Dalton Dietrich: Current Progress on Neuroprotection and Repair following SCI

He’s from the Miami Project, which has a mission to discover and test new therapies that will improve function and quality of life issues in people living with paralysis. It used to be all about sci, but has expanded to include paralysis with other causes (stroke, ms, etc)

They run a bench to bedside/bedside back to bench research program that includes work with mice, rats, pigs, and non-human primates.

(He’s a super fast-talker, people . . . be sure to look at the video of this one if you want the full picture.) I’m letting him run through the basic intro slides, which are about things not that interesting to most of us — old approaches, acute interventions, like hypothermia.

For those who don’t know, that means cooling the body of the injured person within hours of the injury; it seems to be very safe and fairly effective in changing almost half of the ASIA A patients to a better outcome. There’s a major study underway right now. Other strategies for acute injuries include riluzole, minocycline, neither of which seem to work as well as cooling . . . another one is cethrin, also in trials right now.

On to regeneration: there are various helper cells: schwann cells, OECs, astrocytes, macrophages, genetically engineered cells like fibroblasts and schwann cells, stem cells including fetal, embryonic, adult, etc.

Why Schwann Cells? They promote regeneration of axons, they produce growth factors, they myelinate axons, they restore conduction, they enter the cord in big numbers, they’re already in your body . . . right now there are 6 FDA approved clinical trials being run out of the Miami Project, including Schwann cell transplantation for subacutes.

Wow, such a fast talker — I’m sitting here wishing he’d have chosen to talk only about CHRONIC injury intervention and done so at a reasonable pace. 

Boot camp for chronics, with a goal of getting people conditioned. It includes body weight supported training and then injection of Schwann cells.

They’re building a $130 million hospital right next to the project . . . they’ve started a neuro-engineering department, led by Monica Perez.

Talking about using Deep Brain Stimulation to target neuropathic pain. Done two patients, and both of them are getting relief. THAT’S BIG NEWS TO ME. Where can we learn more about this, please?

He invites questions and communication! write to him at ddietrich@miami.edu

Q: You have a lot of things planned and ongoing for acutes and subacutes. What drives an organization like yours to spend so much time and money and energy on acutes instead of chronics?

A: If you look at those 25 trials I mentioned on that last slide, we’re looking at all kinds of things for chronics. (Names a few things)

Q: (same person) no, no, no . . . we’re always told when we ask that things are being studied for chronics, it’s like, someone is doing a psychological study to find out how you are feeling! We want to get up.

A: I hear you loud and clear. Keep in mind that we can learn from these studies. We can only do what the FDA permits, and that often does mean — as in the case of Schwann cells — they wanted us to do acutes only at first.

Q: It’s very important to keep a balance, though. There’s a big imbalance in how much of your work is aimed at acutes v. chronics! There are no acutes in this room, are there? I’m not saying you shouldn’t do that work at all, but you might have a better balance between acutes and chronics.

A: I think if you go into emergency rooms you’ll see plenty of acutes . . . Thank you very much.

Q: About chronics getting Schwann cells & procedure vis a vis surgery & rehab

A: We’re using technology developed in other trials to do the surgery, are adding more cells to the chronics as we demonstrate safety, and yes, for chronics there’s a very serious rehab to maximize return.

Q: Are you collaborating with others across the planet?

A: Yes.

Q: How close are you to developing a cell that you think will work?

A: Schwann cells could work (for a variety of reasons). I think we’re getting close. Some people are showing robust regeneration but it’s not leading to functional improvement. We’re working with StemCellsInc and Neurostem on their programs, because we’re going to need industry.

Q: What’s the main mechanism you expect from Schwann cells?

A: Remyelination, plus growth factors. Creating a more permissive environment by addressing inhibitory molecules . . .

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