Can science help clinicians rewire damaged brains?
Medical school researchers are hopeful that innovative tools will help them discover how patients recover from strokes.
Like engineers can redirect a river around a rockslide, clinicians may be able to help a brain damaged by a stroke switch to undamaged neural tissue, allowing for a more complete and successful recovery.
But first they have to figure out what kind of signal forces the brain to select a more effective option. Where does this signal originate? And can it be used to improve outcomes for those with damage to the brain?
UNC School of Medicine faculty members Adam Hantman and Ian Shih, along with John W. Krakauer from Johns Hopkins University, are working to answer these questions thanks to a $1.3 million grant from the W.M. Keck Foundation. The foundation has funded pioneering research in the sciences and medicine for 70 years.
The grant, Hantman noted, “offers us a runway to fully explore this idea, even though we’re starting from a pretty basic position.”
Hantman and his team have used a noninvasive technique on mice, known as optogenetics, that involves focusing a tiny beam of light on one part of the cerebral cortex that temporarily shuts it down. (Jeyhoun Allebaugh/University Development)
Basic science and seeking answers
To revisit the analogy of the blocked river, it’s clear that having engineers create a new, controlled channel could effectively bypass the rockfall and restore the river. But how do the engineers find out about the problem in the first place?
Krakauer, one of the principal investigators and a renowned expert in stroke recovery, notes that a huge amount of research has been done in this area, but without really finding the answers.
With new tools at hand and by asking the questions differently, Krakauer said, “this is a chance to ask a lot of seemingly simple, basic, fundamental questions and revisit them in a kind of 2.0 version.”
By developing tools and a study protocol to examine the very fundamentals — the whats, hows, wheres and whys of the switch in the brain that triggers a move to undamaged circuitry — the researchers are hopeful of a high level of applicability to human stroke recovery. Even though the type of damage may be different, they anticipate important similarities in the brain’s response.
As Krakauer explained, “the hope is that the basic science you’ve unearthed will give you an idea as to what to do to make people better.”
Song (left), a research scientist, and Albert (right), a postdoctoral fellow, work on a device that uses an MRI machine to image the brains of mice. (Jeyhoun Allebaugh/University Development)
Cautious optimism for pioneering applications
The project is still at an early stage, but Hantman, Shih and Krakauer believe it has the potential to yield important findings in stroke recovery by better discerning the underlying mechanisms in the brain.
One physician who agrees with this view is Dr. David Hwang, a professor in the UNC School of Medicine neurology department, who is not involved with the project. Much about the process of how brain function recovers after a stroke is not yet understood, he said, which leads to limited interventions to improve recovery.
“The knowledge from this project could lead to new treatment approaches down the road for improving stroke recovery,” he said.
Noting especially the paradox of higher levels of impairment leading to better recovery outcomes, he added, “one could imagine therapies for human stroke patients in the future where perhaps specific areas in their brains affected by stroke are actually further deactivated using noninvasive tools — in order to encourage their brains to utilize their other healthy areas to improve overall neurologic function.”
By overcoming practical challenges and creating an innovative approach, and with the critical support of the W. M. Keck Foundation’s grant, the researchers hope to make real progress in the field as they gain new insights into fundamental communication between different regions of the brain.
