You asked the questions about Research for a Cure in Spinal Cord Injury, and we answered!
The University of Alabama at Birmingham Spinal Cord Injury Model System (UAB-SCIMS) answered questions from consumers during the month of June (2013). We could not answer them all, but we did answer those questions most people wanted to know.
Here are all the questions we answered.
Answers for June 3-7
- Why would transplantation of cells into the spinal cord after injury help?
The central idea behind cell transplantation for spinal cord injury (SCI) is that the cells are thought to promote repair and regeneration by: (1) secreting growth-promoting molecules (neurotrophic factors), (2) providing a scaffold for regenerating axons, (3) remylinating damaged axons, or even (4) replacing damaged or lost cells.
- How far is it from getting a cure through stem cell research?
The term “stem cell” is a broad one that includes many types of cells from many different tissue origins. Although current advances in stem cell research and technology show that stem cells may have therapeutic potential, many unanswered questions remain and other new questions emerge. For example, each type of stem cell has specific attributes and it is not yet known which cell type is the “best” for repair after SCI. Also, questions of what dose (i.e. how many cells and what time after SCI) and safety in humans have not yet been answered in clinical trials. Thus, more research is vital to understanding the potential and application of this promising approach. It is an exciting time for stem cell research, but many crucial questions about the use of stem cells remain. As there are many features of the use of stem cell transplant therapy that remain unknown, it is impossible to provide a definitive timeline.
- How promising are Schwann cells as a cure?
Schwann cells, the cells of the peripheral nerve that produce myelin, play an important role in repair of injured peripheral nerve by providing both physical and trophic support. Indeed it is thought that Schwann cells are a key to the ability of the peripheral nerve to repair to a much greater extent after injury than the spinal cord. Schwann cells are known to create an artificial means of guiding the regrowth of axons to facilitate nerve regeneration. Schwann cells also release neurotrophic factors that stimulate regeneration and repair of damaged neurons and can remyelinate demyelinated or newly sprouted axons. New clinical trials testing the safety of Schwann cells transplantation in SCI are underway. Thus, Schwann cells, like stem cells, are a promising potential treatment, although many questions about the safety and effectiveness remain to be answered.
Answers for June 10-14 (Helpful definitions are below)
- How far is it from getting a cure?
Researchers understand that this is a crucial question for all involved; however the knowledge to properly answer this question remains incomplete. Although there are many promising research ideas currently under evaluation at the bench (preclinical) and the bedside (clinical trials), it remains unclear which of these or what combination will be the most effective at treating spinal cord injury. Important research progress continues to be made but too many unknown variables remain for a time-line to cure to be laid out.
- If and when a cure is found for paralysis, won't people who are newly injured benefit from the cure more so than people who are years post injury?
There are many different groups focusing on several aspects of spinal cord injury research. In general, research focuses on (1) developing therapies that protect the spinal cord cells from the injury process (cellular protection), (2) improving rehabilitation and recovery of function by increasing plasticity (connections), (3) promoting repair and regeneration of damaged spinal cord tissue, (4) understanding the causes and developing treatments for secondary complications such as pain, spasticity, or autonomic dysreflexia. Although the protective strategies typically focus on the newly injured, several other lines of research will also be of great benefit to those who have been injured longer.
- Why aren't more researchers concentrating on chronic injury?
As described above, many research teams focus on topics that relate to improving chronic SCI. It is correct that in the field of regeneration and repair that teams often work with the acute post-SCI experiments first. The reason for this is that it is generally agreed that the chronically injured spinal cord is more resistant to repair strategies than the newly injured spinal cord. Thus, researchers initially focus on the acutely injured spinal cord to increase the likelihood of success. In other words, many researchers take the strategy of establishing proof-of-principle in the acute post-injury experiments before conducting the more challenging, although extremely important, experiments in the chronically injured spinal cord. It is important to note, that experiments in the chronic SCI are typically the next step after the acute SCI effect are strongly demonstrated.
Answers for June 17-21
- Looking at the Christopher and Dana Reeve Foundation website under research...there appears to be all kinds of research happening. Is there a governing board that reviews all the work and results to determine if there are protocols that should be adopted at trauma centers or post injury to improve the post injury recovery processes? If so how are those introduced to ensure rapid adoption of discoveries?
This is an exciting time for research and discovery. In general, discoveries must go through a process that takes an idea from the bench to the bedside. Of course, it depends on the nature of the treatment, as to which governing agency review the information. For example, the United States Food and Drug Administration (FDA) oversee the path of discovery for development of new drugs or medical devices. In 2004, the FDA initiated the Critical Path Initiative, a system to improve the discovery of drugs and medical devices, improve the quality of the evidence that a drug or device works, and to improve the clinical use of the product. Researchers at universities and in industry work closely with the FDA in many steps of the process to ensure safe, efficient, and timely transfer of discoveries.
- I read where people in other countries have cures, so why can’t we do it?
It is very important to consider that all information, particularly that from other countries, needs to be verified. As a scientist who presents and attends international conferences on spinal cord injury, I know that there are many statements made by foreign scientists and clinicians that cannot be verified using our accepted scientific methods. In the United States, we use well-accepted scientific methods that are open to evaluation, verification, and peer review. These are the measures of good science and evidence-based medicine and are the foundation to discovery of cures that truly work. Unfortunately, not all countries use these same measures and often individual make claims that do not stand up upon careful inspection.
Definitions:
- Axon is a nerve fiber that conducts electrical impulses.
- Myelin is the insulating material that forms a layer (myelin sheath) around only the axon of a neuron. It is essential for the proper functioning of the nervous system.
- Demyelinate is lost myelin.
- Remylinating is creating new myelin.
- Trophic is a growth factor that can stimulate cellular growth.
- Neurotrophic is a class of growth factors that can signal cells to survive, differentiate, or grow.
