Cure for paralysis passes the smell test
Olfactory cells help man walk
A Polish firefighter, paralyzed from the chest down after a knife attack, is walking again after undergoing a revolutionary procedure for spinalcord injuries. But had Darek Fidyka, 38, not suffered from sinusitis, it is unclear whether he would have made medical history as the first paralyzed man to walk again after a nerve cell transplant.
He has described the feeling of recovering movement in his legs as “incredible,” like being born again.
Mr. Fidyka, whose spinal cord was severed after he was attacked by his ex-wife’s husband, had agreed to receive a transplant of cells taken from the nose. These cells, called olfactory ensheathing cells (OECs), are known to influ- ence the regrowth of olfactory nerves, which transport smells to the brain and regenerate every 30 days.
But his surgeons at Wroclaw University Hospital in Poland were forced to take a particularly daring approach: the patient’s mucus membrane, ravaged by chronic allergic sinusitis, meant OEC s 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 cut into the man’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 18 months, the effects of the pioneering operation were clear:
The firefighter, who was also undergoing physiotherapy, was able to move his lower limbs partially, 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 — Mr. Fidyka had shuffled, albeit with the help of a walking frame, along the spectrum to a class C injury, associated with limited movement.
He additionally retained his sense of smell.
The operation was carried out in Poland, but has been hailed as a British breakthrough because it was masterminded by Professor Geoffrey Raisman from the spinal repair unit at University College London’s Institute for Neurology.
“I believe we stand on the threshold of a historic advance,” Prof. Raisman said Tuesday.
The research was also jointly funded by the U.K. Stem Cell Foundation and the Nicholls Spinal Injury Foundation.
Prof. Raisman discovered OECs in 1985 and showed in 1997 they could reverse paralysis in rats. Now, said Kevin Shakesheff, professor of tissue engineering at Nottingham University, that persistence is paying off.
“This isn’t an overnight success story,” said Prof. Shakesheff, who collaborated with Prof. Raisman in the early 1990s.
“Geoff ’s dedicated his brilliant career to this over the past 20 years, and he has been looking at clinical trials over the past decade. He knows more about OECs than anyone in the world.”
Over the past decade, the hope of tissue repair, including nerve regeneration, has largely been fuelled by the hype of stem cells.
In contrast, OECs are not stem cells but adult cells that have already specialized into their final form. But it is exactly their final function — somehow nurturing and encouraging the growth of nerve cells in the nasal passages — that was so successfully exploited in this research.
“This operation has simply transplanted the repair capacity from one bit of the body to another,” said Prof. Shakesheff.
The research was published in the Cell Transplantation journal.
Further studies in patients are planned by the University College London and Wroclaw University Hospital, said Michael Hanna, director of the UCL Institute of Neurology.