International Physician Update

An Interview with John McDonald, M.D.

John McDonald, a leader in some of the most dramatic spinal cord research ever undertaken,has arrived at Hopkins.

The newest member of the Kennedy Krieger Institute,one of the key physicians who treated the late Christopher Reeve, talks about his approach to spinal cord recovery and paralysis and what the future may hold for his field.

For years, Johns Hopkins has been on the cutting edge of spinal cord and paralysis research and clinical treatment. With the addition of John McDonald III, M.D., Ph.D., the pace of that research and treatment is expected to pick up exponentially.   McDonald’s collaborative research on the underlying pathophysiology of spinal cord injury has kept scientists worldwide intrigued for years. Now, having just arrived from Washington University in St. Louis, McDonald will lead an exciting initiative on spinal cord and paralysis recovery, headquartered at the Kennedy Krieger Institute.

Describe what’s at the core of your therapeutic approach to spinal cord injury.

At Washington University in St. Louis, we helped pioneer what we called “activitybased restoration therapies” to treat patients with spinal cord injury.  We discovered that the central nervous system often held the keys to recovery, and that progress could be made many years after injury. That’s very important to patients with spinal cord injuries because it means that they should never give up hope that we can help them in some significant ways.

Most scientists have an underlying philosophy or concept about the research and the work they do.  Does that apply to you and your work?

Yes, it definitely does. Our focus is to optimize the body’s ability for self-repair. We think it is very doable to halt individuals’ physical decline, such as muscle atrophy, while reinstating patients’ normal patterns of nerve activity below the level of spinal injury. We want to use physiologic activity to try to activate some of the pattern generators.  But we realize that multistage interventions are required, and that there’s no single magic wand that will work miracles.

Can you give us some examples of what techniques you use to help patients with spinal cord injuries?

We use computer-linked stimulators, for example, to contract paralyzed patients’ leg muscles enough to ride a stationary bike. The benefits of that approach include reducing life-threatening skin infections, bone fractures and blood clots, which are dramatic. And the potential for gains of nerve function is offering hope for further recovery with advancing discoveries in regeneration science.

With that hope for further recovery for patients with spinal cord injuries, your lab at the Kennedy Krieger Institute should be an exciting place in the next few years. Give us some idea of what we can expect.

We’ll investigate the basic science of spinal injury and repair as a basis for translation to near-term clinical treatments. Other regenerative strategies such as stem cells and shaping immune response will figure in our work as well.

Stem cell research is certainly a cuttingedge topic these days. Do you view it as a panacea?

Nothing is a panacea. But ultimately, we need to offer hope. Removal of all hope is no longer a tenable strategy for treatment of catastrophic neurological injuries.