October 23, 2014

Paralyzed Man Walks after Nose Cell Implantation: the "Miracle" and the Cautions

Darek Fidyka walks (photo courtesy of BBC)

The recent news -- a paralyzed Bulgarian man is walking again after cells from his nasal cavity were transplanted into his severed spine – has understandably made a big splash around the world.

Dr. Geoffrey Raisman, a professor at the Spinal Repair Unit at UCL Institute of Neurology in London, was a partner in the surgery. He said, “We believe that this procedure is the breakthrough which -- as it is further developed -- will result in a historic change in the currently hopeless outlook for people disabled by spinal cord injury.”

The surgery, done in Poland, has been touted with great hyperbole: as a major leap forward for humanity, more important for the future of our race than the moon landing.

The Usual Concerns
Other medical experts have been quick to sound the alarm: not so fast.

As reported in an article onWebMD.com on October 21,  Dr. Simone Di Giovanni, chair in Restorative Neuroscience for Imperial College London, said that this single case "cannot represent any solid scientific evidence to elaborate upon. In fact, there is no evidence that the transplant is responsible for the reported neurological improvement.”

She continued:
The use of these cells for spinal cord injury repair have been implemented for 30 years now with very controversial results in rodents, non-human primates, and patients. Extreme caution should be used when communicating these findings to the public in order not to elicit false expectations on people who already suffer because of their highly invalidating medical condition.

We’ve heard the caution about creating false hope before. I’ve repeatedly taken Dr. Mary Newport to task for giving false hope to the millions of Alzheimer’s sufferers – and their families and caregivers – by touting coconut oil as a miracle cure based on the unique, positive, temporary experience of her husband Steve. Many whose spirits were immeasurably lifted by Newport's report -- and who then tried coconut oil without any results -- must have found the hyped remedy an unconscionable cruelty. 

The trumpeted news from Poland about this apparent cell-transplant success has also generated the caveat we hear with almost every positive study outcome -- the results need to be replicated in a much larger, placebo-controlled, double-blind, longitudinal study. We don’t have “science” until that happens.

What Happened in Poland
Nonetheless, the successful nose-to-spine transplantation is undeniably exciting, and worth examining.

A headline in The Telegraph, offered with typical British cheek, read "Paralysed man walks again - and the answer was under his nose."  

Here’s how writer Anjana Ahuja explained the complicated surgery in The Telegraph article:
Fidyka, whose spinal cord was cut completely after a knife attack by his ex‑wife’s husband, had agreed to receive a transplant of cells taken from the nose. These particular cells, called olfactory ensheathing cells (OECs), are known to influence the regrowth of olfactory nerves, which transport smells to the brain and regenerate every 30 days. 
In experiments on rats and dogs, OECs had shown promise as a “bridge” that could be used to reconnect severed nerves; previously paralysed animals regained the ability to move. Various teams of scientists around the world were racing to apply the technique in humans. But Fidyka’s surgeon in Poland was forced to take a particularly daring approach; Fidyka’s mucus membrane, ravaged by chronic allergic sinusitis, meant that OECs could not be harvested from the nasal passages. 
Instead, the special cells – which are not stem cells but living adult cells – were collected through brain surgery. Neurosurgeons at Wroclaw University Hospital in Poland cut into Fidyka’s skull, extracted the left olfactory bulb and cultured a ready supply of OECs. These cultured cells were then transplanted into the spinal breach, along with strips of ankle nerves to act as a scaffold along which the nerves could regrow. 
Within a year and a half, the effects of the pioneering operation were clear: the fireman, who was also undergoing physiotherapy, was able partially to move his lower limbs, could feel sensations in his legs, grew muscle on his left thigh and recovered some bladder sensation and sexual function. 
From being struck down with a class A spinal injury – the most severe kind, usually indicating lifelong paralysis – Fidyka had shuffled, albeit with the help of a walking frame, along the spectrum to a class C injury, associated with limited movement. And even though most of us would regard it as a fair bargain, he didn’t lose his sense of smell.

Graphic artist Sam Dodge created this excellent visual for The Telegraph to explain the procedure:

Other Implications: Ageing, Parkinson’s, Cancer, Stroke, Heart Disease
That same article described broader therapeutic implications of this surgical success. It also provided a clear definition of the different types of stem cells:
Not only does the research help the injured, but there are longer-term goals in mind: the diseases of ageing, such as heart disease, cancer and Parkinson’s, are largely the result of cell deterioration and cell death. Being able to create healthy, transplantable replacement cells has an obvious place in the future of medicine. 
Over the past decade, the hope of tissue repair, including nerve regeneration, has largely been fuelled by the hype of stem cells. Stem cells fall into two types: embryonic ones, which can be harvested from early embryos, with all the attendant ethical quandaries; and adult stem cells, which can be extracted from adult bone marrow and some body tissues. 
The key feature of stem cells is their potential to grow into particular cell types; they have a potency that scientists have long dreamt of unlocking, with embryonic stem cells regarded as the most versatile. That is why they have been pursued eagerly as potential therapies for heart disease, diabetes, Parkinson’s and spinal cord injury.
There’s no denying that Darek Fidyka -- the Bulgarian patient -- must consider his surgery’s apparent success a miracle. "When you can't feel almost half your body, you are helpless, but when it starts coming back it's like you were born again," he said.

Professor Raisman – who led the UK research team – described the surgical achievement as "more impressive than man walking on the moon.”

Once again, time alone will tell.

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Details of the research are published in the journal Cell Transplantation.

As you might expect, a multitude of news media reported the news from Poland. Here are just a few: 


Franky said...


If you asked two months ago I would have said NO. After done a serious research YES.

You might want to have a look to another "miracle". ;-)

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Cannabis and Parkinson Disease


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Franky said...

One more point. Always from a science and medicinal point of view.

Cannabis has more than THC. THC-A, THC-V, CBD, CBG, CBN, CBC...

Cannabinoid Profiles - THC, THC-A, THC-V, CBD, CBG, CBN, CBC & Terpenes


A powerful real case. Not much to say.

Weed - CNN Special Dr Sanjay Gupta 2013 Documentary Full English