Day: June 22, 2026

Lab-grown Brain-spinal Cord Model Shows ‘Irreversible’ Nerve Damage May Be Reversed

Illustration of the model, with the brain organoid, spinal organoid, and muscle tissue (left to right). Credit: András Lakatos lab

Cambridge scientists have grown miniature circuits in the lab that mimic how the brain and spinal cord connect up, which underlies our movements. They used this model to show how damage to these connections previously considered ‘irreversible’ could, in fact, be reversible.

Our sophisticated organoid models help bridge the knowledge gap from animal models to what we see in patients.

András Lakatos

As we develop and grow from embryo to foetus to infant, our nerve cells (neurons) form connections, allowing information to be transmitted between the brain and the spinal cord. A key component of each neuron is the axon – the nerve fibre ‘cable’ that transmits information to other neurons to activate muscle contractions. 

At some point, we lose the ability to grow axons in the central nervous system, or this ability is at least greatly impaired or slowed down. This means that damage to the brain and spinal cord becomes permanent, leading to devastating disabilities, such as the inability to grasp or walk. This is often the case for traumatic spinal cord injury and can be a feature of many neurological diseases, including motor neurone disease or multiple sclerosis. 

In 2021, Dr András Lakatos and colleagues at the University of Cambridge developed ‘mini brains’ using human patient-derived stem cells – special cells that have the potential to develop into most human cell types – which they guided to grow into pea-sized brain ‘organoids’. These organoids were 3D models that resemble parts of the human cerebral cortex. The team used these to demonstrate molecular problems in motor neurone disease and potential ways to prevent them.

Now, in research published in Cell Reports, Dr Lakatos’s team has taken its research a step further, building a mini version of the connected human brain and spinal cord system in the lab by recreating these tissues using organoids.

In the human body, the brain and spinal cord tissues are distinct but connected by axons, so the researchers kept the brain and spinal cord organoids apart. They saw that nerve fibres from the brain tissue grew across the gap to connect to the spinal cord, forming a working circuit that could even cause tiny muscle clusters to contract.

By growing this human system in the dish for more than a year, they found that up until around day 150 – which corresponds to the mid-trimester of pregnancy – the axons were able to regrow after damage, but after this time, their growth was greatly impaired.

George Gibbons from the Department of Clinical Neurosciences at the University of Cambridge, the study’s first author, said: “Neurons taken from less mature organoids regrew long fibres after injury, but those from more mature organoids showed a sharp drop in their ability to regrow. In other words, poor regeneration is built into human neurons as they mature in the central nervous system.”

By analysing the gene expression – a sign of how active the genes are – in neurons that connect the brain and the spinal cord, they were able to identify a network of genes that acts as a ‘switch’ restricting the axon growth ability while the neurons mature to form connections (synapses). Amazingly, blocking key regulators of this network switched back on the ability of axons to grow.

The team then scanned a database of drug compounds to search for those that act on the genes in this network and identified as a candidate lynestrenol, a hormone drug licensed for managing certain menstrual disorders and as a contraceptive. When they tried this drug on damaged neurons, they found that it significantly boosted axon regrowth.

While scar tissue and inflammation may also restrict axon repair, exploring and tackling neuron-specific causes – the subject of this study – is very important. This is supported by evidence that axons of less mature neurons can grow through non-permissive environments that characterise injury sites.

Senior author Dr András Lakatos, who led the project at the Department of Clinical Neurosciences, said: “When the brain and spinal cord are damaged, the nerve fibres that carry movement signals from the brain to the spinal cord rarely grow back. That’s why paralysis is usually permanent. But we didn’t know exactly when the ability of axons to regenerate becomes limited. Our model provides a good indication that this block happens during development, and it can still be reversed after this point.

“Lynestrenol itself may not be the answer to spinal cord repair, but it shows us that, in principle, it should be possible to directly target human neurons and regenerate their axons. Although we still need to show that this strategy will also help to re-establish appropriate connections between the brain and spinal cord cells, this gives us hope that one day we may be able to treat conditions previously thought untreatable.”

Organoid models are an important way of understanding human biology. While animal models – for example, mice and rats – are useful for studying our biology as they share some similarities with humans, their differences ultimately limit what we can learn. Organoids grown from human stem cells can more closely mimic human biology.  

Dr Lakatos added: “Much of what we know about nerve regeneration comes from rodents, whose neurons behave differently from human neurons. Our sophisticated organoid models help bridge the knowledge gap from animal models to what we see in patients. They are also an important contribution to efforts to reduce the use of animals in research.”

Organoids, often referred to as ‘mini organs’, are being used increasingly to model human biology and disease. At the University of Cambridge alone, researchers use them to repair damaged liversunderstand Crohn’s disease in children, and model the early stages of pregnancy, among many other applications.

The research was funded by the UK Research and Innovation Medical Research Council and Spinal Research. Dr Lakatos has a long association with Spinal Research, from being a funded PhD student to now sitting on the charity’s Grant Advisory Board Committee. 

Spinal Research Chief Executive Louisa McGinn said: “Today, we are entering a new era of hope and possibility for the 15million people worldwide living with a spinal cord injury.

“The next five years present an unprecedented opportunity to change what’s possible for people living with spinal cord injuries. Breakthrough therapies are nearing clinical reality and frontier technologies are creating bold new pathways toward repair and recovery.

“Spinal Research is committed to funding the most promising research and the best researchers around the world. The incredible work that Andras and his Group are doing at Cambridge shines a powerful light on what that can achieve and we’re delighted to support it.”

Source: University of Cambridge

Inside The Box with Dr Andy Gray | How Should the Compounding of Medicines Be Regulated?

Photo by National Cancer Institute on Unsplash

By Andy Gray

The South African Health Products Regulatory Authority, with the South African Pharmacy Council, recently announced what was described as a crackdown on a compounding pharmacy. They allege “critical regulatory non-compliance” in relation to the compounding of unregistered medicines. In his latest Inside The Box column, Dr Andy Gray provides some background to the issues at stake, while recognising that some key elements remain contested.

Until the 20th century, medicines dispensed by pharmacists were all compounded (mixed) from raw ingredients, most of which were inorganic chemicals and herbal products. The gilded majolica jars displayed in pharmacies and museums depict the names of those common ingredients, often in Latin. Hence, a jar labelled as “Paraf mol alb” would contain “paraffinum molle album”, or white soft paraffin (white petroleum jelly), more commonly known as Vaseline.

The market for finished pharmaceutical products, in the form of modern tablets, capsules and the like, has grown dramatically over the last century. Even so, the need for the preparation of medicines in a pharmacy, from either raw ingredients or existing products, has not entirely disappeared.

#InsideTheBox is a column by Dr Andy Gray, a pharmaceutical sciences expert at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. (Photo: Supplied)

There has always been a need for the preparation of particular products for individual patients in cases where a commercial product does not exist or is not suitable. For example, a pharmacist may be asked to produce an eye drop when no commercial products exist, using an injection as the starting material. Similarly, where a patient is unable to swallow tablets or capsules, an oral liquid preparation may be compounded. In many cases, the preparation is done extemporaneously, meaning that it is done specifically for that patient at a point in time. Such medicines are compounded by pharmacists as part of their usual professional practice in community and hospital pharmacies.

Exceptions, limitations and contestation

Modern medicines regulatory practice is based on the concept of registration or marketing authorisation. This is where a manufacturer is required to provide evidence to the national medicines regulatory authority of the quality, safety and efficacy of a medicine, before it can be sold. However, an exception has been created, allowing for compounding of medicines. In the South African medicines legislation, this is provided by section 14(4) of the Medicines and Related Substances Act (Act 101 of 1965).

The usual approach is described in section 14(1) of the Act, which states that “no person shall sell any medicine … which is subject to registration by virtue of a declaration published in terms of subsection (2) unless it is registered”. The declaration in this regard refers to the call-up notices issued for different pharmacological classifications of medicines since 1967, when the Act came into operation. All pharmacological classifications have now been made subject to registration.

The exception is provided by section 14(4), which states that subsection 14(1) will not apply when a medicine is “compounded in the course of carrying on his or her professional activities by a pharmacist”. A similar exception applies to licensed dispensing and compounding practitioners and veterinarians. Two scenarios are envisaged: compounding a preparation in accordance with a prescription for a particular patient, or compounding by a pharmacist for the retail trade.

However, there are three critical additional restrictions: a compounded medicines shall “not contain any component the sale of which is prohibited by this Act or any component in respect of which an application for registration has been rejected”, the compounded medicine “is not or has not been advertised”, and the “the active components of such medicine appear in another medicine which has been registered”. Thus, unless declared undesirable or never before registered, an active ingredient may be compounded and sold without being registered. A compounded medicine may also not be advertised to the public or to health professionals.

Further details were provided by the General Regulations to the Medicines and Related Substances Act, which were published in 2017. The initial version of those regulations added some additional restrictions, for example restricting the quantity to be compounded to the “quantity that is intended to be used by a patient for not more than 30 consecutive days from the date of compounding”. More importantly, sub-regulation 3(3)(a) prohibited compounding that was intended “to circumvent the provisions of section 14 of the Act”, the requirement for registration.

Legal challenge

In December 2021, the North Gauteng High Court in Pretoria ruled in a case brought by The Association of Compounding Pharmacists of South Africa, challenging the regulations. While noting that “[w]hat constitutes pharmacy compounding is not well defined”, Judge Norman Manoim ordered that the regulations be redrafted and that a draft guideline on good compounding practice be published. In particular, the judgment recognised the need to clarify what was needed for “anticipatory compounding”, where medicines were compounded in anticipation of a prescription or for sale by a pharmacist.

In accordance with the court judgment, amended regulations were published for comment and finalised in 2022, deleting sub-regulation 3(3)(a), and recognising that a pharmacist could “based on the amount of medicine compounded previously for a particular period, compound such medicine in anticipation of supply thereof within such particular period”. Lastly, the regulations required that draft guidelines on good compounding practice be published within 6 months, for public comment. These draft guidelines were published for comment in June 2023, but have not been issued in final form. The draft guidelines are no longer accessible on the South African Health Products Regulatory Authority (SAHPRA) website.

Compounding pharmacies

While the extemporaneous compounding of medicines for individual patients is routinely performed in most community and hospital pharmacies, “anticipatory compounding” has emerged as a speciality practice.

Compounding pharmacies are not recognised as a specific category of pharmacies licensed by the Department of Health and recorded as such by the South African Pharmacy Council (SAPC). The current regulations to the Pharmacy Act only recognise community, institutional (hospital), wholesale, manufacturing and consultant pharmacies. The services that each category of pharmacy can deliver are regulated, with both community and institutional pharmacies enabled to perform “compounding, manipulation or preparation of any medicine or scheduled substance”. Specialist compounding pharmacies are thus licensed as community pharmacies.

SAHPRA licenses manufacturers and wholesalers of medicines, not community pharmacies. Section 22C(1)(b) of the Medicines and Related Substances Act states that the Authority “may … issue to a … manufacturer, wholesaler or distributor of a medicine … a licence to manufacture, import, export, act as a wholesaler of or distribute, as the case may be, such medicine … upon such conditions as to the application of such acceptable quality assurance principles and good manufacturing and distribution practices as the Authority may determine”.

Whether a compounding pharmacy, licensed as a community pharmacy, can import active pharmaceutical ingredients (APIs) for the purposes of compounding, is contested. It is the API which is responsible for the desired medicinal effect but can also be the cause of adverse events. Inactive excipients are added to produce the final dosage form administered to patients.

The question of quality

As was outlined in a previous column in this series, patients are assured of the quality of medicines on the South African market by virtue of their registration by SAHPRA and compliance with Good Manufacturing Practice (GMP) standards by licensed manufacturers. Compounded medicines are an exception to the rule – they are unregistered, and their preparation is not subject to GMP.

In the case of medicines compounded for individual patients, the risk is more manageable. Where larger quantities are prepared in anticipation of demand, and in particular where sterile preparations such as injections are made, the risks may be greater.

Equally, there is a need to ensure that APIs used for manufacturing or compounding medicines are of acceptable quality. A draft guideline on post-importation testing, published by SAHPRA for comment in May 2026, applies to all imported APIs.

Following a major incident in the United States, where contaminated compounded corticosteroid injections resulted in a number of serious fungal infections, US law was amended in 2013 to create a new category of outsourcing facilities regulated by the Food and Drug Administration (FDA), not by state pharmacy boards. State pharmacy boards were not considered to have the capacity to effectively regulate large scale compounding, especially for higher risk sterile preparations.

In South Africa, while the Good Pharmacy Practice standards issued by the SAPC cover the usual services delivered by community and hospital pharmacies, they are insufficient to cover larger scale anticipatory compounding or outsourcing services.

Ongoing contestation

Existing South African law may well be deficient in the way in which it regulates compounding pharmacies. How the current legal provisions are applied and interpreted is contested and will be the subject of a number of court challenges.

Patient safety must remain the key animating feature of any future regulatory process that is fit for purpose and effective.

*Dr Gray is a Senior Lecturer at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. This is part of a series of columns he is writing for Spotlight.

Disclosure: Gray serves on three technical advisory committees at the South African Health Products Regulatory Authority.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

| Republished from Spotlight under a Creative Commons licence.

Read the original article.

A New Oral Combo Drug for AML Eases Treatment Burden

Photo by Kampus Production

The ASCERTAIN V clinical trial demonstrated that an all-oral drug combination for older patients with acute myeloid leukaemia (AML) is an effective alternative to the current standard, which requires repeated hospital or office visits for intravenous treatment. In the international phase 1/phase 2 trial, patients took a regimen of two pills, decitabine-cedazuridine and venetoclax, with strong response rates and survival outcomes. The study results were published in the New England Journal of Medicine.

Nearly half of patients (46.5%) achieved complete response, while 63% experienced either complete response or complete response with incomplete haematologic recovery, meaning cancer cells were undetectable, but the patient’s healthy blood cell counts had not yet returned to normal. The median overall survival reached 15.5 months – comparable to existing intravenous therapies.

The oral combination of decitabine-cedazuridine and venetoclax received U.S. Food and Drug Administration approval on May 13 for the treatment of AML in newly diagnosed adults 75 years or older and patients clinically unable to undergo traditional, intensive chemotherapy.

“Having received approval, we anticipate that this oral AML regimen will become the standard of care for patients who are older or more frail,” said lead author Dr Gail J. Roboz, professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell and a haematologist oncologist at NewYork-Presbyterian/Weill Cornell Medical Center. “We hope these results point to a future for AML patients where the treatment journey is less disruptive and less burdensome without sacrificing outcomes.”

Turning a Standard into an Oral Treatment

AML is an aggressive blood cancer that can be diagnosed at any age and is especially difficult to treat in older adults and patients with other serious health conditions. For these individuals, the current standard treatment combines venetoclax with a class of drugs known as hypomethylating agents, such as decitabine. Venetoclax inhibits Bcl-2, a protein that leukaemia cells overproduce to avoid cell death, while hypomethylating agents restore the activity of genes involved in cell growth and survival, helping slow leukaemia progression.

However, this regimen requires monthly treatment cycles that combine oral venetoclax with five to seven days of an injectable hypomethylating agent delivered in a clinic or hospital. These frequent visits create significant physical, logistical and emotional challenges for patients and families.

More recently, pharmacologists developed a pill version of decitabine by pairing it with another drug called cedazuridine that prevents decitabine from being broken down when ingested.

With the ASCERTAIN V trial, Dr Roboz and her colleagues tested whether decitabine’s oral version, combined with venetoclax, could match the efficacy of intravenous AML treatment.  

The nonrandomised phase 1/phase 2 study enrolled 189 newly diagnosed AML patients at centres across the United States, Canada and Spain. The patients took a month of venetoclax, along with five days of decitabine-cedazuridine at the start of each treatment cycle.

The oral regimen demonstrated a safety profile consistent with what doctors already expect from standard AML therapies, which commonly deplete healthy blood cells alongside leukaemia cells. The most common serious side effects included anaemia, neutropenia and fever associated with low white blood cell numbers.

Tailoring Treatment to Reduce Side Effects

During the trial, researchers also investigated how to fine-tune the treatment schedule to optimise leukaemia control, while minimising side effects related to low blood counts.

The paper offers recommendations for physicians, including careful monitoring of leukaemia cells until they reach a certain threshold and then strategically pausing venetoclax to allow the body to replenish normal white blood cells, red blood cells and platelets.

“The goal of the all-oral therapy is to keep people out of the hospital, especially once they have achieved remission,” said Dr Roboz, who is also a member of the Sandra and Edward Meyer Cancer Center at Weill Cornell. “Patients are thrilled not to have to deal with monthly chemotherapy injections or infusions.”

Looking Ahead

For now, most patients taking the oral regimen must continue treatment to maintain remission, much like a chronic condition. “AML patients taking ongoing cycles of treatment require close monitoring but can still have an excellent quality of life,” Dr Roboz said.

In the future, the researchers hope that increasingly sensitive blood monitoring tests may identify when patients can safely stop treatment.

Dr Roboz and AML researchers worldwide are also exploring “triplet therapies,” which add additional targeted drugs to the decitabine-cedazuridine and venetoclax combination.

“The goal is to get away from treatment cycles that go on indefinitely,” said Dr Roboz. “We want to drive the leukaemic cells to such low levels that patients can discontinue therapy and be cured.”

Source: Weill Cornell Medicine

Slow Breathing Can Influence Brain Activity and Decision Behaviour

Credit: Scientific Animations CC4.0

A new study published in the journal Neuron shows for the first time that targeted control of human breathing rhythm can influence decision behaviour by modulating heart and brain function. The research team was able to demonstrate that prolonged exhalation increases heartrate variability and the brain’s reward sensitivity, thus enabling us to make bolder decisions.

Accelerated breathing and rapid heart rate often lead to quick decision–making. Judgements under these circumstances, can lead to a more cautious decisions to minimise potential loss – whether it is making investments under time pressure, during a critical employee meeting, or when quickly selecting a meal. In contrast, slow breathing and a calmer heart could presumably lead to assessing the situation more positively and making bolder decisions.

New Perspective: Body, Brain, and Decision in Harmony

Traditional theories assume that decisions arise in the brain. The present study investigated how the interplay of different organs can influence brain function and thereby control our decisions. It was spearheaded by Prof Soyoung Q Park in cooperation with institutions such as Neuroscience Research Center at Charité – Universitätsmedizin Berlin, Freie Universität Berlin, and German Naval Institute of Maritime Medicine.

“Our decisions are rarely determined solely by external information. Rather, our judgment emerges from the interplay between cognitive processes and our current bodily state. It was previously unknown how the conscious regulation of our body, for example through targeted breathing, could actively control our decision–making process. We wanted to create a physiological shift using slow breathing pattern to change the quality of our decisions,” explains Soyoung Q Park, head of the Department of Decision Neuroscience and Nutrition at DIfE, summarising the research question.

In the study, 41 healthy participants were observed in a state-of-the-art multi-methods research setting as they made risky decisions while adhering to specified breathing protocols. The participants followed visual breathing cues and breathed either in their individual natural rhythm or slower with an extended exhalation (2:8 inhale-exhale ratio). While they breathed, they were asked to make several risk decisions. Meanwhile, the researchers captured brain function using functional magnetic resonance imaging and simultaneously monitored breathing parameters, heart activity, skin conductance, and pupillary reactions. By combining these measurements, the researchers were able to investigate whether extended exhalation not only lowers heart rate but also leads causally to modulated reward processing in the brain.

The Body’s State Influences Our Decisions

The scientists found that extended exhalation led to riskier decisions by slowing down heart rate. Notably, the risky decisions were more guided by potential rewards, while the consideration of potential losses remained unchanged. Furthermore, there was increased activity in the ventromedial prefrontal cortex and the precuneus area. These two key brain regions influence both the time intervals between heartbeats – known as heart rate variability – and reward sensitivity. “Our study thus underscores the transformative role of breath–based interventions. The interplay between breathing and cardiac dynamics makes the brain more receptive to rewards,” explains lead author Wenhao Huang, interpreting the results.

The Practical Benefits of Breathing Techniques

The findings expand the field of body-brain interaction research and support so-called neurovisceral models, which posit that physical condition strongly influences cognitive processes. Park explains: “Breathing techniques have accompanied humanity for millennia across various religions and cultures. With this study, we provide scientific proof that it is a reliable and targeted method capable of controlling our decisions.”

Thus, breathing techniques represent a simple, inexpensive, and easy-to-learn option for everyday self-regulation. Moreover, they have immense potential value in clinical settings as an adjunctive, non-pharmacological strategy – for example, for conditions such as anxiety disorders or depression, which are characterised by autonomic dysregulation and altered reward perception.

The next step should be to investigate whether the observed effects can be generalised to a broader clinical population, such as people with overweight. “Since dietary decisions are strongly influenced by reward assessment and physical state, targeted breath regulation could also play a role in consciously perceiving and more effectively managing eating behavior,” Park summarises for future research activities.

Source: Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke