CUMC researchers were awarded a highly competitive stroke center research grant worth about $12 million over five years, making it one of the largest stroke grants CUMC has ever received. The grant provides support for three novel, translational research projects that rely on collaboration among a variety of departments in P&S, the Mailman School of Public Health and NewYork-Presbyterian Hospital. This will include the first study of high-dose statins for treating stroke.
This particular type of National Institutes of Health (NIH) grant, a Specialized Programs of Translational Research in Acute Stroke (SPOTRIAS) award from the National Institute on Neurological Disorders and Stroke, is the only new SPOTRIAS grant issued this year. Four other institutions have ongoing SPOTRIAS grants.
"The SPOTRIAS program is designed to reduce disability and mortality in stroke patients by promoting rapid diagnosis and effective interventions," says principal investigator Ralph Sacco, associate chairman and professor of neurology (P&S) and professor of epidemiology ( Mailman School). "It also requires a multidisciplinary approach, to bring together clinical researchers from different specialties to develop new stroke treatments and diagnostic approaches. CUMC is uniquely qualified to do this work because of the wealth of research talent we have."
The project, called the New York Columbia Collaborative (NYCC) SPOTRIAS, involves researchers and clinicians from neurology, emergency medicine, pathology, radiology, and cardiology in P&S and biostatistics, epidemiology and sociomedical science in the Mailman School and NewYork-Presbyterian Hospital. NYPH will apply the research results to help stroke patients throughout the more than 30 hospitals in the NewYork-Presbyterian Health Care System.
The grant consists of three research projects and four core organizational elements. The projects are a safety study of high-dose statin drugs -- typically prescribed to lower cholesterol -- as a stroke treatment; an fMRI study of brain changes during stroke; and a public education project to teach people at high risk how to recognize stroke symptoms and get care quickly. There are cores for patient access; biostatistics and data management; blood and tissue pathology; and career development, to train future translational stroke researchers.
The study of the safety of high-dose statins, the first project, is led by Mitchell S. Elkind, assistant professor of neurology, and evolved partly out of findings from another Columbia study, the Northern Manhattan Study (NOMAS). One NOMAS finding is that people already taking statins before having a stroke tended to have less severe strokes and a better recovery. Tests of high-dose statins as a stroke treatment in animal models have been promising. "In phase two of the project, we hope to conduct a randomized comparison of high-dose statins versus placebo," Sacco says.
Randolph S. Marshall, associate professor of clinical neurology, is directing the fMRI study to detect any changes in the brain shortly after the onset of stroke that can predict recovery. Marshall's preliminary studies have indicated changes on the other side of the brain from where the stroke occurs. If these alterations in the brain have functional significance, the researchers will investigate whether treatment can mitigate the brain injury.
The third project, the Stroke Warning Information and Faster Treatment (SWIFT) component, is lead by Bernadette Boden-Albala, assistant professor of sociomedical sciences in neurology. Its goal is to educate stroke and transient ischemic attack survivors so that if their symptoms reappear, they get into the hospital faster and know how best to navigate the emergency department.
"We want to see whether the people who receive the education will retain the information, and also whether they get into the hospital faster than usual," Sacco says. In the future, stroke prevention education will be offered to more people in the community to see if the information can help prevent stroke in people who have never had one.
Other key members of the multidisciplinary team include Josh Stillman, assistant professor of clinical medicine and a member of the emergency department; Howard Andrews, associate clinical professor of biostatistics; Myunghee Paik, professor of biostatistics; Jay P. Mohr, Sciarra Professor of Neurology; Stephan Mayer, associate professor of clinical neurology; and Daniel J. Fink, associate clinical professor of pathology.