Guest Post: This is a guest post authored by Dr. Barmada, a stem cell doctor at Gulf Coast Stem Cell. Gulf Coast Stem Cell offers stem cell therapy for patients with most neurological disorders, including spinal cord injuries, through pioneering SVF harvesting and deployment methods. Enjoy his insights into neurological applications of of stem cells.
Encased within the bony vertebrae of the spinal column is the spinal cord, the vital communication superhighway between brain and body. This biological apparatus, termed the Central Nervous System (CNS) enables us to recognize sensation, temperature and other sensory information while also transmitting the power to control the muscles, both those involved in the conscious act of movement and those which automatically regulate our breathing, bladder and bowel control, blood pressure and other functions.
The spinal cord is formed of sensitive tissue which, once damaged, is unable to repair itself. Depending on the extent and location of the damage, patients with spinal cord injuries (SCIs) will experience a loss of sensation and partial or total paralysis.
Types of Spinal Cord Injury and Existing Treatments
Around 3 million people worldwide are afflicted with an SCI. To classify these injuries, the vertebrae are numbered and the spinal column is divided into four sections: cervical (neck), from C1 to C7; thoracic (upper torso), from T1 to T12; lumbar (lower back), from L1 to L5 and the sacrum, which supports the spinal column and is made up of five vertebrae. In children, the five vertebrae of sacrum (S1 to S5) are individual, but they fuse into one structure during the teens. SCIs are also classified, using the ASIA impairment scale, from Grade A, where there complete sensation of neurological signals from and to the lowest nerves at S4-5, to Grade E, where there is no abnormal transmission below the injury. A complete injury does not necessarily mean that the spinal cord has been severed, but the damage is so extensive that there is no motor or sensory function below the injury.
A primary spinal injury usually arises from mechanical forces, for example as a result of a car accident, but certain toxins, infections or ischemia (reduced blood flow) can cause severe damage. Injury may then be followed by secondary injury from the body’s own response to the damage, e.g. swelling, especially in a confined area– termed a ‘biochemical cascade.’
Although there are early interventions that can limit the damage caused by secondary injury, there is currently no approved and effective treatment for the healing of spinal injuries. Patients with incomplete SCI often recover a degree of function over time, with help from physiotherapy, but for those with complete spinal injury, motor and sensory functions are usually lost permanently. However, some exciting developments in the field of regenerative medicine indicate that this may not have to be the case.
Trials Involving NSC Transplantation
One of the main reasons why SCIs are so devastating is that spinal cord nerve cells do not regenerate on their own once damaged. However, brain tissue contains neural stem cells (NSCs) which can differentiate into the three types of cells found in the CNS: neurons, oligodendrocytes (responsible for generating the important myelin sheath around neurons) and astrocytes. Following successful experiments on mouse models, the field is now undergoing human trials to establish the safety and efficacy of allogeneic NSC transplantation in human SCI patients. The researchers are looking for evidence that NSCs help to re-establish some of the damaged circuitry that is crucial for the transmission of sensory and motor information through the CNS.
One such trial, which ran from 2010 to 2015 in Switzerland recruited patients with chronic thoracic SCI and involved administering a dose of NSCs through multiple injections into the patient’s thoracic cord. Interim results reported that four from the 12 enrolled patients had experienced significant sensory gains following the transplantion. This has stimulated further trials, both in Europe and America, with the same company currently recruiting a larger sample of chronic cervical SCI patients for a similar trial.
Other companies, including one which had already conducted the first FDA-approved trials into Amyotrophic Arterial Sclerosis, are currently trialling their NSC cultures on patients with a variety of chronic and acute SCIs. The Miami Project is even conducting a trial which involves the use of the patient’s own Schwann cells; these are the counterpart to oligodendrocytes in the peripheral nervous system (PNS) which can regenerate itself.
MSCs and ESCs in Spinal Stem Cell Trials
Other researchers are investigating whether mesenchymal stem cells (MSCs) can help with SCI. This would open up the possibility of autologous stem cell treatments whereby stem cells from the patient’s own bone marrow or adipose (fat) tissue are used, rather than NSC cultures. MSCs from umbilical cord blood are also being tested for safety and efficacy.
Some of these trials introduce MSCs by injecting into the injury site itself while others inject the cells into the spine canal and cerebrospinal fluid (CSF), intravenously or under the skin. While MSCs may not be able to differentiate into neurons or glial (neuron-supporting) cells, they may still be able to successfully treat SCI by helping to provide the tissue protective molecules and growth factors that may support the re-establishment of neural circuitry through the damaged area.
The controversial area of embryonic stem cell (ESC) transplantation is another potential avenue for SCI treatment due to the pluripotent abilities of this type of cell. In 2015, Asterias Biotherapeutics (part of the BioTime group) recommenced the trials discontinued by Geron back in 2011. The program involves differentiating ESCs into oligodendrocyte precursor cells (OPCs) and injecting these into the spines of five patients with complete thoracic SCIs. The preliminary safety trials have showed no adverse affects and efficacy trials with ascending doses are now ongoing. Although these trials are at a very early stage, there are a few promising signs that the extent of injury in the spinal cords of four patients has decreased– an effect observed in previous animal models.
As we await to see which types of stem cells will feature in future SCI treatments of this type of injury, it seems that one possible solution may have been literally under our noses all the time.
Case Study: How a Paralysed Polish Stab Victim Walked Again
The case of Darek Fidyka was revealed to the world in 2014 to give hope to millions. Fidyka, a former fireman from Poland, was stabbed in the back in 2010 in an attack which nearly severed his spinal cord but for a thin strip of connective tissue; the SCI left Mr Fidyka completely paralyzed from the chest down. Researchers in the UK had used olfactory ensheathing cells (OECs), a type of glial cell found in the nose, to aid in restoring movement to paralyzed rats and dogs and Polish surgeons drew on this expertise to harvest OECs from Mr Fidyka’s olfactory bulb in a pioneering treatment. These OECs were then injected into the surviving spinal cord tissue and the gap between spinal cord sections bridged with a scaffold made from strips of nerve tissue from Mr Fidyka’s ankle. OECs are not actually stem cells at all but they facilitate the periodic regeneration of nerve fibers in the nose, the only area of the body where nerve cells replenish themselves. The results made the global headlines as Mr Fidyka, who had experienced no improvement following two years of intense physiotherapy (as expected with a Grade A SCI) regained a degree of sensation and also some motor control to the extent that he would eventually walk again with the aid of a frame and even ride an adapted tricycle.
This unique case serves to illustrate the fact that regenerative medicine is the way forward when it comes to treating, and perhaps even curing, some of the most complex and debilitating illnesses and injuries suffered by humans. In the next few years, as the many trials begin to yield their results, the picture should become clearer and SCI patients can look forward with genuine hope.
About the Mississippi Stem Cell Treatment Center
At the Mississippi Stem Cell Treatment Center we offer stem cell therapy for patients with most neurological disorders, including spinal cord injuries, through pioneering SVF harvesting and deployment methods. However, we do not deploy the stem cell rich suspension at the site of injury, but rather, we rely on the stem cells traveling through the CSF to the site of injury. To book a consult, or find out more, please visit our website at http://www.gulfcoaststemcell.com OR call (886) 855 4823. Connect via Facebook.
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