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A Neuroscience Reboot


Dr. Ali Rezai and team at the Rockefeller Neuroscience Institute

Written by Stacey Elza

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Even though almost four decades have passed, Judi Polak remembers the babies she treated as a newly minted nurse at West Virginia University's hospital. "I remember all their names," she says. "I can't forget the babies." But today, as the 61-year-old retired nurse goes about her life in Morgantown, W.Va. - walking her dogs, eating dinner with her husband, volunteering at Ruby MemorialHospital's Neonatal Intensive Care Unit -her brain is accumulating plaques that will cause her memories to fade with time. Polak has Alzheimer's disease, the most common form of dementia. It's associated with the buildup of harmful proteins between and inside of neurons. The disease is degenerative, and it has no cure.Yet.

Researchers at the WVU Rockefeller Neuroscience Institute are now giving Alzheimer’s patients, their families and friends, and their doctors a reason for optimism. In a phase II multi-center clinical trial led by the institute’s executive chair, Dr. Ali Rezai, a team of medical experts, scientists and engineers are exploring whether focused ultrasound can open up the blood–brain barrier in Alzheimer’s patients so that the plaques are reduced and the patients’ symptoms are improved with lessening decline. The device that the study revolves around was provided by INSIGHTEC, an Israel-based medical technology company. It requires neither pharmaceuticals nor painful incisions.

Polak is the first person in the world to undergo this treatment at the brain target of the hippocampus. “I will not be someone who will sit around and mope about myself. I wanted to be in the clinical trial and fight for what we need to do,” she says. “This is not going to be for me but for the people in the future.”

Judi Polak is a retired nurse

Judi Polak is a retired nurse who took the leap in this Alzheimer's trial to advance research for future patients. (Photo by Raymond Thompson Jr.)

This study is one of many that neuroscience researchers at WVU have launched recently. In less than two years, the reinvigorated institute has expanded its team of scientists and broadened the scope of its research efforts.

Rezai joined the institute in 2017, bringing with him his vision and expertise in Alzheimer’s disease and other neurological disorders. Neuroscientist Randy Nelson, who specializes in circadian rhythms, became RNI’s director of basic science research in 2018 and soon after was named the inaugural Hazel Ruby McQuain Chair for NeurologicalResearch. And in 2019, Marc Haut — who chairs the WVU Department of Behavioral Medicine and Psychiatry — began his tenure as the institute’s vice chair and director of clinical research and education.

This work is the start of what researchers hope will change the status quo for conditions from Alzheimer’s to post-stroke depression to pain relief.

After Stroke

When scientists view the same problem from different angles, they can make new connections between seemingly unrelated ideas. In some cases, they may even generate experimental data faster. For example, neuroscientist Elizabeth Engler-Chiurazzi is conducting animal studies to pursue an innovative treatment — called “transcranial magnetic stimulation” — for post-stroke depression. Meanwhile, her colleagues Amelia Adcock and Jessica Frey are exploring the idea in humans, observing how the treatment lessens depression symptoms in actual stroke patients.

“We’re going to get some sense about the mechanistic effects at the same time that we get some sense about the clinical viability of this treatment, and I think that is a strength of this team that many others may not have. If I were sitting here working at the bench, I’d figure out all these mechanisms, but it would be many years before it got to clinic,” Engler-Chiurazzi said.

Erin, Judi, Mark and Emily Polak. The family takes a selfie following Judi's procedure.

Erin, Judi, Mark and Emily Polak. The family takes a selfie following Judi’s procedure. (Photo provided.)

During the stimulation procedure, a physician uses magnetic fields to induce electrical currents in specific areas of a patient’s brain. The U.S. Food and Drug Administration has already approved trans cranial magnetic stimulation asa treatment for major depression that therapy and medication alone can’t help.

Just as protein buildup on neurons can sabotage someone’s memory, a stroke can plunge someone into depression —due to inflammation, lack of blood flow or some other cause that scientists have yet to pinpoint.

“People who have a stroke but haven’t lost their ability to drive or walk are still at a higher risk of developing depression. We know there’s a cardiovascular component,” Adcock says. And depression can sap patients’ motivation to follow their nutritionists’ advice for a healthier diet, do physical therapy exercises at home, and take other measures to help them get better and make subsequent strokes less likely.

“We know that patients with post-stroke depression aren’t going to recover as well,”says Frey, “so if we catch them early and are just as aggressive at treating post-stroke depression as we are at treating their other symptoms, can we actually have better outcomes overall for these patients?”

Tiny Pain Reliever

Amid an opioid health crisis, the medical community is seeking alternative pain remedies for chronic conditions, such as sciatica, a type of back pain that affects more than five million people nationwide. University researchers are participating in a national, randomized clinical trial to determine if a pellet smaller than a grain of rice can combat the condition.

Sciatica is a pain that originates near the base of the spine and radiates down both legs. The micro pellet at the center of the study contains a non-opioid pain medication called clonidine. When the micro pellet is injected into a sciatica patient’s lower back — the source of the pain — it steadily delivers the medication in an extended release form locally at the site of the pain and provides long-term pain control in initial studies.

"[I want to] make a positive and measurable impact on the integrated health of an entire state, one resident at a time." -DR. ALI REZAI, director of the WVU Rockefeller Neurosciences Institute

The micro pellet is distinct in that it releases the medication at a small dose and over an extended period, which minimizes side effects. In addition, the micro pellet doesn’t influence that broad range of nerves, organs and tissues that oral pain medications do. This, too, limits the side effects.

“Many painful problems that involve nerve pain may be helped by the pellet,”says Richard Vaglienti, the researcher leading the trial. In the future, it may even be used to treat other types of chronic pain. And because the micro pellet works by delivering a non-opioid medication to the pain source, it can reduce or eliminate a patient’s reliance on opioids.

“A primary mission of the Rockefeller Neuroscience Institute is to accelerate research and academic, industry and government partnerships to tackle large public health issues,” Rezai says, “and right now, opioid addiction is one of the biggest problems facing our country.”

But even as the institute sets its sights on sweeping public-health crises, its researchers want to affect individual patients. When Rezai came to WVU, he said he wanted to “make a positive and measurable impact on the integrated health of an entire state, one resident at a time.” Judi Polak is one of those patients.

“You have to change the rules,” says Judi’s husband, Mark, who is chief of neonatology in the School of Medicine. “When you hear about Alzheimer’s, it’s so-and-so is suffering from Alzheimer’s, or so-and-so died from Alzheimer’s. People put them under the covers.

“We’ve got to change that perception, and the only way we’re going to do that is to fight it.”