GETTING PEOPLE OUT OF WHEELCHAIRS

A historic development of immense potential benefit to mankind

The first patient

The novel procedure involves transplanting cells from the patient’s own nasal lining into an area of damage in the spinal cord.  Before operation the patient was paralysed, confined to a wheel chair, and without sensation from the waist down.  He is now able to walk independently and has resumed the activities of his former life, including sexual function. 

In his words, ‘I feel I have been born again.’

An international scientific collaboration.

This advance is based on a long standing collaboration between the team of Professor Geoffrey Raisman in London and Dr Paweł Tabakow in Poland.

Over decades Professor Raisman’s team in Oxford, the Medical Research Council and now the world famous Institute of Neurology, Queen Square, University College London have developed this novel procedure at the scientific level in the laboratory.

The Polish interdisciplinary team was assembled and headed by Dr Paweł Tabakow under Professor Włodzimierz Jarmundowicz at the Department of Neurosurgery at Wrocław Medical University.  They are the first in the world to develop the modifications needed to apply the procedure to a patient.

A one hour BBC Panorama programme entitled To Walk Again was broadcast on Tuesday, 21st. October 2014 on BBC One and is available on BBC iPlayer for 12 months.

To access click here : www.bbc.co.uk/programmes/b04mm8zl

Professor Raisman writes:

·        Years of research have step by step led to the development of a safe technique for transplanting cells into the spinal cord.

·        The first patient to receive cells isolated from his own olfactory bulb has shown amazing recovery.

·        I believe this is the first time that a patient has been able to regenerate severed long spinal nerve fibres across an injury and resume movement and feeling. 

·        I believe we have now opened the door to a treatment of spinal cord injury which will get patients out of wheel chairs. 

·        Our goal now is to develop this first procedure to a point where it can be rolled out as a worldwide general approach. 

·        I believe we stand on the threshold of a historic advance and that the continuation of our work will be of major benefit to mankind.

Explanation of the findings in the current patient

We believe that the recovery in this patient is due to reconnection of long spinal fibres tracts across the injury because:

1.     The laboratory scientific research showed that after spinal cord injuries structural and functional reconnection occurs when bulbar olfactory ensheathing cells (OECs) are transplanted in such a way as to provide a complete bridge across the injury.

2.     Dr Tabakow devised a new operation which combined transplanting a patient’s own OECs with the use of nerve strips to bridge a large gap between the stumps of a severed spinal cord.  This is the first time the conditions of the laboratory work have been fulfilled in a clinical operation.

3.     The combination of OECs and nerve strips was carried out on the left of the spinal injury.  The pattern of recovery was that muscle control reappeared first in the left leg and sensation in the right.  This matches the normal routes taken by spinal nerve fibres.  This pattern of recovery would be difficult to explain on other grounds than reconnection of severed fibres.

The findings are published in full in the journal Cell Transplantation:

www.ingentaconnect.com/content/cog/ct/pre-prints/content-CT-1239_Tabakow_et_al

Spinal Cord Injury

In patients where the injury has completely severed the spinal cord so that the two stumps are completely disconnected, reconnection by regeneration of severed fibres across the injury is the only way that recovery could occur.

In the majority of spinal cord injuries the cord is not completely severed.  In these cases a considerable degree of recovery occurs by re-organisation of connections in the surviving tissue (‘plasticity’).  A large proportion of patients spontaneously recover very significant function by this route.

There are a number current approaches (antibodies, enzymes, electrical stimulation, OECs, stem cells) designed to enhance this natural plasticity.  These can be expected to add major benefits in this large group of patients. 

However, once both spontaneous and therapeutic plasticity have achieved their full potential there will still be a significant proportion of patients left with major permanent disability.  In this group, the reconnection of severed fibres by transplantation of OECs and bridging materials currently holds the only hope of improvement.

Future plans

1.     The first priority is to confirm the findings in this single patient in several more individuals together with independent international monitoring of improvement.

2.     Prolonged improvement occurred under intensive post-operative rehabilitation.  To ensure maximum benefit, rehabilitation needs to be evaluated, optimised and continued.

3.     We anticipate ongoing research will identify better sources of cells and bridging materials.

PLEASE BE AWARE this is only one patient.  It requires confirmation.

Wider Horizons

Apart from walking, spinal injured patients may show return of sexual function, and improvements in bowel and bladder control, hand movements and breathing.  In the longer term the ability of transplanted OECs or other cells combined with bridging materials applies not only to injuries to the spinal cord but also injuries to the brain – strokes – and to the nerves of vision and hearing.

Glaucoma

In collaboration with Moorfields Eye Hospital, we have already shown, in a laboratory glaucoma model, that transplanted OECs can protect endangered nerve fibres and arrest the progression to blindness.  It is quite possible that this may come to application to patients within the time scale of our current spinal cord project.  Whichever comes first, the proof of clinical value of OECs in any one field will greatly strengthen and accelerate the use of OECs other fields.

All this progress depends on funds.  Donations should be directed to www.trustpa.org          

Geoff Raisman 2015