Help for paraplegics
Researchers in the National Centre of Competence in Research (NCCR) “Neuro – Neural Plasticity and Repair of the Nervous System" are working on repairing the nervous system: with some success. This was only possible because researchers from various institutes and disciplines have worked together intensively.
A fall, a fracture in the back or neck: accidents like this can seriously damage the spine. Every year around 200 people in Switzerland, mostly young, are paralysed from the waist down for the rest of their lives and can no longer move their legs or arms. As recently as 25 years ago, specialists agreed that spinal cord injuries could not be healed. Unlike nerves in the legs, arms or fingers, nerves in the brain and spinal cord do not grow back once they have been destroyed. However, in recent years, new hope has emerged that injuries to the spinal cord can be at least partially healed. Research is being conducted at a feverish pace worldwide.
The most promising approach currently comes from Switzerland. Neurobiologist Martin Schwab works at the University and ETH of Zurich. Some 20 years ago, he discovered a certain protein that suppresses nerve growth in the sheath surrounding the nerve fibres in the spinal cord and brain. He called this protein Nogo. In his meticulous research done in painstaking detail, Schwab created an antibody that blocks this growth-inhibiting protein. This antibody releases the brake, so to speak, and allows nerves to grow again.
The scientists in the NCCR "Neuro " are advancing research with the antibodies at lightning speed. It was only possible because researchers from various institutes and disciplines cooperated continuously and intensively from the start ‒ a particular strength of the NCCR.
The effect of the antibody Nogo was first examined on rats. "Even at this stage we wanted to make sure we were examining injuries on the areas of the spinal cord that are also clinically relevant for humans," comments Martin Schwab. Specialists at the Paraplegic Centre at the Balgrist University Clinic, one of the partner institutes in the NCCR “Neuro” network, provided support on issues such as this.
The continuous exchange of knowledge is one of the greatest benefits offered by the National Centre of Competence in Research according to Martin Schwab. "It’s a continuous process of give and take," he remarks. Everyone benefits from the experience of the others. When for example, neurobiologists at the University of Zurich were unable to make headway with the strange behaviour of the rats examined in the laboratory, the doctors at the Balgrist University Clinic were able to help. In the Clinic, doctors had frequently observed spastic cramps in their patients, symptoms very similar to the behaviour of the laboratory animals.
Before the researchers could use the Nogo antibody as a medicine they had to ensure its safety and therefore tested the antibodies of the human Nogo in monkeys. In this case, the cooperation with researchers at the Neurophysiological Department of the University of Fribourg – also partners in the NCCR “Neuro” – proved to be a stroke of luck. The studies in Fribourg showed that the molecule was extremely effective. Thanks to the treatment, primates with spinal cords injuries up to the hand nerve level regained the use of their fingers almost entirely.
After the successful studies with primates, the researchers could at last begin to prepare clinical tests on people paralysed from the waist down. For this large-scale and expensive venture, they sought other partners and found them in various European hospitals and at Novartis. Headed by the Basel pharmaceuticals company, studies are currently in full swing. The first definitive results are expected around the middle of 2010. According to Martin Schwab, interim results give those involved grounds for optimism.
At the same time the researcher cautions against overly optimistic expectations stating that it will never be possible for a person paralysed from the waist down to simply get up and walk after a few injections with a drug. However, if the new drug allowed patients to move even a few muscles again, for example to allow their hands to grip things, this would be a huge advance compared to their initial situation.
During the period of convalescence, intensive physiotherapy is also set to play a crucial role in the future. "Patients must quite literally learn to move their limbs again," explains Martin Schwab. The enormous benefit of close cooperation in the NCCR “Neuro” is obvious in this case as well. The Balgrist University Clinic is specialized in innovative rehabilitation aids. One of the aids is a robot that has been developed, so that very weak patients can train themselves to walk. Thanks to good networking in the NCCR “Neuro”, initial tests have already been conducted to establish whether Martin Schwab’s antibody therapy and these physiotherapeutic measures can complement one another.