the BRAIN - Shepherd Center

Research
It’s an exciting time for neuroscience, including the hope for
new therapies to treat spinal cord injury (SCI). While basic
scientists and clinicians are making important advances, they
face daunting challenges when it comes to moving promising
research from the bench to the bedside.
To identify and address these barriers, leading experts in neuroscience
and stem cells recently came together for the one-day
workshop at the University of Georgia.
“The concept of this workshop grew out of a need for better
communication between stem cells scientists, who dared to use
the term ‘cure’ for spinal cord injury, and care providers, who are
worried about raising ‘false hopes’ and setting unrealistic goals
for people with spinal cord injury,” says Ann Kiessling, Ph.D.,
associate professor of surgery at Harvard Medical School and
director of the Bedford Stem Cell Research Foundation, which
organized the second annual gathering in cooperation with
Shepherd Center. “Both groups clearly have the patient’s best
interest at heart, but were not hearing each other’s concerns.”
A key challenge for people with SCI is the concern among
clinicians that any direct intervention at the site of the injury
could impose further damage and additional loss of function,
Dr. Kiessling says. “They are understandably reluctant to expose
their patients to the risk of further spinal cord damage for
research purposes,” she adds.
There is also a lack of infrastructure within the SCI research
community to support multi-center studies, and to define how
studies in SCI can be made safe and relevant to human patients.
Keith Tansey, M.D., Ph.D., director of spinal cord injury research
at Shepherd, spoke to the group about the need to ensure
animal studies are more relevant to humans.
“Humans aren’t necessarily just big rats, and we need to better
understand how and why animals are recovering from SCI
because the mechanisms may not be the same in humans,”
Dr. Tansey says. “Studies of animals and humans with incomplete
injuries reveal a bias toward spinal plasticity in animals
and brain plasticity in humans as the reason for functional
recovery, so treatments may need to be different. In complete
injuries, spinal circuits in rodents can regain stepping, but
humans can’t, so we need to learn how to make human spinal
cords function like rats’.”
Dr. Kiessling agrees, adding that animal model research needs
to be more carefully aligned with human injuries and the outto
Bedside
From Bench
Leading experts in basic science and clinical care discuss barriers to a “cure”
for spinal cord injury. By Amanda Crowe, MA, MPH
come goals for human therapies. “If walking is the outcome
measure, animal models need to reflect that. But if bladder
control is what’s important, a different animal model may be
needed,” she says.
Researchers and clinicians must gain a better understanding
of how much recovery is due to re-establishment of brainspinal
cord connections versus improvements in interpreting
and using sensory information in the spinal cord below the
level of injury. Dr. Tansey challenged the traditional view of
translational research in which discoveries at the cellular level
move from the lab to clinical practice, arguing that it should
be more of a two-way street. That is, questions that arise in the
clinical setting can go back to the lab to find answers. Other
attendees said this model could help inspire greater communication
and partnership, as well.
A memorable highlight of the workshop was a tour of
Shepherd Center, the only specialty rehabilitation center in
the country that combines intensive medical care, rehabilitation
and a clinical research program under one roof. This visit
gave basic scientists a chance to see what their work can do at
the human level, well beyond studying cell biology in the lab.
“We could have held this workshop anywhere in the
country, but we were impressed by the clear enthusiasm and
determination of Shepherd’s leadership, particularly Alana
Shepherd, in creating a unique center of excellence in patient
care,” Dr. Kiessling says.
Still, experts say the complexity of SCI cannot be overstated,
and there is no silver bullet – no single cell, no single
surgery, no single nerve-growth factor that will solve the
whole riddle. “The more realistic expectation is that a combination
of incremental steps is needed to improve recovery and
maximize function,” Dr. Tansey says. “There is huge potential
with stem cell biology and cell-replacement therapies, but
there’s also a long distance between where we are today and
where we need to be to find a ‘cure.’”
Collaborations among these leading experts will help
forge the path forward. In the meantime, patients and their
families should be encouraged by the progress made thus far,
experts say. Prevention and early intervention, regeneration
therapies at the cellular and extra-cellular levels and aggressive
rehabilitation are all contributing to significant neurological
recovery after SCI.
2 0 Spinal Column
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