Brain, heal thyself
Texas Children’s surgeon in chief talks about regenerative medicine.
In the often mysterious world of regenerative medicine, doctors can harness the power of a body’s own cells to heal itself. After decades in pediatric surgery, Dr. Kevin Lally, surgeon in chief at Children’s Memorial Herman Hospital and chair of the department of pediatric surgery at McGovern Medical School at UTHealth, heads a team of researchers who are working on a way to use such treatment for children and adults with traumatic brain injuries.
According to the Centers for Disease Control, 1.7 million people sustain traumatic brain injuries each year in this country; about 275,000 are hospitalized; and 52,000 die. Nearly a half million who end up in the emergency room are somewhere between newborns and age 14.
In collaboration with Dr. Charles Cox, co-director of Memorial Hermann Red Duke Trauma Institute and lead investigator on UTHealth’s traumatic brain injury stem cell trial, the team has found that using a patient’s own stem cells appears to dampen the body’s inflammatory response to trauma and preserve remaining brain tissue.
The Chronicle sat down with Lally to discuss the promising development. These are his edited comments:
Q: Can you please explain in the most basic terms what you are doing?
A: We’re using the patient’s own stem cells to help them repair their brain.
Q: What is the theory behind this?
A: It probably goes back 20 years. When the field of tissue engineering was in its very early phases, it created an exciting opportunity for me as a pediatric surgeon. The fundamental problem that we had, and still have, is that there are children who have deformities or problems where ideally you would create a new piece of tissue out of their own tissue that would grow with them. In traumatic brain injury, we actually thought that we were going to make new brain tissue. That’s not how it works.
Q: So what does work?
A: When you have a brain injury, you have the immediate injury, but at the same time the body responds and may set up inflammations to joints or some other place. That’s dangerous. When we use the stem cells, it shuts that inflammation off. It turns it off and allows the body to recover. We can’t fix the part that’s gone, but we can stop further injury and at the same time allow the brain to heal itself. Without the stem cells, you have this ongoing inflammation and injury in the brain.
Q: Is there an impact on life expectancy?
A: That’s our hope. Even if you get a little difference in function, it’s an enormous difference in a child’s life. If you have someone who can’t sit up at the table, maybe they have cerebral palsy, and you move from a wheelchair-bound person to someone who can sit at the table with the family, that’s a big impact.
Q: So where is your research right now?
A: We are in Phase 2 trials for children and a Phase 2 trial as well for adults with head injuries. The kids are funded by the National Institutes of Health, and the adults are funded by the Department of Defense.
Q: What have the results been so far?
A: Very promising. If you look at the brain imaging on these injured children, they stop repairing themselves in normal cases. But in stem cell patients you see progressive evidence of ongoing improvement.
Q: What is your role?
A: I’m just a supervisor, and I help. If you think of the Olympic curling thing where there’s someone in front who does the sweeping to get things out of the way, I’m the sweeper. My job is to collect and support enormously talented investigators like Dr. Cox. Because we have such a busy trauma center, we can bring these patients in for trial. These are patients with severe traumatic injury, not in mild concussion. That project is finished, and now we are in a second phase of a trial to look at it more critically and determine if it’s a truly effective therapy.
Q; Where do you want to see this go?
A: All over the place.