BMJ 2014;349:g6396 doi: 10.1136/bmj.g6396 (Published 22 October 2014)
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NEWS Paralysed man walks again after cell transplantation Zosia Kmietowicz London
A man who was paralysed in a knife attack in 2010 has been able to walk again using a frame, after doctors transplanted cells from his nasal cavity into his spinal cord. The pioneering cell transplantation treatment involved taking olfactory ensheathing cells (OECs) from one of Darek Fidyka’s olfactory bulbs and growing them in culture. The cells are crucial to the continual replacement of nerve cells in the nose that give us a sense of smell.
The treatment was developed by scientists at University College London (UCL) and applied by surgeons at Wroclaw University Hospital, Poland. They have stressed that the technique will have to be repeated to confirm that it can stimulate spinal cord regeneration. Fidyka, who is 38, was left with an 8 mm gap in his spinal cord after being stabbed. After his injury he had 13 months of rehabilitation with no improvement and a further eight months in a recovery programme to check if he would regain any movement in his lower body without surgery. The researchers said that the chance of a spontaneous recovery after that time was less than 1%.
After being grown in a cell culture for two weeks the OECs were injected into Fidyka’s spinal cord, above and below the injury. Four strips of nerve tissue from his ankle were also used to patch up the gap in his spinal cord. The research methodology is described in the journal Cell Transplantation.1 It was jointly funded by the UK Stem Cell Foundation and the Nicholls Spinal Injury Foundation, a charity devoted to spinal injury research. Three months after the transplantation the muscle in Fidyka’s left thigh began to grow, and after six months he started to walk with the help of a physiotherapist and leg braces. Now, two years on, he can walk using a frame and has also regained some bladder sensation and sexual function. His recovery and rehabilitation were detailed in a BBC1 Panorama programme, “To Walk Again,” on 21 October.
Fidyka described the ability to walk again using a frame as “an incredible feeling” and added, “When you can’t feel almost half your body, you are helpless, but when it starts coming back it’s as if you were born again.” Geoff Raisman, chair of neural regeneration at UCL’s Institute of Neurology who led the UK team, first discovered OECs in
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1985 and successfully showed that they could be used to treat spinal injuries in rats in 1997. Raisman said in a statement from UCL, “It is immensely gratifying to see that years of research have now led to the development of a safe technique for transplanting cells into the spinal cord. I believe we stand on the threshold of a historic advance and that the continuation of our work will be of major benefit to mankind.”
He added, “I believe we have now opened the door to a treatment of spinal cord injury that will get patients out of wheelchairs. Our goal now is to develop this first procedure to a point where it can be rolled out as a worldwide general approach.” Raisman said that the teams were raising funds to verify the treatment in further patients.
Michael Arthur, UCL president and provost, said, “This is an outstanding example of the true power of translational medicine, where great science in the form of successful cell transplantation is brought direct to real clinical need. The results achieved for this patient are truly inspiring, although further work is needed to determine whether the technique can be applied to other patients.” Commenting on the reports of the treatment through the Science Media Centre, Simone Di Giovanni, chair in restorative neuroscience at Imperial College London, said, “[One] case of a patient improving neurological impairment after spinal cord knife injury following nerve and olfactory cell transplantation is simply anecdotal and 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. “The use of these cells for spinal cord injury repair [has] 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.” 1
Tabakow P, Jarmundowicz W, Czapiga B, Fortuna W, Miedzybrodzki R, Czyz M, et al. Transplantation of autologous olfactory ensheathing cells in complete human spinal cord injury. Cell Transplant 2013;22:1591-612.
Cite this as: BMJ 2014;349:g6396 © BMJ Publishing Group Ltd 2014
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BMJ 2014;349:g6396 doi: 10.1136/bmj.g6396 (Published 22 October 2014)
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