"In one day, three patients were able to stand, walk, ride a bike, and even swim."
Written by | Ling Jun
Source | "Medical Community" public account
Allowing patients with spinal cord injury (SCI) paralysis to regain their feet and even regain multiple motor functions may become a reality.
On February 7, Nature Medicine published a blockbuster article in which Swiss researchers used tablet-controlled neurostimulation devices to restore diverse motor abilities to the most severe SCI patients.
"In one day, three patients were able to stand, walk, ride a bike, and even swim." Professor Grégoire Courtine of the Swiss Federal Institute of Technology in Lausanne said. According to the researchers, no side effects have been recorded, and further large clinical studies will be conducted, with the goal of making all patients paralyzed by spinal cord injury available within a few years.
His spinal cord was completely severed and he can now "swim"
In fact, as early as 3 years ago, the team has achieved a blockbuster breakthrough. At the end of 2018, a picture of a man standing and walking spread around the world.
Source: CNN
David M'zee, 30, suffered a partial spinal cord injury during a 2010 sports accident and doctors determined he would never be able to stand and walk.
But in 2018, he was involved in a trial by a Swiss research team. The researchers implanted a device that provided electrical stimulation just below the point of injury to David M'zee's spine. He was thus able to get up from his wheelchair and walk with the help of a booster.
In 2018, the Swiss team developed the system
Later, the same research team developed another system. Unlike David M'zee, the three patients involved in the latest trial had complete spinal cord damage.
Michel Roccati was one of three subjects whose spinal cord was completely severed in a car accident 5 years ago. But in the months after implanting the latest device, he was able to stand for hours, walk nearly a kilometer, climb stairs, swim and canoe.
Unlike before, the team used a new electrode plate that targets all the nerves associated with leg and trunk movements in the spinal cord.
"The breakthrough was the design of longer, wider implantable wires with electrode arrangements that are exactly the same as spinal nerve roots," said Professor Jocelyne Bloch, a neurosurgeon and one of the researchers. "This allows us to reach more muscle and precisely regulate the neurons of a particular muscle."
According to the public account "Shenghui", Li Xiaojian, a senior engineer at the Institute of Brain Cognition and Brain Diseases of the Shenzhen Institute of Advanced Technology of the Chinese Academy of Sciences, explained:
The 18-year-old system employs the principle of spinal cord nerve remodeling compensation, more like an auxiliary rehabilitation device, and after months of training, paralyzed patients with local injuries to the spinal cord can still walk without the device.
The principle is a functional alternative device for patients who are completely paralyzed, but the patient must always rely on the device to walk.
How does this new device work? According to the research team:
The patient's spinal cord is modeled first, and then a wire is implanted into the spinal cord of the paralyzed person, and two small remote controls are connected to the walker and wirelessly connected to the tablet.
The patient selects the exercise he wants to perform on the computer, and the tablet sends a signal to a pacemaker in the abdomen. The pacemaker, in turn, transmits signals to implanted spinal cord wires, stimulating specific neurons that allow the patient to perform corresponding activities.
Even, in addition to restoring specific mobility, the researchers say the device may stimulate the regeneration of damaged nerve cells in the spine.
"The observed spinal cord repair was completely unexpected." Professor Grégoire Courtine, one of the researchers, said: "This stimulation system may be effective in the treatment of SCI-related diseases, such as high blood pressure and bladder dysfunction, and may also be useful for patients with Parkinson's disease." ”
Of course, researchers' pursuit of "black technology" is not satisfied. In addition to further improving the efficiency of electrical stimulation, the tablet is "too big" and the operation is complicated, and the researchers intend to join a speech recognition system in the future, implant a microcomputer in the patient's body, and directly connect with the patient's smartphone.
It is reported that the relevant team is currently applying to the FDA for clinical trials of the device.
For many world firsts, the future of paralyzed people may be rewritten
Is this device "God"?
This is a milestone in the field of spinal cord injury-related treatments, but some experts have questioned the description of the efficacy.
Walking, cycling, swimming independently? Dr. Peter J. Grahn, assistant professor of neurosurgery at the Mayo Clinic, disagrees with the researchers' use of these "ambiguous" terms in their reports, fearing that they will "deify" the findings.
"They say they can resume walking independently on day one, but the truth is that when patients try exercise, they are supported by more than 60 percent of their own body weight strength from assistive devices." Dr. Peter J. Grahn told the media.
Patients ride bicycles during rehabilitation Source: Globe News
"This is not a treatment for spinal cord injuries." Researcher Professor Grégoire Courtine admits, "But it gives paralyzed people the right to stand and move again, not as an end result, but as an extraordinary step." ”
In fact, depending on the degree of spinal cord injury, patients lose more than the ability to walk. Legs, arms, hands or lungs, thermoregulation, bowel and bladder control, and sexual function may be affected. Over the years, the academic community has also been studying ways to repair spinal cord injuries.
On the same day (February 7) when the Swiss researchers published their paper, scientists at Tel Aviv University in Israel also published a blockbuster research paper in the journal Advanced Science.
The team made the world's first 3D human spinal cord tissue for paralysis and implanted it in mice. Mice are divided into two groups: an acute model (recently paralyzed) and a chronic model (paralyzed for one year). The results showed that 100% of the mice with acute paralysis and 80% of the mice with chronic paralysis after implantation recovered the ability to walk.
Researcher Professor Tal Dvir introduced:
After isolating the cells of the patient's abdominal adipose tissue from the extracellular matrix, we edited them using genetic engineering to return them to a state similar to embryonic stem cells—that is, cells capable of becoming any type of cell in the body.
A hydrogel is then produced from the extracellular matrix to ensure that no immune or rejection reactions are caused after implantation. Encapsulating the stem cells in a hydrogel, we turned these cells into neuronal network 3D implants that mimic the development of spinal cord embryos. ”
"We hope to enter human clinical trials in the next few years and get paralyzed patients back on their feet." Professor Tal Dvir said.
Japanese scientists are not idle. They are setting their sights on the fiery field of IPS stem cell therapy.
The technique is to stimulate mature, specialized cells to return them to a stem cell state, and then induce them to differentiate into cells desired for treatment.
Recently, Keio University in Japan announced the successful transplantation of IPS stem cells into a spinal cord injury patient, using its replication ability to repair damaged tissues and organs.
It is also the world's first human clinical trial of the therapy for spinal cord injury, and the research team has transplanted more than 2 million neural stem cells derived from IPS stem cell technology into the spinal cord of patients. As of now, the relevant data after treatment is still in the confidential stage.
Dr. Grégoire Courtine is also following these developments. Once the academic community is ready, he said, his "electrical stimulation device" implantation technique could be combined with nerve regenerative therapy.
At present, millions of people around the world are paralyzed by spinal cord injuries, and many have been sentenced to spend the rest of their lives in wheelchairs at a young age. The researchers believe their fate may be rewritten for the foreseeable future.
bibliography:
2. Restore the walking ability of patients with complete paralysis within one day, the Lausanne Federal Institute of Technology team developed personalized spinal cord stimulation implants, and is promoting commercialization, Shenghui, https://www.163.com/dy/article/GVQCCFA80532PL1J.html
3.Human Spinal Cord Implants: Breakthrough May Enable People With Paralysis To Walk Again，https://scitechdaily.com/human-spinal-cord-implants-breakthrough-may-enable-people-with-paralysis-to-walk-again/
4.New implant offers promise for the paralyzed，https://www.humanbrainproject.eu/en/follow-hbp/news/2022/02/07/new-implant-offers-promise-paralyzed/
5.New technology enables paraplegic patients to walk again，https://www.sbs.com.au/news/new-technology-enables-paraplegic-patients-to-walk-again/18ea67b3-4315-456e-b2c1-ffa88c61bbea
6.Umugabo yamugaye inyuma yo gucika uruti rw'umugongo yasubiye gutambuka, bamushizemwo icuma，https://www.bbc.com/gahuza/amakuru-60299228
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