For years we have looked at spinal cord injury or brain injury
and said, end of story, no further progress.
No, that's no longer the rules!
We need to find out how to do this stuff. We need to find out if we've
got a chance of helping the nervous system heal itself.
I'm one of over 5000 New Zealanders with a spinal cord injury,
one of the highest rates per capita in the Western world.
New Zealanders are about to start a controversial trial
of stem cell treatment, taking cells from the participant's own nose
and planting them in the injured spinal cord.
The rules are changing and they're going to be rewritten in the next 10 years.
I'm willing to be one of the first human guinea pigs out there.
Like they say, in Australia, we should wait for Australia to do it,
and wait 10 years and see what happens.
Well, I'll be 60 by then, it'd be too late for me,
I mean, this is my shot at it.
Oh, definitely to be able to walk,
absolutely, to be able to walk,
and climb up stairs, and you know? Have a dance, exactly, absolutely!
That's the dream.
In Portugal and now New Zealand, scientists are taking the first steps
towards making it a reality.
A Portugal clinic offers stem cell transplantation as a treatment,
and claims some success.
New Zealand's about to step onto the world stage, with
the first clinical trial of this procedure.
Incredibly, the campaign all started with a Matamata grandmother, Noela Vallis.
For 25 years, Noela has tenaciously raised funds and rallied the troops.
From her living room.
So Noela, tell me about, why did you start out this Spinal Cord Society?
Well because my husband was paralyzed, and I was determined to
find a cure for spine injury, because, he had a lot of pain
And I thought, right, I'll see if I can find a cure for spine injury.
And it's 25 years, but we've now gotten through ethics and we're ready to do some trials.
Being called for a Matamata grandmother, but Noela's been the driving force
behind getting research in New Zealand off the drawing board and into the lab.
Money the Spinal Trust raised is 100 percent for research and [natago].
Now, Noela intends to find another two million, the cost of the two year stem cell trial.
My aim is to get this -- in the next two or three years,
into the medical world, for everybody.
So that if you broke your back again, or if you
were an able bodied person who broke your back,
you'd go into hospital, and you'd be drip fed some stem cells of your own
stem cells, and within a few months you'd be back in the work force,
same as a broken arm or a broken leg.
Not quite that simple, but you have to admire her enthusiasm.
This trial has been rejected twice by the ethics committee.
I really feel the problem was that the ethics board straight away thought --
because the majority of them are [late] people, I think they thought,
oh this is fetal cells, and embryonic cells, and soon as you talk about stem cells,
98 percent of people think that.
They don't realize that the adult stem cells are their own cells,
which is what we're going to use.
And they didn't understand that, and once we got it right,
got our side of the story in that there are two types of stem cells,
they've now taken a completely different attitude.
Now the trial has the green light, it's over to the scientists.
This is where it's all happening, at the Center for Renovation.
When I was here 18 months ago, the research team's proposal to
begin human trials had been rejected by the ethics committee.
Now they've got the green light, I'm keen to find out exactly what's involved,
and how it might affect thousands of kiwis like me.
The clinical research team will use olfactory cells, cells from
the inside of the nose, and transplant them into a damaged spinal cord.
These are the [classified] nodules in the matrix
that is present around each of the cells...
These olfactory cells seem to have regenerative properties
that can help to repair nerve cells and also encourage nerve cells
to regrow and restore function.
It's based on some studies done back in the 1990s,
looking at olfactory tissue - that's tissue up the roof of the nose,
which provides a sense of smell.
Now, people have suddenly realized that this is a rather
unusual part of the nervous system,
because we're constantly replacing the nerve cells there,
and those new nerve cells have to grow through the tissues, through the basic
skull, and up into the brain to establish meaningful connections.
Part of the process is shown here of our footage of surgery
being performed in Portugal.
They realized there must be be some very important
guidance signaling the mechanisms there, to support that. And when they looked
they found a cell called the olfactory ensheathing cell.
And it's that cell that a number of research studies
show is able to help support the repair of injured spinal cord nerve cells.
Professor Grant Gillett specializes in medical ethics
while Dr. Jim Faed, a cellular biologist, leads the research team.
One of the ethics committee's biggest concern,
is safety for the participants. And the danger of false expectations.
Those two things have been addressed in two ways, first of all,
getting more safety evidence, and responding to the specific points,
for instance, neuropathic pain, that were raised in the relation to safety,
and secondly, making sure that the information given to the participants
was realistic in terms of the state of the art at the moment.
This research isn't new.
The Portuguese team, led by Dr. Carlos Lima,
reported small improvements for patients who had olfactory stem cells
transplanted into the injured spinal cord.
Some reported activity in muscle groups previously dormant.
Others were able to better control bowel and bladder function.
What you don't hear about with this and other experiments in treatment,
are those for whom it made no difference. Or worse, left them in considerable pain.
While the Portugal clinic offers a treatment, the New Zealanders are carrying out
a clinical trial, with a control group and documented results.
We hope that that kind of filling in with neuroscience
between nothing and clinical change will actually start to tell us
a whole lot more of the story about human neurological recovery.
Which even now, it's a story we don't fully know for another 20 years,
or 30 years, or however long it takes.
It carries hope for a person who's paralyzed, who needs to feel that
something is being done.
12 people will be selected for the trial. Six will get the surgery and
an intensive physiotherapy program.
The other six will get only the physiotherapy treatment.
In past stem cell trials, the [inaudible] had suggested that
may have been the physiotherapy element alone that caused
a change in function.
To dispel or prove this theory, in these trials, both the groups receiving
the stem cells and a control group that don't will have to undergo
a rigorous physiotherapy regime.
The reasoning is that you want to see real changes dependent on the surgery,
not changes brought about by increased optimism, or
involvement, or physiotherapy regime, or some other kind of rehabilitation
program, that's aimed at an individual of the type concerned.
When we visited Dr. Carlos and his team in Portugal, we learned
that physiotherapy is a huge part of the rehabilitation process.
As is with these trials.
What I'm wondering is how they're going to motivate the 12 kiwi participants
to keep up with the strict physio regime, for two years.
I spent a year of my life doing intensive physio.
I know how hard it is.
In this trial, they will be expected to do two hours of physio, 6 days a week,
for two years.
It's one of the other important questions of the research, one is,
obviously, the effects of the surgery.
But the other is, looking at whether we can maintain people in an
optimal physical activity program for two years.
And people will be -- a part of the eligibility criteria of coming into the
study is making sure they do have high levels of motivation to begin with.
It'll be a tough assignment for the control group, the ones who don't get the surgery.
No one chooses which group they're in.
The issue for trials where you have controls is that everyone is part of the team.
Now, in a rugby team, or a netball team, you don't have everyone all scoring
the trials, and all scoring the goals, that's not the way things happen.
But you need the whole team there to actually ever have a chance of scoring one goal,
or more. So it's an integrated process. Everyone's participating in.
In the long term, everyone will benefit from better knowledge.
There will be strict criteria about who gets onto the trial.
You must be under 35, it must be a complete spinal injury,
and it happened between two and seven years ago. Open only to paraplegics,
not quadriplegics.
We were going for thoracics initially, that is from below the base of the neck down
to the mid to low thoracic area, because surgery there, if a technical
problem cropped up,
would not lead to more significant problems for the person.
Issues of age of the individuals, yes, we're taking people up to age 35 only,
from 18 to 35, and that's purely because the olfactory tissue in the upper nose
becomes less accessible in older individuals.
And not everyone thinks we're ready to do this kind of trial.
Dr. Angelo Anthony of the Burwood Spinal Unit says the research team is on the right track,
but believes the safety of the procedure hasn't been proven.
Can you give them the assurance, that they would be alright? Because we
don't know what the long term effects of such treatments are going to be.
There's no talk of a cure. But the Otago scientists do expect small gains
to be made. Gains that could make
a real difference to the lives of New Zealanders with a spinal cord injury.
We're not looking for -- that the person will be able to walk after the trial.
It's very early stage in this type of surgery.
If anything, there might be some slight improvements in sensation, which we can
measure with sensory testing. Then maybe a slight improvement
in relation to muscles, so particular around the hip joint,
the muscles might be able to move a bit more.
How that will translate into function, it might mean those people
might be able to stand up a bit better.
It's like building a television. You start out from a crystal set,
[bam]. A [BC], and we get to play some TV,
but you're not gonna do it unless you keep working with what you've got.