Professor Wagih el-Masri, a surgeon and founder of spinal injury charity SPIRIT, watches as Bulgarian man Darek Fidyka walks with the aid of leg-braces and parallel bars at the Akron Neuro-Rehabilitation Center in Wroclaw, Poland, after receiving revolutionary treatment to repair a severed spinal column that rendered him paralysed from the chest down. Source: BBC Source: AFP
British professor Geoff Raisman, chair of neural regeneration at University College London’s Institute of Neurology, who jointly led a project to treat paralysed Bulgarian man Darek Fidyka. Source: BBC Source: AFP
Professor Alan Mackay-Sim one of the pioneers involved in the 2002 world-first Brisbane trial which involved the implanting of nasal cells into the spinal cord of a paralysed patient. Photo: David Kelly Source: News Limited
ON the other side of the world, a man paralysed from the waist down after a knife attack four years ago, is walking again with the aid of a frame and it’s thanks, in part, to Queensland researchers.
A Brisbane team of doctors and scientists has been left pondering what might have been after news broke this week of Bulgarian fireman Darek Fidyka’s breakthrough operation in Poland which involved transplanting nasal cells into his spinal cord.
Twelve years ago, the Queensland group, led by Griffith University scientist Alan Mackay-Sim, was the first in the world to implant olfactory ensheathing cells into the spinal cord of a patient severely paralysed in a car accident, the damage much more severe than in Fidyka’s case. Two more patients followed at Brisbane’s Princess Alexandra Hospital, under the trial’s medical director, Tim Geraghty.
The pioneering study ended in 2007 with the Brisbane researchers concluding the process was safe – a mandatory first step before bigger trials – but a frustrating lack of funding prevented them from furthering their work.
The Courier-Mail’s July 11, 2002, front page story of the world-first surgery.
“We would have liked to have continued but we didn’t have the money,” Professor Mackay-Sim says.
British researcher, Geoff Raisman, who worked with the Polish surgeons in Fidyka’s case, was a keen follower of the revolutionary Australian research, flying to Brisbane to meet with the Queensland team within days of the first operation being announced exclusively in The Courier-Mail in July, 2002.
Seventeen years earlier in animal studies, Professor Raisman found that olfactory ensheathing cells, which form part of the sense of smell, allow nerve fibres to be continually renewed, triggering hope they may be useful in spinal cord regeneration. When the spinal cord is damaged, scar tissue forms at the injured site, preventing nerve fibres from regrowing.
Raisman, chair of neural regeneration at University College London’s Institute of Neurology, performed the first transplant of olfactory ensheathing cells into the spinal cord of a rat in the 1990s.
This week, Fidyka’s small, halting steps with the aid of a frame were portrayed as a giant leap for research into spinal regeneration.
Bulgarian man Darek Fidyka walks with the aid of leg-braces and a walking frame at the Akron Neuro-Rehabilitation Center in Wroclaw, Poland. Source: BBC. Source: AFP
“To me, this is more impressive than a man walking on the moon,” Raisman says. “I believe this is the moment when paralysis can be reversed.
“What we’ve done is establish a principle – nerve fibres can grow back and restore function, provided we give them a bridge.”
In 40-year-old Fidyka’s case, nerve grafts from his ankle were placed across the injured spinal cord and olfactory ensheathing cells were implanted above and below the injury.
The scientists believe the nasal cells provided a pathway, enabling nerve fibres above and below the injury to reconnect, using the nerve grafts to bridge the gap in the spinal cord.
Mackay-Sim greeted the news with excitement, given the reputation of the team behind Fidyka’s treatment. But he’s also cautious.
“My hope is it’ll stimulate a lot more people to try this in spinal cords in different states of repair,” he says.
“Before we suspend our disbelief and think that it’s an absolute cure for everything, we have to see if it could be done in other patients.”
Professor Alan Mackay-Sim. Source: News Corp Australia
Ear, nose and throat surgeon Chris Perry, who was also involved in the Brisbane trial, says it was done under rigid ethical protocols restricting the type of patients that could receive the transplanted cells.
Although the trial was designed primarily to test the safety of the process, one of the patients reported improved sensation in his legs after the experimental treatment.
“Our trial was a safety study to make sure no tumours grew,” Associate Professor Perry says. “We had all the technology, we were ready to continue the work but we couldn’t get more funding.
“It’s a perfect example of why we should be funding science in this country and we should be supporting it.”
Mackay-Sim, who is having treatment for multiple myeloma, a blood cancer, says the case underlines the importance of the Federal Government’s proposed $20 billion medical research future fund. If the fund gets off the ground, he says the results it produces may ultimately save the health system more than the research costs.
British professor Geoff Raisman, chair of neural regeneration at University College London’s Institute of Neurology, jointly led the project to treat Darek Fidyka. Source: BBC. Source: AFP
About 300 Australians suffer spinal cord injuries each year. The financial burden of spinal paralysis is estimated to cost the community $2 billion a year, but Mackay-Sim’s Griffith University colleague James St John says funding for biomedical research is “frustratingly low”.
“With considerable funding commitments, the restoration of function could be a reality for many patients,” says
Dr St John, a lead stem cell researcher at the university.
The National Centre for Adult Stem Cell Research clinical manager Julie Cochrane, based at Griffith University, is still in contact with patients recruited for the Brisbane trial. She says the study was met with considerable resistance before it was approved.
“The hospital was nervous. We were setting a precedent,” she recalls. “No one had ever done it before. For an ethics committee to say yes to something like this when you’ve got nothing to compare it with was a big leap of faith for everyone involved.
“We had plenty of people saying: ‘You’re cowboys’. But when it all proved to be safe, they did a complete backflip. Our study kicked off discussions around the world about doing these sorts of studies in humans. It’s exciting that something’s gone on from our research. The work opened the way.”
With Fidyka’s treatment being compared with landing on the moon, Perry describes Brisbane’s contribution as akin to Russian cosmonaut Yuri Gagarin becoming the first human launched into space.
janelle.miles@news.com.au