SpineUniverse spoke with Michael G. Fehlings, MD, PhD, Head of the Fehlings Laboratory for Neural Repair and Regeneration at the University of Toronto in Canada. Dr. Fehlings is a neurosurgeon clinician-scientist, Professor of Neurosurgery at the University of Toronto and holds the Halbert Chair in Neural Repair and Regeneration at the Krembil Neuroscience Centre Toronto Western Research Institute and University of Toronto. Here, Dr. Fehlings discusses his research in neural repair and regeneration, which is showing great promise in at least one very fortunate patient.
SpU: Please tell us about your laboratory and research related to spinal cord injuries.
Dr. Fehlings: Our neuroscience unit is part of the University of Toronto system and located in the new Krembil Discovery Tower. It is a state-of-the-art facility housing the spinal cord injury unit, basic science unit, and a clinical research discovery center.
One of the most prominent areas of research deals with stem cells, although our lab has a number of other areas of focus. Currently, I’m leading an international, multicenter, randomized controlled clinical trial that is examining a neuroprotective drug for the treatment of acute spinal cord injury. The name of the drug is riluzole; it is a sodium channel blocker. Riluzole is a drug that is approved by the US Food and Drug Administration (FDA) and is used around the world to slow the rate of nerve cell degeneration in patients with ALS (amyotrophic lateral sclerosis or Lou Gehrig’s Disease). The drug is available in a generic formulation. Essentially, there isn’t any drug company that is not championing riluzole.
In 2013, we published the results of a Phase I clinical trial with 36 patients and 36 controls (observations made during the clinical trial). The result of using riluzole in the treatment of traumatic spinal cord injury is very promising.
SpU: We understand your research with riluzole is moving forward.
Dr. Fehlings: Yes. We are now conducting a more formalized, multicenter, randomized, double-blind controlled trial. Randomized means the patients participating in the study receive riluzole at random; not all the participants receive the drug. Neither the clinical trial investigators nor the patients know if riluzole or a placebo is administered (called double-blind). We are conducting this research in partnership with AOSpine North America and the Christopher and Dana Reeve Foundation.
SpU: How do nerve cells react following spinal cord injury?
Dr. Fehlings: That is the second area we are focusing on—trying to optimize the area of the spine damaged to facilitate central nervous system regeneration. The first strategy is directed at trying to protect nerve cells after the initial injury.
There are different types of trauma that can cause spinal cord injuries, such as a fracture, dislocation of the spine, blunt contusion, or penetrating injury (eg, bullet, knife). The point is—there is initial trauma that occurs, and some of the nerve cells are irreversibly damaged. Of course, there are a lot of other cells that become injured but if the cells are protected, they can recover. If cells are not protected, they undergo secondary degeneration; sometimes called secondary injury. The neuroprotective characteristic of riluzole is directed at trying to protect the nerve cells.