Katerina Sheardova, M.D., Ph.D. will now represent the Czech Republic on the European Academy of Neurology (EAN) panel on dementia. Her main goals within this platform include focusing on clinically available early biomarkers of the disease and strengthening research on lifestyle-related risk factors for dementia and promoting them as a preventive measure to the general public.
We asked in a short interview how these goals relate to research within the Cognitive Disorders and Dementia Research Team of the International Clinical Research Centre of St. Anne’s University Hospital in Brno (FNUSA-ICRC).
You have been researching neurodegenerative diseases for more than ten years. Are the goals you have set for yourself as a representative of the Czech Republic on the EAN Scientific Panel related to your existing research or is it an extension of it?
Yes, it is very closely linked. As an example, I will mention the Czech Brain Aging Study, which is a preventive study, involving people who already have a memory problem but have not yet developed dementia. The difficulties may be subjective or measurable by sensitive psychological tests, we call it mild cognitive impairment. We monitor over time how their memory deficit develops, how the MRI findings develop, and possibly biomarkers from their cerebrospinal fluid. We also focus on some lifestyle indicators, analysing, among other things, how lifestyle affects the rate of brain cell loss or the risk of dementia.
Another intervention study, the results of which we published in Clinical Interventions in Aging, I would like to follow up on, was on mindfulness, which is the ability to fully experience the present moment and to let go of emotions. It was specifically about Mindfulness-based stress reduction therapy, the use of this technique in stress management. It was an eight-week program for patients who were taught to use these techniques in their daily lives, to be mindful of the present moment and reduce stress, which is one of the most significant risk factors for neurodegenerative diseases. It is the reduction of these factors, which can be influenced during life, that we should focus on the most in order not to be at increased risk of dementia. In addition to stress, there is also depression and chronic inflammation in the body, which mindfulness techniques have an excellent effect on, as we have also published. In fact, dementia and neurodegenerative diseases in general are associated with chronic inflammation, which is increased in old age, so-called immunosenescence. When I say chronic inflammation, I mean an increase in markers that we can read in the blood, for example, the activation of certain types of lymphocytes, an increase in certain immunological factors… If we reduce stress, then in addition to inflammation, we also reduce the secretion of stress hormones, such as cortisol, which, when it acts chronically and for a long time, has harmful effects on our organs, including the brain. And if the hippocampus, which is related to memory implantation, is damaged, it can contribute to the development of Alzheimer’s disease. So, to summarise, the research that we are doing is related to the goals that I have set for myself in my role on the EAN dementia panel.
What about your latest research using organoids?
With organoids, which are defacto little brains, these little balls with a structure similar to brain tissue, we are looking at Alzheimer’s disease from a different perspective. Typical of this disease is a pathological cascade of protein clotting. One of these is amyloid, whose function is to protect the brain from infectious agents, i.e. viruses or bacteria. There is a theory that the action of a particular virus or pathogen may cause this protein to clot more than is permissible and thus trigger the pathological cascade. And we’re trying to find which pathogens that might be, and we’re using these “minibrains” to do just that.
So it’s like a cytokine storm, where the immune system overreacts?
Figuratively speaking, we also know that in general, in old age, originally functional proteins are more likely to precipitate, and this is not just amyloid, but also, for example, the Tau protein, which actually accompanies neurodegenerative diseases. So the object of the research is to find out why proteins start to precipitate, because then they stop working as they should. Because of this, cells then start to die, which is manifested by so-called atrophy, i.e. the loss of brain tissue in certain parts of the brain, which then manifests itself in different clinical symptoms, depending on which areas of the brain are most affected. Atrophy can be monitored by magnetic resonance imaging.
What impact do your areas of interest have on patient treatment?”
There is currently a great effort to find drugs that will stop the pathological cascade. But because this disorder starts maybe a decade before a person has clinical symptoms and goes to the doctor, the most important thing is to find these patients early. And this is related to my second goal, which is to find tests that are affordable, clinically accessible and have relevant results. Although we already have ways to test for these specific non-functional proteins, such as amyloid pet, which is an expensive imaging test that is not available to everyone, or they can be detected by lumbar puncture, which is invasive and unpleasant for the patient. The search for biomarkers in the blood is currently being developed so that it would be possible to detect the disease after a blood draw. Another very simple option is special, very sensitive neuropsychological tests that would detect this incipient deficit earlier than the conventional tests used now. Our team specializes in spatial navigation, where the inspiration was research on animal models, which we have translated for use for patients using computers as simulated orientation in an arena to test a person’s ability to reach a destination. Or there are those that combine multiple questions together, such as the FNAME test, where the patient is presented with faces to which they are assigned names and their occupations, and after a certain point the patient has to reconnect the faces with other information about them. There are more of these tests, it’s about finding the best ones.
If I can’t remember the name of a person I know for sure, is that a signal that I should start worrying?
Name dropping is a typical sign of aging, not a pathology. It’s a normal part of being age-related, something we probably all deal with. The test mentioned is not just about names, it is mainly testing the memorability of new information. Which is the problem with Alzheimer’s – we are unable to remember newly presented information. The people tested remember well what they have known for a long time, but they have an impairment in storing a fresh memory trace.
So what should be the main contribution of the topics you propose in the EAN dementia panel?
To summarise, the two aims are linked and should lead to early detection of neurodegenerative disease and then, based on research, to the recommendation of an appropriate therapeutic approach. The more distant goal is that these recommendations should not only serve to detect early those who are already ill, but should also help those who are at increased risk of, for example, Alzheimer’s disease, so that they can take effective measures, whether pharmacological or lifestyle measures, in order to prevent the disease from developing in the first place. I would like to be able to extrapolate the findings further, as prevention of neurodegenerative diseases for the general population.
How to become employer of choice in life science academia
Members of Alliance4Life recently conducted the mapping of best practices in career systems in life sciences research, including the self-assessment of human resources (HR) systems in twelve research organisations in Central and Eastern European (CEE) countries, and are committed to working hard to offer better conditions for the career development of their researchers. The detailed report presents a very useful set of best practices and is also freely available to other research organisations that are striving to improve their human resource practices in order to attract, develop and motivate talent.
The international alliance of twelve leading research institutions and universities operating in the field of life sciences have worked intensively for the past six months to perform self-assessment programmes in order to select best practices in HR areas. Members of Alliance4Life discussed the career systems applied at individual institutions and defined nine main priorities and areas of interest: 1) HR excellence in research-award implementation, 2) career development/system and career track, 3) mobility and internships, 4) strengthening of group leaders as managers, 5) recruitment: an increase of both quantity and quality of applicants, 6) internationalisation and recruitment of people from abroad, 7) welcome services and integration support, 8) diversity, equal opportunities, and women in science, and 9) culture in science, and culture of the institute as a HR tool.
Based on self-assessment, and with provided inputs by all partners, a summary of best practices in career systems in Life Science research was formulated. All partners were asked to discuss the career system in their institution and make a self-assessment in order to grade the proposed areas in three grades: missing system, basic and advanced.
Basic self-assessment confirmed that HR systems in research organisations in the CEE region are rather less developed. A positive aspect of this exercise was the realisation that in all nine HR areas, at least one institution was graded as advanced and can therefore share its best practices with the others. Among the least developed areas were: strengthening of group leaders as managers, welcome services for foreign employees and integration support, culture in science, and culture of the institute as a HR tool.
Out of all twelve partners of the A4L, six institutions are holders of the prestigious HR Excellence in Research Award. Out of six holders of the HR Excellence in Research Award, CEITEC MU and the Medical University of Lodz evaluated themselves as “advanced” in the system of the award implementation. CEITEC MU focuses on the overall organisation of the “HR Award” and presents the process from the decision to apply for the award, the application preparation and continuous work on the implementation of the action plan and its assessment. CEITEC has integrated the HR Award implementation into the standard operation of the institute. The Medical University of Lodz focuses on the implementation phase. As good practice they present the experience with a two-step study – quantitative and qualitative research, which was designed by the Department of Sociology of MUL and conducted among all stages of researchers at the university. FNUSA-ICRC received the HR Excellence in Research Award in May 2021. As of this date, it is officially in the implementation phase, but many of the planned steps began earlier. The main goal is not only to improve and set up HR processes in accordance with the Charter for Researchers and the Code of Conduct for the Recruitment of Researchers, but the whole process also includes the improvement of other areas such as science popularization, quality management system, implementation of project management tools and others.
The “career development/system and career track” area could be considered as the most advanced in Alliance4Life, measured by the highest number of advanced grades (three Alliance4Life members) and by the low number of “missing system” grades (two Alliance4Life members). CEITEC MU presents its formal career system and its practical implementation in the form of career development opportunities for various groups of researchers. LIOS also presents a structure and rules of its career system and adds two interesting tools (motivation system and internal grants for students). The University of Tartu presents how the university responded to the amendment of the national law, which gave universities more flexibility in developing career models, including the adoption of principles of retiring with the emeritus status.
Regarding mobility and internships, clear strategy, concrete goals and experiences are presented by the University of Tartu and by the Medical University Sofia. The University of Tartu emphasises that they signed a considerable number of bilateral partnership agreements with universities abroad which provide for exchanges of students and researchers, as well as other cooperation in teaching and research. Around 20% of academic staff participated in mobility; within various programmes, staff members travelling abroad in the year was close to 70%. The Medical University Sofia has officially signed more than 150 institutional agreements for academic exchange and 33 memorandums of academic cooperation. They present stages in the process of implementing the actions of mobility as well as consequences of good practices for the implementation of teacher mobility and overall cooperation between the universities. Since its establishment in 2011, FNUSA-ICRC has been working closely with the Mayo Clinic (Rochester, Minnesota, USA and Phoenix, Arizona, USA), where 236 FNUSA-ICRC staff members have already completed 236 work placements.FNUSA-ICRC also cooperates with other foreign partners and has many agreements in the framework of academic cooperation with universities in Europe, America and Asia. In 2019, 219 employees participated in training at foreign institutions, while in other years the number was lower mainly due to the Covid-19 pandemic.
Best practices in career systems in life science research also identified some shortcomings to be addressed in the future. There is a challenge in the area of combining careers in medical/life sciences (research at the university/research centre and at hospital) – none of the Alliance4Life members considered its system as “advanced”. We are still missing best practices in this area. And we are missing a standardized monitoring tool for the grading and assessment of progress in HR/career systems. An important aspect that complicates the implementation of advanced systems from one institution to another is the national context (national legislation, and related (de)centralisation of HR management). The partners identified general factors/enablers enhancing positive, institutional change that are valid across not only nine HR areas, but also across individual countries and institutions. These factors make career system upgrades functional and sustainable in the long run.
In the CEE, efficient human resource management and modern career progression systems are often absent. Innovating and implementing the career systems of the partner institutions is expected to tackle this issue. Best practices in career systems in life science research gives us a starting point for the future evaluation of progress in HR management of all Alliance4Life members. The resulting set of best practice measures, proven through operation, will be presented to the board, representing all member institutions, at the Alliance4Life´s community meeting in April 2022. The partners will internally discuss how to use the best practice to improve their HR management, and how it could lead to better scientific performance and employee satisfaction. In addition, the achieved results will be used for the formulation of the consecutive deliverable “report on advances in career system upgrades”, with the aim of monitoring progress at the level of Alliance4Life members and their HR management systems.
Three awards for young researchers from Stroke team III
Mgr. Sandra Thalerová is looking for new methods of stroke treatment in the lab
The third award winner is Sandra Thalerová, a PhD student in biochemistry at the Faculty of Science of Masaryk University and a researcher at the Cerebrovascular Research Programme of FNUSA-ICRC. For the publication of her research findings in the field of drug combinations and their effects on stroke treatment under laboratory conditions, she was awarded the Masaryk University “Scholarship Program for the Support of Creative Activity for the Publication of Outstanding Results of Own Research”. Two years ago she was also awarded the Brno Ph.D. Talent. Sandra is part of a research group dealing with in vitro laboratory experiments, which brings together the staff of the Institute of Biophysics of the CAS and the Cerebrovascular Program of FNUSA-ICRC.
What does this recognition of your work mean to you?
Every award or invitation to give a talk is an indicator to me that there is interest in our research and that in vitro modelling has a strong place in stroke research. Also, every award increases the publicity and prestige of our team, and I’m very happy about that. The award is also my thanks for the excellent guidance of my supervisor Dr. Jan Viteček and my supervisor in the Cerebrovascular Team, Prof. Robert Mikulík.
Can you introduce us more about the excellent results of your research?
We tested the effect of a new oral anticoagulant used for stroke prevention. We investigated how it affects the effectiveness of another drug, alteplase, on ischaemic stroke (stroke caused by blockage of a blood vessel in the brain, ed.), which helps dissolve a blood clot. We wondered if this preventive medicine could improve the treatment of stroke if it occurs despite its use. However, our results did not show a possible improvement in treatment due to the interaction of the two drugs.
How are the drugs tested?
Our group is involved in the implementation of innovative in vitro model systems. We are using them to test the efficacy and other properties of agents that could improve current stroke treatments. Our models are transparent, so they offer the possibility to monitor blood clot experiments in real time. We can design them as needed and are able to simulate the properties of blood vessels based on real-world examples. In addition, in vitro models allow the use of human material (blood, plasma, cells), therefore the experimental conditions can be in many ways closer to the real situation of stroke patients compared to laboratory animals.
Three awards for young researchers from Stroke team II
Dr. Ondřej Volný compares different methods of stroke treatment and brings new insights for clinical practice
This year’s Henner Prize of the Czech Neurological Society for the best publication by young authors under the age of 35 was awarded to neurologist Ondřej Volný, M.D., Ph.D.
What does the award by the Czech Neurological Society mean to you?
It is a great honour for me. Professor Henner is the father of modern Czech neurology, who raised it to a higher level. Moreover, it is an award directly from a professional society, i.e. people who have tangible results behind them and work to make Czech neurology visible in the world.
What is the focus of the publication for which you received the Henner Prize?
There are various treatment options for stroke. We can administer a drug to dissolve the blood clot that caused the blockage of the cerebral artery. Or we can remove it with a catheter and use what’s called a mechanical thrombectomy. In 2015, studies were published that showed that mechanical removal of a cerebral artery blockage is highly effective. Although we were not involved in these studies, we decided to compare their results with data from the Czech registry. We then published comparable findings in 2016. Two years later, I went to Calgary to work as a physician in the ictal unit. During my time there, I decided to focus my research on a group of patients not included in those studies. Patients who had a cerebral artery occlusion but were not suffering from a severe neurological deficit. We put our heads together with Prof. Hill from Calgary and Prof. Mikulík and created a new study design. In this international study, we compared different therapeutic approaches. While in Calgary the patients were treated pharmacologically, in the Czech Republic they were treated with mechanical thrombectomy. The study contributed additional pieces to the mosaic of how to treat these patients.
What was most interesting for you in working on this study?
Around 30 co-authors were involved in the research. For me, this was the largest study I have been involved in so far. The research was also unique in that we analyzed the data using a more advanced statistical method and ran into the limitations of the software. We eventually had to contact the manufacturer to put in the algorithm we needed. Finally, the publication appeared in the prestigious journal Neurology.
What were your research beginnings?
I got into clinical research about 10 years ago while studying medicine. I started going to Prof. Mikulík for his night services and we wrote my first article, which incidentally became the most downloaded article of the journal Czech and Slovak Neurology and Neurosurgery after its publication. After finishing medicine I became a PhD student. I started with a simpler project, thanks to which Professor Mikulík helped me arrange a research internship at the Cerebrovascular Program in Calgary, Canada. Here, I was subsequently offered the opportunity for a clinical fellowship, which I completed in 2019. The opportunity for international education advanced my research knowledge immensely. The awards I have received, such as this year’s Henner Prize, are a pleasing testament to this. Upon my return, I opted for an attractive job offer at the University Hospital in Ostrava, although I continue as a member of the ICRC Cerebrovascular Research Team, where our collaboration has been very productive.
Three awards for young researchers from Stroke team
The International Danubius Young Scientist Award, the prestigious Henner Prize and a scholarship for outstanding results of his own research. Three researchers of the Cerebrovascular Research Programme of the International Clinical Research Centre of St. Anne’s Hospital in Brno received the award for their work under the guidance of Prof. Robert Mikulík. Petra Šedová, Ondřej Volný and Sandra Thalerová are researching strokes – each from a completely different perspective.
In a small series we will introduce them through their medallions.
Dr. Petra Šedová provides accurate information about stroke in the Czech Republic, which is used by the Ministry of Health or health insurance companies to plan or improve health care.
Dr. Petra Šedová received the Danubius Young Scientist Award on 11 November 2021 for her outstanding work in the field of neuroepidemiology. The award is given to only one researcher in the country and competes between different scientific disciplines. The impact of the research on the countries of the Danube region is assessed. (The award is given by the Austrian Federal Ministry for Education, Science and Research (BMBFW) and the Institute for the Danube Region and Central Europe (IDM). The Cerebrovascular Research Team is proud to be the second researcher ever to receive this award (in 2016 it was also awarded to Ondřej Volný, MD). Dr. Šedová has other awards to her credit, and in 2018 she received the Martina Roessel Memorial Grant (awarded by the Institute of Organic Chemistry and Biochemistry) supporting women scientists who care for preschool children while developing their scientific careers.
What does the Danubius Young Scientist Award mean to you?
It is a great honour for me, which I accept with humility, and an appreciation not only of my work but of the whole Cerebrovascular team and also of my two mentors, Professor Brown and Professor Mikulík, who are very supportive. During my research work so far, I have had three children and the collaboration has never been interrupted, it has been perfect and very effective. At the same time, the award is an encouragement for further research and confirmation that our work has clinical and practical impact on a wider international audience.
What areas of your scientific work are you involved in?
I am interested in the epidemiology of stroke. Using data from the Institute of Health Information and Statistics of the Czech Republic, our group has described the incidence (the ratio of new cases to the whole population, ed.) of stroke and mortality trends in recent years, which also reflects the quality of medical care. We also described the incidence of stroke in Brno and risk factors in the Brno community study. Another project we carried out in the context of the Covid-19 pandemic examined the decline in the number of hospitalised stroke patients and the number of mechanical thrombectomies. On the last project, we are collaborating with the Office of Health Insurance of the Ministry of Health. Using data from health insurance companies, we are looking at how treatment with mechanical thrombectomy varies between centres in the Czech Republic. We are looking for the differences and also trying to find the causes. The results will then help to improve the quality of stroke treatment in the Czech Republic.
How did you get into stroke research?
During my studies at the Faculty of Medicine, I did cardiology and spent 3 months at the prestigious Mayo Clinic in the USA. After graduation I joined Prof. Mikulík as a PhD student to study vascular neurology. He sent me on a one-year research fellowship with Prof. Brown again at the Mayo Clinic. Since 2013 I have been working at this foreign clinic as a research associate with Prof. Brown. In 2017, I completed my PhD under the supervision of Prof. Mikulík and now, in addition to my own research, I am leading the neuroepidemiology group within the Cerebrovascular Program of the International Clinical Research Center and am involved in mentoring both undergraduate and graduate students. As a physician I work at the Internal Hematology and Oncology Clinic at the University Hospital Brno.
Šárka Kunzová among the winners for the best abstract
The American Heart Association (AHA) has awarded the best abstract award to a team including Šárka Kunzová, MD, PhD, researcher and physician from the Kardiovize team of the International Clinical Research Centre of St. Anne’s University Hospital in Brno. The Paul Dudley White International Scholar Award, as the full title of this prestigious award reads, was presented to the researchers at the AHA Scientific Sessions 2021 conference for their abstract, Validation of a Brief Dietary Questionnaire for Use in Clinical Practice: Mini-EAT™.
“Under the guidance of Professor Lopez, we set out to create a validated questionnaire for rapid nutrition assessment in clinical practice,” described Dr. Kunzová. Healthy nutrition is one of the pillars of treatment and prevention of cardiovascular disease. Currently, the gold standard for nutrition assessment at the Mayo Clinic is the so-called VioScreenᵀᴹ, a complex and time-consuming questionnaire that provides a detailed assessment of the extent to which a patient’s dietary habits meet professional recommendations.
A 19-item questionnaire was designed in collaboration with nutritional therapists and other colleagues. In a study with more than 600 participants, this questionnaire was then compared with the VioScreenᵀᴹ questionnaire. “Although it sounds simple, it was quite difficult to include all the major components of nutrition while formulating the questions in a way that was understandable to the respondent,” Dr. Kunzová said. As part of the validation study, the questionnaire was further reduced to maintain its good reporting value.
The questionnaire in its current form cannot be used globally and was designed for the US population to correspond with local dietary specifics, usual eating patterns and food supply. Healthy eating recommendations there are based on the Healthy Eating Index, which quantifies the extent to which an individual’s eating patterns are consistent with the recommendations. “In our country, we have defined general dietary recommendations, but there is no standardised questionnaire that can capture this,” Dr Kunzová said.
A manuscript of a peer-reviewed article detailing a validation study of the Mini-EAT™ questionnaire, a tool for rapid assessment of dietary habits that could help in routine outpatient settings, for example in patients with cardiovascular disease, to easily determine the extent to which consultation with a nutritional therapist is indicated, is currently being completed.
Lose weight healthily. Under the supervision of experts from Kardiovize
This year I’m finally going to lose weight. This is the New Year’s resolution of many people. But after two visits to the gym and a week-long fast according to the guaranteed advice from the Internet, the quest for a slimmer figure often ends. If you want to lose weight in a healthy way or help someone close to you to lose weight effectively, take advantage of the offer of preventive examination at the Kardiovize at the International Clinical Research Centre of St. Anne’s University Hospital in Brno.
Twenty-nine-year-old Milan also decided to start his fight against excess weight under the supervision of doctors. “I was particularly intrigued by the fact that this is not another generic diet that circulates on the internet, or consultations with consultants who try to push expensive products on you.”
On the first day, those interested in a Kardiovize examination will have to take several measurements. “People will find out the ratio of fat to muscle in their body, learn how much sugar they have in their blood and whether their liver and kidneys are functioning properly,” said Michal Havelka, the study’s coordinator. After the results are analyzed, a consultation with a nutritional therapist follows. “I was a bit surprised that I didn’t get an exact itinerary of what to eat when. Instead, we talked about what foods I should include more of and what to replace my favourite snacks with if necessary,” Milan described.
According to the experts at St. Anne’s University Hospital, this approach is exactly sustainable. “There is no point in playing forbidden foods. People may deny themselves for a while, but most of the time they slip into old habits. The important thing is that they learn that it is the quantity and calorie counting that is important,” Havelka said.
Milan changed his lifestyle habits according to the advice given to him after the Cardiovision examination. “I won’t say that the results came all at once. I had to work on my diet and add a lot of exercise. I wasn’t always able to stick to the regime 100 per cent, but in six months I lost ten per cent of my body weight, most of which was fat,” the man boasted. He also appreciated that those around him noticed the change. “”Oh, and of course I’m happy that my sugar and cholesterol levels have improved, so I hope I won’t see the doctors too often,” he added with a smile.
So if you want to change your lifestyle and avoid diets that can gamble with your health, or you want to please a loved one, feel free to head over to the Kardiovize website where you can order a preventive screening.
Investigation of left ventricular myocardial deformation in patients with sarcoidosis
Sarcoidosis is a systemic granulomatous disease affecting various organs including the heart. It is characterised by the formation of granulomas, i.e. foci in the tissue in which there is an aggregation of immune cells responding to a previously unknown stimulus. Females are more likely to suffer from this disease of unknown origin than males, in a ratio of 1.5-2.0:1. Sarcoidosis of the heart is clinically quite rare, reported to affect between 2 and 7% of patients (although some sources suggest that this may be as high as 30-40%). However, it is one of the most serious forms of the disease, as it causes cardiac arrhythmias that can lead to sudden death.
Scientists at our center focused on the following in their study entitled “Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis“, whether myocardial deformation analysis by magnetic resonance imaging could help in the early detection of this disability.
One hundred and thirteen patients with airway and/or extrapulmonary sarcoidosis without evidence of cardiovascular disease participated in the study. In these patients, myocardial strain was measured from cardiac magnetic resonance images using a technique called feature tracking (CMR-FT), followed by comparison with twenty-two healthy patients. “The main parameters measured were global longitudinal strain, global circumferential strain and global radial strain of the left ventricle,” said Assoc. MUDr. Roman Panovský Ph.D.
The results of the research conducted by scientists from the Cardiovascular Magnetic Resonance Research Team of the FNUSA-ICRC show that the values of myocardial deformation of patients with sarcoidosis did not differ significantly from the results of the control group. A possible explanation could be that the patients were investigated at an early stage of the disease when the heart muscle is not yet affected. Despite these results, the CMR-FT method has great potential for use, especially considering the fact that it offers additional information about the systolic function of the heart without prolonging the examination. The study was published in the Orphanet Journal of Rare Diseases (IF 3.7).
Supported by the European Regional Development Fund – Project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868).
The EAN representative on the dementia panel is Dr. Sheardova
Katerina Sheardova, M.D., Ph.D. will now represent the Czech Republic on the European Academy of Neurology (EAN) panel on dementia. Her main goals within this platform include focusing on clinically available early biomarkers of the disease and strengthening research on lifestyle-related risk factors for dementia and promoting them as a preventive measure to the general public.
We asked in a short interview how these goals relate to research within the Cognitive Disorders and Dementia Research Team of the International Clinical Research Centre of St. Anne’s University Hospital in Brno (FNUSA-ICRC).
You have been researching neurodegenerative diseases for more than ten years. Are the goals you have set for yourself as a representative of the Czech Republic on the EAN Scientific Panel related to your existing research or is it an extension of it?
Yes, it is very closely linked. As an example, I will mention the Czech Brain Aging Study, which is a preventive study, involving people who already have a memory problem but have not yet developed dementia. The difficulties may be subjective or measurable by sensitive psychological tests, we call it mild cognitive impairment. We monitor over time how their memory deficit develops, how the MRI findings develop, and possibly biomarkers from their cerebrospinal fluid. We also focus on some lifestyle indicators, analysing, among other things, how lifestyle affects the rate of brain cell loss or the risk of dementia.
Another intervention study, the results of which we published in Clinical Interventions in Aging, I would like to follow up on, was on mindfulness, which is the ability to fully experience the present moment and to let go of emotions. It was specifically about Mindfulness-based stress reduction therapy, the use of this technique in stress management. It was an eight-week program for patients who were taught to use these techniques in their daily lives, to be mindful of the present moment and reduce stress, which is one of the most significant risk factors for neurodegenerative diseases. It is the reduction of these factors, which can be influenced during life, that we should focus on the most in order not to be at increased risk of dementia. In addition to stress, there is also depression and chronic inflammation in the body, which mindfulness techniques have an excellent effect on, as we have also published. In fact, dementia and neurodegenerative diseases in general are associated with chronic inflammation, which is increased in old age, so-called immunosenescence. When I say chronic inflammation, I mean an increase in markers that we can read in the blood, for example, the activation of certain types of lymphocytes, an increase in certain immunological factors… If we reduce stress, then in addition to inflammation, we also reduce the secretion of stress hormones, such as cortisol, which, when it acts chronically and for a long time, has harmful effects on our organs, including the brain. And if the hippocampus, which is related to memory implantation, is damaged, it can contribute to the development of Alzheimer’s disease. So, to summarise, the research that we are doing is related to the goals that I have set for myself in my role on the EAN dementia panel.
What about your latest research using organoids?
With organoids, which are defacto little brains, these little balls with a structure similar to brain tissue, we are looking at Alzheimer’s disease from a different perspective. Typical of this disease is a pathological cascade of protein clotting. One of these is amyloid, whose function is to protect the brain from infectious agents, i.e. viruses or bacteria. There is a theory that the action of a particular virus or pathogen may cause this protein to clot more than is permissible and thus trigger the pathological cascade. And we’re trying to find which pathogens that might be, and we’re using these “minibrains” to do just that.
So it’s like a cytokine storm, where the immune system overreacts?
Figuratively speaking, we also know that in general, in old age, originally functional proteins are more likely to precipitate, and this is not just amyloid, but also, for example, the Tau protein, which actually accompanies neurodegenerative diseases. So the object of the research is to find out why proteins start to precipitate, because then they stop working as they should. Because of this, cells then start to die, which is manifested by so-called atrophy, i.e. the loss of brain tissue in certain parts of the brain, which then manifests itself in different clinical symptoms, depending on which areas of the brain are most affected. Atrophy can be monitored by magnetic resonance imaging.
What impact do your areas of interest have on patient treatment?”
There is currently a great effort to find drugs that will stop the pathological cascade. But because this disorder starts maybe a decade before a person has clinical symptoms and goes to the doctor, the most important thing is to find these patients early. And this is related to my second goal, which is to find tests that are affordable, clinically accessible and have relevant results. Although we already have ways to test for these specific non-functional proteins, such as amyloid pet, which is an expensive imaging test that is not available to everyone, or they can be detected by lumbar puncture, which is invasive and unpleasant for the patient. The search for biomarkers in the blood is currently being developed so that it would be possible to detect the disease after a blood draw. Another very simple option is special, very sensitive neuropsychological tests that would detect this incipient deficit earlier than the conventional tests used now. Our team specializes in spatial navigation, where the inspiration was research on animal models, which we have translated for use for patients using computers as simulated orientation in an arena to test a person’s ability to reach a destination. Or there are those that combine multiple questions together, such as the FNAME test, where the patient is presented with faces to which they are assigned names and their occupations, and after a certain point the patient has to reconnect the faces with other information about them. There are more of these tests, it’s about finding the best ones.
If I can’t remember the name of a person I know for sure, is that a signal that I should start worrying?
Name dropping is a typical sign of aging, not a pathology. It’s a normal part of being age-related, something we probably all deal with. The test mentioned is not just about names, it is mainly testing the memorability of new information. Which is the problem with Alzheimer’s – we are unable to remember newly presented information. The people tested remember well what they have known for a long time, but they have an impairment in storing a fresh memory trace.
So what should be the main contribution of the topics you propose in the EAN dementia panel?
To summarise, the two aims are linked and should lead to early detection of neurodegenerative disease and then, based on research, to the recommendation of an appropriate therapeutic approach. The more distant goal is that these recommendations should not only serve to detect early those who are already ill, but should also help those who are at increased risk of, for example, Alzheimer’s disease, so that they can take effective measures, whether pharmacological or lifestyle measures, in order to prevent the disease from developing in the first place. I would like to be able to extrapolate the findings further, as prevention of neurodegenerative diseases for the general population.
The ICRC Academy now also offers internships in our administrative teams
The administrative teams support the International Clinical Research Centre at St. Anne’s University Hospital in Brno so that its scientists can concentrate fully on their research.
It is these teams that are looking for interns to join their ranks. They can offer, for example, the opportunity to learn about the fascinating environment of clinical research and experience in (project) management in science and healthcare, European and national grants.
Read more here:
One in four will experience a stroke. Only one-third of patients are cured
Friday, 29 October, is World Stroke Day, an annual observance by the World Stroke Organization. Stroke affects one in four people in their lifetime and one third of all cases end in the death of the patient. At the same time, stroke is the most common cause of permanent disability. Stroke can be recognised by three symptoms. Quick medical intervention can save a patient’s life and lead to a full recovery. That’s why on October 29, the Public Health Group of the Cerebrovascular Research Program at International Clinical Research Center at St. Anne’s University Hospital (FNUSA-ICRC) is preparing a live broadcast to spread stroke awareness.
Stroke affects more Czechs annually than heart attacks. The latter affects around 22,000 people each year, while stroke affects around 25,000 per year. Although the average age of a stroke patient is around 70, the number of younger patients is increasing worldwide.
One of the young patients treated after a stroke attack at St. Anne’s University Hospital (FNUSA) is Eliška Nováková. She suffered a stroke at the age of 20. “I had a stroke in the morning, but we didn’t call an ambulance until the afternoon and I was taken to the operating room at six in the evening. The doctors told my parents that it was a miracle that they saved me. I forgot to speak and took my first steps only after a few weeks in hospital,” she says of her experience. Today, eight years later, she still practises her speech and mobility daily. She shares her story with others through the blog „Girl with a Disability“. (https://www.holkashandicapem.cz/)
Like Eliska, many people underestimate the symptoms of a stroke. That’s why they come to the care of doctors too late. The consequence is a high rate of death and permanent disability. “The most common symptoms of stroke include limited mobility or paralysis of the limbs on one side of the body, drooping of the corner of the mouth and unintelligible or confused speech,” lists prof. MUDr. Robert Mikulík, Ph.D., who is the head of the Cerebrovascular Research Team of the FNUSA-ICRC.
Time plays the most important role in stroke treatment. Every minute, a patient loses two million neurons, so it is essential to immediately call the emergency services on 155 when recognizing at least one of the symptoms described above. “Treatment should ideally be started within an hour of the onset of symptoms. The later the patient gets to medical care, the more the chances of a cure decrease,” explains prof. Mikulík.
Rapper MC Gey also raps about stroke in a new awareness video. He drew on his own experience when writing the lyrics – two of his loved ones have survived strokes, but each with differently severe consequences. The clip, aptly titled Corner, will premiere live on a Facebook event called World Stroke Day, which kicks off at 2pm on Friday. In addition to the new video clip, those interested can look forward to an online program full of information and tips. The online event will include an interview with Eliška Nováková, information about risk factors, prevention, and what happens to a patient after being transported by ambulance to the hospital. The virtual guided tour will be conducted by prof. Robert Mikulík.
Saste Roma – Improving Health in Excluded Localities project is funded by EEA Grants 2014-2021, project no. ZD-ZDOVA2-002.