Friday, November 21, 2008

Nanotechnology for Spinal Cord Injury

A cure for spinal injuries that leave people paralyzed, currently incurable, is being developed by Researchers at Northwestern University in Chicago. They are looking into using new nanotechnology that could enable them to completely heal cut and severed spinal cords allowing the previously paralyzed to walk again.

Spinal cord injury often leads to permanent paralysis and loss of sensation below the site of the injury due to damaged nerve fibers which can’t regenerate. These nerve fibers (axons) have the capacity to grow but don’t because they are blocked by scar tissue that have developed around the injury. Northwestern University researchers have shown that a new nano-engineered gel inhibits the formation of scar tissue at the injury site and enables the severed spinal cord fibers to regenerate and grow.

The gel is injected as a liquid into the spinal cord and self -assembles into a scaffold that supports the new nerve fibers as they grow up and down the spinal cord, penetrating the site of the injury. When the gel was injected into mice with a spinal cord injury, after six weeks the animals had a greatly enhanced ability to use their hind legs and walk.

However it was stressed that the results were preliminary and there is no magic bullet and it may not necessarily work on humans, but it helps a new technology to develop treatments for spinal injuries.

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Nose Cells May Heal Spinal Cord Injuries

People paralysed by spinal cord injuries could soon be "repaired" using cells from their own noses, say Otago University researchers.

The Health Ministry's ethics committee has just approved an application by the Spinal Cord Society to open the way for a clinical trial involving 12 patients, which could start next year.

The society's president, Noela Vallis, said there was no shortage of volunteers ready to take part.

"Some have already gone overseas out of a sense of frustration that they can't access it [the experimental treatment] here," Mrs Vallis said.

About 5000 Kiwis are in wheelchairs as a result of accidents - the highest rate of any country in the developed world.

Research director Jim Faed, who heads the the Spinal Cord Society's lab at Otago University, has spent five years developing laboratory methods for growing cells potentially useful for spinal cord injury repair.

His team is focusing on two promising cell types: one is a kind of adult stem cell produced by a patient's own bone marrow.

However, researchers are likely to begin trials using olfactory (scent receptor) cells from the patient's nose, injecting them into damaged spinal cord.

"The olfactory tissue in the nose is unique because it is the only place in the body where there is constant replacement of nerve cells throughout life," Dr Faed said.

"There is growing medical opinion that these cells can help overcome the blocks that prevent nerve cells regenerating after damage to the spinal cord."

The nasal tissue acts like "nurse cells", providing growth factor hormone to nerve cells, enabling them to make "meaningful connections".

Internationally, several research groups have done animal trials using the cells, but there has been only one human trial - in Portugal in 2006. The Otago group is in contact with Portuguese neuropathologist Carlos Lima, who pioneered that trial.

Dr Faed said some participants experienced side-effects, but they were "few and manageable" and none had been fatal.

Positive benefits for patients included return of some muscle function and sensation in parts of the body which previously had no feeling.

Dr Faed said the Dunedin lab hoped to get full approval for the trial before Christmas, and would then begin recruiting patients. The first 12 could start treatment next year.

Mrs Vallis - who founded the society after her late husband was paralysed in an accident - said the group aimed to raise $1 million to fund the trial, in addition to the $300,000 it finds every year to run the lab. "We should be at the forefront of developing this medical treatment, given the number of our citizens in wheelchairs."

Feilding man Iain Scott, a quadriplegic since dislocating his neck while playing rugby 19 years ago, said the possibility of the treatment was "huge" and gave hope to people with spinal cord injuries. "If nothing happens, at least you had a go ... you don't want to die wondering."

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Promising Therapies for Spinal Cord Injuries

A quarter of a million Americans are currently living with spinal cord injuries, according to the National Institute of Neurological Disorders and Stroke.

Although most people know this type of injury can be a devastating diagnosis, not everyone knows there are many different types of spinal cord injuries. The location of the injury along the spinal cord determines what parts of the body are affected. Different types of spinal cord injuries include:
  • Cervical Spinal Cord Injury: Affects vertebrae C1-C8 and causes paralysis or weakness in both arms and legs. This is also known as quadriplegia or tetraplegia.
  • Thoracic Spinal Cord Injury: Affects vertebrae T1-T12. These injuries can cause paralysis or weakness of the legs along with loss of physical sensation, bowel, bladder and sexual function.
  • Lumbar Spinal Cord Injury: Affects vertebrae L1-L5 and result in weakness or paralysis of the legs. This is also known as paraplegia.
  • Sacral Spinal Cord Injury: Affects vertebrae S1-S5. Sacral level injuries mainly cause loss of bowel and bladder function as well as sexual dysfunction. They can also cause weakness of paralysis of the hips and legs.
Injuries can also be complete or incomplete. Complete injuries are indicated by a total lack of sensory and motor function below the level of injury, whereas incomplete injuries are marked by some remaining sensation and movement (Source: Paralysis Resource Center).

With spinal cord injuries, the speed and quality of medical attention can dictate how the patient will live the rest of his or her life. Immediate treatment can include medications, immobilization and surgery.

One of the most important drugs used to treat spinal cord injuries is methylprednisolone, an adrenal corticosteroid that protects against further damage if administered within eight hours of injury. However, this drug may pose a risk of harmful side effects.

Clinical trials of a compound called GM-1 ganglioside show it may be another drug that can protect against secondary damage in these types of injuries. The compound is also showing promise in improving recovery during rehabilitation, a process that all victims of spinal cord injury have to undergo -- sometimes for years.

Another promising therapy for spinal cord injury involves an electronic chip implanted in the brain. Studies in rats show the animals could move a prosthetic arm using only their thoughts.

Researchers from the University of Florida implanted an electronic chip into rats' brains. A computer decoded the chip, and over time, the computer learned to adapt to the rats' needs. When a rat thought about moving, the computer responded by moving a robotic arm.

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Monday, November 10, 2008

Stem-cell Therapy in Moscow Attracting Patients from West

Every three months, David Martin, a quadriplegic, returns to a small clinic here in the Russian capital for therapy he cannot legally get back home in Kalamazoo, Mich.: injections of stem cells taken from his own body, at a cost of $12,000 per visit.

Martin's U.S. doctors have tried to dissuade him from believing any improvement in his condition could be the byproduct of stem-cell treatments, a therapy not yet approved in the United States. No scientific evidence has ever shown that such treatments can repair human spinal-cord injuries, experts say.

Yet Martin notices glints of progress — a twinge of sensation in one of his curled, still hands, a faraway feel of something cold on his skin. He attributes it to the stem-cell treatments he has been getting in Moscow.

"It's definitely unfortunate that the U.S. isn't doing this," said Martin, 36, paralyzed since a car accident in 2006. "It's not an inexpensive venture, and it's not easy on the body to have to travel this distance."

Martin is just one of a growing number of Americans and Europeans turning to Russia, China and other countries where the stem-cell industry operates unfettered — and largely unregulated.

NeuroVita, the clinic Martin has been visiting since 2007, attracts paraplegics and quadriplegics from around the world and maintains a waiting list for overflow clientele. Elsewhere in the capital, chic beauty clinics rely on stem-cell therapy to beckon Moscow's moneyed elite, pitching the treatments as a surefire answer to wrinkles and stretch marks.

What troubles critics is the rush in some countries to offer stem-cell therapy on the health-care market, the absence of governmental oversight associated with stem-cell treatments in those countries, and the lack of any proof that the treatments actually work. If patients feel improvement, experts say, it's likely a placebo effect or the result of their body's own healing mechanisms.

NeuroVita relies on adult stem cells taken from the patient's own bone marrow, a type of stem cell widely regarded as having far less therapeutic potential than embryonic stem cells — stem cells derived from human embryos.

"About making money"

While adult stem cells may be useful in treating cancer or brittle-bone disease, most experts think it's impossible to turn blood-derived adult stem cells into nerve cells, and that anyone offering such treatments is not relying on peer-reviewed science.

"I don't think there's much science to it," said Vladimir Smirnov, director of the Moscow Institute of Experimental Cardiology, a licensed Russian stem-cell researcher and a leading critic of clinics that sell stem-cell injections. "It's all about making money."

The wonder of stem cells lies in their ability to reproduce and differentiate into whatever variety of tissue the body requires. Adult cells do not reproduce, but stem cells divide freely. Stem cells also tend to seek out damaged tissue, making them catalysts for restoration. In recent years, scientists have been encouraged by research that suggests stem-cell therapy could one day be applied to a wide array of disorders and injuries.

A recent study involving rats with Parkinson's disease showed that embryonic stem cells genetically altered to yield dopamine-producing neurons could be transplanted into the rats' brains and improve motor function. Other studies have shown that adult stem cells injected into mice with damaged hearts can repopulate heart tissue with new heart-muscle cells.

Doctors have been relying for four decades on bone-marrow transplants that use adult stem-cell technology to treat cancers such as leukemia and lymphoma.

But the U.S. Food and Drug Administration (FDA) has yet to approve embryonic or adult stem-cell injections to treat other disorders. The FDA allows stem-cell clinical trials involving humans, but the research is carefully controlled and usually involves a small number of patients.

Elsewhere in the world, however, regulations governing stem-cell therapy are lax and usually poorly enforced.

In Russia, the Federal Health Inspection Service must approve a clinic's use of stem-cell therapy. Several years ago, Russian authorities shut down more than 30 medical institutions illegally carrying out stem-cell treatments, but numerous clinics continue to sell the injections under the radar of regulators.

Clinical trials allowed

A Moscow clinic called Beauty Plaza has the government's permission to carry out adult stem-cell injections within the framework of clinical trials. The stem cells are taken from the patient's fatty tissue. Usually, subjects of clinical trials do not pay for their treatments, but Beauty Plaza clients have to pay for theirs, says the clinic's director, Alexander Teplyashin.

"We can eradicate atherosclerosis symptoms, and we can cure diabetes Type 2," Teplyashin said confidently during an interview at his clinic. "After the treatments, patients stop getting the flu. ... They become more energetic, more active."

According to its Web site, NeuroVita has governmental approval to offer adult stem-cell therapy to neurological patients. The clinic's director, Andrei Bryukhovetsky, said NeuroVita has used stem-cell treatments on 200 patients since 2002, 70 percent of them foreign citizens and at least 30 patients from the United States.

Bryukhovetsky touts results that most experts would label as doubtful: A young man from Siberia paralyzed from the neck down now "eats on his own, drinks tea, all within a year." For another patient with a spinal-cord injury in his neck, "one injection was enough. After one day he began writing," Bryukhovetsky said.

"How can we explain it? I don't know," Bryukhovetsky said. "But it works."

The trouble with such anecdotal evidence, said Evan Snyder, a U.S. expert on stem-cell research, is that it lacks credibility. And the best environment to ensure that credibility, Snyder said, is a "proper, well-controlled clinical trial."

"Anecdotal evidence doesn't mean anything to me," said Snyder, a stem-cell researcher at the Burnham Institute in La Jolla, Calif. "I'm happy for the patient if he feels better. But one has to be cautious about what to attribute that improvement to."

Stem-cell treatments aren't without risk, Snyder adds.

"It could be a situation where the stem cells go to the wrong place in the body, or they are the wrong type of cells for a given region," he said. "They could turn into cancer themselves, or cause neighboring cells to become cancerous."

It remains unclear when stem-cell technology will be ready for broader application in U.S. health care. Patients like Martin say they don't want to wait.

Patient sees progress

On a recent afternoon in a physical-therapy room at NeuroVita, Martin demonstrated what he believed was progress attributable to the stem-cell injections he received in his spine. He winced slightly as his hands, fastened to weight machine handles with leather straps, pulled back to lift 55 pounds. Before the treatments, he could lift just 2 pounds, he said.

"I've come a long way," Martin said. "Seems like every time I come back from Russia, I've gone up 5 or 10 pounds."

Martin, manager of an automotive component plant before the accident, spent $33,000 on an initial visit, for an overall cost of about $81,000 on five visits to NeuroVita since June 2007.

He believes he'll need one more year of treatments.

"If someone has the wherewithal to do something like that and it improves their psychological well-being, I wouldn't prevent them from doing it," said, Snyder the stem-cell researcher, "as long as they recognized that the likelihood for improvement is minimal."

By Alex Rodriguez
Chicago Tribune
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