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Scientists unlock brain's natural clean-up system to develop new treatments for stroke and other neurological diseases

Monash University

In short:

• Monash scientists are helping to pioneer a new, non-invasive approach to treating stroke by boosting the brain’s natural waste-clearing system – its lymphatic network
• The treatment helps neck lymphatic vessels pump more effectively, improving the clearance of waste products from the brain after a stroke
• Early imaging studies have revealed differences between male and female brain-draining lymphatics, paving the way for more tailored treatments for conditions like stroke and Alzheimer’s that disproportionately affect women

Scientists from Monash University are partnering with colleagues at the Yale School of Medicine in New Haven, Conn., to develop a new, high-tech approach for treating ischemic stroke by enhancing removal of toxic waste products from the brain.

The “brain-draining lymphatics” are a set of drainage pathways that clear waste from the brain, with dysfunction of this “clean-up and drainage network” linked to Alzheimer’s disease and other neurological and neurodegenerative diseases (NNDs).

The work is being done in collaboration with faculty at Yale School of Medicine, including Anne Eichmann, PhD, Lindsay McAlpine, MD, and Jean-Leon Thomas, PhD.

It was the Yale team who originally found that improving brain-draining lymphatic function can boost recovery following ischemic stroke. Together, Yale and the Monash Institute of Pharmaceutical Sciences (MIPS) are now developing non-invasive devices that help the neck’s lymphatic vessels pump more effectively, improving the clearance of excess fluid and harmful waste from the brain right after stroke has occurred – at a time when every second counts.

The researchers are also using advanced imaging techniques to study the brains of 140 participants. Initial studies have found that women have less lymphatic vessel coverage in the brain’s outer layer compared to men, potentially leading to less efficient waste drainage and explaining why women are at higher risk or have worse outcomes for many NNDs, including stroke and Alzheimer’s disease.

This information will be used to explore sex-specific treatments for NNDs which disproportionately affect women, including stroke and Alzheimer’s.

The Monash lead of the Advanced Research Projects Agency for Health (ARPA-H)-funded project, Professor Natalie Trevaskis from MIPS, said that since the project inception a year ago the team has made significant strides in building on current evidence in this relatively new area of research.

“For decades, the brain was considered to be devoid of a lymphatic system. It wasn’t until 2015 that two separate teams discovered lymphatics in the brain’s outer layer transport fluid and waste products from the brain to lymphatic vessels in the neck,” Professor Trevaskis said.

“We now know that this system plays a crucial role in keeping the brain healthy. By boosting this natural clean-up system, we hope to change how ischemic stroke and other NNDs are treated.”

Professor Trevaskis added that the Yale team's findings, which help explain why women might be more affected by diseases like stroke and Alzheimer’s, opens up a new roadmap to develop treatments that take biological sex into account.

Yale’s Professor Anne Eichmann, Co-Director of the Yale Cardiovascular Research Centre and project co-lead said “We are excited to investigate brain fluid clearance in healthy volunteers across sex and age and develop therapeutics that can enhance brain waste clearance and promote recovery from stroke.

“By understanding the subtle differences in how men’s and women’s brains clear waste, we can design therapies that are more precise, effective and equitable.”

The ARPA-H project has a particularly strong focus on ischemic stroke due to its prevalence - it impacts around a quarter of women at some stage in their life and is the second leading cause of death globally.

Current treatments involve intravenously administering “clot-busting” drugs or removing clots using specialised equipment. These approaches have limitations and need to be administered within a few hours following the stroke in order to be effective.

“While current treatments can be very effective, they are associated with significant risk of bleeding and there can be several barriers limiting people’s access to them in a timely manner - particularly the requirement for a well-equipped medical facility and team - our goal is to overcome these barriers to access,” Professor Trevaskis said.

“The ultimate goal is to develop new therapeutic technologies that enhance lymphatic removal of toxic waste products from the brain following stroke, which can aid more effective recovery and reduce ongoing disability such as difficulty speaking, walking and completing everyday activities.”

The research team is working closely with two lived-experience advocates, Mirela Giles and Brian Beh. Further information can be found below.

Mirela Giles, aged 46, Lake Macquarie, NSW
In 2024 Romanian-born Mirela was having a slow but not out-of-the-ordinary start to the day when she went to have a glass of water and discovered she had lost the ability to swallow. Next, she tried to talk, but no words came out. To her shock, Mirela - who was only 46 at the time and in excellent health - was having a mini stroke.

“Although my stroke was defined as ‘mini’, the road to recovery and life-changing impact it had was significant. I developed a stroke-induced condition called aphasia, which in my case meant I’d  essentially lost my ability to talk - something that had been central to my livelihood as a teacher of English as a second language,” Mirela said.

“With the loss of my voice came loss of work and, ultimately, my identity and self-esteem.”

"After my stroke, every day has been about small steps towards regaining my voice and learning to trust my body again. I became involved in the Monash and Yale project because the idea of this new approach to treatment gives me hope - not just for me, but for every person and family living with the long shadow a stroke leaves behind."

Fast forward nearly two years and Mirela is now able to share her story. Through a combination of classic speech pathology and music therapy in the form of singing and drumming, Mirela has slowly but surely regained her voice and turned her stroke experience into a win both for herself and others who have shared similar experiences. Mirela advocates for aphasia and stroke awareness and is working towards building a singing and drumming community for others living with aphasia.

Brian Beh, aged 78, Sydney
Brian has always been driven and having an ischemic stroke in 2016 has in no way hindered this - if anything, he has never been as busy as he is today.

Following Brian’s stroke, there were many things he needed to start from scratch, including learning to walk again. This took four months of intensive daily rehabilitation but he had one goal keeping him going - to walk out of hospital wearing his best suit, which he did.

“Nearly 10 years on from my stroke, I now walk up to 12km every day,” Brian said.

“I’m a numbers guy and I’ve done the maths - since my stroke I’ve estimated that I’ve walked around 22,000km, including 118 climbs up the Empire State Building.”

With a background in corporate communications, Brian is now applying his skillset to advocating for and supporting others living with the ongoing challenges that come from having a stroke.

“For me, it’s important to emphasise that every stroke experience is unique and no one can ever truly understand what an individual has experienced, both physically and mentally. I always try to take a glass-half-full outlook on life, and so helping support others through the mental and emotional struggle post-stroke has been especially rewarding.”

"Living with the effects of stroke changes everything - your independence, your confidence, even simple daily moments. Knowing that new treatments could help the brain recover faster and reduce long-term damage gives me hope that future stroke survivors might reclaim their lives sooner, with less fear and more freedom."

Aside from a lot of walking and ongoing rehabilitation, Brian’s days are now filled with working alongside the Stroke Foundation, universities, and other organisations as a lived-experience ambassador and critical contributor to research programs working to gain a better understanding of the stroke experience.

Contact details:

MEDIA ENQUIRIES
Kate Carthew
Media and Communications manager, Monash University
P: +61 438 674 814
E: [email protected]

GENERAL MEDIA ENQUIRIES
Monash Media
P: +61 3 9903 4840
E: [email protected]

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