© Stefan Voitl

You asked, the scientists answered


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Last week, we asked you to send us your questions about spinal cord research. Please find below the most frequently asked questions, which were answered by top-ranking scientists during our annual scientific meeting.

Is it really possible to find a cure? Why does it take so much time?

Michael Sofroniew, University of California Los Angeles, USA:
Everything depends on what you understand under the term cure. A full cure might take a long time, although nobody can really predict how long this time might really be. We hope to achieve progressive improvements. An example: More subtle recovery like gaining back the function of the hands, will dramatically improve the quality of life of a tetraplegic patient. Such “modest”, yet essential improvements should require a shorter time. Finding a cure requires so much time because the human nervous system is simply the most complex thing in the universe and there are still many things that we do not know or understand. Every year we are cracking small parts of this “puzzle” and hope to know enough soon to bring a first treatment to the spinal cord injury community.

Which approach is most promising?

Stephen Strittmatter, Yale University School of Medicine, New Haven, USA:
The complete cure will come but it will be a stepwise process. We need to have success in one realm and then another and probably add them together in the end. So that can include training and stimulation, it could include pharmacological interventions, the promotion of plasticity or sprouting, and perhaps even cellular therapies. And maybe in the end, we will need to use all of these, to get the cure.

When do you think the first spinal cord injury treatment will come out officially?

Michael Fehlings, University of Toronto, Canada:
I’m hopeful that there will be an acute neuroprotective drug approved in the next 5 to 10 years based on the clinical trials that are currently underway. For chronic patients it’s more difficult for me to determine this but again I’m very hopeful that one of the strategies, potentially the electrical stimulation of the central pattern stimulator may emerge also in the next 5 to 10 years.

What do you focus on? Is it more on the recovery of motor functions or sensory functions or the autonomous nervous system?

Stephen Strittmatter, Yale University School of Medicine, New Haven, USA:
The attractive research directions are not really modality selective. They might end up helping either the motor, the sensory or the autonomic system, but hopefully all these functions might improve from a specific treatment. Projects are not really designed to work selectively on only one of these functions. Instead, they are more general about plasticity, building new networks or training. So probably there will be more benefits in multiple domains from anything that goes forward.

Does Wings for Life has any strategy to enable and accelerate the path to combination therapies?

Prof. Dr. Dr. Jan Schwab, Scientific Director of Wings for Life:
We believe that a combination of various approaches offers the best chances of success. Therefore, Wings for Life has a consistent history of supporting combinatorial approaches. One example is the research project of Prof. Dr. Wolfram Tetzlaff (ICORD, University of British Columbia). This project combines (1) a diminished intrinsic capacity of CNS neurons to regenerate, (2) the inhibitory glial environment of the CNS following SCI, and (3) the absence of sufficient substrates for growth across the lesion site. Wings for Life will continue to use this strategy also in the future.

Do you focus more on projects for chronic patients or on therapies for acute patients?

Prof. Dr. Dr. Jan Schwab, Scientific Director of Wings for Life:
Wings for Life equally supports research projects on acute as well as chronic injuries. We intend to publish a detailed article on this topic soon on wingsforlife.com.

Are there any new drugs or treatments other than Tizanadine, Baclofen, Pregabalin available to help relieve spasm without negative side effects?

Thomas Kessler, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland:
The medications mentioned are those currently used in all clinics. Physicians are very aware of the fact that they have side effects but – unfortunately - there are no better alternatives to control spasticity problems to date.

Do you suggest intensive rehabilitation training in the chronic stage or other training methods?

Armin Curt, Balgrist University Hospital, Zurich, Switzerland:
There are good rational reasons to consider intensive training also in the chronic stage after a spinal cord injury. To be in the best possible shape, patients need to engage, they need to keep the neuromuscular system below the level of injury active. This is even more important for patients who want to enter a new intervention. Patients with a good condition will be more likely successful in any kind of interventional study.

Does stem cell transplants help to improve condition?

Martin Oudega, University of Pittsburgh:
Although some stem cell treatments for spinal cord injury are currently being tested on humans and will hopefully be successful in the coming years, there is so far no positive proven effect. Scientists seek to understand this further to develop a successful therapy. We believe that different types of therapies (whether it is stem cells or any other type of approach) will target different types of injuries.

Are there any good rehabilitation programs achieving tangible results for chronic incomplete patients?

Armin Curt, Balgrist University Hospital, Zurich, Switzerland  
There are indeed some studies for chronic incomplete patients, which help the patients to improve a certain level of performance and independence. But it is not possible to publish a general recommendation. This is due to the fact that these studies need to be matched to the specific condition of the patient and his personal targets.

Whilst great work is being done for spinal cord injury research, is there also work being done for spinal defects such as Spina Bifida, Scoliosis and other spinal defects and diseases?

Dr. Rosi Lederer, Wings for Life:
Wings for Life focuses on finding a cure for traumatic spinal cord injury. The knowledge made in this field should also help treatments for diseases like Spina bifida, multiple sclerosis and other spinal defects. This is due to the fact that the basic pathophysiology is shared between those different spinal cord diseases.

What do you do with the 3 million Euro raised through the Wings for Life World Run?

Anita Gerhardter, CEO of Wings for Life:
Wings for Life will invest this money in the best interest of the patients. We already have a clinical project in mind. Right now, we are negotiating the details. This will take a couple of months.