According to a new report from the Institute of Medicine of the National Academy of Sciences, a multifaceted approach to research on spinal cord injuries—one that pursues combinations of therapies and ways to treat injuries at different stages—is needed to speed progress toward a cure.
The Institute of Medicine was asked by the New York Spinal Cord Injury Trust to assess the status of research on SCIs and to recommend priorities. The committee that wrote the report said that the National Institutes of Health should establish a Spinal Cord Injury Network to lead and organize future research efforts.
The report Spinal Cord Injury: Progress, Promise and Priorities is available from the National Academies Press by calling 202- 334-3313 or 800-624-6242 or visiting the Web site at www.nap.edu. The report is also available at www.nationalacademies. org.
Providing service on the Institute’s Committee on Spinal Cord Injury that developed this report was Stephen G. Waxman, MD, PhD, professor and chairman of the Department of Neurology at the Yale University School of Medicine. Dr. Waxman also serves as director of the PVA-United Spinal Association Center for Neuroscience and Regeneration Research at Yale.
The public’s perception of a “cure” generally means restoring the ability to walk again, but the committee called for a broader approach. Research should be directed not only at restoring major motor functions such as walking, but also at healing the other body systems damaged by these injuries, such as sensory, bowel, bladder, and sexual functions. Also important is finding ways to prevent or alleviate complications such as pain, spasticity, pressure sores, and depression. This approach was the essence of the testimony of United Spinal’s Deputy Executive Director Paul Tobin at a December 2004 committee hearing in Washington, DC.
Few therapeutic interventions are ready for clinical trials, the report says, but many show promise in cell cultures and animal studies. Transplanting cells that protect axons in other parts of the body may be able to stimulate, guide, and protect new axons in the spinal cord. Also, stem cells from embryonic and various adult tissues show strong potential for replacing damaged spinal cord cells. Much remains to be learned about how to induce stem cells to become specific types of cells, as well as about the safety and effectiveness of transplants.
Finding ways to regenerate nerves is only one part of restoring function. This study suggests that another research priority is finding ways to steer axons’ growth so that they connect with and stimulate the right cells and tissues. The committee also urged further study of post-injury care and rehabilitation methods that can maximize patients’ recovery.
The report recommends that the National Institute of Neurological Disorders and Stroke develop a strategic plan to assess the potential for compounds and therapies to be used in combination. For example, therapies that promote the regrowth of axons could be developed alongside agents that produce myelin, the substance that protects axons and speeds nerve impulses.
A coordinated, centralized network will be needed to implement this approach to combination therapies and to aid the translation of basic research into therapies, the report says. The National Institutes of Health should designate three to four current research programs as Spinal Cord Injury Research Centers of Excellence. These centers would form the core of a larger research network that should link all sites pursuing research on SCIs—including federal, state, academic, nonprofit, and industry efforts—with the goal of increasing the investment of the private sector in the development of therapeutic interventions.
State-sponsored programs have an important role to play, said the committee. Many of them have established reliable funding and are in a key position to fund high-risk pilot studies. And because they manage regional trauma systems, states could help steer patients to clinical trials for acute SCIs.
The report was sponsored by the State of New York Department of Health. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.
Terry Moakley is associate executive director of Communications and Public Affairs at United Spinal.
