Aug 9, 2024
3 Body Problem - U2FP's Symposium
Sam Maddox
U2FP’s Annual Symposium is happening September 27-28 in Atlanta, Georgia. You can register here. (Note that early bird pricing ends next Friday, so sign up soon and save yourself some dough). This is the second installment in a series contextualizing the scientific presentations at this year’s gathering. So, let’s look at Friday morning’s second session, entitled “3 Body Problem.”
This session title refers to the eponymous science fiction TV series. I can’t spoil the story for you, I haven’t seen it. From the Netflix trailer it looks like humankind is threatened by extraterrestrial forces able to unravel the laws of nature, including big ones, like keeping earth, moon and the stars in some Newtoniian order. Passionate scientists join forces with creative government agents for an existentially entertaining showdown.
U2FP has convened our own panel of three scientists (passionate to be sure) to consider the association between three interrelated human body characteristics: movement, sensation, and autonomic function. In balance, these features make for a healthy, whole body. The onset of paralysis breaks the law of equilibrium, threatening personhood in an alien encounter of the SCI kind. Existential? It is if it happens to you.
The panel set-up requires a look back at the evolution of spinal cord injury research. Twenty five years ago and beyond, the goal was to restore the nervous system to reactivate most major movements, including locomotion. Then the research community heard from the lived experience community: ”Wait, we don’t really put walking at the top of our priorities. How about you start by addressing things that matter to us, such as bowel, bladder, and pain.”
So, the field responded, and projects shifted toward these more incremental strategies. But wait again: is this playing it too safely? What about looking at the body not as a set of symptoms but as a single system, as a whole? And why not consider again the biggest of issues, walking?
David Magnuson, PhD, University of Louisville, works with the spinal cord stim group there to understand the biology of spinal cord neural circuits. He asks: are we neglecting the interconnectedness in the central nervous system by focusing on a subset of complications?
Click on the image above to read Dr. Magnuson's abstract and bio for this fall's Symposium.
This is all quite complex, and there are limits to our biological knowledge, Magnuson concedes, but he suggests there may be unforeseen effects of pursuing research based on the SCI community’s priorities. He will address these questions directly, looking at spinal cord injury as a syndrome with multiple clinical needs.
Magnuson expects his comments to be provocative. He will explore how we got where we are, noting that researchers are driven by incentives for funding, for academic career advancement, for publication conventions (higher score for novelty, influence and impact; little incentive for clinical benefit).
What are the implications of a whole body approach for developing sustainable, marketable therapies? What happens in the regulatory environment? What about the community’s involvement and pleas for urgency? Does a whole body approach constrain what the SCI community needs now with promises of more comprehensive treatments in the future?
If the answer involves systemic change, it will be resisted by the status quo and will require creative, strategic solutions. This may include increased funding, more collaborative research projects, better infrastructure to manage the translation from lab to commercial success.
Will the system adapt? Perhaps, if incentives change. Here’s Magnuson’s bottom line: If we get people up and walking this will dramatically improve all other secondary complications.
Mind and Body
Next up is Ann Van de Winckel, who directs the Brain Body Mind Lab at the University of Minnesota. She’s presenting on her efforts to retrain the body and rewire the brain for multiple functional improvements. The basics of Van de Winckel’s body awareness work have been explored on the U2FP CureCast, and at the 2021 virtual symposium (start at 7:19 on the video).
Click on the image above to read Dr. Van de Winckel's abstract title and bio.
Van de Winckel and others have found, using functional MRI to study brain networks, that the parts of the brain related to pain and body awareness function differently in people with spinal cord injury and neuropathic pain. Her studies have shown that whole body awareness techniques, such as Qigong and attention to breathing, can restore some of those brain functions.
This body awareness appears to be critical for improving neuropathic pain, but it has also been anecdotally reported to improve other complications, e.g., bladder, bowel, etc.
Sound a little New Agey? It’s based on biology, not metaphysics. Van de Winckel has developed exercises to help paralyzed people restore a sense of joint position and movement. The exercises may involve identifying how legs are positioned in space and in relation to other parts of the body. This body awareness can change the perception of pain intensity.
Breathing & Walking
Gordon Mitchell, PhD, University of Florida, will discuss his work to induce nerve growth to restore breathing function and its broader implications on body systems after SCI.
Click on the image above to read Dr. Mitchell's abstract and bio.
For many years Mitchell and colleagues have demonstrated the restorative potential of acute intermittent hypoxia (AIH), the breathing of low oxygen air alternated with normal air. It’s been shown in incomplete spinal cord injury that this technique induces nerve plasticity, or growth, enabling significant respiratory recovery. AIH combined with task-specific training also boosts plasticity in limb function, including arms and hands.
AIH is complex and interactive across systems of movement, sensation, and autonomic function. The technique is approaching clinical relevance, but work remains to define dosing, safety and efficacy. What motor system (respiratory, upper airway, limb) is the best target? Will combinatorial therapies (drugs, task-specific training, electrical stimulation) enhance the effect? Why do some individuals respond better than others?
It remains a significant challenge to understand how the spinal cord balances numerous systemic processes, including blood flow, immune response, hormones, and movement. Magnuson, Van de Winckel and Mitchell will continue to explore their own specialties while framing spinal cord injury as a one body problem: an integrated, systems biology view, rather than the isolated organ-system perspective. Let’s hope this session expands the conversation about treating spinal cord injury beyond a cell, tissue or motor function focus to a whole-body view.
Stay curious,
PS - You can explore our confirmed speakers here, peruse our full agenda here, and read our presenters abstracts and bios by clicking on their image or name on either of these pages.
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