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John David Spence (born November 10, 1944) is a Canadian medical doctor, medical researcher and professor at the University of Western Ontario. Along with his affiliation with the University of Western Ontario (where he teaches Clinical Neurological Science) he is affiliated with the London Health Sciences Centre’s University Hospital (where he has set up and runs stroke prevention clinics) and the Robarts Research Institute, one of Canada’s leading medical research organizations. He is a recognized expert in stroke prevention and stroke prevention research and has published over 200 articles in medical journals in the last 35 years. Dr. Spence is the director of the (Stroke Prevention & Atherosclerosis Research Centre (SPARC) ) located at the Robarts Research Institute. With Maria Dicicco, RVT, he pioneered the measurement of total plaque area (TPA) in a patient’s carotid artery using ultrasound technology. The ability to measure TPA gives doctors the ability to treat, and measure the change in, the amount of plaque in a patient’s arteries and has given researchers the ability to measure the effectiveness of new drug treatment therapies for stroke prevention.〔Spence JD, et al. Carotid Plaque Area: A Tool for Targeting and Evaluating Vascular Preventive Therapy Stroke. 2002;33:2916-2922〕 Dr. Spence is recognized as “(The Father of Total Plaque Area Measurement )” and the importance of TPA measurement is, in Dr Spence’s words, “We can now treat arteries instead of just treating risk factors”. == Spence - Key Research Discoveries == Cerebral consequences of hypertension: treating high blood pressure prevents only arteriolar strokes. (.〔Stroke 1986; 17(5):808-10〕) This research led to the understanding that the effects of therapies, designed to reduce hypertension, on blood pressure need to be distinguished from other effects on atherosclerosis. Effects of antihypertensive drugs on blood velocity and arterial flow disturbances 1976, 1980, 1995: these studies showed that antihypertensive drugs have different effects on blood velocity and arterial flow disturbances, which have implications for how effective they are at fighting the buildup of arterial plaque. (.〔Magn Reson Med Jan 2002;47:149-159〕) Effects of grapefruit juice on drug metabolism: The discovery with Drs. David Bailey and Malcolm Arnold, that grapefruit juice markedly increases blood levels of a number of drugs that have low bioavailability because of gut wall first-pass metabolism by CYP3A4 made a major contribution to the understanding of pharmacokinetics, and has opened up a new field of pharmacology. (〔Lancet 1991; 337(8736):268-9〕). Ultrasound measurement of plaque: Beginning in 1990, Dr. Spence pioneered the use of carotid plaque measurement (as opposed to intima-media thickness) for research and for management of patients with carotid artery disease. (.〔Spence JD, et al. Carotid Plaque Area: A Tool for Targeting and Evaluating Vascular Preventive Therapy Stroke. 2002;33:2916-2922〕). This has evolved to the use of 3-D plaque volume measurements for evaluation of new therapies. The effect of drug therapies on carotid plaque volume can now be evaluated in a very cost-effective way. Development of quantitative traits for human atherosclerosis: Spence developed a number of quantitative traits that will advance the search for new genetic causes of atherosclerosis, and thus new therapeutic targets and new therapies for atherosclerosis. These are unexplained atherosclerosis and its progression, unexplained protection from atherosclerosis and unexplained regression of atherosclerosis. (;.〔Stroke 1999;30:969-73; Atherosclerosis 1999;144:429-340〕〔Stroke 2003;34:1178-1182, Nature Clinical Practice Neurology 2006;2: 611-619〕〔Lanktree MB, Hegele RA, Schork NJ, Spence JD. Extremes of unexplained variation as a phenotype: an efficient approach for genome-wide association studies of cardiovascular disease. Circ Cardiovasc Genet Apr 2010; 3: 215 – 221〕) Appropriate carotid endarterectomy: Showed in 2005 (〔Stroke 2005;36:2373-2378〕) that with intensive medical therapy most patients with asymptomatic carotid stenosis cannot benefit from endarterectomy or stenting, and that the very small proportion (10%) who may benefit can be identified by (microembolus ) detection on transcranial Doppler. Showed in 2010 (〔Arch Neurol. 2010 Feb; 67(2):180-6〕) that the proportion who could benefit had declined with more intensive therapy to less than 5%. SPARC’s work has recently been confirmed by an international multicenter study. Dr. Spence is now leading a study in the (Canadian Atherosclerosis Imaging Network ), on histological validation of imaging features of vulnerable plaque and it will also serve to identify high-risk carotid plaques. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「John David Spence」の詳細全文を読む スポンサード リンク
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