Driving a treatment for spinal cord injury

Every day in Australia, through spinal cord injury, one life is changed forever. Approximately15,000 Australians currently live with paralysis caused by spinal cord injury and each year around 300 people are diagnosed with the condition. Each case incurs a cost between $5– $9.5 million over a lifetime, costing the Australian economy around $2 billion annually. A successful treatment would not only transform the lives of sufferers, but also create substantial savings for the entire health system.

Researchers like Associate Professor James St John from the Menzies Health Institute Queensland (MHIQ) and the Griffith Institute for Drug Discovery (GRIDD) at Griffith University are working towards exactly that. Their globally recognised team is planning to undertake a clinical trial next year to progress this journey and show that this therapy can further regenerate patients’ sensory and motor function.

The path to ending paralysis

Research into finding a treatment for paralysis has been undertaken across the world for decades. There have been many dead ends, many partial discoveries and a lot of hope. But now, the pathway to ending paralysis is illuminated. The potential answer? Taking a special type of cell from a patient’s olfactory (sense of smell) system and transplanting it into the spinal cord injury site.

Associate Professor James St John and Associate Professor Jenny Ekberg from the Clem Jones Centre for Neurobiology and Stem Cell Research are leading the world in the discovery of a treatment for paralysis and brain injury. Pioneered by the 2017 Australian of the Year—Professor Emeritus Alan Mackay-Sim, this research is working to transform the lives of people who have experienced serious trauma. By combining advanced cell purification techniques with natural product drug discovery and biomedical engineering, the team is designing three-dimensional nerve bridges that will help injured nerves to regenerate.

This exciting new therapy now offers hope for a treatment that could see paralysed patients regaining movement and feeling again.

“By developing a therapy to treat the injured spinal cord, we can then apply similar approaches to treat acquired brain injuries,” says Associate Professor St John.

“Every day in Australia at least one person’s life is devastated by spinal cord injury and many more by brain injury. Our research gives thousands of Australians hope that paralysis doesn’t have to be forever.”

The 2020 trial

The Spinal Injury Project led by Associate Professor James St John and his dedicated team from the Clem Jones Centre for Neurobiology and Stem Cell Research is well underway to progress their pre-clinical research into a Phase I/IIa human clinical trial in 2020. The first human efficacy study in 2014 showed the therapy was effective for partially repairing the human spinal cord. Now it’s time to make this therapy more effective, available and affordable.

The aim is to conduct a Phase I/IIa clinical trial of a small number of patients with chronic spinal cord injury. First, patients will conduct a sustained functional activity-based therapy to prime their spinal nerves, brain and muscles for the cell transplantation. Then a 3D nerve bridge made of olfactory cells will be implanted into patients with chronic spinal cord injury. The 3D nerve bridge maximises the efficacy of the olfactory cells, reduces the existing scar tissue, and promotes the regeneration of the nerve cells.

This methodology ensures that patients receive optimal restoration of motor and sensory function and that outcomes are as consistent as possible. Intensive and sustained functional therapy will be performed starting immediately after surgery for at least 12 months to maximise the regeneration of motor and sensory neural connections. Functional recovery is hoped to be detected in patients within several months after the transplantation. The clinical trial is anticipated to start in south-east Queensland in late 2020. The complete Phase I/IIa clinical trial is expected to cost $20 million over six years.

What are olfactory ensheathing cells?

The olfactory system—or sense of smell—is unique in mammals in that its nerve cells are able to constantly regenerate. It’s the only part of our nervous system that regenerates every single day as part of its normal function. And it’s lucky that it does: every time we breathe in, the nerve cells in our nose are exposed to the bacteria and toxins and get killed off. If these didn’t regenerate, humans would lose their sense of smell in around a month. Olfactory ensheathing cells (OECs) are crucial to this process of regeneration. They prevent scarring

and protect and guide the growing nerve cells. With this knowledge, scientists from around the world have tested the efficacy of OECs for repairing the injured spinal cord, with promising results.

Hope in sight

“While we believe this approach will be successful, there is still a long way to go. This transformative research has the long-term support from the Perry Cross Spinal Research Foundation, the Motor Accident Insurance Commission and the Clem Jones Foundation—but we need your help too. Griffith University and its partners are on a journey to develop a treatment for paralysis for all. With an evidence-based end game in sight—it’s time to make the impossible, possible,” says Associate Professor St John