completely new area of study alongside the traditional ways in which malaria has been addressed through synthetic drugs. We may be onto something very exciting, and I look forward to being involved in the next phases of research.” Garth Greenham, president and chief operating officer of Functional Technologies Corp., commented on the study: “Our purpose in releasing these proof-of-concept results is to make potential partners and collaborators aware of our malaria program, and help accelerate testing and development of this potentially safe, natural and cost-effective treatment.”
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Laboratory Focus September 2010
news New study investigates use of soy-rich diet for preventing chronic pain after breast cancer surgery A study focusing on the benefits of soy in the prevention of chronic pain after breast cancer surgery, has been launched by researchers at the Alan Edwards Pain Management Unit of the McGill University Health Centre (MUHC) and McGill University. “If we can demonstrate that a soy-rich pre-surgery diet, is both safe and effective for the prevention of chronic post-surgical pain, the clinical implications will be significant and could help many women around the world,” said Dr. Yoram Shir, principal investigator of the study and director of the MUHC Alan Edwards Pain Management Unit, who is also a Professor of Anesthesia and Edwards chair in Clinical Pain at McGill University. Chronic pain after breast cancer surgery is the most
common cause for long-term morbidity in women diagnosed with breast cancer, with an incidence that can be higher than 50%. This pain can be resistant to treatment and last for years, burdening women with its physical, emotional and social consequences. This new National Institutes of Health-funded study will determine if a diet enriched with soy protein, consumed by women for two weeks prior to surgery could prevent the development of chronic pain. “If shown to be efficacious, this would be a natural and safe preventive treatment that is easily incorporated into the everyday diet,” said Dr. Shir. Our daily diet can also be enriched with soy protein through shelf products like tofu and soy milk. There is currently no proven
effective method for the prevention of chronic postoperative pain,” said Dr. Shir. “Measures such as pain-relieving medications, commonly used
to relieve acute pain after surgery, are largely ineffective in preventing acute post-surgical pain from becoming chronic.” Over 22,000 new cases of
breast cancer in women are diagnosed each year in Canada and most will undergo surgery as part of their comprehensive cancer therapy.
Royal Society of Canada recognizes SFU biologist
Bernard Crespi Bernard Crespi, renowned globally for his experimental and theoretical contributions to evolutionary biology, is Simon Fraser University’s 40th scholar to be elected to the Royal Society of Canada (RSC). The RSC — founded by the Governor General of Canada, the Marquess of Lorne, in 1882 — has evolved from being a largely honourific society into one of the most prestigious academic organizations to elect Canadian scholars. Crespi’s election to the RSC’s Academy of Science’s division of life sciences recognizes the SFU professor’s contributions to understanding the evolution of social behaviour in many fields of evolutionary biology. An SFU Evolutionary and Behavioural Ecology Research Group member, Crespi inte-
grates genetic, ecological and evolutionary development research to study social evolution across all levels in the hierarchy of life from genes to the human brain. Crespi’s research has led to fundamental new insights into how and when social cooperation and different reproductive strategies evolve, and how human evolutionary history has influenced the causes of diseases.
In the last two years, Crespi’s work has shaken the theoretical foundations of how mental disorders are understood. He has proposed and tested the hypothesis that autism and schizophrenia are opposite disorders, with risks directly influenced by changes to genes underlying human social evolution. His analysis of all the genetic and genomic data available on both disorders has proven
a mother’s genetic makeup is associated with schizophrenia, while a father’s predicts autism. Crespi, who lives in Port Moody, has given more than 100 invited talks about his work, worldwide. He has published more than 100 articles in premier scientific journals, including four articles in Nature. He has served on the editorial boards of many of the top journals in his field.
Among his many awards are the Theodosius Dobzhansky Prize, a Killam Research Fellowship and the E.O. Wilson Award from the American Society of Naturalists for his contributions to evolutionary biology. Crespi will be formally recognized as a new fellow of the RSC during the induction and awards ceremony on Nov. 27 in Ottawa.
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September 2010 Laboratory Focus www.bioscienceworld.ca
aPPoinTmenTS
COM DEV International Ltd. has commenced its search for a new chief executive officer following the decision by the company to replace John Keating. Keating has also resigned as a director of the company. “COM DEV wishes to express its gratitude for the significant contribution that Mr. Keating has made to the company and wishes him well in his future endeavours,” said COM DEV’s chairman, Terry Reidel. The board of directors has appointed Mike Pley as interim CEO during the search process. MethylGene Inc. announces the appointment of Dr. Martin Godbout as chairman of its board of directors effective immediately. Dr. Godbout has been a member of MethylGene’s board of directors
Dr. Martin Godbout
since 2002 and was the president and chief executive officer of Genome Canada from April 2000 to October 2009. He was also formerly the senior vice president of BioCapital and president and general manager of Societe Innovatech Quebec. Prior to that, he was a member of the board of the “Conseil de la science et de la technologies du Quebec” from October 1996 to 2004 and has been an advisory member of several Canadian biopharmaceutical venture firms such as SGF Sante and Royal Bank Ventures Inc. as well as a board member of the Societe Innovatech du Grand Montréal. In 2005, Dr. Godbout was named Officer of the Order of Canada. He was also awarded the Grand Prix Recherche from the Quebec Mental Illness Foundation for his previous work on Alzheimer’s disease in 1991, as well as a “Prix Summa” in 1994 from the Faculty of Sciences and Engineering of the Universite Laval. In 1994, he founded BioContact Quebec which has become one of the most important biopharmaceutical symposiums in North America.
enGene Inc. announces that Dr. Russell J. Mumper has joined the company’s Scientific Advisory Board. Dr. Mumper is an internationally recognized leader in developing nanotechnologies for drug delivery and is currently the executive associate Dean for Academics and the John A. McNeill Distinguished professor at the UNC Eshelman School of Pharmacy at the University of North Carolina (UNC) at Chapel Hill. He also serves as the director of the Center for Nanotechnology in Drug Delivery at UNC. Dr. Mumper has contributed extensively to the fields of nano-scale drug delivery systems, drug-polymer conjugates, and trans-mucosal drug and vaccine delivery. He has also authored more than 215 scientific publications/abstracts and holds 38 granted and pending patents. Notably, Dr. Mumper was the first scientist to demonstrate the use of chitosan as a carrier for nucleotides and holds the earliest patent in this field. Theratechnologies has appointed John-Michel T. Huss as president and chief executive officer of the Company. Huss has over 20 years experience in the pharmaceutical industry in various international positions and was responsible for various disease areas including diabetes and metabolism. Until recently, he was chief of staff, office of the CEO, of Sanofi-Aventis in Paris. He began his career in 1990, at Merck & Co., Inc. primarily in sales and marketing in the U.S., Germany and Switzerland. In 1996, he was offered a position with F. HoffmanLa Roche as an Internal Product Manager at their Basel headquarters in Switzerland. In 1999, he joined Sanofi-Synthélabo GmbH, as Business Unit Director and has held various positions of increasing responsibility in marketing and sales. He became General Manager in Switzerland in 2007. During his tenure at Sanofi-Aventis (SanofiSynthélabo merged with Aventis in 2004) he held positions in Germany, Canada, Switzerland and France. Huss completed his first University degree in Applied Linguistics in Germany and then received an MBA in the U.S., specializing in International Business. Industry association LifeSciences British Columbia has appointed Don Enns as the new president of the organization effective immediately. Enns has been a leader in the British Columbia life sciences
industry for over 25 years, most recently as president and CEO of CANTEST Ltd., a BC-headquartered global organization providing professional analytical and clinical services in support of environmental quality, pharmaceutical, biotechnology and food safety industries as well as related projects for business and government. Enns received his MBA from UBC in 1987 and his Bachelor of Science Chemistry from TWU in 1982. He is a director for numerous local companies and non-profit organizations involved with technology development, education, community enhancement and environmental sustainability. He currently serves as a director or committee advisor to Genome British Columbia, the World Wildlife Fund and two UBC faculties amongst other organizations. Dr. Jeff Turnbull, Ottawa Hospital chief of staff and co-founder of the Ottawa Inner City Health program is the new president of the Canadian Medical Association
Dr. Jeff Turnbull. Photo: Couvrette/Ottawa
(CMA). Dr. Turnbull takes over the presidency from Dr. Anne Doig, a family physician from Saskatoon. The “passing of the torch” occurred during the association’s 143rd annual meeting in Niagara Falls, ON. Dr. Turnbull received a bachelor’s degree from the University of Toronto and his medical degree from Queen’s University. He completed an internal medicine residency and a master’s degree in education at the University of Western Ontario. For nine years, Dr. Turnbull joined the faculty at the University of Western Ontario where he combined clinical practice, education and research. Jeff Turnbull was recruited to the University of Ottawa and served as vice-dean for Medical Educa-
tion for several years, before being appointed chair of the Department of Medicine, a position he held until 2008 when he became chief of staff at The Ottawa Hospital. Dr. Turnbull also served as president of the College of Physicians and Surgeons of Ontario and chaired the CMA’s Future of Medicine Project. Dr. Turnbull was also Program Director of UNESCO’s Universities in Solidarity for the Health of the Disadvantaged. Jeff Turnbull continues to practice internal medicine both at The Ottawa Hospital and at several shelters associated with Ottawa Inner City Health. In 2007 he received the Order of Canada. Regenicin, Inc. announces that Dr. Joseph Rubinfeld, one of the four original founders of Amgen, Inc., has agreed to join the company’s board of directors. Dr. Rubinfeld will be instrumental to assisting the company’s commercialization efforts of PermaDerm™, Regenicin’s proprietary autologous cultured skin substitute intended to restore the qualities of healthy human skin for use in the treatment of burns, chronic wounds and a variety of plastic surgery procedures. In addition to his efforts in founding Amgen, Dr. Rubinfeld has a forty-year history in pharmaceutical and consumer product development. His accomplishments include the creation of the multi-billion dollar antibiotic Amoxicillin as well as the first synthetic biodegradable detergent. He has obtained over 100 patents during his distinguished career. He began his career as a research scientist with several pharmaceutical and consumer product companies including Schering Plough and Colgate Palmolive. He served for 12 years at Bristol Myers, where in addition to developing Amoxicillin and Chephadroxil, he was instrumental in licensing their original anti-cancer line of products, including Mitomycin, Etoposide, and Bleomycin. After co-founding Amgen in 1980 and serving as its chief of operations, Dr. Rubinfeld has served as an advisor or board member to a number of companies including AVI BioPharma and Quark Pharmaceuticals. In 1991 he co-founded Supergen where he served as president and CEO until 2003 and as a member of the Board of directors until 2005. During that time he oversaw the company’s initial public offering and its rise to a multi-billion dollar market capitalization.
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Laboratory Focus September 2010
Pharma Notes Oncolytics Biotech Inc. (Toronto, ON) announces that the Gynecologic Oncology Group (GOG) intends to conduct a randomized Phase II trial of weekly paclitaxel versus weekly paclitaxel with REOLYSIN® in patients with persistent or recurrent, ovarian, fallopian tube or primary peritoneal cancer (GOG186H). The study has been approved and will be sponsored by the Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, U.S. National Cancer Institute (NCI), which is part of the National Institutes of Health, under its Clinical Trials Agreement with Oncolytics. Oncolytics will provide clinical supplies of REOLYSIN for this study. The study chair will be Dr. David E. Cohn of The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. SemBioSys Genetics Inc. (Calgary, AB) releases that the United States Patent and Trade Mark Office has granted the company U.S. patent 7,786,352 entitled “Methods for the Production of Apolipoproteins in Transgenic Plants”. The granted patent claims include the methods for the expression of apolipoprotein (Apo) in plants, including Apo AI(Milano), the introduction of related chimeric nucleic acid into plant cells and producing plant cells capable of growing into mature plants which produce seeds that express apolipoprotein. This patent is key to successfully commercializing plant made and seed expressed Apo AI(Milano). The intent of the Company’s global patent strategy is to own exclusive rights to transgenic production of biosimilar drugs and novel drug candidates like Apo AI(Milano) in select plant and plantseed lines and to be able to make such drugs in a scalable and affordable manner. In doing so, the Company believes it is rapidly becoming a highly attractive partner to large pharma partners looking to enter these markets with a differentiated and patent protected manufacturing cost structure. Labopharm Inc. (Laval, QC) announces that OLEPTROTM (trazodone hydrochloride extendedrelease tablets), a novel once-daily formulation of the antidepressant trazodone, has been launched in the United States by its joint venture with Gruppo Angelini, Angelini Labopharm. OLEPTROTM is indicated for the treatment of major depressive disorder (MDD) in adults. The efficacy of OLEPTROTM has been established in a trial of outpatients with MDD as well as in
trials with the immediate release formulation of trazodone. Merck (Montreal, QC) announces that New Brunswick, Nova Scotia and Alberta are the first provinces in Canada to reimburse
SIMPONITM(golimumab) for the treatment of three different rheumatic conditions. SIMPONITM, a subcutaneous anti-tumour necrosis factor (TNF) therapy, is now reimbursed by the drug formularies of these three provinces for people
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living with moderately to severely active rheumatoid arthritis, moderately to severely active psoriatic arthritis and active ankylosing spondylitis. All three rheumatic conditions are inflammatory and can cause debilitating pain and stiffness.
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September 2010 Laboratory Focus www.bioscienceworld.ca
Feature By Jim Mulry
Benchtop Flow Cytometry Energizes
Biofuel
Development In 2006, Canadian provinces and territories agreed to a national target of 5 per cent average renewable content in gasoline and 2 per cent in diesel and heating oil sold in the country by 2010 and 2011, respectively. Characterized as “aggressive” at the time, the goal called for a tenfold increase in the country’s production of renewable fuels, requiring as much as three billion litres of biofuel production annually. A report from Reuters in late 2009 indicated that Canada’s current biofuel supply is expected to fall short of the target when the government mandate takes effect in the fall of 2010.
Green Crude is renewable crude oil that is a result of our proprietary process of turning sunlight, CO2, and algae into green oils to be refined into fuel. Catfish ponds showing algae growth. Photo by Scott Bauer
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Laboratory Focus September 2010
Feature Turning Algae into Energy In support of these efforts, a $5 million National Research Council project is exploring the production of biofuels from algae. The composition of lipids found in algae are similar to petroleum molecules and can be extracted and transformed into biofuels. The NRC project, launched in 2010, includes construction of a 50,000 litre cultivation pilot plant in Halifax, NS. The project will focus on identifying local strains of algae that are most suitable for biofuel production. Local strains will be acclimatized to the environment so they are easier to grow. Algae are one of the fastest growing plant species. Some algal strains can double in size every day. Algae use photosynthesis to combine water with carbon dioxide to create biomass – a mixture of carbohydrates, proteins, and lipids. The NRC project is also exploring ways to infuse CO2 emissions from local coal-fired electricity plants into the algae cultures to support efficient growth and increased oil content. The challenge to find those algae strains that consume the largest amounts of CO2 while producing the highest grade of oil is well underway. Although the mechanism of photosynthesis in algae is similar to that of higher plants, algae convert solar energy more efficiently because of their simple cellular structure. In addition, algae grow in aqueous suspension,
so they have more efficient access to water, CO2, and other nutrients. As a result, algae are capable of producing a significantly higher amount of oil per unit area, compared to terrestrial plants Thousands of strains of algae exist and there can be significant variations in lipid content among them. Efficient identification of high lipidproducing strains is a prerequisite for the sustainable and economicallyviable production of fuel from algae. Environmental factors such as climate, humidity, salinity, oxygenation and water pressure can play important roles in species selection Advances in flow cytometry instrumentation are allowing this powerful technology to be used by biofuel researchers to rapidly screen algae strains for lipid and chlorophyll content and monitor cell numbers and culture densities.
Figure 2. Algae samples in a 96-well plate can be analyzed in about 30 minutes using the guava flow cytometry system.
The Power of Benchtop Flow Cytometry Flow cytometry is used to measure and analyze multiple physical and chemical characteristics of cells as they flow in a fluid stream, single file, through a laser beam. The technology is employed extensively in life sciences laboratories for counting and sorting cells based on their individual characteristics and for assessing cell viability. Flow cytometry can also be used for complex studies of immune
function, apoptosis (programmed cell death), cancer, stem cells and to support drug discovery. While well-recognized for its power as an analytical tool, the size, complexity, cost, amount of waste generated, and maintenance requirements of conventional flow cytometry systems have frequently confined their use to core facilities and laboratories with expert users on staff. These factors have limited the use of this powerful technology to support cutting-edge biofuels research and development.
Thousands of strains of algae exist and there can be significant variations in lipid content among them.
Figure 3
Variation in median lipid content in nine different algae strains as measured by mean fluorescence intensity on the guava flow cytometry system.
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September 2010 Laboratory Focus www.bioscienceworld.ca
Feature The recent introduction of benchtop flow cytometry instruments such as EMD Millipore’s guava easyCyte 8HT system (Figure 1), combined with user friendly software and turnkey assay kits, is now enabling use of flow cytometry at the lab bench by both experts and novices alike. Benchtop systems are significantly easier to set up and run than traditional flow cytometers. The guava flow cytometry instruments incorporate innovative microcapillary flow cell technology that eliminates the need for “sheath fluid” – the liquid used to carry cells through the laser beam. This innovation allows researchers to use smaller samples and results in a minimal amount of liquid waste (from litres per day to less than 50 mL per day). With benchtop systems able to deliver data on large quantities of samples with quick turnaround and a minimal learning curve, flow cytometry is now integral to the research and development of biofuels derived from algae. The guava easyCyte 8HT benchtop flow cytometry sys-
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Figure 1. New benchtop flow cytometers, such as this guava easyCyte 8HT from EMD Millipore, fit right on the lab bench.
tem offers a high-speed, automated, cost-effective method for assessing lipid content as well as other characteristics of algae cultures including: • Cell numbers and culture densities
• Relative chlorophyll content with identification of bright, dim, and negative subpopulations • Estimates of potential lipid production
Guava benchtop systems can rapidly provide multiparametric data on algae samples, including neutral lipid content, chlorophyll content, relative cell size and density. Samples in a 96-well plate
can be screened in about 30 minutes (Figure 2). When coupled with a robotic plate loader, hundreds of cultures can be screened with walkaway automation. Algae samples are prepared and evaluated on the guava system via the following process: • A fluorescent dye that binds to neutral lipids is added to algal samples. After a brief incubation period, samples are placed into the flow cytometer. • Cells are struck by a laser as they pass through the flow cell. Light bounces off each cell; the resulting colour emitted depends on the presence of the fluorescent tags bound to the cell’s lipids. • Light and colour detectors process the signals bouncing off the cells. The presence and amount of the tag bound to each cell provides information about the cell’s specific characteristics. Intensity of the green fluorescence indicates neutral lipid content while chlorophyll-positive populations are indentified by red autofluorescence. • Data from the light and colour detectors are sent to a computer for processing.
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Laboratory Focus September 2010
FeaTuRe In addition to identifying mean lipid levels across various algal strains that can vary considerably (Figure 3), flow cytometry can be used to identify the type of chlorophyll present in the strain. Algae strains contain different combinations of chlorophyll molecules, designated A, B, and C. Algal strains containing chlorophyll A produce lipids that are best suited for biofuel development. Some algal strains may have high lipid content but the lipid has not been generated via a process involving chlorophyll A. Therefore, the lipid may not be optimal for biofuel production. Even within algal strains containing chlorophyll A, there are significant differences in lipid content. Researchers can use flow cytometry to separate chlorophyll A-positive populations within the spectral plot and then directly evaluate them for lipid content. (This process is known in flow cytometry as “gating.”) Both chlorophyll A and lipid content can be evaluated in an algal sample in less than three minutes on the guava easyCyte system. Samples in 96-well plates can be placed in the guava system allowing for walk-away automation. Benchtop flow cytometry is also used to count cells and monitor algal cultures for contamination. By determining the size of the cells, researchers can use the flow cytometer to distinguish algal cells from bacteria. The guava system’s elimination of sheath fluid provides additional benefits when working with algae: minimizing the amount of waste generated; allowing for a small instrument footprint, and reducing sample size requirements. Most sheath fluids are formulated for use with mammalian cells, rather than algal cells. The sheath fluid used in conventional flow cytometry systems can impact the physiology of algae cells before they reach the detector. Furthermore, because there is no sheath fluid in the guava benchtop system, algae samples can be drawn directly from the matrix in which the cells are growing. With an eye towards reducing dependence on fossil fuels, pollution, and CO2 emissions, researchers are optimizing processes for the development
and use of biofuels. Supporting these efforts is flow cytometry – a powerful, high-speed, easy-to-use technology that is now available directly on the lab bench.
Jim Mulry is with the Flow Cytometry Group, EMD Millipore and can be reached at Jim_mulry@millipore. com
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)T ALL ADDS UP IN THE END Call Wyvern and save 30% or more on cartridges for your lab water system. % Proven, quality replacement cartridges for most makes of lab water systems % Free technical support and seminars % 20 Years Water Purification Experience % Guaranteed quality and satisfaction For more information about Wyvern’s water purification products, or to place an order, call or fax ---, visit .. or email sales@wyvernsci.com
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September 2010 Laboratory Focus www.bioscienceworld.ca
FeaTuRe
Dual Path Platform® Technology as a Basis for Next-Generation
Rapid Diagnostic
Testing
By SeBaSTian ThaleR
The worldwide market for point-of-care (POC) immunoassays is projected to reach $2.77 billion in 20121 just as the number of people living with HIv in Canada and globally continues to grow.2 The success of, as well as certain limitations of, existing rapid screening assays has motivated the development of a patented, next-generation testing approach known as Dual Path Platform (DPP®) technology.
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Laboratory Focus September 2010
FeaTuRe The initial focus for DPP® is rapid HIV testing, although it can be adapted to test for many infectious diseases. These tests are designed to significantly reduce the time to diagnosis and to reduce the costs of testing assumed by healthcare providers. DPP® technology was patented by Chembio Diagnostics Inc. (Medford, NY) in 2007 following several years of focus on the emerging global need and opportunity for rapid HIV tests. DPP® enables development of POC assays that that provide unique features and capabilities such as multiplexing and improved control of challenging sample types, such as oral fluid. Tests developed to date on DPP® include an oral fluid HIV 1/2 test, a five-band POC confirmatory test for HIV 1/2, and a combination screening and confirmation test for syphilis. Prototypes of an oral fluid test for hepatitis C and various strains of influenza have also been developed. The standard screening tests for antibodies to HIV include the enzyme immunoassay (EIA or ELISA), which is widely used in Canada and around the world, as well as Western Blots and PCR-based assays. The EIA test requires two visits to a clinic or medical facility: one to receive pretest counseling and to have blood drawn for HIV testing, and the second to receive test results and additional counseling (and, if needed, referrals). In contrast, rapid tests such as those made possible by DPP® produce results within 20 minutes or less and allow testing, counseling and referrals to be accomplished in one visit. Rapid tests are less costly for testing agencies to perform due to the fewer outreach visits required to deliver results. Also, studies have shown that rapid tests are as sensitive and specific as conventional immunoassays. In addition, the tests can be safely stored at room temperature for up to 24 months before use, making them ideal for the OTC market as viable at-home HIV tests. DPP® technology incorporates a number of advantages over the widely used lateral flow (LF) technology widely employed in home pregnancy tests. First, DPP® offers sig-
nificantly increased analytical and clinical sensitivity. DPP® HIV rapid test results have shown substantially improved sensitivity ranging from 10 to 50 times that of LF. Independent migration paths for the
sample and conjugate (material that allows visualization of binding) account for this increased sensitivity, coupled with a more effective binding of the analyte to the binding site in the test zone prior to
the reaction of the conjugated marker with the test zone complex. Second, the speed as well as sensitivity of DPP® assays are enhanced due to improved membrane clear-
ance that results from better uniformity and consistency of conjugate particles that an migrate without the sample particles. In particular, DPP® is able to effectively resolve common aggrega-
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September 2010 Laboratory Focus www.bioscienceworld.ca
FeaTuRe furthermore, DPP® is able to run tests on different types of body fluids while maintaining a high level of sensitivity and the ability to test for the presence of any ligand. tion issues presented in lateral flow assays with large particle analytes (e.g., bacteria). In DPP®, the bacterial samples (after filtering) are applied directly to the test site and immobilized while the marker conjugate is free to migrate without the sample to the test zone. This approach allows DPP® assays to be extremely sensitive and specific. In addition, DPP® allows an enhanced multiplex capability with independent and simultaneous delivery of samples. The technology provides multiple analyte results with a high degree of sensitivity without compromising specificity due to cross-reactivity as is common in lateral flow methods. Analytes are able to migrate independently without the conjugate and reach the test zone independently, and thus are able to bind equally so that the same level of sensitivity is maintained across all different analytes.
DPP-HIv Cassette by Chembio Diagnostics Inc.
Furthermore, DPP® is able to run tests on different types of body fluids, including blood, serum, oral fluids, sputum, urine, or feces, while maintaining a high level of sensitivity and the ability to test for the presence of any ligand. Here we detail the DPP® HIV 1/2 Screen Assay. This is a single-use immunochromatographic, rapid screening test that utilizes immobilized antigens for the detection of antibodies to Human Immunodeficiency Virus types 1 and 2 in oral fluid, fingerstick whole blood, venous whole blood, serum, or plasma samples. This Assay employs a unique combination of a specific antibody binding protein, which is conjugated to colloidal gold dye particles, and HIV 1/2 antigens, which are bound to the membrane solid phase. The sample is applied to the SAMPLE + BUFFER well. After the sample and buffer have migrated onto the test strip ad-
ditional buffer is added to the BUFFER well. The buffer releases the conjugate to the antigens. In a reactive sample (i.e., one containing HIV antibodies that have bound to the antigens in the TEST area), the conjugate is captured in the TEST area, producing a pink/purple line. In the absence of HIV antibodies, there is no pink/purple line in the TEST area. In all cases, the sample and conjugate have each also migrated further along the strip to produce a pink/purple line in the CONTROL area containing immunoglobulin G antigens. This procedural control serves to demonstrate that sample and reagents have been properly applied and have migrated through the device. A pink/purple line should always appear in the CONTROL area, whether or not a line appears in the TEST area. If there is no distinct pink/purple line visible, then the test is invalid. Following the test, and assuming results are valid, there are two possible interpretations of these results. One pink/purple line in the CONTROL area, with no line in the TEST area, indicates a nonreactive result. A nonreactive result at 10 minutes from the addition of the second buffer indicates that there are no detectable HIV antibodies in the sample. (A nonreactive test result does not exclude the possibility of HIV infection.) In contrast, two pink/purple lines, one in the TEST area and one in the CONTROL area, indicate a reactive result. The line in the TEST area may look different from the line
in the CONTROL area. Intensities of the TEST and CONTROL lines may vary. A test result with visible lines in both the TEST and CONTROL areas, regardless of intensity, is considered reactive. A reactive test result means that HIV-1 and/or HIV-2 antibodies have been detected. The test result is interpreted as preliminary positive for HIV-1 and/or HIV-2 antibodies. Given the urgent need for improved sensitivity, use of different bodily fluid sample types, and the desirability of testing for multiple analytes in one point of care device, it is anticipated that DPP® may lead to a new generation of testing options.
Notes 1. The Worldwide Market for In Vitro Diagnostic (IVD) Tests, 6th Edition. Rockville MD and New York NY: Kalorama Information: 2008. 2. “HIV Statistics.” Canada Statistics Summary. http://www.avert. org/canada-hiv.htm. Accessed August 11, 2010.
Sebastian Thaler is staff writer at The Investor Relations Group in New York City.
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Laboratory Focus September 2010
New Products
Mixer stands Sharpe Mixers introduces a line of portable mixer stands that eliminate the need for multiple mixers in a wide range of applications, especially where the mixing requirements vary. Sharpe Portable Mixer Stands feature all stainless steel construction and eliminate the need for several mixers in applications where the number of tanks being mixed varies. Providing power assist raising and lowering of the mixer’s shaft into the tank, it comes in an electric series (ELS) with a remote control or in a compressed air-operated series (ALS). Available with a 36”, 48”, and 60” stroke length, Sharpe Portable Mixer Stands meet USDA paint-free equipment mandates and can be supplied with a variety of options such as counterweights, adjustable leveling guides, and locking casters. The ELS-Series includes a 1/2 HP motor with a worm gear drive and can be electro-polished and provided with ASME-BPE validation.
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CPK models Harvard Apparatus features CPK atomic models. The accuracy, scale and easeof-use of the CPK atomic models make it one of the best model systems. It can be assembled, disassembled and reassembled easily using simple construction tools. CPK atomic models are offered in three different formats: as individual atoms, connectors and accessories; as sets for construction of specific molecules; and as pre-assembled molecular models, e.g., amino acids, purine and pyrimidine bases, nucleosides, nucleic acid helices, fatty acids and derivatives, enzyme cofactors, water and fat soluble vitamins and many more. CPK models are effective teaching tools, great tools for new drug presentations and allow the user to visualize chemical structures for enhanced understanding. It is also extremely durable and provides true 3D and spatial perspectives of molecules, not available in computer simulations.
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Incubator Sanyo North America Corporation Biomedical Solutions Division launches its CytoGrowTM GLP series of cell culture CO2 incubators that include the 6.0 cu.ft. MCO-18AC, MCO-18AC(UV) and the 12.0 cu.ft. MCO-36AC and MCO36AC(UV). Ideal for research and clinical microbiology, CytoGROW™ CO2 incubators offer a precise control and contamination resistance solution when most critical for mainstream cell culture applications. The CytoGROW™ GLP CO2 incubator series is designed to accommodate a variety of microbiological and cell culture protocols used in various laboratory settings. Exclusive SANYO inCu saFe™ copper enriched stainless steel interior surfaces provide constant germicidal protection against cross contamination among specimens or contaminants introduced during routine door openings.
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Water baths Lab Armor™ introduces the Bead Bath™, a waterless alternative to contamination-prone traditional laboratory water baths. The waterless Bead Bath is designed from the ground up, delivering exceptional temperature uniformity while eliminating a major source of contamination in laboratories. The Bead Bath is always on, ready for the next experiment, so scientists don’t have to plan around warm-up times. There is also no burn-out risk because there is no water to evaporate. The Bead Bath keeps samples organized, naturally holding vessels in place without the need for racks, floats and bottleneck weights. Vessels that can be used with the Bead Bath are not limited to water-tight containers. Scientists can safely incubate multi-well plates, petri dishes, and open-top samples at any angle.The Bead Bath is practically maintenance free, providing scientists with more time for science. In addition, Lab Armor Beads can be used to replace water in existing water baths, aluminum blocks in dry baths and even ice in ice buckets. These innovative beads can also be used in containers placed in ovens and incubators to replace sample racks. The Lab Armor Bead Bath’s thermal uniformity is: 37°C ±0.5°C and 65°C ±1.0°C with a temperature range of 5°C above ambient to 80°C. Lab Armor Beads support a wide temperature range of -100°C to +400°C in laboratory equipment.
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Syringe pump KD Scientific’s new Legato 270 Syringe Pump has an optimized user configurable syringe mechanism designed to deliver a full volume in infuse and withdraw modes whether using small or large syringes. The reconfigurable mechanism allows the user to change the syringe clamping mechanism to hold from 0.5 ul up to 140 ml syringes. Two removable pins adjust the syringe mechanism to allow full stoke of the larger syringes. The Legato 270 features a continuous push and pull pump. When used with check valves, the unit will draw fluid from a reservoir while the opposite side is dispensing fluid and after the user selected volume is dispensed, the pump will automatically switch through the check valves and refill the empty syringes while dispensing from the other side. This will continuously dispense as long as there is fluid in the reservoir.
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Thermometres Omega’s new line of handheld metres are high accuracy thermocouple, RTD or combined input data logging thermometres. There are three display locations on the large, easy-to-read LCD that displays the temperatures and differences of the two inputs as well as the specific function when in use. The front of the device features MAX/MIN/AVG/ REL/HOLD functions. The HH100 logs data in real time PC monitoring and each channel is capable of storing up to 9999 data records per channel in the data logging mode. Also included with the product is a protective rubber boot over the device and PC software. Ideal for R&D, food, and all types of lab temperature experiments.
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September 2010 Laboratory Focus www.bioscienceworld.ca
NEW PRODUCTS Microscope
scopes with a stably designed column construction. Highly precise guideways ensure exact adaptation of the sample area in the z direction. Sample stages with travel distances of up to 300 mm can be used on the stable aluminum base plate. The Axio Imager Vario microscope module can be combined with AxioCam microscope cameras and AxioVision software for optimal results in image recording, documentation and archiving.
Carl Zeiss introduces the Axio Imager Vario, a microscope module for industrial tasks where large samples requiring various contrasting methods, such as solar cells, wafers, flat panel screens or printed circuit boards, are examined. The sample space of the Axio Imager Vario has been adapted to object sizes with up to 300 mm lat eral and up to 250 mm vertical extension. This microscope combines the excellent optics and high functionality of the Axio Imager 2 upright micro-
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Array technology Array technology FOSS NIRSystems introduces the ProFoss, which is a process analysis system based on high resolution diode array technology. It provides nondestructive analysis of pharmaceutical and chemical products directly in the process line without bypass. The solution helps to optimize the use of raw materials and to consistently run production closer to target specifications. The ProFoss will soon be available for the pharmaceutical and chemical markets.
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September 2010 September 15 BioPharm America Venue: Boston, MA Tel: (760) 930-0500 Email: hmersy@ebdgroup.com
September 17 IMAGENENATION-National Biotechnology Week Web: http://www.biotech.ca
September 19-23 HUPO 2010 Venue: Sydney Convention & Exhibition Centre, Sydney, Australia Tel: +61 (0) 9254 5000 Fax: +61 (0) 0251 3552 Email: info@hupo2010.com Web: www.HUPO2010.com
Laboratory Focus September 2010 Email: dsiele@ sciencepolicy.ca and Melissa@sciencepolicy.ca Web: http://www. sciencepolicy.ca/cspc2010
October 28-29 British Columbia Preclinical Research Consortium (BCPRC) Inaugural Symposium Venue: SFU Harbour Centre, Vancouver, BC Web: www.bcprc.ca
November 2010 November 16-17 9th Annual Market Access Summit Venue: Four Points Toronto Airport, Toronto, ON Contact: Jennifer Mirara (ext. 253) Tel: 1-866-298-9343 Fax: 1-866-298-9344 Email: mirara@ strategyinstitute.com Web: www.marketaccess.ca
Calendar December 2010
December 11-14
December 5-7 BioPartnering China Venue: Renaissance Shanghai Pudong Hotel, Shanghai, China Web: www.techvision. com/bpc
Pacific Rim Summit on Industrial Biotechnology and Bioenergy Venue: Honolulu, Hawaii, USA Email: pacrim@bio.org Web: www.bio.org/pacrim
September 21 BIO India International Partnering Conference Venue: Hyderabad, India Email: tdalal@bio.org Web: http://www. bioindia.bio.org/opencms/ bioindia/2010
September 30 BCSLS Annual Congress Venue: Vancouver, BC Tel: (604) 714-1760 Fax: (604) 738-4080 Email: bcsls@telus.net Web: www.bcsls.net
October 2010 October 5 CanBio National Conference Vancouver, BC Web: http://www.canbio.ca
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October 11-13 Translational Research Excellence 2010 Venue: Brisbane, Australia Web: www.trx10.com.au
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September 2010 Laboratory Focus
CaReeR SPoTlighT Bio-economy Career Profile Compiled by BioTalent Canada Position: Clinical Project Manager Name: Nicola Price Company: Xenon Pharmaceuticals, Inc. Salary Range: $60,000 to $120,000 per year
Queen’S exPanDS on iTS meDiCal SChool oFFeRingS Construction of the new School of Medicine building at Queen’s University has passed another critical milestone. Pouring of the concrete roof slab on the $77-million structure at the corner of Stuart and Arch streets recently was followed by a traditional “topping off party” for the construction crew. It is expected to be all closed in by the start of November. Mechanical and electrical services have already been roughed in on the first two levels, where concrete pillars display an attractive glazed finish, which is produced by leaving them in round forms for 40 days. Use of natural light throughout – including a stunning, three-floor “glass lantern” atrium – is another distinguishing feature of the design. Built to certified LEEDS specifications, the medical school home will be the first structure at Queen’s to comply with new provincial building code seismic requirements. The footprint is 125,000 square feet, including four floors and a penthouse. “Construction of the new building means more than just the addition of new facilities,” explains Richard Reznick, dean of the Faculty of Health Sciences. “With it comes a spirit of renewal and revitalization. We look towards positive change in the way we educate our health professionals, and we expect Queen’s to be at the leading edge of emerging novel educational processes.” Bringing together teaching, research, administrative and student facilities in one building, the facility will be a hub for innovative medical education, including small group teaching, simulation and integrated science labs. It will allow the university to further expand medical programs and ultimately provide the region, province and country with greater access to doctors. The project has been made possible through support from the Canada-Ontario Knowledge Infrastructure Program: $28.8M from the federal government and $28.8M from the provincial government. The balance of $19.4M is provided by generous gifts from alumni, friends, faculty ($1.5M) and students ($.5M).
What I do:
My job is to plan and coordinate the various activities required to perform the human clinical trials and ensure that everything is completed on time and budget. Once a potential drug product has been tested in animals and is found to be non-toxic and efficacious, we can start testing in humans for safety and effectiveness. Clinical trials range from small studies, which may involve less than 30 healthy volunteers, to huge studies, which may involve hundreds to thousands of volunteer patients at sites around the world. Typically, we administer the new medication under close medical supervision and record and analyze any side effects. I generate the plans and timelines, select a site (or sites) for the trial to be carried out, and work with the site and scientists to ensure they have everything they require. Before the trial can begin, I coordinate the submission of supporting documentation to the relevant government authority for its approval. When the trial is ongoing, I monitor progress and deal with any issues that may arise. Once the trial is complete, I coordinate the data analysis, authoring, review, and finalization of the clinical-study report.
What education and skills do candidates need for this position?
There are no academic qualifications that will automatically make you eligible to be a Clinical Project manager. A Bachelor of Science degree is usually preferred, but is not essential. Many project managers have nursing degrees or diplomas because they moved from nursing into a CRA role and then into project management. You require excellent verbal and written communication, strong organization and time-management skills, and an ability to prioritize effectively. You need to be able to interact with a wide range of people with different skills, education, and experiences. You should have a solid understanding of the different activities required to perform clinical trials and knowledge of regulatory requirements. You also need to be detail oriented while not losing sight of the overall plan.
What are the best parts of your job?
I like that the job varies. One day I might spend the entire day writing or editing a document and the next day I’ll be in meetings or interacting with people, making plans, dealing with issues or answering project-related questions. It is also very rewarding to know that the drugs tested in clinical trials that I helped design and implement will be used to treat patients with severe or debilitating diseases.
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