Tuesday, October 21, 2014

This Tuesday In Science Land...The Spinal Cord Correction.


That big stem cell spinal cord regeneration story you've been hearing so much about in the public prints and the sound-bite landscape for the last couple of days?


BioSciBlogger extraordinaire PZ Myers does a very good analysis of the study. Here are a few chunks:

...The basic procedure is straightforward. There is a population of neural cells in humans that do actively and continuously regenerate: the cells of the olfactory bulb. So what they did is remove one of the patient’s own olfactory bulbs, dissociate it into a soup of isolated cells, and inject them into locations above and below the injury. They also bridged the gap with strips of nerve tissue harvested from the patient’s leg. The idea is that the proliferating cells and the nerves would provide a nerve growth-friendly environment and build substrate bridges that would stimulate the damaged cells and provide a path for regrowth...

...Now here’s the clinical assessment. Three patients were operated on; T1 is the one who has made all the news with the most remarkable improvement. There were also three control patients who showed no improvement over the same period.
Neurological function improved in all three transplant recipients (T1, T2, T3) during the first year postsurgery. This included a decrease of muscle spasticity (T1, T2) as well as improvement of sensory (T1, T2, T3) and motor function (T1, T2, T3) below the level of spinal cord injury.
A marked decrease of muscle spasticity of the lower extremities was observed in Patients T1 and T2 from the first day postsurgery and remained unchanged throughout the next 12 months. In Patient T1, the mean Ashworth score decreased from 1.25 to 0, and in Patient T2, from 3.25 to 1.12. Spasticity in lower limbs did not change essentially in Patient T3. Mean Ashworth score increased from 2.0 to 2.5. In contrast, there was no change of the Ashworth grade in patients from the control group after 12 months of rehabilitation.
The Ashworth scale measures the rigidity of the muscles — a zero is normal tonicity, while a high score of 4 means the limb is rigid and resistant. That two of the patients showed a marked decrease in score is good news.
In Patient T1, the first symptoms of recovery of sensation below level of injury were noted at 6 months post- surgery. The patient reported tingling in the dermatomes S4–S5. This impaired sensation turned to a sensation of light touch or pin prick by 8 months post-cell grafting. In the same period, the patient gained voluntary adduction of lower extremities (2 points in the Medical Research Council Scale, MRC), and at 12 months, a slight voluntary flexion of the right hip (MRC 1), indicating conversion of the ASIA grade from A to C.
Patient T2 showed also symptoms of recovery of sensation in dermatomes S4–S5 at 9 months postsurgery. We also noted an increase in the strength of abdominal muscles in this patient, but as this type of motor function is not included in the ASIA score, we classified him as ASIA B.
After an initial decrease of the sensation concerning mainly the sensory level and the zone of partial preservation on the right, noted in the first 3 months after surgery, Patient T3 recovered sensation at 4 months to the state before surgery. In addition, new areas of sensation covering the dermatomes from T9 to T11 on the right side were noted 12 months after cell transplantation, and a slight increase in the strength of abdominal muscles was observed in the period from 4 to 12 months. As this type of neurological improvement is not scored in the ASIA classification, this patient was assessed as ASIA A.
The ASIA scale is a measure of the loss of motor and sensory function. An A is bad; it means there is no sensory/motor ability below the lesion site. A B means some sensation is retained, but there is no motor activity. A C means you’ve also got partial recovery of some muscle activity. A D (none of the patients reached this level) means that more than half the muscles are responsive. An E is normal function.
So the end result is that one patient upgraded all the way to C, another made it to B, and the third patient showed no significant recovery, although there were hints of some restoration of activity.
I think there’s good reason to be optimistic and see some hope for an effective treatment for serious spinal cord injuries, but right now it has to be a realistic hope — progress has been made. A cure does not exist...

The link to the actual paper is here.

Upshot...This clinical research did not spring up in an operating room out of nowhere...The fundamental stem/olfactory ensheathing cell stuff was done in basic biology and biomedical labs funded by you and me.



Danneau said...

This is a somewhat different post, but fascinating and a post that raises issues of how things get done (or don't) in our current scientific-medical sphere of activity. It reminds me of the item I saw somewhere yesterday about how the license for the Ebola vaccine sent off to WHO in Switzerland should be transferred to a larger company. Is this typical of how our health system works? Are we so concerned with the issues of intellectual ownership that we can't work out a scheme to test and manufacture what might be a vital link in the protection of life? Those who tout the efficiency of market solutions ought perhaps to give their heads a collective shake before seeking to hold up something that is in the public interest pending their building a scaffold from which to plunder. Researchers should be paid handsomely and should be spared the eternal scramble for grants. If this were done through public funding, the results of the research would be part of the public weal and necessary production could be done by the private sector where they could demonstrate that they could produce at quality and price superior to what a public facility could. As I get older, I find that the areas of endeavour that should be left to unfettered market forces becomes more and more restricted, much of that feeling being based on the observation of the damages wreaked by the greed and narrow self-interest that characterizes so much of our private sector enterprise.

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scotty on denman said...

"...basic biology and biomedical labs funded by you and me." Me 'n' you, eh?...you know, I'm kind of proud of that. It's been a long time, since way back when choosing a lifetime career path was feasible, that I entertained the idea of saving money by doing my own brain-surgery. As it turned out, I saved a lot of money by not pursuing a medical degree---lucky choice, I guess, cuz nowadays you can find half of it on the net for free!

Seriously, though, funding basic research is tax money well spent, and I'm glad when we do it. I'm also happy to leave some things to the experts.