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  • #91
    Do we know what injuries Chondroitinase can work on lets say elongated or on totally severed can it work on both scenarios?

    Comment


    • #92
      Not on totally severed. We need to bridge the lesion and get axons out the other side and to their targets for some measure of supraspinal control. This strategy has worked remarkable well when applied at acute stages for the respiratory (See Alilain et al Nature) locomotor (See Houle et al J Neuroscience ) and now urinary (Lee et al in preparation and see W2W 2011 video) systems. We still have a way to go for bridge building in chronic cord injury although there was one paper from the Houle lab showing some promise in a chronic model (not as robust as acute). Ch'ase has been shown to improve function via sprouting/plasticity consistently in models with incomplete lesions and especially where rehab is instituted.

      Comment


      • #93
        Originally posted by kate View Post
        Emphasis mine.

        The community should, imo, pay attention to this.
        What can we do, write to the company. Can Dr Silver give us some suggestions

        Comment


        • #94
          Dear Dr. Silver ,

          Hi , a question , how do you do the graft on CONTUSION chronic sci (assuming the cord is not broken and is narrowed due to the age of injury and athrophy ,etc ) ? do you actually make a cut in the cord intentionaly and then make a graft inside or do you make the graft from the side , etc , how does it work ? (sorry if i am ignorant about this and you explained this somewhere else before) . also , for now, and for the first time clnical trial with this , do you think the clinical trial should be with chondroitinase alone (saturating the injury site with chonddroitinase ,etc) , or the combination of chondroitinase and graft , or should be both (half of the subjects get chondroitinase and the other half chondrotinase plus graft ,etc )?
          Thank you so much for working so hard in this research .
          This is really great and remarable that a well respected scientice/ researcher like you suggests that , it is time to take this research (chondroitinase plus graft ,etc) to clinical trial right now . YOU have a great weekend.
          Last edited by kz; 10-22-2011, 12:21 PM.

          Comment


          • #95
            Originally posted by soimumireland View Post
            What can we do, write to the company. Can Dr Silver give us some suggestions
            stay tuned . . . it takes a bit of doing to plan an effective and organized response.

            Comment


            • #96
              Dr. J. Silver and W. Young. - Will clinical trials investigations’ as for cord blood mononuclear neuro throphine cells etc not be the best route in a clinical trial sci setting for chronics, and then why, why not so or, pls explain further Dr. Silver and Dr. Young. Thanks.
              Last edited by Leif; 10-22-2011, 07:49 PM.

              Comment


              • #97
                Dr.Silver and Dr.Young should collaborate and make pressure to Acorda to give them full access to Chase. If community must be united, why not the scientist that work in the field?

                -Ramps in buildings are necessary, but it would be usefull to have another ones for people (mind/heart).....

                -Hoc non pereo habebo fortior me

                Comment


                • #98
                  -Hoc non pereo habebo fortior me

                  I agree.


                  But sci in the West live as long as ab ppl., so whom gives a shit.

                  Last edited by Leif; 10-22-2011, 11:16 PM.

                  Comment


                  • #99
                    The Western SCI doctrine is, do not try to help, moving 3-world as for sci, and not you (hey), because if so you are a clown. And if you try to move sci in the West we are super clowns. How lazy.

                    Comment


                    • Ppl not in the boat, as for moving sci, - have never done it. Us the sci nead to fix things with proactive ppl. The rest (not focused) can go and hide. Bloddy hell, enough sci suffering.

                      Comment


                      • Most of the sci world is a joke. none cares at the end, only a few.

                        Comment


                        • Originally posted by kz View Post
                          Dear Dr. Silver ,

                          Hi , a question , how do you do the graft on CONTUSION chronic sci (assuming the cord is not broken and is narrowed due to the age of injury and athrophy ,etc ) ? do you actually make a cut in the cord intentionaly and then make a graft inside or do you make the graft from the side , etc , how does it work ? (sorry if i am ignorant about this and you explained this somewhere else before) . also , for now, and for the first time clnical trial with this , do you think the clinical trial should be with chondroitinase alone (saturating the injury site with chonddroitinase ,etc) , or the combination of chondroitinase and graft , or should be both (half of the subjects get chondroitinase and the other half chondrotinase plus graft ,etc )?
                          Thank you so much for working so hard in this research .
                          This is really great and remarable that a well respected scientice/ researcher like you suggests that , it is time to take this research (chondroitinase plus graft ,etc) to clinical trial right now . YOU have a great weekend.


                          Please see our Nature paper (July 14) for a description of the grafting procedure at acute stages. The procedure we use is a modification (with the addition of ch'ase) of that originally published by Cheng and Olson. At chronic stages, we still have a ways to go before we have all the ingredients needed for robust regeneration with good functional recovery. Basically, a very small slit is made in the dura just above the lesion and the autograft is inserted. Axons are allowed to regenerate toward the other end of the bridge which is then inserted into a small slit on the other side of the lesion. Ch'ase is added to both ends of the graft. This is the procedure we use in rodents but will need to be scaled up for use in human. (please see the description below of the work of Henrich Cheng who has done nerve grafting in humans). I'm planning on writing to him to learn if he plans to add the enzyme to his strategy. It is most likely that the first use of chondroitinase in the USA will be for people with some sparing below the level of the lesion coupled with a large amount of rehab. However, both acute and chronic injuries could be treated with just the enzyme.

                          Dr. Heinrich Cheng: In 1996, Dr. Cheng and colleagues (Stockholm, Sweden) published a widely cited article on functional regeneration in rat spinal cords after peripheral nerve implantation (Science 273, 1996). Building upon this work, he has since transplanted peripheral nerve segments and injected a mixture of growth factors into the injury site of many patients with both acute and chronic SCI. There is considerable interest in SCI in Taiwan because the country’s “first lady” sustained a SCI.

                          Recently, Cheng and colleagues (Tapei, Taiwan) reported a case study of a patient who sustained an injury from a stabbing four years previous to surgical intervention (Spine, 29(14), 2004). Stabbing represents a more unique transection injury compared to the contusion injury that most patients with SCI have sustained. Specifically, the lesion at the T11 level was bridged with sural nerve grafts that redirected specific pathways from white to gray matter. The grafted area was stabilized with fibrin glue containing fibroblast growth factor. Two-and-a-half years after surgery, the patient had improved from C to D on the commonly used ASIA assessment scale.

                          Over the 2000–2003 period, Cheng has treated 25 cases with the approach. Of these cases, 10 were cervical injuries of which seven improved in motor score and sensory scores. He has been authorized to carry out an additional 115 patients.

                          Comment


                          • Wouldn't it be interesting to add chondroitinase to the following strategy (see below).

                            J Neurosurg Spine 8:208–214, 2008
                            208 J. Neurosurg.: Spine / Volume 8 / March 2008
                            FTER traumatic cervical SCI, the immediate surrounding
                            areas below the injury site are afflicted by
                            an overwhelming loss of neurological function.
                            Necrosis and subsequent cell death often follow from the
                            primary mechanical injury. In the pathophysiology of SCI,
                            however, the primary mechanical damage that occurs triggers
                            a delayed secondary sequence of events, and multiple
                            neurological systems of the body are subsequently harmed.
                            The consequences of necrotic and apoptotic cell death triggered
                            by secondary adverse reactions may include vascular
                            abnormalities, ischemia–reperfusion injuries, oxidative cell
                            injury, homeostatic disturbances, or profound inflammatory
                            responses.1
                            As a consequence of both the primary injury and the secondary
                            adverse reactions, spinal cord degeneration ensues
                            and leads to loss of motor function and a very poor prognosis
                            for functional recovery. Various investigators, after
                            achieving successful results in their respective animal studies,
                            3–5 have advocated the adoption of a range of spinal cord
                            repair strategies for the recovery of human motor function
                            following SCI. The first of such repair strategies in humans
                            was reported by Cheng and colleagues6 in 2004, in which
                            sural nerve grafting was performed on a young man with
                            a penetrating injury using fibrin glue with acidic FGF. To
                            date, however, there has been no reported long-term study
                            series that investigated spinal cord repair in humans.
                            We therefore designed this prospective Phase I clinical
                            study to add to the body of research on nerve repair in patients
                            with SCI, using strategies that have so far been successful
                            in animal models. We chose the strategy of using
                            fibrin glue containing acidic FGF for nerve repair in 9
                            Nerve repair using acidic fibroblast growth factor in human
                            cervical spinal cord injury: a preliminary Phase I clinical
                            study
                            JAU-CHING WU, M.D.,1,2,5 WEN-CHENG HUANG, M.D.,1,2,5 YUN-AN TSAI, M.D.,2,3,5
                            YU-CHUN CHEN, M.D., M.SC.,2,4,5 AND HENRICH CHENG, M.D., PH.D.1,2,6
                            1Department of Neurosurgery and 2Neural Regeneration Laboratory, Neurological Institute, Taipei
                            Veterans General Hospital; Departments of 3Physical Medicine and Rehabilitation and 4Family
                            Medicine, Taipei Veterans General Hospital; and 5School of Medicine and 6Institute of Pharmacology,
                            National Yang-Ming University, Taipei, Taiwan
                            Object. The aim of this study was to assess functional outcomes of nerve repair using acidic fibroblast growth
                            factor (FGF) in patients with cervical spinal cord injury (SCI).
                            Methods. Nine patients who had cervical SCI for longer than 5 months were included in pre- and postoperative
                            assessments of their neurological function. The assessments included evaluating activities of daily living, associated
                            functional ability, and degree of spasticity, motor power, sensation, and pain perception. After the first set of
                            assessments, the authors repaired the injured segment of the spinal cord using a total laminectomy followed by the
                            application of fibrin glue containing acidic FGF. Clinical evaluations were conducted 1, 2, 3, 4, 5, and 6 months
                            after the surgery. Preoperative versus postoperative differences in injury severity and grading of key muscle power
                            and sensory points were calculated using the Wilcoxon signed-rank test.
                            Results. The preoperative degree of injury severity, as measured using the American Spinal Injury Association
                            (ASIA) scoring system, showed that preoperative motor (52.4 6 25.9 vs 68.6 6 21.5), pinprick (61.0 6 34.9 vs
                            71.6 6 31.0), and light touch scores (57.3 6 33.9 vs 71.9 6 30.2) were significantly lower than the respective postoperative
                            scores measured 6 months after surgery (p = 0.005, 0.012, and 0.008, respectively).
                            Conclusions. Based on the significant difference in ASIA motor and sensory scale scores between the preoperative
                            status and the 6-month postoperative follow-up, this novel nerve repair strategy of using acidic FGF may have
                            a role in the repair of human cervical SCI. Modest nerve regeneration occurred in all 9 patients after this procedure
                            without any observed adverse effects. This repair strategy thus deserves further investigation, clinical consideration,
                            and refinement. (DOI: 10.3171/SPI/2008/8/3/208)

                            Comment


                            • Dear professor Jerry Silver. If you have time (early November) go with dr. Wise Young to Hong Kong.

                              Comment


                              • Thanks U2FP,

                                I miss being there and miss u all. U Rock

                                Dr. Silver, thank you so much for coming to CC to visit with us.

                                Hi Leif, Your right we're trying to turn 30 years of mind set one advocate at a time.

                                It will take the big break through before the crowd pulls the head out of the sand.

                                Having more W2W symposiums are a must, maybe some mini events around the states and up north.

                                Just got to read whole thread, a great read. Hey wheres the photos
                                http://justadollarplease.org/

                                2010 SCINet Clinical Trial Support Squad Member

                                "You kids and your cures, why back when I was injured they gave us a wheelchair and that's the way it was and we liked it!" Grumpy Old Man

                                .."i used to be able to goof around so much because i knew Superman had my back. now all i've got is his example -- and that's gonna have to be enough."

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