SHIVA: the fight against cerebral small vessel disease

The SHIVA research project aims at preventing cognitive impairment and dementia by tackling one of their leading causes: cerebral small vessel disease.

  • 31/10/2019

The SHIVA research project, awarded over 8M€, is one of the winners of the “Hospital-University Research in Health” call of the “Investments for the Future” program of the French government. SHIVA (coordinated by the University of Bordeaux), is led by Stéphanie Debette (Professor of epidemiology, hospital practitioner in neurology at Bordeaux University Hospital, and Vice-president for external relations at the University of Bordeaux, director of the VINTAGE team at the Bordeaux Population Health Inserm U1219 Center) and co-led by Thierry Couffinhal (Professor of Cardiology at Bordeaux University and Head of the Exploration, Prevention and Care Center for Atherosclerosis (CEPTA) at Bordeaux University Hospital, director of the INSERM Unit U1034).

Better detection and management of cerebral small vessel disease

Stroke and dementia are the most common age-related sources of neurological disability, representing a huge burden for society. It is estimated that by 2030, between 1.5 and 2 million people in France will have dementia, despite potential prevention strategies.* This represents an increase of 75.7% in just 10 years.

Vascular brain injury, which includes stroke and (most often) covert vascular brain injury, detectable on brain images in stroke-free persons, contributes considerably to the occurrence of dementia. Its most frequent substrate is cerebral small vessel disease (cSVD). Covert cSVD is very common in older community persons and is a powerful predictor of stroke and dementia risk. Better detection and management of covert cSVD would have a major impact on preventing disability and costs related to stroke and dementia. The SHIVA research program aims at developing personalized management of cSVD, preventing its complications, and deriving novel biological targets for cSVD treatment.

This project is a gamechanger, taking our research on cerebral small vessel disease one step further, thus accelerating the translation to clinical innovation and developing novel prevention strategies for stroke, cognitive decline and dementia.

Profs. S. Debette and T. Couffinhal —

A transdisciplinary research approach

The project, which will  last 5 years, gathers together a consortium of internationally recognized research teams with complementary expertise from: the University of Bordeaux, Inserm, and CNRS; clinical departments at Bordeaux University Hospital, and APHP-Broca and National Ophthalmology Hospital in Paris; 3 French SMEs (small and medium-sized enterprises) specialized in IT solutions (Fealinx), brain imaging medical device software (Qynapse), and high-resolution optical instruments (Imagine-Eyes). In addition to these French partners, scientific collaborators and subcontractors  from Japan, Canada, Sweden and the USA will be strongly involved in the project.

Project objectives

Extensive data will be leveraged from complementary cohort studies, spanning across the clinical spectrum of cSVD, with the aim to:

  • Improve diagnosis and characterization of cSVD by developing novel integrative methods for quantification of cutting-edge imaging biomarkers in brain and retina (a window on microvessels), using a dedicated IT infrastructure (SHIVA platform) and leading to novel software / medical devices
  • Discover novel blood biomarkers for cSVD, and derive a cSVD biomarker-signature using high throughput technologies (genomics and multiple other “omics” modalities) to improve detection of high-risk individuals and understanding of disease pathways
  • Identify and explore novel biological targets, through bioinformatics and experimental approaches (in vitro and in mice), to help accelerate the development of novel cSVD treatments
  • Optimize personalized risk prediction of cSVD complications (stroke, cognitive decline, dementia) using innovative analytical approaches, including machine learning, and include best performing algorithms into the SHIVA platform and medical device software
  • Propose pragmatic, evidence and expert-panel based recommendations for cSVD management, accounting for ethical aspects, and suggest priorities for a cSVD trial design

*Epidemiological study published in the European Journal of Epidemiology (Jacqmin-Gadda H et al. 2013). Projections made using data from INSEE and the Paquid cohort (population over 65 years of age followed for 20 years in the Bordeaux region).