Ischemic stroke is the leading cause of disability with $2.2 trillion in projected costs of care over the next five decades in the United States alone. However, current stroke management is limited by the inability to measure the underlying physiology. The primary goal in the management of acute ischemic stroke and related brain injury is to maximize cerebral blood flow (CBF) in the affected region and surrounding penumbra. Because of the paucity of tools available for monitoring CBF in such patients, however, interventions to augment CBF are typically prescribed empirically based on expectations of neurological deficits, or in response to clinical deterioration. In the first fundig cycle, our Bioengineering Research Partnership (BRP) demonstrated that diffuse optical methods provide unique benefits for monitoring cerebrovascular physiology. Specifically, the BRP proved feasibility of optical CBF for stroke monitoring and confirmed individual variability of CBF responses. This research could not have been carried out without a unique multi-disciplinary team; or BRP team is comprised of clinical and biomedical investigators, with expertise in cerebrovascular physiology and neurocritical care, and physical scientists and engineers with expertise in optics, electronics, mathematics and computation. The proposed renewal BRP has evolved to contain three core components, a Biomedical Optics Group led by PI (Yodh), and two Clinical Groups focused on adult populations at the Hospital of the University of PA (Detre), and pediatric populations at the Children's Hospital of Philadelphia (Licht). The clinical and technological groups cross-inform the development and application processes, uncovering new ideas for clinical applications and new demands for technology. Proposed research will construct new probe- heads which emphasize the front-end of the device, in contact with the patient head, that address important limitations that have prevented wide-scale clinical adoption, and proposed research will broaden the clinical studies to ascertain cerebrovascular autoregulation responses in other management paradigms and in new patient groups such as pediatric populations eligible for Extra-Corporeal Membrane Oxygenation therapy, which will, in turn, create more opportunities for clinical translation. Technology commercialization and dissemination will be facilitated by Michael Poisel, Director of the UPSTART program in the Center for Technology Transfer (CTT) at Penn.

Public Health Relevance

Although ischemic stroke is the leading cause of disability and a leading cause of mortality in the United States, surprisingly, bedside techniques for continuous monitoring of blood flow in the brain of stroke victims following their stroke are needed. This program develops, validates, and translates optical instruments into the clinic that permit bedside monitoring of brain blood flow and oxygenation in acute stroke patients prior to the onset of new symptoms, thereby facilitating their clinical management.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS060653-09
Application #
9269626
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Koenig, James I
Project Start
2008-09-15
Project End
2019-04-30
Budget Start
2017-05-01
Budget End
2018-04-30
Support Year
9
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Physics
Type
Schools of Arts and Sciences
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Busch, David R; Balu, Ramani; Baker, Wesley B et al. (2018) Detection of Brain Hypoxia Based on Noninvasive Optical Monitoring of Cerebral Blood Flow with Diffuse Correlation Spectroscopy. Neurocrit Care :
Cochran, Jeffrey M; Busch, David R; Leproux, Anaïs et al. (2018) Tissue oxygen saturation predicts response to breast cancer neoadjuvant chemotherapy within 10 days of treatment. J Biomed Opt 24:1-11
He, Lian; Baker, Wesley B; Milej, Daniel et al. (2018) Noninvasive continuous optical monitoring of absolute cerebral blood flow in critically ill adults. Neurophotonics 5:045006
Lynch, Jennifer M; Ko, Tiffany; Busch, David R et al. (2018) Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg 156:1657-1664
Lin, Nan; Flibotte, John; Licht, Daniel J (2018) Neuromonitoring in the neonatal ECMO patient. Semin Perinatol 42:111-121
Lin, Jainn-Jim; Banwell, Brenda L; Berg, Robert A et al. (2017) Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 18:249-257
Yazdi, Hossein S; O'Sullivan, Thomas D; Leproux, Anais et al. (2017) Mapping breast cancer blood flow index, composition, and metabolism in a human subject using combined diffuse optical spectroscopic imaging and diffuse correlation spectroscopy. J Biomed Opt 22:45003
Uohara, Michael Y; Beslow, Lauren A; Billinghurst, Lori et al. (2017) Incidence of Recurrence in Posterior Circulation Childhood Arterial Ischemic Stroke. JAMA Neurol 74:316-323
Fogel, Mark A; Li, Christine; Elci, Okan U et al. (2017) Neurological Injury and Cerebral Blood Flow in Single Ventricles Throughout Staged Surgical Reconstruction. Circulation 135:671-682
Cochran, J M; Chung, S H; Leproux, A et al. (2017) Longitudinal optical monitoring of blood flow in breast tumors during neoadjuvant chemotherapy. Phys Med Biol 62:4637-4653

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