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Thread: Ten frequently asked questions concerning cure of spinal cord injury

  1. #181
    Until recently, most researchers have been focusing on the question of which cells will do the most when transplanted into animal models of spinal cord injury and seeing whether they will get animals to walk. Much data suggest that the cells will need help to do the right thing and stimulate the spinal cord to regenerate successfully. These include making sure that the cells are secreting the appropriate neurotrophins and other growth factors, as well as the right cell adhesion molecules that axons like to grow on. Finally, there is a need to include therapies that overcome growth inhibitors in the spinal cord so that the axons, once they get across the injury site, would keep going all the way until they reach suitable targets. We are of course anxiously and enthusiastically watching the Novartis phase 1 clinical trial of anti-Nogo antibodies and the Bioaxone Cethrin phase 1 clinical trial, as well as hoping that chondroitinase will reach clinical trials.

    Regarding the stem cells themselves, there is ample data suggesting that fetal cells of all kinds can be safely tranplanted to chronically injured spinal cords. Well over a thousand patients have received fetal transplants to their spinal cords and I have heard of very few documented cases of tumors or other adverse complications associated. Likewise, hundreds of people have received bone marrow and nasal mucosa transplants. In general, the cell transplants alone appear to be safe but they alone don't seem to be producing dramatic improvements. Some patients appear to be getting several levels of sensory and motor return, however.

    One possibility is that the safety record of fetal transplants is good because they are usually not matched for HLA-type and many or most of the cells are rejected, albeit slowly, after transplants. We don't know this for sure, of course, but this would account for why tumors have been observed. Note that there is one report of a tumor that has grown from fetal cells transplanted into a patient in China (this is from a group that I don't know and I am not sure of the type of cell that was transplanted... the results were apparently reported in a Vancouver meeting about two years ago).

    Embryonic stem cells have not yet been transplanted into any patient, at least not to my knowledge. Although there are many internet reports claiming that embryonic stem cells have been transplanted, I think that this is because people are using the term embryonic interchangeably with fetal. In any case, there is a significant worry that embryonic stem cells can produce tumors called teratomas when transplanted. This is because embryonic stem cells are the only cells that are really pluripotent all by themselves while fetal, neonatal (umbilical cord blood), and adult (mesenchymal) stem cells require a consortium of other cells (now called niches) to engage in pluripotent behavior. The way that scientists are getting around this problem is to pre-differentiate the cells by treating them with retinoic acid and sonic hedgehog before transplantation. This seems to work pretty well and most recent studies have not shown a significant incidence of teratoma formation of the cells after transplantation. However, I hasten to add that there is not all that much experience with embryonic stem cell transplantation into injured spinal cords even in animal studies. There are only 3-4 studies published to date and all involve xenograft transplants of either human or mouse embryonic stem cells into rats. Note that nobody has successfully cultivated rat embryonic stem cell.

    Sorry about this long rambling response but I hope that it is useful for starting the discussion.

    Wise.

    Quote Originally Posted by aton
    I wonder if someone could post a timeline of steps or goals on the way to achieving a treatment or “cure” for SCI. What are the obstacles that need to be overcome? I realize a big question is "How does something like a stem cell know to produce the correct cell?" This is a concern that needs to be addressed first. What other options are being developed? How far along are researchers? In the U.S. and abroad?

    Or if there is something like this already, where is it?

    Thanks.

  2. #182

    Feeding tude in stomach?

    Dr. Young,
    My niece was recently moved from Jackson Memorial Hospital in Miami back to Tampa General (she couldn't get out of there quick enough). The care there wasn't at all what my sister-inlaw and brother had hoped. My niece has continued to lose weight through this whole ordeal. She was 108 lbs and is now 80 lbs (within 2 1/2 months). She is scheduled to be discharged tomorrow and will be home until she is well enough to be admitted into Schriner's Hospital in Philidelphia. My question is....
    They want to insert a feeding tube (g-tude?) directly into her stomach at this point instead of trying to let her gain it back on her own. Do you feel this is a little drastic at this point? Or are there better methods available for her to gain weight? Thanks once again.
    Uncle Steve

    ps- I look forward to meeting you at the open house this Friday(Oct 7th). I reserved a spot today.

  3. #183
    Steve,
    I am so happy to learn that your niece will be going to Shriners. Sally started going to Shriners a few years ago. They were the first people to say "we can help you". And they have!

    Regarding G-tubes.....Sally also had significant weight loss, she could not consume enough food by mouth to sustain herself. She came home with a G-tube (actually it was a J-tube), but was soon back at the hospital because the tube had eroded the lining of her intestine. Her weight was down to 70 lbs at this point. She had surgery to repair her damaged insides and replace the feeding tube, then, IV feeding to bring her weight back up. In Sally's case we had no other choice but to have a feeding tube, she simply did not have enough strength to eat and swallow. But, a feeding tube can be risky, although certainly preferable to slowly starving. Your niece, if she is able, should be given every opportunity to begin regaining weight on her own. Has a nutritionist been consulted? Has she she had metabolic testing done to determine how many calories she needs to consume each day? Does she understand that getting a feeding tube is a surgical procedure? If she feels that there is no way she can regain and maintain her weight on her own, then the G-tube is probably best. But, if she thinks that she might be able to get back on track on her own, she should be given the opportunity to do so. Can she take a week or so at home to try and develope a schedule for eating to gain weight? I know she is used to discipline, training schedules, and goal setting. Young athletes can sometimes achieve amazing results if just given the chance.

    Sandi

  4. #184
    Quote Originally Posted by Uncle Steve
    Dr. Young,
    My niece was recently moved from Jackson Memorial Hospital in Miami back to Tampa General (she couldn't get out of there quick enough). The care there wasn't at all what my sister-inlaw and brother had hoped. My niece has continued to lose weight through this whole ordeal. She was 108 lbs and is now 80 lbs (within 2 1/2 months). She is scheduled to be discharged tomorrow and will be home until she is well enough to be admitted into Schriner's Hospital in Philidelphia. My question is....
    They want to insert a feeding tube (g-tude?) directly into her stomach at this point instead of trying to let her gain it back on her own. Do you feel this is a little drastic at this point? Or are there better methods available for her to gain weight? Thanks once again.
    Uncle Steve

    ps- I look forward to meeting you at the open house this Friday(Oct 7th). I reserved a spot today.
    I agree with Sally's Mom. I have a high opinion of Shriner's hospital. I have seen a number of people who have received feeding tubes and it should be easily reversible and, since she has lost so much weight, I think that it is helpful. Wise.

  5. #185
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    Stem Cell Treatment

    Dear Dr. Young

    I have taken my fresh CT Scan which tells that there is retropulsion of the vertebral body causing compression over the anterior thecal sac and the distal spinal cord. There is also spinal canal stenosis at this level secondary to retropulsion of the vertebral body.


    Now as i have told you that i am 26 and my injury level is L1. I am walking very well but have lost feelings of bladder, bowel and sexual function. I have been operated twice and harrington rods are placed.

    What kind of treatment you suggest for me if there is any? Can i recover my lost feelings if there is any treatment? Recently Dr. Kleinbloesem's bone marrow stem cell surgery is being discussed more on carecure. Do you think i should get this treatment or there is any other treatment for my kind of injury? I need your advise as i could come out from hard times. Waiting your reply. Let me know what should i do? Whom should i contact for treatment?

    Sincerely

    Jawaid

  6. #186
    Based on your description, I think that you need to have decompression surgery of your spinal cord. There is not enough information concerning bone marrow stem cell transplants to recommend it as a treatment to people at the present. Bone marrow transplants to treat spinal cord injury is still experimental therapy at the present. There are many good spinal surgeons in India who should be able to do the decompression operation.

    Wise.

    Quote Originally Posted by Jawaid
    Dear Dr. Young

    I have taken my fresh CT Scan which tells that there is retropulsion of the vertebral body causing compression over the anterior thecal sac and the distal spinal cord. There is also spinal canal stenosis at this level secondary to retropulsion of the vertebral body.


    Now as i have told you that i am 26 and my injury level is L1. I am walking very well but have lost feelings of bladder, bowel and sexual function. I have been operated twice and harrington rods are placed.

    What kind of treatment you suggest for me if there is any? Can i recover my lost feelings if there is any treatment? Recently Dr. Kleinbloesem's bone marrow stem cell surgery is being discussed more on carecure. Do you think i should get this treatment or there is any other treatment for my kind of injury? I need your advise as i could come out from hard times. Waiting your reply. Let me know what should i do? Whom should i contact for treatment?

    Sincerely

    Jawaid

  7. #187
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    Which doctor in India can be contacted

    Dear Dr. Young

    Thanks for your advise. Please tell me that which doctors are in India whom i can contact for decompression surgery? Give me their names and email address as i could have contact to them.

    Dr. Young do you think that i can get recovery after decompression surgery in india as my injury is six years old now? I am waiting your reply.

    God bless you and thanks God for having doctor like you to guide us.

    Sincerely
    Jawaid

  8. #188
    Jawaid, I am not knowledgeable enough to provide you with the advice that you seek. The last time that I visited india was in 2001 and, while I have know many doctors in India, my information is dated. I will enquire and see if I can get an answer for you. Wise.

  9. #189
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    Hello Dr. Young

    Dear Dr. Young

    Can i not recover my feelings of bladder, bowel and sexual function through any stem cell surgery which are recently being done in some countries as Russia, China,Turkey and i think Barbados. Also you seem to be very impressed by the treatment being done at Kunming Army hospital China or you would suggest decompression surgery for me?

    Jawaid

  10. #190
    Quote Originally Posted by Jawaid
    Dear Dr. Young

    Can i not recover my feelings of bladder, bowel and sexual function through any stem cell surgery which are recently being done in some countries as Russia, China,Turkey and i think Barbados. Also you seem to be very impressed by the treatment being done at Kunming Army hospital China or you would suggest decompression surgery for me?

    Jawaid
    I think that you should get decompression surgery. All the rest right now is unproven therapy. Wise.

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