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12-27-2005 15:12

These spinal cord injury patients come from all over the world. They come to Beijing not to tour but to get treatment for their spinal cord injuries. Who are the doctors they come to Beijing to see? Why do they come to Beijing for surgery? Can their spinal cord injuries be cured in Beijing?

In fact, they come to Beijing to see Dr. Huang Hongyun, a doctor at the Beijing Chaoyang Hospital, affiliated with Capital University of Medical Sciences.

Spinal cord injuries usually lead to paralysis. We all know that paralysis, especially complete paralysis, is incurable. This means that patients having such a disease will never stand up again.

Chris, 21, is one of these patients. He comes from the United States and is a motorcycling sports fan, favoring motorcycle acrobatics. March 17, 2002, was a day that Chris will never forget.

The accident happened in on brief moment, but it has forever changed Chris’ life.

After being rescued, although Chris survived, his neck fracture injured his spinal cord, and he lost all feeling below his cervical spine. He now has to rely on a breathing machine to breathe.

In our body’s spinal column, there is a piece of long soft tissue called the spinal cord. It’s the highway between peripheral nerves and the brain. The spinal nerve and the cerebral nerve consist of the so-called central nerve.

This is a section of an animal’s vertebra, which is very similar to our body’s spinal column. The white part in the middle is the spinal cord.

The spinal cord is like a highway stretching from the brain stem down to the ending of the second lumbar spine.

Like highways, peripheral nerves branch from the spinal nerve and spread to the skin, organic tissues and other areas.

When peripheral nerves feel perspiration, they first send this signal to the spinal nerve and then to the brain stem. After the brain realizes perspiration, it sends out a sweat-wiping movement signal to the spinal nerve and then to the peripheral nerves, which then excite muscular tissues to make movements to wipe sweat.

Once the spinal cord is injured, sensory signals of the peripheral nerves can’t be sent to the brain, while movement signals given by the brain can’t get to the peripheral nerves. So the injured person loses feeling and movement and becomes paralyzed.

If the injured position lies at the cervical spine, the patient’s four limbs may be paralyzed. If it lies at the thoracic and lumbar spines, it may paralyze the patient’s legs. The patient’s body parts below the injured position will lose movement capacities, feelings and have incontinence.

Most of traumatic spinal cord injuries are caused by traffic accidents. In China, traffic accidents are increasing, so the spinal cord injuries caused by them are also increasing. In addition, other injuries caused by knives, guns and sports can also cause spinal cord injuries.

We all know that after skin is wounded, it can heal after a period of time. This means that peripheral nerves have the capacity to regenerate.

But the central nerve is thought to have no such a self-regeneration capacity.

Since human learned of spinal cord injuries over 2,000 years ago, this disease has always been considered incurable.

Because the central nerve has a low-level self-regeneration capacity, the clinical late-phase complete spinal cord injuries are still considered incurable up to now. This point of viewhas obstructed the research on the treatment of spinal cord injuries.

Scientific research can usually turn the impossible into the possibile. Scientists have constantly conducted research on the treatment of spinal cord injuries. They discovered that after a mammal’s central nerve is injured, it in fact has a very weak self-regeneration capacity.

At the injured area, some substances are produced to inhibit the regeneration of cells. Moreover, at the injured area, a scar will form. Even if some nerves can regenerate, they have no ways to pass through this scar. Can we find a method to help the nerves pass through the scar to recover the function of the injured spinal cord?

After being wounded, Chris has fought his disease with a strong will. After his injury stabilized, his parents and relatives were calling on doctors everywhere. By chance, his grandfather found Dr. Huang Hongyun on the Internet.

Dr. Huang has been engaged in the study and treatment of spinal cord injuries for over 20 years. In 1997, Huang went to the USA as a visiting scholar to conduct a series of experiments on the function recovery of spinal cord injuries.

HUANG HONGYUN (Doctor of Chaoyang Hospital, Capital University of Medical Sciences, Tel: 086-10-85231760/85231762)

At first, I just wanted to do some work in the field of spinal cord injuries in USA but didn’t know what specific research work I should do. At that time, I had some immature ideas, one of which was olfactory ensheathing cell transplant. At that time, there weren’t many articles about olfactory ensheathing cells (OECs). But soon there were increasing articles about OECs and OEC transplant. After reading these articles, I found that OECs have some unique features that other cells don’t have.

At that time, some treatment methods for spinal cord injuries had been developed. All these methods stress improving the microscopic environment of the injured parts of the spinal cord. Many of them can promote the regeneration or function recovery of injured axons. Among these methods, Dr. Huang thought that the olfactory ensheathing cell transplant is one of the most promising methods.

Olfactory ensheathing cells (OECs) distribute in the olfactory bulbs and olfactory nerves of our noses. They exist and migrate between peripheral nerves and the central nerve. They can excrete amounts of various nerve nutrients and supporting factors, helping cells and axons regenerate.

OECs have a powerful migratory capacity, which is very important to the self-regeneration of spinal cord injuries. The scar formed after the spinal cord is injured is like a barrier. After OECs are transplanted into the injured part, because they have a strong migratory capacity, they can freely move inside the spinal cord, passing through the scar and connecting the injured nerves.

Dr. Huang decided to shift his research to OEC transplants. But where do such magic cells come from?

HUANG HONGYUN:

OECs come from embryonic brain cells. The embryonic brain cell transplant has been studied for years in the world, so it’s very safe. It’s also been studied for several years in China. The OEC transplant is in fact a type of the embryonic brain cell transplant. So there is no problem with its safety.

How can such magic cells be successfully used to treat spinal cord injuries? Dr. Huang found that the model other scientists used at their labs was a crosscut, which assumed that the spinal cord injuries are all uniform. But in reality, the spinal cord injuries are irregular and are called contusion. In his experiments, Dr. Huang used a contusion model that is closer to reality.

In his experiments, Dr. Huang gradually discovered that after these cells were transplanted, experimental white mice’s forelegs and hind legs could walk. This research model simulates the patients’ clinical spinal cord injuries, so it has a good clinical trial prospect.

After obtaining such a basic research result, Dr. Huang at once began to apply this technology to clinical surgery and conducted the first OEC transplant surgery in 2001.

HUANG:

From the result of our first OEC transplant surgery, we found that the patient’s feeling or movement functions had greatly improved, but the result wasn’t very satisfactory. After the second surgery was finished, the patient’s first reaction was that his originally paralyzed thumb could move. When finding his thumb could move again, the patient was so excited he shed tears. We were very excited, too.

Did this result occur by chance? Lots of subsequent experiments have proven the certainty of this result. Up to now, Dr. Huang has did 400 surgeries, and many of them have been successful.

Holding a cup of water to drink is a very simple movement for an ordinary person. But this movement can let us clearly see the patient’s change before and after OEC transplant surgery.

HUANG:

Some functional improvements are totally beyond our expectation, because we originally estimated that the patient’s functional improvement is a slow, gradual process. But we clinically find that such improvement can occur 1-3 days later after surgery. Up to now, its mechanism is in fact unclear. It can’t be explained by OEC recovery mechanism, such as the axonal regeneration mechanism and marrow ensheathing repair mechanism. Because a spinal cord injury is a chronic injury, the marrow ensheathing repair and axonal regeneration can’t be finished in a short time. So inside this phenomenon, there must be a mechanism that is still unknown to us. We guess that this mechanism may be an activation mechanism or something else.

Dr. Huang thinks that after a person’s spinal cord is injured, there must be some nerve cells or axons left in its injured parts. Because OECs can excrete nerve nutriment factors and various other factors, after OECs are transplanted into the injured parts, they may improve the microscopic environment of these nerve cells and axons. But what role the magical OECs play inside the injured parts is still a mystery. Some people even say that the person who can discover the OEC action mechanism will win the Noble Prize.

On May 21, Chris was prepared to enter the operating room. He asked his mom to place one of his best friend’s medals in his hand. When Chris was wounded, this friend gave him mouth-to-mouth resuscitation for two hours and saved his life. Chris hoped that this surgery could produce a miracle, too.

Can Chris’s surgery produce a miracle?

Spinal Cord Injuries and Their Treatment

Part Two

At 8:00 AM, at Beijing Chaoyang Hospital of Capital University of Medical Sciences, Chris, who was paralyzed due to a spinal cord injury, was pushed into the operating room. His spinal cord injury was located at the cervical spine. Such high-level paralysis is very rare.

Before starting the OEC transplant surgery, Dr. Huang usually checks if the patient suffers a complete spinal cord injury to remove other factors.

At present, the decompression surgery is a common method to treat acute spinal cord injuries. When the spinal column suffers external pressure, its bone will distort or break and directly compress spinal nerves. After suffering compression, some spinal nerves will lose their transport functions. So the decompression surgery can remove spinal compression. But if the nerves have died, decompression surgery won’t work.

In March 2002, Chris was out of danger. In May 2003, he was treated and received physical therapy at 3 famous hospitals in the USA. Doctors there told him: “Wait for future medical developments, or you have to rely on the breathing machine for the rest of your life”.

At 11:00 AM, Dr. Huang prepared to transplant OECs into the both ends of the injured part on Chris’s spinal cord to have the OECs work at both ends at the same time.

On one side, doctors were busily making the surgery; while on the other side, Chris’s parents were anxiously waiting outside.

This is a spinal cord picture seen under a common microscope. The small white spot in the middle of the picture is OECs. After being transplanted into the injured part, OECs have already spread throughout this part. This is a picture got by an electric microscope. The green portion in the picture is nerves. Under the help of OECs, these injured nerves grow outer sheaths again.

At 12:00 AM, the surgery was still going on. At the same time, doctors were carefully observing and preparing OECs. When the cells reached the surgical requirement, the doctors rapidly sent them to the operating room to keep them active. This is a small bottle of OECs. What could it bring to Chris?

Because countless nerve endings are thickly distributed inside the spinal cord, any tiny carelessness will cause new injuries to the spinal cord. The surgery must be done under the microscope.

When Chris woke up during the surgery, he still was humorous and lighthearted.

Some OECs were needed to be transplanted into Chris’s head to strengthen the role of OECs in his spinal recovery. Can more transplanted cells play a greater role?

HUANG HONGYUN (Doctor of Chaoyang Hospital, Capital University of Medical Sciences):

After the microscopic environment of his spinal nerve cells has been changed, the function of his spinal nerve may recover. But this doesn’t mean that more transplanted OECs can make the microscopic environment better. At a partial area, more cells usually consume more food and energy and also can lead to more dead cells. This may have a bad effect on the microscopic environment and be unfavorable to the growth of cells. But in this case, this dose of cells transplanted into his spinal cord can certainly help recover his spinal functions.

At 4:00 PM, Chris’s surgery was complete. When he slowly woke up in the ward, his parents felt relieved at once. Without having a rest and meal, Dr. Huang and his assistants kept observing and checking Chris after the surgery and found that Chris’s oxter could perspire.

On the sixth day after the surgery, Chris felt his body was moving downward, and his breathing machine could be moved away for a few minutes. After being wounded, Chris has been in a constant battle against death. Now, he seemed hopeful.

Ordinary people may think that Chris’s change isn’t as much as expected. They may feel disappointed that the patient can’t still stand up to walk after surgery. Some people may look down on Dr. Huang’s surgery. But this is really an amazing breakthrough!

Spinal cord injuries have existed for over 2,000 years. At first, spinal cord injuries were thought incurable. Later, people realized that the spinal cord could be repaired. And now, the OEC transplant surgery is used to treat spinal cord injuries and can recover some of the patient’s spinal functions. We believe that this worldwide problem will be conquered some day.

After surgery, the patient’s condition usually improves more or less. Is such an improvement just temporary? How is it months after the surgery? We followed Dr. Huang to come to Ms. Wan Rumei’s home.

Ms. Wan Rumei, 58, is a retired worker in Shandong Province. After retirement, she led a leisurely, comfortable life.

Unluckily, an accident interrupted her comfortable retired life and paralyzed her from the neck down in 2000. Since then, she has to lie in bed motionless every day, incontinent, almost unable to eat, just staring at the ceiling all day. In the summer of 2003, her husband called on Dr. Huang to see if the doctor had some way to cure his wife. Dr. Huang thought that Ms. Wan’s spinal cord injury was very serious and was almost impossible to recover. So he suggested Ms. Wan have an OEC transplant surgery.

After the surgery, Ms. Wan felt very excited when she saw that she could sit up and wave her own hands freely.

By July 2000, a half year later after the surgery, she could turn over her body by herself and sit up and even stand up for a while.

QIN BENHONG (Ms. Wan’s Husband):

In the past, when she wanted to go to the lavatory, she had to be carried by two people. She didn’t feel pain at all even when she had sores on her bottom due to incontinence and sitting in her own stool. But now when she lies on bed for a while, she has to turn over her body, because she feels uncomfortable. Now she can feel pain when her feet or bottom are pressed.

But Dr. Huang doesn’t stop his exploration. After doing a surgery on a patient whose spinal cord injury was complicated with brain infraction, Dr. Huang found that the patient’s brain infraction also became better.

HUANG:

We unconsciously discovered that our method can cure other nerve diseases. So in addition to spinal cord injuries, we use our treatment method to treat some other diseases, such as motor neuron disease, brain stroke, traumatic brain injury sequelae, and cephalitis sequelae. After our surgeries, there’s some improvement.

Motor neurons refers to the nerve cells that control our muscular movement. Generally speaking, the motor neurons in our brain are called upper motor neurons, while those in our brain stem and spinal cord are called lower motor neurons. Some diseases can also make the spinal cord atrophy. When seeing their own muscles gradually atrophy and become powerless, patients usually feel scared and their lives seem to gradually slip away. Unfortunately, the patients who suffer motor neuron disease have to confront a cruel fact.

HUANG:

Under the strong demands of the patients who suffer motor neuron disease, We’ve made trial treatment on them. Such trial treatment isn’t blind. It is based on amounts of spinal cord injury treatment. So it’s very safe. If a treatment method is effective and safe for spinal cord injuries, it may be useless to motor neuron disease but still certainly is safe.

Motor neuron disease is an acute disease. After a person is diagnosed with it, he usually will die within 3-5 years.

In 2000, Mr. Guo Lin was diagnosed with motor neuron disease, and in March 2003, he received OEC transplant surgery. This is him before and after the surgery.

Since the first case of OEC transplant surgery, Dr. Huang has made in-depth studies and improvements on it. In the past, the incision for such surgery was usually very big. But now, this surgery becomes a minimally invasive surgery and reduces complications.

Danni, coming from Belgium, was extremely happy to see his change after the surgery.

Coincidentally, today was Danni’s birthday. He was born 39 years ago today. On the same day in 2004, it was Chinese doctor Huang Hongyun’s superior medical skills that restored his confidence in life and gave him a bright future.

 

Editor:Wang Ping