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Thread: Working2Walk 2011 features Dr. Jerry Silver!

  1. #21
    Senior Member
    Join Date
    Feb 2006
    Location
    Murrieta, Ca.
    Posts
    424
    Dr. Silver,
    I didn't mean for you to wake up on Sunday morning barraged with a bunch of questions but thank you for responses to my question although they take me some time to digest due to my limited understanding of SCI research, but I'm learning....

    It's very exciting and uplifting knowing there are dedicated people like yourself (and others I need to ad) using a lifetimes worth of work/knowledge and making the progress you are towards a fix for this injury.

    I don't want to bog you down with a bunch more questions because I know you have much more important work ahead of you but I do appreciate you coming here and filling us in on your works progress, we are all eager for that news, so please continue to do that.

    Keep up the great work you are doing and I'm sure I will read shortly that you have figured out a graft that will help walking.......

    Rick James

  2. #22
    Dear rjames,

    Please, don't hesitate to ask lots of questions. I am truly grateful to those who seek answers and knowledge about SCI. Asking questions helps brings out the truth about how close we really are to helping people with SCI regain function.

    In regards to the use of bridging strategies to build a roadway for regeneration, there are a huge number of different approaches. In general, every single approach, including the use of stem/progenitor cells, biopolymers and even segments of peripheral nerves alone tend to allow regenerative growth into but not beyond the graft. We have chosen the peripheral nerve autograft +chondroitinase for a number of reasons. Mother Nature has engineered the peripheral nerve over millions of years to be the most perfect regeneration bridge , so why not take advantage of her efforts. She just needed a little help when it came to transplanting the regenerative potential of the PNS into the CNS in order to get some axons out of the bridge. Our work with this technique to restore respiration after cord hemisection, has demonstrated that a profound amount of breathing recovery can occur when we do things right. We are now perfecting techniques to improve upon this strategy for other systems and in animals with cord lesion that are much larger. We anticipate the use of 2 bridges for the potential restoration via regeneration of crude hand function and I showed at W2W our ongoing studies to restore urinary function after complete transection injury. Now the question remains as to whether neurosurgeons will apply these strategies to humans. For those with high cervical lesions we will need to be especially cautious that the technique does no more harm. So I think we will need to demonstrate the efficacy of the technique in a larger animal model. For those with lower injuries the chances of additional damage are mitigated by the lower position of the lesion, so surgeons may be more willing to operate. We just need to keep going full speed and publish very high quality papers. If we do this only good things can follow but I need to stress that walking is one of the more difficult hurdles to overcome. i envision a collaborative effort between the FES people (such as Reggie Edgerton/Susan Harkema) and us biological regenerators to maximize walking potential.

  3. #23
    Chase and bridging is a one shot therapy? Or could be used more than once to improve even more (3-4 years before the first therapy for example)?
    -Ramps in buildings are necessary, but it would be usefull to have another ones for people (mind/heart).....

    -Hoc non pereo habebo fortior me

  4. #24
    Dr. Silver,

    We often group bladder, bowel and sexual function together like it's one thing. Can you offer your opinion on lumping these functions together as it relates to your approach to improving urinary function?

    Asked more directly, does your technique restore/improve bowel and sexual function along with bladder function?

  5. #25
    Senior Member
    Join Date
    May 2005
    Location
    Pakistan
    Posts
    1,177
    Good question by quadfather

  6. #26
    Originally Posted by kivi66
    jsilver, what was the reason that Mother-Nature have chosen to wrap PNS nerves in Schwann cell-formed myelin and for CNS ones have decided that oligodendrocytes is more suitable material, are there any reasonable explanation to this?
    You have assessed Paul Tesar's findings on oligo as a "good thing", what sci-models will benefit from it where Schwann cells are in no way do the job?

    Well, nobody really knows the answer to this. Schwann cells and astrocytes do not mix with each other at all. In addition, Schwann cells make what is known as a basal lamina, a tenacious membrane between astrocytes or fibroblasts. The Schwann cell basal lamina around peripheral axons is in the form of tubes (called Bands of Bungner) and are a major reason why PNS axons can regenerate along Schwann cells. It is likely that basal lamina in the CNS is not desirable because in gray mater this would markedly interfere with synapse formation. Oligodendrocytes can myelinate many axons but Schwann cells tend to myelinate just one at a time.

    jsilver, what about the second question?

  7. #27
    Quote Originally Posted by Isildur View Post
    Chase and bridging is a one shot therapy? Or could be used more than once to improve even more (3-4 years before the first therapy for example)?

    If we do this right the first time there should be no need to re-enter the spinal cord for repeated injections of the enzyme. Also this would not be desirable.

  8. #28
    Quote Originally Posted by quadfather View Post
    Dr. Silver,

    We often group bladder, bowel and sexual function together like it's one thing. Can you offer your opinion on lumping these functions together as it relates to your approach to improving urinary function?

    Asked more directly, does your technique restore/improve bowel and sexual function along with bladder function?
    We have not examined bowel or sexual function although bowel function is in part controlled by the same neurons that control the bladder.

  9. #29
    Dr. Silver,

    I wonder how you think stem cells and chase would be best administered. Would they be injected concurrently, or would chase be administered prior to the stem cells in order to clear out the CSPG. Also, would injecting these therapies simultaneously affect the dosage available for either therapy due to the limitation on injection volume?

    Thanks for taking the time to answer these questions.

  10. #30
    Quote Originally Posted by jsilver View Post
    Dear rjames,

    Please, don't hesitate to ask lots of questions. I am truly grateful to those who seek answers and knowledge about SCI. Asking questions helps brings out the truth about how close we really are to helping people with SCI regain function.

    In regards to the use of bridging strategies to build a roadway for regeneration, there are a huge number of different approaches. In general, every single approach, including the use of stem/progenitor cells, biopolymers and even segments of peripheral nerves alone tend to allow regenerative growth into but not beyond the graft. We have chosen the peripheral nerve autograft +chondroitinase for a number of reasons. Mother Nature has engineered the peripheral nerve over millions of years to be the most perfect regeneration bridge , so why not take advantage of her efforts. She just needed a little help when it came to transplanting the regenerative potential of the PNS into the CNS in order to get some axons out of the bridge. Our work with this technique to restore respiration after cord hemisection, has demonstrated that a profound amount of breathing recovery can occur when we do things right. We are now perfecting techniques to improve upon this strategy for other systems and in animals with cord lesion that are much larger. We anticipate the use of 2 bridges for the potential restoration via regeneration of crude hand function and I showed at W2W our ongoing studies to restore urinary function after complete transection injury. Now the question remains as to whether neurosurgeons will apply these strategies to humans. For those with high cervical lesions we will need to be especially cautious that the technique does no more harm. So I think we will need to demonstrate the efficacy of the technique in a larger animal model. For those with lower injuries the chances of additional damage are mitigated by the lower position of the lesion, so surgeons may be more willing to operate. We just need to keep going full speed and publish very high quality papers. If we do this only good things can follow but I need to stress that walking is one of the more difficult hurdles to overcome. i envision a collaborative effort between the FES people (such as Reggie Edgerton/Susan Harkema) and us biological regenerators to maximize walking potential.
    Do you think the FES would mainly be used to retrain the walking motion and build up muscle and then dispensed with? Or are you proposing some sort of hybrid system? I thought the central pattern generator meant that very little spinal cord was needed to enable good walking?

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