It has allowed a paralysed man to walk again, so just how far can cell treatment go? Sarah Freeman reports on the revolutionary techniques being pioneered in the UK.
Claire Lomas has had this week marked in her diary for months.
It’s seven years since the mother-of one was left paralysed following a freak horse riding accident and she has been patiently waiting for the day when the world would get to hear about a pioneering treatment which could eventually transform her life and thousands like her.
Yesterday, that wait was over, when footage was released of 40-year-old Darek Fidyka taking his very first steps unaided since being paralysed from the chest down following a stabbing attack in 2010. The Polish fireman is the first person in the world to undergo the ground breaking procedure which has been developed and championed by one UK scientist.
“I felt I was privy to an incredible secret,” says Claire, who is patron of the Nicholls Spinal Injury Foundation, which helped fund the research along with the UK Stem Cell Foundation. “It’s not to say that treatment will be available to everyone with a spinal injury, but it is a huge step forward. One of the key things is that Darek had been paralysed for over the year.
“Any improvements with spinal injuries tend to happen within the first 12 months. After that, there is no chance of the body healing itself, which is why this procedure is so revolutionary.”
Almost from the day she was told she was unlikely to ever walk again, Claire, who was treated at Sheffield’s Northern General Hospital after she was thrown from her horse during a three-day event competition, has been determined to defy the bleak prognosis.
Using a battery-powered robotic suit manufactured by Cyclone Technologies, based near Hull, she successfully completed the London Marathon, is in much demand as a motivational speaker and recently cycled 400 miles around the country on a hand-powered bike, stopping off at various schools to share her story. However, despite her relentless positivity, living with paralysis is not easy.
“It’s not just the fact you can’t walk, but it effects your bowel and your bladder - they’re the less visible side-effects of a spinal injury,” says Claire, who has a three-year-old daughter Maisie. “I still consider myself lucky that I didn’t end up paralysed from the neck down or suffer a major head injury. I’ve tried to not let it stop me doing the things I want to in life, but if I had the chance to walk again unaided would I seize it? Of course I would.”
The pioneering procedure is the work of Professor Geoffrey Raisman, who has spent the last 40 years perfecting spinal cell treatment. Now based at University College London’s Institute of Technology, he and his team have quietly been plugging away in the laboratory, determined to find a way to help damaged spinal chord nerves repair themselves - something that was previously thought impossible.
“The observed wisdom is that the central nervous system cannot regenerate damaged connections. I never believed that,” says Prof Raisman. “Nerve fibres are trying to regenerate all the time. But there are two problems - crash barriers ,which are scars and a great big hole in the road. In order for the nerve fibres to express that ability that they’ve always had to repair themselves, first the scar has to be opened up and then you have to provide a channel that will lead them where they need to go.”
The procedure involves transplanting olfactory ensheathing cells (OECs) from the nose to the spinal cord where they appear to enable the ends of severed nerve fibres to regrow and join together. The team’s work builds on a body of research in a field known as ‘plasticity’.
“Imagine that part of the M1 motorway from London to Edinburgh has been washed away by the River Trent in the Midlands,” explains Prof Raisman. “Cars will eventually find their way through the B roads and country roads - that’s plasticity. Clearly it’s never going to be as efficient as using the motorway. What we’re doing is repairing the motorway and it’s the first time this has been achieved.”
Darek began his treatment two years ago. Six months after surgery, carried out by a team in Poland, which included Dr Pawel Tabakow, one of the world’s leading spinal repair experts, he was able to take his first steps with the help of parallel bars and leg braces. Today he is able to walk relatively freely with just the support of a simple frame.
“The patient is now able to move around the hips and on the left side he’s experienced considerable recovery of the leg muscles,” says Prof Raisman. “He can get around with a walker and he’s been able to resume much of his original life, including driving a car. He’s not dancing yet, but he’s absolutely delighted.”
Someone who has witnessed Prof Raisman’s commitment to the cause is John Haycock, professor of bioengineering at the University of Sheffield.
“When he first said that he believed damaged spinal cords could be remodelled in the 1980s it was quite controversial. There were a lot of people who dismissed it as nonsense. Lesser scientists might have been put off, but Prof Raisman just kept on going and that is incredibly admirable.
“He knew that the cells in the nose get battered every single day and yet when they are damaged they are able to regenerate. His basic idea was to take those cells and see if that same principle could work in a different part of the body. Over the last few decades he has put his theory through meticulous trials, but finally his belief and hard work has paid off.”
Prof Haycock is working on a similar project, which if it comes to fruition will allow peripheral nerve damage in hands and feet to also be repaired. His team are just at the start of a four-year period of funding with the aim of developing a new material which can be implanted in patients. The idea is that it will act as a bridge between damaged nerves, allowing new cells to grow across and so restore the connection.
“When it comes to treating those with spinal cord injuries, there isn’t one size fits all,” he says. “This particular patient had the least severe type of nerve damage and there may well be different outcomes for those who have damaged their spine in a different way. Clearly, it’s also a very expensive form of treatment and it will be interesting to see what happens now in terms of funding.”
Prof Raisman hope that if they can raise enough money, the team in Poland will be able to treat at least three more patients in the next three to five years.
“There are millions of people around the world who are paralysed,” adds Prof Raisman. “If we can convince the global neurosurgeon community that this works and that it is not the result of spontaneous repair through hidden residual nerve connections then it will develop very rapidly indeed.”