Spinal repair restores breathing

13 July 2011 Last updated at 17:02 GMT By James Gallagher Health reporter, BBC News Damage to the spinal cord in the neck can result in problems breathing The ability to breathe has been restored to mice with spinal cord injuries, in what US researchers describe as a medical first.

Some patients with damaged spinal cords need ventilators as they are unable to breathe on their own.

A report in the journal Nature showed a nerve graft, coupled with a protein, could restore breathing.

Human trials could begin soon, which the charity Spinal Research said could be "potentially life-changing".

Damage at the top of the spinal cord, around the neck, can interrupt messages to the diaphragm - a layer of muscle involved in breathing.

Challenge

The cord is notoriously resistant to repair. Techniques such as nerve grafts, which worked in the arms and legs, had shown limited success with the spinal cord, doctors at the Case Western Reserve University said.

The spinal cord scars after it is damaged, and molecules - chondroitin sulphate proteoglycans - prevent nerves repairing and forming new connections.

Continue reading the main story There are approximately 800 spinal cord injuries in the UK each yearRoughly half are in the neckThe majority of these patients will have some degree of impaired breathing

Source: Spinal Research

The researchers used a nerve graft to form a bridge across the scar at the same time as injecting an enzyme - chondoitinase ABC - which attacked the inhibitory molecules.

Three months later, tests showed the mice had recovered 80-100% of breathing function.

Professor of neuroscience and lead researcher Jerry Silver said: "The use of the enzyme, that's helped get the nerve fibres out and we were amazed at, once they get out, how well they can reconnect.

"The spinal cord can just figure things out and restore really beautiful functional breathing patterns."

Researchers hope to begin trials in humans. They are also investigating whether bladder function can be restored, which can be lost when the lower spine is damaged.

Dr Mark Bacon, from the charity Spinal Research, said: "Long distance regeneration has remained quite elusive in the field of spinal cord injury repair, so to achieve this and at the end of it establish functional connections that actually do something useful - restore breathing - is remarkable.

"It is potentially life-changing if this or similar techniques can be translated to the clinic."

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Air bags used for pyramid's repair

9 June 2011 Last updated at 06:38 GMT By Neil Prior BBC News, Wales Giant inflatable air bags are being used to make the 4,700 year old pyramid safe

A south Wales engineering company is using 21st Century technology, including air bags, to help preserve one of Egypt's most imposing landmarks, dating back to 2,700 BC.

The Pyramid of Djoser is Egypt's oldest step-built pyramid. But it was at risk of collapse after an earthquake in 1992.

Newport specialist engineers Cintec, who have previously provided solutions to structural problems at landmarks such as the White House and Windsor Castle, were set the task of helping it last another 4,700 years.

The team has now completed phase one of the work at the site at Saqqara, south west of Cairo.

It involved using pressurised air-filled bags, in order to hold up the roof of the 60m high pyramid, while more permanent repairs are carried out.

However managing director of Cintec, Peter James, says this is just the first step in a project which has been complicated by the recent political upheaval in Egypt.

"We were all packed and ready to begin work in January, just when the Egyptian government began to fall," said Mr James.

"We've had to sit on our hands for another four months before getting the go-ahead; all the while hearing stories of looting, and worrying about how much additional damage was going to be caused."

"Fortunately, even though most of our computers and equipment were stolen, the pyramid itself wasn't touched; which is just as well considering how unstable it was when we got in there."

Mr James, who started his career as a buildings inspector for Cardiff Council, said, even with the amount of preparation they'd done, they still weren't prepared for quite how badly damaged the supporting ceiling of the burial chamber really was.

"The earthquake had essentially shifted everything sideways, and an 8m section, in the shape of an inverted cup, had dropped out."

"Until we got the scaffolding in place, we had no idea what was holding up the remaining 60m of stone."

"It was a lethal and massive game of Ker-Plunk; trying to hold everything up, without dislodging anything further."

The air bag technology Cintec employed, was originally created by Mr James to aid in the safer disposal of IEDs in Afghanistan.

It works on the principal of surrounding an explosive with a bag, strong enough to withstand an explosion or collapse, but with such precise control over the pressure, that it only just kisses the surface of an object, without adding even greater forces to unstable materials.

However in the case of the Pyramid of Djoser, Mr James was forced to adapt his technology; substituting a water filling for compressed air.

"We'd originally planned to use our Water Wall system, but as soon as we got a good look at the chamber, it was clear that inflating the bags with water wasn't going to work."

The pyramid is at Saqqara, south of Cairo

"The rocks in the ceiling were too jagged, and posed an unacceptable risk of deluging the 4,500-year old pyramid, which has been bone-dry since it was built.

"But also we hadn't realised that there were secret tunnels running under the chamber's floor, so I didn't think it would be able to take the weight of water-filled supports."

Knitted together

"So we used the delays to stress-test our system with a compressed air filling. We needed them to withstand 12 Kilonewtons per square inch, but they actually did better than we could possibly imagine, comfortably supporting 28!"

The step pyramid was built above the tomb of pharaoh Djoser, a warrior who reigned in the Old Kingdom in the third dynasty for 19 years. Mummified remains were excavated in the 1930s.

Eleven air pillars now hold up the pyramid's roof, with another six, flatter, bespoke columns currently being manufactured to support the lower corners of the burial chamber.

Once stable, Mr James and his team will perform a permanent repair, threading the latest in thermo-dynamic steel rods diagonally through the steps of the pyramid, in such a way that the six levels will be knitted together without being visible.

The steel, which Cintec have previously used to improve the bomb-resistance of major landmark buildings around the world, is designed to expand and contract with the pyramid, under the extreme temperatures of the desert.

Their final task will be to reclaim as many of the fallen original rocks as possible, and re-point them with authentic 2,700 BC mortar.

"The really tricky parts are the visible bits of the pyramid."

"Underneath the surface we're able to use 21st Century technology to make it as strong as we know how to, but on the outside it needs to be 100% authentic."

"That's involved finding the strongest blend, by testing hundreds of combinations of mortar, all entirely made from components which would have been available to the ancient Egyptians."

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Hearts made to repair themselves

8 June 2011 Last updated at 17:00 GMT By James Gallagher Health reporter, BBC News More people are surviving heart attacks, but that means more are living with heart failure A drug that makes hearts repair themselves has been used in research on mice.

The damage caused by a heart attack had previously been considered permanent.

But a study in the journal Nature showed the drug, thymosin beta 4, if used in advance of a heart attack, was able to "prime" the heart for repair.

The British Heart Foundation described repair as the "holy grail of heart research", but said any treatment in humans was years away.

Due to advances in health care the number of people dying from coronary heart disease is falling.

But those living with heart failure are on the rise - more than 750,000 people have the condition in the UK alone.

Wake up

The researchers at University College London looked at a group of cells which are able to transform into different types of heart tissue in an embryo.

Continue reading the main story

Deaths from coronary heart disease

1961 - 165,2162001 - 117,7432009 - 80,223

Estimated people living with heart failure

1961 - 100,0001971 - 300,0002010 - 750,000

Source: British Heart Foundation

In adults epicardium-derived progenitor cells line the heart, but have become dormant.

Scientists used a chemical, thymosin beta 4, to "wake them up".

Professor Paul Riley, from the University College London, said: "The adult epicardial cells which line the muscle of the heart can be activated, move inward and give rise to new heart muscle."

"We saw an improvement in the ejection fraction, in the ability of the heart to pump out blood, of 25%."

As well as pumping more blood, the scar tissue was reduced and the walls of the heart became thicker.

Peter Weissberg, medical director of the British Heart Foundation, said he was "very excited" about the research but warned the scale of improvement seen in animals was rarely seen in humans.

Epicardium derived progenitor cells (in red) lining the heart

However, he argued that even a small improvement would have a dramatic impact on people's quality of life.

"A normal heart has lots of spare capacity. In patients with heart failure it is working flat out just to sit down [and] it's like running a marathon," he said.

"You could turn a patient from somebody who's gasping while sitting in a chair to somebody who can sit comfortably in a chair."

Advance therapy

The mice needed to take the drug in advance of a heart attack in order for it to be effective. As the researchers put it, "the priming effect is key".

If a similar drug could be found to be effective in humans, then the researchers believe it would need to be prescribed in a similar way to statins.

Professor Riley said "I could envisage a patient known to be at risk of a heart attack - either because of family history or warning signs spotted by their GP - taking an oral tablet, which would prime their heart so that if they had a heart attack the damage could be repaired."

He said this could be available in 10 years.

The British Heart Foundation, which funded the study, said repairing a damaged heart was the "holy grail" of heart research.

The results strengthened the evidence that drugs could be used to prevent the onset of heart failure, it said.

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