Amyotrophic lateral sclerosis (ALS) is a progressive degeneration of spinal motor neurons. Systemic delivery of ciliary neurotrophic factor (CNTF) has therapeutic potential but is limited clinically because of systemic side effects, short half-life, and the inability to cross the BBB. Continuous intrathecal delivery of CNTF proximal to the nerve roots in the spinal cord could result in less side effects and better efficacy of CNTF in ALS patients. After safety, toxicology, and preclinical evaluation, a clinical trial was performed to establish the safety of encapsulated CNTF-producing cells in ALS patients. Six ALS patients with early-stage disease received BHK cells that were encapsulated into 5 cm long x 0.6-mm diameter hollow membranes and implanted into the lumbar intrathecal space. CNTF from the cells was found in all six patients at 3-4 months postimplantation. All six explanted devices had viable cells and detectable CNTF secretion. More recently, a phase I/II clinical trial was initiated in 12 ALS patients using the same approach. CNTF was detectable for several weeks in the CSF of 9 out of 12 patients, and only a very weak antigenic immune response was detected with bovine fetuin as the main antigenic component.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.