Click here to Sign the Petition  to move OEG transplants into Huma Clinical Trials for Spinal Cord Injury

Courtesy of Dr. Wise Young...

Olfactory ensheathing glia (OEG) are a promising regenerative therapy for spinal cord injury. OEG are very unusual cells that normally reside in the olfactory nerve and bulb, the organs that carry olfactory information to the brain (See diagrams at the bottom of this page.) . The olfactory nerve is the only cranial nerve that continuously regenerates in adult mammals. This ability has been credited to the presence of these cells. At least half a dozen laboratories have now reported that these cells will facilitate functional neural regeneration when transplanted to the brain or spinal cord (Almudena Ramon-Cueto, Geoffrey Raisman, Mary Bunge, Giles Plant, Jeff Kocsis, J. Lu and colleagues).

OEG are very special cells that appear to be specialized for enhancing axonal regeneration.

1. First, they are migratory cells that seem to be attracted to growing axons. They look almost as if they are ushering axons to their destination.
2. Second, they can form multipolar cells with long processes that express a variety of axon-stimulating cell adhesion molecules such as L1 and laminin. Thus, they may serve a guidance function, i.e. bringing axons in for the landing.
3. Third, they can myelinate axons, hence the word "ensheathing" in their name.

The studies that have been carried out to date in animals have suggested that OEG transplants do improve functional recovery. However, the recovery to date have not been consistent. While many of the transplanted animals have recovered more than control untreated animals, not all have recovered and many of the animals do not recover fully. Some of the variations or limitations of recovery may be related to the timing of the transplantation or the type of injuries used. For example, most of the studies have transplanted OEG cells shortly after injury and in animals that have had hemisected or transected spinal cords.

The major issue that must be resolved in the source of OEG for transplantation. Several sources have been demonstrated to be feasible: adult olfactory bulb (autograft), adult olfactory mucosa (autograft), fetal olfactory bulb (heterograft), human cadaver olfactory bulb (herograft), and porcine fetal olfactory bulb (xenograft). Clinical trials have already begun in China and Australia assessing the feasibility and safety of OEG transplants in chronic spinal cord injury. In the United States, several centers are looking into the possibility of initiating clinical trials.

In China, one group headed by Dr. Hongyun Huang in Beijing has already transplanted fetal OEG cells into the spinal cords of over 150 people. In Australia, a group headed by Dr. Phil Waite is transplanting OEG derived from olfactory mucosa. Likewise, in Lisbon, Portugal, there is a clinical trial that has already transplanted nasal mucosa into the spinal cord of four patients with chronic spinal cord injury. Although the results of these trials are not yet available, preliminary reports suggest that OEG transplantation is feasible and safe.

Rigorous demonstration of the clinical efficacy of OEG transplants in the United States will probably require randomization of patients to an alternative therapy for comparison since a sham surgery could not be ethically justified given the invasiveness of the operation. One possibility is that OEG transplants can be compared against other cell transplants that have been reported to have beneficial effects on animal models. For example, Schwann cell transplants have now been reported by at least two groups to have some beneficial effects in multiple sclerosis and other demyelinating diseases. Another possibility are stem cells.

At the present, a clinical trial to assess the efficacy of OEG transplants will probably require several hundred patients to answer three questions. First, when is the best time to implant the cells? Second, how many cells are required? Third, which of the several sources of OEG are the best? These questions are being investigated in animal models. In the coming months, the results of the phase 1 clinical trials in China, Australia, and Portugal will have yielded sufficient results to indicate the safety and feasibility of fetal OEG or nasal mucosa transplants.

Funding for OEG transplant trials is very limited. Of the several sources of OEG, only the porcine fetal OEG source currently has commercial support. As a result, the clinical trials will require government or private support. Because the trials involve surgery, hospitalization and rehabilitation costs will be substantial, probably exceeding $50,000 per patient in the United States. A trial that involves 100 patients therefore will cost millions of dollars.

In summary, much animal data indicate that OEG transplants can restore function in animals after spinal cord injury. These cells play an important role in facilitating axonal regeneration in the olfactory nerve and seems to improve functional recovery when transplanted to injured spinal cords. A major obstacle in the application of these cells to people is the source of cells. They can be autografts from the same individual or heterografts from fetal sources, or even xenografts from animals. The clinical trials to establish the efficacy of OEG transplants will require comparison with another therapy and the clinical trial costs will be high because of surgery, hospitalization, and rehabilitation 

Wise Young, Ph.D. M.D. is a Professor and Director of the W. M. Keck Center for Collaborative Neuroscience at Rutgers University. A researcher who has specialized in spinal cord injury for over 20 years, he lead the team at NYU Medical Center that helped demonstrate that high-dose methylprednisolone is beneficial when given shortly after spinal cord injury. He led the Multicenter Animal Spinal Cord Injury Study (MASCIS) that developed the standard model of rat spinal cord injury used by over 100 laboratories around the world.

Dr. Young is also the moderator of The Carecure Community for which thousands of people with spinal cord injury are eternally grateful.

Answers to Frequently Asked Questions

1. What Are OEG?
2. Do OEG Really Work?
3. What's Going on in Portugal and Australia?
4. Are There Any Complications Associated with OEG Technology?
5. Are OEG Stem Cells?
6. Are OEG Taken from Human Fetuses?
7. Who Will Receive This Petition?
8. Why Should I Sign This Petition?
9. How can I help?

What Are OEG?

OEG stands for "olfactory ensheathing glia" and in plain English they come from the nose (or the olfactory system).  The olfactory system is part of the central nervous system.  Olfactory neurons die and are replaced throughout an adult's lifetime.  The fibers of these  neurons grow within the olfactory nerve and eventually connect with the olfactory bulb (i.e. the part of the brain concerned with smell). OEG ensheathe or envelope the nerve fibers of the unmylineated olfactory nerves along the entire extent of the nerve from the origin of the nerve in the nose to their termination in the olfactory bulb. OEG are harvested from two sources -- the olfactory bulb and the nasal mucosa, the latter being the least invasive.  There is only a temporary loss of smell from the procedure of harvesting the OEG for transplantation.  Please see the diagrams.

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Do OEG Really Work?

Yes OEG Really Works!  Functional recovery has been reported in more than half a dozen nonhuman animal studies.  There is currently a human trial with OEG happening in Portugal and the results have been very good. Doctors there have reported functional recovery below the line of injury in a chronic contusion model of quadriplegia.  Information on this study is to be published very soon.  There is also a human trial with OEG happening in Australia but the preliminary results are not in yet.

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What's Going on in Portugal and Australia?

Human trials of OEG have already begun in Lisbon, Portugal and Brisbane, Australia.  Although, their techniques vary, both groups are working with chronic type spinal cord injuries.  The Portuguese group has had positive results so far and they are preparing to publish in the scientific journals.  It should be noted here that the technique of the Portuguese group delivers stem cells and another type of cell called a. Schwann cell which has a proven regenerative capacity.  Preliminary results from the Australian group is not yet available, but here is a media release from them--Click Here

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Are There Any Complications Associated with OEG Technology?

There is only a temporary loss of smell from the procedure of harvesting the OEG for transplantation less any complications that may arise from the transplantation and opening of the vertebrae.

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Are OEG Stem Cells?

OEG are not stem cells!  Although, there are stem cells in the mix of cells harvested with the OEG.

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Are OEG Taken from Human Fetuses?

OEG are in no way shape or form derived from human fetuses.

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Who Will Receive The Petition?

This petition will initially be targeted at Christopher Reeve but many more groups are going to see it.  This petition's purpose is to influence the decision-making process for a human clinical trial at its various levels.  That means funding organizations, the government, clinicians, and the media are going to be approached with this petition.  It is hoped that Christopher Reeve, to start, will bring much more awareness of OEG to the right people including the public. 

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Why Should I Sign This Petition?

If you have a spinal cord injury (and even if you don't), now is the time to act!  You can make this therapy a reality!  OEG is coming of age of right now!

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How can I help?

First, you can help by signing the petition.  Then, tell everybody you know about it!  Finally, you can volunteer your time promoting this petition, click here-- I Want to Volunteer

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Diagram 1

This is the general overview of the olfactory bulb.  The OEG can be harvested from the olfactory bulb but it is much less invasive to take them from the nasal mucosa (see Diagram 2).  The olfactory bulb is circled here.

Diagram 2

This is a close up of the olfactory bulb and a better view of the nasal mucosa.  The nasal mucosa is circled here.  See Diagram 3 for a close-up of the olfactory nerve.

Diagram 3

This is a close-up of the olfactory nerve.  The OEG ensheath these cells, hence they are called olfactory ensheathing glia.  The olfactory nerve is circled here.  There is also a better view of the nasal mucosa which is circled.  The nasal mucosa is the ideal source for OEG.

Diagram 4

This is an x-ray of a typical contusion type spinal cord injury.  The OEG are harvested and then placed at the site of injury where they fill the cavity and incorporate with the spinal cord.