As the world’s largest health care system providing care to people with spinal cord injury (SCI) and related conditions – more than 26,000 annually – the Department of Veterans Affairs (VA) is at the forefront of supporting and conducting research through a network of sites and facilities to address multiple aspects of SCI, benefitting paralyzed veterans and all people with SCI.
Some advances are very dramatic, others less visible, but on multiple fronts, research is moving forward in ways that provide continuing hope for those with SCI to have increased mobility, fewer medical complications, and better quality of life.
Research at this center focuses on precisely these issues that affect spinal cord injury patients in their daily lives. Their method is to understand the mechanisms responsible for the problem, and then design an intervention to improve function, applying that paradigm to every organ system.
According to Audrey Kusiak, Ph.D., scientific program manager for the VA Rehabilitation Research & Development Service (RR&D) Spinal Cord Injury Program, the Office of Research and Development (ORD) funded 97 projects in FY 2014 on SCI and peripheral nerve injury. “The portfolio is very well rounded,” said Kusiak. “We have a multitude of approaches to study and to help restore function in individuals with spinal cord injury.”
The portfolio’s scope includes medical consequences of SCI on multiple body systems, neural engineering, wheelchair engineering, plasticity (the body’s own reparative process), regenerative medicine or cell therapies, rehabilitation, robotics or exoskeletons, and community reintegration.
The VA has a consortium of researchers conducting ongoing investigations to develop a cell-based therapy that can regenerate damaged spinal cord tissue and restore function. The concept is to regenerate axons, extensions of nerve cells that carry impulses from the cell.
“The good news is that many cell types have been shown to be safe in both animal models and in Phase 1 human clinical trials,” Kusiak said. These cells that assist axonal regeneration include oligodendrocyte precursor cells, olfactory ensheathing cells, mesenchymal stem cells, and neural progenitor cells.
“This is a really big step for the cell therapy/regenerative approach,” she added, because if these cell types are safe, the research can move to combining the cells with growth factors and possibly bio-material scaffolds with the goal of restoring function.
With studies having been done in rodents, the research is moving toward a long-term chronic SCI model to more appropriately represent the chronically injured patient. “The model is now a non-human primate model that has been injured three to six months and then transplanted with the cell therapy. The team is seeing some very interesting results from this,” said Kusiak, noting that the cell therapy is combined with a targeted rehabilitation program “to take advantage of the body’s own reparative processes.”
Obtaining results is very slow because the animals must survive two years in order to gather data, she continued. “We’re seeing from MRIs that the cells are surviving, and we do see the anatomical extension of axons, much like we did see in the rodent model. So the anatomy looks really good. We’re trying to see what’s happening in terms of the function now.”
Medical Consequences of SCI
In addition to paralysis, people with SCI face multiple complex medical problems, including muscle and bone atrophy, pressure ulcers, pain, cardiovascular disease, pulmonary disease, bowel and bladder issues, and many others. Founded by William A. Bauman, M.D., and Ann M. Spungen, Ed.D., director and associate director, respectively, the RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury at James J. Peters VA Medical Center (VAMC) in Bronx, New York, works to improve the quality of life and increase the longevity of patients with SCI by identifying problems and finding solutions to these issues.
“We all appreciate that if someone has a spinal cord injury, they have difficulty moving their legs, or if it’s a higher lesion, their arms and their legs,” said Bauman. “That has been the focus of much of the interventions and research that was performed for decades, and the medical consequences of spinal cord injury, which is what patients deal with on a day-to-day basis, got short shrift.”