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Spinal Cord Injury Site "Scar Tissue"

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  • #76
    Originally posted by 6 Shooter View Post
    Dr. Young, when you have time, could you describe what a glial scar looks like in an injured spinal cord of a human. Is it a thin membrane? Clear, opaic, brown? Is it thick and hard like the scar on skin? Does it completely surround the spinal cord? Can it be cut/sliced and then unwrapped by a surgeon? Could the scar be weakened and thined out by using some sort of abrasive (thinking of something like sandpaper)?

    Maybe Jerry Silver could comment on these same questions in relationship to the mice/rats spinal cords that have been seen his lab. Jerry did mention that the glial scar does get smaller (thinner?) as the years go by for chronic SCI.

    Bless you both for your lifetimes of hard work and sacrifices to help SCI's eventually get out of these chairs and recover function.
    6 Shooter,

    Very few people have seen a "glial scar" in human. Richard Bunge probably looked at more chronically injured human spinal cords than any other scientist before he died. I remember looking at some of the spinal cords once when I visited him at the Miami Project. I remember seeing a lot of macrophages in a spinal cord of a woman who died more than 20 years after injury. He also showed me axons with bulbous terminals at the injury edge, suggesting that the axons are still trying to grow and are showing signs of what Jerry Silver has called "frustrated axons". There were glial cells around and within the lesion site.

    I have looked at many (hundreds) of contused rat spinal cords. In almost all of the spinal cords (6-14 weeks after contusion), gliosis (increased GFAP staining) around the injury site and a loose matrix of GFAP positive cells within the injury site. If a true cavity were present (usually lined with ependymal cells) at the injury site, there is usually a astrocytic lining at the borders of the cavity. However, these are relatively rare. We see them only in 20% or so of the spinal cords and there is almost always a rim of white matter around the cavity through which axons should be able to grow.

    In very severely injured human spinal cords, there may be little tissue left at the injury site. Usually, these spinal cords have been crushed and have not been decompressed for long periods. The injury site is severely atrophied and much scar tissue outside of the spinal cord constrict the cord. In these cases, if the "scar" constricting the spinal cord is removed, the spinal cord expands. Scar outside of the spinal cord may tether the cord. These are usually wispy and barely visible at surgery, easily removed by just sweeping the surface of the cord with an instrument or even cotton swab.

    I have seen the histology of the injury site from human spinal cords shown by Carlos Lima at a meeting Vancouver about a decade ago. He and his colleagues had cut out the injury site and did histology on the tissue that they removed. He showed pictures of tissue that had thousands of silver-stained axons in the sections. That really shocked me. I don't remember seeing any GFAP stained section and did not see anything that looks like a glial scar/barrier.

    In my opinion, there is simply not enough evidence from human spinal cords that would justify the surgical of "glial scar" inside the spinal cord. Yes, there is evidence of gliosis but many studies have already shown that gliosis alone does not present physical barrier to axon growth. More important, I am not sure that the surgery to remove the "glial scar" would actually result in formation of a true glial scar, i.e. meningeal fibroblasts invading into the cut site and astrocytes walling off these fibroblasts.

    The presence of terminal axonal bulbs at the injury edges, seen by Richard Bunge and colleagues at the Miami project, does suggest that CSPG is present and the axons are stopping their growth and forming the terminal bulbs. This justifies, for example, the use of chondroitinase or CSPG receptor blocker, to see such treatments would facilitate axon growth. But, I have not seen evidence of a physical glial scar that would warrant surgical removal of the injury site.

    There are some who says that since axons are not growing across the injury site, why not just remove the injury site and put something more conducive to axon growth at the injury site. While they usually use the excuse of "glial scar" to say that lesion site should be removed, what they really want is to show that their biomaterial is better than the injury site for supporting axon growth. Since the Kunming group showed that intradural decompression improves locomotor recovery in patients with subacute spinal cord injury, we have been thinking that the cavity left behind after removing necrotic tissue would be an excellent place to put biomaterial.

    I recently heard the presentation of a scientist who believes wants to put a biomaterial into the spinal cord. We have been evaluating different biomaterials that can be put into the cavity of subacute injured spinal cord. These include the self-assembling peptide (SAP), different hydrogels, and other materials that may contain growth factors. In the coming year, we are hoping to initiate a multicenter phase III trial to confirm that subdural decompression and intensive locomotor training restore locomotor function in patients with ASIA A complete spinal cord injuries. I am hoping that we can then initiate trials of various biomaterials placed into the cavity.

    Wise.

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    • #77
      Wise are u also testing these biomaterials in lumbosacral models?

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      • #78
        Originally posted by Jawaid View Post
        Wise are u also testing these biomaterials in lumbosacral models?
        No. Our goal is to replace motoneurons in the lumbosacral spinal cord. Wise.

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        • #79
          Jack, I moved your post to /forum/showthread.php?t=214227 for further discussion. Wise.

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          • #80
            Originally posted by Wise Young View Post
            Alan, I know. Neurosurgeons are conservative. I am not sure why but I think that very few of them have exposed a chronically injured spinal cord and, if they do, it must be for a good reason. Otherwise, if a patient gets worse after surgery, he will be blamed for doing an unnecessary surgery.

            Wise.
            Yes, that does happen.

            Of course, if Dr.Long's diagnosis of ongoing scar tissue growth between my two little, stable syrinxes is correct, untethering wouldn't collapse that, anyway. It appears that the word for me here is "screwed."
            Alan

            Proofread carefully to see if you any words out.

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            • #81
              I've found that orally consumed proteolytic enzymes, which digest proeins (presumably the chondroitin-6-sulfate glycoproteins, NOGO, etc), such as bromelain and papayin, to be of tremendous benefit in helping to recover sensation post-injury. I've never taken them for a long time due to side-effects (bowel problems in the form of liquification of feces preumably due to the digestive effects or possibly even allergies). If I keep taking these enzymes I suspect the results would lead to greater benefits, especially if combined with otherr protocols (such as oxygen therapy (in the form of dilute hydrogen peoxide solutions) and nicotine in addition to Alpha Lipoic Acid , etc. as I have recently explained elsewhere on this forum). Has anyone ever tried using these enzymes to cure spinal cord injuries?
              Last edited by Ryan B; 03-25-2013, 07:21 PM.

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              • #82
                Thanks for this; very interesting. Runny bowels are never nice, but for us they are a big deal. If treatment were to become part of SCI care units the problem would be more manageable.
                2010 SCINet Clinical Trial Support Squad Member
                Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature.

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                • #83
                  Thank you, Chris. I'm always willing to share my insights.

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                  • #84
                    Originally posted by Ryan B View Post
                    Thank you, Chris. I'm always willing to share my insights.
                    Please keep posting them.

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                    • #85
                      Another supplement I take which I forgot to mention, because it is not directly related...is potassium ioddide. I take this to combat urinary tract infections and also to combat digestive tract infections and food poisoning. At the moment I am using it to prevent an infection in a severe burn to my foot. I use a very low dosage 225 micrograms per tablet. Sometimes I take several tablets a day if one does not help. I try to avoid doing this frequently for a long period of time to avoid problems with taking too high a dosage. Hiigher dosage tablets in the mg range are available (such as 35 mg) and these are more effective against infections but definitely should not be taken frequently for a long period of time to avoid thyroid gland dysfunction. I also use highly dilute hydrogen peroxide which seems to be effective for most infections. Not all but most. What the peroxide doesn't kill, the potassium iodide usually will.

                      The problem I face is that while I can keep bladder infections from becoming extremely severe using these methods, I cannot keep them away completely. due to the fact that I use intermittent catheterisatiion to void the bladder. For some reason, keeping the bladder infections at bay seems to help with recovering function. I suspect this may be due to neuro-toxins being produced by the infecting bacteria affecting my nerves (some of these neurotoxins even cause paralysis!). An alkalizing diet in addition to alkalizing supplements also seem to aid tremendously in recovering function, possibly because it helps to battle bladder infections.

                      If anyone attempts to try these supplements, etcetera, I should warn you to AVOID using potassium iodide while taking carbonates/bicarbonates, or vice verse, because the potassium iodide (probably the potassium ions) seems to react in the body with the carbonate/bicarbonate and causes severe adverse reactions in addition to reversing any progress I have made in recovering function.
                      Last edited by Ryan B; 04-16-2013, 12:03 AM.

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                      • #86
                        Whatever it is growing in my spinal cord (the syrinxes aren't) is continuing to make things worse.
                        Alan

                        Proofread carefully to see if you any words out.

                        Comment


                        • #87
                          Originally posted by alan
                          Whatever it is growing in my spinal cord (the syrinxes aren't) is continuing to make things worse.
                          It might be inflammation.

                          Comment


                          • #88
                            Just a rant-I am sick of having symptoms that mimic an expanding syrinx without having an expanding syrinx. Whatever keeps growing in my cord, which is not a syrinx (the difference between my two little stable syrinxes and what keeps growing between them-which I was told scar tissue-is definitely visible when the neurosurgeon shows me on my MRI scans) is continually making things worse.
                            Alan

                            Proofread carefully to see if you any words out.

                            Comment


                            • #89
                              Originally posted by alan
                              Just a rant-I am sick of having symptoms that mimic an expanding syrinx without having an expanding syrinx. Whatever keeps growing in my cord, which is not a syrinx (the difference between my two little stable syrinxes and what keeps growing between them-which I was told scar tissue-is definitely visible when the neurosurgeon shows me on my MRI scans) is continually making things worse.
                              i'm going thru the same thing, loss of strength, loss of stamina, huge increase in pain but according to mri and my doc the syrinx is stable.
                              "I'm manic as hell-
                              But I'm goin' strong-
                              Left my meds on the sink again-
                              My head will be racing by lunchtime"

                              <----Scott Weiland---->

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                              • #90
                                Molecular Trick Diminishes Appearance of Scars, Stanford Study Finds

                                "Scars are normally formed when a type of skin cell called a fibroblast secretes a protein called collagen at the injury site"

                                http://blog.cirm.ca.gov/2015/04/22/m...d-study-finds/

                                Maybe Wise or another researcher can say if this discovery can be also useful to cure SCI.

                                Paolo
                                In God we trust; all others bring data. - Edwards Deming

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