The Tartan

By By Katherine Casarrubias Gallardo

The March 24 issue of The Tartan introduced Dr. Robert J. White, a neurosurgeon who performed cephalic transplants on rhesus monkeys as part of his work to improve and prolong the lives of individuals suffering from spinal cord injuries and progressive mobility diseases.

Understanding the motivations behind White’s work is of special interest as, without it, his surgeries border on the Frankenstinian, unnatural, and draconian with no clear objective. After all, a cephalic transplant will not treat a damaged spinal cord, but rather provide a full set of functioning organs. There exists the possibility that the body will reject the head, which would mean the person loses function throughout the entire body instead of just one organ. Not to mention the likelihood of being indefinitely dependent on a mechanical respiratory machine. And how would eating even work?

One cannot help but think about the hurdles that mending a severed spine would overcome. It seemed impossible, until a stem cell scientist, Hideyuki Okano, injected induced pluripotent stem (iPS) cells into the injury site on the spinal cords of four patients, leading to mixed, but promising, results.

iPS cells are created by taking mature cells, such as skin or blood cells, and reprogramming them into an embryonic-like pluripotent state, which allows them to develop into any type of cell in the human body.

Okano and his colleagues at Keio University in Japan created iPS cells from a donor and subsequently turned them into neural precursor cells, which have the potential to develop into neurons, glial cells, and astrocytes (cells vital in neural and spinal functions). From there, two million of these cells were injected into each of the four patients who participated in the trials, with scientists hoping they would mature into neurons and glial cells.

All individuals who participated in the study were adult males, with two being over the age of 60. They were injected with stem cells four weeks following their injury and were provided with immunosuppressant drugs to prevent their bodies from rejecting the iPS cells.

At the beginning of the study, all participants were classified as grade A, based on the American Spinal Injury Association (ASIA) Impairment Scale, a standard neurological exam that assesses sensory and motor levels in individuals with spinal cord injuries. There are five classifications in which an individual can be placed: Grade A, B, C, D, and E. In grade A, impairment is complete, and no motor or sensory functioning remains below the level of the injury. In grade B patients, some sensory function occurs below the neurological level, but no motor function is preserved. Individuals assigned a grade C classification have motor function below the neurological level, but more than half of the key muscles have a muscle grade of less than three, indicating they are not strong enough to move against gravity. Grade D patients possess motor function below the neurological level with less than half of the key muscles being below the muscle grade of three. In grade E, sensory and motor function are normal.

Two patients showed no signs of improvement in their condition. Another patient did show improvements and moved up to grade C, as they can now move some of their limb muscles but are unable to stand. One patient, however, was able to move up to grade D and is now able to stand independently.

Although these results are promising, it is largely agreed that larger trials are needed to prove the effectiveness of the procedure, as it is possible these findings are a result of the patients’ natural recovery process. Still, I wonder what Dr. White would say about these trials if he were alive.