Regeneration of the spinal cord has become a fact. Polish neurosurgeons transplanted olfactory glial cells into a patient with a torn spinal cord. This treatment, combined with intensive rehabilitation, allowed the patient to take his first steps. It gives other wheelchair users hope that they will also get back on their feet someday.
The firstsurgery to transplant glial olfactory cellsto a patient with a ruptured spinal cord was performed at the Department of Neurosurgery, Medical University of Wroclaw. The results are very promising, but the full assessment of the therapeutic effects of the innovative therapy has to be put on hold. Nothing happens quickly in this branch of transplantation. After a heart or kidney transplant, the benefits for the patient are visible almost immediately. In the case of the nervous system, you have to be patient, undergo daily rehabilitation and wait, because the first noticeable results may not appear until after a year.
Unusual olfactory glial cells
In the human nervous system there are nerve cells and glial cells. The latter are very diverse and fulfill various functions, eg help in the nourishment of nerve cells, synthesize enzymes needed for the production of neurotransmitters, etc. The olfactory glial cells have special features. Their structure was known from the beginning of the 20th century, but their functions and properties remained a mystery for a long time.
They were decoded by prof. Geoffrey Raisman from the British University of Neurology, London. Their unique feature is the cyclical (it is assumed that every 6 weeks) rebuilding of olfactory neurons. The olfactory receptors in the olfactory membrane of the nose are constantly exposed to damage (e.g. by contact with airborne toxins, bacteria, fungi and viruses), which can lead to a temporary loss of smell. If nature had not thought about recreating them, the damaged olfactory receptors would not be able to regenerate and we would have lost our sense of smell. And it is a sense that plays an important role in the behavior of Homo sapiens and other mammals, and therefore has outstanding self-healing properties. The olfactory glial cells that produce neurotrophic substances that stimulate the regrowth of damaged nerve fibers are responsible for its constant regeneration.
ImportantOlfactory glial cellstransplanted into placespinal cord injuries contribute to the restoration of broken nerve connections. These remarkable cells are found in the olfactory membrane of the nose, but also in the higher part of the olfactory tract, the olfactory bulb in the brain. The glial cells in the bulb have a greater regenerative potential than the glial cells in the nose.
Core regeneration: promising experiments in the world
The properties of olfactory glial cells have interested scientists who are looking for a method to regenerate a damaged spinal cord, which would thus provide a chance for paralyzed people to recover. Is it possible, then, to implant these unusual cells in damaged areas and will they contribute to the restoration of broken nerve connections? The experiments were promising. It turned out that animals can recover from spinal cord injury by implanting olfactory glial cells. But can the same be done with humans? Such trials were carried out in Portugal, Australia and England, but did not achieve spectacular results.
ImportantThe first glial cell transplants
Three pioneering surgeries in patients who suffered a spine fracture (the result was a crushing of the spine), doctors from Wrocław carried out on their own in 2008 and in 2010. Transplantation of the patient's glial olfactory cells into a damaged spinal cord is an extremely complicated procedure to carry out which took 10 hours. First, the doctors had to uncover the spinal cord and then insert the cultured cells into it. In order for the olfactory glial cells to reach the site, doctors had to perform several dozen spinal punctures and over a hundred single microinjections. But before that, olfactory glial cells were collected and grown only by Polish specialists. They also developed a preoperative rehabilitation program for both patients and performed both operations.
Spinal cord regeneration: Wrocław thread
The Polish history of olfactory glial cells begins with prof. Włodzimierz Jarmundowicz, head of the Department of Neurosurgery, for which prof. Jan Haftek - passionate about the regeneration of the peripheral and central nervous system. Reports on the possibilities of olfactory glial cells encouraged doctors from Wrocław to check whether they really have such extraordinary power. Animal experiments have been successful. It was 2002. The team of prof. Jarmundowicz was joined by Dr. Paweł Tabakow. Researchers explored the possibilities of exploiting the properties of olfactory glial cells. You had to start with the basics - learn to download safelyfor patients way glial cells, isolate them, grow them. It was not easy to obtain associates or research funding, as it was believed at the time that functional regeneration within the central nervous system was impossible. However, there were allies: prof. Andrzej Górski and neurobiologists Dr. Ryszard Międzybrodzki and Dr. Wojciech Fortuna from the Institute of Immunology and Experimental Therapy of the Polish Academy of Sciences in Wrocław. With their help, it was possible to develop original methods of collecting cells from the olfactory membrane of the nose, as well as conditions for their cultivation and isolation. These rules have been patented. In 2004, scientists were able to present the results of their work. Though the difficulties were stacking up, they were presented at the 1st Hong Kong World Neuroregeneration Congress. The achievements of Poles aroused the interest of prof. Raisman, a precursor in the field of research into the properties of glial cells. This is how closer contacts were established between the team of scientists from Wrocław and London.
Spinal cord regeneration: surgery and hard work for the patient
The doctors from Wrocław performed the first transplant operation in 2008. The third one, which was carried out in 2010, was performed by prof. Raisman as an observer. He was impressed by the skills of Polish doctors and suggested joint action. Improvement in sensation and changes in muscle tone could be noticed in all patients who had been transplanted with olfactory glial cells. - We entrusted prof. Juliusz Huber from Poznań, who specializes in the pathophysiology of the musculoskeletal system - explains prof. Jarmundowicz. - Unfortunately, no spectacular success was achieved in the former cases. An inseparable part of the treatment process in such cases is rehabilitation 5 times a week for 5 hours each day. It is simply a murderous effort that not everyone can endure. We warned our patients that not everything could turn out as expected. And they, although they subconsciously believed that it would be fine when they did not see a significant improvement, gave up further rehabilitation.
ImportantAnd what went into the world?
In 2013, BBC journalists came to the clinic in Wrocław with a proposal to make a film. Our doctors decided that this was a good opportunity to promote Polish scientific thought. However, they made a condition: the film was to be broadcast after the publication in the scientific journal "Cell Transplantation" of a paper describing the course of the innovative procedure. The work was co-authored by prof. Raisman. After it was published, the video was shown to the BBC. It has great scientific value, unfortunately it does not clearly show the effort of the entire team of Polish researchers. Watching a movie, British viewers can relatethe impression that the English team was responsible for the scientific program that was conducted in Wrocław by Polish doctors.
Spinal Cord Regeneration: The Future
Today it is difficult to say that the transplantation of olfactory glial cells grown from the olfactory bulb or the olfactory membrane of the nose will be an effective method of treating all cases of spinal cord injury. Time will tell. The Wrocław Neurosurgery Clinic is flooded with letters from people who would like to undergo such a procedure. But you have to remember that this is just the beginning. There is still a long way to go before this method of surgery becomes a common method of treatment. The first operation was successful, as evidenced by the progress made by Dariusz Fidyka. Its value and importance for neurosurgery has also been confirmed by an independent expert, eminent scientist and experienced practitioner in the field of spinal cord injury, Prof. Wagikh El Masry from Stoke Mandeville, England. The scientist explicitly admitted that he did not think he would live to see such an effect of the operation of a torn spinal cord. And yet it worked! And Polish doctors did it. The next patients who will be prepared for such surgeries are those who - as in the case of Dariusz Fidyka - had a spinal cord cut. It will be possible to speak of a full success when the same treatments can be repeated also for other people.
ImportantThe first patient took the first step
Dariusz Fidyka - a patient who made the world talk about the achievements of Wrocław neurosurgeons - 20 months after the glial cell transplantation, he could take a few steps on his own. His story could be the basis of a sensational film. A few years ago, he was stabbed several times. One of the blows went between the vertebrae of the spine and cut the spinal cord. The man survived, but was paralyzed from the waist down. After a stay in various centers, he went to the Department of Neurosurgery in Wrocław, to Dr. Paweł Tabakow. It turned out that the patient could not collect glial olfactory cells from the nose. The reason - chronic sinusitis and polyps. Transplanting such glial cells could pose a risk to the patient. Then the idea of collecting material from the olfactory bulb in the brain was born. This has never been done before. The risks of opening the skull were feared, but it was reassuring to know that the glial cells in the olfactory bulb had a greater regenerative potential. Darek's surgery was also supported by the fact that the scar on the spinal cord was small. This prompted doctors to consider excision of the scar, filling the defect by creating a nerve bridge, andthen implantation of glial olfactory cells. Nerves contain Schwann cells that are responsible for starting the regeneration process in the peripheral nerves, so they can speed up the reconstruction of nerve connections in the spinal cord. Detailed tests and 10 months of intensive rehabilitation were preceded by the first procedure, i.e. taking a sample from the olfactory bulb, from which the glial cells were to be multiplied. The collection was made by Dr. Paweł Tabakow on April 12, 2012. Then the sample was subjected to a special treatment - with the help of English scientists the olfactory glial cells were multiplied. After 12 days, Dr. Bogdan Czapiga and Dr. Paweł Tabakow performed the second essential part of the operation - they implanted glial olfactory cells. On the other hand, the preparation of the spinal cord for transplantation, i.e. excision of the scar and implantation of a bridge of skin nerves that were taken from the patient's shank in the place of the defect, was performed by prof. Włodzimierz Jarmundowicz assisted by Dr. Bogdan Czapiga and dr. Paweł Tabakow. After 9 hours, the first such procedure in the world entered the history of neurosurgery. It was successful, and after the wounds healed, Mr. Dariusz began intensive rehabilitation. He felt the first positive changes 7 months after the surgery.
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