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Thread: Possibilty of cure: chronic vs. acute

  1. #1

    Possibilty of cure: chronic vs. acute

    As I move further away from acute injury, and further into chronic, I've read about how a cure is expected for acute injuries first. Why is this school of thought so prevalent? I have some guesses, but want to know if there's anything else. My main guess is that the rest of the body deteriorates, with atrophy and who knows what else, the longer you sit around. Are there any other reasons?


  2. #2
    Quote Originally Posted by Ax8
    As I move further away from acute injury, and further into chronic, I've read about how a cure is expected for acute injuries first. Why is this school of thought so prevalent? I have some guesses, but want to know if there's anything else. My main guess is that the rest of the body deteriorates, with atrophy and who knows what else, the longer you sit around. Are there any other reasons?
    Ax8,

    Actually, very little work is currently being done on acute spinal cord injuries. I define acute spinal cord injury therapies as those that reduce the damage, usually during the first 24 hours after injury. In fact, I don't know of any clinical trial that is underway or planned for acute spinal cord injury right now.

    Several clinical trials have focused on the subacute period after injury (with treatments starting within 2 weeks after injury). For example,
    • Proneuron completed a phase 1 trial and started a phase 2 trial with their activated macrophage transplants within 2 weeks after injury. Unfortunately, the company is out of money.
    • Purdue University finished a phase 1 clinical trial testing alternating electrical currents to stimulate regeneration of the spinal cord, reporting positive results. The device is implanted within 2 weeks but I think that they stimulate for several months. The FDA approved the device recently and I think that they may be planning a phase 2 trial.
    • Bioaxone just finished a phase 1 trial to assess cethrin (a modified bacterial toxin that blocks rho, an intracellular messenger that mediates the inhibiting effects of Nogo and other growth inhibitors) and I am hoping to hear about their results soon.
    • Novartis is doing a phase 1 clinical of IN-1, an anti-Nogo antibody. I believe that they are also treating people within the first two weeks.

    Several clinical trials have or will be treating people with chronic spinal cord injury.
    • Acorda Therapeutics finished a phase 3 trial assessing the effects of 4-aminopyridine (Fampridine SR) on people with chronic spinal cord injury. Unfortunately, the trial results were not significant. However, Acorda recently completed a trial of Fampridine on MS and found very significant effects. I hope that Acorda will be able to go back to retest Fampridine in people with spinal cord injury, using the new clinical trial design.
    • Aventis completed a phase 1/2 trial on a drug called HR184. This drug is supposed to improve neurological function in much the same way as Fampridine. I don't know the results but I have heard that they are planning a phase 3 trial.
    • Geron. This company is planning to transplant human embryonic stem cells into people with spinal cord injury. I don't know the details of this study but I presume that it will be in people with chronic incomplete spinal cord injury because their announced goal is to transplanted cells that have been differentiated into oligodendroglial precursor cells to remyelinate axons.
    • ChinaSCINet. This is a clinical trial network that I have been working on in China. We plan to do a clinical trial of umbilical cord blood cell transplants and lithium in people with chronic spinal cord injury.

    Several companies are planning clinical trials of other treatments. I am not at liberty to talk about these yet but I think that most have been focusing on chronic spinal cord injury.

    Dozens of clinics in Central Asia, India, China, and Korea that are offering experimental therapies for people with chronic spinal cord injury. These include transplants of fetal olfactory ensheathing glial, fetal Schwann cells, bone marrow cells, and adult Schwann cell transplants.

    So, there is quite a lot of activity aimed at subacute and chronic spinal cord injury.

    Wise.

  3. #3

    Dumb Question

    I figure this is a dumb question but I need to ask it.
    What is the difference between acute and chronic?

  4. #4
    When people say acute, I think they are referring to the sub acute period.
    Last edited by antiquity; 10-20-2006 at 01:02 PM.

  5. #5
    What is the difference between acute and chronic?
    To me acute just means a fairly recent injury, whilst things are still settling down. My doctors told me that it takes about two years for things to settle and it is not unusual for patients to get some spontaneous improvement whilst things are settling. Chronic just means and older injury where everything has become stable the way that it is.

  6. #6

    Lightbulb omg...

    i will elaborate in more detail my thoughts regarding the above later, sorry i am to upset at the moment..
    Last edited by Susan Fajt; 10-21-2006 at 04:00 AM.
    Godspeed~
    Susan
    www.sciwalker.com

  7. #7
    Quote Originally Posted by GeneL
    I figure this is a dumb question but I need to ask it.
    What is the difference between acute and chronic?
    GeneL, it is actually a very good question.

    To me acute means the early period after spinal cord injury during which the injury is still developing or resolving. Thus, acute therapies are primarily neuroprotective. Subacute is the period between acute and chronic. Chronic is the period during which neurological recovery has essentially stopped and neurological status is stable. Treatments during the subacute period are intended to facilitate or accelerate recovery. Finally, chronic therapies are those that regenerate, remyelinate, or otherwise restore therapies. But, it seems that most people define acute as the early period before chronic.

    Wise.

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