01 September 2020

Giving blood transfusions to people who have had a stroke could help to protect their brains from damage, according to a new US study.

Researchers at West Virginia University (WVU) say that blood substitution therapy rescued the brains of mice from ischemic damage – the first time this has been demonstrated – and this could potentially lead to a therapy for stroke in humans.

Study leader Dr Xuefang Ren, assistant professor in the Department of Neuroscience at WVU, said: “What we were able to demonstrate is that if you remove part of the blood from a subject undergoing stroke, and replace that blood from a subject that’s never had a stroke, the outcomes of that stroke are profoundly improved.”

The current FDA-approved treatment regime for ischemic strokes is tissue plasminogen activator (tPA), which dissolves the clot and improves blood flow, but it must be administered within three hours of the stroke.

However, Dr Ren’s research, published in Nature Communications, suggests that blood transfusions could be beneficial to health even up to seven hours following a stroke.

The research team found that replacing 20% of the blood in a mouse was enough to show a profound reduction in damage to the brain.

Following a stroke, the make-up of a patient’s blood changes, causing disruptions in the brain and how the body responds. Neutrophils play a role in increasing the levels of the enzyme MMP-9, which can lead to blood-brain barrier leakage and degeneration in brain tissue.

The researchers say that blood replacement therapy removes inflammatory cells and decreases neutrophils and MMP-9 levels following a stroke.

Co-author Prof James Simpkins, director of the Center for Basic & Translational Stroke Research at WVU, said: “The immune system doesn’t recognise much of what’s happening when there’s a stroke, so the neutrophils go to the brain and try to clean up the damage that happens. But there’s too much in the brain and those same neutrophils release MMP‑9, which then exacerbates the damage.

“What we learn is that stroke is simply not a cerebral vascular event. It’s a whole-body event. Both the brain and the body get signals that something’s going on in the brain and as the immune system responds to try to help, it actually worsens the outcome. Therefore, by removing the blood and replacing it with the blood of those that have not experienced stroke, we get good outcomes.”

Source: Ren X, Hu H, Farooqi I, Simpkins JW (2020) “Blood substitution therapy rescues the brain of mice from ischemic damage.” Nature Communications, doi: 10.1038/s41467-020-17930-x


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