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Thread: SHEEP STUDY SHOWS PROMISE OF RESTORING BOWELS, BLADDER, AND SEXUAL FUNCTION

  1. #1

    SHEEP STUDY SHOWS PROMISE OF RESTORING BOWELS, BLADDER, AND SEXUAL FUNCTION

    Pus
    Sheep study shows promise for spinal cord repair
    By CLAUDIA FELDMAN
    Copyright 2003 Houston Chronicle
    Claire Hulsebosch puts on her best lab coat, squares her shoulders and marches into a darkened room at the University of Texas Medical Branch in Galveston.

    In the next few minutes, she will study the microscopic nerve cells of one very pampered sheep.

    If Hulsebosch sees a field of black, the news is inconclusive at best.

    If, however, she sees round nerve cells filled with dye -- yellow moons on a midnight sky -- there is reason to hope the work she and Dr. Guy Clifton have done in the past year eventually will lead to the restoration of bladder function -- and perhaps bowel and sexual function -- in the 75,000 Americans with lower back spinal cord injuries.

    Sam Ye, a researcher at UTMB, adjusts the microscope, then flashes what he sees onto a computer screen. There are two full moons shining brightly, and 10 others fainter and more translucent. They are ample evidence the nerves -- damaged, then rewired -- functioned normally in at least one of the eight experimental sheep.

    "Very good," says Hulsebosch, sounding stunned. "This is huge."

    This is one of several hundred sheep slides that Hulsebosch, professor of anatomy and neuroscience at UTMB, and Clifton will study in the next few months. But this afternoon, she asks to see just one more, then jumps up for a closer look. The second slide shows 12 full moons or neurons filled with dye, and about that many more glowing faintly.

    She thanks Ye and other colleagues involved in the project, then dashes back to her office to call Clifton, the neurosurgeon who did the sheep surgeries and serves as director of Mission Connect. It's a bold local project to tackle the problems of patients with spinal cord injuries and attempt to solve them one by one.

    "Guy," Hulsebosch says, "we did real good. In a field of 25 cells, we had about 12 lit up like light bulbs."

    She listens for a few moments and smiles ruefully.

    Hulsebosch wants to do more sheep surgeries to make sure the rewiring of the nerves will improve bladder function significantly. She believes the re-routed nerves will function, but she's not sure they will give patients freedom from their catheters. Anything short of that, she says, probably is not worth the surgical risk.

    Clifton, on the phone, suggests a different approach. "Shoot," he tells Hulsebosch, "let's take this to patients."

    He agrees the questions Hulsebosch raises are good ones. He's on tenterhooks to know the answers himself. But there's nothing more to learn from sheep, he says.

    To advance medical science, they have to take the next step: clinical trials.

    Hulsebosch says goodbye and hangs up.

    She knows she's right to be cautious.

    She also knows he's right to be bold.

    "That's the thing about Guy," Hulsebosch says. "He pushes the frontier of neurosurgery. We need surgeons willing to take risks."


    The sheep study is one of 11 scientific initiatives in Mission Connect, a collaborative, $10 million project involving five research institutions in or near the Texas Medical Center. The long-term goal is to reverse spinal cord injuries.

    Already, researchers have come a long way.

    Before World War II, patients with spinal cord damage often died from their injuries. After World War II and improved medical care, patients survived but had many physical limitations. Today, as central nervous system research cranks up here and around the world, patients have reason to hope for incremental improvements -- increasing independence, the use of paralyzed muscles, bladder control.

    Roughly 250,000 Americans live with spinal cord injuries. Thirty percent have injuries in their lower backs and might be helped by the sheep experiments conducted in Galveston.

    The project began with 10 sheep. In the first phase, Clifton cut one chest wall nerve in each sheep, then waited three months for the nerve to deteriorate. The idea was to simulate a real-life spinal cord injury, not ideal surgical conditions.

    Before the start of phase two, one sheep died of liver parasites. Another died of surgical complications. With the eight remaining sheep, Clifton connected the deteriorated nerve to the freshly cut chest wall nerve.

    Three months later, in phase three, Clifton shot dye into the mended nerves to determine whether cells really did pass through the surgical repair. Two weeks later, the sheep were euthanized, and Hulsebosch and her team began the painstaking task of examining the evidence.

    Hulsebosch and Clifton think the two dozen sheep surgeries, hundreds of hours of work and $150,000 in research dollars already have paid off.


    Clifton agrees with Hulsebosch: The million-dollar question is whether similar procedures performed on people will give them sufficient bladder control to ditch their catheters.

    The answer, he says, lies with patients.

    The operations Clifton would like to perform at Memorial Hermann Hospital will be slightly different than those done in a basement at UTMB. Instead of connecting two chest wall nerves, Clifton plans to splice a chest wall nerve to a bladder nerve.

    "It's unlikely we'll get total return," he says. "We'll be looking for partial recovery in some patients."

    Clifton is cautiously optimistic that the return will be enough to be useful to people. Beyond the sheep work, he has another reason to hope. A few weeks ago he received a paper to review for the scientific journal Spinal Cord. The article was written by a Chinese doctor who described an almost identical nerve-splicing technique that he already tried on patients.

    "The data is skimpy," Clifton says, "it's not the detail I'd like to see. But it seems the doctor found some bladder return in a significant number of patients."

    Over the years, Clifton says, he's learned to be skeptical about papers that are long on claims and short on facts. "But, if the paper is accurate, it gives me confidence that I'll be able to help patients in an early trial."

    For Clifton, the next steps are analyzing the strengths and weaknesses of the Chinese data, finishing his sheep homework, then seeking approval from the institutional review boards of Memorial Hermann Hospital, the University of Texas Health Science Center, Baylor College of Medicine and TIRR (The Institute for Rehabilitation and Research) to start clinical trials.

    "With their permission, I can begin to interview patients. I'd like to be operating by next spring."

    Clifton will look for 15 TIRR patients who want to try the surgery and appear to be good candidates. If the operations go well, he says, the repercussions could be:

    ·More patient trials.

    ·Additional work on restoring bowel and sexual function. Clifton explains the same nerve controls bladder, bowel and sexual function, but it has to work well farther from the repair to bring about bowel and sexual function.

    ·Using the same or similar surgery to solve other medical problems.

    "We hope to create some momentum," Clifton says. "One success leads to another."

    Of all the problems Clifton is juggling, he is not worried about finding patients willing to undergo the experimental surgery. Many tell him they'd rather get rid of the catheters and regain bladder control than walk.

    Deb

  2. #2
    Senior Member Leo's Avatar
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    I think we should buy these folks tickets to China, to see Dr. Huang's work. Gotta love their attitude,

    Clifton, on the phone, suggests a different approach. "Shoot," he tells Hulsebosch, "let's take this to patients."

    "All you have to decide is what to do with the time that is given you."
    Gandolf the Gray

  3. #3
    Senior Member DA's Avatar
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    dr young how can you control your bladder using chest nerves? would the control be normal like pre-sci?

  4. #4
    Thanks Debbie!

    the work she and Dr. Guy Clifton have done in the past year eventually will lead to the restoration of bladder function -- and perhaps bowel and sexual function -- in the 75,000 Americans with lower back spinal cord injuries.
    Why only lower back injuries? Is it because the nerve that he removes needs to be properly innervated in the chest wall thus excluding those with paralysis involving the chest area?

    Clifton is cautiously optimistic that the return will be enough to be useful to people. Beyond the sheep work, he has another reason to hope. A few weeks ago he received a paper to review for the scientific journal Spinal Cord. The article was written by a Chinese doctor who described an almost identical nerve-splicing technique that he already tried on patients.
    Is he referring to Dr. Cheng's work?

    "With their permission, I can begin to interview patients. I'd like to be operating by next spring."
    We need more pioneers like this.

  5. #5
    Originally posted by DA:

    dr young how can you control your bladder using chest nerves? would the control be normal like pre-sci?
    DA, from the description in this article, it sounds as if Guy Clifton is doing in sheep what Zhang in Shanghai has been doing for several years in humans. He seems to be re-routing an intercostal nerve to the pudendal nerve to the bladder. Clair Hulsebosch appears to be looking for neurons in the spinal cord that backfilled with a fluorescent dye (probably Lucifer yellow or Procion yellow) from the bladder nerve into the neurons of the thoracic cord.

    Zhang's experience suggests that people can learn to activate the thoracic motoneurons to activate the bladder. In dogs, they did such experiments and found that it is possible to scratch the dermatome innervated by the thoracic segment and get the dogs to pee. In any case, they appear to be trying to repeat these experiments to make sure that it works. Very interesting.

    Wise.

  6. #6
    Senior Member Josh's Avatar
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    so if you have lower motor-neuron damage and are a complete then this wouldn't work for you? I understand that it isn't proven anyway but if it were to work in other injuries?

  7. #7
    josh, if this is what I think it is, it is using the motoneurons in the thoracic spinal cord above the injury site to innervate the bladder. Lower motoneuronal damage would occur if your injury level is at the lumbosacral enlargement (T11-L1). But even if you have lower motoneuronal injury, this should work. I can't describe it so well in words and so I drew a picture
    Attached Files Attached Files

  8. #8
    How can one not have a bright outlook for the future?

    This website is a godsend!

    Sign me up for all this stuff!

    Hey! Ho! Let's Go!

    J.

  9. #9
    Wise
    In June I made a post about bridging the damaged area. This is different as it is only one function. I thought instead of connecting to a peripheral nerve you could connect to an electronic device that could interpret the signal and relay it to another electronic device after the damaged area, and then to the nerve. Do different jobs in the nerves produce different signals? Either by different voltage or frequencies. If they did then they could be distinguished and sent to the proper nerve. Like my computer can go to the c drive and find a folder or go to the drive. If the second electronic device was attached to nerves after the damaged area and we stimulated them we could follow the path and identify which terminal it was connected to. We could also do the same thing on the pre injury electronic device and figure out which terminal is being fired up by which suggestion. Then being it is an electronic device we could assign which terminal in the first device should trigger the terminal in the second device. In this way we wouldn't have to be concerned about correctly connecting each nerve, as we would have options after they were connected to assign them.

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    Banned Acid's Avatar
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    Homo chimp crimes and their "euthanasia" attempts to beautify murder
    of internally related.


    "Additional work on restoring bowel and sexual function.
    Clifton explains the same nerve controls bladder, bowel and sexual function,
    but it has to work well farther from the repair to bring about bowel and sexual function."

    farther?

    Somehow, when I played around here trip pic games,
    back then a while processing about some stuff,
    aiming shifts were tried for a bladder correlated muscle region
    and sexual organs.
    But I do not recall at all for bowel.
    How does one do the branch-off do bowel?

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