Wroclaw - The British television broadcaster BBC ONE is reporting this evening about man who has made surprising progress in rehabilitation after suffering from an almost complete paraplegia. In study in Cell Transplantation (Online), they are traced back to an operation in which new connection was created between the severed nerve fibers using transplant of cells from the olfactory bulb.
The 38-year-old man was in 2010 knife fight advised. The blade had severed the spinal cord at the level of Th9 to margin of two millimeters. Elsewhere, there was gap of up to 8 millimeters between the interfaces of the spinal cord. The man had lost all sensory and motor skills as result of the injury. The doctors diagnosed grade A paraplegia on the American Spinal Injury Association (ASIA) scale. Motor evoked potentials or electromyographic activity were no longer detectable in the lower extremity.
About 20 months ago the patient was operated twice at the Wroclaw University Hospital by team led by neurosurgeon Pawel Tabakow. During the first operation, the surgeons opened the anterior base of the skull in craniotomy to remove the left olfactory bulb (olfactory bulb). This was transported to the laboratory. There the so-called “olfactory ensheathing cells” (OEC) were isolated using enzymes, which, as Schwann cells, surround the fibers of the olfactory nerve. These cells were then expanded in culture together with fibroblasts.
Twelve days after the craniotomy, the patient was operated on second time. This time the neurosurgeons exposed the spinal cord at the level of Th9. After preparing the lesion, they filled the gap with suspension made from the cells that had grown in the laboratory. At the same time, they transplanted several strips of leg nerve (sural nerve) as guide rail for the cells.
The surgical procedure was devised by neurologist Geoff Raisman from University College in London. He, along with number of other researchers, attributes stem cell-like properties to the OEC. The OEC are held responsible for the extraordinary regenerative capacity of the olfactory nerve fibers, which - unlike most other cells of the central nervous system - can regenerate for the rest of their lives.
Raisman has been trying these abilities for the treatment of paraplegic injuries for decade to use. Animal studies were followed by first phase 1 study on three patients, which was published in Cell Transplantation (2013; 22: 1591-1612) last year. Now, together with Tabakow, Raisman reports on the results of patient in whom the therapy apparently achieved certain degree of success.
While the patient made no progress in intensive physiotherapy in the months before the operation, five months after the operation he showed the first signs of superficial sensitivity in the dermatome S4-S5, which continued to improve in the following months. He later reported for the first time pain in spot on his right hip where small pressure sore had formed. At about the same time, the first signs of motor recovery became apparent. According to the study, the patient was able to perform the first abduction and adduction movements of the hip and, from the 14th month, also move the knee slightly. The spasticity of the muscles has decreased. According to Tabakow and Raisman, these neurological advances had positive effect on the exercises during the rehab treatment.
Six months after the operation, the patient was able to stand on parallel bars on his own two feet and move about 10 meters forward. At first he needed the support of physiotherapist, later he made it on his own. He is now supposed to cover very short distances with rollator, although he needs the support of his therapist and his legs are held by orthoses. BBC ONE's Panorama program should show details. According to the study, the degree of paralysis was downgraded to grade ASIA C ("motor incomplete paralysis").
Despite the overall limited success in rehab treatment, the researchers could for the first time through (quasi) stem cell treatment succeeded in alleviating the extent of paraplegia, even if the latest MRI images cast doubt. The researchers carried out diffusion tensor imaging several times in the postoperative course, with which the course of nerve fibers can be visualized. While it initially appeared that new fibers had actually formed in the area of the severed spinal cord, the latest images could no longer confirm this.
Whether the treatment has any prospect of improving the rehab results must have been show further results. Tabakow and Raisman are not the only researchers active in this field. In July, Portuguese neurosurgeons reported similar operation on young American woman who was paraplegic after Th10 and Th11 spinal cord injury. After the operation, the patient developed an “intramedullary mass” in the spinal cord that had to be removed as precaution. The treatment was rated as failure.
By contrast, the Polish patient has not suffered any disadvantages so far.According to the study, the ability to smell the left side slowly recovered after the operation.