More than 1,000 neurological disorders affect more than 1 billion people worldwide. The Emory Brain Center is unlike any other health care system in the country, combining five brain health specialties under one roof: neurology, neurosurgery, psychiatry/behavioral sciences, rehabilitation medicine, and sleep medicine. Emory’s new initiative with Georgia Tech and Grady Memorial Hospital, the Brain Restoration Center, brings to life technological innovations that ensure brain disorders no longer prevent patients from leading productive lives. The resulting network is focused on improving brain function for a wide variety of disorders, such as ALS, Parkinson’s, Alzheimer’s, traumatic brain injury and stroke. And the innovations in surgical technologies and techniques promise to make “inoperable” brain tumors a thing of the past.
Opening the Blood-Brain Barrier:
Neurological disorders account for more than 6% of the global disease burden, with costs in the US alone exceeding $1 trillion per year. The blood-brain barrier is like an iron door, preventing 98% of all potential pharmaceuticals from reaching the central nervous system. Emory is interested in investing in a low-frequency transducer ($1M) which would interface with their high-intensity focused ultrasound machine to selectively open the blood-brain barrier. This would allow researchers to explore the possibility of breaking up Alzheimer’s plaques, shrinking brain tumors, creating more effective low-dose pharmacological options, and experimenting with gene therapies for a host of neurological and neurodegenerative conditions.
Restoring the Ability to Function, Communicate and Breathe (Dr. Nicholas Au Yong):
Motor neurons extend from the brain to the spinal cord and then to muscles throughout the body. When motor neurons are damaged, they stop signaling muscles, and muscles stop functioning. Spinal cord injuries and neurological issues such as ALS rapidly destroy motor neurons, and thus, a person’s ability to function. Using an array of micro-electrodes, as well as brain-to-computer interfaces, Emory’s team is working to restore limb function, along with restoring signals from the motor cortex which have been disconnected during trauma (as in cases of traumatic brain injury or stroke, for example). Emory’s investigational system is allowing people with spinal cord injury, brainstem stroke and ALS to control a computer cursor simply by thinking about the movement of their own paralyzed limb, directly driving limb movement by stimulating electrodes implanted in the patient’s own muscles. In addition, Emory’s clinicians are finding ways that will enable communication for people with locked-in syndrome, as well as monitoring neural activity that will assist in the diagnosis and management of ALS.
Micro Robotics to Treat Brain Tumors (Dr. Kimberly Hoang):
The technological tools at a neurosurgeon’s disposal are limited, making craniotomies (removing part of the skull to expose the brain for surgery) and tumor resection dangerous. And then there are tumors too deep, or in too sensitive an area (brain stem, spinal cord) to safely remove, without critically damaging surrounding tissue. Emory is developing minimally invasive nanoscale robots that have the potential to perform local microsurgeries, targeted drug delivery and biopsies. These magnetically actuated microrobots easily travel over the uneven surface of the brain, and within fluid-filled ventricles in controlled, non-linear trajectories. Current robot technology often uses macroscale instruments that are limited to linear trajectories to access brain tumors, and their use requires craniotomies, making surgery risky and highly invasive. Thus, the untethered steering device being created at Emory has the potential to reach regions of the brain currently inaccessible. This technology also has tremendous potential for transporting drug delivery and gene therapy for most any neurological, psychiatric or neurodegenerative disorder imaginable.
Targeting Stem Cells to Prevent Tumor Recurrence (Dr. Tomas Garzon-Muvdi):
Glioblastoma stem cells drive resistance to chemotherapy and radiation. Additionally, glioblastoma cells can migrate to the healthy brain, as well as return following an otherwise successful resection. And they are notoriously resistant to current therapies. Emory is working on ways to decrease glioblastoma cell invasion into the healthy brain, as well as finding ways to target the stem cell population in an effort to prevent origination, recurrence and therapy resistance. Emory’s novel research indicates that a particular protein implicated in other organ cancers has decreased expression in brain tumor stem cells. By targeting this protein and overexpressing it, researchers hope to kill those deadly stem cells.
Therapeutic Strategies for Traumatic Brain Injury (Dr. David Gimbel):
Emory researchers studying traumatic brain injury are working with Grady Memorial Hospital’s Neurotrauma center to identify the striking similarities of the cellular prion protein common in both traumatic brain injury and Alzheimer’s disease. Currently, there is no effective therapeutic treatment for brain injury. However, this discovery of the similarities could use Alzheimer’s therapies to inform a preventative therapeutic means of protecting contact-sport athletes. It might also be possible to develop a neuroprotective drug that can be given to TBI patients immediately after incurring injury…making it the first-ever preventative drug for brain injury.
Microsensors to Distinguish Healthy Brain Tissue from Tumors (Dr. Kimberly Hoang):
Distinguishing between healthy brain tissue and abnormal lesions is challenging for even the most experienced neurosurgeons. They currently must rely on contrast dye to visualize brain matter, which is not only subjective, but complicated by tumors that are dye-resistant. Furthermore, because brain tissue is responsible for so many delicate functions, it is difficult to take margins when extracting a tumor and difficult to know in real-time exactly what to remove and what to remain intact. Emory’s team is in the process of developing microsensors to quantitatively distinguish healthy tissue from tumors, making neurosurgery safer and more effective. In partnership with Georgia Tech, Emory’s research team is working to develop a flexible arm that can replace the linear tools that are so limiting.
Microsensors to Distinguish Healthy Brain Tissue from Tumors (Dr. Kimberly Hoang):
Approximately 20% of all pediatric brain tumors are Diffuse Intrinsic Pontine Gliomas (DIPG), a deadly form of pediatric brain cancer that occurs in the pons, the part of the brainstem that links the brain to the spinal cord. These tumors (Elleanor’s original diagnosis) usually develop in children when they are 5-7 years old. There are no viable treatment options, and due to the highly sensitive nature of the brainstem, most are never biopsied since severe neurological complications are likely. As these tumors are typically inoperable, there is a need for alternative treatment approaches, including direct delivery of chemotherapeutic agents into the masses. Effective therapy research for these aggressive brain tumors is crippled by the absence of a good large animal model in which surgical approaches can be refined. Emory has developed the first pig model to support research for DIPG interventional approaches. There is now an opportunity to develop a more advanced method of neurosurgical navigation, and Philanthropy would enable Emory to evaluate the efficacy of new proposed therapeutic strategies.