A single injection of an oxygen-carrying chemical could buy stroke patients extra time for treatment while simultaneously revealing which parts of their brain can still be saved. Current stroke care relies on a tight 4.5-hour window for clot-busting drugs, but fewer than 5% of UK patients receive them. Advanced brain scans could help identify more eligible patients, but they take too long—and in stroke, every minute costs brain tissue. The GOLD approach solves this paradox: the perfluorocarbon Oxycyte, combined with inhaled oxygen, both keeps brain tissue alive and enhances MRI signals that distinguish salvageable tissue from dead tissue. This means the scan itself becomes part of the treatment. If successful, this project would allow doctors to make treatment decisions based on each patient’s individual brain physiology rather than a rigid clock. More patients could safely receive clot-busting drugs, and researchers could better stratify patients for future trials. The project will first optimise the oxygen-carrier dose in the lab, confirm its safety alongside existing stroke drugs, then test it in a small human study.
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Acute ischaemic stroke is common and disabling, but lacks acute treatment options. The thrombolytic drug rt-PA (alteplase), given within 4.5 hours of onset based on clinical symptoms and basic brain imaging, significantly increases independent recovery, but is under-utilised (<5% of UK patients). Advanced brain imaging offers a means of targeting treatment to a wider population but existing technologies are not widely used because of additional time incurred, and limited diagnostic validation. GOLD (Glasgow-Oxygen-Level-Dependent) is a new combined diagnostic and therapeutic approach in which an IV oxygen carrier perfluorocrabon (Oxycyte) enhances imaging of brain metabolic responses to inhaled oxygen with MRI, differentiating potentially salvageable penumbral tissue from irreversibly damaged tissue. Unlike alternatives, additional imaging time carries no penalty (“time lost is brain lost”) since PFC+oxygen maintains brain viability and reduces ischaemic damage. The project's goals are to optimise dose for diagnostic sensitivity and to confirm Oxycyte+50%O2 preclinical safety when coadministered with thrombolytics and radiological contrast agents. The project also aims to establish safety and tolerability in acute ischaemic stroke patients in an ascending dose, randomised, controlled study and confirm diagnostic imaging feasibility in stroke patients. GOLD, developed by Professor Keith Muir and Dr Celestine Santosh, will allow individual treatment decisions based on brain pathophysiology, not time alone, widening eligibility and improving safety of rtPA, and stratifying patients for future research.
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