Concerted National Effort Needed To Develop New Therapies
Washington, D.C. – infoZine – Recent discoveries about the Central Nervous System’s capacity for Regeneration and repair could lead to important gains in restoring function and improving quality of life for individuals living with spinal cord injuries. A multifaceted approach to research on spinal cord injuries – one that pursues combinations of therapies and ways to treat injuries at different stages – is needed to speed progress toward a cure, says a new report from the Institute of Medicine of the National Academies. The National Institutes of Health should establish a Spinal Cord Injury Network to lead and organize future research efforts, said the committee that wrote the report.
“Exciting new discoveries in neuroscience are leading to great promise for translating basic neurobiological studies of regeneration of the spinal cord into actual patient treatment,” said Richard T. Johnson, committee chair and Distinguished Professor of Neurology, Microbiology, and Neuroscience, Johns Hopkins University School of Medicine, Baltimore. “Before World War II, most individuals who sustained a spinal cord injury died within a year of the injury, but the discovery of antibiotics and development of Rehabilitation medicine led to survival and greater assisted function. We now need to think about a new stage in recovery – actual improvement of the injured cord.”
The public’s perception of a “cure” generally means restoring the ability to walk again, but the committee called for a broader approach. Research should be directed not only at restoring major Motor functions such as walking, but also at healing the other body systems damaged by these injuries, such as sensory, bowel, bladder, and sexual functions. Also important is finding ways to prevent or alleviate complications such as pain, Spasticity, pressure sores, and Depression.
Research in recent years has shown that nerve cells and their axons – the threadlike fibers that conduct electrical impulses to other cells – can be regenerated, a finding that has created new possibilities for treating spinal cord injuries. The Institute of Medicine was asked by the New York Spinal Cord Injury Trust to assess the status of research on spinal cord injuries and to recommend priorities, as well as ways to accelerate progress.
Few therapeutic interventions are ready for clinical trials, the report says, but many show promise in cell cultures and animal studies. Transplanting cells that protect axons in other parts of the body may be able to stimulate, guide, and protect new axons in the spinal cord. Also, stem cells from embryonic and various adult tissues show strong potential for replacing damaged spinal cord cells. Much remains to be learned about how to induce stem cells become specific types of cells, as well as about about the safety and effectiveness of transplants.
Finding ways to regenerate nerves is only one part of restoring function, however. Another research priority is finding ways to steer axons’ growth so that they connect with and stimulate the right cells and tissues, the report says. If they connect in the wrong way, then pain and spasticity – rather than restoration of movement and other functions – can result.
More research also should be devoted to developing acute-care therapies that could be administered soon after an injury, the report adds. A cascade of inflammation, cell death, and scarring occurs in the hours and weeks after the trauma, and finding ways to block these processes may help minimize damage. The committee also urged further study of post-injury care and rehabilitation methods that can maximize patients’ recovery.
The NIH’s National Institute of Neurological Disorders and Stroke should develop a strategic plan to assess the potential for compounds and therapies to be used in combination, the report says. The goal should be to identify complementary treatments before and during their development, rather than simply relying on trial and error afterward. For example, therapies that promote the regrowth of axons could be developed alongside agents that produce Myelin, the substance that protects axons and speeds nerve impulses.
A coordinated, centralized network will be needed to implement this approach to combination therapies and to aid the translation of basic research into therapies, the report says. The National Institutes of Health should designate three to four current research programs as Spinal Cord Injury Research Centers of Excellence, and also establish two or three new centers. These centers would form the core of a larger research network, also supported by NIH, that should link all sites pursuing research on spinal cord injuries. Mechanisms are also needed to link federal, state, academic, and nonprofit efforts with those of industry, with the goal of increasing the investment of the private sector in the development of therapeutic interventions.
State-sponsored programs for research on spinal cord injuries also have an important role to play, said the committee. Many of them have established reliable funding and are in a key position to fund high-risk pilot studies. And because they manage regional trauma systems, states could help steer patients to clinical trials for acute spinal cord injuries.
The report was sponsored by the State of New York Department of Health. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.
infoZine Staff
