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healthy heart

10 things you can do for your heart

Heart disease is the leading cause of death for both men and women in the United States, and it’s the second-leading cause of death in Kentucky. Here are 10 things you can do to keep your heart healthy.

1. Know your numbers: Your blood sugar, blood pressure, cholesterol and body weight reveal a lot about how likely you are to develop heart problems. This guide shows the basics of what your numbers mean. Here are two ways to get them:

  • Your doctor can record them at your next checkup.
  • Watch for free health screenings (pharmacies – including those at department stores and grocery stores – as well as hospitals sometimes offer these; googling “free health screening” followed by your city is a good place to start).

2. Learn your family history: If a close relative has had heart trouble, you are more likely to have it. Find out whether your brothers, sisters, parents or grandparents have had heart disease and how old they were when they developed it, and share that information with your doctor.

3. Exercise: A good goal to start with is 30 minutes a day, five days a week, of moderate intensity aerobic exercise such as brisk walking, ballroom dancing, bicycling, doubles tennis or water aerobics. You can get more benefits if you add muscle-strengthening activity twice a week through weightlifting or calisthenics (pushups, pullups and situps, for example).

4. Eat well: A diet low in saturated fats (from animal products – meat and dairy) and trans fats (found in fried foods and baked goods) helps reduce the risk of high LDL blood cholesterol. The DASH diet is easy to follow and good for you.

5. Quit smoking and avoid secondhand smoke: Check out these 11 strategies.

6. Get enough sleep: Those who don’t sleep enough are at higher risk for cardiovascular disease. How much sleep do you need? This is a good place to find answers. Also, UK HealthCare’s Dr. Zoran Danov offers tips for how to sleep better.

7. Reduce stress: Slowing down, staying organized, exercising and sleeping well can all help. Dr. John A. Patterson recommends mindful breathing.

8. Control high blood pressure: High blood pressure weakens the arteries to the heart. Dr. Khaled Ziada, an interventional cardiologist at the UK Gill Heart & Vascular Institute, explains how to manage it.

9. Reduce belly fat: Abdominal fat has been linked to an increased risk of heart disease (it’s not just how much weight you’re carrying but where you carry it, studies have concluded).

10. Take it easy on the alcohol: An average of one to two drinks per day for men and one per day for women is fine, but more than that can lead to higher fat levels in the blood as well as obesity. Binge drinking can damage the heart muscle.


Next steps:

  • The UK Gill Heart & Vascular Institute is at the forefront of the battle against heart disease in Kentucky. Learn more about what we’re doing to treat and prevent cardiovascular disease.
  • Heart health also affects your risk for stroke. At UK HealthCare, we’re on a mission to change stroke care forever. Learn more about our Comprehensive Stroke Center.
stroke

Stroke can devastate lives. This is what we’re doing to change that.

Did you catch our new TV spot, which debuted during the Super Bowl?

It’s all about how we’re revolutionizing stroke treatment in Kentucky – and for patients everywhere.

Our stroke physicians and researchers are hot on the trail of new treatments that don’t just stop stroke in its tracks – they help reverse the damage that’s already happened in the brain. And these treatments are available now – only at UK HealthCare.

Stroke is the fifth-leading cause of death in Kentucky and in the United States, and until now, those who did survive were often severely disabled. They may have lived, but the stroke changed their lives forever.

These new treatments are working to change that, to not just save lives from stroke but to restore those lives to what they were before and get people back to living and doing the things they love.

We’re incredibly proud of the new TV spot, but there’s so much more to the story that we just couldn’t fit into 60 seconds. Visit our website to see videos from our stroke experts, learn more about our Comprehensive Stroke Center status and why it matters, and to learn what you can do to help prevent stroke in yourself or others.

When a stroke happens, getting help fast can make all the difference. But so can getting that help at a hospital that’s on the leading edge of advances in stroke treatment.

Through education, prevention, treatment and research, together we can stop the scourge of stroke in Kentucky. It’s our mission.


Next steps:

deep brain stimulation

Improving treatment options for patients with Parkinson’s

Written by Dr. Craig Van Horne, a neurosurgeon at UK HealthCare, and Dr. George Quintero, a deep brain stimulation neurophysiologist at the Kentucky Neuroscience Institute.

Parkinson’s disease is a degenerative neurologic condition that affects more than 1 million people in the United States and 10 million people worldwide.

Parkinson’s attacks the nerves in the brain, causing tremors, rigid muscles and other problems so that people gradually lose their ability to move fluidly. There is no cure, but drugs can help reduce the severity of some symptoms.

These drugs, however, can have significant side effects. After long-term use, these side effects can be almost as bad as the disease itself. When those drugs are no longer effective, some patients turn to deep brain stimulation, or DBS, a procedure that helps the brain regulate the signals that control movement.

How DBS works

DBS implantation requires two surgeries. During the first surgery, a physician will place one or two insulated wires called “leads” in the brain. These leads are strategically placed based on detailed pre-surgical testing in the exact locations that control specific symptoms patients are experiencing.

A week or two after the leads are placed, the patient will undergo a second procedure to implant a “stimulator” – a device about the size of a stopwatch that powers the leads. It is typically implanted under the skin in the chest, much like a pacemaker for the heart. The stimulator will be turned on after the second surgery, producing mild electrical impulses to stimulate a specific region of the brain and help override tremors and other movement problems.

But DBS also has drawbacks. The batteries in the neurostimulator must be replaced every three to five years, which presents an ever-increasing risk for serious – even life-threatening – infections.

UK is making DBS better for patients

Now, however, there is a new option that uses a rechargable battery with a 15-year lifespan. This new technology could save patients from undergoing a minimum of three additional surgeries.

Even better: The new device can be attached to the existing system, which means that people who already have DBS can switch without replacing the entire system.

Doctors at the Kentucky Neuroscience Institute were the first in the U.S. to switch a patient from the old device to the new.

DBS is also approved for treatment of dystonia and obsessive-compulsive disorder and is also being studied as a treatment for chronic pain, PTSD and other affective disorders.

While DBS is not a cure, it may help improve day-to-day life for patients with Parkinson’s disease. If you are considering DBS for the first time, or if you already have DBS, consult your doctor about this new option.


Next steps:

  • Learn more about the UK Movement Disorders Clinic, which provides specialized treatment for patients with a range of conditions and diseases including Parkinson’s, dystonia and Huntington’s disease.
  • Experts from the UK Brain Restoration Center, including Dr. van Horne, recently took their expertise to China and helped doctors at that country’s largest hospital learn how to perform deep brain stimulation surgery.

Know the stroke risk factors you can control – and those you can’t

From your blood pressure and cholesterol level to your family history and current lifestyle, there are plenty of factors that can indicate whether you’re at risk for a stroke.

Factors you can control

Alcohol: Drinking too much can cause other health problems that contribute to stroke risk, such as high blood pressure and obesity. If you do decide to have a drink, limit yourself to one per day. That means no more than 12 ounces of regular beer, 5 ounces of table wine or 1.5 ounces of hard liquor.

Atrial fibrillation (AFib): AFib is a type of irregular heartbeat. If you’ve been diagnosed with AFib, be sure to talk with your doctor about strategies to control it. Uncontrolled AFib increases your risk of stroke by four to five times.

Blood pressure: High blood pressure is the leading cause of stroke. If your blood pressure is high, it might be related to your family history. The good news is diet, exercise and medication can help you bring your high blood pressure under control.

Cholesterol: Like blood pressure, high cholesterol can be reduced through medication and lifestyle changes.

Diet: Consider adopting a diet low in salt and low in fat, which can lower your risk of stroke.

Exercise: Recent research shows that regular exercise can cut your risk of stroke by more than 25 percent. Try to get 30-60 minutes of exercise each day. Exercise doesn’t have to be complicated – add more movement to your daily routine with these easy tips.

Obesity and diabetes: Obesity and diabetes greatly increase your risk for stroke. Lifestyle changes, such as improved diet and increased exercise, can reverse both of these problems.

Smoking: Smoking places you at a significantly higher risk of stroke than non-smokers: If you smoke two packs a day, you are six times more likely to have a stroke than a non-smoker. Ask your doctor for resources to help you quit.

Factors you cannot control

Your age and sex: As you grow older, your risk of stroke and heart disease begins to increase and keeps increasing with age. Overall, more women than men have a stroke, but at younger ages, stroke incidence is actually higher in men than women.

Your family history: Find out if any of your family members have had a stroke in the past. You have a greater risk of stroke if any of your close blood relatives have had a stroke.

Your personal history: If you’ve had a previous transient ischemic attack (TIA), you’re at a higher risk of a future stroke.


Next steps:

Get moving to lower your stroke risk

Recent research shows that regular exercise can cut your risk of stroke by more than 25 percent. Even moderate exercise increases cerebral blood flow, which improves the function and health of your brain.

Any form of exercise will do – the key is to increase your heart rate and push yourself to feel at least a little warm and a little out of breath.

You should aim for 30 minutes of moderate-to-vigorous physical activity five or more times a week – if you don’t have time for a half-hour all at once, don’t worry – you can break it up into smaller blocks of time throughout the day.

Here are some easy ways to add physical activity to your day:

  • Take the scenic route at work. Park farther away in the parking lot and take the stairs instead of the elevator. You can park farther away when shopping or running errands, too.
  • Take your dog for a walk.
  • Instead of standing around and waiting – like when you’re waiting to board a flight or waiting for your kids to finish practice – use the time to take a walk.
  • Plan fun activities that get you moving – like dancing or playing with your kids.
  • Turn household chores into exercise – from cleaning your house to gardening and yardwork. Just make sure you move quickly enough to get your heart rate up.

If you haven’t been active recently, or if you’re over 40 and have any medical conditions, be sure to speak to a doctor before you increase your physical activity.


Next steps:

Team of young scientists at UK publishes innovative spinal research

According to a paper recently published in Cell Reports, labs from Case Western Reserve and UK’s Spinal Cord and Brain Injury Research Center (SCoBIRC) were able to demonstrate the existence of a parallel neural network that could potentially restore diaphragm function after spinal cord injury.

This ghost network operates entirely separate from the brain, which has long been considered the only organ capable of directing respiratory function, and appears able to instruct the diaphragm to contract when properly activated.

While practical solutions are a long way away, the implications of this research for quadriplegics, many of whom rely on a respirator to breathe, are enormous. Constant mechanical ventilation increases the risk of fatal infection, which is the leading cause of death for spinal cord injury patients. Reducing reliance on ventilators would go a long way toward improving quality and longevity of life for those with devastating spinal cord injuries.

Building a team of young scientists

Perhaps more amazing is that this research is credited to a group of young scientists – one not yet graduated from college.

Warren Alilain heads the lab at SCoBIRC where Rachel Maggard, Lydia Hager and Daimen Stoltz work. Alilain has long been researching combination therapies to restore breathing function to patients with older cervical spinal cord injuries.

“Jared Cregg and Jerry Silver [my colleagues at Case Western] have been looking into ways to restore diaphragm function after spinal cord injury for a while, and their research uncovered this latent network in neonatal mice about two years ago,” Alilain said.

“The initial neonatal results from Case Western were intriguing, but since most spinal cord injuries occur in adults, it was an important step to replicate the results in adult rats, and Jared knew my lab had the appropriate experience.”

So Cregg reached out to Alilain for help. Alilain collected his lab group together, mapped out the proposal from Case Western, and then asked, “Who wants to do it?”

Maggard and Hager, both first-year graduate students, and Stoltz, a college senior, looked at each other and thrust their hands in the air.

So, for three weeks last summer, the women duplicated Cregg’s experiments using adult rats and were able to confirm the presence of the ghost network.

Impressive results

And then Cell Reports came knocking.

All three women call the experience of having a manuscript accepted for a major publication at such a tender age “surreal.”

“It’s a huge career boost,” said Hager, who credits Alilain’s unwavering support and guidance both in and out of the lab for their success, with an enthusiastic chorus of seconds from Maggard and Stoltz.

In a moment reminiscent of a meeting of the Mutual Admiration Society, Alilain protests, saying that the credit belongs entirely to this group of bright young scientists.

“Warren has high expectations of us but he also helps us get there,” said Stoltz, who will receive her undergraduate degree this spring. “He brought us along to several national neuroscience meetings – a rare opportunity for someone my age – and taught us that science is about more than working in a lab.”

Maggard agreed with Stoltz, adding that being with Alilain at scientific meetings was like following a rock star around.

“Warren showed us that networking and sharing ideas were all critical elements of good science,” Maggard said.

Abundant opportunities at UK

Hager, Maggard and Stoltz also praise UK for the research opportunities it affords students.

“I was surprised at how many undergrads get to do lab work here,” Hager said. “They have their own projects, just like graduate students,” which gives them a leg up on their training.

Maggard called the sheer abundance of research opportunities at UK mind-boggling.  “It’s like an all you can eat buffet – there’s plenty of opportunity for those who look for them.”

UK Vice President for Research Lisa Cassis has long advocated for an inclusive and collaborative research environment, encouraging senior principal investigators to invest in one-on-one mentoring for students of all genders and at all levels.

“People generally think of a researcher as a gray-haired gentleman in a white lab coat, but more and more we are seeing that younger people – both men and women – are the new face of research,” Cassis said.

Positive sense of community

Cassis explained that the collegial nature of research at UK has fostered an environment where scientists feel comfortable sharing their ideas and techniques with each other and with students, noting that UK even gives financial incentives to units that collaborate with one another.

“That sense of community trickles down to the younger scientists and even our students, who learn that teamwork helps us stay competitive.  Many universities do not have that culture – some places are so competitive that it’s taboo to walk into someone else’s lab – and that’s a real barrier to student learning.”

Next up for Alilain’s group:  looking for clinically relevant ways to activate this latent breathing network to mimic normal breathing rhythm in people with spinal cord injuries.

“This is always the hardest challenge: taking knowledge gleaned from the bench and successfully applying it to the human condition,” Alilain said.

But he – and the next generations of scientists who benefit from the early opportunities afforded them at UK – are up to the task.


Next steps:

stroke

Timing is everything when it comes to a stroke

Dr. Michael Dobbs

Dr. Michael Dobbs

Written by Dr. Michael Dobbs, a stroke expert at the Kentucky Neuroscience Institute and the director of the UK HealthCare/Norton Healthcare Stroke Care Network

A sudden onset of blurred vision, slurred speech, or numbness or paralysis in the face, arm, or leg can be indications of a stroke.

Many people experiencing these symptoms wait to seek help, but this can be a fatal mistake: The risks of permanent damage or death increase the longer treatment is delayed. In fact, six million people die and five million more become permanently disabled because of a stroke each year.

Nationally, the number of stroke deaths has declined, but in Kentucky, strokes are increasing. Yet stroke is a largely preventable disease: keeping blood pressure, cholesterol, weight and/or diabetes in check can greatly reduce the risk.

When a stroke occurs, however, the most important factor is time.

BE-FAST

Take preventive measures, know the symptoms and BE-FAST if you suspect a stroke.

Balance – Does the person have trouble walking or standing?

Eyes – Are there any changes to eyesight, such as blurry vision?

Face – Do the eyes or mouth appear to be drooping?

Arms – Does the person complain of arm weakness?

Speech – Does the person slur their speech or mix up words?

Time – If any of those signs are present, it’s time to call 911.

If you or someone you are with show any of the above symptoms, call 911. It’s better to have a false alarm than to delay any treatment.

As with any medical issue, prevention is key in avoiding a stroke. High blood pressure and cholesterol are two main risk factors. Engaging in regular physical exercise, quitting smoking, and cutting back on salty and/or fatty foods can make a big difference.

Stroke Care Network

The Stroke Care Network, a partnership between UK HealthCare and Norton Healthcare, is an affiliation of 34 regional hospitals dedicated to the highest-quality stroke care. Based on extensive research, the Stroke Care Network has developed a system of care that provides prompt diagnosis and treatment to minimize the damage a stroke can cause.

A key step in stroke diagnosis is a computerized tomography (CT) scan to find bleeding in the brain or damage to the brain cells. Since 2015, the time it takes to get a CT scan read by doctors and begin a treatment plan has decreased from 52 minutes to 39 minutes in a Stroke Care Network hospital. Clot-busting medication may reduce long-term disability, but is only available within a few hours of the first symptom.


Next steps:

Do you know what a stroke is?

A stroke happens when an artery that carries blood from the heart to the brain bursts or is blocked. This means that part of the brain does not get the blood and nutrients it needs, so it starts to die. When this happens, abilities caused by that area of the brain, like memory or muscle control, are lost. There are three main types of stroke.

Ischemic stroke is the most common. It happens when an artery in the brain is blocked, and there are two types:

  1. Embolic stroke is when a blood clot or plaque forms and moves through the arteries to the brain. Once in the brain, the clot blocks a blood vessel and leads to a stroke.
  2. Thrombotic stroke is when a blood clot forms inside an artery that takes blood to the brain. This interrupts blood flow and causes a stroke.

Hemorrhagic stroke, less common than ischemic stroke, happens when a blood vessel in the brain bursts and spills blood in or around the brain. There are two main types:

  1. Intracerebral hemorrhage is when a burst blood vessel bleeds into brain tissue. This causes brain cells to die and part of the brain to stop working correctly.
  2. Subarachnoid hemorrhage is when a blood vessel bursts near the surface of the brain and blood leaks in between the brain and the skull.

A transient ischemic attack (TIA), or mini-stroke, happens if an artery in the brain or one that goes to the brain is blocked for a short time. This causes temporary numbness, weakness or loss of vision, and it might cause trouble speaking or loss of balance.

Even though blood flow to the brain is only blocked for a short time – usually no more than 5 minutes, a TIA is a medical emergency and a serious warning sign that you might have a stroke.


Next steps:

stroke research

UK team first to offer innovative stroke care through clinical trials

The combination of a new clinical trial and a tissue bank is innovating stroke care and research at the UK. Led by a multidisciplinary team of clinicians and scientists, the two studies aim to develop new treatments using existing therapies that protect brain tissue after a stroke, and to learn more about the physiology of the event.

The MAVARIC (Magnesium and Verapamil After Recanalization in Ischemia of the Cerebrum) clinical trial leverages existing standards of care and approved drugs to improve how the brain heals following a stroke. The related BACTRAC (Blood and Clot Thrombectomy Registry and Collaboration) study is developing a tissue bank of thrombi (stroke-causing clots) and distal and peripheral blood to examine the immediate molecular changes that occur at the stroke site. Both the MAVARIC trial and the BACTRAC study are the first of their kind.

The burden of stroke is especially severe in Kentucky, where it’s the third-leading cause of death (compared to fifth nationally) and occurs at earlier ages than in the rest of the country. Globally, stroke is the leading cause of morbidity and physical incapacity.

Despite the prevalence of stroke, current standards of care include only two potential treatments. One is a drug called tPA, which, if administered quickly enough, can break up the clot that caused the stroke. This treatment, however, has a limited window of opportunity – three to four and a half hours – and can exacerbate injury if delivered too late. The second treatment option is a thrombectomy, where the clot that caused a stroke is physically removed through a catheter inserted into the blood vessel. The therapeutic window for thrombectomy is much longer, sometimes up to 24 hours.

Even with the advances of tPA and thrombectomy, which can be highly effective in removing the cause of the stroke, neither therapy treats the injury inflicted by a stroke.

“Thrombectomy has become common and widely effective, but only 60 to 70 percent of patients will be independent in three months – so there is more to be done,” said Dr. Justin Fraser, director of cerebrovascular surgery at UK and one of the principal investigators of the MAVARIC trial.

Leveraging existing drugs and modalities

In the hope of improving stroke outcomes by treating the injured area of the brain, Fraser partnered with Dr. Gregory Bix, director of the UK Center for Advanced Translational Stroke Science, to look at repurposing existing drugs that, in combination with thrombectomy, could limit brain tissue damage and promote healing in stroke survivors.

“After the clot is removed through the catheter, there’s immediate access to the site in the brain where the injury is occurring. We’re taking therapeutics that already exist and putting them into the catheter immediately after we remove the clot, so that the drug is delivered directly to the stroke-affected area of the brain,” Bix said.

Fraser and Bix began by repurposing an existing calcium channel blocker called Verapamil, which is mainly used to treat heart arrhythmias but is also FDA-approved for use to relax brain blood vessels that contract after a thrombectomy. Fraser noticed anecdotally that patients who received Verapamil during a thrombectomy had better outcomes than their imaging and symptoms would have predicted.

In a previous preclinical study and Phase I trial – the first in the world to pair thrombectomy with immediate, intra-arterial administration of a neuroprotective drug – Fraser and Bix found that intra-arteria delivery of Verapamil was safe. Furthermore, in cell culture and animal models of stroke, it was effective in preventing significant ischemia-induced injury. But they also understood that Verapamil alone wasn’t addressing the complex process of damage caused by stroke.

“There’s not going to be a single magic bullet in terms of drugs. When someone has a stroke, multiple pathways get activated and damaged. If you give a drug that addresses only one pathway, it doesn’t treat everything. So we need to try combining drugs,” Fraser said.

MAVARIC clinical trial

In the MAVARIC trial, which opened in October, Fraser and Bix are investigating whether combining magnesium with Verapamil can bestow even greater neuroprotective benefits. Magnesium has previously been studied for its potential to protect the brain after a stroke, but this trial is the first to intra-arterially deliver a neuroprotective “cocktail” to the stroke site. A total of 30 stroke patients will be enrolled; stroke size, safety, and functional and cognitive outcomes will be evaluated through randomized, blinded outcome assessment.

“By using the catheter that was inserted to remove a clot, we’re then able to deliver neuroprotective drugs directly into the brain tissue that was just reopened,” Frasier said.

The combination of Verapamil and magnesium was first validated in preclinical models before moving to a clinical trial.

“When I used these two drugs in experimental stroke models, it demonstrated very cleanly that there was a significant reduction in mean infarct volume – in other words, smaller strokes – as well as better functional outcomes. We were the first to model this completely in lab animals,” Bix said.

Because the trial uses existing FDA-approved therapeutics and modalities, the research team can conduct animal model and clinical research simultaneously, allowing them to refine the animal model as they learn more through the clinical research.

The trial also includes collaboration with Kentucky Appalachian Stroke Registry, which will enable analysis of thrombectomy and severe stroke patients who might have been candidates for the new procedure, as well as analysis of a rare but increasing stroke condition called moyamoya.

Support for the MAVARIC trial comes from the UK Multidisciplinary Value Program, which funds investigator-initiated clinical trials at UK through support from the College of Medicine, the Office of the Vice President for Research, and the Center for Clinical and Translational Science.

BACTRAC study

Leveraging thrombectomy technology even further, Fraser, Bix, and Keith Pennypacker, PhD, professor of neurology and associated director of the UK Center for Advanced Translational Stroke Science, are developing a stroke tissue bank that will greatly enhance stroke research through increased molecular understanding of the injury. The BACTRAC study is the first to collect and analyze both the stroke clots and surrounding blood. The samples are obtained as a matter of standard thrombectomy procedure and require nothing additional. The process does, however, rely on a highly collaborative process of tissue collection and informed consent that will enable inclusion of nearly every thrombectomy case at UK.

“We have a pager – we call it the Thrombectomy Pager – and when it goes off, everyone involved swarms together. One of the people who carries a pager is a researcher who will come in and process the samples on the spot. There’s centrifuge right outside the angio suite,” Frasier said.

Clot and blood samples are analyzed to examine protein, genetic and blood gas changes that occur at the stroke site. From early analysis of their first samples, the team is already noticing surprising changes in the blood and tissue where strokes occur. The observations could eventually allow for more targeted treatment of strokes.

“We’re getting the first glimpse of molecular events that are occurring due to the stroke, and some of these events are involved in signaling the immune system,” Pennypacker said. “The inflammation response is essential for the healing of the injury, but sometimes it can overreact and cause additional damage. So if we can get a handle on these molecular events, we can possibly eliminate the molecules that cause excess damage without blocking the beneficial immune molecules.”

In analyzing the first samples they collected, the team has observed calcium depletion in the blood and blood vessel distal to the clot, as well as changes in protein and RNA related to gene expression.

“We’re discovering things about stroke that no one knew six months ago – incredible changes even in single samples that could really help us understand stroke on the very acute, early side of things, which has been very difficult to study until now,” Fraser said.

Eventually, they hope, the BACTRAC study will include enough stroke cases that researchers will be able see how stroke affects people differently based on age, sex and other health conditions, such as obesity or diabetes. One limitation of current stroke research is that animal research models use predominantly young, homogeneous male mice, whereas the human population that experiences stroke is older, less healthy and much more diverse.

Such a diverse patient population is one of the main problems in finding a cure for stroke.

“In basic science animal models, we mostly use a homogeneous population, and we’ve found that they’re receptive to experimental therapies in ways that we don’t always see in humans,” Pennypacker said. “But, if we have a huge database with thousands of patients that allows us to pull out various groups and see the differences in their response to stroke, it could give insight into different treatments that work better for people based on age, sex and other health conditions.”

Initial support for the BACTRAC tissue bank comes from the UK Department of Neurology Pilot Grant Program, which funds investigator-initiated pilot studies. Further grant applications are currently underway.

Translating discoveries through team science

The multidisciplinary innovations of the MAVARIC and BACTRAC studies, which unite patient care and lab research, depend on the combined expertise of scientists, clinicians and research staff.

“There aren’t a lot of places in the U.S. that have this translational integration for stroke between basic research and clinical research,” Bix said. “What makes an academic medical center special is that we are at the cutting edge of developing new therapies. Where’s the next cure going to come from? A place like UK – an academic medical center running clinical trials it has developed itself, where people are pushing the envelope.”

To learn more these studies, visit the MAVARIC and BACTRAC clinical trial webpages.

As a designated Comprehensive Stroke Center by The Joint Commission, UK HealthCare is distinguished from other stroke centers for meeting the highest standards of care to receive and treat the most complex stroke cases.

The Multidisciplinary Value Program supports innovative, multidisciplinary clinical trials at UK. Learn more here.


Next steps:

  • Researchers are working hard to identify new treatments and strategies to improve health, but they need healthy participants and those with medical conditions to participate in clinical studies. Find out how you can participate in clinical research at UK HealthCare.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.

How a Markey lab is helping stroke patients

When George Quintero first heard about a new clinical trial that could improve motor function in stroke patients, he knew he had to find a way to bring it to UK HealthCare.

Quintero, a research analyst for the UK Department of Neuroscience, first obtained a list of criteria to apply. The phase II trial required a physician with experience in frame-based surgery, which was easy for UK to fulfill: Dr. Craig van Horne, a neurosurgeon for the Kentucky Neuroscience Institute, has been performing this style of surgery on neurology patients for more than 20 years.

The second required element was a bit trickier. To be a treatment site for this innovative trial, the stroke team needed resources and buy-in from a stem cell lab with specific cell processing skills near the hospital.

“Originally, we thought we just needed a cell lab,” Quintero said. “We realized we didn’t have any experience in the sort of cell delivery we needed. My background is basic sciences and I have a plain cell lab, so it wouldn’t be sufficient.”

Finding the right lab

Quintero hunted for an appropriate lab across the city, beginning with UK’s Center for Clinical and Translational Science (CCTS). He combed through the work of individual investigators, and then tried to identify facilities around town that would have the means and experience to carry out the specific stem cell work needed for the trial.

After running into several dead ends, he stumbled upon the idea of bone marrow transplants, which use stem cells collected from bone marrow to repopulate the blood after aggressive treatment for blood cancers. Quintero finally had a lead: Just across the street from KNI, the UK Markey Cancer Center’s Blood and Marrow Transplantation (BMT) Program performs upward of 100 bone marrow transplants for patients each year.

Quintero reached out to Dr. Gerhard Hildebrandt, division chief of Hematology and Blood and Marrow Transplantation at UK. Although the work required was unrelated to the usual duties of the stem cell lab, Quintero says Hildebrandt was on board with the project.

“He was very excited,” Quintero said. “He thought that sort of stem cell delivery for neurological diseases would be a really advantageous thing for UK to have. So he was an early supporter of us moving forward, and he got me in touch with the group at the cell lab.”

Working together to improve patient care

Tucked away on the second floor of Albert B. Chandler Hospital, the three staff members of UK’s stem cell lab – lab manager Rita Hill and medical technologists Martha Pat Kinney and Giovi Hidalgo – quietly and efficiently go about their work of preparing stem cells for bone marrow transplant patients at the UK Markey Cancer Center.

Overseen by Dr. Roger Herzig, medical director of Markey’s Blood and Marrow Transplant Program, the lab processes stem cells for both autologous transplants – those using the patient’s own stem cells – and allogenic transplants, in which stem cells harvested from related or unrelated donors are used.

When presented the opportunity to help KNI participate in this trial, Herzig was immediately interested, having previously collaborated on other projects at UK HealthCare. Hill says the team wanted to help but had some initial reservations because of their already busy workload – to do the study, the Markey stem cell team would have to take on additional work outside of their usual service area.

“I first met Dr. Quintero and he gave us a protocol to look at, and wanted to know if we were interested,” Hill said. “We thought, ‘Yes.’ But there is a time constraint and with the BMT program rolling, we weren’t sure if we could really support it.”

For the trial to work, the stem cell team would have to work closely with Quintero and van Horne to ensure seamless patient care. The lab would receive genetically modified stem cells from the pharmaceutical company, process the cells for implantation per trial protocol, and deliver them to Quintero. Once he signed off, van Horne would initiate the procedure by drilling a small hole into the patient’s skull and injecting the stem cells into the brain. Because most of the patients in the trial would be traveling long distances just for this procedure, it was essential to have the process streamlined and efficient from start to finish.

“An idea is pretty easy to have and say, ‘Let’s do this!'” van Horne said. “But when you realize all the work that has to go into these things, it’s phenomenal.”

First, scheduling was key. Hill says Quintero and van Horne were willing to be flexible on the timing of when they could bring in patients, and they worked out a schedule that wouldn’t conflict with their normal duties for Markey.

Secondly, Hill and her team looked closely at the protocol, and noted some small elements of the process that could be improved. After several conversations, the company sponsoring the trial even adopted Hill’s suggestions and implemented them at other trial sites nationwide.

“One of the advantages of having Rita is that she has a lot of expertise in managing cell labs and the requirements of cell processing,” Quintero said. “She sort of gave some direction that the study needed, and the study welcomed that because they wanted the input from individuals to make the project better.”

Culture of collaboration

This recent trial is yet another example of what van Horne describes as “the proliferation of collaborative culture to solve human problems” across UK’s academic and healthcare campuses.

“One of the things that I think is unique about UK is there’s really a culture of collaboration,” van Horne said. “I’ve previously been in other institutions where that culture doesn’t exist… It’s not, ‘This is too much, we just can’t do this,’ but ‘Oh, that’s a great idea, let’s figure out a way to make that work.’ And everybody stepped up and pitched in and made it happen.”

“This kind of collaboration is what keeps making the research and the medicine new,” Herzig said. “And that’s what keeps me coming back to work.”

It’s not the first time the stem cell lab has stepped up to help other across the medical campus. They’ve previously assisted with stem cell research in nephrology and cardiology. Participating in these outside projects has helped the team learn more about what properties stem cells possess aside from the ability to reconstitute blood, which may prove useful in future endeavors.

“Part of the academic mission is collaboration; that allows us to tackle problems that individually we can’t do,” Herzig said. “You never know what technique you have today that you’ll be able to transfer to a different situation tomorrow. The things that we’re learning from this are probably going to be helpful in other future projects.”

Hill and her team spend most of their working time in the lab, but they do personally deliver stem cells to the bone marrow transplant patients who are preparing to undergo their infusions, giving them a brief encounter with the person who will be benefiting from their work. In addition to simply “enjoying the science” of this new project, Hill says the idea of helping even more patients provides some extra personal motivation.

“Who knows, you could have a family member or loved one later on who suffers from a stroke, and this trial could benefit them in the future,” she said. “Why wouldn’t you want to help?”


Next steps:

  • Researchers are working hard to identify new treatments and strategies to improve health, but they need healthy participants and those with medical conditions to participate in clinical studies. Find out how you can participate in clinical research at UK HealthCare.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.