Caffeine hit could help stroke patients

By SIMON COLLINS, science reporter

An "Irish coffee" cocktail of coffee and alcohol is giving some stroke victims the power to repair their own damaged brain cells.

The cocktail, dubbed "caffeinol" by its Texan inventor Jim Grotta, has to be injected into an arm vein within hours of a person suffering a stroke.

Caffeinol cut brain damage in rats by up to 80 per cent, and is now being tried on human stroke victims in the United States.

Professor Grotta, a neurologist at the University of Texas, Houston, was in Auckland this week to plan trials of two other stroke drugs which have been isolated by Neuronz, a company spun out of Auckland University.

He said one of the Neuronz drugs, labelled NNZ2566, had proved remarkably effective in repairing rats' brain cells for days and weeks after strokes, after they had been treated with caffeinol in the first few hours.

"This [NNZ2566] is the first drug we have been able to show that has additional effect for three weeks," he said.

"For long-term recovery, the best we have been able to do is various physical therapy approaches. This is the first pharmacological treatment that can improve recovery.

"We have a 50 per cent reduction in the amount of faults and errors that the rat has when treated with this drug and caffeinol in combination. That means that they [the rats] are back to almost normal, because all animals make some mistakes."

The endorsement from Dr Grotta, one of the world's leading stroke experts, is a big boost for Neuronz, which has delayed clinical trials on human patients, apparently for medical and financial reasons.

It is finally ready to start human trials of its first drug, glypromate, in the middle of this year, at the same time as it is solving its financial constraints by completing a merger with a major pharmaceutical company - originally flagged more than a year ago.

Chief executive David Clarke said glypromate, a compound that occurs naturally in the brain, produced impressive brain repair in rats if injected within hours after heart attacks.

The company has slightly modified the compound to produce six new drugs including NNZ2566, which was developed specifically to have a longer-lasting effect.

Neuronz and Dr Grotta plan further animal trials with NNZ2566 and if all goes well will seek approval to try it in human stroke victims late next year.

Dr Grotta and Neuronz's chief scientist, Dr Peter Gluckman, have collaborated on stroke research for almost 20 years, and Dr Grotta last visited in 1990 when his daughter was working here on a tree-planting project.

A keen mountaineer in his spare time, he and his wife holidayed on the Coromandel Peninsula before catching up with Dr Gluckman and other Neuronz scientists in Auckland this week.

Apart from drugs, both groups are working on treating brain injury by cooling the patient. Neuronz developed a novel "cooling cap" for newborn babies, and Dr Grotta has shown that unconscious adult heart attack victims recover better, on average, if their body temperature is cooled from the usual 37C to 33C.

He is now working on cooling techniques for stroke victims, which is more difficult because they are usually conscious and cannot tolerate being cold for too long.

"After a stroke there is an inflammatory response. The cells release chemicals that result in inflammation, which leads to cell death," he said.

"We think the cooling dampens that inflammation. It could have an effect on biochemical things, and it seems to slow everything up."

In the US, Dr Grotta said the authorities now recommended cooling as a routine treatment after heart attacks.

In stroke victims, he hoped to get the body temperature down to 34.5C for 24 hours.

"Patients can tolerate it, but you still have to give them some medicine to suppress the shivering."

He said strokes - blocked arteries in the brain - were caused by the same factors which also caused heart attacks by blocking arteries around the heart.

"We can do even more for stroke by good prevention - recognising and treating high blood pressure, recognising and treating elevated cholesterol, and stopping smoking," he said.

"If we did that, we would reduce the number of strokes by more than half. Blood pressure lowering medicines of various kinds can remarkably reduce the incidence of stroke, and blood thinners such as aspirin and aspirin-like compounds are a most important approach."

Dr Grotta sets a good example for avoiding strokes with his own active lifestyle, but said that was not why he climbed mountains.

"I fortunately have a very low-risk profile for stroke in my family.

"But I think exercise is very good and important for healthy living."

Strokes

* Strokes are the third leading cause of death (after cancer and heart disease) in New Zealand.

* Older people, especially men, have a higher risk of stroke.

* Maori and Pacific Islanders are more likely to have a stroke than Europeans.

* Ten per cent of victims have a second stroke in the 12 months after the first.

Source: Ministry of Health, Stroke Foundation