Slow progress towards a cure

While research into a cure for a spinal cord injury has made leaps, there is still some ways to go. We take a closer look at where the research is now

The Wings for Life World Run took place on Sunday, 4 May. Racers from across the globe gathered to outrace the Catcher Car in support

This year, 310 719 racers from across the globe, including 1 838 wheelchair users and 8 000 people in South Africa, participated. A total of 8,6 million euros (R177 million) was raised for SCI research. All the funds will go to the Wings for Life Foundation.

Currently, the Foundation is supporting around 68 projects in various fields, such as neuroprotection, regeneration, neural construction and rehabilitation. Each area focusses on different part of the puzzle. The spinal cord is a highly complex system. Therefore, the cure won’t be a simple fix.

When injured, there is bleeding and inflammation in the spine. The cells in the spine die rapidly. As the death rate of the cells increase, the tissue around the injury also die. The body makes the injury worse! It seals or scars over the injury to leave behind a cyst. All of this creates tremendous damage that is hard to remove or fix.

While some research projects focus on rebuilding the cells, or preventing the swelling in the spine, others look to how the impact of the SCI can be minimised.

Several of the projects are showing great promise in advancing the level of care and improving recovering for people with SCIs. Some even seem close to finding a cure. We break down some of the projects:

Early and intensive training

Lisa Harvey and her team in Australia are investigating the impact of intensive training on people with a high-level SCI. Their early research found that repetition is very important for task-specific training following a neurological condition “particularly if trying to prompt an injured spinal cord to repair itself”.

Despite the need to practice, practice, practice if you want to regain mobility, they found that therapy is often not given in high dosages. Only half an hour to three hours, three times a week, were dedicated to therapy in the cases that they reviewed.

Another study that they reviewed found that patients with upper-level injuries only attempted to move their upper limbs, like arms and hands, 42 times a day during both physio- and occupational therapy. Once they left the rehabilitation centre, patients would only move their arms around 15 times.

“This same study indicated that people received a total of 1,5 hours of physiotherapy and occupational therapy a day but less than an hour of this time was devoted to moving the upper or lower limbs in any way,” the research says.

Through her research, Lisa aims to significantly increase the number of times a patient practices their movements. Specifically, she wants to aim for 12 hours of movement per week for 10 weeks with a focus on task-specific training.

Her study is currently in clinical phases. If she is successful in motivating more task-specific training, it could set a new gold standard for rehabilitation and offer new high-level injured patients much better recovery.

Spinal stimulation for movement

In more than half of SCIs, the individuals are left with some sensation or movement below the level of injury. Chet Moritz and his team in the United States (US) are looking at restoring movement through skin-surface stimulation of the neck above the cervical spinal cord.

Their research has already seen prolonged improvements in hand function, autonomic control (bladder and bowel function) and improved strength, function and sensation in the legs of their participants.

Now, they will test if stimulation at the neck and lower back can further improve walking and autonomic functions. They will combine a non-invasive spinal stimulation with intensive rehabilitation.

Scar prevention, cell transplant

Austrian neuroscientists Frank Edenhofer and Sébastien Couillard-Després are researching ways to restore nerve connections in the spine while reducing the scar formation.

First, they will repeatedly apply extracellular vesicles (EVs) to the lesion site. These special EV cells help fight inflammation and act as a communication system for other cells.

The EVs will be placed in the spine where the injury occurred as well as into the blood stream for seven days after the injury. The goal is to reduce the scar formation.

Thereafter, they will graft (transplant) induced neural stem cells (iNSCs) into the area of the injury. These cells are considered a safer stem cell for the spine and will hopefully help to restore communication between the brain and the body. Their research is still in its early stage and no human trials are possible.

Understanding the environment

Replanting stem cells is still a good option for repairing the spine. However, this is challenging as the area around the SCI isn’t very hospitable. The replanted cells die very quickly, which makes them less effective in helping to repair the area.

US-based Martin Oudega and his team are researching how much of an impact the hostile environment has on the transplanted cells. With more information on how the environment is impacting the cell repair, researchers can look for solutions to keep the cells alive longer.

Back on their feet

One of the projects funded by the Foundation saw incredible results in 2018. Neuroscientists Grégoire Courtine and Jocelyne Bloch managed to get the brain to talk to the limbs using stimulation movement overground (STIMO).

A small electrode chip is implanted at the spine. With epidural electrical stimulation, electric currents are sent to the chip. This is all voice controlled. There were three participants who were part of the study and were able to walk again.

Will there ever be a cure? Yes. But not for some time yet. While there have been tremendous strides, the spinal cord remains a highly complex system, and researchers still don’t know enough. Fortunately, events like the Wings for Life World Run are raising funds to continue the research so that we can find a cure.