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LC DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

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National Institutes of Health
Bethesda, Maryland 20892

August 2, 1996

TO: The Secretary

FROM: Director, NIH

SUBJECT: NIH Plan for Spinal Cord Research

Per your telephone request to me, attached is the NIH plan for

research in spinal cord injury and regeneration, in response to the
President’s initiative on spinal cord research.

Ae

Harold Varmus, M.D.

Attachment
NIH PLAN FOR RESEARCH IN
SPINAL CORD INJURY AND REGENERATION

ISSUE

In response to the President’s initiative in spinal cord research, the National Institutes of Health
has undertaken a plan to commit an additional $10 million over the next year to research in
spinal cord injury and regeneration. This initiative represents an increase of 20 percent over the
current NIH budget committed to this field of research. The NIH effort will identify and support
research grant applications submitted during FY 1996 that would not have been supported due to
budget constraints. The NIH will also identify new areas of investigation to be funded through
new applications during the coming fiscal year and will encourage new investigators to enter the
field of spinal cord injury and regeneration research.

BACKGROUND

Spinal Cord Injury. Every year, 10,000 Americans’ spinal cords are permanently injured as a
result of traffic accidents, falls, sports injuries, gunshot wounds, and other trauma. Spinal cord
injury can happen to anyone at any age. In the 1950s, spinal cord injury was often fatal; in the
1990s, the prognosis for spinal cord injury patients is more optimistic. Because of research
leading to new and better treatments, the average length of a hospital stay and rehabilitation has
declined from 137 days in 1974 to 73 days in 1993. Nevertheless, in the United States today,
200,000 people are, to varying degrees, living without being able to sense cold, heat, pressure, or
touch and without the ability to walk, move, or even breathe on their own as a result of spinal
cord injury.

Biology of the Brain and the Spinal Cord. The central nervous system—the “central processing
unit” of the body—consists of both the brain and the spinal cord. The brain is the “command
center,” while the spinal cord is the “highway” along which messages travel. The brain and the
spinal cord are built of nerve cells, or neurons. Each neuron has a cell body from which long
branches, called axons, convey information. This information system transmits sensations such
as touch, temperature, and pain; conveys instructions for movement; and controls breathing,
heart activity, digestion, and the urinary and reproductive systems. Severe spinal cord injury can
permanently disrupt sensation, movement, or other vital body functions.

Unlike many other cells in the body, those of the central nervous system do not readily
regenerate. Why? Neuroscientists have been seeking the answer to this question for many years.
Neuroregeneration, or the formation of new neurons, is believed to be key to treating spinal cord
injury. Research in central nervous system injury and neuroregeneration is progressing along
many lines of inquiry.
Page 2

THE NIH PLAN

The NIH will take the following steps in carrying out the President’s initiative to increase
funding for spinal cord injury and regeneration research:

Funding through the NIH Director's Discretionary Fund. The NIH Director’s Discretionary
Fund allows the NIH Director to respond to emerging research opportunities and public
health priorities. In FY 1996, the Director will commit $2.791 million from the Fund to 12
meritorious new research projects that would not otherwise have been supported. These
projects encompass a broad range of animal and human research that seeks to understand the
spinal cord’s ability to transmit movement and sensation and the changes in neuron function
and structure that result from spinal cord injury. These projects will also explore the role of
the inflammatory and immune responses to injury as well as approaches to minimizing
damage and developing innovative treatments. An additional $200,000 will be committed
from the Discretionary Fund to support four Shannon awards, grants that provide short-term
funding for promising investigators. These investigators will examine how nerve cells
change after injury, how injury affects non-neuronal cells that support normal neuron
function, and how developing neurons are guided to the tissue they innervate.

Additional FY 1996 Efforts. The National Institute of Neurological Disorders and Stroke, the
principal supporter of spinal cord research at the NIH, will commit $981,000—a substantial
portion of the Institute’s remaining FY 1996 funds—to award a center grant to study central
nervous system trauma and edema and loss of blood that usually accompany spinal cord
injury. The NIH Institutes will also commit an additional $690,000 to co-fund the 12
research projects and 4 Shannon awards supported from the Director’s Discretionary Fund.

FY 1997 Initiatives. To engage the best investigators in neuroscience and neurology in
identifying promising new directions for research, the NIH will sponsor a workshop on
emerging concepts in spinal cord injury research on September 30 and October 1, 1996. The
$120,000 cost of the workshop will be funded from the FY 1996 Director’s Discretionary
Fund. The workshop will consist of presentations regarding ongoing basic and clinical
research related to spinal cord injury and discussions of unanswered research questions and
promising avenues of research that may lead to the answers. Following the workshop, the
NIH will issue a Program Announcement calling for new applications in areas identified as
most promising. Approximately $5.3 million will be set aside by the participating Institutes
to fund the most meritorious projects in FY 1997.

Most projects begun in FY 1996 carry commitments in future years. Therefore, while the
FY 1996 commitment to the spinal cord research initiative is $4.782 million, there will also
be $4.2 million invested in the second year of the research projects in FY 1997. This

$4.2 million is in addition to the $5.3 million to be invested through the FY 1997 Program
Announcement.

August 2, 1996