A cure for quadriplegia
As Kerri-Anne Kennerley and her husband, John, embark on his rehabilitation journey, Clair Weaver investigates new treatments.
WHEN THE ne ws broke that John Kennerley had been paralysed in a freak accident, comparisons were immediately drawn to the late actor Christopher Reeve. At first, it seemed John’s injuries were similar to those of the Superman star, who was left quadriplegic after an equestrian accident 21 years ago.
However, we now know John’s condition is less severe than originally feared. Unlike Christopher, whose skull became disconnected from his spine and had to be surgically reattached, John has “incomplete quadriplegia”, with some feeling and movement below his injury. John broke his C3 and C4 vertebrae, which are near the top of his spine, but lower than Christopher’s C1 and C2 injury, which left him on a ventilator. Just a centimetre or two can mean the difference between hope and despair.
Despite his catastrophic injuries, Christopher became a powerful advocate, leading his eponymous foundation in funding scientific discoveries and debunking the centuries-old dogma that the spinal cord could never be repaired.
✽✽✽✽✽ over the past decade, headlines have regularly heralded miracle treatments for spinal injuries, often with stem cells. Nevertheless, in reality, there’s still little that can routinely be done today for patients beyond minimising post-accident damage, good rehabilitation and making the most of life in a wheelchair.
It begs the question: is there real hope in this field or is it all hype?
Stem cells
We can expect to see big leaps in treatment in coming years – but not in the form of a magic bullet cure. That’s the advice of Dr Andrew Nunn, Director of the Victorian Spinal Cord Service at Austin Health.
“Stem cells are part of the equation,” Dr Nunn says. “We’ll see progress, but the way we think about this will change.”
The theory of using stem cells to reverse damage or restore function in a person with paralysis is beautiful. Stem cells have the potential to develop into different cell types in the body and can renew themselves. However, with spinal injuries, it’s not simply a matter of injecting generic stem cells and letting them do their work.
“The spinal cord is made up of many nerves and axons [which act like] computers and cables – and they have different cells,” explains Dr Nunn.
Complicating matters, he adds,
“The best stem cells [for treatment] are those as close to the one you are trying to replace.” Vital “cable” insulation, known as myelin, must also be reproduced.
The obstacles don’t end there. Professor Martin Pera, Program Leader of Stem Cells Australia and Chair of Stem Cell Sciences at the University of Melbourne, explains, “Challenges for transplantation therapy include making connections between nerve cells across the damaged region, the presence of scar tissue and the poor survival and integration of grafted cells.”
Duncan Wallace, CEO of SpinalCure Australia and himself quadriplegic, is optimistic, but acknowledges that the glacial pace at which stem cell research moves can be “hugely frustrating” for those waiting for a breakthrough.
“Stem cells have huge potential,” he says. “The real benefit will come when they’re combined with other therapies, like electrical stimulation.”
There are international clinic trials underway, but no more than partial recoveries have been recorded in some animal studies to date.
“If we can rebuild parts of the brain or spinal cord with stem cells,” says Dr Nunn, “it will be monumental progress. We hope this works, but we need people to be realistic.”
Breakthroughs
US-based Christopher & Dana Reeve Foundation is driving exciting research into epidural stimulation, which implants an electrical device into a patient’s spine. It sends signals to their spinal cord, reminding it what it can do (think of the spinal cord as disconnected, not dead).
Rob Summers, a baseball player who was paralysed from the neck down after being struck by a hit and run driver, is one of four men who received epidural stimulation.
“I’ve got a lot of function back,”
Rob says. “I can move my toes, ankles, knees, hips – all on command. I have gotten back very good sensation and feeling, as well as bladder, bowel, and sexual function, the ability to sweat … my experience has been life-changing.”
On our own doorstep, the Victorian Spinal Cord Service did a world-first triple nerve transfer, restoring hand and arm function to a 23-year-old man left quadriplegic after diving into the surf.
“It’s the greatest thing that’s been done for quadriplegics,” says Dr Nunn. “It’s hand function they want most of all, even more than leg function.”
Since 2012, Dr Nunn says the team has completed around 100 surgeries to re-route nerves that don’t function because of injury to working nerves.
Meanwhile, US scientists recently revealed in the journal Nature how they implanted a microchip into a 24-year-old quadriplegic’s brain so he regained control of his right arm. Using his thoughts, he could send instructions to his fingers and wrist, and play a video game guitar, pour from a bottle and pick up a phone via a signal decoder and electrode sleeve around his forearm.
False hope
One of the problems with the hype around stem cells is some unscrupulous or over-enthusiastic clinics are ready to offer unproven and unregulated treatment.
And with the internet, it is easy for people to find out about or be targeted for therapies offered in China, India and Eastern Europe.
Associate Professor Megan Munsie, Head of Education, Ethics, Law & Community Awareness at Stem Cells Australia, has interviewed people who have travelled overseas to receive unregulated stem cell therapy, as well as the clinics and regulators.
“Because of the enormous potential of regenerative medicine, people who never had hope before have something to latch on to,” says Professor Munsie. “We have heard there are people in rehab who hear about stem cells and question whether they need to do physiotherapy because they are talking about getting out of hospital and going to India for stem cell therapy.”
If it was your child who was paralysed, she says, you would do anything, even re-mortgage your home.
Dr Mario D’Cruz, a Victorian doctor who became quadriplegic 15 years ago after a car accident, says patients are vulnerable to exploitation by unethical operators.
“The impact can be devastating when it becomes obvious treatment hasn’t worked,” he says. “The persisting impairment coupled with the large financial outlay can be as traumatic as the injury, and can lead to major rifts and disputes among family and friends.”
Professor Pera says there are big risks, including infections and tumours. “This is a new science, so we still have an enormous amount to learn about the best way to use cells to repair injury or disease,” he says.
Moving forward
While we wait for future treatments, experts are now focussing on improving outcomes. This includes immediate care after an accident to prevent secondary injuries and neuroprotective measures (drugs and cooling to reduce inflammation and slow injury progression).
In Christopher Reeve’s case, the timely administration of a steroid likely reduced the severity of his injuries.
“We need to help people preserve what they’ve got so if anything does come along, they’re physiologically prepared,” says Dr Nunn.
Dr D’Cruz is optimistic it’s “only a matter of time” before stem cell signalling codes are deciphered sufficiently to develop an effective treatment, but this treatment would have to be straight after an injury.
“A stem cell cure for older spinal cord injuries has a far less convincing scientific rationale,” he says. “It’s less likely [a cure for] established paraplegia and quadriplegia will emerge.”
Such realism doesn’t get him down, though. Indeed, Dr D’Cruz, who often talks to those who have just begun living with a spinal injury, says his life is better today than it was pre-accident.
“I’m able to continue practising as a doctor,” he says. “I find doing things for other people is often more rewarding and fulfilling than doing things for myself. I have a large extended family and many friends with whom I enjoy cooking, eating and living a truly fortunate life.”
“Stem cells are part of the equation. We’ll see progress.”