Imagine a drug that acts like a fire engine--it follows the smoke signals, goes straight to the problem, puts out the fire, and then packs up and leaves.
That's how a potentially game-changing new stem cell therapy for stroke works. In animals. The company that's developing it--Athersys--is located right here in Northeast Ohio, and this summer it got the green light from the FDA to start human clinical trials.
VAN BOKKELEN: These cells can actually provide some pretty serious help, when it's needed, and shift things in the right direction, and we're anxious to demonstrate that clinically.
Dr. Gil Van Bokkelen is chairman and CEO of Athersys. He says that their therapy--using stem cells taken from the bone marrow of healthy, consenting adults--is, a "living drug," because it reacts dynamically in the body, helping protect and repair brain cells and blood vessels.
During a stroke--when blood supply to part of the brain is severely reduced--the body launches an arsenal of defenses that can actually do more damage than good. This stem cell therapy, at least in animals, seems to calm down this over-protective response, setting the stage for revival of dying brain cells.
VAN BOKKELEN: It's not magic I can assure you of that.
Again, Athersys CEO Van Bokkelen:
VAN BOKKELEN: We think we've found a creative way to harness an important element of the body's natural healing process so that we can essentially shift the balance more toward healing and less toward the inflammatory defense mechanism response you'd typically see.
This cell therapy would not replace conventional stroke care--that aims to restore healthy blood flow to the brain--but it could have profound impact on the severity of brain damage and disability.
That's because, after a stroke, there's often a lot of savable brain tissue--these are stressed out neurons that will eventually die unless they get a leg up. Van Bokkelen:
VAN BOKKELEN: So it's not that the tissue dies right away, in fact we know a lot of it doesn't die right away--some of it does--but a lot of that tissue is sitting there waiting for help .
That help could come in the form of stem cells, which might coax brain cells back from the brink of death.
STEINBERG: -Well in my opinion, they're extremely promising but we have to avoid the hype that accompanies any kind of stem cell therapy these days.
Dr. Gary Steinberg is a neurologist at Stanford University who researches stem cells and stroke. He's unaffiliated with Athersys, and calls their approach "useful" but cautions that we don't yet know what will work best for the disease.
And a final assessment is years away. If their clinical trial goes well, Athersys says it would likely be five to ten years after that before we see stem cell therapy as a mainstream stroke treatment.
Another hot area of research in stroke care is, well, cold. Very cold. Frigid even.
Doctors are experimenting with use of controlled hypothermia, to reduce brain damage during a stroke.
Hypothermia is a condition where your body temperature drops dramatically--and it can be quite dangerous if you're on, say, a mountain top in a snowstorm with no help nearby. Your organs will shut down, and if you don't warm up, you'll die.
But hypothermia, when used in a hospital setting with careful monitoring of your vitals, can actually be a boon for your brain.
Dr. Susana Bowling, director of the Summa Stroke Center in Akron Ohio, says hypothermia is critical for one thing:
BOWLING: To buy time. So if a neuron is cooled down, instead of dying in five minutes it might be able to survive a little longer.
When the body is cold, it is less needy, so brain cells can survive on less oxygen, which gives doctors more time to fix the problem and possibly save the surrounding tissue.
Summa developed a set of hospital-specific protocols for using hypothermia on stroke patients.
MARTIN: This is our stroke box.
(sounds of opening the box and pulling out contents)
Dr. Brad Martin, chief of critical care medicine at Summa Health System, shows me around.
MARTIN: And it has just a guide to contents, probes, cooling blankets, notecards for the nurses on the procedures. So it's set and ready to go whenever we have a patient.
Other hospitals harness hypothermia in similar ways: locally, University Hospitals uses it, and MetroHealth's developing protocols for future use.
Dr. Robert Ferguson, a neuroradiologist at Metro, says that hypothermia might just be the next big thing for stroke care--a groundbreaking new tool--and he plans on releasing a proprietary method for utilizing it in a couple years.
Still, like stem cell stroke therapy, hypothermia stroke care is experimental at this stage. These are examples of the breadth of approaches being pursued and progress being made to harness stroke’s debilitating brain damage.