Our current research focuses on cerebrovascular diseases, with four primary lines of investigation:
1.-Clinical research on hemorrhagic and ischemic stroke
Epidemiology, natural history and vascular risk factors of stroke
Our studies focus on prognostic factors for hemorrhagic and ischemic stroke, as well as the impact of arteriosclerosis in premature death cases. We have published findings on the influence of acetylsalicylic acid, cardiac failure, arteriosclerosis, sex, cholesterol and accumulated risk factors; stroke in renal transplant patients; the role of pre-treatment with statins; and clinical consequences of hemorrhagic and ischemic stroke and stroke while asleep, as well as the influence of atmospheric changes on clinical outcome.
Our most recent studies have addressed early neurological deterioration, the factors related to elevated risk of recurrence in patients with transitory ischemia or minor stroke, and the benefits of receving attention in stroke units. Some of these studies have been carried out in collaboration with Cardiovascular Epidemiology Genetics, another group in the HERACLES network.
Serum bank of stroke patients
A prospective register (BASICMAR) has been in place since January 2005, including all acute stroke patients admitted to our hospital and supported by a grant from Instituto Carlos III (PI051737). The protocol includes a clinical section (vascular risk factors and vascular, demographic, etiolgical and prognostic data) and a biological section (blood samples for biochemical, immunological and genetic studies). To date we have gathered more than 2000 samples from stroke patients.
Diet and stroke
We are developing a register of the dietary habits of all stroke patients attended in our hospital and their caregivers. Blood samples have been drawn to measure lipid levels in stroke patients and control groups. Diet is known to modify lipid profile, improving vascular risk factors. Trans-fatty acids, the result of industrial food production, are known to contribute to the development of arteriosclerosis, although the effect on cerebrovascular diseases is still unknown.
2.-Genetics and stroke
A variety of genetic studies of stroke patients are underway, using the BASICMAR blood samples:
3.-Oxidative stress, biomarkers and stroke
It is a known fact that NO production increases during cerebral ischemia. In a pro-oxidative environment, NO generates peroxynitrite, a highly reactive molecule that can induce protein nitration, through which a nitrogen group (NO2) is added to certain proteíns, especially to a tyrosine terminal that produces 3-nitrotyrosine. Nitrotyrosination is a reaction that can modify the effects of proteins through loss of protein activity or function. We are analysing the hypothesis that the formation of peroxynitrate during an acute cerebral ischemia can induce a lesion with the nitrotyrosination of some proteins (fibrinogen, albumin, plasminogen) that have a determining role in endothelial functioning and hemostatic cascade.
Together with other groups in the HERACLES network, we are beginning a study of the role of circulating endothelial cells and endothelial progenitor cells in cardiovascular disease. This study is supported by a grant from the Instituto Carlos III (FIS 2008: PI080459).
4.-Neuroimmunology and stroke
Cerebrovascular disease can be advanced by certain prior immunological processes (innate immune response, chronic viral infections, …) in which the immune system plays a predominant role. In collaboration with the NK Cell Receptors and Infection group led by Dr López-Botet, we are analysing the relationship between the expression of various NK receptors in lymphocytes and stroke subtypes.