The injured brain
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Developing new strategies for treating patients with spine injuries
Scientists at the Veterinary School have been building on research from the Brain Repair Centre to show that transplanting specialised cells associated with smell can result in the recovery of spinal cord function following injury
How can a delicate “computer” such as the brain ever recover from injury? Brain function crucially depends not only upon an adequate supply of oxygen and glucose but also on keeping a vast array of very powerful chemicals in their correct place. Brain injury caused by trauma, haemorrhage or water on the brain (hydrocephalus) disrupts many of these mechanisms. Furthermore, following injury, the brain may swell within a closed box (the skull) so that pressure builds up and restricts blood flow to the brain, proving lethal if untreated.
Damage to the brain and spinal cord, often as a result of trauma such as road traffic accidents, can have profound consequences for the sufferer. Spinal cord injury can lead to permanent paralysis, while damage to the brain can manifest as a whole range of symptoms from loss of memory to convulsions, seizures or a coma. Each year in the United States, approximately one million people will seek medical intervention for a blow to the head. Of that number, 50,000 to 100,000 will have prolonged problems that affect their daily lives. Similarly, with over 800 new cases of spinal cord injury presenting in the UK each year, and a staggering 10,000 new cases being identified annually in the USA, devising new treatments for spinal cord injury is a key focus of research Cambridge neuroscientists.
This approach has highlighted the benefit of using existing veterinary ailments to develop strategies for managing human injuries, while at the same time advancing veterinary care
Research into the effects of traumatic damage to the central nervous system spans from work on spinal cord injuries in dogs to sophisticated psychological and imaging techniques to improve the diagnosis, treatment and rehabilitation of patients with traumatic brain injuries. Cambridge researchers have spearheaded the approach of using domestic pets with damage to their spinal cord to identify treatments that could benefit human patients. Spinal cord injury, primarily a result of road traffic accidents, is relatively common in domestic dogs and – as in humans – there is currently no effective treatment to help these animals regain functions such as walking or bladder control. In true collaborative spirit, scientists at the Veterinary School have been building on research from the Brain Repair Centre to show that transplanting specialised cells associated with smell can result in recovery of function of the spinal cord. As part of this ongoing research programme, injured dogs have a small number of specialised cells, called olfactory ensheathing cells, removed from the back of their noses. These cells offer particular promise because they are the only cells in the central nervous system capable of constant regeneration. These specialised olfactory cells are harvested in small numbers and then grown in the laboratory, before being transplanted back into the damaged part of the dog’s spinal cord. As well as regaining some movement, the dogs also seem to recover sensation below the site of injury. The results of this intervention have proved promising, although it is still too early to say how these findings will translate into treatments for human patients with spinal cord injury. Nevertheless, this approach has highlighted the benefit of using existing veterinary ailments to develop strategies for managing human injuries, while at the same time advancing veterinary care.
Experimental work suggests that the extent of brain damage may be reduced by early interventions that improve blood flow and block abnormal responses to brain chemicals. However, translation of such ideas into safe patient care has proved disappointing except with the use of a calcium antagonist drug or acute statin therapy after subarachnoid haemorrhage. In Cambridge, we have developed the resources successfully to explore questions at each stage of the patient pathway from the roadside, through neurointensive care, recovery from coma, and rehabilitation to final outcome. The Wolfson Brain Imaging Centre provides state-of-the-art brain imaging (Positron Emission Tomography, MR) within the environment of the Neurosciences Critical Care Unit in which patients benefit from world-class intensive care and multimodality bedside monitoring. All this work involves extensive collaboration between Neurosurgery, Anaesthetics, Wolfson Brain Imaging Centre, Brain Repair Centre, Neuroradiology, Medical Physics, Engineering, Cavendish Laboratory, Paediatrics, Psychiatry, MRC Cognition & Brain Sciences Unit and the Behavioural & Clinical Neuroscience Institute.