Lawrence R. Wechsler, M.D.

Stem cell therapy offers remarkable potential for changing the natural history of stroke. Learn the latest advances and challenges in this promising field by attending the "Stem Cell Therapy for Stroke (Basic and Translational Neuroscience of Stroke Recovery)" Wednesday, Feb. 9.

"The area of brain recovery and brain repair is beginning to mature, and one of the principal approaches is the use of stem cells for treatment in stroke," said moderator Lawrence R. Wechsler, M.D., chairman of the Department of Neurology at the University of Pittsburgh Medical Center. "It's an area of considerable basic research that is just beginning to be translated into the clinical realm."

Stem cell treatment for stroke has also been an area of translational neurology that has generated high expectations, noted co-moderator Mark F. Mehler, M.D., chairman of neurology and director of the Institute for Brain Disorders and Neural Regeneration at Albert Einstein College of Medicine, New York. "The great promise of this new biology has yet to be realized, but we are entering an era in which we are getting much more sophisticated in our approaches," he said.

Leading off the symposium will be an overview on "Types of Stem Cells in Stroke Therapy" presented by Gary K. Steinberg, M.D., Ph.D., chairman of the Department of Neurosurgery at Stanford University School of Medicine, Palo Alto, Calif., an expert in the pathophysiology of stroke. Steinberg will address basic stem cell biology, therapeutic stem cell types, support of transplanted stem cells via growth factors or neuroprotective agents, and multi-modal delivery approaches from stereotactic injection to intra-arterial routes.

"In addition, there is the rapidly evolving field of activation of endogenous stem cells within the patient's brain to promote self-repair," Mehler said. "These stem cells frequently remain dormant in adult life and have the potential to be activated selectively to respond to injuries like stroke. It's also an approach that avoids the damaging immune-mediated inflammation that occurs with delivery of foreign stem cells into the brain."

Animal model studies supporting stem cell applications will be the focus of "Pre-clinical Data in Stem Cell Therapy for Stroke" by Cesar Borlongan, M.D., director of cell transplantation and associate professor of neurology at the Medical College of Georgia, Augusta. He is a leading expert on stem cell transplantation, has published on endogenous stem cell repair and has worked with growth-factor complementation.

"He will review the different stem cell types and how they respond in different animal models of stroke," Wechsler said. "He will present the evidence for efficacy, mechanism and cell survival."

Key insights into a promising delivery mode will be presented during "Intra-arterial Stem Cell Delivery in Stroke" by Dileep R. Yavagal, M.D., director of interventional neurology and co-director of endovascular neurosurgery at the University of Miami Leonard M. Miller School of Medicine. He is an interventional, stroke-trained neurologist with experience in catheter delivery of stem cells into the brain.

Mark F. Mehler, M.D.

"In the past, we've looked at stereotactic injection of stem cells into specific areas of the brain," Mehler said. "We are now thinking of more creative approaches such as using intra-arterial delivery to inject stem cells peripherally that can be disseminated into specific affected areas of the brain through the arterial system."

The complexity of designing appropriate clinical trials will be addressed during "Clinical Trial Design in Stem Cell Therapy for Stroke" presented by Steve C. Cramer, M.D., associate professor of neurology and anatomy and neurobiology at the University of California at Irvine. He will detail the challenges associated with designing clinical trials using cellular therapy, including timing, location, stroke type, cell type and patient characteristics.

"It's a challenge to design appropriate studies because the design elements are going to vary depending on stem cell type, its delivery time after stroke, the stem cell's presumed mechanism of action, mode of stem cell delivery and the type of patient involved," Wechsler said.

As for the entire symposium, he predicted that it would draw a mix of clinicians and basic scientists. "It is important for clinicians to see where the field stands today and to understand what the potential is for this to be an effective treatment," he said. "For basic scientists, it's a presentation of the latest cutting-edge research."

Mehler anticipates a highly provocative symposium. "It will cover the breadth of the stem cell field," he said. "The future is bright, but only if we are diligent as we continue to focus on innovative laboratory research and begin to design more sophisticated types of clinical trials."