Breaking new ground in stroke research and care

Simone Schoenwaelder from Australia’s Heart Research Institute tells us about exciting advancements in stroke research and care that could dramatically improve clinical outcomes for patients

Stroke is a leading cause of death and disability globally, with 16 million people suffering strokes annually. Approximately 85% of strokes are ischaemic, caused by a blockage of an artery within the brain which reduces cerebral blood flow. If not resolved within a few hours, irreversible brain damage can occur.

Many stroke victims are never able to return to their normal life. Some cannot work, while others end up in nursing homes, regardless of age.

Unmet clinical needs in stroke research and care

Despite decades of research, there is currently only a single treatment which dissolves blood clots in the acute phase of stroke, Tissue plasminogen activator (tPA). The problem is that only 10% of stroke victims can receive it, leaving those that cannot have the clot surgically removed to suffer the devastating impacts of stroke.

To make matters worse, tPA has many limitations and does not work effectively in many stroke patients. There is a significant unmet clinical need to identify new anti-clotting approaches that can improve tPA function and reduce stroke injury.

Breaking new ground in the treatment of stroke

It has never been a more exciting time to be in medical research as we break new ground in treating cardiovascular disease thanks to the advancement of technology. At the Heart Research Institute in Australia, research led by Professor Shaun Jackson’s Thrombosis Group strives to improve clinical outcomes for patients suffering from cardiovascular diseases, including stroke.

Having identified and developed a new anti-clotting compound with the potential to improve blood flow to the brain and reduce and/or prevent brain injury, the team has demonstrated in preclinical models that when combining this revolutionary new class of anti-clotting drug with existing stroke therapies, blood flow to the brain can improve and thus reduce/prevent brain injury.

This discovery is the holy grail of stroke research. It could be a game changer in advancing the traditional methods of treating ischaemic stroke and improving the quality of life for thousands of stroke sufferers.

The team is preparing to take the novel anti-clotting drug to the next level, commencing Phase 2 clinical trials in humans. If successful, this discovery will be the first pharmacological scientific breakthrough for stroke in two decades. It could have an optimal impact on minimising cognitive and physical disabilities caused by stroke.

This new drug, developed over the last 15-20 years, has been a long time coming. Its potential for improving stroke therapy has been aided by advancements in technology, including cutting-edge fluorescence microscopy, which allows us to monitor the development of a blood clot in real time.

Fluorescence microscopy

Technology is already revealing critical new insights into how these clots form within the body, providing us with the necessary information which will assist in the design of safe and effective therapies for acute stroke care.

Previously, scientists could detect deadly clots blocking blood flow to vital organs such as the brain or heart by monitoring blood flow markers. We knew a clot was forming as we could observe changes in blood flow, but we could not visualise the dynamics of clot formation in larger arteries.

With the development of a fluorescence macroscope imaging system, it is now possible to introduce fluorescent markers into models to identify and track the different cell types involved in clot formation in real time, providing never-before-seen dynamic information on how these clots form. Current standard-of-care clot-busting therapies can be administered to learn more about their limitations and complications.

This has allowed researchers to learn more about the complications of current therapies and ultimately inform the development of new treatments to save more lives.

Could a novel anti-clotting drug revolutionise stroke care?

The new drug developed at the Heart Research Institute belongs to a similar group of blood thinners known as antiplatelets, including drugs such as aspirin, often used to treat heart attacks. The benefit of this novel anti-clotting drug is its unprecedented safety profile. Unlike aspirin and other antiplatelets on the market, its anti-clotting activity comes without the potentially devastating risk of bleeding, which can lead to further brain damage and death.

When the anti-clotting drug is combined with the existing tPA, it not only helps dissolve the stroke-causing blood clot more effectively but can also stop the clot from reforming altogether. It achieves this by targeting different and complementary components of the blood clot than tPA alone and does so without an added risk of bleeding, which we know leads to more strokes, so this drug may help reduce the risk of another stroke.

If successful, it will mean 90% of stroke sufferers could now have increased options when it comes to treatment in those crucial first 48 hours.

This exciting and cutting-edge research will mean that over the next decade, healthcare professionals worldwide could potentially have a better treatment for stroke, translating to less death and disability for stroke sufferers.