Research in action
Delivering cutting-edge treatments to patients is a key motivation for neurology expert Associate Professor Neil Spratt.
More than 60,000 Australians suffer strokes each year and one-third of first-time sufferers die within a year. Clinician and stroke researcher Associate Professor Neil Spratt maintains that such grim statistics are all the motivation he and his colleagues in the University's translational research team need in their quest to develop urgently needed new treatments.
Spratt likes to use the case of a particular patient to illustrate the effectiveness of practice-driven research, which combines the benefits of scientific discovery and clinical observation.
"Three of our key research programs came together to ensure this patient's successful treatment," explains Spratt, a neurologist who leads the stroke translation laboratory within the School of Biomedical Sciences and Pharmacy at the University of Newcastle.
Thanks to a triage protocol instigated by the stroke research team that works across the University and the John Hunter Hospital (JHH), ambulance officers identified the 26-year-old patient as a candidate for time-critical treatment and expedited her transfer to the hospital, where Spratt was waiting in the emergency bay to assess her condition. The patient quickly underwent advanced CT perfusion imaging – a cutting-edge technique pioneered by the Newcastle research team to assess brain damage and determine a patient's suitability for clot-busting treatment. Then, she received the drug Tenecteplase (TPK) as part of a groundbreaking clinical trial – later published in the New England Journal of Medicine – that has shown it to be a more effective treatment than the standard medication, Alteplase (TPA).
From displaying poor speech and registering weakness down her whole right side on admittance, the woman was discharged three days later showing no obvious effects of the stroke. A happy ending for the patient but also, as Spratt points out, a great example of translational research in action.
"Combining clinical work with research allows us to more quickly move promising therapies from the laboratory into practice," he asserts. "We talk about the concept of 'bench to bedside' research but translational medicine is also 'bedside back to bench'. In this case we were able to see the direct results of those three research programs – the triage protocol, the CT imaging and the Tenecteplase trial – and that is very exciting and gratifying for a researcher."
Spratt, a neurology specialist at the JHH, is a key member of the Hunter Medical Research Institute (HMRI) Stroke Research Group. His team's current research into the use of body cooling to reduce the spread of brain injury in stroke victims has led to a breakthrough finding that could makethe treatment more viable for a much wider range of patients.
Cooling the body to 32-33 degrees Celsius for between 12 and 24 hours – effectively putting it into a state of hibernation – can stall the progression of brain injury and buy time for a blood clot to break up. The procedure is potentially life-saving, but putting the body into a prolonged state of hypothermia can produce severe side effects, including pneumonia or disruption to heart rhythm. As well, pressure within the skull (intracranial pressure) tends to rise sharply in stroke victims within 72 hours of the incident, and while cooling will reduce this pressure, it may return or go even higher once the patient's body is warmed up again.
Spratt and colleagues Dr Damian McLeod and PhD student Lucy Murtha have discovered, through laboratory work with animal models, that if the body is cooled for just one to two hours before the pressure within the skull has risen, there is no subsequent rise in pressure after the treatment, and less likelihood of other side effects.
"There are other research groups around the world looking at body cooling as part of stroke treatment but we are the only team to have honed in on the possibility that short-period body cooling can effectively prevent intracranial pressure rising, so it is a novel and very important discovery," Spratt explains. "Elevated intracranial pressure is a problem in many other diseases, too, so our findings may well have application in medical fields outside of neurology."
Spratt's team has received more than $422,000 from the National Health and Medical Research Council (NHMRC) to further its research, which he hopes will lead to full clinical trials within three years. He also holds a three-year NHMRC-funded fellowship to continue his work in the field.
Returning to Newcastle to pursue his research career gave Dr Neil Spratt the opportunity to link with leading researchers Professor Mike Calford and Professor Chris Levi, of the Priority Research Centre for Brain and Mental Health.
"I have great respect for both of them," Spratt states. "Both Chris and I trained at the National Stroke Research Institute (NSRI), in Melbourne, which has a very strong focus on 'bench to bedside' research, and even before coming to Newcastle I was collaborating with researchers in Mike's team of neuroscientists."
Spratt completed undergraduate studies in medicine and medical science at the University of Newcastle and undertook a PhD at the NSRI and the University of Melbourne. He returned to Newcastle in late 2006 to take up a Senior Research Fellowship sponsored by HMRI and the Greater Building Society. Spratt believes he has been fortunate to have had "wonderful mentoring" in Newcastle, nominating Calford and Levi as major influences, as well as senior neurologist Associate Professor Mark Parsons and neuroscientist Professor John Rostas.
"What has been important to my career is being part of this translational research team that works across the University of Newcastle, the hospital and HMRI. The clinical research in the hospital is world-class and is matched by the standard of scientific research.
"It is critical in my field to have that capacity to think about new ideas and collaborate with people in other disciplines. There is a culture here of hard work and high expectations and the physical proximity of the hospital and the University really facilitates those vital collaborations."