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    Cellular therapies for SCI

    An interesting publication that I think it worth reading:

    "Demostrating efficacy in preclinical studies of cellular therapies for spinal cord injury - How much is enough?"

    from the first page under "Methods":

    "A focus group meeting supported by the Rick Hansen Institute and hosted by the lead authors (BK and WT) was held on the evening of october 18, 2012 during the society for neuroscienze annual meeting in New Orleans. Members of the SCI scientific and clinical community who were already attending the annual SFN meeting were invited to attend this side meeting..."

    At page 34 under "time window of intervention"

    "While there is much interest in developping treatments that would be applicable in the chronic injury state, in the majority of preclinical studies, the cells are transplanted at relatively early time points (most often between 1 and 2 weeks post injury)"


    In the "discussion" it was discussed again "Timing of intervention" at page 41:

    "There are important advantages of testing cells in clinical trials of chronic SCI. A more stable baseline neurologic status may be presents and the probability of further spontaneous neurologic recovery is more predictible, allowing an assessment of the cellular therapy in a smaller cohort of subjects"

    See the attachment.

    Paolo
    Last edited by paolocipolla; 16 Jun 2013, 7:00 PM.
    In God we trust; all others bring data. - Edwards Deming

    #2
    When you just look at those diagrams when they were asked to agree/disagree thats an indicator for me that shows how far away we are away of finding a cure...

    Comment


      #3
      Originally posted by KK11 View Post
      When you just look at those diagrams when they were asked to agree/disagree thats an indicator for me that shows how far away we are away of finding a cure...
      Yep, just that it doesn't look good at all.

      Then when hear they realize "there is much interest in developping treatments that would be applicable in the chronic injury state"

      and

      "There are important advantages of testing cells in clinical trials of chronic SCI"

      but then

      "in the majority of preclinical studies, the cells are transplanted at relatively early time points (most often between 1 and 2 weeks post injury)"

      now I wonder where is the candid camera?

      I wish it were a candid camera..

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

      Comment


        #4
        Originally posted by paolocipolla View Post
        now I wonder where is the candid camera?

        I wish it were a candid camera..

        Paolo
        Face piles of trials with smiles. It riles them to believe you percieve the web they weave.

        "The Moody Blues"

        Comment


          #5
          Originally posted by c473s View Post
          Face piles of trials with smiles. It riles them to believe you percieve the web they weave.

          "The Moody Blues"
          Song and dance won't make you prance. More need to learn and then we will earn the goal which some yearn.
          http://spinalcordresearchandadvocacy.wordpress.com/

          Comment


            #6
            I have added a question related to this thread to the Live Chat http://news.sciencemag.org/health/20...al-cord-injury

            I hope they will answer it.

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

            Comment


              #7
              I watched it and I would love to hear what Wise would say about the phrase Martin Schwab did : A cure is the total wrong term. To get all the functions back is simply unrealistic. Wise??

              Comment


                #8
                I think Martin Schwab should retire, he builded his career on the NOGO antibody that failed in trials. He has contributed a lot to the field but his failure has turned him into a negative presence in the field. I would give him a nice retirement $$$ if he gets out of the field. Same for Michael Fehlings.
                I would really thank them very much for all that they have done, but now we don't need their services anymore

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

                Comment


                  #9
                  I think that Martin Schwab is a great scientist. Michael Fehlings is an experienced clinician. I don't think that people should be discouraged by what they are saying. If you define cure as recovering all function, I would agree that it is unlikely in the near future. This does not mean that there will not be therapies that return substantial and useful function. To me that would be very welcome. I don't think that either of them would deny that this will happen. Wise.

                  Comment


                    #10
                    Paolo, there are a lot of people who say negative things about the cure, including you. I believe that both Martin Schwab and Michael Fehlings have been, are, and will be important contributors in the field. We not only should thank them for what they have done but encourage them to remain in the field. Nogo is and continues to be a very important contributor to the field. In fact, it is turning out that Nogo is an important molecule regulating plasticity in the central nervous system. Michael Fehlings is one of the few clinicians in North America that is doing meaningful clinical trials. His STASCIS trial, for example, is very important because it shows the importance of early decompression of the spinal cord. Wise.

                    Comment


                      #11
                      Wise,

                      Martin Shwab is responsable for scaring away Novartis (and as a consequece all big pharma) from sci research after the NOGO trial failed, just because he keeps focusing on acute trials that are economically unreasonable and it seems he didn't learn this lesson from the NOGO failure.
                      Michael Fehlings has been very critical about methylprednisolone, so I am surprised you support him.


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

                      Comment


                        #12
                        Wise,in which ways can you as a scientist ´´guide´´ those possible function recoverys. I mean if the safety question is answered do you simply put the cellular treatments in the cord and letting suprise yourself what the outcome is or do scientists target specific things before a treatment?
                        I mean with your knowledge you can of course predict which recovery can take place but Im interested in the things you guys do before applying the treatment?!
                        I hope you got me :-)

                        Comment


                          #13
                          Michael Fehlings has been very critical about methylprednisolone, so I am surprised you support him.
                          Actually, Canada doesn't use methylprednisolone in it's protocol for traumatic spinal cord injuries.
                          http://spinalcordresearchandadvocacy.wordpress.com/

                          Comment


                            #14
                            Paolo, you don't know what you are talking about. Martin Schwab was the person who convinced Novartis to do the trial on Nogo. In his STASCIS trial, Michael Fehlings and colleagues showed that the group of patients that did the best were those that received early decompression and methylprednisolone. Wise.

                            Comment


                              #15
                              Originally posted by KK11
                              Wise,in which ways can you as a scientist ´´guide´´ those possible function recoverys. I mean if the safety question is answered do you simply put the cellular treatments in the cord and letting suprise yourself what the outcome is or do scientists target specific things before a treatment?
                              I mean with your knowledge you can of course predict which recovery can take place but Im interested in the things you guys do before applying the treatment?!
                              I hope you got me :-)
                              KK11,

                              We decided to use umbilical cord blood mononuclear cells because it is a safe source of cells that have been reported by over a dozen independent groups to improve recovery of walking when transplanted into the spinal cord at a week or more after injury in rats and dogs. So, we went ahead to develop the way to isolate, purify, and ship the cells from HLA-matched umbilical cord blood, transplanted the cells into 8 patients in Hong Kong to show that it is safe, and then transplanted the cells into 20 patients in Kunming. The trial confirmed that the treatment is safe and showed that 75% of the patients recovered ability to walk at KLS IV and WISCI 8 levels, compared to 95% at KLS II or less and WISCI 2 or less before treatment. We were surprised to find that the patients were not able to move their legs voluntarily when lying down prone even though they can walk many hundreds of meters with minimal assistance using a rolling walker.

                              What is the most important preclinical data before a trial? The treatment should be safe and there should be some evidence of efficacy. Umbilical cord blood has been transplanted into many thousands of patients over the last 25 years. It is a very safe and sterile source of cells that can be HLA-matched so that they are not immune-rejected. Over a dozen independent laboratories have published studies of human and canine umbilical cord blood cells transplanted into the spinal cord with no reports of tumors or any other problems. All of them reported improved walking recovery in the animals. Most of the studies treated the animals at one week after spinal cord injury. At one week, the cells be acting by being neuroprotective, i.e. reducing damage. Several other groups have reported that umbilical cord blood cells do not cause astrogliosis or microgliosis when transplanted into the spinal cord. We believed that it was worthwhile trying transplanting these cells.

                              Wise.

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