Irina Victorovna Gannushkina
Authors: Boleslav Lichterman, Irina Konorova
Journal: BMJ (2007)

Irina Victorovna Gannushkina had a lifelong interest in experimental neurology. Her fundamental studies of collateral blood circulation in the brain, individual susceptibility to cerebral ischaemia, and cerebrovascular biomechanics opened new perspectives for neurology and neurosurgery clinics. She also studied neuroimmunology and demonstrated the role of autoimmune factor in the pathogenesis of stroke, traumatic brain injury, and other nervous diseases. She wrote Collateral Cerebral Blood Circulation (1973) and Immunological Aspects of Traumatic and Vascular Brain Lesions (1974) and coauthored Hypertonic Encephalopathy (1987) and Immunopathology of Traumatic Brain Injury (1996).

Irina Gannushkina was born in Moscow in 1929 into a medical family (her father was a neurologist and her mother a nurse). As a student in the paediatric faculty of the Stalin Moscow State Medical Institute N2, she became interested in pathology and spent four years at the students' society of the chair of pathology (in many departments in medical schools there are voluntary circles or societies for those students who are interested in the subject; they normally get together once a month during term; at these meetings, guided by a head of the chair (professor) or by an assistant or associate professor, students present the result of their research work and read papers on the subject of their interest). Here Gannushkina performed her first experimental research on changes in the permeability of capillaries after chloroform narcosis. She married her fellow student Leonard Kapuller, who later became a pathologist.

From 1954 until her death Gannushkina worked at the Institute of Neurology in Moscow. In 1955 she entered aspirantura—a three year postgraduate research programme for writing a kandidatskaya dissertation (the Russian equivalent of a PhD thesis). Initially her supervisor was Professor Leonid Smirnov—an outstanding Soviet neuropathologist—but owing to his sudden death Gannushkina had to finish her work under the guidance of Professor Boris Klosovsky. Her thesis, defended in 1960, was on the sequelae of occlusion of cortical vessels.

In 1962 Gannushkina became head of the laboratory of experimental pathology at the Institute of Neurology and held this position until she died. In 1969 she defended her doctorskaya dissertation (equivalent to a habilitation thesis in German-speaking countries) on changes in brain vessels after impairment of cerebral blood flow and became a professor of pathophysiology in 1972.

Gannushkina was already nicknamed “an academic” as a first year medical student. In 1991 she became a corresponding member of the Soviet (now Russian) Academy of Medical Sciences and a full member in 2004.

In her research Gannushkina described the characteristics of vascular changes and neural damage in different types of collateral blood circulation. She discovered the principles of structural reorganisation of cerebral blood vessels in response to haemodynamic load and rheological changes. These vascular changes might be reversed, which justifies reconstructive neurosurgical interventions such as extra-intracranial anastomoses of middle cerebral arteries.

Gannushkina and her colleagues studied mechanisms of ischaemic cerebral lesions and the difference between arterial and venous ischaemic lesions. She proved the possibility of the adverse effect of sudden recirculation in previously ischaemic brain tissue, which clinically manifests itself as the steal syndrome. It can be reversed by different types of metabolic protection.

Since 1972 Gannushkina's laboratory concentrated on the pathogenesis of the damage to cerebral blood vessels and brain tissue in arterial hypertension. This research revealed vulnerable parts of cerebral blood vessels, especially in occipital lobes, explaining the clinical symptoms of a hypertension crisis such as occipital headaches and visual impairments. This new concept of impaired autoregulation at the upper border of cerebral blood flow justified new principles of treatment of hypertension crises aimed at diminishing brain oedema.

Differences in cerebral metabolism might predict the severity of subsequent brain ischaemia. Gannushkina's studies using magnetic resonance imaging and spectroscopy showed the relation between susceptibility to ischaemia and emotional resistance in experimental animals. Emotional stress had a negative impact on the development of cerebral ischaemia.

In 1949 an English chemist, B A Toms, discovered that dissolving small quantities of heavy long chain molecules (polymers) in solution reduced drag during turbulent flow through a tube by up to 70%. The so called Toms effect has been successfully applied in the oil industry. Gannushkina and her colleagues injected small doses of polymers in atherosclerotic vessels in experimental animals and observed an increase in diameter of cerebral vessels and normalisation of cerebral blood flow that lasted for a week. Long chains of DNA with molecular weight comparable to Toms' polymers were discovered in the plasma of healthy volunteers. However, in patients with ischaemic stroke DNA concentration was much higher and DNA itself was represented mostly by short fragments (including oligonucleosomes). Such DNA “stumps” increased blood viscosity and contributed to thrombosis. It remains unclear how DNA enters the blood flow but it seems to be an important factor in the pathogenesis of cerebral ischaemia.

Gannushkina was better known abroad than in her home country. She participated in joint research projects and lectured in Poland, Germany, and Sweden. She was a member of the Soviet National committee of IBRO (International Brain Research Organisation) and had been a deputy chairman of the section on brain pathology at IBRO since 1979. In 1991 she was elected a fellow of the Royal Society of Medicine.

Irina Gannushkina had an open minded and kind personality. But as a head of the laboratory she was tough and demanding. Gannushkina preferred to teach others by her own example. She was a skilful operator and for many decades did animal experiments herself. She was a fighter by character. She fought for her ideas and fought for her life until her sudden death from arterial embolism.

She leaves her husband, Leonard Leonidovich Kapuller, and a daughter.

Irina Victorovna Gannushkina, professor of pathophysiology Moscow, and head of laboratory for experimental neurology, Institute of Neurology (b 1929, q Moscow 1953; MD), died from arterial embolism on 5 February 2007.