Driving a car, riding a bike, diving into water, playing sport, riding a horse or even a low fall; these are some of the everyday activities that have irrevocably changed the lives of more than 12,000 Australians through injury to their spinal cord leading to paralysis. A further 300 Australians will end up with a spinal cord injury this year alone. The impacts of spinal cord injury are usually life-long and devastating, costing patients anywhere between $5 and $9.5 million over a lifetime, and costing the Australian economy billions of dollars annually. Spinal cord injury results in a lack of control, independence and freedom for the patient and a successful cure would not only transform the lives of sufferers, but also create substantial savings for the entire Australian health system.
Research into finding a cure for paralysis has been undertaken across the world for decades. There have been many dead ends, many partial discoveries and a lot of hope. But now, the pathway to ending paralysis is illuminated. The potential answer? Taking a special type of cell from a patient’s olfactory (sense of smell) system, called an Olfactory Ensheathing Cell (OEC), and transplanting it into the spinal cord injury site.
Research pioneered by 2017 Australian of the Year—Professor Emeritus Alan Mackay- Sim and a world-first Phase I clinical trial led by scientists at the Griffith Institute for Drug Discovery (GRIDD), Griffith University, in 2002, demonstrated that the therapy is safe for use in humans. That trial led to a recent human trial by British/Polish researchers demonstrating that restoration of function after severing of the human spinal cord is indeed possible. In this study, a mix of olfactory cells together with a nerve bridge were transplanted into the injured spinal cord. Within 6-12 months after transplantation, the patient, who had been paralysed for several years prior to the treatment, regained some motor function of his legs, bladder control, and, most importantly, sensation. These exciting proof-of-principle results give hope that patients may regain function after spinal cord injury. What is now needed is to improve the transplantation therapy to make it more effective.
In partnership with the Perry Cross Spinal Research Foundation, The Queensland Government (MAIC) and the Clem Jones Foundation, the team at Griffith University’s GRIDD and Menzies Health Institute Queensland (MHIQ) – the Clem Jones Centre for Neurobiology and Stem Cell Research (CJCNSCR)/Spinal Injury Project (SIP) led by Associate Professor James St John is currently conducting preclinical research and plans to undertake a clinical trial in 2020 to progress this journey and show that this therapy can further regenerate patients’ sensory and motor function. The method used has the potential to be the first widely available treatment for spinal cord injury, aiming to make the therapy more effective, available and affordable. It will establish Griffith University, Queensland, and Australia as world-leaders in spinal cord injury treatment.
The complete team of researchers at Griffith with the notable Mr Perry Cross, an SCI survivor of 25 years whose foundation directly supports the project
So what is so special about Olfactory Ensheathing Cells (OECs)? The olfactory system—or sense of smell—is unique in mammals in that its nerve cells are able to constantly regenerate. It’s the only part of our nervous system that regenerates every single day as part of its normal function. And it’s lucky that it does: every time we breathe in, the nerve cells in our nose are exposed to the bacteria and toxins and get killed off. If these didn’t regenerate, humans would lose their sense of smell in around a month. Olfactory ensheathing cells (OECs) are crucial to this process of regeneration. They prevent scarring and protect and guide the growing nerve cells. It is these special properties of OECs that we aim to exploit in our therapy for spinal cord injury. OECs should provide the same guidance and supportive function when transplanted into an injured spinal cord, helping to create an environment that allows for neuronal regrowth.
“A heart-shaped spheroid of OECs” – we use a newly developed technique called ‘naked liquid marbles’ to form a 3 dimensional aggregation of cells from the olfactory system that naturally assemble into layers.
The journey to preparing OECs for transplantation is a difficult one and involves a multi-team approach. The cells need to be purified from the olfactory mucosa of the nose and then assembled into a three-dimensional (3D) “nerve-bridge” suitable for transplantation.
However, transplanting OECs into an injury site wont alone cure spinal cord paralysis. While the cell transplantation aspect is the critical component of the therapy, its success relies on the patients undertaking long-term intensive activity-based rehabilitation to allow the nervous system to make new connections and to re-learn the necessary fine-control needed for proper motor and sensory function. Without the long-term activity-based rehabilitation, the cell transplantation alone will not be successful.
With support of the Perry Cross Spinal Research Foundation, Griffith University has developed a framework for this sustained functional therapy and an App that supports patients to do their activity-based rehabilitation every day for many months and perhaps years. Activity-based rehabilitation combines a range of physical motor and sensory gym-based activities provided by specialist exercise physiologists and physiotherapists trained in spinal cord rehabilitation. We need to test the feasibility of delivering the rehabilitation program prior to the commencement of the cell transplantation clinical trial. A feasibility study is important to identify barriers and improvements that can be made in preparation for the Phase I/IIa clinical trial.
The Spinal Injury Project at Griffith University is now well underway to progress the pre-clinical research into a Phase I/IIa human clinical trial and to develop a treatment for paralysis caused by spinal cord injury.
For more information, contact: A/Prof James St John, firstname.lastname@example.org.
Sheree Chandra has worked in the Life Insurance industry for ten years across multiple operational and project management roles, and currently holds the position of Group Claims Manager at MetLife.
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