Thomas Willis Lecture Award Lecture at ISC19

The International Stroke Conference 2019 (ISC19) was packed with all things stroke. In my previous blogs I outlined the expectations and highlights from the daily goings on in Hawaii. Here I will summarize the Willis Lecture presented by Frank Ray Sharp, MD, FAHA entitled “Molecular Markers and Mechanisms of Stroke.” ISC19 is a premier setting to disseminate the basic science behind cerebrovascular disease as it impacts patient care.

It is well established that ischemic stroke occurs as a result of narrowing of arteries to the brain due to disrupted laminar blood flow. My research has focused on the inflammatory response that leads to the lipid accumulation in the vessels; however, Dr. Sharp’s research, although focused on the brain (neuroscience), can be translated into studies affecting the atherosclerotic vessel.

Identifying canonical pathways and molecular functions of genes, such as histone deacetylase 9 (HDAC9) that are associated with large vessel atherosclerotic stroke, could assist in identifying factors that contribute to peripheral immune, lipid, and clotting systems resulting in vascular injury. For example, an intracerebral hemorrhage has T-cell receptors and CD36 genes (in addition to iNOS), toll-like receptors, macrophages, and T-helper pathways that are differentially expressed; whereas ischemic stroke displays more non-coding RNA. However, both have the potential to undergo angiogenesis, NFAT regulation of immune response, and glucocorticoid receptor signaling pathways. Based on this awareness, we can conclude that all strokes are not one and the same.

What is more, this body of research uncloaked the Biomarkers of Acute Stroke Etiology (BASE) study utilizing RNA targeting as a viable therapeutic model to improve ischemic stroke outcome. BASE is an ongoing observational study that works to identify serum markers that could potentially define the etiology of acute ischemic stroke. Patients in this study present within 24 hours of the onset of their stroke, blood samples are collected at various intervals to obtain RNA gene expression data. There is cutting-edge research being conducted on treating patients with a microRNA-122 mimic and inhibiting NOS2. Evidence is mounting on the role of microRNA-122, a compound that is produced in the liver and secreted into the blood, reduction contributing to a heightened inflammatory response and subsequently the onset of ischemic stroke. Additionally, NOS2 has been shown to be a major player in initiating the inflammatory cascade post-ischemic stroke. Thus, the utilization of a microRNA-122 mimic in addition to a NOS2 inhibitor can potentially modulate an infarct volume as well as lengthening the therapeutic window while extend vascular protection post-ischemic stroke.

There were so many aspects of ISC19 that it would be too exhaustive to cover them all in one blog post, but I would be remised to not mention the telerehabilitation in home versus therapy in clinic for patients with stroke. This rehabilitation method is conducted remotely and quite resembles palliative care. I may be “old school,” but this telemedicine has been on the incline, so we should understand more about how it works. Clinicians use telemedical devices to obtain data such as heart beat, ECG, blood pressure and oxygen saturation for cardiovascular rehabilitation. Employment of telehealthcare reduces the time in hospitals and subsequently bills related to medical care. Patients can conduct rehabilitation exercises at a time that is most convenient to them and hospital staff can connect remotely to the patient’s computer to customize the exercise based on the results of the test. Additionally, health conditions can be assessed in real time and various training forms can be initiated based on patient’s progress.

The take home here, is that science is changing and as a result medical care is changing. We as patients, scientist, and clinicians should gain awareness of how these changes affect us and how we can get/give the best care. Know your risk. Know your options.

Let me know your thoughts in the comments. Share your questions so we can learn more together. Follow me on Twitter @AnberithaT, Instagram @AnberithaMatthews and @AHAMeetings for more information on being heart smart.

Save the Date for ISC 2020, February 19 – 21, hosted in exciting Los Angeles, California!