Research Update

Column of Hope (COH) is proud to announce its latest study published in the peer reviewed journal, Fluids and Barriers of the CNS, published April 29, 2018. This study documents our researchers’ work on findings regarding the role of perivascular and paravascular pathways in cerebral spinal fluid (CSF) flowing out of the spinal cord. This is another important building block in our understanding how to induce more CSF flow out of a syrinx thus reducing syrinx size.

In the past our syringomyelia (SM) research has made unprecedented progress:

• Our sponsored research has discovered how Chiari malformation (CM) influences CSF from the low pressure area outside the spinal cord to enter the high pressure environment inside the cord.
  • The arterial pulse and the CSF pulse becomes out of phase due to the blockage caused by CM (See the cover article of the Journal of Neurosurgery (JNS) April 2010).
  • Later work identified similar processes in syrinxes cause by trauma and arachnoiditis
    • We found that the vascular material that runs in and out of the cord does not form a perfect seal under certain pressure conditions, allowing a pathway for the CSF to enter the cord.
• We have sponsored studies that show the interrupted flow patterns caused by CM and that has led to clinical breakthroughs in how to find the exact cause of SM so that the exact procedure required can be determined. Many CM/SM patients can attest the struggle of trying one procedure after another hoping to eventually find the answer.
• Our researchers learned that aquaporin were always “at the scene of the crime” in post-traumatic SM.
• Amazingly, the researchers were able to “up regulate” the aquaporin and found that in the lab they could actually pull fluid out of the syrinx to reduce its size without surgical intervention.
• We quickly found that our ability to influence CSF movement had out stripped science’s ability to accurately measure it.
• The researchers then developed the first ever method to measure CSF inside and outside of the cord at the same time under a microscope.
• That technique was used to develop to measure fluid flow inside and outside the cord in vivo over time.
• This is allowing us to work on perfecting the right dosing to maximize flow out of the cord over a period of time.
• We hope to work on determining how to protect the cord of spinal cord injury patients to completely avoid SM.
• That sets up the publication in the link above. We have found that CSF is absorbed and expelled in the spinal cord in a different mechanism than in the brain. ( Coincidently, some of the newest work on fluid flow in and out of brain tissue comes from the University of Rochester, just a few exits east of us on the NYS Thruway)
• What is fascinating about our resent study is the mechanism for fluid being absorb and expelled is differently in different regions of the spinal cord.

In less than a decade, the scientific world has gone from not understanding most of the physiology of fluid flow in and around the spinal cord to knowing both the mechanisms and pathways of fluid flow experimenting shrinking syrinxes without surgery based on our work. We believe this work will also lead to developing a protocol to protect an injured spinal cord from forming a syrinx.

We are constantly focused on how to take this knowledge from the lab to physicians’ “tool kit”. To put this progress in prospective, SM was discovered about 475 years ago. COH’s researchers’ progress in the last decade far outstrips the 465 years before that. This progress has been relatively fast in comparison but not nearly fast enough for those experiencing the devastating pain and paralysis caused by SM.

In addition to the research that defines how CM causes SM, we have funded CM specific research as well:

• In 2010, we sponsored possibly the most important paper written on CM. Essentially defining at least 5 different causes of CM and hopefully preventing hundreds/thousands of failed “one operation fits all” surgeries. Surgeons now have more tools to determine which procedure is going to help the individual patient. EDS patients, in particular, can appreciate this work but also insist that much more is required.
• We believe we have been able to define the exact cause of the debilitating “ Chiari headache” , again, published in the JNS
  • We are working on defining what needs to be accomplished to CM surgery to relieve the Chiari headache (without making another symptom worse).
• Earlier in 2018, we have published our first peer reviewed journal article on the cognitive impact of CM. Our partner university in Sydney has agreed to create of full-time faculty position to head the university’s efforts in researching the neuropsychology implications of CM. Again hopefully, this added focus will eventually lead to defining the exact surgical outcome required to improve CM patients’ cognition.

We are trying to bring the scientific advancements to clinics and operating rooms as quickly as possible:

• We have published two important surgical technique papers.
• There are two more diagnostic and surgical technique papers in the queue to be published.
• We are work on how physicians can use cardiac and/or respiratory gated MRI to improve treatment and surgical decisions.
  • In Sydney, our researchers have found that the use of phase contrast MRI can allow physicians to find the location of the issue causing previously unknown, or idiopathic SM. After discovering the exact location of the fluid interruption, surgeons can use a Doppler to find the particular defect that requires surgical correction.
• We have sponsored six (6) physician education programs where world renowned CM/SM experts have educated the Western New York medical community about the latest advances in diagnosis and treatment of CM/SM.
• In 2019 we are planning an international medical and scientific conference to ensure all those involved have the latest information and we hope to increase the number of regional, national and international collaborations both with physicians and scientists.

In total, COH has over 30 publications in peer reviewed journals in addition to text book chapters and Ph.D. theses ( I looked it up that is the word ).

We appreciate our donors’ and volunteers’ support has allowed these advances to occur.

Mark your calendar for October 13, 2018 for our 16th Annual Gala

Please help us continue these ground breaking efforts

For more information, please contact me at info@columnofhope.org

Mark S. Kane, President & Co-Founder