Strokecast

Episode 042 — Meet Dr. Dileep Yavagal

In Episode 035 back in October, I talk with Dr. Nirav Shah about the general state of stem cell therapy for stroke survivors. Afterwards, Nirav connected me with the lead researcher on the University of Miami’s stem cell research team, Dr. Dileep Yavagal so I could talk to him about his research. That brings us to today’s episode.

Dr. Yavagal specializes in vascular neurosurgery. That includes procedures like thrombectomy, where a doctor inserts a catheter into a blood vessel in the groin to go up into the brain a pull out the clot. Mechanical thrombectomy can be done up to 24 hours after stroke symptoms begin, and it can have a tremendous impact on minimizing the damage from an ischemic stroke.

What it doesn’t do today is help patients recover from stroke. It means fewer brain cells die, but the dead and damaged ones don’t get any help. When we say time is tissue or time is brain, this is why. Every minute that a clot blocks a vessel, more brain dies. To recover functionality today, we rely on neuroplasticity. PT, OT, Speech therapy, home exercises, eStim, SSRIs, acupuncture, and more therapies are all about encouraging the brain to rewire in such a way that we can work around that dead spot in our heads.

But what if there was another way?

That’s the question stem cell therapy tries to answer.

Stem cells, as you may recall from my chat with Nirav, are cells that can become other cells. Embryonic stem cell are the ones we here about in the news, but not the ones used in the trials today. These are critical in embryos because those stem cells turn into all the other cells in our bodies — nerves, muscle, brain, heart, left pinky, etc.

Adults have stem cells, too. The most common source is our bone marrow — the soft tissue inside our bones where the body actually creates blood. Research is now looking at how we can use the stem cells to drive the growth of fresh neurons in the brain.

There are two major approaches in the research, today. The Stanford study demonstrated the safety of its procedure in a small study, but more work is being done to test the effectiveness. That process focused on chronic stroke survivors — those several years post stroke. In that study, researches a hole in the skull to inject the patient’s own stem cells into the damaged area. Results are preliminary, but promising.

'Essentially the approach in concept is to enhance mother nature -- enhance the biology of repair -- by giving these cells.' -- @dyavagal #stroke #stemcells Click To Tweet

Dr. Yavagal’s work at the University of Miami is different in several ways. First, his work is focused on using stem cell therapy within the first day or two of the onset of symptoms. Secondly, his work relies on donor stem cells since the patient’s own stem cells are not available in quantity right after the stroke. Third, his procedure involves delivering the cells to the brain through a catheter, similar to that used during thrombectomy or used to repair an aneurysm. His results are also quite prom, and he’s preparing the next phase of study to move the science along and develop safe, effective treatments.

'We could have this (stem cell) therapy given to patients in the next 2-3 years.' -- @dyavagal #stroke #stemcells Click To Tweet

The key question we always ask is, “When will this therapy be available?”

The answer is we are not there today, despite the clinics popping up claiming to offer the therapy. However, it appears we are 2-3 years out if things go well, or potentially 4-5 years out if they don’t.

In addition to his work with stem cells, Dr. Yavagal is also one of the leaders of the Thrombectomy 2020 program — an international initiative to reach 202,000 thrombectomies a year by 2020 and to continue doubling after that. There are communities in the US and around the world where this therapy is simple not available, and yet it can be such an extremely powerful way of reducing the disability caused by stroke, saving hundreds of thousands of people from having to deal with the deficits of stroke and saving billions of dollars in healthcare and disability expenses. We’ll talk more about Thrombectomy 2020 in a future episode.

Who is Dr. Dileep Yavagal?

Dr. Yavagal headshotDr. Dileep R. Yavagal, MD, FAHA, FAAN, FSVIN is the Director of Interventional Neurology and Co-Director of Neuroendovascular Surgery at the University of Miami & Jackson Memorial Hospitals and Clinical Professor of Neurology and Neurosurgery at the University of Miami School of Medicine. He has recently been appointed to lead the Neurological Cell Therapy Platform at the Interdisciplinary Stem Cell Institute at the University.

Dr. Yavagal is an international thought leader in endovascular therapy for ischemic and hemorrhagic stroke as well as a pioneer in the translation of intra-arterial delivery of cell therapy for stroke. He was the national Co-PI of the first US multicenter clinical trial of Intra-arterial delivery of autologous bone marrow stem cells for ischemic stroke: RECOVER Stroke. He was on the on the steering committee of the SWIFT-Prime and MR RESCUE, both landmark randomized clinical trials of endovascular stroke therapy. He co-authored the landmark 2015 AHA Endovascular Stroke Therapy Guidelines as well as the recent groundbreaking DAWN stroke trial in the New England Journal of Medicine. He is the founder and Past-President of the Society for Vascular and Interventional Neurology (SVIN). He has also co-authored the AHA Policy statement on Stroke Systems of Care.

Dr. Yavagal has received several state and federal research grants to study endovascular stem cell therapies for ischemic stroke using small and large animal models of stroke in his research laboratory. He is considered a pioneering researcher the field of intra-arterial delivery of stem cells in stroke therapy.

Hack of the Week

As we head into the gift giving season, we have to start thinking about how to wrap presents. Wrapping paper is great when you have 2 functional hands or you use some sort of gift-wrapping service. If you have just one functional hand, it can be more challenging. You can find videos on YouTube demonstrating one-handed techniques, but I prefer the simpler way.

Gift Bags!

Seriously, make it easy on yourself and uses theses fancy mini shopping bags. Add some tissue paper to the bag, put the gift in, the lightly crumble some more tissue paper to put on top. Then you’re done. If you’re feeling really ambitious, you can tie the handles together with ribbon.

Links

Dileep Yavagal on Twitter

https://twitter.com/dyavagal

University of Miami Interdisciplinary Stem Cell Institute

http://www.med.miami.edu/isci/

University of Miami Department of Neurology

http://neurology.med.miami.edu/

Stem Cells: A Breakthrough in Stroke Treatment?

http://med.miami.edu/news/stem-cells-a-breakthrough-in-stroke-treatment

SWIFT-Prime study

https://clinicaltrials.gov/ct2/show/NCT01657461

Thrombectomy 2020

https://www.svin.org/i4a/headlines/headlinedetails.cfm?id=37

Dr. Seth Finklestein

https://www.massgeneral.org/doctors/doctor.aspx?id=16597

Stroke Episode 035 — Stem Cell Therapy and Stroke Recovery

http://strokecast.com/2018/10/12/episode-035-stem-cell-therapy-and-stroke-recovery/

Strokecast Episode 040 — Meet Dr. Kimberly Brown

http://strokecast.com/2018/11/16/episode-040-meet-dr-kimberly-brown/

Clinical Trials

http://clinicaltrials.gov

PubMed

http://pubmed.com

Stanford Stem Cell Study Announcement

https://med.stanford.edu/news/all-news/2016/06/stem-cells-shown-safe-beneficial-for-chronic-stroke-patients.html

Where do we go from here?

 

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

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