We caught up with Dr. Starke to learn more about his research project.
Tell us a little about yourself.
I am currently the Director of Neurovascular Research in the Department of Neurosurgery at the University of Miami. I am a Neurosurgeon with a specialty in vascular surgery and a radiologist with a specialty in Interventional Neuroradiology. I also work at Jackson Memorial Hospital and Nicklaus Children’s Hospital. Before I became a neurosurgeon, I was a full-time rock climber. These days I spend most of my free time chasing my 4-year-old son.
Why did you get involved in the field of brain aneurysm research?
During medical school, I saw a number of patients die from ruptured aneurysms. I felt that we had a long way to go to improve research in this area. I took two years off medical school to join a cerebrovascular research laboratory at Columbia University. During this time I also completed a masters degree as part of the national and international health clinical research training program.
What is the name of the research project for which you received the grant?
Endothelial Cell Dysfunction & Differentiation in Cerebral Aneurysm Progression & Healing
What are Endothelial Cells?
Endothelial cells are cells that make up the lining of the blood vessel wall. We’re looking at how these cells change their role. Normally they regulate blood flow and create a protective barrier. After injury, their role can change to promote inflammation. Our main goal is to find out what happens to the lining of the blood vessel that leads to changes in endothelial cells and how this contributes to brain aneurysm formation, progressions, rupture.
Can you give us a high-level overview of what you’ll be studying?
The goal of our research is to develop new:
1) medical therapies to treat aneurysms
2) imaging modalities to identify risky aneurysms 3) minimally invasive treatment options.
- We are studying endothelial dysfunction which is an initiating event in aneurysm development, progression, and endovascular treatment failure.
- When cells are damaged they can produce cytokines like interleukin 2 (IL-2). These cytokines can turn on genes in other cells that promote further injury and aneurysm formation and growth (for example mTOR). We have found that during aneurysm formation and rupture both IL-2 and mTOR are upregulated. We are studying how IL-2 and mTOR increase inflammation in endothelial cells and how inhibition leads to improved healing.
What might those treatments be specifically?
- A new medication in the form of a pill
- Imaging that can identify unstable aneurysms
- Stents that can deliver medications to help aneurysms heal
How will your research impact the landscape of preventive brain aneurysm research?
Right now we aren’t good at predicting which aneurysms will bleed, which ones are risky, or which ones are active as opposed to dormant.
What are your ideal outcomes?
Successful completion of this project will enable us to:
1) identify the molecular processes that lead to endothelialization following vascular injury;
2) determine the events behind endothelial cell dysfunction which lead to vascular disease and failure of endovascular therapies; and
3) provide minimally invasive treatment of aneurysms through the endovascular delivery of anti-inflammatory medications.
Assuming successful outcomes, what is the next step to advance your research?
When you have a patient with an unruptured aneurysm you want to know if it is worrisome that it will bleed in their lifetime. If we can predict if the aneurysm is risky, we then decide on the optimal treatment. Potentially a new pill might be better than surgery. In those that need an invasive treatment, potentially a stent that delivers medications might be a less invasive option.
What are the options now?
- Brain Surgery to apply a clip on the brain aneurysm.
- An endovascular coil or stent
What might new options be?
- A pill to prevent an aneurysm from bleeding.
- New endovascular treatment option: tiny coils or a stent lined with medications might be safer and more effective.
Will this research branch out into other areas?
Yes, our hope is that we can find out why the cells in the blood vessel wall change their function which could also have an impact on aneurysms that form in other parts of the body. This may also have an impact on other diseases where atherosclerosis is a key element like stroke and heart disease.
How would you explain this research study to a friend who does not conduct clinical research?
We are studying what goes wrong in blood vessels that lead to aneurysms. Interleukin-2 (IL-2) is a protein that tells the body produces and tell cells how to do their job. During a brain aneurysm, the body makes more of this protein which alters the cells original function causing the cells to injure other cells. We are testing a variety of medications that would block these proteins and stop harmful inflammation.
Are you excited to attend the Honey Bash?
Extremely, I have not been before!
What is one thing you want people to remember about your research?
When research is designed well, you may not know the answer or you may encounter an answer you were not expecting. Regardless, you get an answer that helps to push research farther to find new therapies. So even if we don’t get the results we were expecting, we will get results to propel brain aneurysm research to a place it has not yet been before. Anything that improves our understanding of the disease can improve patient outcomes which is the ultimate goal. This can help answer clinical questions to improve our treatment of patients.
In 50 (or so) words or less, what would you like the world to know about brain aneurysms?
The most important thing to know is that they are extremely common (1 in 50). When a brain aneurysm bleeds, it can lead to death or severe disability. We need to find better ways to identify those risks and develop improved treatment options for these patients.
What needs to be done to better educate people – primary care providers, as well as, those not in the medical field – about the risks and warning signs of brain aneurysms?
Most of the time, when we find out about a brain aneurysm we find out by accident or after they have bled. We need to come up with better ways to identify brain aneurysms before they have a major problem.
How can people outside the medical field best support brain aneurysm awareness and research?
By supporting foundations like The Bee Foundation you can help improve our awareness and research for brain aneurysms.
The 2017 Brain Aneurysm Research Grant went to two researchers, Jennifer Kim, a neurocritical care fellow at Mass General Hospital, and Justin Mascitelli, a cerebrovascular fellow at the Barrow Neurological Institute in Phoenix.
Get your tickets now for the 2018 Honey Bash to see Dr. Strickland’s presentation, enjoy Cocktails, Hors D’oeuvres, a Seated Dinner featuring locally sourced artisanal cuisine by Garces Catering, Dancing and a Live & Silent Auction!