Results 1 to 9 of 9

Thread: What we must do to advance spinal cord injury research in the United States

  1. #1

    What we must do to advance spinal cord injury research in the United States

    Today, I received an email from a person who celebrated his one year anniversary after spinal cord injury. He asked:
    I've been looking through the message board site for some time.テつ* I'm a T-6テつ* ASIA-Bテつ* para from a motorcycle accident.テつ* I have just recently "celebrated" my one year anniversary of my new life being paralysed.テつ* I guess my real question is how far has this research come to curing SCI?テつ* How far have people recovered after the surgery?テつ* What are the factors that enable some people to recover more than others after the surgery?テつ* I guess that is it for now.テつ* Thank you for your consideration and research.テつ*
    Many factors determine whether a person recovers from spinal cord injury. The first and most important is how severe your injury was. The spinal cord is capable of remarkable spontaneous recovery. Almost everybody, even with very severe injuries, recover some function after injury. For example, most people who have a so-called "complete" spinal cord injury with no neurological function below the injury site during the first day after injury will get back at least 1-2 levels of function. About half probably recover 3-4 levels. Perhaps 1 out of 5 persons will recover substantial motor and sensory function, enough to be classified as ASIA C (incomplete motor recovery less than half of the motor function). People who have "incomplete" spinal cord injury recover much more, often to the point of walking. Probably as many as half of people with spinal cord injury recover sufficiently to be able to walk.

    I believe that exercise and motivation plays an important role in recovery of function. It is a truism that if you don't try, you will not recover. But, there is a physiological basis that goes far beyond "not trying". We have long known that muscles will undergo atrophy if they are not used. Recent data suggest that this may also happen in the spinal cord. If one does not use neuronal circuits, the spinal cord stops maintaining those circuits and they stop functioning. This phenomenon is called "learned non-use". The good news is that learned non-use can be reversed by intensive forced use exercise. Several studies in Europe have shown that intensive ambulation exercise on treadmill, for example, can restore function to over 70% of people who have been paralyzed by spinal cord injury and never tried to walk after spinal cord injury. It is true that most of these patients are so-called "incomplete" but I think that this does not detract from the main message: "use it or lose it".

    For many people, however, natural recovery and intensive exercise is not enough. For such people, regeneration, remyelination, and replacement of neurons will be needed. The good news is that much research indicates that the spinal cord can regenerate and that only a small percentage of connections are necessary and sufficient for substantial functional recovery. Regenerating axons face many obstacles in their way. The first and most important is crossing the injury site which has often become a "no-man's land" bereft of signals and markers. Many studies have shown that different kinds of cells transplanted to the injury site can provide an environment that is conducive to axonal growth across the injury site. After crossing the injury site, the axons still have to grow all the way to their original connection point. It is a long ways home for the axons and they will encounter many problems, not the least of which are molecules that inhibit growth and connecting to the wrong neurons. Several therapies have been shown to overcome these problems, including growth factors, blocking growth inhibitors, etc. Recent studies suggest that these therapies are more effective when combined with cell transplants.

    We are entering a very frustrating period in spinal cord injury research. Numerous therapies have been shown to regenerate and remyelinate animal spinal cords. A few of these therapies have reached clinical trial, but mostly overseas. First generation therapies in clinical trials are beginning to show some promising effects. Olfactory ensheating glia, for example, have now been transplanted in several hundred people with chronic spinal cord injury in Beijing, Lisbon, Novosibirsk, and Brisbane. Positive reports of impressive sensory recovery and modest motor recovery have been coming from these centers. In the meantime, animal studies are showing remarkable regeneration when transplants (such as Schwann cells) are combined with drugs that increase cAMP levels, growth factors, or enzymes that break down growth inhibitors in the spinal cord. I am confident that combination therapies will likewise be more effective humans but much work still needs to be done to optimize the therapies for humans.

    To move therapies to clinical trials in the United States, we need to do the following:

    1. Increase government funding of clinical trials in the United States. The Christopher Reeve Paralysis Act (CRPA) has been sitting in Congress for nearly three years, asking for $300 million over three years to fund a network of clinical trial centers devoted to reversing paralysis. With the current pressure on budgets due to anti-terrorism and military priorities, additional new funding for spinal cord injury clinical trials has not become available. However, this is an election year and a year when the community can make a difference by electing candidates who support spinal cord injury research and clinical trials. It will be tough fight because there are many other competing interests.

    2. Support companies developing spinal cord injury therapies. Because most companies still regard spinal cord injury regeneration and therapies to be a small and risky market, major pharmaceutical company have been reluctant to invest seriously into developing such therapies or clinical trials. This situation may be changing because several companies are beginning to invest into spinal cord injury therapies: Acorda (4-aminopyridine, chondrotinase), Aventis, Biogen (Nogo receptor blockers), Novartis (IN-1 antibody), and Proneuron (activated macrophage transplants). We must find some way to support these companies so that one or more of these companies will find positive results because this will stimulate investment by other companies into spinal cord injury therapy development.

    3. Stop the irrational debate over embryonic stem cell research. The raucous debate over embryonic stem cell research has virtually shut down one of the most important sources of stem cells for therapy while it has not increased funding for umbilical cord blood or adult stem cell research. We have lost nearly three years as a result and we still don't have a ready source of stem cells to transplant to the spinal cord. While I respect the right of people (including President Bush) to oppose embryonic stem cell research, I am dismayed that they have chosen to shut down a promising source of cells without increasing adult stem cell research to make up for the time lost. Worse, the current policy has not saved any embryos from destruction. To me, that is a failed policy and must be changed.

    Until we solve these three problems, it may be many years before curative spinal cord injury therapies will become available to Americans.

  2. #2
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839
    Originally posted by Wise Young:

    3. Stop the irrational debate over embryonic stem cell research. The raucous debate over embryonic stem cell research has virtually shut down one of the most important sources of stem cells for therapy while it has not increased funding for umbilical cord blood or adult stem cell research. We have lost nearly three years as a result and we still don't have a ready source of stem cells to transplant to the spinal cord....
    Until we solve these three problems, it may be many years before curative spinal cord injury therapies will become available to Americans.
    Well I am hopeful your third point will be substantially taken care of in about 9 weeks!

    So that we can again concentrate on 1. and 2. as listed by you.

    "We have a chance to take a giant stride forward for the good of all humanity" in the next election. "We can choose between the future and the past, between reason and ignorance, between true compassion and mere ideology."- Ron Reagan Jr.

  3. #3
    Senior Member Schmeky's Avatar
    Join Date
    Sep 2002
    Location
    West Monroe, LA, USA
    Posts
    3,413
    Dr. Young,

    Agreed. My wifes quadraplegic first cousin died last night at 48 years old, 17 years after his injury. He, like many others, did nothing to advocate or help fund research.

    I plan on going out (maybe not kicking) fund raising and doing what I can. How do we accomplish support of drug companies? Specified donations? And Government, I assume we need to push our representatives, etc.? Can we start a mail-in or e-mail drive for the CRPA Bill?

  4. #4
    While I respect the right of people (including President Bush) to oppose embryonic stem cell research, I am dismayed that they have chosen to shut down a promising source of cells without increasing adult stem cell research to make up for the time lost.

    This is an important point. Adult stem cell research is legal in the US yet neither Brownback nor his supporters has called on the NIH to increase funding for studies using ASC's for the treatment SCI!!! Brownback also does not support the CRPA bill which would increase funding for non-ESC research. The supporters of Bush, Brownback and those who oppose ESC research need to challenge them on these issues. As Dr. Young has repeatedly pointed out, legislation to ban ESC research has not prevented ESC's from being destroyed, it has not increased funding for ASC research and it has not resulted in an increase in federal funding for general SCI research. The actions of both Bush and Brownback have been antithetical to achieving a cure for spinal cord injury.

    [This message was edited by seneca on 08-22-04 at 11:16 PM.]

  5. #5
    surely though if a therapy proved to be remarkably successful overseas then the US would quickly adopt it for humanitarian reasons

  6. #6
    schmeky,

    You have asked an interesting and important question. How do we support companies that are doing spinal cord injury research?

    1. I have long thought that there should be a mutual fund that invests in companies that emphasize research that is important for spinal cord injury.

    2. People with spinal cord injury can work with the companies to improve their research, tell them what is important, and serve on advisory boards.

    3. Buy the stock of companies that you think are doing good work, if they are public. When companies that you think is doing good work is going public, you can participate in the IPO to increase the offering price. This brings in more money to the companies which can be used for research (that is of course if the company says that they will do this with the additional funds).

    Wise.

  7. #7
    Just a reminder that there is a free and easy tool available to contact your legislators and ask them to support both CRPA and expanded stem cell research. It's the Adopt a Legislator packet offered by the CureParalysisNow Advocacy Group from Care Cure.

    In my opinion, there is really no excuse for any legislator to be omitted. If you are truly committed to fighting for a cure, you must take action.

  8. #8
    quote:
    __________________________________________________ ___________
    If one does not use neuronal circuits, the spinal cord stops maintaining those circuits and they stop functioning. This phenomenon is called "learned non-use." The good news is that learned non-use can be reversed by intensive forced use exercise.
    __________________________________________________ ___________

    Dr. Young -

    Does intensive forced use exercise reverse learned non-use in neuronal circuits as well as in atrophied muscles? Are there ways to "exercise" neuronal circuits directly? For instance, can neuronal circuits be reawakened through bio-feedback or guided imagery? If so, this would then enhance the benefit derived from the intensive forced use exercise. Are there any studies in this area?

  9. #9
    TsMom, I answered your question in another topic. Wise.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •