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Spinal cord injury. Treatment with stem cells holds much promise of changing life quality for patients with spinal cord injury. Leading Boston-based spine surgeon shares his vast experience of treatment of spinal cord injury. Neurosurgeon explains latest advances in tissue engineering technology. Scaffolding and stem cell therapy will likely change dramatically outlook for spinal cord injury in the next decade. Spinal cord injury treatment with stem cells. There are new advances in spinal cord tissue engineering. Video interview with leading expert in spine surgery. Stem cell treatment of spinal cord injuries involves tissue scaffolding to feed stem cells with growth factors and nutrients. Stem cell–based therapies for spinal cord injury require structural support to quench secondary inflammation. Spinal cord injury treatment with stem cells is rapidly advancing into clinical practice. Medical second opinion after spinal cord trauma ensures that diagnosis is correct and complete. Medical second opinion also helps to select advanced therapy for spinal cord injury. Get medical second opinion on spinal cord injury and be confident that your treatment is the best. Spinal cord injury treatment with stem cells and tissue engineering brings new hope to patients and their families. Repair of injured spinal cord by using biomaterial scaffolds advances spinal cord injury treatment and rehabilitation. Advances made in treatment of spinal cord Injuries give hope for better clinical outcomes. Will stem cell therapy cure spinal cord injury? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. We hope it will help to regrow injured spinal cord and reverse effects of secondary inflammation. Spinal cord injury treatment with stem cells. Dr. Anton Titov, MD. Spinal cord injury. This is another very big topic. Oftentimes patients and families are devastated physically and psychologically. Desperate patients often get treatments that are not evidence-based. Dr. Anton Titov, MD. You deal a lot with the spinal cord injury. This is one of your major clinical interests. What is most beneficial for patients with spinal cord injury in the short term? Dr. Anton Titov, MD. What works for spinal cord injury in the long term? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. Spine Neurosurgeon, Boston. It is a fascinating question. Again, entire careers are spent just studying spinal cord injury. In my former position at Harvard at at Brigham and Women’s Hospital, Dr. Eric Woodard, MD. I was Director the Spine Division. Dr. Eric Woodard, MD. We saw, unfortunately, a significant number of spinal cord injuries. Dr. Eric Woodard, MD. We saw both cervical and mid-thoracic spinal cord injury. Spinal cord injury treatment is changing, fortunately. The traditional treatment of spinal cord injury has been purely supportive. by that Dr. Eric Woodard, MD. I mean generally supporting the blood pressure and the other medical and physiologic functions of the patient who’s been injured. Dr. Eric Woodard, MD. We also focused on removing any compressive lesions, such as fractured bone or dramatically herniated disc from the cord. The goal is to remove the pressure off the cord and give it the best environment to heal. Also it is important to keep blood pressure adequate. These types of things. Those were the mainstays of treatment – supportive. A number of years ago the addition of steroids was added. It was the attempt to reduce some of the swelling and some of the additional inflammation. Inflammation occurs after spinal cord injury. Inflammation in itself can cause further injury after the initial spinal cord injury. Dr. Anton Titov, MD. Like a compartment syndrome, in a sense… Dr. Eric Woodard, MD. In a sense, you are right. There is the initial injury . This, for example, is 10% of the spinal cord. then there is additional 40% of the spinal cord is injured just due to the inflammation. In theory, if you can turn off the inflammation, called secondary injury, you may be able to save more of the viable cord. Dr. Anton Titov, MD. In super acute phase… Dr. Eric Woodard, MD. Correct, this is a immediately peri-trauma. Immediately after the event that caused spinal cord injury. a number of folks have been interested because of experimental models in high-dose steroids. They also aimed to reduce this inflammation. Over the years some excellent clinical trials have been performed to assess effectiveness of steroids. unfortunately, steroids given after the spinal cord injury only minimally affect outcome. In fact, if you treat spinal cord injury with steroids for extended period time immediately after the injury, steroids cause more complications that benefit. there was a lot of enthusiasm years ago for steroid use. But the study showed that it doesn’t benefit significantly outcomes. prolonged steroid use after spinal cord injury causes a higher degree of serious complications. For that reason in the United States now steroids, high-dose steroids in spinal cord injury are decreasingly used. There has been a lot a interest in the last ten years in trying to re-grow spinal cord tissue with technologies involving stem cells. Stem cells, as you know, are specialized cells within our body that can become pretty much any tissue. They can become brain tissue, skin tissue, muscle tissue if they are stimulated in the correct environment. They are very specialized, early cells, very similar to the cells of when we were embryos. Stem cells have been extensively studied. It is an entire field of study now. Stem cell application to spinal cord injury has had a lot of interest. in some areas there is a lot of stem cell research happening. Dr. Eric Woodard, MD. I know in China there has been that a lot of work and in Europe there is been a lot of work. Doctors are trying to adapt stem cell injection into acute spinal cord injury, spinal cord bruises or contusions. one of the problems is the inflammation that occurs right after the injury. Dr. Eric Woodard, MD. I alluded to the inflammation when we talked about steroids. Inflammation is almost toxic, that is why it kills more of the normal spinal cord. Inflammation also kills the stem cells. injecting stem cells acutely into the contusion has not been shown to significantly improve the situation. Dr. Anton Titov, MD. The trials you refer to were done by injection of the stem cells into spinal cord. Dr. Eric Woodard, MD. Correct, stem cells injections. There have been some clinical trials looking at sub-acute and more chronic stem cell injection. That seems to have a bit more favorable outcome. But much in the spinal cord damage has already way past at that time. Most damage has already happened in sub-acute phase. A number of groups are looking at a process known as tissue engineering. In tissue engineering the stem cells are combined with artificial extracellular matrix or a scaffold . This mimics the supporting environment of normal tissue. Dr. Eric Woodard, MD. I have been fortunate to be associated with and one group here at MIT in Boston. Many things can be added to these types of scaffold. Scaffolds are biodegradable, they break down, they are absorbed by the body, they integrate into the normal tissue. Many additional factors can be added to the scaffold Proteins and growth factors can be added to the scaffold. Also a variety of factors that are protective and nutritional for the stem cells can be added. They will additionally influence their development into neural tissue. a combination of both scaffold and tissue engineering technology and stem cells are very active area of research. In fact, we have just started an FDA safety trial and the first patient had the combination scaffold injected into spinal cord injury site just three weeks ago. stems cell and tissue engineering are very very up to date, exciting area of research. in the future tissue engineering techniques will be adaptable to spinal cord injuries. Dr. Anton Titov, MD. Perhaps it is also very important to emphasize this important point. Stem cells are such actively discussed in the media. Nevertheless around the world many patients are offered treatments that are not based on the actual scientific evidence. that unfortunately includes a lot of stem cell-related therapies. Dr. Eric Woodard, MD. That is correct, they are a lot of disreputable “stem cell clinics” unfortunately. People who are emotionally devastated by spinal cord injuries will flock to any possibility of improvement. Dr. Eric Woodard, MD. I can understand that. But stem cell technologies need to be rigorously and scientifically proven before they are widely disseminated to the public. Spinal cord injury treatment with stem cells. Video interview with leading spine surgeon scientist. Tissue engineering and stem cells in new clinical trials.