RECODE-DCM Research Award 2023 Winner: Breathing New Life into Understanding DCM

Each year Myelopathy.org picks the most significant and original research contribution that aligns with the RECODE-DCM Research Priorities.  We had submissions from all over the world, but our independent experts were in unanimous agreement that the following study represented a highly original finding, with numerous implications for how we understand and manage DCM.

The Myelopathy.org community has helped to shine a spotlight on the potential for breathing problems in DCM.  This study helps to confirm the nature of it, and suggest it’s a more pervasive problem.   

Read on to find out more, or you can listen to Dr. Satkunendrarajah and her co-investigator Dr. Aditya Vedantam on our Myelopathy Matters podcast.

Thanks to all those working so hard to make a difference. And remember: applications are now open for the 2024 Research Award.

Dr Ben Davies, Research Director, Myelopathy.org 

#MyelopathyMatters

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Degenerative Cervical Myelopathy (DCM) can significantly interfere with the daily lives of individuals with the condition. Compression of the cervical spinal cord disrupts neuronal networks involved in motor function of the upper and lower limbs, leading to difficulties with fine motor skills, mobility, and sensation. Yet a mystery hangs in the air, how does DCM affect breathing?

The cervical spinal cord orchestrates the intricate pathways essential for regulating our breathing. Clinical assessments reveal subtle respiratory dysfunction, but individuals affected by DCM are disproportionately susceptible to respiratory disorders. This contradiction presents a captivating puzzle: Does DCM substantially disrupt the intricate mechanisms governing adaptive ventilatory responses during diverse respiratory stressors like physical exertion, pathological conditions, or controlled anesthesia states? This inquiry necessitates a thorough exploration into how DCM might affect the precise neural control systems orchestrating ventilatory adaptations amidst varying respiratory challenges.

In a recent study published in the Experimental Neurology journal, Dr. Kajana Satkunendrarajah and colleagues from the Center for Cervical Myelopathy at the Medical College of Wisconsin delved deeper into understanding the respiratory implications of DCM. Their study aimed to comprehensively assess respiratory function and adaptive ventilation in a clinically relevant model of DCM.

Adaptive ventilatory ability is not resorted with late surgical decompression

This study sought to test a crucial hypothesis: although DCM might induce subtle respiratory deficits during resting conditions, its impact on adapting to acute ventilatory challenges might be more pronounced. Using an animal model of DCM, the research revealed a complex storyline. Despite progressive limb impairments, no substantial decline was observed in normal breathing patterns throughout various stages of spinal cord compression. Yet, when faced with acute respiratory challenge, specifically elevated carbon dioxide levels, the ability to respond was significantly impaired. Even after undergoing decompression surgery, the animals were unable to regain their adaptive breathing abilities.

This is a highly original finding; it sheds light on the significant impact of DCM on sustaining ventilation under both regular and demanding physiological conditions. The study also underscores the compounded complexities faced by individuals with DCM, particularly in the presence of concurrent respiratory disorders. Additionally, adaptive ventilatory ability is essential in the emergence from anesthesia, thus, there is a critical need for developing supplementary strategies to enhance respiratory function in DCM-affected individuals.  It may also have important implications for understanding fatigue, a commonly reported consequence of DCM poorly understood.

This study confirms that the story of DCM extends beyond limb impairments; it unravels the intricate interplay between spinal cord compression and the often-unnoticed realm of respiratory intricacies. As the pursuit of understanding this multifaceted condition continues, the spotlight now shines brightly on enhancing respiratory support for individuals navigating the complexities of DCM and paving the way for further research, opening new avenues to explore and redefine the approach to managing this complex condition.

Redefining breathing in the realm of DCM – The Journey Begins.

About the Authors

Dr Kajana Satkunendrarajah, the senior author of the study, is an Associate Professor at the Medical College of Wisconsin and serves as the Associate Director of the Neuroscience Research Center. Her laboratory specializes in probing the pathophysiology of DCM by employing an animal model. Their focus revolves around gaining a nuanced understanding of the cellular transformations and neural circuit alterations associated with this condition. Furthermore, the lab actively explores diverse therapeutic strategies, including pharmacology, neuromodulation, and surgical interventions, to advance treatment options for individuals grappling with DCM. Ultimately, their research endeavors to significantly enhance clinical care and support for those affected by this condition.

Dr Aditya Vedantam, Neurosurgeon-Scientist, is an Assistant Professor in the Department of Neurosurgery at the Medical College of Wisconsin founded the Center for Cervical Myelopathy in 2022 with the goal of creating a community of patients, physicians, and scientists focused on advancing care and knowledge for cervical myelopathy. Dr Vedantam uses of novel MRI techniques and tools to improve care for patients with DCM. 

Hannah Sweetman, the study’s first author, is a research technologist in Dr Satkunendrarajah’s laboratory in the Medical College of Wisconsin’s Department of Neurosurgery. She is actively involved in multiple projects focused on unraveling the pathophysiology of DCM.

Mahmudur Rahman, a medical student at the Medical College of Wisconsin, conducts preclinical research on DCM in Dr. Satkunendrarajah’s laboratory.