Friday, September 21, 2007

Drug Can Help Patients Heal From Spinal Cord Injuries

According to the Spinal Cord Injury Information Network, there are about 11,000 new spinal cord injuries each year. Car accidents have been responsible for nearly 50 percent of spinal cord injuries since 2000, and falls have been the second most common cause of spinal cord injuries. Currently, about 253,000 Americans are living with a spinal cord injury.

Dr. Michael Fehlings from Toronto Western Hospital is studying a new drug to treat spinal cord injuries soon after they happen. The drug, called Cethrin, is applied during surgery to the injury site in a fibrin glue type of material. Cethrin is a recombinant protein that is made through artificial DNA technology. The protein inhibits Rho, a key pathway that triggers cell death and increases damage after a spinal cord injury.

"You apply [Cethrin] directly to the damaged spinal cord and then the medication penetrates the damaged spinal cord," Fehlings said.

Cethrin is still under study, but early results look promising. Results from a one-year study of the drug in 37 patients were presented in April, 2007 at the annual meeting of the American Association of Neurological Surgeons in Washington, D.C. All patients in the study had "A" grade injuries, which are the most serious. Injuries are graded from A to E, with A being the most serious and E being the least serious.

Patients received Cethrin an average of 53 hours after their injury occurred. After six months, 28 percent of patients improved by one or more grades. Five patients improved to a "C" grade, and two improved to a "D" grade.Typically, there is some recovery that occurs after an injury, but the rates of recovery are quite low, in the range of 5 percent to 10 percent.

"In this trial, fully a third of patients showed significant recovery, and almost 20 percent of the patients showed a major degree of recovery. In my own clinical experience, this type of recovery is very unusual," Fehlings said.

Fehlings says the drug is not a cure for spinal cord injuries, but it could have a major impact on patients' lives.

"They might be able to now grip a jar or to drink, or they might be able to transfer themselves, whereas before they might not have had trunk control. In some patients, it might even mean that they could recover the ability to walk," he said.

At least five institutions in the United States and three in Canada are studying Cethrin's role in spinal cord injuries.

By: Ivanhoe Broadcast News

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Sunday, September 09, 2007

Time Matters After Spinal Cory Injuries

About 300,000 Americans are in wheelchairs due to spinal cord injuries. Many patients will recover at least some function in their fingers, toes, hands and limbs after injury, but new research shows there may be a way for them to recover even more.

Michael Fehlings, M.D., Ph.D., neurosurgeon at Toronto Western Hospital in Canada, says the initial impact doesn’t cause all the damage in spinal cord injuries. There are also secondary injuries that come from inflammation and compression on the spine. "This involves the death of nerve cells that might otherwise be initially potentially alive or salvageable after the initial injury," Dr. Fehlings said.

Surgery is often performed to fix the spine and relieve pressure. Dr. Fehlings is currently leading a study to determine the best time to perform that surgery. "It appears that earlier is indeed better than later," he added.

One study shows the most common time for surgery is five days or more after an injury. But Dr. Fehlings' research shows surgery within 24 hours can prevent more severe damage and lead to better outcomes.

"We are seeing that some people are walking away from injuries where they would normally not be able to walk away," Dr. Fehlings said.
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Friday, September 07, 2007

Skin Stem Cells Used to Mend Spines of Rats

Toronto research shows injured subjects walking better after injections

A Toronto-led team of researchers has found a way to use stem cells derived from skin to treat spinal cord injuries in rats.

The finding lends promise to the idea that stem cells could one day be used to heal spinal cord injuries in humans, helping thousands to walk again.

Injured rats injected with skin-derived stem cells regained mobility and had better walking co-ordination, according to the study published yesterday in the Journal of Neuroscience. The skin-derived stem cells, injected directly into the injured rats' spinal cords, were able to survive in their new location and set off a flurry of activity, helping to heal the cavity in the cord.

Freda Miller, a senior scientist at The Hospital for Sick Children and lead author of the study, said skin-derived stem cells have some advantages over other stem cell types. Scientists who use skin to generate stem cells do not need to use embryos, for example, and skin-derived stem cells can potentially be harvested from patients themselves, she said.

"You can imagine a scenario for people with spinal cord injuries, that maybe, just maybe, we could take a piece of their skin, grow the cells up and transplant them (the patient) with their own cells," she said. "You wouldn't have to give them immunosuppressive drugs. That's a tremendous clinical advantage if it comes true."

Miller and her colleagues from The Hospital for Sick Children and the University of British Columbia have been exploring the possibilities of using skin to derive stem cells since 2001.

Over the course of their research, the team found that skin-derived stem cells share characteristics with embryonic neural stem cells, which generate the nervous system. They also showed skin-derived stem cells can produce Schwann cells, a cell type that creates a good growth environment to repair injured central nervous system axons – the long nerve cell fibres that conduct electrical impulses between nerves – and that these Schwann cells put down myelin along the injured spinal cord. Like the insulation around an electrical cord, myelin wraps around nerves, creating a sheath that helps quickly conduct nerve impulses.

Miller said the next step was to see whether transplanting the Schwann cells directly into spinal cords would help treat injured rats.

To test their hypothesis, Miller and her team generated stem cells from the skin of rats and mice and forced them to differentiate into Schwann cells, which were then transplanted into the rats. After 12 weeks, the rats were able to walk better, with more co-ordination.

Miller said the cells thrived within the injured spinal cord. Before treatment, the injured rats had a cavity in their spinal cord, a result of their injury. But after treatment, Miller said the Schwann cells had created a bridge that spanned the cavity, and helped nerves grow through the bridge.

The next step is to see whether stem cells derived from human skin can produce similar results.

"We are highly encouraged," said Miller.

Story by: Megan Ogilvie

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Thursday, September 06, 2007

In Poor Countries, Spinal Cord Injury Still Means Death

A 6-year-old Palestinian girl may be about to experience at first hand the gulf between care of spinal injuries in the rich world and developing countries.

An Israeli missile strike on a militant leader in the Gaza Strip in May last year killed most of Maria Amin's family and wrecked her spinal cord so high up that she lost not only the use of all limbs, but also the ability to breathe for herself.

Somehow, the Palestinians kept Maria alive long enough to get her to Israel's renowned hospitals.

Israel's defense ministry paid for her treatment there, but now wants to return her to the Palestinian territories -- to medical centers that can only provide a fraction of the care she has received, and may be overwhelmed if her condition worsens.

In a developed country, proper care, equipment and money can make life relatively long and productive, even for someone with such severe disabilities.

Yet in the developing world, even surviving such an injury is practically unheard of. Living with it long-term, with all the expense of permanent care, is all but impossible.

Paraplegics -- those with broken backs who retain full use of their arms and hands -- should be able to live for as long as the able-bodied, provided they have access to the information and equipment they need.

Sometimes this may mean no more than good information and relatively basic equipment such as pressure-relieving wheelchairs and mattresses.

But charities say that in developing countries, most paraplegics are dead in two to three years.

Others linger for years in hospitals or nursing homes, rarely if ever making it out of bed and often suffering repeated pressure sores and resulting infections.

POVERTY THE KILLER

Gladys Charowa broke her back in a car crash in Zimbabwe just before Christmas 2001. She was released from hospital in April 2002 at the same time as 19 other people with spinal cord injuries. By November, she was the only one still alive.

"They died because of poverty and lack of information," she told Reuters by telephone. "If you are paraplegic and you are carried in a wheelbarrow instead of a wheelchair, then of course you will get pressure sores."

Exactly a year ago I broke my neck on assignment for Reuters in Sri Lanka. Unlike Maria, I just about kept the ability to breathe. My arms and legs no longer function.

In the capital Colombo, a doctor told my colleague that people with my level of paralysis were often simply left on side wards to die from pressure sores or pneumonia if there was not enough money to provide proper care.

Maria's Israeli hospital says the Palestinian medical centers similarly lack the capability to cope with her, particularly if her condition deteriorates.

She still cannot breathe for herself or move her limbs, but she can drive an electric wheelchair with built-in ventilator, using a chin-operated joystick. Her father must do everything for her, from washing to feeding.

And if her ventilator stops, she dies.

With the Gaza Strip, her home, now under virtual blockade since the Islamist group Hamas took over the territory, Israel wants to send her to the occupied West Bank.

She may not be sent back -- her case is up before Israel's Supreme Court this month, and her Israeli hospital for now says it will not allow her to be discharged unsafely.

MONEY BUYS LIFE

Charowa, who now works for a disabled women's association in Zimbabwe, says that five years ago in her country, 90 percent of people died soon after sustaining spinal injuries.

Now, thanks to better information -- and proper wheelchairs and cushions -- that rate is down to 20 percent.

She credits a British charity, Motivation, with most of the change -- although she now fears that Zimbabwe's hyperinflation may take away people's ability to buy essentials such as catheter tubes or even food, setting life expectancy back again.

Motivation was founded by the British quadriplegic David Constantine -- who himself has some limited movement but needs full-time care -- and provides training and cheap wheelchairs, cushions and prosthetic limbs in the developing world.

"We see a huge change in attitudes," Constantine told Reuters. "It's a very effective way of spending money -- you see the change in people's lives immediately."

Equipment is only half the story. Patients in the developing world often cannot afford to pay for a caregiver, so that the task falls to family members without training.

Money really can make all the difference. One quadriplegic in Zimbabwe who was able to afford the necessary equipment and care has survived since 1982, Charowa said.

Even in the world's richest countries, ageing populations and limited resources are straining health systems' capacity to fund long-term care for those who cannot afford it themselves.

In parts of Britain, care plans for the newly disabled are already less generous than they were several years ago.

A lack of beds in specialist spinal units means some newly injured are stuck for months in hospitals barely able to cope.

After evacuation from Sri Lanka, I spent five weeks in a major British teaching hospital that failed to properly manage my bowels, leaving me constipated and at risk of a chain reaction of complications that could have led to a stroke.

Like spinal injury victims everywhere, I was still trying to absorb what had happened to me, and didn't know what was needed.

"If you can't ask for what you need, you simply will not get it," said Constantine.

But for some, like Maria Amin and her father, even asking might not be enough.

By: Peter Apps
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Spinal Cord Implant

A team at University College London (UCL) is developing a spinal canal implant that could improve the quality of life and life expectancy for people with serious spinal cord injury.

Previous research has restored function to this patient group by stimulating muscles through the skin using surface electrodes or implanting electrodes in the muscles or between the spinal cord and the muscles.

UCL has for some time been investigating a different approach by putting the electrodes on the nerve roots, which is where the nerves emerge from the spinal cord but remain within the spinal canal.

'These are relatively fine and fragile fibres within the spinal canal,' said Prof Nick Donaldson of UCL's neuroprosthesis engineering department. 'The complication is that there are many fibres very close together which emerge from the spinal canal and form the major nerves that run down into the legs and also control the bowel and bladder.

'The advantage from a surgical point of view is that they're all available in one location, so you can, in a single procedure, field and place the electrodes together rather than having to fit electrodes and route cables over the legs of the patient.'

FineTech Medical makes an implant called the sacral anterior root stimulator for this site in the body which is just used for neurological functions — primarily emptying the bladder and bowel.

'That has been very successful and made a big difference to patients who've had it fitted,' said Donaldson, 'but it doesn't do anything for the legs. I ran a research project in the 1990s where we stimulated the roots a bit higher up — the lumbar roots — and showed that we could get useful leg function, allowing a paraplegic to propel a recumbent cycle.

'We would like to expand the existing device by giving it more channels so we can add leg function to the existing neurological functions of the implants.'

The surgeon inserting the implant has to connect very small electrodes to individual nerve roots in such a way that the currents which flow between the electrodes just stimulate the target nerve roots, not neighbouring ones. This is achieved using a structure called an 'active electronic book,' because the surgeon can place the roots between the 'pages' of the device, separating them.

'The project, which is mainly technological, addresses how we can increase the number of stimulation channels without having many cables going into the spinal canal, said Donaldson. 'At the moment we have really been working at the limit of what the surgeons think is practical, with 12 channels, each corresponding to a nerve stimulated. The number one might want to stimulate is in the region of 20 to 30, so if we could double or treble the number of channels, we could do more for patients.

'That requires us having some way of putting the electronics right down near the electrodes. So the idea of the active book is that it has semiconductor switches and perhaps amplifiers within the electrode structure, we call the book and relatively few wires going through the dura (the outer membrane of the spinal cord) into the canal.'

This has the advantage of reducing the risk of infection and cerebro-spinal fluid (CSF) leak.

By the end of the project, the team hopes to show the technology can run in saline for long periods. It aims to demonstrate a method of sealing the electronics so the implant will be reliable for years, and carry out mechanical tests to prove its robustness.

The EPSRC-funded project runs from 2008 until 2010 during which time UCL will carry out the design of the electronics. When complete, approval will be sought from the Medicines and Healthcare products Regulatory Agency (MHRA) to undertake trials, which could take up to 10 years

UCL's project partners are the Tyndall Institute, which will develop the integrated circuit sealing, and Freiberg University, which has special knowledge of laser cutting tiny electrodes.

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