brain to unlock some of the big mysteries in

medical science: Is there a cure for dementia

? Is it possible to reverse the damage of

alcohol abuse on brain tissue?

Diseased brains have been relatively easy

to acquire— the NSW Brain Tissue Resource

Centre( BTRC), where she is director, houses

about 500 preserved donor cases— but it is

experiencing a chronic shortage of healthy

controls.

“ Controls are vital because almost

all research is conducted as a comparison

between healthy controls and disease

groups of interest,” Professor Kril says.

“ Even when we are comparing between

diseases, neurologically normal controls are

included in the experimental design.”

Professor Kril explains that the brains

she has acquired over the years have been

crucial to her own field of research.

Program, which accounts for most of its dis-

brain becomes unviable and essentially use-

Raising public awareness around brain

Among more than 500 studies published

eased brain cases, the BTRC’ s main source

less for the centre’ s research purposes.

donor programs and signing up more con-

as a result of the BTRC’ s extensive collection

for healthy controls has mostly dried up.

The second issue for the BTRC’ s short-

trols can help address this issue, but she

is a paper she authored that remains one of

The NSW Department of Forensic Med-

age headache is that it can only collect

says ensuring doctors are aware of their

the most cited studies on alcohol-related

icine, which receives all sudden, acciden-

brains from the department when there has

patient’ s donor status is paramount in pre-

brain damage. It was published in Neurosci-

tal and violent deaths, allows BTRC staff to

been a full autopsy— and not all autopsies

venting post-mortem delays in collection.

ence in 1997. 1

visit and assess the reports of death to the

fall into this category now.

“ There’ s a time-sensitive period where

“ It was the first work to actually show

coroner for potential donations.

Dr Claire Shepherd, director of the

they need to sign the death certificate so

that alcohol abuse did actually kill brain

If a deceased individual meets certain

BTRC’ s sister facility the Sydney Brain Bank

that we can collect the brain tissue in as

cells,” she says.

criteria, then the next of kin will be con-

( SBB), says the controls shortage has had an

short a time period as possible.”

“ It demonstrated the selectivity of neu-

tacted to discuss the donation and consent-

even more profound impact on their work.

Professor Kril also wants doctors to bet-

ronal loss in people who abuse alcohol. That

ing process.

Despite owning almost 600 donor cases,

ter assess and record patients’ alcohol con-

is, the damage does not occur universally

“ As you can imagine, if you’ ve just found

the number of true controls in the SBB’ s col-

sumption, including frequency, amount,

but targets cells in specific brain regions.”

out your relative has died and there’ s going

lection is“ less than 2-3 %” of the total cases,

type of alcohol consumed and dietary

This loss underlies the clinical symptoms

to be an autopsy, having someone ring up

says Dr Shepherd, who is also an Alzheim-

factors.

of a person with alcohol addiction, Professor

and say,‘ excuse me, can I have the brain?’

er’ s disease researcher at UNSW.

“ Unfortunately notes often just record

Kril adds.

does sound like a terrible thing,” Profes-

“ We should have a number of control

subjective assessments such as‘ moderate

sor Kril says.“ But the consent rates are

cohorts that are age-appropriate and they

drinker’ or‘ heavy drinker’ without the use

A lot of people found that being able to give a relative’ s tissue for research was something they wanted to do when they were grieving.

really very high. A lot of people found that being able to give their relative’ s tissue for research, for purely altruistic reasons, was something that they wanted to do at the time that they were grieving.”

The problem has been the chronic underfunding of the NSW Coroner’ s Court.

In recent years the court has faced a bigger workload, partly due an increase in the

should be matched to every disease cohort we have and currently we’ re nowhere near that,” she tells Australian Doctor.

Dr Shepherd co-authored a 2015 study published in Nature Communications that showed that abnormalities in neuronal communication pathways contribute to synaptic loss, which is thought to be one of the earliest events in Alzheimer’ s disease

of validated instruments,” she says.

Not only would more detailed patient

records help fulfil the wishes of individuals

who signed up to be a donor, but it would

also create more opportunities for researchers

to continue exploring, despite its dull

goo, the most fascinating organ in the

human body.

For Professor Kril, the people who

reporting by doctors of deaths from unnat-

pathogenesis. 2

choose to take part in this great scientific

The BTRC’ s collection holds about 150

ural causes.

“[ The study ] allows us to get a mecha-

endeavour are fascinating enough without

controls but unfortunately most are already

The state government’ s Department

nism for how we think the nerve cells stop

having to contemplate any metaphysical

‘ matched up’— based on their age and gen-

of Forensic Medicine procedures are also

communicating with each other in Alzheim-

issues associated with the brain— such as

der— with diseased brains in cohort studies,

an issue. The department must determine

er’ s disease,” she explains.

its link with consciousness.

leaving very few unmatched controls avail-

the cause of a person’ s death using the

However, even this study was restricted

“ The generosity of the donors is probably

able for researchers requesting tissue sam-

least invasive procedures possible, which

by the number of controls available— only

the standout thing,” she says.

ples outside of these parameters.

means it must review all medical records

10 were used in the study to compare with

“ I don’ t really ponder the consciousness

“ Matching occurs dependent on selec-

of the deceased person as well as perform

disease-affected cases.

of the person, but I have a deep respect for

tion criteria. A case that is suitable for one

CT scanning on the body. It is only then, if

The SBB recruits all of its cases through

the donors and their families— the selfless-

study may be unsuitable for another because

the cause is still unclear, that an autopsy is

prospective longitudinal programs and

ness of the gift, the positivity in their altru-

the investigator has set specific inclu-

performed.

relies heavily on the BTRC to supply age-

ism and their faith in our ability as scientists

sion and exclusion criteria,” Professor Kril

explains.

Despite having about 600 people

enrolled in its Using our Brains Donor

This process can cause delays of up to three to five days. This is a serious issue for BTRC because if it cannot collect the brain from the body within 24 hours of death, the

matched controls to researchers.

“ It would be nice to at least have at least 10-15 % of the collection being controls rather than the current 2-3 %,” Dr Shepherd says.

to deliver. It’ s humbling.” References: 1. Neuroscience 1997; 79:983-998. 2. Nature Communications 2015; online.