tag:theconversation.com,2011:/global/topics/spinal-injury-5824/articlesspinal injury – The Conversation2021-03-12T04:03:31Ztag:theconversation.com,2011:article/1569472021-03-12T04:03:31Z2021-03-12T04:03:31ZWhat’s a T7 vertebra and what happens when you injure it? 2 experts explain<p>Victorian Premier Daniel Andrews was injured on Tuesday after slipping and <a href="https://www.9news.com.au/national/daniel-andrews-in-trauma-centre-intensive-care-after-falling-on-stairs/71776d5f-e9a4-485e-add1-c5ec620b77e7">falling on wet stairs</a> at a holiday home on the Mornington Peninsula. </p>
<p>Reports indicate he broke some ribs and <a href="https://www.abc.net.au/news/2021-03-12/how-long-will-it-take-for-premier-daniel-andrews-to-recover/13237696">fractured his T7 vertebra</a>, and is now receiving treatment at the Alfred Hospital’s trauma centre in Melbourne.</p>
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<p>Let’s take a look at what an injury to the T7 vertebra actually means.</p>
<h2>The spine</h2>
<p>Injuries to the spine can be particularly debilitating because the spine acts as the central pillar on which we stand. </p>
<p>It also protects some of the vital structures in our bodies such as the nerves, blood vessels and spinal cord. These nerves transport impulses from our brains to the muscles, and feed information back to the brain from our limbs. So certain spinal injuries can potentially be very dangerous if they interfere with these functions.</p>
<p>Though we might not think of the spine as readily as we do heart disease or other conditions as reasons for illness, it represents a considerable burden of disease for the Australian health system.</p>
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<img alt="A diagram of the spine titles 'vertebral column'." src="https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1004&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1004&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1004&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1261&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1261&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389167/original/file-20210311-21-s9g3mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1261&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The spine is often describe as consisting of five main areas.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>About <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-are-back-problems">four million Australians</a>, or one in six, suffer from back problems. Many of these are related to the bones that make up the spine.</p>
<p>Each of the individual bones in this region are called “vertebra”. Your vertebral column (or spine) is composed of five main areas: the cervical spine (neck), the thoracic spine (where your ribs attach), the lumbar spine, and finally the sacrum and coccyx.</p>
<p>There are seven cervical vertebrae (C1-C7), 12 thoracic vertebrae (T1-T12), and five lumbar vertebrae (L1-L5). The area Andrews has injured, the <a href="https://www.theguardian.com/australia-news/2021/mar/10/daniel-andrews-may-require-back-surgery-after-fracturing-spine-in-fall-on-slippery-stairs">thoracic spine</a>, forms a semi-rigid cage due to its attachment to the ribs. These attachments mean this region of the spine is much stiffer and less flexible than the other areas.</p>
<p>The fracture seen in Andrews’ case appears to involve the <a href="https://7news.com.au/politics/daniel-andrews/no-immediate-surgery-plans-for-andrews-c-2328036">seventh thoracic vertebra</a> (T7), which is roughly halfway down the back. As this bone also has a pair of ribs attached, it is not a surprise his reported injuries also include broken ribs.</p>
<h2>Vertebral fractures and the road to recovery</h2>
<p>Fractures (breaks) of the bones in our spine become more likely as we age, and are more common in <a href="https://doi.org/10.1016/j.injury.2008.06.040">women</a> <a href="https://doi.org/10.1007/s001980050222">over 60</a>, whose bones may be weaker as a result of osteoporosis.</p>
<p>In younger patients, spinal fractures are much more likely to be the result of an accident. This is often a <a href="https://scia.org.au/sci-statistics/">car accident</a>, or a <a href="https://doi.org/10.1016/j.injury.2008.06.040">high-energy fall</a> such as falling down the stairs. In this group, <a href="https://journals.sagepub.com/doi/full/10.1055/s-0033-1337124">males</a> are significantly more likely to be injured.</p>
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<p>In general, a patient with a fractured T7 would experience pain when moving, and have difficulty standing for long periods. Patients with associated rib fractures may sometimes even have pain with breathing (particularly when taking big breaths).</p>
<p>If there’s no associated spinal cord injury or damage to the nerves in the area, a full recovery is likely, but this can take weeks or months. This process often involves rehabilitation with physiotherapists and other health-care providers.</p>
<p>We’re not familiar with the details of Andrews’ case. But his medical team has likely performed a series of scans and assessments to ascertain the full extent of any damage, and to decide on the most appropriate course of treatment.</p>
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<img alt="A man holds his back." src="https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=351&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=351&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=351&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=442&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=442&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389196/original/file-20210312-22-177zlc1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=442&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Recovery from a spinal injury can take time.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Falls are common</h2>
<p>On average, nearly <a href="https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-2007-08-to-2016-17/summary">220,000 Australians are hospitalised each year</a> due to falls (that’s more than 600 people a day).</p>
<p>Falls serious enough to take you to hospital are becoming <a href="https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-2007-08-to-2016-17/summary">more common</a> in Australia. National data suggest hospital presentations due to falls are increasing <a href="https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-2007-08-to-2016-17/summary">by nearly 2%</a> each year. In some specific groups, such as males over 65, the increase in the rate of falls is even higher (<a href="https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-due-to-falls/">3%</a>).</p>
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<p>In 2016-17, <a href="https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-2007-08-to-2016-17/summary">41% of hospital admissions</a> for injuries were a result of falls. Falls from, or on, stairs account for <a href="https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-2007-08-to-2016-17/summary">7% of these</a>.</p>
<p>Andrews has clearly suffered a <a href="https://twitter.com/DanielAndrewsMP/status/1369602624161419266/photo/1">serious injury</a>, which can be very painful. We wish him a speedy recovery.</p><img src="https://counter.theconversation.com/content/156947/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Victorian Premier Daniel Andrews this week suffered a fracture to his T7 vertebra. Here’s what that means.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityAllan Stirling, Associate Professor, Clinical Anatomy, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1068722018-11-16T16:20:14Z2018-11-16T16:20:14ZSpinal implant breakthroughs are helping people with paraplegia walk again<figure><img src="https://images.theconversation.com/files/245969/original/file-20181116-194488-f5xqxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Jamani Caillet/EPFL</span></span></figcaption></figure><p>Someone in the world suffers a spinal cord injury <a href="http://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury">every one to two minutes</a>, often leading to irreversible and life-changing loss of movement and feeling. But two research groups recently achieved something that had never been done before. By implanting electrical devices directly on the spinal cord, they reversed some of the effects of the spinal cord injury and allowed people to independently walk again.</p>
<p>So does this mark the end of the road in considering spinal cord injury as an incurable condition? Or is there still a long way to go before wheelchairs become a thing of the past?</p>
<p>Researchers have been trying to use electrical stimulation to reverse the effects of spinal cord injuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824029/">for more than two decades </a>. Artificially increasing electrical activity in the spinal cord helps to activate the nerves that transmit information between the limbs and the brain. While some nerves are permanently damaged by spinal cord injuries, some healthy nerves usually still exist even in the most severely damaged spines, and the electrical impulses give them a boost. In the past two months two studies have been published that significantly push the boundaries of what can be done with this technology.</p>
<p><a href="https://www.nature.com/articles/s41591-018-0175-7">In a study</a> directed by Kendal Lee and Kristin Zhao at the Mayo Clinic in the US, a patient with complete paralysis in their lower body managed to walk 100 metres with a walking frame thanks to a spinal implant. This kind of device, called an epidural electrical stimulator (EES), sends electrical signals to the healthy nerves at the bottom part of the spine (which must be intact in order for the technique to work).</p>
<p>The device uses a pulse generator implanted under the skin to send the appropriate signal to electrodes attached to the dura, the protective layer for the nerves in the spinal cord. The procedure is minimally intrusive and patients can return home on the same day. Living with the implanted stimulator is in many ways similar to living with a pacemaker device. </p>
<p>EES devices have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154251/">tested on patients with paralysis before</a>, but to overcome these sorts of complete spinal cord injuries represents a phenomenal outcome and a new milestone in restoring motion. </p>
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<p>But the study only showed how improvements could be made while the implanted device remained operational. This shortcoming has now been addressed by <a href="https://www.nature.com/articles/s41586-018-0649-2">another study</a> of three patients with partial spinal cord damage by researchers from EPFL in Switzerland. After five months of spinal stimulation, the patients found some of their feeling and movement was restored even when their implants were turned off. One of the patients showed enough improvement when not using the device to change their <a href="https://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf">injury classification</a> from “C” to “D”, representing the least severe injuries.</p>
<p>The device worked in real time, delivering precise stimulation to the relevant part of the spinal cord at the exact time it was needed, which made using it much more intuitive. The initial results also emerged within a couple of weeks, rather than the months of rehabilitation usually needed.</p>
<h2>Unprecedented breakthrough</h2>
<p>These studies have shown unprecedented results in treating spinal cord injuries. These breakthroughs are coming as a result of both technological advancements in implanted devices as well as an increasing understanding on how our brain communicates with and controls our body. </p>
<p>Having demonstrated the proof of principle for applying spinal stimulation on people with paraplegia, it is now time to push the boundaries of this technique outside the confines of the lab and into the real world. Researchers will need to conduct bigger clinical studies that observe a much larger number of patients from their initial injury and device implantation through to the end of the rehabilitation. We need to assess the full advantages of the treatment and create standards for doctors to follow before this treatment can become available to the wider population.</p>
<p>It’s still uncertain if people with the most severe spinal cord injuries will benefit from the improvements when the device is switched off. Particularly for those with injuries so severe that no nerves are preserved at all, it is likely that this approach will not work, as there is no remaining signal to boost. In those cases, other techniques that try to <a href="https://journals.sagepub.com/doi/full/10.3727/096368915X687796">bridge and repair injury</a> will be needed to offer improvements.</p>
<p>Yet while we might not have so far found a way to cure spinal cord injuries once and for all, the growing volume of results from independent research groups using a <a href="https://www.nature.com/articles/srep30383">variety of approaches</a> makes it seem certain we will reach that day soon.</p><img src="https://counter.theconversation.com/content/106872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ioannis Dimitrios Zoulias does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers have found a way to boost damaged spinal cord nerves – in some cases permanently.Ioannis Dimitrios Zoulias, Postdoctoral researcher in biomedical engineering, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1060552018-10-31T18:53:41Z2018-10-31T18:53:41ZHow new spinal injury treatments help some people to walk again<figure><img src="https://images.theconversation.com/files/243183/original/file-20181031-76402-19j6oaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A very precise kind of electrical stimulation has allowed three people with spinal cord injury to walk again. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/empty-modern-wheelchair-outdoors-1184009713?src=KJDymLpFtu_1GgmxSx74EA-1-69">from www.shutterstock.com </a></span></figcaption></figure><p>A spinal cord injury can change your life in the blink of an eye. </p>
<p>But today, research published in two leading scientific journals shows that walking again is possible for individuals following spinal cord injury. </p>
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<figcaption><span class="caption">David Mzee describes the ‘crazy’ feeling of walking again after 6 years.</span></figcaption>
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<h2>Targeted electrical stimulation</h2>
<p>Grégoire Courtine’s research group from the Swiss Federal Institute of Technology in Lausanne reported that a kind of treatment called <a href="https://www.nature.com/articles/s41593-018-0262-6">targeted neurotechnology</a> allowed three individuals who had suffered a spinal cord injury <a href="https://www.nature.com/articles/s41586-018-0649-2">to walk again</a>. The technique delivers timed electrical stimulation, called EES, over the surface of the spinal cord.</p>
<p>The EES was effective despite the injury having occurred more than four years previously, and even though the individuals showed either permanent motor deficits (loss of muscle function) or complete paralysis – even after extensive previous rehabilitation. </p>
<p>Improvements were seen immediately following EES: the people were able to voluntarily activate muscles to produce a desired movement – such as extension of the ankle – in the paralysed leg. </p>
<p>Optimising the EES for each individual allowed them to time their movements to EES sequences appropriately. Within five days, participants were able to walk overground and even adjust their leg movements and walking speed. </p>
<p>Perhaps most excitingly, after a few months of targeted EES, participants regained voluntary control over their previously paralysed muscles, even in the absence of EES. This allowed them to walk or even cycle outside of the laboratory. </p>
<h2>What is spinal cord injury?</h2>
<p>Damage to the spinal cord is typically caused by a traumatic event – such as motor vehicle accidents, sports related incidents or falls. Within Australia, <a href="https://www.aihw.gov.au/getmedia/247d6e98-bf2f-408d-adbf-43db0bb5a7cf/aihw-injcat-193.pdf.aspx?inline=true">250-350</a> new cases of spinal cord injury occur each year, with more than <a href="http://www.spinalnetwork.org.au/our-community/sci-facts">10,000</a> people currently living with a spinal cord injury. </p>
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<p>When an incident occurs, the vertebrae, or bones, that make up the spinal column may dislocate or fracture. This results in bone pushing on and compressing the delicate spinal cord, causing bleeding and bruising. </p>
<p>The damage results in loss of both motor (muscular) and sensory function below the level of injury. Injuries below the cervical (neck region) typically result in <a href="https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury">tetraplegia</a>, where all four limbs are affected. Injuries in the thoracic or lumbar region of the cord typically result in paraplegia, causing paralysis of the trunk, legs and lower part of the body. </p>
<p>It is uncommon to completely severe the spinal cord, with some small function often remaining below the level of injury in most individuals. </p>
<h2>Communication highway</h2>
<p>Our spinal cord serves as the communication highway between our brain and our body. </p>
<p>If a highway is damaged or closed, you can’t travel along it to reach your destination. Similarly, when the spinal cord is damaged, the signals and messages that are normally transmitted between our brain and our body can no longer reach their target destination. This results in loss of muscle control, loss of sensation, bowel and bladder problems and sexual dysfunction. </p>
<p>Walking and other voluntary movements are controlled by signals that travel from the front of the brain, down to other nerve cells in the spinal cord, and then nerves that travel from the spinal cord to the muscles involved. </p>
<p>What is so exciting about this new research is that it suggests several months of EES may be able to restart activity of these pathways. This is consistent with the group’s <a href="https://www.ted.com/talks/gregoire_courtine_the_paralyzed_rat_that_walked?language=en#t-550140">previous work</a>, but is the first time such an effect has been demonstrated in humans. </p>
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<h2>An exciting step</h2>
<p>This is an exciting step forward in a field of research where so many trialled treatments to improve function after spinal cord injury have failed. </p>
<p>Other attempts have been unsuccessful for a number of reasons. First, many of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840303/">models</a> used to explore spinal cord injury don’t accurately mimic the specific types of problems seen in individuals following spinal cord injury. This makes it difficult to translate findings from experimental work into meaningful advancements in the clinic. </p>
<p>Also, spinal cord injury itself is a real mixed bag – not all injuries are created equal. As a result, it’s difficult to find treatments that may be effective for all individuals.</p>
<p>Indeed, even in the study by Courtine’s group, only individuals with less complete injuries to the spinal cord were included. This may limit the applicability of the research to individuals with more severe types of injury. </p>
<p>The success of Courtine’s method also seems to be tied to the use of timed, rather than continuous, EES for the treatment – this allowed the people in the trial to retain a sense of where their legs were placed in space (a sense known as proprioception). <a href="https://www.ncbi.nlm.nih.gov/pubmed/30247091">Other trials</a> had not used this approach. </p>
<h2>What the future holds</h2>
<p>While these studies are an exciting advance, future studies in this area will need to overcome some limitations. </p>
<p>First, this method required the people involved to undergo an invasive and resource-intensive series of steps to implant the EES electrodes and determine the best stimulation approach. This may be prohibitive for others due to physical or financial constraints. </p>
<p>In addition, so far the therapy has only been trialled in a very small number of individuals who have experienced relatively mild, incomplete injuries of the spinal cord. This is not indicative of the severity of injury for many. </p>
<p>It is critical that future studies investigate whether EES may be effective even with more severe injuries, including complete injuries where only a few or no undamaged nerves remain.</p>
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<p>We still don’t know if this technology can lead to improvements in everyday activities. </p>
<p>And it’s important to remember that motor function is only one of a host of symptoms experienced by those with spinal cord injury. In a survey of individuals with paraplegia, <a href="https://www.ncbi.nlm.nih.gov/pubmed/15672628">they said</a> improvement of bladder and bowel control and restoration of sexual function was more important for their quality of life than being able to walk again. </p>
<p>So while those who have suffered a spinal cord injury have reason to feel cautiously optimistic, there is still much work to be done in this area.</p><img src="https://counter.theconversation.com/content/106055/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lyndsey Collins-Praino receives funding from the NeuroSurgical Research Foundation and the Brain Foundation. </span></em></p><p class="fine-print"><em><span>Anna Leonard receives funding from the Neurosurgical Research Foundation, Brain Foundation, Conquer Paralysis Now and Depuy Synthes. </span></em></p>Research published today shows that walking again is possible for individuals with spinal cord injury. After electrical stimulation, three people with lower leg paralysis could walk to some extent.Lyndsey Collins-Praino, Senior Lecturer in School of Medicine, University of AdelaideAnna Leonard, Lecturer and Medical Researcher, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/724932017-02-07T02:08:36Z2017-02-07T02:08:36ZYes there’s hope, but treating spinal injuries with stem cells is not a reality yet<figure><img src="https://images.theconversation.com/files/155776/original/image-20170206-27176-1fksxua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientists hope that stem cells may be able to repair nerves and other cells that support transmission of electrical impulses in the spinal cord. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/binomialphoto/14498062329/in/photolist-o69mPT-nPzcgB-q2ScCx-HabFjj-nx69Av-okB9cC-pdnUNF-8fa2iw-onBsBN-o69WK8-Dw1FJr-52QWhj-gsCU4-29e3Ja-o6aPKn-sqwpb-6CatjE-48zVLm-onBL91-4XJsbd-aXVcLz-7UL65F-o69rTv-FPUved-bKcNCD-cnviq5-bJaZHF-bJb1f4-bJb47P-bJb3s8-bJbcXB-o69VBA-onrfrC-onqQYf-o6auvv-o6aSKR-o69JGQ-FRfE1-6ii6d2-onBotN-59uFJP-o6aCtp-o69wdy-ae72m-bRiR4Z-o6asyz-o69o6b-o69tQs-bJb3MP-bvgezU">binomialphoto/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The <a href="http://www.australianoftheyear.org.au/honour-roll/?view=landing&year=2017">2017 Australian of the Year</a> award went to Professor Alan Mackay-Sim for his significant career in stem cell science. </p>
<p>The prize was linked to barbeque-stopping headlines equating his achievements to the scientific equivalent of “<a href="http://www.smh.com.au/federal-politics/political-news/alan-mackaysim-the-scientist-whose-miracle-made-a-paraplegic-walk-again-named-australian-of-the-year-20170125-gtyiq7.html">the moon landing</a>” and “<a href="http://www.3aw.com.au/news/alan-mackaysim-named-australian-of-the-year-20170125-gtyt48.html">paving the road to recovery</a>” for people with spinal cord injuries. </p>
<p>Such claims in the media imply that there is now a scientifically proven stem cell treatment for spinal cord injury. This is not the case. </p>
<p>For now, any clinic or headline claiming miracle cures should be viewed with caution, as they are likely to be trading on <a href="https://theconversation.com/the-future-of-stem-cells-tackling-hype-versus-hope-72052">people’s hope</a>.</p>
<h2>Why stem cells for spinal cord injury?</h2>
<p>Put simply, injury to the spinal cord causes damage to the nerve cells that transmit information between the brain and the rest of the body. </p>
<p>Depending on which part of the spine is involved, the injury can affect the nerves that control the muscles in our legs and arms; those that control bowel and bladder function and how we regulate body temperature and blood pressure; and those that carry the sensation of being touched. This occurs in part because injury and subsequent scarring affect not just the nerves but also the insulation that surrounds and protects them. The insulation – the myelin sheath – is damaged and the body cannot usually completely replace or regenerate this covering.</p>
<p>Stem cells can self-reproduce and grow into hundreds of different cell types, including nerves and the cells that make myelin. So the blue-sky vision is that stem cells could restore some nerve function by replacing missing or faulty cells, or prevent further damage caused by scarring.</p>
<p>Studies in animals have applied stem cells derived from sources including brain tissue, the lining of the nasal cavity, tooth pulp, and embryos (known as embryonic stem cells).</p>
<p>Dramatic improvements have been shown on some occasions, such as <a href="http://www.sciencedirect.com/science/article/pii/S0092867412010185">rats</a> and <a href="http://www.sciencedirect.com/science/article/pii/S1934590916302673">mice</a> regaining bladder control or the ability to walk after injury. While striking, such improvement often represents only a partial recovery. It holds significant promise, but is not direct evidence that such an approach will work in people, particularly those with more complex injuries.</p>
<h2>What is happening now in clinical trials?</h2>
<p>The translation of findings from basic laboratory stem cell research to effective and safe treatments in the clinic involves many steps and challenges. It needs a firm scientific basis from animal studies and then careful evaluation in humans.</p>
<p>Many <a href="https://clinicaltrials.gov/ct2/results?term=stem+cells+AND+spinal+cord+injury&Search=Search">clinical studies</a> examining stem cells for spinal repair are currently underway. The approaches fit broadly into two categories: </p>
<ol>
<li><p>using stem cells as a source of cells to replace those damaged as a result of injury</p></li>
<li><p>applying cells to act on the body’s own cells to accelerate repair or prevent further damage.</p></li>
</ol>
<p>One study that has attracted significant interest involves the injection of myelin-producing cells made from human embryonic stem cells. Researchers hoped that these cells, once injected into the spinal cord, would mature and form a new coating on the nerve cells, restoring the ability of signals to cross the spinal cord injury site. <a href="http://asteriasbiotherapeutics.com/inv_news_listings.php?listing=1392&#asteriasNews">Preliminary results</a> seem to show that the cells are safe; studies are ongoing.</p>
<p>Other clinical trials use cells from patients’ own bone marrow or adipose tissue (fat), or from donated cord blood or nerves from fetal tissue. The scientific rationale is based on the possibility that when transplanted into the injured spinal cord, these cells may provide surrounding tissue with protective factors which help to re-establish some of the connections important for the network of nerves that carry information around the body.</p>
<p>The field as it stands combines <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484454/#B71">years of research</a>, and tens of millions of dollars of investment. However, the development of stem cell therapies for spinal cord injury remains <a href="https://www.christopherreeve.org/research/reeve-stem-cell-research/stem-cell-caution">a long way</a> from translating laboratory promise into proven and effective bedside treatments.</p>
<h2>The promise and uncertainty of ‘breakthroughs’</h2>
<p>Each case is unique in people with spinal cord injury: the level of paralysis, and loss of sensation and function relate to the type of injury and its location. Injuries as a result of stab wounds or infection may result in different outcomes from those incurred as a result of trauma from a car accident or serious fall. The previous health of those injured, the care received at the time of injury, and the type of rehabilitation they access can <a href="https://www.ncbi.nlm.nih.gov/pubmed/25118259">all impact</a> on subsequent health and mobility. </p>
<p>Such variability means caution needs to accompany claims of “man walking again” – particularly when reports relate to a single individual.</p>
<p>In the case that was linked to the Australian of the Year award, the actual 2013 <a href="http://www.ingentaconnect.com/search/article?option2=author&value2=Raisman&operator3=AND&option3=journalbooktitle&value3=Cell+Transplantation&freetype=unlimited&sortDescending=true&sortField=default&pageSize=10&index=1">study</a> focused on whether it was safe to take the patient’s own nerves and other cells from the nose and place these into the damaged region of the spine. While the researchers themselves recommended caution in interpreting the results, accompanying media reports focused on the outcome from just one of the six participants.</p>
<p>While the outcome was significant for the <a href="http://www.bbc.com/news/health-29645760">gentleman involved</a>, we simply do not know whether recovery may have occurred for this individual even without stem cells, given the type of injury (stab wounds), the level of injury, the accompanying rehabilitation that he received or a combination of these factors. It cannot be assumed a similar outcome would be the case for all people with spinal injury.</p>
<h2>We are not there yet – but there is hope</h2>
<p>Finding a way to alleviate the suffering of those with spinal cord injury, and many other conditions, drives the work of thousands of researchers and doctors around the globe. But stem cells are not a “silver bullet” and should not be immune from careful evaluation in clinical trials. </p>
<p>Failure to proceed with caution could actually cause <a href="https://theconversation.com/buyer-beware-the-hidden-cost-of-stem-cell-tourism-5613">harm</a>. For example, a paraplegic woman who was also <a href="https://www.newscientist.com/article/dn25859-stem-cell-treatment-causes-nasal-growth-in-womans-back/">treated</a> with nasal stem cells showed no clinical improvement, and developed a large mucus-secreting tumour in her spine. This case highlights the need for further refinement and assessment in properly conducted clinical trials before nasal stem cells can become part of mainstream medicine.</p>
<p>It’s also worth noting that for spinal cord injury, <a href="https://docs.google.com/spreadsheets/d/11ZF4Ce_ICmI3AoQlzqvrgNRIhDfc9bl8JUlnwU6CP5Y/edit#gid=838467122">trials for recovery of function</a> are not limited to the use of stem cells but include approaches focused on promoting health of surviving nerves (<a href="https://www.ncbi.nlm.nih.gov/pubmed/19597522">neuroprotection</a>), surgery following injury, nerve transfers, electrical stimulation, external physical supports known as <a href="https://clinicaltrials.gov/ct2/show/NCT02202538?term=spinal+cord+injuries&rank=273">exoskeletons</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20025468">nanotechnology</a> and <a href="https://clinicaltrials.gov/ct2/show/NCT01964261?term=spinal+cord+injuries&rank=489">brain-machine interfaces</a>. </p>
<p>Ultimately, determining which of these approaches will improve the lives of people with spinal injury can only be done through rigorous, ethical research.</p><img src="https://counter.theconversation.com/content/72493/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan Munsie receives funding from the Australian Research Council. She is affiliated with the International Society for Stem Cell Research, Australasian Society for Stem Cell Research and International Society for Cellular Therapy. </span></em></p><p class="fine-print"><em><span>Andrew Nunn and Claire Tanner do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Claims that stem cell treatments can repair spinal injuries right now are overblown. But it’s not for lack of trying, and the science is certainly progressing.Megan Munsie, Head of Education, Ethics, Law & Community Awareness Unit, Stem Cells Australia, The University of MelbourneAndrew Nunn, Adjunct Research Associate , Monash UniversityClaire Tanner, Postdoctoral research fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/571162016-04-04T20:08:45Z2016-04-04T20:08:45ZRegenerating body parts: how we can transform fat cells into stem cells to repair spinal disc injuries<figure><img src="https://images.theconversation.com/files/117240/original/image-20160404-18648-lw7d5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Injecting stem cells to repair damaged tissue isn't a new concept, but this method appears safer than others. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-394470439/stock-photo-young-girl-with-back-pain-close-up.html?src=1PMDrXUik5Ojl67b6oJDZQ-7-22">Africa Studio/Shutterstock</a></span></figcaption></figure><p>We often hear about the next big thing in stem cell therapy, though few of these promises eventuate or are backed up by evidence. </p>
<p>Well, we think we’re close to a genuine breakthrough in stem cell therapy, based on new research published today in <a href="http://www.pnas.org/">Proceedings of the National Academy of Sciences</a>.</p>
<p>We have developed a stem cell technique capable of regenerating any human tissue damaged by injury, disease or ageing. </p>
<p>The new technique, which reprograms bone and fat cells into <a href="http://www.itek.com.au/portfolio/health/item/small-molecule-induced-neural-stem-cells.html">induced multipotent stem cells</a> (iMS), has successfully repaired bones and muscles in mice. Human trials are set to begin next year.</p>
<h2>How the technique works</h2>
<p>Injecting stem cells to repair damaged tissue is not a new concept. Every time someone receives a bone marrow transplant, they have in fact received blood stem cells to rescue their blood production. </p>
<p>But bone marrow is easy to extract and blood is constantly replaced. Therefore, blood stem cells are relatively easy to source. </p>
<p>This is not the case if you need stem cells to repair damage to muscles, cartilage or organs such as the heart and brain. These stem cells are not easy to extract and their turnover is low.</p>
<p>If stem cells are hard to extract, another option is to reprogram mature cells from other parts of the body that are relatively easy to extract. We have developed a method that converts fat or bone cells, which are relatively easy to extract, into induced multipotent stem cells. </p>
<p>This method involves culturing fat or bone cells with a drug called <a href="http://www.australianprescriber.com/magazine/33/3/89/95/drug/914/azacitidine">Azacitidine</a> and a naturally occurring growth factor called platelet-derived growth factor.</p>
<p>Azacitidine is used to treat blood disorders and has the ability to relax the hard-wired gene expression patterns that make a fat cell a fat cell or a bone cell a bone cell. </p>
<p>We think the combination of erasing the cell’s memory with Azacitidine and forcing the cell to proliferate with the growth factor are key to converting fat and bone cells into induced multipotent stem cells.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/117237/original/image-20160404-18622-1e4p281.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><span class="source">UNSW.</span></span>
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<h2>The quest for tissue regeneration</h2>
<p>The new technique is similar to the limb regeneration of the salamander, which can repair multiple tissue types, depending on which body part needs replacing.</p>
<p>In 2006, Japanese Nobel Prize-winning stem cell researcher Shinya Yamanaka identified a small number of genes that could reprogram skin cells from mice into immature stem cells, which could grow into all types of cells in the body. </p>
<p>However, these induced pluripotent stem (iPS) cells, like embryonic stem cells, which are derived from early embryos, are not suitable as a stem cell therapy because they can form tumours rather than repairing damaged tissue. </p>
<p>Since then, scientists have identified different combinations of genes that can reprogram skin or other cells into tissue-specific stem cells that only make cells of a single type of tissue. </p>
<p>A drawback with these reprogramming methods is the use of viral elements to force gene expression. Researchers use a virus as a mechanism to inject the gene into the cell. </p>
<p>Multipotent stem cells, in contrast, are produced without using any viral elements. They can regenerate damaged tissues without making unwanted tissues or tumours at the site of transplantation. </p>
<h2>What did we find?</h2>
<p>We have reprogrammed mouse bone cells into induced multipotent stem cells and injected these cells into mice with damaged bone and muscle. </p>
<p>We were astounded by the ability of these induced multipotent stem cells to regenerate these damaged tissues and also generate their own blood supply to carry nutrients to these developing tissues. </p>
<p>The transplanted cells appear to follow instructions from adjacent cells and divide and mature in an orderly fashion.</p>
<h2>Safety and efficacy</h2>
<p>We are still investigating the safety and regenerative potential of human-induced multipotent stem cells. </p>
<p>We have injected human-induced multipotent stem cells, made by reprogramming human fat cells, into our animal models of tissue injury. We are monitoring signals from these cells and know they are retained at the site of injection. </p>
<p>In a few months, we will retrieve tissues from these mice to measure the contribution from transplanted human-induced multipotent stem cells to tissue regeneration in mice.</p>
<p>We need evidence of robust tissue regeneration and the absence of any unwanted tissues or tumours at these sites before commencing human trials.</p>
<h2>Clinical applications</h2>
<p>The process of human induced multipotent stem cell production is free of animal products and is being developed to meet manufacturing standards appropriate for human cell transplantation. </p>
<p>Our initial clinical focus will be using induced multipotent stem cells either as a stand-alone treatment or with spinal implants to treat <a href="http://www.mayfieldclinic.com/PE-DDD.htm">degenerative disc disease</a> towards the end of 2017. </p>
<p>Low back and neck pain is frequently associated with degenerative disc disease and is a major cause of disability, affecting millions of people globally with crippling physical and economic costs.</p>
<p>Our aim is to use induced multipotent stem cells to regenerate discs to retain the flexibility of the native spine or to stabilise spinal implants by helping them fuse with adjacent bone.</p>
<h2>Next steps</h2>
<p>We need further research to understand how mouse- and human-induced multipotent stem cells respond to signals from damaged tissues. It will also be important know how long induced multipotent stem cells remain at sites of transplantation and retain their ability to proliferate and make new tissues. </p>
<p>Nevertheless, this efficient virus-free method of generating tissue regenerative stem cells brings us a step closer to realising stem cell therapy for repairing tissue injury in the human body.</p><img src="https://counter.theconversation.com/content/57116/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Pimanda is employed by UNSW Australia and the Prince of Wales Hospital and receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Vashe Chandrakanthan receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Ralph Mobbs does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We have developed a new stem cell technique capable of regenerating any human tissue damaged by injury, disease or ageing.John Pimanda, Associate Professor of Medicine and Stem Cell Biology, UNSW SydneyRalph Mobbs, Neurosurgeon at the Prince of Wales Hospital; Conjoint Lecturer, UNSW SydneyVashe Chandrakanthan, Researcher, regenerative medicine, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/448872015-08-13T05:36:57Z2015-08-13T05:36:57ZWhy human head transplants are still a long way from becoming a reality<figure><img src="https://images.theconversation.com/files/91479/original/image-20150811-11104-117v93n.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't think the surgery worked.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-272374298/stock-photo-sentosa-universal-studios-singapore-march-tourists-taking-group-photo-with.html?src=pp-same_artist-272374301-1&ws=1">Frankenstein by Shutterstock</a></span></figcaption></figure><p>Thanks to Frankenstein’s monster, Robocop, and the cyborg commandos of Ghost in the Shell, extreme portrayals of transplant surgery have captured our imagination over the years. The story of a patient’s <a href="http://www.telegraph.co.uk/news/health/news/11748087/Doctors-graft-hand-to-mans-leg-for-a-month-to-keep-it-alive.html">hand grafted on to a leg</a> in China after an industrial accident to preserve it before being restored to his arm is just the latest success story to gain worldwide attention. </p>
<p>So when Italian neurosurgeon Sergio Canavero first announced his intention to perform the <a href="http://www.theguardian.com/science/2015/jun/13/neurosurgeon-first-head-transplant-america-sergio-canavero">first ever human “head transplant”</a> by December 2017 – part of his “head anastomosis venture” or <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821155/">HEAVEN</a> project – science fiction seemed to inch a little closer to science fact. Canavero’s idea involves a 36-hour surgery during which the head of a patient suffering from a debilitating disease would be fused at the spinal cord to a brain dead donor with an otherwise healthy body. </p>
<p>Despite scientists and surgeons voicing some <a href="http://www.cbsnews.com/news/human-head-transplant-is-bad-science-says-neuroscientist/">serious doubts</a> that such a massive undertaking would be successful, Canavero is adamant that the technology now exists – by employing his novel <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322377/">GEMINI</a> protocol, he argues, the likelihood of success is around 90%. </p>
<p>But just how well do his claims stand to scientific scrutiny? Below are just three of the many important issues that haven’t been convincingly addressed.</p>
<h2>Fundamental principles</h2>
<p>First of all, let’s look at how the surgery would be performed. The head of the patient and spinal cord of the donor body would be cooled below 20°C. This would give the surgical teams less than an hour to simultaneously remove both heads at the neck, transfer the head of the patient to the donor body, and reconnect the spine and blood vessels before nervous system cells begin to decay. The spines would be held together and stabilised, and a specialised compound known as polyethylene glycol (PEG) would be used to connect the bundles running through the spinal cords. After all the blood vessels, neck muscles and connective tissue are sewn up, the patient would be placed in a chemically induced coma for three to four weeks to allow the connections to seal and recover.</p>
<p>One of the fundamental principles behind this procedure is that severed spinal cords possess the ability to reconnect, but that spinal injuries smash up the millions of connections beyond repair. Canavero argues that by slicing through the spine with an extremely sharp knife, the mostly intact fibres could reconnect with the help of the PEG glue and electrical stimulation. He illustrated this concept at a <a href="http://tedxtalks.ted.com/video/Head-Transplantation-The-Future">TEDx talk</a> this year, where he compared a banana squashed at the centre with one finely sliced with a sharp knife.</p>
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<p><a href="http://news.discovery.com/human/health/head-transplants-science-or-science-fiction-150609.htm">Serious flaws</a> in Canavero’s proposal include the failure of previous animal models or the implausibility of keeping the head alive during the procedure. Canavero, however, is not only convinced that the head could be connected, but that it could gain full control of the body. To understand whether his conviction is warranted, we should look at the neuroscience behind his arguments.</p>
<h2>Glial scars: the Gandalf between bridges</h2>
<p>Neurons in the brain sprout tails known as axons, which travel through the spinal cord to send and receive signals to and from the body. In a spinal cord injury, these axons are severed, preventing the signals from reaching their target. To some extent, Canavero is correct that the spine is equipped with the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25475091">tools to repair axons</a>, but these connections are actively blocked by the almost immediate formation of <a href="http://www.ncbi.nlm.nih.gov/pubmed/10483914">glial scars</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=309&fit=crop&dpr=1 600w, https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=309&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=309&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=388&fit=crop&dpr=1 754w, https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=388&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/91633/original/image-20150812-11849-sce4mp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=388&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">You shall not pass!</span>
<span class="attribution"><a class="source" href="http://philliecheesie.deviantart.com/art/Gandalf-vs-Balrog-327236615">PhillieCheesie</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Glial scars are clusters of immune cells that flock to the site of injury when the spinal cord is damaged. These scars patch up holes in the axons and protect against further injury, but they also release chemicals that stop the two ends from fusing. Canavero’s GEMINI protocol makes no mention of glial scars, which would likely prove to be a fatal hindrance to his procedure.</p>
<h2>Fixing a spine needs more than glue</h2>
<p>If we ignore the glial scar problem, the next question is whether using polyethylene glycol to fuse the spinal cords would actually work. PEG has indeed been shown to <a href="http://www.ncbi.nlm.nih.gov/pubmed/23893430">promote axon repair to some extent</a>, but most of these experiments were performed on cells isolated in a lab as opposed to in the body. Some promising results have, however, been shown in recent animal models. One group <a href="http://www.ncbi.nlm.nih.gov/pubmed/24713436">used PEG to treat rats</a> with fully severed spinal cords and found that some axons did reconnect. They also restored some movement, with some rats gaining minor control of their hind legs.</p>
<p>No doubt, these findings offer some important implications for treating spinal cord injuries, but when considering how this could be applied to a head transplant, the devil is in the detail. Only the physical control of the body of the rats was tested, which means that we’re still unsure as to whether they regained sensation in their lower bodies. The PEG treatment also offered only modest improvement in function and repair of cells in the spine. Most importantly, though, the rats’ spines were disconnected at the <a href="http://umm.edu/programs/spine/health/guides/anatomy-and-function">thoracic level</a> TH8/9. This is a region about half way down the spine, which is low enough to preserve the most important bodily functions.</p>
<p>In Canavero’s procedure, the spine would be cut at the cervical region where axons carry signals involved in functions that keep the body alive. Unsuccessful fusion of these axons would leave a patient paralysed and breathing with a machine. Canavero claims in his proposal that a research group in China has already successfully carried out a similar operation in mice. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25367718">This is partially true</a>, in that 18 out of 80 mice operated on survived for three hours after being taken off a ventilator. Importantly, there was also no spinal fusion with these mice and the brain stem of the donor bodies were kept intact. As the brainstem controls vital functions including breathing, the mouse heads were essentially stitched onto a paralysed incubator. </p>
<h2>Massive hurdles</h2>
<p>Although Canavero’s proposal is an exciting idea, the research simply doesn’t support his claim that we now have the technology to pull it off. However, significant advances are being made in the way treating spinal cord injuries through <a href="http://www.ncbi.nlm.nih.gov/pubmed/25788906">stem cell therapy</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/24168314">forming bridges</a> over glial scars. A more robust and stable development of this technology would be an important step in the spinal cord injury treatment and a possible first step towards realising Canavero’s vision.</p>
<p>We still have a long way to go, however, before we can start swapping our bodies. Even after we figure out how to fuse spines and restore connectivity, we still don’t know whether the brain can rewire itself to control a new body. We know from studies into <a href="http://www.ncbi.nlm.nih.gov/pubmed/22755418">hand transplants</a>, which are several magnitudes less complex, that function can be restored to some degree, but even this varies in success with our current technology. More worryingly, though, episodes of the immune system attacking the transplanted hand are extremely common. This could be a catastrophic event following a head transplant, as the donor body’s immune system could attack the head.</p>
<p>To convince neuroscientists that this procedure could work, more compelling evidence is needed. In Canavero’s <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322377/">own paper</a> he argues that a preliminary experiment would need to be performed on a primate model. Whether or not this would even be ethical given our current understanding would be another major question. For Canavero’s ideal to be realised, science has some massive hurdles to jump. Before we move onto humans, we should start with fixing the banana.</p><img src="https://counter.theconversation.com/content/44887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darren Ó hAilín does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Science fiction can’t become science fact if neuroscientists are to carry out some daring surgery.Darren Ó hAilín, PhD candidate in Molecular Medicine, University of FreiburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/330722014-12-03T03:24:20Z2014-12-03T03:24:20ZSpinal cord injury: big hope is cell therapy but exercise is best for now<figure><img src="https://images.theconversation.com/files/66038/original/image-20141202-20585-5ai24x.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4272%2C2366&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's still early days for cell therapy.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/chiropractic/3813000260">Michael Dorausch/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>You might have heard about Darek Fidyka, the paralysed man from Poland who <a href="http://www.bbc.com/news/health-29645760">recently walked again</a> after an experimental cell transplant. It made headlines around the world and raised the hopes of many people with spinal cord injuries that they too might one day have their movement restored. </p>
<p>But while early research suggests cell therapy could be used to treat spinal cord injury, it’s still very early days. For now, exercise therapy holds the best promise for recovering movement. </p>
<h2>What are spinal cord injuries?</h2>
<p>Each year <a href="http://scia.org.au/sci-resources-and-knowledge/health-and-sci-facts/sci-statistics">nearly 400 Australians</a> sustain a spinal cord injury. One in three injuries occur in young people between 15 to 24 years old and are usually caused by <a href="http://www.aci.health.nsw.gov.au/networks/spinal-cord-injury/statistics">motor vehicle accidents</a>. Around 12,000 Australians are living with a spinal cord injury, most (84%) of them men. </p>
<p>The extent of damage to the spinal cord and where it occurred determines the severity of injury. An injury can be either “complete”, meaning no sensation or movement below the area of spinal cord damaged, or “incomplete”, where some sensation and movement are still present below the injury. </p>
<p>Injuries to the neck will result in a paralysis of all four limbs (quadriplegia), whereas injuries below this level will result in varying degrees of paralysis from the legs up to the abdomen (paraplegia). </p>
<p>Spinal cord injury often also affects other areas of the body. Bladder and bowel control can be affected, as well as the ability to breathe independently. Nerve damage associated with the injury can lead to persistent pain and uncontrollable muscle spams.</p>
<p>The long-term effects of spinal cord injury can be devastating.</p>
<h2>Emerging therapies</h2>
<p>The most impressive research poised to change the future of spinal cord injury treatments are stem cell therapies and implanted spinal cord stimulators. </p>
<p><a href="http://www.ingentaconnect.com/content/cog/ct/2013/00000022/00000009/art00008">Recent research</a> has shown that injections of a particular type of stem cell from the nose, called olfactory ensheathing cells (OECs), has helped reconstruct a damaged spinal cord and allowed paralysed man Darek Fidyka to walk again. </p>
<p>OECs are specialist cells that repair nerve cells involved in our sense of smell. They sit at the base of the brain and are harvested from deep in the nasal cavity. When doctors injected the patient’s own OECs onto a nerve graft across the injury site the injured spinal cord regenerated across the gap. </p>
<p>Although the severed spinal cord was repaired five weeks after the surgery, it took a further 19 months of intensive exercise therapy before sensation and voluntary movement were regained in Fidyka’s legs. After a further six months of therapy, he has regained a limited ability to walk with braces and a walking frame. </p>
<p>Another promising therapy comes from a team of American researchers. Using a combination of intensive step training and stimulation of the spinal cord, via <a href="http://brain.oxfordjournals.org/content/137/5/1394">electrodes implanted below the injury</a>, five people with spinal cord injuries have recovered the ability to stand and walk. </p>
<p>However, scientists still don’t understand exactly how spinal cord stimulation contributes to the regained movement ability. </p>
<p>These discoveries are in the early stages and it may be many years until the potential therapies are widely available to patients.</p>
<h2>For now, simple is best</h2>
<p>The common intervention used in both of these emerging therapies is surprisingly simple and yet incredibly effective: exercise. OEC transplants and spinal cord stimulators are each used alongside exercise therapy to try to improve the efficiency of this already very successful treatment. </p>
<p>Specialised exercise training, usually in the form of assisted step training on a treadmill, is by far the most beneficial treatment currently available. It results in <a href="http://nro.sagepub.com/content/7/5/455.long">significant improvements</a> in standing and walking after spinal cord injury. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/66041/original/image-20141202-20560-76d3m1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exercise therapy can improve movement.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/23022269@N06/11788703005">M Car/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Most people with spinal cord injuries have some undamaged nerves left around the area of the injury. Exercise training encourages the residual nerves to sprout and form a <a href="http://online.liebertpub.com/doi/abs/10.1089/neu.2007.0392">functional “bridge”</a> around the area of damage. </p>
<p>Early intervention is best, but significant improvements can be achieved even if training begins years after the injury. Impressively, patients can maintain their walking ability long after the training sessions are completed. </p>
<p>The major downfall of exercise therapy is that it needs to be intense (at least 60 minutes per day) and ongoing (60-plus sessions). Greater training time results in better recovery. Unfortunately, the expense and limited availability of this intensive therapy can mean it is inaccessible for many.</p>
<p>The future for treatment after spinal cord injury is indeed very exciting and full of promise, but right now exercise is still the best medicine on offer.</p><img src="https://counter.theconversation.com/content/33072/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Rank receives funding from The National Health and Medical Research Council and SpinalCure Australia.</span></em></p>You might have heard about Darek Fidyka, the paralysed man from Poland who recently walked again after an experimental cell transplant. It made headlines around the world and raised the hopes of many people…Michelle Rank, Neurophysiology Researcher, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/254462014-04-21T20:06:46Z2014-04-21T20:06:46ZIs rugby league too dangerous?<p>After Newcastle forward Alex McKinnon’s <a href="http://www.abc.net.au/news/2014-04-03/mclean27s-suspension-ranks-among-heftiest-sideline-stints/5364730">neck was broken</a> in a lifting tackle in March, some commentators and parents have questioned whether rugby is just too dangerous for children, amateurs – and even professionals – to safely play. So, was McKinnon’s injury a freak accident, or is it a reasonable risk of the game? </p>
<p>In any collision sport, injuries are a relatively common and inevitable part of the game. The risk of sustaining an injury in rugby league that requires medical treatment <a href="http://dx.doi.org/10.1016/j.jsams.2012.03.017">is about</a> 40 injuries per 1,000 playing hours. This varies between playing level (professional versus club, adolescents versus children, and so on), but typically increases as the level increases.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/20092367">Early injury data</a> showed that ligament and joint injuries were the most common in rugby, typically occurring at the knee. </p>
<p>More recent data shows head and neck injuries occur most frequently. This is probably a result of changes in match rules (for example, requiring the defenders to be back ten metres, allowing the tackler to strip the ball in the tackle) combined with an increased focus on the tackle – more players get involved tackles to “wrap up the ball”, in an attempt to slow the ball play.</p>
<p>Junior players see experienced players making illegal tackles with impunity and believe this manner of tackling is an acceptable part of the game. Unfortunately, their junior opponents may not anticipate or expect this form of tackle or have the neck strength of senior players.</p>
<p>Professional players are also <a href="https://theconversation.com/not-so-gentle-giants-how-rugby-players-are-getting-bigger-23978">getting bigger</a>, faster and stronger, leading to <a href="https://theconversation.com/brute-force-reducing-the-impact-of-rugby-collisions-24276">greater impacts</a> and better rehabilitation to return players to the game sooner.</p>
<h2>How does this compare with other sports?</h2>
<p>It is difficult to compare injury rates, as the definition of injury, the methods of reporting, and the period of time over which injury data were recorded all vary. </p>
<p>Perhaps the most comprehensive data comes from the <a href="http://www.acc.co.nz/">New Zealand Accident Compensation Commission</a> (ACC), which records all sport-related injuries that require treatment. <a href="http://www.acc.co.nz/for-individuals/injury-statistics/index.htm">These records</a> showed there were 41 moderate to fracture/dislocation injuries to the back and spine injuries in rugby league over a five-year period. </p>
<p>This was comparable with soccer (41) and surfing (45), but substantially less than rugby union (178), snow skiing (199) and motor sports (352).</p>
<figure>
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<figcaption><span class="caption">Rugby collisions may be brutal but they don’t result in more injuries than other common sports.</span></figcaption>
</figure>
<p>Within Australia, even when all the football codes are grouped together, football <a href="http://scia.intersearch.com.au/sciajspui/bitstream/1/182/1/SSCIS%20ACUTE%20%20READMISSION%20REPORT%2006-12%20Final.pdf">ranks only third</a> in the risks of sport-related spinal cord injury. Motor sports and water-based activities (diving, surf activities) each present about twice as many spinal cord injuries, and horse-related activities are not far behind.</p>
<h2>Has the game become safer?</h2>
<p>Rugby league evolved from rugby union in 1895 because of the financial burden of players being injured and unable to play. </p>
<p>These days, when risk of injury is discussed, former rugby union players frequently declare “it didn’t happen in my day”. This may be possibly due to the manner in which the game used to be played. But more than likely, it was due to the absence of public awareness of the risks involved. </p>
<p>To refute this adage of the game being safer in the past, let’s consider the results of <a href="http://www.ncbi.nlm.nih.gov/pubmed/13118270">an injury study from 1954</a>. The researcher reported six cases of fracture‑dislocations of cervical vertebrae among rugby players in the province of Leinster (Ireland) alone in the period 1934‑1954. In three cases, death occurred within 24 hours.</p>
<h2>How can the game be made safer still?</h2>
<p>The <a href="http://www.nrl.com/">National Rugby League</a> (NRL) is to be commended for its <a href="https://theconversation.com/safety-before-entertainment-leagues-priorities-right-on-shoulder-charge-ban-10903">decision to ban</a> shoulder charge collisions and the lifting tackle. While spectacular to watch, they are contrary to the letter and spirit of the rules. </p>
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<figcaption><span class="caption">Banning shoulder charges has improved the safety of the game.</span></figcaption>
</figure>
<p>High tackles are equally spectacular to watch, but just as dangerous. The rules should be amended to outlaw any tackle occurring above the level of the shoulder. This would reduce the margin of doubt for the referee or subsequent judicial hearing and eliminate the need to decide where contact was first made. </p>
<p>The NRL might also consider reverting to a weight-based grouping for competition, where players are matched by size rather than age. There is <a href="http://dx.doi.org/10.1016/j.csm.2007.10.008">some evidence</a> that lighter players are more likely to be injured. </p>
<p>Coaches and players can also contribute to making the game safer by raising awareness of potentially dangerous techniques. For example, with the changing emphasis on preventing the ball carrier from offloading the ball in the tackle, the ball-carrier is now attempting to “duck under” the tackler. </p>
<p>This straightens the cervical spine, removing its natural, shock-absorbing curvature so that the impact is transmitted down the straighten neck. The neck now acts like the outstretched finger being hit by a basketball – it buckles rather than bends. </p>
<p>In fact, “spearing” or using the helmet as a point of contact has been <a href="http://www.aans.org/en/Media/General%20Press%20Releases/2009/August/The%20End%20of%20Summer%20Means%20Football%20Season%20-%20Prevent%20Potentially%20Tragic%20Head%20and%20Neck%20Injuries.aspx?p=1">banned in American Football</a> since 1976 because it caused such a high number of spinal injuries. </p>
<p>The tackle is an integral part of the game and carries some risk to both the tackled player and the tackler. It is impractical to alter the nature of the game to the extent where all danger is removed. </p>
<p>But it is relatively easy to make tackling safer. The time is right to review this blight on the otherwise positive developments in the game.</p>
<p><em><strong>Further reading:</strong></em> </p>
<ul>
<li><p><em><a href="https://theconversation.com/not-so-gentle-giants-how-rugby-players-are-getting-bigger-23978">Not so gentle giants: how rugby players are getting bigger</a></em></p></li>
<li><p><em><a href="https://theconversation.com/brute-force-reducing-the-impact-of-rugby-collisions-24276">Brute force: reducing the impact of rugby collisions</a></em></p></li>
</ul><img src="https://counter.theconversation.com/content/25446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Milburn does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After Newcastle forward Alex McKinnon’s neck was broken in a lifting tackle in March, some commentators and parents have questioned whether rugby is just too dangerous for children, amateurs – and even…Peter Milburn, Professor, School of Allied Health Sciences, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/251072014-04-02T14:03:18Z2014-04-02T14:03:18ZNew discovery gives hope to spinal injury patients<figure><img src="https://images.theconversation.com/files/45417/original/cmyjwr8r-1396446972.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Regenerating the nerves that can return function to our spinal cords.</span> <span class="attribution"><a class="source" href="http://michaeldorausch.com/">Michael Dorausch</a></span></figcaption></figure><p>Spinal cord injuries are currently irreparable. When nerve fibres in the central nervous system are damaged there is, as yet, no way of reversing this. But research we’ve been doing has led to the discovery of a mechanism for regrowing damaged nerve fibres. </p>
<p>A new study, published in <a href="http://www.nature.com/ncomms/2014/140401/ncomms4527/full/ncomms4527.html">Nature Communications</a>, highlights the role of a protein called PCAF, which seems to successfully trigger a series of chemical and genetic events that allow nerves to regenerate. When we injected PCAF into mice with damage to their central nervous system, this significantly increased the number of nerve fibres that grew back, indicating that it may be possible to chemically control the regeneration of nerves in the central nervous systems.</p>
<p>Nerves are crucial to human activity – they facilitate the constant communication that our brain has with the rest of our body. So, if you touch a hot pan, signals relay this information back to the brain where they are processed and then a signal is sent back to the hand to pull it free from danger. Neurons are the cells that transmit these specific messages.</p>
<p>When the connections between these cells are lost, such as after a spinal cord injury, signals can no longer be transmitted through your body and paralysis occurs. Millions of people worldwide suffer from spinal cord injury, stroke and traumatic brain injury. As yet there are no successful treatments that lead to full regeneration of these lost connections.</p>
<h2>Responding to damage</h2>
<p>The reason why our central nervous system and peripheral nervous system differ in their ability to regenerate and re-establish lost connections has been at the centre of our research. The logic is that if we can understand how the body is able to regrow nerves in the peripheral nervous system, we can apply this knowledge to the central nervous system. This would enable us to help patients suffering from strokes, traumatic brain injuries, spinal cord injuries and even neurodegenerative diseases. </p>
<p>We found that epigenetics was at the core of the peripheral nervous system’s capacity to regenerate. <a href="https://theconversation.com/explainer-what-is-epigenetics-13877">Epigenetic mechanisms</a> are processes that, without altering our core DNA sequence, manage to activate or deactivate genes in response to the environment. </p>
<p>Finding out how to turn genes “on” has been an important part of the process of regrowing nerves, and this is initiated by signals from the injured nerve itself. Until recently it was believed that epigenetic alterations were inherited just as we inherit DNA from our parents. Now, however, it is also clear that environmental signals can trigger these modifications to our DNA, which can temporarily or permanently alter gene expression.</p>
<p>Through tracking how the peripheral nervous system injury signals communicate to neurons that genes involved in nerve regrowth should be switched on, we have managed to discover the link between injury signals and turning on the right genes.</p>
<p>This work is still preliminary and we would like to determine if this regrowth of neurons establishes connections that lead to increased function. We believe this work can potentially lead to a pharmaceutical way of triggering the nerves to repair and grow, enabling patients suffering from CNS injuries to recover feeling and movement, but there are many hurdles to overcome first.</p>
<p>The next step is to see whether we can bring about some form of recovery of movement and function in mice after we have stimulated nerve growth through the PCAF-dependent epigenetic mechanisms. If this is successful, then there could be a move towards developing a drug and running clinical trials with people.</p><img src="https://counter.theconversation.com/content/25107/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Radhika Puttagunta receives funding from HIH.</span></em></p><p class="fine-print"><em><span>Simone Di Giovanni receives funding from DFG, WFL, HIH.</span></em></p>Spinal cord injuries are currently irreparable. When nerve fibres in the central nervous system are damaged there is, as yet, no way of reversing this. But research we’ve been doing has led to the discovery…Radhika Puttagunta, Post-doctoral researcher at the Hertie Institute for Clinical Brain Research, University of TübingenSimone Di Giovanni, Chair in Restorative Neuroscience, Imperial College LondonLicensed as Creative Commons – attribution, no derivatives.