The use of nasal material shows how a paralysed man walked again in Poland. Story 2.


This 38-year-old Bulgarian patient, who suffered his injury in 2010, is believed to be the first person in the world to recover from the complete severing of the spinal nerves.image

FIRST STEPS: Darek Fidyka walks with the aid of leg-braces and a walking frame at the Akron Neuro-Rehabilitation Center in Wroclaw, Poland. Photo: AFP

A paralysed man has begun to walk again after pioneering surgery injected cells from his nasal cavity into his spine. How was this possible – and what does it mean for others with spinal injury? Kate Hagan stitches together the evidence.

Darek Fidyka sounds as though he has been through a lot. How did he lose his ability to walk?

A Bulgarian firefighter, Mr Fidyka’s spinal cord was severed after he was repeatedly stabbed in the back during a knife attack in 2010. It left the 40-year-old paralysed from the chest down. Despite two years of intensive physiotherapy he had showed no sign of recovery.

Why did scientists think he might be able to walk again?


Scientists have long recognised the potential of particular cells in the olfactory bulb, at the top of the nasal cavity, to stimulate growth of nerve fibres. Called olfactory ensheathing cells, they act as pathway cells to enable nerve fibres in the olfactory system to be constantly renewed throughout a person’s life, preserving the senses of smell and taste.

The role of the cells in the olfactory bulb has led scientists to explore their potential in the spinal cord, where regeneration of nerve fibres fails after spinal injury.


Mr Fidyka had two operations. In the first, Polish surgeons removed one of his olfactory bulbs and grew the olfactory cells in culture in a laboratory. Two weeks later they injected the cells above and below Mr Fidyka’s spinal injury. They also transplanted nerve tissue from his ankle into his injured spinal cord to form a bridge for nerve fibres to grow.

How has the operation changed his life?

Three months after the treatment Mr Fidyka noticed that he was developing muscle on his left thigh. After six months, he took steps along parallel bars using leg braces. Two years later he can walk with a frame and drive a car. He has also recovered some bladder, bowel and sexual function.

Mr Fidyka said walking again was an incredible feeling. “When you can’t feel almost half your body, you are helpless, but when it starts coming back it’s like you were born again,” he told the BBC. Mr Fidyka says he tires quickly when walking, but believes it is realistic to believe he will one day become independent.

What does this mean for paralysed people – will this treatment be broadly applicable? In short, will they be able to walk again?

Researchers involved in Mr Fidyka’s case say the treatment will need to be successfully repeated to definitively show the approach can repair a severed spinal cord. They hope to treat another 10 patients over coming years and have said they will consider patients from anywhere in the world who would likely have a similar injury to Mr Fidyka.

Florey Institute head of spinal research Stephen Davies warned the treatment may not work for all types of spinal injury. He said it was “too early to claim that the experimental therapy represents a silver bullet” and a clinical trial with large numbers of patients was needed to determine its benefits.

And Griffith University group leader of olfactory and brain repair James St John said Mr Fidyka’s case had demonstrated that transplanting olfactory cells into the spinal cord could restore sensation and some motor control in humans – but stressed there was still a long way to go.

“Each patient’s injuries are different and we don’t yet understand why there is recovery in some situations but not in others,” Dr St John said. “It is also important to understand that there are many types of olfactory [cells] and the correct combination of cells has not yet been determined.”

Does the scientific community have any reservations about what appears to be groundbreaking research?

The response has generally been: it is very early days for this form of treatment; let’s not get ahead of ourselves; expect mixed results as further trials are run.

Simone Di Giovanni, the chair in restorative neuroscience at Imperial College London, is among those urging caution about raising false hope for patients with spinal cord injury.

“One case of a patient improving neurological impairment after spinal cord knife injury following nerve and olfactory cell transplantation is simply anecdotal and cannot represent any solid scientific evidence to elaborate on. In fact there is no evidence that the transplant is responsible for the reported neurological improvement,” he said.

And Dusko Ilic, a senior lecturer in stem cell science at King’s College London, said transplantation of olfactory ensheathing cells in animal studies had varied results.

University of Nottingham professor of advanced drug delivery and tissue engineering Kevin Shakesheff added: “At best I’d expect to see quite a lot of variability in the clinical success because of the complexity of the tissue they are trying to repair and the different extent of damage in each patient.”

Henry Sapiecha

Tags: , , ,

Leave a Reply