The latest news and information about what's going on with SCI science and research. Brought to you by Sam Maddox, author of the Christopher & Dana Reeve Foundation Paralysis Resource Guide.

SCI News; Some Perspective On Nose Cell Recovery Story

Regarding the big story this week from Poland .... blazed across the front page of the Times in London, Paralyzed Man Walks Again. I don’t think I’ve ever seen a spinal cord injury cure story taken for such a spectacular spin.
First, let’s hear it for Darek Fidyka, the man who got the stab wound who got his nose cells and nerve grafts put in his spinal cord who got some movement back. ASIA A to ASIA C. From complete paraplegia to an incomplete Brown-Sequard. So, Darek, there may be a quibble about what you are doing on your feet – walking is not the right word for it, but say, man, how about getting back that Johnson?

Second, kudos to Londoner David Nicholls, who helped fund the research through a foundation he set up after his son Dan was paralyzed in 2003. David says he’s raising millions more to take it further.
Third, let’s be kind and allow Geoffrey Raisman his big moment. He is the Brit scientist who more or less ring-led this experiment, and who has been quoted as saying it’s a bigger deal than putting men on the moon. “I believe this is the moment when paralysis can be reversed," said Raisman.
Fourth, after a few days to let the media saturation settle, this is what we know: Darek clearly got some motor and sensory recovery subsequent to a novel surgical procedure. Beyond that, it is not possible to draw conclusions. The science team suggests that the cell transplant, guided by nerve implants, allowed long-distance regeneration of motor nerves to occur. They don't know that for sure but are of course free to speculate. So are the rest of us.
From all indications, the experiment was carefully done. It is legit, meaning that it’s not from a backwater, no-name lab. Raisman is well-known in the SCI cure world, and had a taste of notoriety way back in the late 1960s when he provided the first electron microscope proof that the nervous system was “plastic,” that is, not hard wired. Raisman has studied olfactory ensheathing cells of the sort used in Darek’s spinal cord since the 80s. In 1997 he published a paper on animal research using olfacgtory ensheathing cells (OEC or sometimes OEG, for glia) almost exactly like what just happened in Poland. This, from the paper:
A suspension of ensheathing cells cultured from adult rat olfactory bulb was injected into the lesion site. This induced unbranched, elongative growth of the cut corticospinal axons. The axons grew through the transplant and continued to regenerate into the denervated caudal host tract.
The Poland based medical team is not an overnight sensation either. I reported last year that Raisman and this group treated a small group of patients with OEG cells. From the paper, Transplantation of Autologous Olfactory Ensheathing Cells in Complete Human Spinal Cord Injury:
The first two operated patients improved from ASIA A to ASIA C and ASIA B….The third operated patient, although remained ASIA A, showed improved motor and sensory function of the first spinal cord segments below the level of injury.
Hmm. Did we read that right? At least one went from ASIA A to C? I don’t recall the moonshot analogy then. In fact, that report was not recognized as a moment or a breakthrough. It got zero media traction.
The new paper is different in several major ways. First, it involves a knife wound; second, it allowed for surgical removal of spinal cord scar; and third, it utilized peripheral nerve grafts.
Knife injuries rarely cause spinal cord injury. When this does happen, most folks recover. I found an older bit of literature that reported that about two in three knife-related SCI have good recovery, good defined as being able to ambulate without a device or only with ankle-foot orthoses. In that regard, Darek wasn’t even good.
Removal of scar is interesting because what this does, indeed, is to make a chronic spinal cord injury acute again. You may wonder, how would it be possible to deal with the scar in the more common contusion or crush injury most people living with SCI have? Surgeons like surgery but opening the spinal cord and messing with scar tissue? Not going to happen.
Another confounding variable: Darek’s spinal cord was found to be stuck to its lining; this adhesion was removed. One could speculate that this too contributed to his recovery; untethering, as this is called, is not uncommon after SCI and can result in significant improvement.
The nerve grafts came from a 6 mm piece of sural nerve, harvested near Darek’s ankle. This piece was dissected and reformed in four 12 mm strips, which were then glued between the newly cut 10 mm edges of the spinal cord. These grafts, the Raisman paper suggests, became “guidance tubes” for the important long-fiber motor axons to grow through. (Raisman, I was pleased to see, paid tribute to the pioneers of the peripheral nerve tube growth concept – Albert Aguayo, from Montreal, and an adviser to the Reeve Foundation research program; and the woman who discovered OEG cells, Almudena Ramón-Cueto, from Spain.)
About 500,000 cells were injected in the area of the spinal cord lesion – 96 injections at 24 sites. These cells -- 16% OEGs --  came from Darek’s olfactory bulb; to get them involved major surgery; they had to open his skull and remove the bulb. Because they are self-renewing in the nose, OEG cells are good candidates to repair damaged nerves.
Another impossible to ignore aspect of Darek’s treatment involved rehab. He got five hours of aggressive physical therapy (e.g. locomotor training) five days a week for eight months post surgery. One might suggest that the training alone could have bumped up the chances of recovery.
I recommend reading the full published file about what happened with Darek. The medical report, including illustrations and charts, is available from the Journal Cell Transplantation. It’s science and therefore a little denser than the daily newspaper, but not hard to follow (download the full text).
If you want to review the 30-year history of OEG cells, check out my blogs from last year, and from last summer. This nose cell is indeed an interesting cell, and it deserves further study. Especially now that expectations have been heightened by Darek Fidyka.

Darek got better; something happened. That is good news for the field and I saw that many who follow cure research closely were able to frame it as an interesting paper that demands further consideration. This is not the experiment or procedure that will directly lead to any further reversal of paralysis – it does not signal the moment that SCI will be reversed -- not until someone suggests even the remotest clinical possibility that what Darek got can be applied to the rest of the SCI community, the 98 percent who do not have a nice neat knife wound injury.
This research in itself is good news. It got a little too much wind in its sails – especially from the British press. But what it is is a nice N of 1 study with a fairly nice result. The Polish team is looking to expand the study and prove this is no fluke. They’re looking for more volunteers. Knife wounds only, please.
Posted by Community Admin on Oct 24, 2014 8:25 PM America/New_York