The blood supply for the interior of the brain comes from large blood vessels which enter the brain tissue and divide and get smaller. They continue to branch, becoming smaller blood vessels called arterioles, and finally capillaries, at which point nutrients from the blood pass into the brain tissue. The capillaries then begin to join up again to form blood vessels called venules which take blood away from the brain.
Arterioles, capillaries and venules can be affected by a disease process called cerebral small vessel disease (SVD), which damages the deeper parts of the brain known as the white matter.
This white matter damage can be seen on brain scans, particularly magnetic resonance imaging (MRI) and is very common; being seen in almost half of all people with dementia, including Alzheimer's disease and vascular dementia. However, the picture is complicated as this white matter damage is also seen in other conditions including various types of stroke, in people with depression, and also seen with ageing in people without obvious cognitive (memory and thinking) problems.
To adequately study why and how SVD damages the human brain (a process known as pathophysiology) we need to look at human brain tissues affected by SVD at different stages of brain injury. Animal models in the lab are of limited use, as animals do not get SVD and the models being used are genetically modified to have some aspects of the human disease, but do not encompass the whole picture.
What is the research aiming to do?
The aim of this research programme is to develop a human brain bank to support biomedical research into the pathophysiology of human SVD that may be used nationally and internationally.
The programme will have access to information from several clinical cohorts of patients who have donated their brains after their death (post mortem). However, simply having access to brain tissue after death is not sufficient to achieve these goals.
The programme will therefore seek access to the lifelong medical records of individuals donating their brains, so that the risk factors they have been exposed to (such as high blood pressure, diabetes, obesity and smoking history) can be assessed. The aim is to link this information to investigations that have been undertaken during life, including brain scans (MRI) and blood tests.
As the access to patient data is very tightly controlled, this data needs to be stored in a secured site, known as a ‘data safe-haven’, and accessed only by authorised individuals. Researchers accessing the brain bank will need to be provided with tissues linked with associated clinical data (including age, sex, body mass index, smoking history, blood pressure) but in a confidential way; so that the researcher cannot work out the identity of the donor from the information provided.
What difference could this research make?
The programme should be able to offer biomedical research groups access to all aspects of human SVD, covering deep small strokes, brain haemorrhages, SVD with cognitive problems, and SVD with no cognitive problems.
Professor Colin Smith was awarded the 'Stroke Association & Medical Research Council Priority Programme Award' in 2017. Colin is pictured below (centre) receiving his award from Lady Estelle Wolfson and Professor Sir Mark Walport at our 2018 Keynote Lecture.