Interview with Gabriël Rinkel, Jaap Kappelle and Ynte Ruigrok

"Tying the neural knot." uitklapper, klik om te openen

Every year, more than 40.000 people in the Netherlands have a stroke. The  stroke-center in Utrecht is perfectly staffed and equipped for improving care and optimising prevention, its scientific leaders say. “We've created a vibrant environment.”

For its wide range of research projects –varying from collecting material for an extensive brain-bio-bank to finding out if lowering body temperature down to 35 degrees in the early phase after stroke  improves outcome– the stroke  neurologists and neurosurgeons team up with all available talents: epidemiologists, neuropsychologists, radiologists, rehabilitation physicians, vascular surgeons... If a project benefits from larger patient groups and expertise outside Utrecht, collaborations are sought with other centers, nationally and internationally.

The inspirations are a result of hard work with talented people, who in their turn attract other “really good doctors and researchers”, says neurologist prof. Jaap Kappelle. “At present, we have five people doing excellent research on a prestigious personal grant. Five! I can safely say we're doing well.”

Fellow neurologist prof. Gabriel Rinkel is fond of one-and-one-makes-three-endeavors: “Take our recent draft for a plan on how to prevent stroke and other vascular diseases after subarachnoid hemorrhage: we've built that on Jaap's years of experience in secondary prevention and added my knowledge on long-term outcome after subarachnoid haemorrhage.”

Enriching a bio-brain-bank with aneurysm samples of people who undergo aneurysm-operations is part of Ruigrok’s research. She also collects a bit of skin and artery, plus control artery samples, obtained from people who undergo epileptic surgery. “That's as close as we can get to healthy brain vessels.” Before their operation the aneurysms of the patients are scanned with 7-Tesla MRI and the bio bits of the aneurysms are subsequently explored with electronic microscopy – to date a one-off combination of sampling and imaging in Europe.

The stroke team also coordinates a nationwide study on DNA collection from patients with all types of stroke. By 2017, this collection should consist of contributions from 20,000 patients with detailed clinical information and outcome data – a unique dataset in the world.

Neurogenetics uitklapper, klik om te openen

Aiming for accurate and personal risk-assessment in intracranial aneurysms and stroke, makes neurogenetics one of the main focuses. Neurologist Ynte Ruigrok, Rudolf Magnus Young Talent Fellow: “My goal is to find genetic markers to predict one's chances on developing aneurysms and, also, on these actually doing you harm. Aneurysms exist in lots of people, but not many of those will rupture.” Her work is a continuation of her PhD-research (From intracranial aneurysm to subarachnoid hemorrhage: unraveling the genetics, 2006).

Patients uitklapper, klik om te openen

Patient-participation is large: more than 90 percent of –especially– clinical patients contribute to scientific progress. Kappelle: “This is also because we do emphasize it. From the start this center has been all about letting patients directly benefit from the research results.” 

Both neurologists expect much from neurogenetic knowledge merging with medical progress. Rinkel: “In about 15 years, coiling, clipping and stents will be treatments of the past. Instead there will be a pharmaceutical solution for people with aneurysms. And I hope that won't be my only research-dream come true.”