On the forefront of stroke research

Men in lab-coats scurry around and high-tech equipment bleeps laser pulses.

We study the brain’s underlying mechanisms that lead to injury and recovery during and after a stroke because, till today, this is still not fully understood

The basement laboratories at the University of Malta’s Faculty of Medicine and Surgery are a hub of cutting-edge research into, among other things, strokes.

Answers about future medicine lie in these laboratories or, to be more precise, in the small rodents under the microscopes.

At the Laboratory for the Study of Neurological Disorders, for more than two decades, dedicated researchers have been studying the brain and what happens to it when it breaks down due to illness or accidents.

Five researchers and an engineer, led by Mario Valentino, specialise in the study of strokes:

“Stroke is the third leading cause of death in Western civilisation. It is the first cause of disability and the second main cause of dementia,” says Dr Valentino, senior lecturer at the Pathology Department.

Stroke is not considered to be an accident anymore because it can be preventable.

It is a brain attack, which, if treated on time, can be cured, Dr Valentino noted.

There are thousands of publications on the attempts to protect the brain from stroke but, so far, there is only one effective drug: tissue plasminogen activator (t-PA), which dissolves the blood clot caused by the illness.

However, this is far from a miracle cure. It has to be given within three hours to be effective and it can only be administered to select patients who tick very strict criteria.

Dr Valentino explains that, for the past 40 years, in the world of medicine there has been no breakthrough when it comes to stroke cures.

Experiments are constantly being carried out in research centres around the world, including Malta, testing the use of novel drug treatment strategies to protect the injured brain.

“We try to bridge gaps in our knowledge, by testing drugs and publishing our results, which can then be taken up by researchers in the pharmaceutical field and the scientific community at large,” he says.

At the SND Laboratory, experiments focus on how to limit the damage caused by a stroke.

“We study the brain’s underlying mechanisms that lead to injury and recovery during and after a stroke because, till today, this is still not fully understood,” admits Dr Valentino.

Most of the testing is carried out on rodents because the brain structure and blood vessels are very similar to that in humans. These tests are crucial because they preclude the phase before drugs are then tested on humans.

The goal of Dr Valentino’s team is to study the brain non-invasively, without the need of surgery or inserted electrodes.

Transgenic mice, specifically bred with a yellow or green fluorescent glowing protein in the brain’s nerve cells, are used. Laser beam is then microscopically directed towards a target blood vessel on the surface of the rodent’s brain to interrupt blood flow and cause a ministroke.

This technique, unique to Malta, requires no surgery and allows the study, in 3D, of the rodent brain before, during and after induced injury.

The special, customised microscope used in this technique also gives the researchers the facility of assessing the rodent’s reaction to injury and recovery.

“This gives us a picture of what is going on in real time during a stroke. There is no better way of looking at what is happening there and then,” explains Dr Valentino.

The SND Laboratory will soon be submitting a paper with the most recent findings about stroke in pre-natal and post-natal babies.

Studies have revealed that newborns are more resistant to stroke than in adults. This finding is very important, according to Dr Valentino, as it opens up “an awareness that the extent of injury in the immature brain is developmentally regulated” and highlights the urgent need to develop new and more precise treatments.

The laboratory is one of the few in Europe that study the deepest areas of the brain, known in technical terms as white matter.

This is the area inside the brain that is made up of supporting cells and nerve extensions and makes up 50 per cent of the brain.

“Following a stroke, there is significant injury here and several structures in the brain become irreversibly disconnected, leading to significant neurological deficits and impairments,” Dr Valentino says.

Away from the laboratories and the white coats, there is still a lot that can be done, for a stroke is something that can be prevented in time.

“Awareness can save a lot of lives,” says Dr Valentino.

Risk factors for stroke

• High blood pressure
• High cholesterol
• Cigarette smoking
• Diabetes
• Obesity
• Physical inactivity
• Heart problems
• Illicit drugs
• Binge drinking

Learn to recognise the signs and symptoms

• Sudden numbness or weakness of the leg, arm, face
• Sudden confusion
• Speech difficulty or understanding
• Sudden dizziness
• Loss of balance and coordination
• Eyesight problems in one or both eyes
• Sudden headaches with no known reason

• Valuable research projects such as this, a vital part of the University’s role, require adequate funding. The University’s Research Innovation and Development Trust (RIDT) has been set up to strengthen investment in high-calibre research and development across every faculty and to attract the necessary funds. For more information go to www.ridt.org.mt.