Stroke Association Margaret Giffen Reader Award
This Lectureship award is kindly supported by the Margaret Giffen Charitable Trust.
Around 1 in 10 strokes are caused by bleeding in the brain. This is called an Intracerebral Haemorrhage (ICH) – a type of haemorrhagic stroke. Strokes caused by bleeding are generally more severe than those caused by a blockage (ischaemic stroke) and are associated with a considerably higher risk of dying. Around a third of patients don’t survive longer than one month, and many remain dependent on others.
This Lectureship has two main objectives:
- Develop new anti-inflammatory treatments for ICH.
- Improve the delivery of standard care for ICH patients.
Developing new anti-inflammatory treatments
Inflammation is a normal biological process which helps to protect our bodies from infection or damage. After a stroke there are higher than normal levels of inflammation in the brain. Rather than protecting it from further injury, this inflammation can lead to swelling in the brain, causing further damage. This may result in more severe disability and increased risk of death after stroke.
A protein called interleukin-1 (IL-1) is a molecule in the body that causes inflammation and has an important role in tissue damage worse after ICH. The inflammatory effects of the IL-1 are blocked in the body by another molecule – Interleukin-1 Receptor antagonist (IL-1Ra). An artificial version of IL1-Ra is licensed as a drug treatment for some inflammatory conditions, such as rheumatoid arthritis. It has also been shown to lower markers of inflammation in the blood of stroke patients in previous research.
One of the pieces of work that Dr Parry-Jones will undertake during his Lectureship will investigate whether IL-1Ra has an effect on levels of inflammation and swelling in the brains of ICH patients. It will also look at whether IL-1Ra improves recovery at six months after ICH. He hopes that by reducing inflammation in the brains of ICH patients, there will be less swelling. This should result in less damage being caused to the brain in the days and weeks after stroke.
Improving the delivery of standard care for ICH patients
Previous work carried out by Dr Parry-Jones combined three standard treatments for ICH patients into the ‘ABC hyperacute care bundle’. This was introduced at three stroke units in the Greater Manchester area between 2015 and 2017. Results have been promising. At one hospital, the number of deaths by 30 days after ICH was reduced, saving around two lives every month.
The ABC care bundle will now be introduced in hospitals across the NHS in England through the National Stroke Programme. Dr Parry-Jones will evaluate the national roll-out of the ABC bundle to see whether it reduces deaths, improves recovery and is good value for money for ICH patients.
Although ICH is a major health problem in high-income countries such as the UK, 80% of cases of haemorrhagic stroke across the world happen in low and middle income countries (LMICs). This work will also investigate the changes that need to be made to the ABC bundle so that it can be introduced in LMICs.
This research aims to improve outcomes for ICH patients by improving the treatments available and the care given, not only in the UK but around the world.