Is an MS Drug the Next Treatment for Spinal Cord Injuries?

March 13, 2012— -- A drug found to slow some of the physical problems and reduce the number of flareups of multiple sclerosis (MS) could also show promise for treating spinal cord injuries, according to a new Japanese study.

Researchers from the Jichi Medical University School of Medicine and the Universisty of Tokyo's Graduate School of Medicine found that FTY720, also known as Gilenya, helped mice with spinal cord injuries (SCIs) recover some motor function when they were given the drug immediately after the injuries.

FTY720 acts in a number of ways, the study authors wrote. The drug, provided by its manufacturer, Novartis, for this study, suppresses the immune system, which reduces inflammation that occurs after injuries. Inflammatory effects, they explained, can worsen the damage done by SCIs. The drug also helped the mice's damaged tissue regenerate, among other effects.

"The main biological activity responsible for these actions is believed to be immunological, but our data suggest that nonimmunological role(s) of FTY720 are also important in the treatment of SCI," they wrote.

The drug still needs to be evaluated in larger animals before determining whether it is effective in treating SCIs, but still has promise, the authors added.

Experts not involved with the study, however, are a bit more skeptical. Many interventions work in mice, so determining the utility of Gilenya for SCIs in humans is a long way off, if it happens at all.

"Another issue is that in this study, the drug was given immediately after the SCI, and rarely do we have the opportunity to give a drug immediately after this type of injury in humans," said W. Dalton Dietrich, professor and scientific director of the Miami Project to Cure Paralysis at the University of Miami's Miller School of Medicine. "One big question is if the drug delivery is delayed, will it work?"

Studies have found that in some people, the steroid drug methylprednisolone has been effective at restoring a little bit of function if given within eight hours of injury, but not all doctors are convinced steroids are the best option since high doses can lead to serious side effects.

But other drugs -- mostly experimental -- that clinicians have tried with post-SCI patients have not been particularly effective.

"Acutely, we really don't have any drugs to try to protect the nervous system," said Dr. Bruce Dobkin, director of the Neurologic Rehabilitation and Research Program at UCLA's Geffen School of Medicine. "The most important thing is rehabilitation."

"Right now, during the time right after an injury, we focus on providing good stabilization of the spinal cord, physiological monitoring and early spinal decompression surgery if it's appropriate," Dietrich said.

Despite more and more research into possible treatments for spinal cord injuries over the past decade or so, Dobkin said formerly promising options have not lived up to their hype.

"All the things we've done to try and improve walking haven't turned out to be that great, like robotics, electricial stimulation and other interventions," he said.

Newer experimental therapies include the use of stem cells to rebuild damaged nerve pathways and the use of cooling shortly after spinal cord injuries.

"In more than 30 patients, we tried mild cooling in the emergency room after patients came in with spinal cord injuries, and in those patients, the therapy seems to be safe and to provide some improvement in function," Dietrich said.

Although few effective therapies are out there right now, experts are optimistic.

"It's hopeful that within five or 10 years, we will have a couple of interventions we can use early that will give people more function," Dobkin said.