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Estrogen could be used to stem paralysis by Mary Helen Yarborough Public Relations The substance that separates men from women could be used to stop the progression of damage in people suffering from severe spinal cord injury.   Researchers at MUSC have demonstrated that estrogen inhibits some nerve damage in laboratory rats with spinal cord injuries. Lead investigator Naren Banik, Ph.D., said the results are so promising that he believes that estrogen could become an effective therapy for humans. His current research, being conducted with his  team members Swapan Ray, Ph.D., Eric Sribnick, Ph.D., and Denise Matzelle, a research specialist, is the only animal study involving the use of estrogen in injured subjects.   Funded by a $1.3-million grant from the National Institutes of Health (NIH), the research has involved injecting estrogen intravenously within a certain period of time after injury. Estrogen, which is a steroid, inhibits  increases in enzymes that destroy proteins, thereby protecting nerve cells below the injured spinal cord. While inhibiting the production of cell-destroying enzymes, estrogen also enhances blood flow, which is impaired after spinal cord injury. Since cells cannot survive without blood that supplies nutrients, estrogen helps retain a degree of blood flow that also protects the cells, Banik said.   Banik said the research, which is up for renewal next year, shows promise for the millions of men and women worldwide who suffer disabilities and paralysis as a result of spinal cord injuries.   Banik’s estrogen research, which began in 2002, was selected among MUSC’s two dozen pilot programs under the Clinical Translational Science Award (CTSA) initiatives. Banik is hopeful that, with the CTSA pilot selection and renewal of the NIH grant, tests could be translated to human studies.   “It would take a lot of resources,” Banik said, “but we can develop a test for clinical studies. We have to look at the efficacy of acute injury. ...We can apply it in chronic injury and treat for a little longer. The important part is that patients would improve function and survive a longer time.”   The cost of saving patients from paralysis far exceeds the costs to continue the studies, he indicated.    “The average age of someone with spinal cord injuries resulting in functional deficits and paralysis is between 18 and 35 years,” said Banik, who has been moved by meeting people suffering from the complexities of paralysis. “They have their whole lives in front of them. The nation spends $10 billion a year —12,000 new cases a year added to the existing 250,000 existing patients. And we know that it’s the emotional part of the person who’s severely injured after paralysis.”   So far, his research has involved injecting estrogen into rats with spinal injuries within 15 minutes and 24 hours of injury.   “You have a window for treatment, usually between two and eight hours [since injury] to make it clinically relevant,” he said.   Banik said that while the earlier injection shows greater cell protection, even in 24 hours enough protection exists that could minimize or prevent some injury.   “Even 5 percent of your feeling  is better than nothing at all,” he said. “We believe that we could save at least 20 to 40 percent of a person’s feeling and function. With physical therapy, he or she could lead a better life,” he said. Why estrogen? Scientists discovered the value of estrogen therapy in reversing the degree of illness during a study of pregnant women with multiple sclerosis (MS).   “In pregnant women, estrogen levels are very high,” Banik said. “Women with MS had their diseases go into remission while they were pregnant. Of course, after delivery of the babies, the severity of the MS returned.”   Banik said that further tests showed that women suffering head injuries fared better than men with similar head injuries. Scientists then concluded that the difference in the recovery rates may be due to the increased presence of estrogen (men have low levels of estrogen as women have low levels of testosterone).   Banik also is working on another NIH project to find out what actually destroys the tissue in spinal cord injuries. Research also suggests that melatonin, in combination with other therapeutic agents, has a similar effect as estrogen on injury recovery, Banik said. Much of his findings have helped apply the estrogen therapy to treat such injuries in a laboratory setting.   While Banik and his fellow MUSC researchers are racing to rescue patients from one of the most devastating injuries, the  current treatment also relies on a previous MUSC-participated discovery, corticosteroid treatment, or cortisone, which is also given intravenously after injury. This therapy acts as an immunosuppressant and an anti-inflammatory that reduces the free-radical production that follows injuries. There is promise, however, that therapy with estrogen may prove to be even more effective, Banik concluded.     Friday, Dec. 8, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.