(adapted from September 2005 “Paraplegia News” article)

We are a part of a global community in which the devastation of spinal cord injury (SCI) bows to no flag, and solutions will not be any country’s exclusive domain. Integrating the diverse pieces of the puzzle necessary to develop real-world solutions requires that we open-mindedly work in cooperation and not in competition. With such cooperation, restored function after SCI will be a coalescing reality and not just a never-ending, elusive pie-in-the-sky dream. 

In this spirit of bridge-building, I recently traveled to Moscow, Russia where I became the first American scientist to check-out an innovative stem-cell program for SCI developed by the NeuroVita Clinic under the direction of Dr. Andrey Bryukhovetskiy. His work is especially important because few scientists have accumulated as much hands-on experience as he has in treating human SCI with stem cells, an approach many experts believe will play a key therapeutic role in the future.

THE SCIENTIST:
I’m always amazed how good often emerges from the tragic. For example, the Paralyzed Veterans of America (PVA), whose programs have benefited so many with SCI over the years, was born out of World War II’s violence. Bryukhovetskiy’s promising stem-cell therapies also grew out of a desire to help paralyzed veterans, in this case, those who sustained injury in Russia’s Afghan and Chechnya military conflicts.

He is a veteran, specifically a 45-year-old retired Colonel who once directed the Russian Navy’s neurology department. Because of his long-standing empathy for paralyzed veterans, Bryukhovetskiy expressed a desire to collaborate with US veteran organizations, such as PVA, to accelerate the development of real-world SCI therapies.

Bryukhovetskiy is a charismatic leader passionately committed to his mission and patients. His work in humans is built upon a strong foundation of research using a variety of SCI animal models. Because much of his research has been published in Russian, it is not well appreciated in the world’s English-emphasizing scientific community. As seems to be the case for so many innovators regardless of country, he has often struggled to carry out his pioneering research because the vision behind it runs counter to more entrenched perceptions of what is possible after SCI.

Reflecting Hippocrates’ ancient wisdom “that natural forces within us are the true healers of disease,” Bryukhovetskiy told me that stem cells “are the medicine within us.”

In 2002, Bryukhovetskiy established NeuroVita, a state-of-the-art, private clinic that treats a variety of neurological disorders. The clinic occupies several floors in a wing of the massive N.N. Blokhin Russian Cancer Research Hospital Complex five miles southeast of downtown Moscow.  Staff includes numerous physicians and Rehabilitation specialists, and has access to the expertise of nearby hospital scientists. Although to date patients have been treated under an official scientific research protocol, soon after my visit, the Russian Health Ministry authorized the use of Bryukhovetsiy’s stem-cell technology for general clinical practice.

TRAVEL:
My trip to Moscow went through ten time zones, taking several days for my luggage to catch up. Because of jet lag and Moscow’s “white nights” near the summer solstice, it was difficult to sleep at night but nodding off in the day was common. During my visit, I stayed in clinic-affiliated lodging. Although few understood English, and the Russian Cyrillic alphabet makes understanding even more challenging, I was able to get around with relative ease, e.g., take the subway to the Kremlin and Red Square, go to the market, etc.

As a reflection of our emerging global community, television showed, for example, American sitcoms and Arnold Schwarzenegger movies dubbed in Russian, as well as rock videos featuring Britney Spears, unfortunately still in English. Although I was unable to talk to waiters, American rap music was often loudly played in the background. Fortunately, Bryukhovetskiy’s assistant Maria Zhukova, a former English teacher, provided excellent translational assistance.

TRANSPLANTED CELL TYPES:
Stem cells are progenitor cells that have the potential to differentiate into a variety of cells that theoretically can treat various neurological disorders. Bryukhovetskiy has used both embryonic/fetal and adult stem cells.

Although embryonic/fetal stem cells have the greatest potential to mature into a variety of cell types, they are controversial, and it is difficult to direct their differentiation pathway.

Adult stem cells are found in many tissues, including bone marrow, which produces, for example, hematopoietic stem cells that give rise to blood cells, and nervous tissue, whose stem cells can evolve into neurons and neuronal support cells (i.e., glia). Although adult stem cells usually differentiate into the specialized cells associated with the originating tissue, when certain micro-environmental cues are provided, they can mature into cells associated with other tissue. For example, under appropriate circumstances, bone-marrow-derived stem cells have the potential to become nerve cells.

Certain drugs stimulate the bone-marrow to produce more stem cells, which then spillover into the blood, where they can be collected.

When the patient is the source of the cells (i.e., autologous), there is no immunological rejection when they are re-introduced. In contrast, embryonic/fetal cells represent different genetic material (i.e., allogeneic) and have rejection potential, although to some degree their undifferentiated nature helps minimize this risk.

Bryukhovetsiy no longer uses embryonic/fetal stem cells due to the ethical controversy surrounding their use, their rejection potential, and, most importantly, his belief that autologous, adult stem cells are more effective.

In some patients, Bryukhovetskiy has transplanted autologous olfactory ensheathing cells (OECs) using procedures developed by England’s Dr. Geoffrey Raisman. Although not technically stem cells, OECs have considerable Regeneration potential and have been the focus of much attention in the SCI research community. When OECs are transplanted into the injured spinal cord, scientists theorize that these cells promote axonal regeneration by producing insulating Myelin sheaths around both growing and damaged axons, secreting growth factors, and generating structural and matrix macromolecules that lay the tracks for axonal elongation.

ASSESSMENT PROCEDURES:
Improvement was evaluated using a variety of assessment procedures, including the commonly used ASIA (American Spinal Injury Association) Impairment scale in which grade A and E represents the most and least severe injury, respectively. Although this scale is frequently used, experts emphasize it is often insensitive to small but significant Functional improvements. Bryukhovetsiy has noted this insensitivity in his research; i.e. some of his patients with very real life-enhancing improvements did not improve their ASIA grade. Other measurements included FIM (Functional Independence Measure), which assesses dysfunction in daily-living activities; various electrophysiological tests designed to assess neuronal conduction; magnetic resonance imaging (MRI); and urodynamic testing for bladder function.