ESO: The structural backbone of European stroke research

Founded only 11 years ago, the European Stroke Organisation (ESO) has announced itself as the voice of stroke research across Europe. Working collaboratively with some huge corporate partners, including AstraZeneca and Boehringer Ingelheim, ESO are going above and beyond to ensure stroke research receives the funding and attention it requires. Not only that, but they are adding a stroke of organisational genius to the development of treatments and rehabilitation methods for stroke disease sufferers.

We spoke with Dr Valeria Caso, the President of ESO, to ascertain the influence her organisation has had on improving stroke research in Europe since its inception back in 2007.

Hello Valeria! Could you tell us a bit more about your role as the President of the European Stroke Organisation, outlining the kind of responsibilities and objectives you have there?
My main goal is to ensure that stroke treatment is delivered in the same way all over Europe. We are currently updating our guidelines to highlight the main objectives for stroke clinicians, physicians and researchers. We want to develop a research plan – a treatment plan – to outline what the objectives are that we must reach by 2025. I will leave my post as President in 2018, so this is now my key focus – to review the burden of non-communicable disease in Europe and outline the major goals we must reach by 2025.

The ethical approach to future work is very important. It is vital to ensure that research is carried out ethically, effectively, within the right hands, and with the right level of care

Could you tell us a bit about ESO’s background and the work into stroke research that you do there?
Our aim is to be the voice of stroke in Europe, which I think we have now become. If you look at our conference’s main trials and the research presented during our recent conference, you can see how the leaders of stroke research are all now a part of our society. In fact, most of the research that is currently being funded within stroke treatment is carried out by our members.

The society itself was founded in 2007, where we initially existed as a conference managed by one of our colleagues. We then decided as a big society to take over this responsibility and organise the conference ourselves as an organisation. Our vision for this was to make our conferences purely academic, not-for-profit events, which ensure that what we are doing is based on quality science, rather than a continual beg for support.

My main goal is to ensure that stroke treatment is delivered in the same way all over Europe. We want to develop a research plan that outlines the major goals we must reach by 2025

ESO has several corporate members, including AstraZeneca, Amgen and Boehringer. How important is it to have these worldwide collaborations with other research institutions, especially in terms of enhancing stroke research and improving patient outcomes?
For me, it’s fundamental. It’s important to collaborate with industry because it can provide an important analytic difference to the improvement of healthcare. For example, we’re working on a very important project now in Eastern Europe, called ESO-EAST, where we hope to improve stroke treatment and awareness in Eastern European countries. This project has been supported by Boehringer Ingelheim and EVER Pharma, two of our industry partners. It’s not about luck; it’s about how research can receive unrestricted grants to continue vital work.

ESO recently ran a ‘Stroke Update’ conference in Stockholm. Could you tell us some more about this, and why these events are so important in progressing stroke research?
We run a big conference annually called the ESOC – our European Stroke Organisation Conference – and then we also run an event every three years called The Karolinska Stroke Update. These are events where we discuss current guidelines and issues within stroke research with an audience, the president and other stroke-related professions who are present. We provide a method for the audience to participate and be involved because we believe this is vital to progressing stroke research. For example, this year we discussed how to reach cognitive end points in neurological trials, so it’s important to provide a platform where all members can interact with the thinking process.

These events are open to everyone, so anyone can be involved – including stroke sufferers themselves. We have another closed event as well called the European Stroke Science Workshop. This is a science workshop where we meet physicians and researchers from all over Europe to discuss the latest research developments. This event can be very positive for younger physicians especially, as it offers them an opportunity to present their latest findings.

What kind of influence has ESO’s work had on stroke research? Do you have any examples of accomplishments you are particularly proud of?
We have seen a huge influence as a result of our work. One notable example of this has come from my university where students came to study from Eastern Europe. When they left my institution, they were equipped with many tools and techniques that will help to progress stroke research back in their home countries. For example, they were taught how to write research papers and specific transcripts, and were given an opportunity to carry out research – collecting data themselves and writing it up.

There’s a particular style you need for this, especially within science: when you know there is a problem, you must find a way to solve it. To do this within Eastern European countries, you must firstly understand where the problem is and learn how to collect data without using the computerised stroke registries that more developed countries are used to. In these countries, you can go through the registry and in just five minutes have the data you need sent straight back to you. This is something that doesn’t exist in Eastern Europe, so it’s important to teach stroke researchers, from less-developed countries especially, techniques that can help them to obtain data wherever they are in the world.

It’s fantastic to see how much colleagues without funding do for stroke patients, and it is especially satisfying to witness the determined intentions of our researchers. What we as a stroke organisation need to do is support them. Even if the standard of their research is different to ours, we can ensure that the work they are doing is worthwhile and helping the wider community.

Aside from your role as President of ESO, you are also a stroke neurologist at the University of Perugia Stroke Unit in Italy. How does it feel to be such a recognised peer of stroke research? Is it ever difficult finding the time to balance both these positions?
That’s such a good question because I don’t know! It’s a lot of work, I can tell you that for sure, but you already know that when you take on the responsibility of being President.

I have worked in this job for two years now but have had a strong motivation to do it throughout. When I first started, I was in a great position because of the excellent preparation and groundwork my predecessors had left. My main objective throughout my presidency was to expand the political influence of ESO, which has been surprisingly easy. There is now a large amount of interest in our organisation because we are at a recognisable level to achieve the objectives that we set out.

What are the ethical considerations you have to take into account when researching stroke disease? How do you conform to these at ESO?
So, at ESO we follow the Declaration of Helsinki, and it is very important to reflect the ethics of this in the research we fund. This is something we absolutely need to do. We need to be compliant with all the rules that are set out for us, and we need to be the organisation that supervises researchers so that nothing happens outside the current ethical view of research.

Where do you see stroke research going over the next ten years or so? Are there any areas you are particularly excited about?
I think what we are particularly excited about looking into are the cognitive aspects of stroke disease – the decline of motor functions within the brain during strokes. During all of our trials, we need to understand that we are not only working on the vascular aspects of stroke health within the brain, but we also need to consider the affect of strokes on cognitive function.

The second area we need to look at is rehabilitation. Patients are living longer and longer, and some will have a disability for twenty, thirty years. We need to give them the opportunity to work on their disability, by progressing research in areas such as virtual reality, robotic rehabilitation, and potentially even stem cells. We are not yet able to say whether stem cells will have any effect: further research has to answer this question. In order for this to happen though, the rules surrounding the administration of stem cells need to change. They need to be administered in a controlled manner, to ensure their ethicality and safety during randomised trials.

The ethical approach to future work, especially in terms of stem cells, is very important. It is vital to ensure that research is carried out ethically, effectively, within the right hands, and with the right level of care.

• Dr Valeria Caso is the current president of the European Stroke Organisation. Aside from her presidency, she has authored and co-authored more than 200 published research papers and acted as a peer reviewer for countless others. Her own research has been largely related to international projects looking at cervical artery dissections, intracerebral haemorrhages and acute stroke treatments. Dr Caso is also a stroke neurologist at the University of Perugia, where she has supervised several masters, residents and MD-theses. Currently, her personal research focuses on preventing stroke disease within women, looking at the underlying mechanisms behind stroke disease onset.

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