Dear Pain Matters blog readers,
Here’s some positive news for patients with spinal cord injury! It was recently reported that stem cell treatment in a patient with spinal cord injury resulted in partial recovery.
While more studies are needed, a 3-minute video (see BBC News link) introduces Darek Fidyka, a 38-year old man who suffered paralysis from his chest down after being repeatedly stabbed in his back in 2010. The knife attack left Darek with a completely severed spinal cord, leaving him with a mere thin strip of scar tissue on the right side of his spinal cord, and unable to walk.
Pre-stem cell treatment, Darek was paralysed for almost 2 years after the knife attack, with virtually no hope for recovery despite intensive physiotherapy.
Post-stem cell therapy, and in collaboration with UK scientists, Polish surgeons removed 1 of Darek’s 2 olfactory bulbs (used in the sense of smell) from his upper nasal cavity to make a culture of olfactory ensheathing cells and olfactory nerve fibroblasts. After 2 weeks, the cells in this culture were directly transferred into his spinal cord (via 100 micro-injections, both above and below the injured site).
The olfactory bulb offers the greatest source of olfactory ensheathing cells. Importantly, these olfactory ensheathing cells provide a pathway for the continual regeneration of the olfactory nerve fibres throughout adult life.
Nerve tissue was removed from Darek’s ankle (4 thin strips) and grafted into an 8mm gap on the left side of his spinal cord (to ‘bridge the gap‘ between the top and bottom of his severed spinal cord).
The researchers hypothesized that the transplanted (and regenerative) olfactory ensheathing cells can help nerve fibres to reconnect. In other words, these olfactory ensheathing cells stimulated the spinal cord cells to regenerate/repair. The ankle nerve tissue was auto-grafted into the 8 mm gap of the spinal cord, like a ‘bridge’.
There was nil risk of rejection of the ankle nerve tissue, olfactory ensheathing cells, nor olfactory nerve fibroblasts (as they were his own), hence no need for immunosuppressive drugs.
Darek took his first assisted steps 6 months after stem cell therapy. Two years post-therapy, Darek is now able to walk with a walking frame. He has improved trunk stability, partial recovery of voluntary leg movements, partial recovery of sensation, as well as increased muscle mass in, and improved vascular function of, the left leg (consistent with left-sided stem cell treatment).
MRI scans confirmed that the 8mm gap in the spinal cord was closed, post-stem cell therapy.
While moderately successful, walking with a walking frame is (quoting Darek) “an incredible feeling. When you can’t feel almost half your body, you are helpless, but when it starts coming back it’s like you were born again.“
Quoting Dr Tabakow, consultant neurosurgeon, “It’s amazing to see how regeneration of the spinal cord, something that was thought impossible for many years, is becoming a reality.”
Prof Geoff Raisman stated that this is “more impressive than man walking on the moon“.
Follow-up studies are needed before any final conclusions can be made. It is hoped that 10 patients with comparable injuries can be similarly treated in the next year(s).
The patient, Darek Fidyka, offers a small glimmer of hope and inspiration to many patients with spinal cord injury including Daniel Nicholls. His father, David Nicholls, contributed generously to this ground-breaking research (via The Nicholls Spinal Injury Foundation), together with the UK Stem Cell Foundation.
Daniel Nicholls was only 18 on 30 December 2003 when he broke his neck and became paralysed from the neck down after diving into a wave and hitting a sandbank on Bondi Beach in Sydney, Australia (where I regularly swim and snorkel).
Many patients with spinal cord injury also suffer from nerve pain. It would be interesting to find out if targeted stem cell therapy for spinal cord injury could also lead to reduced nerve pain in these patients.
Until next week,
Sabina Walker, Blogger of Pain Matters blog
A journey of a thousand miles begins with a single step…..
(Lao-tzu, Chinese philosopher)
(1) Tabakow 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 (21 Oct 2014).
(2) Fergus Walsh. Paralysed man walks again after cell transplant.
BBC News Health (21 October 2014).
(3) Callaghan, Greg. Australian of the Year Alan Mackay-Sim on the advantage of being ‘an interested scientist’.
Sydney Morning Herald (Good Weekend) (8 April 2017): 18-21.