Disaster Relief for Brain Cells

Thanks to the work of a Canadian neurology professor leading to a clot-busting drug, some stroke sufferers can walk home the next day.

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When someone suffers a stroke, there is a precious window of time for doctors to administer tPA, a clot-busting drug that can transform a stroke from being an event that triggers a lifelong handicap to one that patients can recover from. Some can even walk home the following day.

Antoine Hakim, professor of neurology at the University of Ottawa, received the 2017 Canada Gairdner Wightman Award for the pioneering research that led to this breakthrough.

During a stroke, a blood clot disrupts the flow of blood to part of the brain. Deprived of oxygen and nutrients, brain cells start to die.

“Think of it like you would of an earthquake,” says Hakim. “In the middle, the buildings are crumbled. No one will ever live in them again. But just outside of that, the buildings, the walls are cracked. The buildings are eventually going to crumble unless you hurry up and go in there, and strengthen those walls back up into good function.”

Initially, it was believed that the damage caused by a stroke was immediate and beyond repair. Hakim showed that there was still a critical region, the penumbral region just outside the core of the stroke, where surviving cells were holding their breath, weakened but waiting for rescue.

“So we actually study patients, to whom I owe an incredible debt of gratitude, who had just suffered a stroke a few hours before, brought them into imaging and studied what was going on, and confirmed that in fact that region that is affected doesn’t immediately die. It’s not working, it’s resulting in deficits, but it’s alive,” says Hakim.

“All of a sudden, we had work to do.”

This new understanding led to the development of a clot-busting drug, one that could restore blood flow to the stroke region and help surviving cells recover. Hakim also led the creation of the Canadian Stroke Network, helping shift longstanding practices in stroke treatment to incorporate this new drug into acute stroke care.

“That is a beautiful Canadian invention,” says Hakim. “Bringing science to the public, switching stroke from a lifelong handicap to a temporary problem that you can walk away from has been a major achievement that I will always be very proud of.”

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Antoine Hakim is one of Canada’s most distinguished scientists, who has earned a world-renowned reputation for his leadership in neuroscience research with an emphasis on stroke research. In the early 1980's, Hakim characterized a penumbral region around a stroke’s ischemic core — brain tissue with enough energy to survive for a short time after blood loss and with the potential to regain normal function if blood flow was restored. Hakim, who joined the University of Ottawa in 1992, led the charge to set up the Canadian Stroke Network, a network of centres of excellence; he then partnered with the Heart and Stroke Foundation and other organizations to develop and apply a nation-wide Canadian Stroke Strategy. This work was critical to changing attitudes towards strokes, which went from being a devastating condition to one that is preventable, treatable and repairable. In 2006, Dr. Hakim and colleagues published the first ‘Canadian Best Practice Recommendation for Stroke Care’ (updated in 2008, 2010 and 2012) and developed performance indicators and toolkits for healthcare providers to set up stroke units and improve emergency medical services. They also instituted a multi-layered national education program to enhance stroke prevention and the delivery of acute stroke care through the coordination of services and the implementation of best practices. Within five years of the Strategy’s implementation, Ontario alone saw referrals to stroke prevention clinics increase by 34% and stroke patient admissions decrease by 11%.

Research2Reality is a groundbreaking initiative that shines a spotlight on world-class scientists engaged in innovative and leading edge research in Canada. Our video series is continually updated to celebrate the success of researchers who are establishing the new frontiers of science and to share the impact of their discoveries with the public.