“I dream of a day when can we provide a DNA sequencing to predict patients’ disease risk. How can we optimize medical management based on an individual’s genomic signature? This would be a true revolution in the era of precision medicine.“
Always fascinated by medicine, Dr. George Yousef completed an MD in Egypt. He constantly questioned how medicine could innovate and move past its boundaries so completed a masters, then received a scholarship to pursue a PhD in molecular biology in the Department of Laboratory Medicine and Pathobiology in the Temerty Faculty of Medicine.
“I was a practicing clinician in Egypt and was attracted to LMP as the bridge between clinical and research work.” he explains.
Based in Mount Sinai, his PhD was under the supervision of Dr. Eleftherios Diamandis, with now Department Chair, Dr. Rita Kandel on his supervisory committee.
His PhD brought some unexpected results. Initially investigating one of the Kallikrein genes, he turned the scientific community on its head. The Kallikrein gene family are important biomarkers for cancer, specifically the prostate-specific antigen (PSA). Many scientists had investigated this group of genes and it was a ‘known fact’ that there were three genes in the Kallikrein family. He started experimenting with informatics and gene prediction – new technologies at the time - and discovered that there actually 15 Kallikrein genes which opened a new world of possibilities in cancer diagnostics and treatments.
As he was a PhD student with little publishing history and was challenging the current thinking, his first paper was repeatedly rejected until other research groups started to corroborate his findings. Once his discovery was accepted, he published 23 papers during his PhD and eventually became a co-founder of the International Society of Kallikreins.
“My PhD was tough, but it was worth it,” laughs George, “It unleashes your potential and teaches you how to accept a challenge. It’s exactly what a PhD should be. The courses were heavy, but I remember the amazing mentorship I received - world-class scientists who were ready to help and always had their doors open.”
He left Toronto to complete a Pathology residency in Newfoundland but soon found his way back to complete an elective at Sunnybrook. He then accepted a position as a Pathologist at St Michael’s Hospital with a faculty appointment in LMP, eventually moving to the Hospital for Sick Children as the Chief of Paediatric Laboratory Medicine.
“I find cancer fascinating because, unlike any other disease, it is a cell reprogramming issue. Like programming computers - somehow the programming of the cell is changing so it’s instructing the cells to keep growing infinitely and to even destroy others”. At the start of his research career, microRNAs were recently discovered and their role in programming cells for development in the embryo understood. He wondered since this was about cell programming, could they be involved in the reprogramming of cancer cells? He went on to prove that micro RNAs affected cancer stem cells in kidney cancer.
“If we can manipulate the micro RNAs we could slow or reverse the growth of cancers. As a pathologist, we take this unique angle of transferring research into the clinic, so I’m also interested in using this for diagnostic tools in precision medicine. MicroRNAs have many amazing applications,” says George.
This precision medicine approach is used in prostate cancer: the most common cancer among Canadian men with one in eight being diagnosed in their lifetime. For many, surgery and other treatments have significant negative side effects, but research has found that around 50% don’t need surgical resection, only careful follow-up – the cancer will not grow enough to cause them harm. In collaboration with Dr. Neil Fleshner at UHN and in the Division of Urology at U of T, the Yousef Lab discovered a miRNA signature that can predict whether a prostate cancer patient should receive treatment or go under ‘active surveillance’ where they are monitored and do not need to undergo unnecessary treatments.
Alongside his clinical and research roles, he is Vice-Chair of Clinical Education, overseeing the education of medical residents and students, clinical fellows and programs like the MHSc in Laboratory Medicine. “I love the challenge of education – of capturing someone’s attention and engaging them. For me, education is a connection between generations. It's a mentorship in which I also learn a lot from my students”.
George’s love for new technology and innovation isn’t restricted to his research. He was involved in the digital transformation of the National Royal College exams for residents, removing the need for residents to bring their own microscopes to Ottawa. He also, in collaboration with residents, created a simulated learning platform for pathology residents. The program takes residents through a simulated scenario of pathology cases, which is now on its way as a testing module for pathology residents and as a teaching tool for the pathologists’ assistants. He hopes it will be adopted into the Royal College exam.
He has a keen eye on developments in precision medicine, digital pathology, AI and how medicine plays an active role on social media in this information age. “I want to bring pathologists and laboratory scientists into the forefront of patient care, and not to stay in the background. How can we play a stronger and more public role in patient education and knowledge translation?”
George has spent the last four years at The Hospital for Sick Children as Chief of the Department of Paediatric Laboratory Medicine and a Senior Associate Scientist. He will be leaving SickKids and joining UHN as Program Medical Director and Head of the Laboratory Medicine Program (LMP) on April 1, 2022. A move he hopes will help him build on his precision medicine innovation focus. “I believe UHN has the infrastructure, ability, and ambition to take us into a new age of precision medicine.”
You may ask how one balances such a busy academic career. For George, it is all about organisation, prioritisation and delegation. “I have to be very strict about what I do. There are many things that are tempting but I don’t do them. I also delegate and trust they will do a good job and not micromanage”.
Most importantly, most of what George doesn’t feel like work. “My work really is my hobby; this is my leisure time and I’m using it for something I really love.”
