fidykaIn 2010, 40 year old Bulgarian firefighter Darek Fidyka had his spinal cord severed at mid-chest level during a brutal knife attack. He was completely paralyzed below the wound and, despite intensive physical therapy, showed zero improvement in the two years following the attack. Then, as you will see, something miraculous happened. This story is one of the most amazing and uplifting science stories that I have come across in quite a long time.

In order to fully appreciate what is happening with Mr. Fidyka, we need to start with a brief overview of the nervous system.  The nervous system is divided into two sections: the central nervous system (CNS) which consists of the brain and spinal cord, and the peripheral nervous system (PNS) which consists of all other nerves. Nerves control and coordinate all of the actions in your body, everything from wiggling your toes to conjuring up memories, through a series of electrical and chemical signals.

The structure and functioning of nerve cells are rather fascinating. While I might enjoy writing several paragraphs describing this to you, that information is not required for this story. What you do need to know is that nerve cells in the PNS can heal after injury, while those in the CNS generally cannot. The inability of the nerves to heal is what makes a spinal cord injury so terribly devastating.

Approximately half of the serious spinal cord injuries in the United States occur to people between the ages of 16 and 30.  Below is the distribution of the causes of injury:

Car crashes                                              37%

Falls(1)                                                      28%

Violence (gunshot, knife)                     15%

Miscellaneous                                         12%

Sports                                                        9%

There are approximately 250,000 Americans, 80% of whom are male, currently living with a serious spinal cord injury, and I expect that most of them are following Mr. Fidyka’s progress with great interest.

In a scientific sense, Mr. Fidyka’s story begins in 1985 with the discovery of olfactory ensheathing cells. When nerve cells in the nose – which are part of the PNS – are injured, olfactory ensheathing cells are produced by the body and used to help the nerve cells heal and regrow. Once their function in the healing process in the nose was understood, scientists wondered if ensheathing cells might be able to help nerve cells in the spine heal as well – the Holy Grail of the field. The essence of the question was whether nerve cells in the CNS were actually incapable of healing or whether they simply lacked the necessary environment and assistance to do so. In 1997, scientists tested this question by using ensheathing cells to successfully repair severed spinal cords in rats, a remarkable and promising sign. It would take another 15 years of study and testing before this treatment was tried on Mr. Fidyka.

Mr. Fidyka’s treatment began with surgery to remove one of his olfactory bulbs, where olfactory ensheathing cells reside, from behind his nose. The bulb was placed into cell culture for two weeks, during which time additional ensheathing cells were grown and collected. At this point, we should pause for a moment and marvel at our ability to remove cells from the body, put them in a Petri dish, and have them continue to live, grow, and divide. The techniques for cell culturing may be the topic of a future column.

Two weeks later, Mr. Fidyka had a second and far more significant surgery, this time to inject the olfactory ensheathing cells along with four strips of nerve tissue from his ankle into his spinal cord.(2) The hope was that the ensheathing cells would encourage nerve growth and that the strips of nerve tissue would provide bridges across the gap in his severed spinal cord. It did not take long until the miracles began to happen.

Three months after the surgery, Mr. Fidyka’s thigh muscles began to grow, a clear sign that his nerves were causing his muscles to contract on their own during physical therapy. Six months after the surgery, he was able to walk with the help of leg braces. I like to try to imagine what that must have felt like for him. Now that two years have passed since the surgery, he can walk with a walker (see the picture at the top of the page) and drive a car.

While the science behind this story is truly fascinating, I think I am primarily drawn to it because it touches on one of my darkest fears. While I find things like heart disease and cancer to be frightening possibilities, to me the prospect of paralysis is overwhelmingly terrifying. It is too soon to know if therapy with ensheathing cells will be the ultimate answer to spinal cord injuries, but there is cause for quite a bit of optimism.

I would be remiss if I did not point out that this story is yet another reminder of the value of investing in basic research. Way back in the 1980s, a researcher found a cell in the nasal cavity, did not know its purpose, and wanted to figure that out. Her curiosity and the funding which allowed her to follow it were the first steps on the 30 year journey that allowed Mr. Fidyka to walk again. As this column will be published two days before the mid-term elections of 2014, please vote for candidates who support investments in basic scientific research.(3)

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1. As you can see, injuries from falls can be quite serious. In addition to spinal cord injuries, falls may result in many other broken bones, notably hips, which can be quite serious. Most of these debilitating falls occur at home due to improper use of ladders or from standing on chairs and tables. Please keep this in mind and be safe out there. 

2. Note that all of the cells used in the process are from other parts of Mr. Fidyka’s body, thereby removing the challenges of preventing rejection of foreign material by the immune system.

3. In case it is not clear, those would be the Democrats.