Thread: ChinaSCINet Update

  1. #1621
    Quote Originally Posted by kz View Post
    Dr.Young ,
    Hi, Did any of china sci network centers use FES after their umbilical cord blood cells transplants on subjects? If not, do you think using FES on some specific muscles after transplants (in addition to walking program) could have some effect on motor scores etc. ? just a thought .
    kz, we do not use FES. Also, long experience with FES have never shown any person improving their motor score as a result. I hope that the subjects will recover motor and sensory function. It may take two years or more.

    We did not expect to find better walking without motor and sensory score improvements. I think that our finding here may be unique to regeneration in a population of patients who are truly "complete" and that the recovery is due to regeneration and not to sprouting of surviving axons.

    Here are some additional thoughts that have occurred to me over the last few months as the data emerged.
    1. Sprouting of surviving axons can occur within days after injury and improved function can be seen within weeks. Indeed, this is what a number of other groups have reported after transplantation of OEG and others cells. Most transplanted patients may have 4 or more dermatomes of sensation back. However, in our case, although a few patients showed a descent in sensory level, most did not get such sensory changes.
    2. Sprouting should produce a descent in sensory level by expansion of dermatomes. Regeneration should not produce a descent in sensory level but should rather produce patchy sensory improvements after a long period. The sensory axons must grow from the injury site to the brain stem to restore touch and proprioception (position sense) or to the thalamus (spinothalamic) to restore pinprick sensation. This is a long ways for the axons to grow.
    3. Motor sprouting should result in strengthening of weak muscle function in people with incomplete motor injuries. Regeneration, however, should result in recovery of voluntary function from proximal to distal. Therefore, the first muscle that we should expect voluntary motor recovery in is the psoas, the hip flexor. The motoneurons for this muscle group is located at L2, the same level as the CPG. We are looking for this in the 12-month followup data.
    .


    Wise.

  2. #1622
    Dr Young,

    How confident are you in your findings? Do you believe your on the right track to reversing SCI or do you believe you will find more is needed? you seem rather confident while im sure there has to be a lot questions and doubt.

    I guess the second or better question would be ,do you believe your trial is having some real effect? Are you sure so far that it is doing something to the trial participants?

  3. #1623
    Quote Originally Posted by Eric.S View Post
    Dr Young,

    How confident are you in your findings? Do you believe your on the right track to reversing SCI or do you believe you will find more is needed? you seem rather confident while im sure there has to be a lot questions and doubt.

    I guess the second or better question would be ,do you believe your trial is having some real effect? Are you sure so far that it is doing something to the trial participants?
    Eric,

    Do I have confidence that the treatment works? No. We are talking about ongoing phase II trials where we have not even yet collected all the 12 month data. A lot of people are jumping to the conclusion that the subjects will not recover motor and sensory scores. Even if they don't, I believe that we should do a Phase III with more patients to make sure that there is a significant difference between patients who have just received the surgery and those that have received the surgery and transplant.

    Do I believe that the trial is having some real effect? Yes, I think that the treatment is having some effect on growth of fiber tracts across the injury site and I believe that more patients are walking better as a result of the therapy than would be expected from locomotor training alone. I am not certain how many people will respond to the therapy and that it is just the transplants as opposed to the untethering surgery and locomotor training. That is for the phase III trial to show.

    Wise.
    Last edited by Wise Young; 02-10-2013 at 03:09 PM.

  4. #1624
    Quote Originally Posted by Wise Young View Post
    Eric,

    Do I have confidence that the treatment works? No. We are talking about ongoing phase II trials where we have not even yet collected all the 12 month data. A lot of people are jumping to the conclusion that the subjects will not recover motor and sensory scores. Even if they don't, I believe that we should do a Phase III with more patients to make sure that there is a significant difference between patients who have just received the surgery and those that have received the surgery and transplant.

    Do I believe that the trial is having some real effect? Yes, I think that the treatment is having some effect on growth of fiber tracts across the injury site and I believe that more patients are walking better as a result of the therapy than would be expected from locomotor training alone. I am not certain how many people will respond to the therapy and that it is just the transplants as opposed to the untethering surgery and locomotor training. That is for the phase III trial to show.

    Wise.
    is your lack of confidence that the treatment works due to the little amount of data collected or what you've seen so far?

  5. #1625
    Quote Originally Posted by Eric.S View Post
    is your lack of confidence that the treatment works due to the little amount of data collected or what you've seen so far?
    I can answer for him on this one: the Phase II trial is ongoing, so speculation on whether or not it works is premature. This is what the Phase III trial is for...

  6. #1626
    Quote Originally Posted by ay2012 View Post
    I can answer for him on this one: the Phase II trial is ongoing, so speculation on whether or not it works is premature. This is what the Phase III trial is for...
    outside of statistical evaluation you would think you can get an idea if something works or not unless the data collected so far is just so small you can't draw an anecdotal conclusion.

    a.k.a. "you dont need a weatherman to know which way the wind blows"

  7. #1627
    Quote Originally Posted by Eric.S View Post
    outside of statistical evaluation you would think you can get an idea if something works or not unless the data collected so far is just so small you can't draw an anecdotal conclusion.

    a.k.a. "you dont need a weatherman to know which way the wind blows"
    The patients in the Phase II weren't randomized...also there were less than 40 of them. I know it's tempting to jump to those types of conclusions, especially in something that changes so little over time, like a very severe chronic spinal cord injury. You and I can do that (although we wouldnt be right). For the sake of the credibility of the ongoing trials Dr. Young, one of the principal investigators, simply cannot...and he knows the science enough to know that it would also be unscientific to do so.

  8. #1628
    Quote Originally Posted by Wise Young View Post
    [*] Motor sprouting should result in strengthening of weak muscle function in people with incomplete motor injuries. Regeneration, however, should result in recovery of voluntary function from proximal to distal. Therefore, the first muscle that we should expect voluntary motor recovery in is the psoas, the hip flexor. The motoneurons for this muscle group is located at L2, the same level as the CPG. We are looking for this in the 12-month followup data.
    By this logic, wouldn't you first expect to see some voluntary motor recovery in the trunk? Or in the case of cervical injuries some part of the arm or hands?

  9. #1629
    Quote Originally Posted by Eric.S View Post
    outside of statistical evaluation you would think you can get an idea if something works or not unless the data collected so far is just so small you can't draw an anecdotal conclusion.

    a.k.a. "you dont need a weatherman to know which way the wind blows"
    Eric,

    I am not sure what you are looking for but I clearly don't have confidence in the limited data that we have to date. I have already said that we should not expect much functional return until more than a year after treatment. We don't even have all the 12 month data.

    Wise.

  10. #1630
    Quote Originally Posted by Wise Young View Post
    Incidentally, the doctors at Kunming have been documenting the walking with electromyography as well. The subjects do show electromyographical activation of muscles when they are walking, so it is not just a trick that they are employing.
    I think this is an important part to highlight. It provides good evidence that the CPG is being activated and not, as said, some trick is being employed.

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