New stem cell research – a cure for spinal cord injuries?

Posted on 5 December 2017

Sustaining a spinal cord injury means either partial or total loss of mobility and certain bodily functions. So far, rehabilitation has been restricted, but current research into stem cell therapy is promising. Our expert explains:

A spinal cord injury (SCI) is permanently life altering and it can have far reaching implications for patient, family, and even society as it reduces the person’s ability to work for a living and contribute to economic growth.

Between 250 000 and 500 000 people globally suffer a spinal cord injury every year. In South Africa, there is no extensive data. A recent study, however, estimates the incidence of traumatic spinal cord injury (TSCI) for the City of Cape Town’s population at 75.6 per million persons. [1]

Globally the majority of SCIs affect young people aged 16 to 30. But the average age of a spinal cord injury survivor is 42. Nearly 60% of spinal cord injury survivors were employed at the time of the injury. [4]

Research into the use of stem cells to regain sensory and motor function in spinal cord injury patients, however, has been promising. With a recent, groundbreaking report of patients having regained motor function of the upper limb, hand, and fingers.

A spinal cord injury is currently incurable and, depending on the level and location of injury, it either leads to immediate death, or partial to total paralysis of the limbs and other functions. This is due to the inflammatory response and cell death within the spinal cord that results in neurological compromise (e.g. anatomy, functions, and organic disorders of nerves and the nervous system). [2]

‘If the patient sustained a high spinal chord injury the prognosis is unfortunately worse,’ says Dr Maleho Maku, spinal orthopaedic surgeon at Mediclinic Muelmed. He adds, ‘You lose hand function, bowel and bladder function and mobility.’

Implications on the patient’s quality of life are therefore extensive.

In the case of loss of lower limbs only – or paraplegia, the prognosis is generally better because patients retain upper bodily mobility and are able to use a wheelchair.

In either case, Dr Maku says the costs of acute care and rehabilitation can be overwhelming, especially when the patient is providing financially for a family.

‘It has psychological effects as well; imagine you wake up one day, you’re going to work and the next day you’re in a wheelchair. It’s devastating to the person and their family,’ he adds.

Current treatments

A spinal cord injury is currently not curable. According to Dr Maku, there are two stages of injury: primary and secondary stage insult to the spinal cord.

‘The primary stage would be a fracture or a fracture dislocation during the unfortunate accident or incident. The spinal cord becomes contused, lacerated or stretched during the acute injury. Then the second insult would be the inflammation that accompanies the initial insult.’

In order to prevent the second insult, Dr Maku says they will try to reduce the dislocation, which involves:

• Reducing the fracture-dislocation of the spine,
• Resuscitation of the patient,
• Administering fluid, oxygen, anaesthesia, among other treatments;
• Placing the patient in a bed;
• Fusing (surgically stabilise a fracture) and/or decompression (to relieve or reduce the pressure or inflammation)

‘But remember, because these are traumatic cases, the patient often needs to be resuscitated and we need to make sure there are no other injuries to the head, chest, abdomen and long bones. If the injured person is fit to go to theatre, then we surgically remove the damaged vertebrae if required,’ he explains.

Spinal fusions are performed to help patients with later rehabilitation for wheelchair use and transfer.

Future hope of better treatments

The neurological damage caused by a spinal cord injury is due to cell death (inflammatory response) within the spinal cord. Stem cells (self-renewing human cells) have now been shown to limit inflammatory response and promote cell growth in patients during clinical trials.

Ideally, stem cell treatment (transplanting nerve cells to re-establish sensory connections) can:

• limit existing cell death,
• stimulate growth from existing cells, and
• replace injured cells.

The authors of a 2016 literature review evaluated findings on four different types of stem cells:

• Mesenchymal stem cells (MSCs) – commonly harvested from bone marrow
• Peripheral nervous system stem cells
• Embryonic stem cells (an ethically controversial area of research)
• Induced pluripotent stem cells (iPSCs), derived from adult skin cells

iPSCs were the newest stem cells being investigated out of the four and early animal studies indicated that these cells offer benefits similar to those of embryonic cells without the same ethical issues.