Allopurinol and Stroke
Allopurinol, a commonly used drug for gout, a form of arthritis may reduce risk of stroke and be a useful treatment for angina and heart failure. We are performing clinical trials of the effect of allopurinol on blood vessels in patients who have suffered stroke and are moving towards a large study where we measure the effect of allopurinol on rate of stroke.
Improving arm function after stroke
We are exploring new strategies to improve arm function after stroke. Many stroke survivors are left disabled due to arm weakness despite current rehabilitation treatments. We are trying two novel approaches. One is the use of very early robotic rehabilitation therapy started within a week after stroke and the other is use of a vagus nerve stimulator. This is a device which is implanted under the skin in the chest and attaches to a nerve in the neck. This nerve connects with the brain. We are exploring whether by stimulating this nerve we can send signals to the brain which help it re-wire and repair itself after stroke. This is the first time use of vagus nerve stimulation has been used after stroke.
Polytherapy for stroke
Stroke is a leading cause of death and the leading cause of disability in the UK. There is only one treatment for stroke which <5% of sufferers receive highlighting a pressing and urgent need to identify new interventions. A complex array of mechanisms are involved in stroke-induced brain damage including uncontrolled release of substances due to a lack of oxygen and glucose causing the brain cells to die. Destructive free radicals are generated which increase the levels of oxidative stress leading to further death due to an active death pathway called apoptosis. microRNAs are small molecules which reduce expression of genes. Uniquely, by altering expression of one microRNA effects on many pathways involved in stroke can be achieved. Rational polytherapy inhibiting multiple pathways may prove as useful for stroke intervention as it has in treating disorders such as high blood pressure. Using an animal model which reflects many of the risk factors seen in stroke sufferers (high blood pressure, altered metabolic handling) we aim to reduce damage and improve long-term outcome after experimental stroke by preventing both free radical generation and apoptosis by combining drugs and gene therapy approaches. Furthermore, using a novel gene delivery system shown to efficiently target the brain we will alter the expression of one or more microRNA(s) to elicit a polytherapy style outcome through a monotherapy approach.
Stroke, Cognition and Elderly Care
Stroke is the commonest cause of adult disability and is a major cause of death in the western and developing world. We lead clinical trials of acute treatments for stroke and novel preventative measures for stroke. We collaborate closely with colleagues throughout the USA and Europe on novel approaches for treatment of brain bleeding episodes and on hypothermia as a treatment for stroke. We work closely with industry on all aspects of trials, from planning through data monitoring, analysis and reporting. We founded and run the VISTA collaboration, an academic led archive of clinical trial data, which provides access to high quality data to help explore and design new studies to help patients with stroke.