Stem cell implant is outside mainstream
SOUTH BEND — In his quest to help victims of spinal cord injury, Dr. Steven Hinderer admits he’s ventured outside the comfort zone of conventional wisdom and standard practice.
Hinderer, medical director of the Center for Spinal Cord Injury of the Rehabilitation Institute of Michigan, in Detroit, has developed an intense program of rehabilitation that goes far beyond the normal scope, both in the exertion it requires of patients and in its basic goals.
He is also working closely with a promising but unproved adult stem cell implant performed only at a hospital in Lisbon, Portugal.
The highly invasive surgery cannot be performed in the United States, not because of the federal ban on stem cell research funding, but because the Food and Drug Administration has not yet approved its safety.
Two young people with local ties, both of them athletes paralyzed by spinal cord injuries, have been evaluated by Hinderer’s program as candidates for the Lisbon stem cell procedure.
Sarah (Schools) Clay, 22, a former Mishawaka High School basketball star, is scheduled for the surgery next month. Her sister, Stephanie Schools, organized a softball tournament to raise funds for the operation, rehab and related expenses, estimated at $100,000.
Joey McTigue, also 22, a former Marian High School soccer player and now a junior at the University of Iowa, was scheduled for the surgery in June, but has decided not to have it this summer so he can graduate with his current classmates.
His father, Dr. Stephen McTigue, himself a surgeon, said Joey plans to go through Hinderer’s rigorous rehab program this summer and may decide to have the stem cell transplant in the summer of 2007.
“We have not closed the door on Lisbon,” McTigue said. “It’s still a viable option.”
At McTigue’s invitation, Hinderer came to South Bend last month to explain his program and to vigorously defend his reasons for going outside the conventional bounds of rehab medicine.
He spoke to physicians at Memorial Hospital and gave a public lecture at Indiana University School of Medicine, South Bend, as part of IU’s annual mini-med school series.
Hinderer said doctors have gotten much better in recent decades at saving the lives of people paralyzed by spinal cord injuries, so much so there are now 250,000 people paralyzed by the injuries living in the United States.
Likewise, Physical Therapy and assistive devices also have improved, greatly expanding the boundaries of what people with spinal cord injury can accomplish in their lives.
But what has not changed — and what Hinderer has set his sights on — is the cast-in-stone notion that the function of the spinal cord itself will not improve below the point of injury after one year. It’s considered impossible in all but 5 percent of cases.
As a consequence, conventional rehab is aimed at helping people make the most of the muscles and feelings that still work.
“We have to move the mark,” Hinderer said.
Hinderer described three experimental approaches that have shown promise, including:
-Implanting adult olfactory stem cells that are taken from the roof of the patient’s own nasal cavity.
The normal function of these stem cells is to replenish olfactory nerves, which give the sense of smell. (Olfactory nerves are the only nerves in the body that are rapidly replenished by stem cells the way that blood cells, for example, are, Hinderer said.)
Lisbon surgeon Dr. Carlos Lima’s procedure is to put them in the spinal cord in the hope they’ll replenish lost nerve fibers there.
The “aggressive” operation involves opening the patients’ spine, removing scar tissue from the injury site and inserting the cells.
Other important “helper cells” called glia are harvested along with the stem cells and implanted. These may also aid in recovery.
-Injections of immune cells called macrophages into the cord soon after injury to promote healing. Macrophages aid healing by removing dead cells and debris and by sending out signals that recruit other natural healing factors to the site.
In most spinal cord injuries, the cord is actually crushed rather than being severed, Hinderer said. The bruised area does not heal well, partly because macrophages are not as prevalent in the cord as in other parts of the body.
-Researchers at Indiana University School of Medicine, in Indianapolis, are experimenting with the use of magnetic fields to coax nerve fibers to grow across the damaged spot in the cord.
IU researchers have implanted electromagnetic devices in sea lampreys, rats and dogs and more recently in 10 people.
While Hinderer’s program evaluates candidates for the Lisbon procedure, he does not endorse it. No scientifically valid data has been reported to prove that it works, he said.
“I can’t advise people to do it or not to do it,” he said. “That’s what I told Joey and Steve (McTigue) when they were up there.”
He does, however, endorse the safety of the operation. Of the 80 people who have had the implant, two suffered infections and recovered after treatment. Additional precautions are now taken to prevent infections by pretreating patients for bacteria present in their nasal cavity.
Spinal cord injuries affect a relatively small number of people — about 11,000 new injuries annually in the United States.
But the vast majority are young, and the impact of their paralysis is huge in terms of lost productivity and reduced quality of life.
“This is an injury of the young, and most will live a full life span,” Hinderer said. “We need to find ways to help them recover.”
Staff writer David Rumbach: