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  • #16
    Originally posted by sbdspray
    Dr. Young-

    Would you call me a fool if I thought there hasn't been great strides in SCI research progress ( more effective therapy options being studied ) in the past 5 years?
    Sherman, you know that I would never call you a fool. I agree with Chris Chappell that we have made significant progress. Let me innumerate the positive steps. I'm sure that I can come out with more if I took a little time to think about it more.
    1. Combination therapies. Five years ago, the concept of combination therapies was just a gleam in our eyes. Now, it has become clear that it must be one of the major objective of clinical trials. Five years ago, we hoped that the cell transplants alone would be sufficient and it is clear that they are not. Now, several laboratories have come out with clear evidence indicating the combination therapies are better than individual therapies.
    2. Growth factors. There was a great deal of confusion concerning growth factors. Five years ago, I think that most scientists were thinking in terms of BDNF and NT-3 as the main candidates for growth factor stimulation. Attention has shifted to GDNF and other growth factors.
    3. Nogo/CSPG. Five years ago, the effects of Nogo blockade was known and we really had only one option, i.e. using IN-1 to bind Nogo. Today, we not only have IN-1 going into clinical trial but we have several alternative approaches to blocking Nogo effects, including Nogo receptor blockade and use of Cethrin to block the second messenger systems for Nogo. Chondroitinase has been shown to stimulate regeneration.
    4. Cell transplants. Five years ago, we had only one cell transplant that had been tried in humans: mixed fetal cells (Russia and Gainesville). Today, we have clinical experience with activated macrophages, fetal olfactory ensheathing glia, nasal mucosa, pig fetal neural stem cells, bone marrow stem cells, and umbilical cord blood stem cells. We know now that none of the transplants alone are producing dramatic return in function although many people have had significant return of sensory function and modest return of 1-2 levels of motor function. We also know the cell transplantation into the spinal cord is safe. Despite hundreds (perhaps even thousands, if we include the Russian experience) of patients receiving a variety of cell transplants, we have had almost no reports of mortality, tumor formation, or significant loss of function from transplants (all feared complications). It also seems that none of the cell transplants are producing significant increases in severe and long-term neuropathic pain (another feared complication).
    5. Availability of cells. We are making some progress in having cells available for transplant. Five years ago, only fetal neural cells were available. Now in various places around the world, we have at fetal OEG cells, nasal mucosa, bone marrow autografts, umbilical cord blood stem cell heterografts, fetal neural stem cells, embryonic stem cells (even cloned embryonic stem cells), and others.
    6. Clinical trials. Five years ago, we had perhaps three or four clinical trials going on around the world. Today, we have dozens of trials going on overseas. We also have a clinical trial network in China that is poised to start trials. Congress is seriously considering funding clinical trials in the United States through the Christopher Reeve Paralysis Act. There are many clinicians who are doing cell transplants around the world and even some in the United States who have had experience transplanting cells.
    7. Funding. Five years ago, we had relatively little funding for clinical trials of therapies.
      1. Industry investment. In 2000, there was only Acorda (4-AP), Proneuron (activated macrophage), and Diacrin (fetal pig stem cells) funding spinal cord injury trials. Today, we have
        • Acorda (4-AP),
        • Proneuron (activated macrophages),
        • Novartis (Nogo antibodies),
        • Aventis (HP184),
        • Bioaxone (Cethrin),
        • Medtronics (alternating electrical current).
      2. Countries. In 2000, we had only one country doing significant spinal cord injury clinical trials for chronic spinal cord injury (Russia) and a few scattered efforts here in the United States with omentum transplant and fetal stem cell transplants. In 2005, we have the following countries:
        • Russia: Moscow (fetal neural cells) and Novosibirsk (fetal neural cells)
        • U.S.: Purdue (alternating current)
        • Canada: Toronto and some U.S. cities (Cethrin)
        • China: Beijing (fetal OEG cells), Kunming (fetal schwann cells), Zhengzhou (bone marrow stem cell autografts)
        • Portugal: Nasal mucosa autografts
        • Australia: Nasal OEG autografts
        • New Zealand: Nasal mucosa autografts
        • Korea: bone marrow stem cells, umbilical cord blood stem cells
        • Turkey: bone marrow stem cells
      3. Current Clinical Trials on subacute or chronic spinal cord injury
        • Activated macrophage transplants (Proneuron)
        • Bone marrow stem cell transplants (Turkey, Korea, China, Russia)
        • Umbilical cord blood stem cell transplans (Korea)
        • Cethrin (Bioaxone)
        • Nogo antibody (Novartis)
        • HP184 (Aventis)
        • Fetal OEG (Beijing, China)
        • Fetal Schwann cells (Kunming China)
        • Nasal mucosa transplants (Lisbon)


    Many clinical trials are being planned, including of course ChinaSCINet. In short, we are making progress. Spinal cord injury research is following what some people in Wall Street might call a "hockey stick" curve. In 2000, we were at the leading edge of the hockey stick near the bottom of the graph. We have moved out of the flat part of the hockey stick and have begun to move up the handle.

    Wise.
    Last edited by Wise Young; 08-26-2005, 01:58 AM.

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    • #17
      Dr. Y,

      Great write up.

      Incidentally, the hockey stick graph appears to have a complete transection at about the T-6 level.

      Comment


      • #18
        schmeky, I put the break in there to remind myself and others that it can break any time and that we should not be complacent. Wise.

        Comment


        • #19
          Dr Y,

          Please don't think I am being flippant. I am trying to hold on to what sense of humor I have left.

          With Best Regards,

          Schmeky

          Comment


          • #20
            Originally posted by Schmeky
            Dr Y,

            Please don't think I am being flippant. I am trying to hold on to what sense of humor I have left.

            With Best Regards,

            Schmeky
            Schmeky, I know and thanks for what you are and do. Wise.

            Comment


            • #21
              Desperation

              Wise

              People go to have experimental procedures out of desperation in the absence of any plausible options in 'mainstream' medicine.

              How long are we going to have to wait for real therapeutic options to be available in the 'West'?

              Comment


              • #22
                Originally posted by Christopher Paddon
                Wise

                People go to have experimental procedures out of desperation in the absence of any plausible options in 'mainstream' medicine.

                How long are we going to have to wait for real therapeutic options to be available in the 'West'?
                East, West, Middle earth, we will go for treatment wherever it is. The issue here is how RELIABLE this treatment is.

                Comment


                • #23
                  Dr. Young,
                  Your postings, as usual, are incredibly informative. Thank you.
                  Five years ago (give or take a few), we were told to "grin and bear it" - "the spinal cord obviously cannot be repaired." You've been out here in the real world trenches with us and words cannot express our gratitude for your efforts. Scientific Research is not Engineering and has no timeline.
                  Thank you,
                  Carl

                  Comment


                  • #24
                    Anything Happening in Canada???

                    Dr. Young

                    Is there anything of interest happening in Canada in regards to working towards a cure that you could direct me to. I would like to know what to put support behind (and pressure on), and have something to talk about that would raise people's awareness about what we are working towards. I feel out of the loop ~ not being able to write to congressmen/senators ~ and hope maybe I can make a difference here. I'm in the Toronto area.

                    Thanks for all the information you provide.


                    Shelley

                    Comment


                    • #25
                      Originally posted by shelley
                      Dr. Young

                      Is there anything of interest happening in Canada in regards to working towards a cure that you could direct me to. I would like to know what to put support behind (and pressure on), and have something to talk about that would raise people's awareness about what we are working towards. I feel out of the loop ~ not being able to write to congressmen/senators ~ and hope maybe I can make a difference here. I'm in the Toronto area.

                      Thanks for all the information you provide.


                      Shelley
                      There are several major efforts ongoing in Canada. The four places that I know are Toronto, Vancouver, Edmunton, and Halifax. There is a stem cell network that is very active. Finally, the Cethrin trial is going on and that is Canada's own.

                      Wise.

                      Comment


                      • #26
                        Thanks Dr. Young ~ I'll do some research here.

                        Shelley

                        Comment


                        • #27
                          Originally posted by carl
                          Dr. Young,
                          Your postings, as usual, are incredibly informative. Thank you.
                          Five years ago (give or take a few), we were told to "grin and bear it" - "the spinal cord obviously cannot be repaired." You've been out here in the real world trenches with us and words cannot express our gratitude for your efforts. Scientific Research is not Engineering and has no timeline.
                          Thank you,
                          Carl
                          Carl, thanks. There are times when I get frustrated because of the roller coaster ride and every once in a while, I have to look back at how far we have come. Despite all the obstacles, the minimal funding, and the politics, we have come a ways. Although we are not there yet, we have come a long ways. What is wonderful is the fact that the scientists are just as excited and the naysayers are not as vociferous as before. Wise.

                          Comment


                          • #28
                            Campaign for Cure

                            Originally posted by Christopher Paddon
                            Wise

                            People go to have experimental procedures out of desperation in the absence of any plausible options in 'mainstream' medicine.

                            How long are we going to have to wait for real therapeutic options to be available in the 'West'?
                            Chris, people should not be just "waiting" for therapies to come. They should be doing what they can to prepare for when the therapies come and, if they can, help in the campaign for cure. Waiting is boring. Learn about the therapies and, as you know, there is so much to learn. Talk to people about the therapies, write letters to the editors of your newspaper, keep them up on the news and the latest coming out. The more people we recruit to the campaign for cure, the faster the cure will come. Wise.

                            Comment


                            • #29
                              Waiting is boring

                              Yeah I've been waiting 22 years now and the estimates given in the various articles that come out is still ten years, the same as when I first had my injury.

                              I am getting worried that the likes of "Paradude" and "Bubo Hungary" might be right, there will be no cure in our life times and we will be disabled for the rest of our lives as our doctors told us at the time of the accident.

                              Some people are adjusted to the idea of being disabled forever but for me it would take a huge readjustment having convinced myself early on that a cure would forth coming.

                              Comment


                              • #30
                                At least they are a little bit interested now than ever

                                http://www.cerebricon.com/services_i...cordinjury.htm

                                At least companies are considering the SCI model in their array of disease models

                                Cerebricon Releases Model for Spinal Cord Injury
                                Thursday, June 30, 2005 15:20

                                Kuopio, Finland
                                June 21st, 2005

                                Cerebricon Ltd., a contract rersearch organization specializing in preclinical models of CNS disease, announces the release of a new model for the study of pharmaceutical candidates aimed at treating spinal cord injury.

                                The model, based on a T10 contusion, has both a basic histological end point package and a more comprehensive functional, behavioral and MRI battery if required.

                                The SCI model has been fully validated by Cerebrícon's scientists in Cerebricon's proprietal laboratories.

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