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Is There Really Hope For Chronics Soon?

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    Is There Really Hope For Chronics Soon?

    Dr. Young & Members,

    I am convinced there will be effective treatments for acutes in the near future, the evidence is clearly overwhelming. However, as I research and glean info from the CC Forum, a discrimnating pattern seems to emerge for chronics.

    Research funding is always in short supply for SCI and as you have eloquently pointed out in the past. The time and expense in performing chronic studies is precisely why they are rarely conducted.

    Board members frequently point out that acute research will/should eventually translate into success with chronics. I personally haven't seen any evidence of this yet.

    Dr. Young, is your lab currently doing any chronic research? The only organizations I am aware of that have publicly stated they are doing chronic research is the Miami Project and the Spinal Cord Society. Ironically, most of the recent human experiments (Lima, Huang, Brisbane, Novosibirsk, etc.) have been performed on chronics.

    I just fear dying in this chair, a thought that crosses my mind more frequently as I age [img]/forum/images/smilies/frown.gif[/img]

    It's kind of like marshmallows Schmeky. Theres always room for hope.......& mallows [img]/forum/images/smilies/smile.gif[/img]

    "Failure is impossible"
    "Failure is impossible"


      Schmeky, we are doing chronic studies. I would not assume that therapies applied early after injury cannot be applied to chronic spinal cord injury. Acute usually refers to neuroprotective therapies that are designed to prevent progressive injury rather than restore function through regeneration, remyelination, or replacement of neurons. Just because a study involved treating an animal within a week after injury does not mean that the therapy cannot be applied to chronic. It is just that studies of chronic animals are so difficult and time-consuming.

      A better divide between the therapies is neuroprotective versus restorative therapies. In my opinion, the latter far outnumber the former. In fact, I am despairing that there will be any therapy that will replace methylprednisolone soon. Although my laboratory was one of the first to show that high-dose methylprednisolone is effective in reducing tissue damage after spinal cord injury in 1979-1981, this was 25 years ago! In all this time, we have not yet discovered and shown in clinical trial a better therapy. This is not good.

      In the meantime, there are so many restorative therapies that it would take me an hour or more just to lecture about them. They include transplantation of all kinds of cells ranging from olfactory ensheathing glia, Schwann cells, neural stem cells, embryonic stem cells, neural progenitor cells, glial restricted progenitor cells, bone marrow, and even intestinal glia (a stem cell in the intestines). Many factors, drugs, and enzymes have now been reported to stimulate or enhance regeneration in the spinal cord, including chondroitinase, rolipram/dbcAMP, Nogo antibodies, Nogo receptor blockers, and even lithium.

      Several groups have now reported that combining cell transplantation with growth factors are producing the best regeneration of all. This research hit like a blockbuster about 10 months ago (as you may remember) and I know many laboratories that are working on combination therapies. I had expected some of them to be presenting their results at the Neurotrauma and Neuroscience meetings this year but I think that few were actually ready.

      Chronic spinal cord injury experiments take a lot longer and are harder to do than acute spinal cord injury experiments. In order to carry out such experiments, the laboratories have to put together an experienced and dedicated animal care team. Without a team that is capable of maintaining a large colony of spinal-injured rats for many months, the experiments fail. Months of work can go down the drain with the death of a few animals. Technicians who have experience taking care of chronic spinal cord injury are in great demand. Over the past two months, for example, half of our animal care team (two technicians) were recruited by pharmaceutical companies in the region. While this means that they are interested in spinal cord injury experiments, it was very difficult for us. We have had to stop the experiments, interview and train technicians, and rebuild the team again.

      Furthermore, such experiments require painstaking assessment of behavioral recovery in the rats, injecting tracers and microscopically examining thousands of slides to prove that regeneration has taken place. I estimate that it takes a good investigative team a minimum of one week of full-time work per rat to assess regeneration. Combined with the need for a good surgeon, a superb animal care team, these experiments frequently take 12-18 months to complete. Don't worry, the work is happening and I think that we will be seeing the results popping up in the coming months.