Treatment of patients sustaining a complete spinal cord injury remains an unsolved clinical problem because of the lack of spontaneous regeneration of injured central axons. A 38-year-old man sustained traumatic transection of the thoracic spinal cord at upper vertebral level Th9. At 21 months after injury the patient presented symptoms of a clinically complete spinal cord injury (American Spinal Injury Association class A-ASIA A). One of the patient's olfactory bulbs was removed and used to derive a culture containing olfactory ensheathing cells and olfactory nerve fibroblasts. Following resection of the glial scar the cultured cells were transplanted into the spinal cord stumps above and below the injury, and the 8 mm gap bridged by 4 strips of autologous sural nerve. The patient underwent an intense pre- and post-operative neurorehabilitation program. No adverse effects were seen at 19 months postoperatively, and unexpectedly, the removal of the olfactory bulb did not lead to persistent unilateral anosmia. The patient improved from ASIA A to ASIA C. There was improved trunk stability, partial recovery of the voluntary movements of the lower extremities, and an increase of the muscle mass in the left thigh, as well as partial recovery of superficial and deep sensation. There was also some indication of improved visceral sensation and improved vascular autoregulation in the left lower limb. The pattern of recovery suggests functional regeneration of both efferent and afferent long-distance fibers. Imaging confirmed that the grafts had bridged the left side of the spinal cord, where the majority of the nerve grafts were implanted, and neurophysiological examinations confirmed the restitution of the integrity of the corticospinal tracts and the voluntary character of recorded muscle contractions. To our knowledge, this is the first clinical indication of beneficial effects of transplanted autologous bulbar cells.
I posted this late yesterday so I uploa again for anyone who missed it. When we were at Queen Square Geoff Raisman was showing how you could use olfactory ensheathing cells (OEC) to get spinal injured rats walking. He has teamed up with some Polish surgeons to test these approaches in humans and the results are now published. Nerves generally do not regrow in the central nervous system, but to keep your sense of smell going you do actually make new nerves.
So in this study they took these cells from the olfactory bulb from the brain, this contains the olfactory ensheathing cells. These were cultured and then transplanted above and below the stab injury that caused the paralysis in this trial. They also took a piece of peripheral nerve and used this to bridge the gap between the two sides of the spinal cord. Many years ago I was in a Lab where we used pieces of muscle to act as a conduit to allow nerves to regrow through the muscle tubes to get sensation back to the feet of people with Leprosy. That was peripheral nerve and this is central nervous system, which is a whole dimension of extra difficulty. One person has done reasonably well after this treatment. He had intensive physiotherapy and neurorehabilitation before the transplant to show this had not affect and after the transplant, but the results are very encouraging.
Of course we will need to see this replicated and larger trials are planned in UK and Poland. It is early days but this is definatively a move in the right direction.
On the down side I wonder how many quack sites will spring up offering OEC. However this is not a simple procedure and this requires brain surgery and are not nose cells as reported widely in the media..
Perhaps a cut is the best thing to try and heal first. As you know a sharp cut leaves a nice scar whereas a blunt damage does not. However the treatment was long after the injury. The challenge for MS is greater because you have an ongoing disease process and multiple sites of damage. However the fact that this approach was started many months after the injury leaves me with a lot more optimism. However, this has involved a lot of hard work but the recipient and his rehabilitation has been ongoing for 2 years..so remember it may not be a quick fix, but that this work suggests that nerves can have plasticity.
I remember when Geoff was presenting his inaugural lecture at Queen Square and watching his injured rats climb ladders. I saw that his funding was largely from charities and not central government and the trials were funded by the efforts of some dedicated people. It is through this support, that breakthroughs are possible and so keep up the good work...Research needs you!
It will be some time before this treatment becomes standard practice but a giant stride forward, so well done to all those involved notably the Polish Team. The results are published in Cell Transplantation, which a couple of years ago had No Impact Factor and now it is around four. The impact factor is a metric that some people i the University Top Brass use to judge how good the work is....This shows that you should judge a book by its cover. This paper has no doubt had global media coverage, is this the new metric....If it is time to start research on sex...it always gets the media interested:-) For those of you in the UK who want to know more on the story then go to BBC iPlayer and you have a month to see the programme broadcast yesterday "To Walk Again" on Panorama. This is science in action.