Breakthroughs for Paralysis -- In-Depth Doctor’s Interview

Ivanhoe Broadcast News interview with
Richard Borgens, Ph.D., Biophysicist,
Purdue University, West Lafayette, Indiana
TOPIC: Breakthroughs for Paralysis 
Date of Interview: June 24, 2006

How have spinal cord injuries been treated in the past?

Dr. Borgens: If you had a spinal cord injury before World War II, you would’ve died. If you had a head injury before World War II, you would’ve died. What’s different after World War II? Drugs. Antibiotics helped keep you alive but didn’t change the status of your injury. After World War II, you could live after the injury, but you couldn’t get better. Look where are we now. Nothing is different.

This is an area a lot of people told me not to look at because, “Why waste your career working on something that you can’t possibly expect to fix?” I’m glad I didn’t listen to them. Part of that comes right from being a Texan. I don’t like to be told what I can or can’t do at any time.

Since World War II, there has been no medical therapy to recover functions in people who’ve had spinal cord injuries or who have had brain injuries. This also applies to those who have had stroke as well. Some weeks after injury, you can tell what you will have the rest of your life. We are working to restore useful functions and improve the quality of life for injured people. Oscillated field stimulation (OFS) can now be said to do that. It’s still in testing. A total of 13 people have been tested so far. We expect to move that number to hundreds next year. At that time, we’ll get a much clearer picture of how people with all kinds of post-injury problems respond. It’s looking very promising.

What exactly is oscillated field stimulation (OFS)?

Dr. Borgens: Oscillated field stimulation is a fancy word for producing a very weak voltage over an injured area of spinal cord. And in the future, hopefully over the brain. It causes injured nerve fibers to form sprouts, so it initiates new growth around the area of the injury. It produces function because of new connections.

What have you seen in patients implanted over the last two years?

Dr. Borgens: Patients implanted in the last two years have slowly gotten better with time. This is based on growth. When we published our results, quadriplegics in the study were faring better than paraplegics. Quadriplegic people are injured in the neck region. They do not have the ability to control their hands and arms, so those people were gaining control that was useful in their upper extremities. The most impressive changes in people implanted recently have been increases in their perception of the world around them, like feeling of pain and knowledge of where their body is in space. We’ve had significant changes in almost all patients in that area.

You’ve been working on this research for many years. How exciting is it to find something that is going to help restore function?

Dr. Borgens: Our first example of having something that could produce functional recovery of people wasn’t with OFS. It was with one of our first discoveries made here at the center at Purdue in the early 90s. It was a drug that does not cause growth, but it allows the nervous system to function in a way so people often recover some function within hours of taking a pill, or in the early days of getting an injection. That was my first experience of actually seeing someone improve. In these cases, they had been injured many years before and were able to move a leg or breathe more normally after taking medication. It was at that point I knew we had cracked the egg. Once you break the ice and you know you can change the quality of life for people in small ways, it becomes an issue of engineering.

It’s very exciting. I like working with companies now. I’ve never done that before. I’ve been a scientist here at this center for 25 or 26 years. Now I’m going all around the country, working with different people to commercialize this stuff and bring it into a position where a large number of people can benefit. It’s very, very exciting for me to see how medical therapies make it to everybody.

Can you tell me how molecular banding can repair nerve fibers?

Dr. Borgens: Polyethylene glycol is best known, but several different kinds of liquid plastics do this. They repair injured nerve fibers immediately. They don’t cause them to grow, like oscillated field stimulation. The polymers, when injected into the bloodstream, repair fibers immediately, so millions of damaged fibers that cause you not to feel a certain muscle become immediately repaired. If you repair damaged fibers with an injection of polymers, you’ll see functions return immediately. In animals, often within minutes or hours. We expect the therapy will be designed to repair, not regenerate, when we begin testing in humans next year. In my view, it is probably going to take a lot of strategies to make a more complete recovery for people.

So the treatment will help people repair after injury, but it probably won’t cause total recovery?

Dr. Borgens: Let me give you an anecdote. I told my friend we could cut cells and put them back together using polyethylene glycol. It repairs damage so we could actually fuse cells together. I don’t think he believed me at all. The next week, he came to the lab with a couple of residents, and we cut the cord completely in two with a tiny knife.

He stopped and said, “Wait a minute. I want to look.” He lifted the cord with forceps. Then he looked back at his residents, and said, “Yep, he’s cut it in two.”

I know what they were talking about in the car on the way up. They were saying, “This can’t be true. These guys have cut the cord but didn’t really cut into two pieces.” There was a lot of skepticism about this in early days. The early days were 1999. Now, a lot of labs are using it, and it does repair. If it repairs immediately, the notion we have a functional return on the repair goes without saying. You get a functional repair. Do you get a complete recovery of function? No, because not all cells are repaired.

How much improvement did you see in patients?

Dr. Borgens: Dogs recovered ability to walk more normally, but not perfectly. For man to have any of that ability was great. We saw recovery in perception of pain. We saw recovery in the ability to use bowel and bladder once again. When you damage your brain or spinal cord, you lose things. When you recover things, even imperfectly, you see recovery. A patient might regain sensation, lower function, sexual potency, perhaps continence, which is important. Continence is the fancy word for bowel and bladder recovery. In another patient, it might be all motor. Maybe it’s all muscle and very little sensation. It’s hard to judge what these therapies will bring back in an individual patient.

When should treatment be administered? Immediately after injury?

Dr. Borgens: You want to get in there as soon as you can. Some cells slowly die over a period of days, so the sooner you repair them, the better. Are you going to repair every cell? No. You may have to regenerate some. The important point to make is repair strategies are best used in the first day, if possible. Something like polyethylene glycol, or PEG, can be dissolved into fluids in an ambulance at the accident scene. It’s completely non-toxic. It’s safe and could be part of immediate health care at the accident scene. Restore agents can be given any time.

We’re working on better drugs now that do the same thing, but with fewer side effects. That might be useful for someone five years post-injury. Would PEG be useful for someone five years post-injury? No. What about regeneration? Regeneration could be useful anytime after treatment. We like to give the OFS units two or three weeks after initial surgery because this is a surgical implantation of an electronic device. These people are critically injured. They have a lot of other problems than just their spinal cord. We wait until their other medical problems are stable. You can go in later and implant an OFS unit and weeks later take it out. Or we could put it in within the first two or three days. We don’t have to. We know from animal studies we don’t have to do that. So we let the patient stabilize.

What do you predict for treatment five to ten years in the future?

Dr. Borgens: I think we are at the cusp. That is the fancy “we,” which means me and all the scientists that work together on these problems. This is a new era. I served on spinal cord injury boards in the late 70s and early 80s, and there was nothing available then. We had to just dream as a group about what we might like to do. Now, those dreams are realities.

We have experimental therapies that are changing injured animals and humans for the better. Do we continue to modify these therapies? This is no different than working with cancer drugs. You start sparing 25 percent of life of people taking the drug. As continued information develops, the population spared from cancer increases. It’s no different with the central nervous system. The big message is we’ve broken the ice. Science has broken the ice in the last few years, producing therapies we know now can change the quality of life for the better in injured people.

Over the 80s, a variety of people used the word cure. They were trying to raise money to tell where we were in the science of attacking spinal cord injury. I have never felt it is responsible or appropriate to use the word cure. The reason is we’re not there yet. We won’t find a cure during the lifetime of my students. Does that mean I’m a pessimist? No. I just spend time telling you we can improve the quality of life of people. If you’re quadriplegic and you can’t even grasp a cup of water, you have to be fed by an attendant, an attendant has to get you out of bed in the morning, then if you could just grasp and use your upper arms just a little bit, then all of a sudden, you could feed yourself, you don’t need an attendant 24 hours a day, then you would have huge gains. If you can use hand controls in the car, you might even get a job.

Let’s stop talking about putting Humpty Dumpty together again, taking a former basketball star and having them play basketball again. That’s what the word cure means to people, to families of injured people and injured people themselves. Cure means making them exactly like they were before they were injured. It’s irresponsible to use that word at this stage in development of this science

I’m a little passionate about that. I remember Christopher Reeve sitting on Jay Leno saying, “They’ll just need to regenerate this tiny little few millimeters, and I’ll be cured. I’ll be riding horses again.” We all watched him whither away and die. You know who a lot of people hold responsible for that? People like me, because we’re the ones who are out there saying, “If you give us so many millions of dollars, we’ll find a cure therapy.” I won’t do that. I’m not going to be responsible for making promises we can’t live up to

So you would not say this research could lead to a frontline cure?

Dr. Borgens: I’m going to tell you a story. When I was a young man in my late 20s, I developed a way to get frogs to begin growing their legs back. A person from no less than the Chicago Tribune, a science writer, came down to interview me at Purdue. I said, “Remember, I can get the frog to begin to grow his legs back. Large adult frogs don’t grow their limbs back after amputation. Salamanders do, not frogs.” And I told him the reasons why.

One of the tests would be to get the frog to grow his leg back partially using electric current. I made it clear to the writer you couldn’t get a normal leg back. You could only get things that looked like limbs. When I got the Sunday supplement with the science edition two or three weeks later, there’s a big cartoon of a frog with a new leg plugging himself into a light socket.

I have learned to be very careful about these sorts of things. I have had more than my share of times with cure, saying you’re going to cure somebody with this, only to see it in the paper. No cure is on the horizon. There’s a method to my madness that comes from a number of years of being disappointed.

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END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc., or any medical professional interviewed. Ivanhoe Broadcast News, Inc., assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors in different ways; always consult your physician on medical matters.

If you would like more information, please contact:

Center for Paralysis Research
Purdue University
408 South University Street
West Lafayette, IN 47907
(765) 494-7600
http://www.vet.purdue.edu