John Wood McDonald III has been Assistant Professor of Neurology and Neurological Surgery at the Barnes-Jewish Hospital at the Washington University School of Medicine since 1998.

After graduating from the University of Illinois, Champaign-Urbana in 1985, McDonald completed his M.D. and Ph.D. in Neurosciences at the University of Michigan in 1992.

McDonald's research focuses on developing means of reducing injury and promoting regeneration and recovery of function after spinal cord injury (SCI). He is interested in the molecular mechanisms of SCI and neurological diseases.

The author of more than 50 peer-reviewed articles and textbook chapters, McDonald is also the recipient of numerous awards. In 2000, he received the Research for Freedom Award, given to the researcher whose work gives hope to those with Spinal Cord Injuries, their family and friends. Since 1995, McDonald has been a member of the Christopher Reeve Paralysis Foundation Research Consortium on Spinal Cord Injury.

4.24.01 Paula Akbar asked:
How has your research been affected by the political issues surrounding stem cells?

McDonald's response:
The political issues surrounding use of human embryonic stem cells have affected research all over the U.S. Investigators are not willing to commit to a line of research that may be prevented or limited by governmental funding restrictions. The cells already exist and in theory do not have to be isolated again. There are important considerations on both sides of the ethical argument but certainly a reasonable compromise can be reached that will meet concerns of both arguments. In time, important advances will come from ES cells and their use for research and treatment. Such research is advancing in other countries more rapidly because of their government backing

4.24.01 Jenny Garofalo asked:
Hello, I was diagnosed in 1996 with having MS. How will your work affect people with demyelinating diseases versus people with severed nerves? Also are you doing any clinical trials on humans at your hospital anytime soon?

McDonald's response:
In general, mechanisms of regeneration are similar amongst the many diseases of the nervous system. The work we are doing with remyelination will directly apply to multiple sclerosis (MS). In MS, the immune system causes injury to myelin, the equivalent of the plastic covering of wires in your house, and without the myelin the neural connections do not function properly. Later staged MS can also involve loss of the connections and remyelination alone cannot recover that. Currently, it is not known how to build new circuits, but remyelination is a doable target, as it does not require new connections. The key to all nervous system injuries is that a cure is not needed or relevant, only partial repair is needed to restore disproportionate function. Traumatic SCI involves demyelination in addition to loss of cells and neural circuits. In this case, remyelination may be predicted to induce important but limited return of function such as recovery of bladder and bowel control, improved breathing, or improved movement of a limb.

We are conduction a human trial with transplantation of porcine neural cells in humans with SCI for the purpose of remyelination and for pain control. These are Phase I clinical trials designed to test safety only. These are early days, but we are all putting our shoulders to the wheel in helping make restoration of function a reality.

4.24.01 Michael Poss asked:
You talked about replacing damaged nerve for the spinal cord. What about replacing damaged nerves in the ear for people who are hearing-impaired or deaf as a result? Is this similar to the medical work you have done with spinal cords? If so, is there a timetable as to when humans can be treated for this?

McDonald's response:
Interesting question. Impairment of hearing can result from multiple causes each with different mechanisms. For some, such as sensorineural hearing loss, replacement strategies are an interesting target. I am not aware of such work in this area, but I have no doubt that such work will occur. Loss of hair cells in the ear and neurons in the cochlear nucleus (brainstem) are structures that would require repair.

4.24.01 Mark Glazer asked:
When do you anticipate stem cell research will result in an effective treatment for spinal cord injuries in humans?

McDonald's response:
This is always a difficult question and the answer is that no one knows the answer. However, I can approximate the issues for you. There are a set of standards required to demonstrate safety and efficacy in human trials and this process typically takes a decade. In the case of stem cells, more basic science work is required before attempts at clinical trials. The tremendous need and lack of potential alternatives, which are present in SCI, are factors that can accelerate the pace. Other key factors are national funding levels (resources) and governmental commitment (right now human stem cell work is being hampered because of the latter).

Of the regenerative strategies, some will be more doable than others- recreating neural circuits is one of the most difficult. Remyelination may be one of the most doable.

4.24.01 Devin Waggoner asked:
It seems as though the emphasis thus far is on people who have sustained a spinal cord injury later in life. Is it probable that these techniques will help people such as myself who have the congenital defect Spina Bifida?

McDonald's response:
Good question. Yes. Strategies to repair the injured cord can also apply to congenital defects such as spina bifida. For the other readers, let me explain what spina bifida is. Spina bifida occulta is a benign form where there are only vertebrae defects, typically in the arches surrounding the cord (occurs in 5% of the population), and no associated neurological defects. Spina bifida occurs because of incomplete closure of the neural tube during early embryo development. This occurs at the ends of the spinal cord (near the head and near the sacrum). Defects can range from simple cutaneous lesions, such as a hairy mole, a pilonidal sinus, a dermal sinus, telangiectasia, or a subcutaneous lipoma to severe defects including a double spinal cord, tethered spinal cord associated with loss of function in the lower body.

Repair strategies will also be applicable to such congenital disorders, but the problems are somewhat different than with trauma, but largely similar.

4.24.01 Jim Gdog asked:
What made you decide to work in spinal cord injury research?

McDonald's response:
I was trained as a physician scientist in a special governmental program designed to produce physicians with dual MD and PhD degrees. As such I have always been interested in nervous system diseases that I could apply both my clinical and research interests. I was originally trained as a general neurologist but became involved with the Christopher Reeve Paralysis Foundation 5 years ago and this exposure allowed me to realize that SCI is an ideal area for my interests. Most importantly, it is clear that we will be able to make meaningful contributions to the field in terms of injury preventing and regenerative therapies. I was also given the opportunity to build a clinical SCI program here at Washington University in St. Louis. I was fortunate to work with some great mentors and I thank them for pointing me in the right directions early. So far, my choice has been very rewarding. We can do a lot for individuals with SCI. If anyone is interested in finding out about these options they can visit our website that outlines our program.

4.24.01 Kim Demchik asked:
Can a complete spinal cord injury turn into an incomplete injury? If not, have you ever known anyone with a complete injury to walk again?

McDonald's response:
Yes. Conversion can occur from ASIA A (complete) to ASIA B-D (incomplete). The terms complete and incomplete are confusing as they do not refer to anatomy but are purely clinical designations based on a clinical neurological exam. Sacral sparing of motor and sensory function (anal sensation and contraction) is what is used to distinguish complete from incomplete.

Reasons for the conversion are multiple and include among many: recovery from spinal shock, regeneration, co-incident head injury (that makes the SCI look worse than it is.) Up to 11% of individuals classified as ASIA A (complete) will convert to incomplete (ASIA B-D). It is possible for a person classified as ASIA A (complete) to walk again but this is rare. Pat Rummerfield is such a person and he currently works in our SCI Prevention program. He can be reached at 314-747-5268 or by email at conimail@aol.com. As our care for individuals with SCI is improving these numbers are increasing.