Speaker 1 00:00:41 Thank you for joining disability and progress, where we bring you insights into ideas about end discussions on disability topics. My name is Sam. I'm the host of this show tonight. We are with Dr. Anne park. Dr. Parker is with us and she's talking about spinal cord injuries and treatments for them. Dr. Parr is an MD and a PhD. He is a neurosurgeon and associate professor of neurosurgery at the university of Minnesota medical school. Good evening. Good evening. And thank you for inviting me here. Did I get all that? All right, thank you very much. Could you please just give us a little bit of history and talk about the path that led you to medicine? Sure, absolutely. Um, I'm Canadian, um, and uh, recently became American just, uh, last year. Thank you very much. Uh, so I was born in Canada in a small town in Northern Ontario called Sperry found, uh, which is known actually, uh, the hockey town and the home of Bobby or, um, but, uh, my future did not lie in hockey.
Speaker 1 00:01:55 Uh, so I studied life sciences at Queens university at Kingston, Ontario, where I researched fetal alcohol syndrome and I became really interested in, um, neuroscience. Uh, and so after that time I stayed there for medical school and then I subsequently went into neurosurgery at the university of Toronto. Um, and I did a PhD in spinal cord injury yet my time at university of Toronto. Cool. Cool. All right. Um, what made you decide on spinal cord injury? I mean, there's a lot of things you could have gotten into I'm. Sure. Yes, absolutely. Um, I had this early interest in neurosciences as I, uh, as I mentioned earlier. Um, but, uh, really what, when I became interested in spinal cord injury was my first or second year of neurosurgical residency. Um, and I think it was really the patient exposure and the patient experience, uh, that sort of stoked my interest in spinal cord injury.
Speaker 1 00:02:58 Um, and I, it was just that it was so frustrating, you know, as a neurosurgeon and I could see how frustrating it was for patients that there were really no treatment options available when you think of spinal cord injury, I guess it, so it feels so broad. Could you give, like what somebody would give a definition of a spinal cord injury would be yes. Uh, so the term itself really is broad spinal cord injury means, um, anytime a spinal cord is damaged, that is technically a spinal cord injury. So this could also include temporary or permanent damage damage at any level and the neck or in the thorax. Um, it could also include things like, uh, ALS or Lou Gehrig's disease, multiple sclerosis, cervical myelopathy, and other types of spinal cord pathology, uh, but almond usage, uh, most people when they think or refer to spinal cord injury, they're talking about traumatic spinal cord injury or that, that occurs after an accident or another traumatic event.
Speaker 1 00:04:04 Okay. Um, how common is a spinal cord injury? Uh, so in the United States, there are more than 12,000 new cases of spinal cord injury each year. And that's, that's traumatic spinal cord injury alone. That doesn't include all those other pathologies that I spoke of. Uh, young adults are primarily affected and the lifetime estimated costs of cervical spinal cord injury, or that's when that occurs in your neck and a 20 five-year-olds is approximately $5 million. So not only is it devastating for patients and their family, that's also really expensive. Yeah. Yeah. So while many groups have focused on therapies for subacute spinal cord injury, or that is injuries that have just occurred or occurred recently, chronic spinal cord injury, which is the spinal cord injuries that occurred years, weeks to years to months earlier, really chronic spinal cord injury remains an unmet need. And there's an estimated 250,000 people currently living with chronic spinal cord injury in the United States.
Speaker 1 00:05:09 Oh my. Okay. Can you give us, I think a lot of people don't realize all of what the, what the spinal cord all does and how long is it? So can you give us a brief description of how long the spinal cord is, how it runs and what it's responsible for sure. Absolutely. So when we were born, the spinal cord in babies actually goes down right to the bottom of your spine. Um, but interestingly, your spinal cord doesn't grow at the same degree to the same degree that your spinal column does. So as you grow into your adult height, your spinal cord actually retract up your spinal canal. So in an adult, the tip of your spinal cord typically reaches only to about the upper lumbar region about the lumbar one or lumber two level. Um, and so any injury below that in your lumbar spine is actually a nerve root leak, and it's not actually an injury to your spinal cord and that has some implications.
Speaker 1 00:06:14 So, um, the function of the spinal cord is really to provide motor control over your arms and legs. And that's what most people are for most familiar with, you know, and that is paralysis after spinal cord injury. Um, but the spinal cord also provides sensory function to your brain. So, and sensory function is not only something like light touch or pain, but it also is, um, very important functions like proprioception. And what that means is that your spinal cord tell your brain where your legs and arms are in space. So if you can imagine, if you close your eyes and you reach out for something, you know, where your arm is in space, whether it's in front of you or beside you, or behind you, and it's your spinal cord that, um, really, uh, controls that function. So as well as the spinal cord also helps to control your blood pressure and your bowel and bladder function. Um, in fact, the really interesting thing is that many of these functions are contained entirely within the spinal cord. So I think it's wrong. I think that the spinal cord is a relay system for motor function and sensory function. But, um, and so it's not just the system for messages between your brain and your body, but it's actually a lobe of the brain itself and is able to process information independently of the brain. Ah, okay.
Speaker 1 00:07:40 Quite an amazing thing it is, but our entire body's pretty amazing if you really break that down. When I was doing some research, I saw something about no, that there is sometimes drugs that are given after injury that would preserve or help cells. And pretty obviously there's still damage when there's injury. Um, how does this work? So right now there aren't any drugs, unfortunately, that are clinically available to patients that have been recently spinal cord injured, but there are many that are being explored in clinical trials. Um, and so it's really interesting because when you talk about drugs for spinal cord injury, you really have to think about how reef the spinal cord injury occurred. And exactly as you said, right up final cord injury, there is this thing that we call secondary damage. And what it is is that there's an injury initially like a crush injury of the spinal cord that leads to a certain amount of damage.
Speaker 1 00:08:56 But then in the hours to days to weeks that follow that injury, there's continued damage because the, um, if you have an inflammatory reaction, your body has a reaction to that damage and tries to clean up the dead cells and things like that. But in the process, it can actually cause further damage. So one of the strategies to dealing with spinal cord injury is something we call neuro protection or protection of the neurons and other elements of the spinal cord and, um, how this works, many of the drugs are actually anti inflammatory agents or that they block inflammation and swelling and other small processes that happen. And in that way they limit further damage. The problem is that while these drugs would, are, can be very effective in acute or subacute spinal cord injury, that is again, spinal cord injury that happened recently. Many of these drugs, aren't very helpful in chronic spinal cord injury because of the period of that secondary injury has already passed.
Speaker 1 00:10:05 Oh, and presumably this is not just common with spinal cord injuries, but it would happen in other places with the body that have been injured too, that they have to be secondary injuries. Well, that's exactly right. So it is also applicable to traumatic brain injury. And it's been, been known for a very long time in stroke that this is a, this is a key element. And in the stroke, we actually have a special name for it. So when somebody has a stroke, there's the area of the brain that dies, unfortunately. And then there's the area of the brain. That's fine and it's alive, but there's this area between the dead and the alive that we call the penumbra that's full of dye yang cells. And those cells are either going to live or they're going to die. And that decision is made within a few days, perhaps even hours of the stroke itself. And that's why, like, for example, getting on top of stroke and being able to diagnose it very, very quickly and treat it, um, it's so important. And so now we're kind of taking that idea of time is brain too. Time is fine, where we feel that we need to intervene really quickly, um, spinal cord injury.
Speaker 1 00:11:30 Um, before we get into this more complicated section, I'd like to take a short station break and we'll be right back,
Speaker 2 00:11:41 Uh, supported bind two Betty's. Everybody knows about two baddies. It's the locally owned company, providing green cleaning services for residential and commercial spaces besides being eco-friendly to Betty's is known for offering us employees, flexibility, living wages, health insurance, and a 401k to Betty's is looking for people to join their team now to learn more, go to, to Betty's clean.com/jobs desk to Betty's clean.com/jobs,
Speaker 1 00:12:20 Disability. And we are with Dr. Par and Dr. Parr is passing about spinal cord injuries and treatments that I'd like to get into the, um, most common treatments for spinal cord injuries. Could you talk a little bit about those? Sure. So, uh, right now they are, as I said, that the good news is that there are many, many treatments in currently in clinical trial for spinal cord injury. Um, but unfortunately there are not many of them that are clinically available. Um, right now, if a patient comes into the hospital with a spinal cord injury, um, and they're at a center that doesn't offer or doesn't have any clinical trials running, then the main staple of treatment for spinal cord injury is admitting the patient to the ICU, um, to make sure that their blood pressure is high enough, that they're able to perfuse their injured spinal cord.
Speaker 1 00:13:20 Um, B if this wound cord is being compressed by a piece of broken bone, for example, it's really important to get that patient to the operating room as soon as possible to decompress that. Um, and then after that, the main thing is to get the patient to a good rehab facility of which there are many in the twin cities and, uh, and to get them a Maximo rehabilitation, uh, therapy to optimize their outcome. Um, the clinically available treatments, uh, like I say, are, are limited. Um, but some of the areas of research are stem cell treatments, um, electrical stimulation, treatments, and different, uh, anti inflammatory treatments for neuroprotection, as we kind of talked a little bit about earlier. So right now, currently what we're looking at is surgery or like using, yeah. So that's, that's, um, basically if a patient has, there's pretty good evidence that if a patient has, uh, ongoing spinal cord compression, that it's the right thing to do to take the patient as soon as possible to decompress their spinal cord, to give them the best outcome.
Speaker 1 00:14:35 So sometimes that involves fusion. Um, if, if it's a fracture where the spine is unstable, um, but it doesn't always, sometimes it just involves the decompression and decompression again would be. Yeah. So a decompression is basically where you open, it's still a surgical intervention. Uh, you open up around the spinal cord and then you remove, if there's a diff or some blood or a piece of broken bones, that's squishing the spinal cord. You remove that are there. I sometimes have heard, like you can give injections and maybe buy some time or help w you know, with the compression that might be going on. Is that possible? Um, well with mechanical compression, or if that, is there something that's physically compressing the cord, there really is nothing better than just to go in there and to take out the compression. And then if there's an unstable spine to stabilize the spine, there's pretty good evidence that that's kind of the only thing to do. And that injecting things won't really help that. But then the question is that at the time, should the patient also be given some drugs to prevent or decrease the swelling? Um, and that's where it becomes a little bit tougher because there are some of these types of drugs in clinical trial, but so far, none of them have passed the bar to make it to regular usage.
Speaker 1 00:16:06 What does it mean to pass the bar to make it to regular usage? So what that means is basically a randomized clinical trial. So patients come in and you randomized patients either to being treated with the drug or not getting the drug to see which patients do better in the long run. Um, and so one of the most well-known, uh, trials like this was the one using methylprednisolone that took place a number of years ago. And even years later, this is still controversial because the problem is, is that when you're designing a clinical trial, one of the problems is you want to include as many people as possible, but on the other hand, you don't want to be you, if there's a specific group that may benefit from a treatment and you're including everybody, you may not pick up that specific group. So the problem with using things like methyl prednisone alone is that yes, it decreases the swelling of the spinal cord after injury. And yes, there is some evidence that it helps some patients, but the problem is it also totally shuts down parts of your immune system. So a lot of older patients that came in actually did worse because they were susceptible to pneumonia and things like that. And then they got infections and died. Oh yeah.
Speaker 1 00:17:32 So how long does it usually take for I'm sure I'm thinking it takes several trials, but how long does it usually take before something comes to the public from the time of first discovery? Um, I think they average about eight years. It's quite, unfortunately it is quite a, a long time. Um, there, I think that, you know, we've been talking a lot about drugs for acute spinal cord injury. And like I said, there are a number of, of drugs like that in clinical trial right now. Um, but one of the more exciting things I think that's also coming up is trials for phonics spinal cord injury, because those have been very, very few. And one of the things that we have recently is that electrical stimulation. And that actually seems to be one of the most promising things that this period of time, rather than an injection of something, it's rather the electrical stimulation. And clearly, um, while a person is waiting for one of these magical trials to come to, you know, or one of these magical drugs that come to the public things could be getting worse for them.
Speaker 1 00:18:51 Yes. The, the, so the neuroprotective drugs, like the ones that I talked about that reduce inflammation and reduce secondary injury, much like, you know, traumatic brain injury or stroke, those ones are only useful, like right after your injury. So if they're like, if you had, unfortunately, if you had like an injury today and the drug's not available, then it's not going to help you down the road. So then you become eventually a chronic spinal cord injured patient, and then you have a lot of attendant problems with that. Um, things like pressure authors and problems controlling your blood pressure. And so there are a lot of unfortunately really negative effects than, yeah. So over time people are, um, really have to pay a lot of tents into their personal health and things like that. So as not to develop any secondary complications, um, but that's why, you know, we're really excited about new treatments for, um, chronic spinal cord injured patients, because any, every patient who is an acute at this point in time is it has an acute spinal cord injury eventually becomes a chronic bump, one in three patients.
Speaker 1 00:19:58 I was fascinated to see that you have your own laboratory. Um, can you talk a little bit about it and what its role is? Sure, absolutely. So our laboratory is a neural regeneration laboratory. Um, and so we do a lot of basic science right up to translational science in my lab. Um, I have a lot of great people that work with, um, and, uh, our sources of funding are from the spinal cord society. Um, who've been very generous. Uh, we get some money from philanthropy. We get some funding from the Minnesota state spinal cord injury and traumatic brain injury granting, um, uh, mechanism. Um, and we've also had money from the Morton cure paralysis foundation and, um, also the, um, the wings for life and a few other places, or I just thought I, I wanted to mention them to give them so certainly our lab would not be able to continue functioning without all these sources of funding.
Speaker 1 00:21:02 Um, and so our lab, we really like to focus on chronic spinal cord injury because I really think it's an unmet need. Um, in my lab, we work on a couple of different things, uh, because I, I do believe that the eventual world best treatment for spinal cord injury is going to be multi-factorial and it's going to be patient specific. I think that it really depends on again, I kind of described the different treatments for acute versus chronic spinal cord injury, but also there may be different treatments for neck injuries versus thoracic injuries, um, and also like complete versus incomplete injuries. And there's basically every patient as an individual. And in this age of personalized medicine, I think that really matters. So that's one of the reasons that in my lab, we're working on a number of different things. So one thing we work on is electrical stimulation therapy.
Speaker 1 00:21:52 Um, another one is stem cells. So we use regionally specific, um, spinal cord stem cells. Uh, and we also use 3d printing. So we use a 3d printed scaffolds, uh, to deliver the cells to the foreign court a lot there. Yeah. So the term I H C or M you know, his stove chemistry. Can you talk about that? So, yeah, sure. I I'm, you know, histochemistry is, is a lab techniques that is mainly used to identify cells and to tell what's going on in the cell. So we use a rat model of spinal cord injury, um, because we can look at the rat issue afterwards to see what ha what's happening, the human cells, we do use human cells for transplantation purposes. Um, and so what immunohistochemistry is, is basically it's a way of identifying cells. And for example, we know that neurons express on the surface, they have certain proteins on the surface of the cell.
Speaker 1 00:22:58 So then what we do is we take an antibody again that binds or attaches to those, um, proteins on the surface of the style. And then there's a secondary antibody that has a fluorescent tag on it that binds to the primary antibody. So basically what it is is if a cell is a neuron, then we attach these, use these antibodies to make the neuron become fluorescent. And then we use it for a microscope and we look underneath the microscope and we can identify which cells are, which cells. And are you, you're using these in the studies for rats? Yes. Yes. We, we use this as a very common technique. For example, we use stem cells and then we transplant them into the wrap, but then how do we, how do we know what cells, um, or, you know, are they forming an exercise with other styles and things like that?
Speaker 1 00:23:57 That's always the main things we want to know. And so we use immunohistochemistry and different types of microscopy or different microscopes to, uh, so we can see what these cells are becoming. So if you are taking them fluorescent, obviously you can see where they are and what the, as you said, what they're connecting to exactly and what cell type they become, because all of our cells don't become neurons. Some of them become other supporting cells. Like astrocytes are all a good emphasize. And we also want to see what those cells are doing. How do you know what's the net, what's the cells to do? Does it matter where you put them and then they kind of just adjust to that area?
Speaker 1 00:24:42 Well, that's a bit of a complicated question, but, uh, basically we don't just throw any cells because one of them, some of the more recent studies show that, like, for example, if you grow brain neurons and put them into the spinal cord, they're actually not going to do anything useful, which kind of makes sense. Right? So first of all, we take very specific neural progenitor cells or stem cells that are stem cells from the spinal cord in humans. And so we start by using those cells and then we put them into the rat spinal cord, and then we see what happens to them. So I understand we're always going to the humans and taking spinal cord cells.
Speaker 1 00:25:32 Well, that's the really interesting part is that we are making human spinal cord stem cells, but we're not getting them from spinal cord because that would be really difficult to do. And then if you took cells from somebody's spinal cord, that would injure their spinal cord. So you wouldn't want to do that. Yeah. So, okay. So that's part of actually our technology is that one of the things that you might say, well, how do you prevent cell rejection? And so this is what, how use IPFC technology or induce stem cell technology. So basically we have the ability to take human skin or blood cells. And then we use genetic manipulation to turn back the clock, to make them like embryonic stem cells, but they're not from embryos, they're from adult. And then we subsequently culture those cells, and we can make them into any cell in the entire body. And so in this way, the idea would be that if you had a spinal cord injury, I could take one of your skin cells and turn it into a spinal cord cell that then I could use for you because theoretically, if you turn back the clock enough, every cell is an embryonic cell. Exactly. This is awesome. I need to take it another short station break, right?
Speaker 3 00:26:58 A lot of time and effort goes into your favorite programs here at KFH, but there are also a lot of Fords, Hondas, and Toyotas that go into these programs too, to all of our listeners who have donated their cars to KFA this year. We say, thank you, your old car is already making a difference. Thanks so much for turning your old car into the programs you love.
Speaker 4 00:27:20 Programming is supported by the science museum of Minnesota, presenting science fusion and event series, celebrating diversity, creativity and science museum. Guests can discover the possibilities of a career in the sciences through virtual career talks and panels and in-person field trips and events, museum visitors can meet inventors, engineers, educators, and other stem professionals from the twin cities, more information at dot org.
Speaker 1 00:27:56 This is cafe 90.3 FM Minneapolis and KVI dot O R D. We're speaking with Dr. Anne Parr, who is talking about spinal cord injuries and treatments. Um, back to par, I asked about the 3d printing, because that was fascinating to me. I think people are familiar with 3d printers now, but I don't think anybody thinks of it being introduced into like the human part of things, as far as printing parts or stills or whatever you might be doing. Could you explain how that works? Sure. Um, and first of all, I have to acknowledge my collaborator, Dr. Michael McAlpine, um, with the department of bioengineering at the university of Minnesota. Um, and he is really an expert in 3d printing and actually 3d printing of any body parts, which is pretty exciting. Um, but typically we collaborate on 3d printing of brain and spinal cord. And so we were the first to be actually to, um, to report printing neuron cells.
Speaker 1 00:29:10 Uh, and so we print the scaffolds that can be implanted into the spinal cord, but we also have the ability to print cells, the cells and different cell type in specific locations within the scaffold, which is something new. And they think that's going to be really add bam, ADA. Um, and so the we're able to do this, um, basically by printing droplets of cells, uh, within panels within the scaffold themselves. Um, and as I said, essential advantages of this, uh, would be to be able to precision place specific different cell types within the channel so that we can recapitulate the spinal cord. Um, and then, uh, and also incorporate different things into the scaffolds themselves like growth factors or, or, um, anything supportive to improve cell survival, um, printing the cells into channels and improve the directionality of the axons that extend from the neuron.
Speaker 1 00:30:21 Um, and we've actually shown that this promotes the function of neuronal networks, um, to provide a relay system across the site of injury. So we're pretty excited about that. So the 3d printer machine, is there anything different about your printing machine than just a normal 3d printing machine? So the key is actually not the machine itself, but the software that used to run it, uh, because these 3d printers are pretty advanced technology and the 3d printer itself is, or regular 3d, like just a regular bio 3d printer. Um, but it has specific programming, uh, do what we want it to. Ah, okay.
Speaker 1 00:31:07 So this is a, presumably this is a big stretch or where are you going with this and getting it to the, to be accepted into the public? Where are you now with? Well, we are still working on, uh, some of the basics, uh, for example, we can print our scaffolds many different types of materials. Um, and so we have been using silicone bricks ourselves really seem to like, but there are those that think that the materials should be biodegradable. We're not entirely convinced of that, but because of it, we're trying to dumper of different materials. Um, we're also trying some different bio to print the cells in, um, just so that we have the optimal cell survival and optimal conditions for the cells. Um, we are currently implanting these into rat stone that they serve the cells survive and that they do form the cell type that we want them to form, and that they do actually send back thoughts out and form connections with the native spinal cord.
Speaker 1 00:32:14 So it is possible for these to act as a relay system. So this is sort of what we're really excited about. Um, and the only problem is to translate to humans. So it really does take FDA approval, which often can be the big hurdle. Um, because often the FDA wants us to show that this empty scaffolds are not dangerous and the cells are not dangerous and then we can put them both together. So unfortunately it does take a really long time to get this through approval. So I understand, um, you know, what I hear sometimes this commonly is a neuro cell or a stem cell. Um, are they interchangeable? Did I stop what they are? I know what I think a stem cell is, but explain a neural cell then. Yeah. So it is different people use the technology or use the terminology differently. So it does become really, really confusing.
Speaker 1 00:33:15 Technically a stem Sao is, can give rise to any of the cell types of the entire body. So the, there really is only one stem cell and it's an embryonic stem cell. Okay. And then, but it's not quite that simple because over time cells differentiate and become more and more and more specialized. So after, so there is such a thing as a neural stem cells, but some people call them neural progenitor cells because the argument is it's not a true stem cell because it can't give rise to say a liver or a lung. Um, and so it's sort of like been thinking, I always think of it like a family tree. You know, if you draw like the genealogy three, where all the grandparents and give rise to the children, and then, you know, you have a little six coming down from there, they give rise to the next generation.
Speaker 1 00:34:10 You can write everybody's name and things like that. It's kind of, if you imagine that in your mind, that's sort of what, like what it is except for, instead of two people at the top, there's one embryonic stem cell. And then those give rise to a bunch of progenitor cells that have limited ability to give rise. And then those give rise to more limited cells. And then eventually they give rise to fully different data itself. And so a neural stem cell is a cell that give rise to all of the cell types of the brain and spinal cord. But it can't, for example, give rise to a long or a liver or something like that. So it's more specific. Yes, exactly. Okay. So if you had a neural stem cell that you were wanting to use for another part of the body, it would have to kind of come from that part of the body. Well, you would have to get, like, for example, a long stem cell or a liver stem cell. And as I said, some people don't even like the use of the word lung stem cell. They'd use the word. Well, progenitor cell. Okay.
Speaker 1 00:35:23 So you talked about rejection rate and the idea is use your own cells. So you have no rejection, correct? Yes. And this is the, of anybody who's playing around with the whole concept of using stem cells or cells to help grow or cure, or, you know, you use your own. And, um, there, the rejection rate goes hopefully next to none. However, if you injured that part, then we're going back to the neural stem cell. How do you get the cells? The good cells? Yes. So, um, you're right. So if I, if I turn away from spinal cord injury for a minute, and I just talk about medicine in general and where regenerative medicine is going. So the IPS cell technology that I talked about is actually applicable to all regions of medicine. And so the person who invented IPSE technology was actually a Japanese gentleman who won the Nobel prize for this in medicine a few years ago.
Speaker 1 00:36:34 And so, yeah, the eventual idea would be for example, that if you had kidney failure and you needed a new kidney and you didn't have a match, or even if you had a map, but you would still need some immunosuppressive drugs, dad, you could have your skin sampled or your blood sampled, which we know is relatively easy. And then we take those cells and put them in a lab, we've manipulated them genetically turn back box and make them into these embryonic like cells that we call induced, pluripotent stem cells, or IPS CS for short. And then you can subsequently culture those cells to make them into a new kidney or a new lungs for a new heart or a new liver. And that's the whole idea behind that whole branch of regenerative medicine.
Speaker 1 00:37:27 I want to ask you that, um, you've done obviously research in traumatic brain injury, which you mentioned earlier, um, how does it relate to the spinal cord? So that's a great question because, um, as I mentioned earlier, it's one thing that I always say that I consider the spinal cord and other lobe of the brain, because I think that if you define the brain as something that's able to think, for example, and what is thinking well, thinking really what it is is you're able to take input, process the input and then have an output from that area of your brain, because you think that most of what we think of is thinking as frontal lobe, like higher order, but yet your cerebellum as part of your brain, for example, but it's very primitive and it takes care of things like balance and some of your, um, coordination of speech and things like that.
Speaker 1 00:38:23 Well, the spinal cord actually has some amazing roles that it takes care of all by itself, for example, urination. So if you think about it, actually urination is not as easy as I'm going to use the restroom. And then I go in and I use it in that fit actual seat. It's very complicated. Not only does your bladder have to squeeze to empty it, you actually have two different, um, thinkers, or they're like sort of holding, you're holding you close so that you don't leak everywhere. And so you have to have perfect coordination of your bladder squeezing and these thinkers, both opening in sequence. And so it's a very coordinated effort. And another example is walking. It takes a lot of coordination to walk because if you think you think it's so easy to know to walk across the room, if you're not a spinal cord injured person.
Speaker 1 00:39:18 But if you really think about what it takes, for example, your arms are swinging, your legs are, you know, they're, they're swinging then that your heel strike and then you put your foot down and at the same time your other foot is lifting off the ground. Meanwhile, you're looking around, you're coordinated. You're not falling over your balance is all of these amazing things that, that go on. A lot of that actually happens within your spinal cord itself being like the mini brain. Yes, exactly. And so that's why traumatic brain injury and spinal cord injury are really just two sides of the same coin. That is fascinating. Uh, we're going to take one more space and break and we'll be right back.
Speaker 5 00:40:05 Programming is supported by the science museum of Minnesota, presenting sciences, all of us, a celebration of diversity in science, featuring online experiences and activities in person events and exhibits about science connected to race and culture museum visitors can discover a scientific perspective on race in the race. Why are we so different exhibit and explore how generations of Dakota and Ojibwe people have made their home in this place now called Minnesota in the we move and we stay exhibit more
[email protected].
Speaker 1 00:40:52 Dr. Anne park and I and Dr. Park, what is translational research? So research is broken up into several different categories, but I would say the easiest way to understand is that there's basic research, translational research, and then clinical research. And these things all overlap. It's really a spectrum of research. Basic research would be research on cells. And so we do some of that in my laboratory. Um, and then we also call it sometimes, um, knowledge research because some of the point doing some basic research is that it's not focused on one disease. It's more to understand further, for example, cell cycles or cell signaling or, um, other base mechanism. Um, there is translational research or rather on the very opposite end of the spectrum is clinical research, which is research on patients. It's usually focused on a specific disease and it's a specific treatment to see if that works. And then there's this area called translational research. And it's, how do you get this basic science research to clinical trials or clinical practice? And it's that part in the scene that takes that science and tries to apply it often it uses animal models. So they'll not always, um, or model systems to try to figure out what works the best. So then that can be brought to human patients.
Speaker 1 00:42:34 I'm just curious when you're teaching with your students, what is your goal for them to take away class? And obviously when you're teaching, presumably they're going into the same kind of spinal cord injury, or they could be going into any type of neural stuff. So I think a lot of different students actually, I, I do teach a couple of classes, um, usually in the physical therapy department or in the spinal cord, um, or sorry, the stem cell Institute. Um, but I teach a lot of different types of students. I would divide them sort of into two main categories though. One are my residents. Um, I do have neurosurgery residents and I teach them all kinds of, uh, neurosurgery things and the clinic and the, uh, in the operating room. Um, I teach them operative techniques. I teach them, uh, proper clinical judgment. Um, in my lab I have a completely different group of students. Some of them are students that want to go to medical school that are having a research experience before then. Um, some of them want to do MD PhD, um, and some of them are neuroscience students who want to have, who don't want to see patients, they, they want to do, uh, neurological focused research. Um, so there's kind of a combination of, of since, can you talk about difference of complex spinal surgery and minimal invasive spine surgery?
Speaker 1 00:44:17 Um, absolutely. So I'm a final neurosurgeon. Um, I did a fellowship in complex spine at the university of Miami, um, and, uh, spine really has a very, very broad of what we do as neurosurgeons. Um, the three smaller things like microdiscectomy and things like that. Um, we do through a minimally invasive surgery and basically what that is, is, uh, trying to operate through a very small tube. So a lot of our incisions are like two centimeters long. Uh, we'll go in with a tube and a microscope and all our instruments are what we call bayoneted so that our hands aren't in the way when we're doing the operation. Um, just it very fine, uh, but very small and trying not to disrupt the tissues on the very other ants of things. There's a lot of recent research with spinal deformity surgery, um, that, uh, aligning a person's spine properly, um, is the best way to address pain and many patients. And so spinal deformity surgery is an entirely different, um, uh, animal where we do quite invasive surgeries. Um, patients are in the hospital for quite a few days afterwards, and basically we can realign a person's entire spine.
Speaker 1 00:45:44 So with the minimally invasive, what kind of injury are you talking about that you do that on? Well, most of the minimally invasive surgery that we do are not spinal cord injuries, per se, most of the minimally invasive things that well, that's not entirely. Okay. So most of the minimally invasive surgery that I do are things more like disc herniations in that that aren't really spinal cord injuries. Um, the one thing that we do for, uh, spinal cord injury, as I, as I mentioned before, if there's ongoing persistent compression and spinal cord injury, it's really important to get those patients to the operating room right away. But sometimes patients with spinal cord injuries don't have ongoing compression and they don't require a decompression, but they might have an unstable spine. So in that case, we might use something like minimally invasive percutaneous screws. For example, we have ways of putting the screws in through the skin that doesn't require a diet exposure.
Speaker 1 00:46:53 Oh, okay. So on the side note, what are nerves neurosurgeons feeling about? Um, well, that's it, that's a really great question because it is something that I get asked quite frequently and, you know, I have a number of people that I trained with in undergrad. We went to chiropractic school. Um, I think that there are many people that are helped by chiropractors. Um, I have a number of patients that come to me and say, you know what? I have a chiropractor and he's, or she has really helped me. And I say to them, if it helps then by all means, but know that used to do careful, I believe careful research on who you're choosing and presumably they can hurt just as much as help. Well, I would say that obviously, if somebody has like been unrecognized fracture somewhere in their neck or their lower spine, then that's when things can go really wrong.
Speaker 1 00:47:59 And, um, you should never go to a chiropractor if you have that kind of injury. Um, but I will say a good chiropractor will ask, like, if your neck hurts, they'll say, where are you in an accident recently? Or, and if they have any concern, they will order an x-ray and they will send them immediately to us without touching them if they have a fracture. So there were two terms that I stumbled upon and I wanted to ask the difference between the term and perhaps you can explain them as well between myelin oligodendrocyte. I probably mispronounced that by the way, but yeah, it's a, that's a big one. The, uh, yeah, so I, I was talking about, um, different cell type and, uh, we were talking about neural stem cells and the fact that they give rise or they can become all of the cell types of the brain and spinal cord.
Speaker 1 00:48:58 Well, in the brain and spinal cord, there are three major cell type one cell type third neurons. And we know that those neurons are the ones that send out nerves and they talk to each other and they communicate and signal. Um, but there are also supporting cells and one sporting cell are called astrocytes and the other supporting cell are called oligos Dendra sites. And the main purpose of all of the D'Andre site is to provide insulation for the nerves because nerves are really an essence electrical wires, right. And so you can think of them like electrical wires in your house, and they just don't work properly if they don't have insulation. So the insulation in the spinal cord and in the brain is called myelin. So the oligodendrocytes themselves are cells. The myelin is the fatty substance that's produced by the oligodendrocyte that acts insulate the nerves. Oh, I just had to tell you, my son is named myelin, M Y L I N. So I just wanted to have him share this definition for somebody who really knows. Well, um, what do you want to see happen in, you know, spinal surgery and cures? What would you like to, what do you foresee as in the future?
Speaker 1 00:50:31 Well, I think that, you know, ultimately of course we'd all love an easy care for spinal cord injury. Um, but I think that's not realistic in terms of one thing. And we talked about this a little bit earlier, you know, in this age of precision medicine and the fact that all patients are different and that ultimately I think that there are going to be a number of treatments that are going to help people with spinal cord injury. So the first thing, you know, we recognized and in terms of surgery, that early intervention for people with ongoing final cord compression is really, really important. And then we have guidelines about making sure that patients have optimal blood pressure control. Um, and then we would like to have something, a drug that we could administer to patients as soon as they arrive in the hospital that will limit secondary injury and give them better outcomes.
Speaker 1 00:51:29 But, and for some people who have not slept about 5 43, that may be a cure. But I think for the majority of patients, unfortunately, that is not going to be a cure. It's just going to give them better outcomes. So then we need to turn to chronic spinal cord injury and what we can do in terms of that. And I think that our, you know, in our lab, we're looking at these 3d bioprinted scaffolds to provide a relay across the site of injury, uh, in order to regenerate the entered spinal cord. And I would really like to see this come to clinic, to patients. And then on top of that, we also have this knot, that of electrical stimulation that I mentioned earlier, that we've already shown in our clinical trial that helps people with spinal cord injury, chronic spinal cord injury. But again, that is an obscure, I think that all these together I would like to see come to clinic that, um, will bring the up optimal outcome to patients with spinal cord injury.
Speaker 1 00:52:32 Okay. Okay. Well, that's part, thank you so much for being willing to come on and I really appreciated, um, your time and hope that you have great success with your laboratory. Thank you so much. Thank you. This has been disability and progress. The views expressed on this show are not necessarily those of cafe or its board of directors. My name is Sam. I'm the host of this show. Charlene doll is my research team. This is KVI 90.3, FM Minneapolis, and 1 0 6 or sorry, KFC I dot O R D. We were speaking tonight with Dr. Ann Parr and on spinal cord injuries and treatments. Dr. Parr is an MD and a PhD, and she was a neuro surgeon and associate professor and neuro surgery, uh, associate professor and neurosurgery at the university of Minnesota school of medicine. Thank you for joining us tonight. If you want to be on my email list, you may email
[email protected] address
Speaker 6 00:58:44 I can't tell am I adding Brown skin up against my brows? No,
Speaker 6 00:59:07 People from Mississippi. Apparently your skin has been kissed by you make me want to her. She's kidding. Every time I see all that makes me think of honey is worth more than a goal to me. I'll be almond joy. It'll be my sugar. Daddy broski. No, I love your brown big brown ski.
