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10 of the most significant advances in spinal injury repair

Until World War II, people with spinal cord injuries had few treatment or rehabilitation options. And even today, spinal cord injuries can have catastrophic effects on everything from mobility to sensation, bladder, bowel and sexual function.

However, over the past 20 years, several breakthroughs in spinal cord repair and technology have emerged. No single breakthrough has achieved a full repair, but each has advanced our understanding of the complexities of spinal cord injuries. Here are ten of the most important advances in spinal cord injury repair.

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April 2001

Spinal cord plasticity

Spinal cord plasticity Here is a caption

In April 2001, two Swiss scientists discovered that, although spinal cord injuries won’t recover by themselves, some function can be restored to affected limbs following physiotherapy. This surprising discovery was published in the prestigious Nature Reviews Neuroscience, and supporting evidence showed exercise or physiotherapy was helping nerve fibres surrounding the injury sprout new inter-connecting fibres in a process called plasticity. This may not amount to a spinal cord injury repair, but it may become an important method of achieving spinal cord repair in the future.1

Did you know...

Spinal cord injured cats can recover some walking ability when strapped to a moving treadmill. Nerves in their spinal cord may be able to take over the walking movement without any involvement of the brain.2 3 4

References

1Olivier Raineteau and Martin E. Schwab (2001). Plasticity of motor systems after incomplete spinal cord injury. Nature Reviews Neuroscience 2, 263-273 (April 2001)| doi:10.1038/35067570

2R.G. Lovely, R.J. Gregor, R.R Roy and V.R. Edgerton. Effects of training on the recovery of full-weight-bearing stepping in the adult spinal cat. Experimental Neurology; 92:421– 435 (1986).

3Serge Rossignol and Laurent Bouyer. Adaptive Mechanisms of Spinal Locomotion in Cats. Integrative and comparative biology (2004)

4J.A. Hodgson. Can the mammalian lumbar spinal cord learn a motor task? Medicine and Science in Sport and Exercise (Dec 1994); 26(12):1491-7

Spinal cord plasticity Here is a caption
Did you know...

Spinal cord injured cats can recover some walking ability when strapped to a moving treadmill. Nerves in their spinal cord may be able to take over the walking movement without any involvement of the brain.2 3 4

April 2001

Sodium channel blockers

Sodium channel blockers Here is a caption

In April 2001, Canadian scientists discovered that a drug called Riluzole, used to treat a type of motor neurone disease, could also protect nerve cells after spinal cord injury.5 Riluzole slows down inflammation of nerves by blocking the sodium channels to them, effectively anaesthetising them after injury. Clinical trials have been going on for four years and an academic paper published in 20146 said the drug could become a potential way of improving nerve recovery, if used shortly after injury. A bigger clinical trial of 350 patients will report its results in 2018.7

Did you know...

The Christopher & Dana Reeve Foundation, set up by the spinal cord injured Superman actor Christopher Reeve, is financially supporting this trial.8

References

5Schwartz G et al. Evaluation of the neuroprotective effects of sodium channel blockers after spinal cord injury: improved behavioral and neuroanatomical recovery with riluzole. Journal of Neurosurgery (2001 Apr);94(2 Suppl):245-56

6J.R. Wilson, M.G. Fehlings et al. Riluzole for acute traumatic spinal cord injury: a promising neuroprotective treatment strategy. World Neurosurgery (2014 May-Jun);81(5-6):825-9.

7Riluzole in Spinal Cord Injury Study (RISCIS) https://clinicaltrials.gov/ct2/show/NCT01597518?term=Spinal+cord+injury+AND+riluzole&rank=2

8https://www.christopherreeve.org/research/nactn/riluzole-in-spinal-cord-injury-study-riscis

Sodium channel blockers Here is a caption
Did you know...

The Christopher & Dana Reeve Foundation, set up by the spinal cord injured Superman actor Christopher Reeve, is financially supporting this trial.8

2006

Antibiotic minocycline

Antibiotic minocycline Here is a caption

In 2006, scientists discovered that minocycline, a commonly prescribed antibiotic closely related to the better known tetracycline, could protect nerves and prevent inflammation after spinal cord injury. This was shown in research carried out at the University of Calgary in Canada in 2006.9 An academic paper which followed the research showed patients given minocycline had greater improvement in the movement of muscles paralysed by injury than those given a placebo pill. A larger clinical trial of 250 patients is now taking place in Calgary and may explain how minocycline does this. Results are expected in 2018.10

Did you know...

Tetracycline is a naturally occurring antibiotic and can be found in certain types of soil.11

References

9B.W. Festoff et al. Minocycline neuroprotects, reduces microgliosis, and inhibits caspase protease expression early after spinal cord injury. Journal of Neurochemistry (2006 Jun);97(5):1314-26.

10Minocycline in acute spinal cord injury (MASC) https://clinicaltrials.gov/ct2/show/NCT01828203

11Kummerer, Klaus (editor). Pharmaceuticals in the Environment (2008) p.228

Antibiotic minocycline Here is a caption
Did you know...

Tetracycline is a naturally occurring antibiotic and can be found in certain types of soil.11

2008

Botulinum toxin

Botulinum toxin Here is a caption

In 2008, an article published in the American Journal of Physical Medicine and Rehabilitation found that botulinum toxin – the active ingredient in Botox - could be used to treat spasticity and spasm after spinal cord injury.12 28 spinal cord injured adults were treated with botulinum toxin and improvements were noted in walking, and upper limb function in more than half of patients. Pain decreased in an impressive 83.3% of cases. The authors concluded botulinum toxin seemed an effective treatment for reducing disability in spinal cord injury. As well as treating spasticity, it is regularly used as a treatment for bladder dysfunction following spinal cord injury.13

Did you know...

Botox could be a possible treatment for depression. A paper published in 2014 showed that patients injected with the drug experienced a significant reduction in their depression symptoms.14

References

12C. Marciniak et al. The use of botulinum toxin for spasticity after spinal cord injury. American Journal of Physical Medicine & Rehabilitation (April 2008)

13 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm269509.htm

14M. Magid et al. Treatment of major depressive disorder using botulinum toxin A: a 24-week randomized, double-blind, placebo-controlled study. The Journal of Clinical Psychiatry (Aug 2014). 75(8):837-44.

Botulinum toxin Here is a caption
Did you know...

Botox could be a possible treatment for depression. A paper published in 2014 showed that patients injected with the drug experienced a significant reduction in their depression symptoms.14

2012

Therapeutic hypothermia

Therapeutic hypothermia Here is a caption

Scientists working at the Department of Neurological Surgery and The Miami Project to Cure Paralysis have discovered that cooling parts of the body – what is called “therapeutic hypothermia” - by 4 degrees Celsius for 48 hours can slow down injury to the spinal cord if carried out very quickly after injury. A 2012 study found 15 out of 35 spinal cord injured patients given therapeutic hypothermia showed an improvement in their condition.15 Therapeutic hypothermia may encourage spinal cord repair, although to what degree is still unknown.

Did you know...

In 2007, an American footballer was spinal cord injured during a match. Doctors immediately chilled his body which may be a contributing factor in why he was able to walk again a few months later.16

References

15M. Dididze et al. Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study. Spinal Cord (2013 May); 5 1(5):395-400.

16https://www.scientificamerican.com/article/did-hypothermia-therapy-allow-kevin-everett-to-walk/

Therapeutic hypothermia Here is a caption
Did you know...

In 2007, an American footballer was spinal cord injured during a match. Doctors immediately chilled his body which may be a contributing factor in why he was able to walk again a few months later.16

June 2014

Thought control

Thought control Here is a caption

In 2014, a 23-year-old spinal cord injured quadriplegic man discovered he could move his fingers and hand with his own thoughts thanks to a “thought control” device developed in the US.17 The device works through a brain implant which controls arm movements by interpreting nerve signals and sending this information to a sleeve on the patient's forearm, bypassing the spinal cord injury. The device does not repair the injury but helps the body bypass it and is the result of a partnership between Ohio State University and Battelle, a non-profit research and development organization.

Did you know...

It was once thought possible to move objects at will by thought control or telekinesis. This theory is now generally disbelieved.18

Thought control Here is a caption
Did you know...

It was once thought possible to move objects at will by thought control or telekinesis. This theory is now generally disbelieved.18

December 2014

Transplanting nose nerve cells

Transplanting nose nerve cells Here is a caption

In 2014, an academic paper came out about a patient who had become paralysed at T9 following a stabbing incident. The paper described how the patient had partial recovery of voluntary movements in part of his limbs following transplantation of nerve cells from his nose and nerve bridging.19 The nose nerve cells called olfactory ensheathing cells (OECs) form part of the sense of smell and are continually renewed. Scientists believe OECs can be transplanted from the nose to the spine and can enable fibres above and below the injury to reconnect, using the nerve grafts to bridge the gap.

Did you know...

Olfactory ensheathing cells have a lifespan of just 6-8 weeks. Some human body cells have lifespans of years or even decades.20 21

References

19Tabakow et al. Functional Regeneration of Supraspinal Connections in a Patient With Transected Spinal Cord Following Transplantation of Bulbar Olfactory Ensheathing Cells With Peripheral Nerve Bridging. Cell Transplantation, Volume 23, Number 12, 2014, pp. 1631-1655(25)

20 https://www.researchgate.net/publication/7150323_Olfactory_Ensheathing_Cells_Characteristics_Genetic_Engineering_and_Therapeutic_Potential

21 http://phenomena.nationalgeographic.com/2013/02/25/neurons-could-outlive-the-bodies-that-contain-them/

Transplanting nose nerve cells Here is a caption
Did you know...

Olfactory ensheathing cells have a lifespan of just 6-8 weeks. Some human body cells have lifespans of years or even decades.20 21

2015

Scar-busting chondroitinase

Scar-busting chondroitinase Here is a caption

Although nerves in spinal cord injury try to regenerate they usually get stuck in scar tissue that has sealed off the area of damage. In 2015, researchers led by Prof. Elizabeth Bradbury of Kings College, London, showed that a scar-busting enzyme called chondroitinase could dissolve the scar tissue in animals.22 The James Lind Alliance, an influential body which brings together clinicians and patients to discuss research priorities, recently said looking at whether chondroitinase is the solution to spinal cord injury in humans was a top research priority for scientists.23

Did you know...

Chondroitinase is an enzyme produced from a bacteria called proteus vulgaris that lives in the intestines of humans and animals.24 25

References

22Bradbury E et al. Chondroitinase gene therapy improves upper limb function following cervical contusion injury. Experimental Neurology (2015 Sep);271:131-5.

23microbe wiki http://www.jla.nihr.ac.uk/priority-setting-partnerships/spinal-cord-injury/top-10-priorities/

24Open Repository and Archive, College of Pharmacy Seoul National University, South Korea. http://s-space.snu.ac.kr/handle/10371/18049

25microbe wiki: microbewiki.kenyon.edu/index.php/Bacteroides_thetaiotaomicron

Scar-busting chondroitinase Here is a caption
Did you know...

Chondroitinase is an enzyme produced from a bacteria called proteus vulgaris that lives in the intestines of humans and animals.24 25

September 2016

Stem cell treatment for cervical spinal cord injury

Stem cell treatment for cervical spinal cord injury Here is a caption

In 2016, American bio-tech company Asterias Biotherapeutics reported significant improvements in patients with complete cervical spinal cord injury. This was following treatment with cells grown from human embryonic stem cells which eventually grow into nerve cells called oligodendrocytes.26 27 Five patients have received injections of these cells into their spinal cord lesion. After 90 days, all five showed signs of upper body improvement and an increased ability to perform daily activities independently, suggesting possible spinal cord repair.28 More results are eagerly awaited in 2017.

Did you know...

A single oligodendrocyte can coat 50 axons or nerve fibres with a protective coating called myelin which insulates and protects them. 29

References

26 http://asteriasbiotherapeutics.com/asterias-biotherapeutics-announces-positive-efficacy-data-in-patients-with-complete-cervical-spinal-cord-injuries-treated-with-ast-opc1/

27Initial Clinical Trials of hESC-Derived Oligodendrocyte Progenitor Cells in Subacute Spinal Cord Injury. ISCoS Meeting September 14, 2016

28http://asteriasbiotherapeutics.com/inv_news_listings.php?listing=1557&#asteriasNews

29Jim Barnes. Essential Biological Psychology (Feb 2013)

Stem cell treatment for cervical spinal cord injury Here is a caption
Did you know...

A single oligodendrocyte can coat 50 axons or nerve fibres with a protective coating called myelin which insulates and protects them. 29

November 2016

Fat derived stem cells transplant

Fat derived stem cells transplant Here is a caption

A type of stem cell grown from fat tissue and transplanted into spinal cord-injured patients has resulted in major improvements according to scientists carrying out ground-breaking research in South Korea.30 In the research, 14 patients were given fat derived stem cells through a lumbar puncture and, according to the American Spinal Injury Association (ASIA) impairment scale, there were improvements in sensation in ten patients and improvements in motor skills (the ability to control muscles) in five patients after just eight months.

Did you know...

The ASIA impairment scale describes a patient’s level of injury, ranging from A (complete lack of function below injury) to E (normal neurological function).31

References

30 J.W. Hur. Intrathecal transplantation of autologous adipose-derived mesenchymal stem cells for treating spinal cord injury: A human trial. Journal of Spinal Cord Medicine (2016 Nov);39(6):655-664.

31Understanding Spinal Cord Injury: Produced by Shepherd Center for spinal cord injury. http://www.spinalinjury101.org/details/asia-iscos

Fat derived stem cells transplant Here is a caption
Did you know...

The ASIA impairment scale describes a patient’s level of injury, ranging from A (complete lack of function below injury) to E (normal neurological function).31

Future

The future of spinal cord injury research and repair

The future of spinal cord injury research and repair Here is a caption

These ten breakthroughs are all interesting advances which could eventually lead to full spinal cord repair. One of these projects or a combination of them may be successful in making advances in, or achieving full spinal cord repair.

One promising and much publicised area of investigation is stem cell research. It’s thought that stem cells may encourage the re-growth or rehabilitation of damaged nerve cells and it’s quite possible a full spinal cord repair may emerge through this avenue of research. In the future, spinal cord repair may also be achieved by drugs that dissolve scar tissue allowing nerves to re-grow.

Regardless of which spinal injury breakthrough is the most successful, one thing is clear – crucial breakthroughs in spinal cord repair are happening. While it’s inaccurate to talk about a ‘cure’ for spinal cord injury, these developments give us reason to be cautiously optimistic for the future.

Technological advances and scientific breakthroughs will continue to help us better understand the human body and its incredible workings. One day, we hope they will also be able to fully repair all of the effects of a spinal cord injury.

The future of spinal cord injury research and repair Here is a caption