Neurosurgeon Named Head of TIRR’s Mission Connect

Dr. Guy L. Clifton, Runnells Distinguished Chair, and professor and chair in the department of neurosurgery at The University of Texas Medical School at Houston, has been named director of The Institute for Rehabilitation and Research’s Mission Connect program.

Dr. Clifton has been principal or co-investigator on 16 grants studying various aspects of brain and spinal cord injury. He is currently principal investigator for a National Institutes of Health-funded, $7.2 million multicenter randomized study designed to test moderate systemic cooling as a treatment for acute, severe brain injury – a treatment developed by Dr. Clifton. The study is scheduled to enter its second phase this month.

"With the naming of Dr. Clifton to head Mission Connect, we will continue to aggressively move forward with the work TIRR and our consortium partners are prepared to do," said E. Ashley Smith, president and CEO of TIRR Systems. "With more than 20 years’ experience in clinical research, Dr. Clifton will lead all scientific and clinical aspects of Mission Connect.

Dr. Clifton said Mission Connect is more than just rehabilitation – it’s the desire to affect the nervous system with biological interventions. Mission Connect is the TIRR-led initiative to conduct collaborative research in central nervous system injuries, diseases and disorders. TIRR is a 42-year-old, not-for-profit rehabilitation hospital in the Texas Medical Center, known internationally for its patient care work with individuals with catastrophic injuries and illnesses.

"We want to try to affect the biology of the brain and spinal cord after injury," Dr. Clifton said. "We are literally trying to make damaged cells work better, and possibly in the future, create new nerve cells."

The Mission Connect team is working on several projects, all either in clinical trials or in the planning stages. Currently in the works are four spinal cord and three brain injury projects.

The incidence of spinal cord injury is five per 100,000, and 15 percent of all of these, Dr. Clifton said, occur in the low back, near the base of the thoracic spine, which is where the spinal cord ends. The injury occurs in the spine, but below the spinal cord.

"There is tremendous potential for these nerves to recover," he said. "We’re currently evaluating the clinical applicability of these ideas, and deciding practical steps needed to take this to clinical trial."

Spinal cord injury projects include:

"This involves having cells grow across the gap where an injury was, dissolving the scar in the gap, and giving the cells a structure to grow on to bridge the gap." There are five researchers working on the project, and Dr. Clifton said he is hoping to expand the team to seven, including a stem cell researcher. "Stems cells are the only way we can think of to make new cells. All other current research methods encourage the existing cells to reattach."

Dr. Clifton said experimental surgeries have been done in other places in the world, where surgeons took nerves out of patients’ ribs and flipped them down, hooking them to nerves in the bladder. This type of surgery has primarily been performed on children born with spina bifida and on paraplegic patients.

"There is some reason, from both animal and human studies, to think that it may be possible to get bladder recovery, even late after injury," Dr. Clifton said. "We need to figure out what types of studies need to be done to take this to clinical trial, and test whether this really has the potential to recover bladder/bowel functions. I think we’ll take this to clinical trials within a year."

• Causing sensory cells to reconnect in the spinal cord by injecting neurotrophic proteins – proteins that encourage cell growth – around damaged nerves.

"There are a lot of steps we have to go through, but this is doable," Dr. Clifton said.

Brain injuries present a larger public health problem than spinal cord injury, Dr. Clifton said. "Incidence of brain injury with neurologic deficit, including both comatose and noncomatose patients, is about 70 per 100,000 – about half the number of patients with stroke, which causes the most amount of neurologic deficit," he said.

Brain injury projects include:

Ideally, within about two hours of injury, neurotrophic proteins are pumped into the brain. It is the team’s hope that the outcome of this procedure will be useful for treating those patients with more severe injuries. Currently, this method has been very effective, even after 24 hours, and up to three days, when these proteins are pumped into the brains of animals with head injuries.

Dr. Clifton said the difficulty with this method is determining how to distribute the proteins in humans.

"You can’t just be pumping proteins into people’s brains," he said. "We’ve been working on how to deliver these neurotrophins to the brain through intravenous administration. We think there’s real opportunity to use these proteins late after brain injury to improve recovery."

"If we can get the proteins in within three days of injury, and deliver them for some time," he continued, "the hypothesis is that it will result in permanent improvement in memory and attention."

"Most people who die of brain injury, die from swollen brains," Dr. Clifton said. "It happens right before your eyes and you can’t stop it. With some of the new technology that is around, we think there may be ways to halt it."

The team members at Mission Connect are made up of researchers from UT-Houston, Baylor College of Medicine, The University of Texas Medical Branch at Galveston, and Texas A&M University.

"I have really seen a great spirit of cooperation on these projects," Dr. Clifton said.

Howard Wolf, a 20-year TIRR trustee and chairman or the TIRR Foundation board of trustees, said, "The success of Mission Connect will depend upon the translation of 21st century scientific breakthroughs into practical clinical applications. Dr. Clifton is uniquely qualified, based on his background in research and clinical practice, to be the director of Mission Connect."

"Guy Clifton and TIRR have enjoyed a close relationship for years. Many of the patients he sees in the operating room at Memorial Hermann Hospital are later transferred to TIRR for rehabilitation," E. Ashley Smith said. "Dr. Clifton knows the life-changing consequences of severe injuries for individuals and their loved ones. He also knows the hope that Mission Connect affords these patients and their families."

In addition to his other roles, Dr. Clifton is chief of neurosurgery service at Memorial Hermann and director of the Vivian L. Smith Center for Neurologic Research, yet still maintains an active clinical practice. He also serves on the editorial boards of Spinal Cord and Journal of Neurotrauma, and is one of the authors of Guidelines for the Management of Severe Head Injury, the first guidelines approved by the American Association of Neurological Surgeons. Dr. Clifton is a member of the NIH/NINDS Clinical Trials Initial Review Group, and "Who’s Who in Medicine and Healthcare," "Best Doctors in America," and other publications have listed him among their honorees.

A fifth-generation Texan, Dr. Clifton earned his bachelor’s degree from Texas A&M University in 1971 and received his medical degree from UT Medical Branch in Galveston with high honors in 1975. He is a member of the Memorial Hermann Healthcare System Foundation board and co-chairman of "Save Our ERs."

– Nancy Hudgins, The Institute for Rehabilitation and Research and Kathleen Charter, Texas Medical Center News

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©2006 Texas Medical Center

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