New hope for stroke repair
Stroke is the leading cause of disability in Australia with more than 250,000 people estimated to be living with the aftermath of strokes, but research at the University of Adelaide's Robinson Institute is providing new hope.
Research into the potential regenerative benefits of stem cells is advancing at an incredible pace around the world.
At the University of Adelaide, Associate Professor Simon Koblar is leading research on the use of stem cells from teeth to repair stroke-damaged brains.
"In Australia there are 60,000 strokes a year, 5000 in South Australia - one every 10 minutes," says Assoc. Prof. Koblar.
"After one year, one-third of those people will have died, one-third will improve, and the other third are left with a disability.
"The challenge to improve function after a stroke is enormous but there are huge potential benefits, not just to the individuals, but for the whole Australian community."
The research is being carried out in collaboration with Associate Professor Stan Gronthos from SA Pathology, who was one of the first to isolate stem cells from the dental pulp of adult teeth. Assoc. Prof. Gronthos is Co-Director and Assoc. Prof. Koblar is Clinical Advisor of the University's Centre for Stem Cell Research at the Robinson Institute.
A pilot study last year, funded by the Catholic Archdiocese of Sydney, investigated transplanting dental pulp stem cells into stroke-affected rats.
Preliminary data show promising results with improvement in mobility of the stroke-affected rats with stem cell transplants over the rats without the application of stem cells. The results are encouraging but more research needs to be done to prove the benefit in animal models before it can be trialled in humans.
Much has been heard about the use of embryonic and umbilical stem cells but this work is using adult stem cells. Stem cells can be found in various parts of the body including bone marrow, skin and teeth, and they have the ability to regenerate tissue of specific organs.
Research to date has shown that dental pulp stem cells, extracted from teeth, may prove more beneficial for brain repair than other types of stem cells.
"Stan Gronthos and I have been collaborating on this work over the past eight years and we've published several research papers showing that adult dental pulp stem cells have an intrinsic ability to produce neurones (brain cells) and to make a range of growth factors important in neural repair," says Assoc. Prof. Koblar. "Recent research showed that the nervous system of chicken embryos may even be rewired with the use of these stem cells."
Apart from this ability to naturally grow into neurones, whereas other stem cells naturally produce other tissue, there are other important potential benefits of dental pulp stem cells. Because they are in teeth, they are easily accessible and they can also be taken from the patient needing treatment, which potentially removes tissue rejection issues.
Depending on funding, the next steps in the research are another study with rats, due to start next year, and a two-to-three year project using sheep.
"We'll transplant sheep dental pulp stem cell into stroke-damaged sheep brains and may even do autologous (same animal) transplants," says Assoc. Prof. Koblar.
"If we can see benefit from a functional point of view in both rats and sheep, I think it could then be appropriate to proceed with Phase One clinical studies to ensure the safety of injecting stem cells into humans."
Simon Koblar is one of Australia's leading stroke physicians. He is Director of the University's Stroke Research Program, a Senior Consultant Neurologist and Patron for Stroke SA, a community-based service for stroke victims.
He trained at the Royal Adelaide Hospital as a physician and followed up with neurology training at Guy's Hospital in London. He did his PhD in neurobiology at the Walter and Eliza Hall Institute in Melbourne.
Ten years ago he returned to Adelaide, setting up the Stroke Research Program at the University of Adelaide, in collaboration with The Queen Elizabeth Hospital.
He maintains a clinical practice, teaches undergraduate and postgraduate medical and science students, trains physicians in neurology and heads a research group of 14 PhD and Honours students and postdoctoral researchers.
Over the past 10 years, Assoc. Prof. Koblar has been instrumental in setting up South Australia's stroke services. The state only has five stroke physicians and they have all been trained by him.
Assoc. Prof. Koblar believes the stem cell research has great potential to help stroke patients: "Even if all we can do is to get someone's hand function to improve, that would be a magnificent advance."
But, like all research, what can be achieved depends on funds raised.
The Robinson Institute is currently establishing a Foundation to raise awareness of and support its life-giving research programs. The Institute is currently working with University of Adelaide graduate and stroke victim, Peter Couche, to set up a fund in his name to help raise money for stem cell stroke research.
"Peter contacted me several years ago and we've become friends and meet regularly," says Assoc. Prof. Koblar. "He recognises the potential from stem cells and the great need for more research, and he wants to help."
Peter Couche graduated from the University of Adelaide with a Bachelor of Economics in 1971. At just 41 and a highly successful stockbroker, he suffered a brain-stem stroke in 1992 which left him a quadriplegic with 'Locked-In Syndrome' - he can't speak and has little muscle control.
Mr Couche lives in Adelaide with his wife Simona and, despite his massive disabilities, lives a full life and has until recently carried on a business practice.
His book Lifelines tells his inspiring story. Lifelines took 13 years to produce; writing and editing on a computer with his one-finger movement and with the help of readers.
In 2005, Mr Couche received stem cell treatment from a clinic in the Netherlands and he says he has benefited with regained muscle strength and flexibility, and swallowing ability.
"I have so much to look forward to, so many things still to achieve and I am growing stronger every day," says Mr Couche in his book.
"Of all the qualities with which I have had to arm myself, patience, persistence and a positive attitude have been the most important. And so is the life-giving power of laughter." ■
STORY ROBYN MILLS
For information regarding supporting the stroke research or other Robinson Institute research, please contact Alissa Nightingale (08) 8313 1334 or email@example.com
For more details about Associate Professor Simon Koblar research into stem cells and stroke repair visit www.adelaide.edu.au/researchtuesdays/