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New hopes for patients with spinal cord injury
Mon, 24 Sep 2007 01:27:00
By Patricia Khashayar, MD., Press TV, Tehran
Dr Hooshang Saberi is a neurosurgeon in Tehran University of Medical Science. Dr Saberi
received his MD from Tehran University, where he also trained in neurosurgery and graduated
in 1995.
He also passed a one-year course in anatomy and then received an MPH in epidemiology from
Tehran University of Medical Science. He is now the deputy head of the Brain and Spinal
Injury Repair Research Center (BASIR).
The extent of Dr. Saberi's contribution to public health is reflected in the number of the
patients he has treated and the nature of their diseases, besides his papers. Dr Saberi has
also put together a skilled research team that has performed the Schwann cell transplantation
and spinal cord repair for the first time in Iran.
Q- During the recent months, many have heard the name of Dr Hooshang Saberi as the
initiator of the 'spinal cord repair' project in Iran. As the leader of the team which, have make
a breakthrough in repairing spinal cord injuries for the first time in Iran, could you tell us
about the project and specially your role?
A. I was the director of the research team. The project was aimed at evaluating the role of
the Schwann cell transplantation in improvement of neurological functions in spinal cord
injuries. In the project, we set a series of criteria for selecting patients. We also performed
tissue harvest, intramedullary transplantation of Schwann cells, and neurosurgical follow-up.
Q. How did you get interested in the subject and how did you eventually choose this field for
research?
A. We had seen the suffering of the patients with spinal cord injuries during our practice; the
impact of the condition on the life of the patients is so profound that necessitates such works.
Q. How did you get started in this project? Tell us about the steps you had taken to achieve
today's success.
A. The capability of the peripheral nervous system to repair may be due to the role of
Schwann cells. On the contrary, spinal cord lacks such capability. This prompted us to launch
a research to find out if Schwann cells could do the same in the spinal cord.
Previous works had highlighted the role of the peripheral nervous system in the repair
mechanisms of the CNS and then we tried to prove the hypothesis experimentally and
reproduce the repair process.
Afterwards, we conducted a preliminary study in human subjects with spinal cord injuries, the
good results of the study promoted us to conduct the phase 2 treatments.
Q. Is this operation performed routinely in other developed countries?
A. As far as we know, cell therapy for spinal cord injuries is performed in Russia, China, and
Germany. They are not routine procedures and somehow experimental.
Q. Could you provide us some statistics to let us know the extent of the researches on this
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subject, for example the number of operations performed and etc.?
A. The success rate for the procedure is variable and about 60 percent; so far, we have been
able to treat about 60 patients.
Q. And our country, where does it stand?
A. I think we are the third country which has started using this technique.
Q. Is your technique the same as what is performed in other countries?
A. Absolutely not, there are major differences. Russian researchers have performed this
operation using olfactory OEC and stem cells; on the other hand, the Chinese has studied the
effect of embryonic cell (stem and OEC cells) which was completely different to our technique
in which we have used Schwann cells.
In other words, our country is the first which have used Schwann cells to treat spinal cord
injuries. It should be noted that an Australian researcher have reported the safety of
Schwann cell transplantation in four cases.
Q. How many patients have undergone such an operation in your center so far?
A. About 60 cases.
Q. And what was your success rate?
A. About 60 percent overall.
Q. What factors influence the outcomes of the treatment?
A. The most important factor is choosing the appropriate candidate.
Q. Are there any criteria for selecting the suitable patients or predicting the success of the
transplantation?
A. Yes, of course. There are two crucial factors:
- Spinal cord lesions should be limited to less than 10 mm
- The pattern of muscular impairment should indicate an upper motor neuron involvement
- Other criteria include: the absence of ferromagnetic artifacts on MRI scan, no evidence of
axonal degeneration in electrodiagnostic studies and, the patient should not have an atonic
bladder.
Q. Is the time of injury a critical factor?
A. It seems that the more chronic the lesion the less would be the success rate but there is
no close correlation.
Q. Is the patient's age decisive too?
A. Yes, patients younger than 50 years do better.
Q. Is this operation also helpful in those with congenital spinal lesions?
A. Although those with congenital spinal cord disorders may need surgery, this type of
treatment is not suitable for them.
Q. Are there any specific complications reported following the operation?
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A. Transient pain is very common but wound infection is rare. Only one case had temporary
neurological deterioration. There was no case of tumor formation or viral infections.
Q. What were some of the most rewarding and/or challenging moments you experienced in
your work?
A. The most rewarding was observing the recovery of motor functions and urinary control in
our first patient who was a war veteran; the most challenging was waiting to see the first
signs of improvement.
Q. What encourage you to continue the research?
A. The need of patients to receive treatment and the joy of seeing a patient happy after
neurological functions begin to improve.
Q. In your opinion what would be the next breakthrough in this field? Where would we stand
over the next ten years?
A. the treatment of the lesions of more than 10 mm in length has been promising, requiring
vigorous investigation and research. Also, minimizing the costs and optimizing the procedure
are our main challenges. I hope we could develop the technique further, and propagate it
worldwide.
Q. And now could you give some advice to the young physicians who are willing to be
involved in this field of research?
A. I invite them to contact the Brain and Spinal Cord Injury Research Center (BASIR), they
would be welcomed.
Q. What do you see as the challenges young physicians/researchers face?
A. I think at the beginning this task may appear cumbersome and somehow impossible, they
should not give up.
Q. What specific goals would you recommend the young physicians/researchers set for
themselves? Any suggestions about how to achieve them?
A. In medical research in particular, I recommend them to focus their efforts on their
patients' welfare.
PKH/RE
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