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Combinatorial pharmacological and biomaterial-based intervention after experimental spinal cord injury therapies to promote spinal cord repair
What you need to know
Institution:
Imperial College London
Lead researcher:
Prof. Simone Di Giovanni
Functional target:
Plasticity and Regeneration
Treatment type:
Pharmacological
- The cellular and molecular interactions in the spinal cord micro-environment are highly complex, many processes continue to remain poorly understood.
- Researchers have identified a small molecule called TTK21 which will be used to attempt regeneration in combination with a bioactive scaffold creating a bridge through the injury site after SCI.
- Researchers will study any biochemical changes as well as improvements in recovery.
In a nutshell
Following spinal cord injury (SCI), normal regrowth of injured nerve axons fails. (Adult nerves do not regenerate after SCI)
Researchers have recently discovered that a small molecule called TTK21, is associated with the growth of sensory and motor axons and promotes active new connections in chronic spinal cord injury. However, this molecule has some limitations. Unfortunately, TTK21 itself is not effective at promoting nerve growth across the lesion.
Using animal models, this study will exploit the growth potential of TTK21 via a biological scaffold which will bridge the injury site, and therefore allow neuronal regrowth across the lesion.
How this supports our goal to cure paralysis.
Ultimately, these studies aim to better understand the various molecular components which regulate neurons. By obtaining a more detailed understanding of the various biochemical processes, researchers hope to identify targets that can be used to promote repair and recovery after spinal cord injury.
Although current studies are performed using animal models, these biomaterials are already proven to be safe in humans, therefore they have the potential to be translated to humans to foster axonal growth and subsequent recovery of function.
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ImPRESS: Improving Pelvic Rehabilitation using Epidural Stimulation after SCI
What you need to know
Institution:
Royal National Orthopaedic Hospital
Lead researcher:
Dr. David Baxter
Functional target:
Bowel, bladder, sexual function
Treatment type:
Neuromodulation, Rehabilitation
- While the bladder and bowel are relatively simple organs, their control system is highly complex and becomes severely compromised following a Spinal Cord Injury (SCI).
- Existing bowel management techniques are far from ideal as around half of people living with SCI continue to experience incontinence, constipation and infections.
- Improving bowel management is a major priority among people living with a SCI.
In a nutshell
Recently, studies exploring epidural stimulation (stimulation of the spinal cord) for restoration of motor function after SCI have identified important improvements in pelvic (bladder and bowel) functions. In this trial we will explore epidural stimulation specifically targeting bowel function in people with SCI.
This study will recruit volunteers with SCI to undergo a short trial with epidural stimulation.This will involve the surgical implantation of electrodes close to the spinal cord, in the epidural space, whilst the device and wires are placed external to the body. Stimulation will initially be trialled in hospital to measure the effects on bladder and bowel function; then volunteers will trial stimulation at home alongside their usual bladder and bowel management.
People who respond well to the trial will then be offered a fully implantable epidural stimulator. We will ask them to use their stimulator at home for 8 weeks whilst performing a programme of pelvic floor muscle training. Before and after the programme, we will measure their bowel function. At the end of the trial, volunteers can have their implanted devices removed or keep them.
How this supports our goal to cure paralysis.
Restoration of bowel, bladder and sexual function are rated among the highest priorities for recovery in individuals with SCI. Not only do these conditions individually impact the health-related quality of life, but they also have life-threatening complications. For example, stimuli from bladder (during care, catheterization, or evaluation) are the most frequent triggers of severe episodes of hypertensive crisis known as autonomic dysreflexia. Despite this, the vast majority of research is focused on overt disabilities following SCI (e.g., motor paralysis), whereas more devastating ‘invisible’ disabilities, like pelvic organ dysfunctions, are unfortunately understudied.
This research could help develop a safe and long-term route to improving these critical functions for those living with paralysis. This would be life changing, helping to restore freedom, and dignity to the community.
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Determining the effects of transcutaneous spinal electrical stimulation on sensorimotor function in chronic complete tetraplegia
What you need to know
Institution:
Glasgow University
Lead researcher:
Dr. Mariel Purcell
Functional target:
Upper limb function
Treatment type:
Neuromodulation, Rehabilitation
- Following a spinal cord injury, sensation and function is often lost below the level of injury
- Stimulation of the spinal cord through modulated electrical pulses has shown the potential to restore function post injury.
- Stimulation can be delivered safely through the skin. This is known as transcutaneous stimulation.
In a nutshell
This study aims to investigate the use of transcutaneous spinal cord stimulation (tsES) in the recovery of function and sensation. The neuromodulation stimulator used in this study could become a low-risk treatment and can easily be adopted in rehabilitation or community settings.
There is a potential for individuals with SCI to benefit from the recovery of lost sensory and motor function with lasting improvements leading to increased independence and quality of life
Project Summary
In a previous pilot study, four chronic complete tetraplegic participants with a spinal cord injury (SCI) received four-week transcutaneous spinal cord stimulation as well as prescribed activity-based therapy (ABT). This resulted in two of the subjects gaining lasting sensory and motor function below their injury level.
The aim of this study is to investigate this further, with a similar patient cohort but over a longer period. Prior to delivering up to 16 weeks of tsES/ABT, the research team will pre-condition (strengthen) the participants’ paralyzed muscles using 6 weeks of functional electrical stimulation (FES) therapy.
The study aims to observe any immediate and lasting changes in motor (movement) and sensory function.
How this supports our goal to cure paralysis.
Stimulation of the spinal cord aims to maximise the existing connections or ”spared circuitry” which exists in the majority of spinal cord injury cases.
Studies such as this show the potential of stimulation away from a ”clinical” setting and could allow members of the SCI community to use this device within the home environment to improve function after injury.
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Non-invasive neuromodulation to treat bladder, bowel and sexual dysfunction following spinal cord injury
What you need to know
Lead researcher:
Prof. Andrei Krassioukov
Functional target:
Bowel, bladder, sexual function
Treatment type:
Neuromodulation, Rehabilitation
- Research shows that autonomic recovery (i.e. bladder, bowel and sexual function) is a priority for people living with spinal cord injury (SCI). However there is still a major lack of research dedicated to improving this for people living with spinal cord injury (SCI).
- This clinical study examines the effects of “transcutaneous” (over the skin) electrical stimulation of the spinal cord (TCSCS) on promoting recovery of bladder, bowel and sexual functions in individuals with SCI.
- This non-invasive therapeutic method involves the application of electrodes over the skin, and is based on ground-breaking work which has shown that spinal cord stimulation can promote functional recovery in individuals with chronic (long-term) SCI.
In a nutshell
- Establish stimulation parameters (i.e., electrode positioning/stimulation intensity) necessary for TCSCS to activate the bladder, bowel and skeletal muscles responsible for successfully passing urine & faeces.
- Monitor the long-term (6 weeks) beneficial effects of TCSCS on bladder, bowel, and sexual functions.
To assess the potential for TCSCS to offer a simple, cost-effective solution to treat autonomic dysfunctions (i.e., urine and faecal incontinence, erectile and vaginal lubrication difficulties etc.) that would significantly improve overall health-related quality of life for individuals with SCI.
How this supports our goal to cure paralysis.
Restoration of bowel, bladder and sexual function are rated among the highest priorities for recovery in individuals with SCI. Not only do these conditions individually impact the health-related quality of life, but they also have life-threatening complications. For example, stimuli from bladder (during care, catheterization, or evaluation) are the most frequent triggers of severe episodes of hypertensive crisis known as autonomic dysreflexia.
Despite this, the vast majority of research is focused on overt disabilities following SCI (e.g., motor paralysis), whereas more devastating ‘invisible’ disabilities, like pelvic organ dysfunctions, are unfortunately understudied.
Transcutaneous spinal cord stimulation could offer a simpler and cost-effective solution that utilizes readily available, inexpensive, conventional electrodes with an established safety profile. Findings from this study may ultimately lead to the development and commercialization of new treatments strategies resulting in a reduced burden of care and improved quality of life for people with chronic SCI.
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Meet the scientists
Our network of scientists are helping develop life changing research.
Meet our scientists
Glossary
Explore our useful guide to the language of spinal cord injury
Glossary
